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Archive for the ‘Obesity’ Category

Quote of the day

Okay, this HuffPo blog post by journalist/author Venetia Thompson on “the culture of obesity” is going to make wendyrg‘s head explode! But I thought this bit of interest:

I would argue that our addiction to fast food, corruption of the food chain, lack of interest in physical activity and resulting obesity epidemic is a symptom of a far more serious problem: the collective misery caused by our increasingly solipsistic, alienating societies.

This resonates with me. And I really must stop procrastinating and read Bruce Alexander’s Globalization of Addiction, since he makes essentially a very similar point.

Alexander argues that we aren’t really seeing a massive failure in personal responsibility so much as we are “being torn from the close ties to family, culture, and traditional spirituality that constituted the normal fabric of life in pre-modern times” … and the result is that people “adapt to this dislocation by concocting the best substitutes that they can for a sustaining social, cultural and spiritual wholeness.”

Yes, for some this is addiction, but for many others, it’s not as far along on the continuum of problematic behaviors.

Alas, I think Thompson has her finger more on the problem than the solution, which according to her starts with “we have to take responsibility for our bodies again” and “aspiring to be a healthy member of society is what gives us dignity.” Oy.

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Stephan Guyenet asks the question: Has Obesity Research Failed? The short answer is “no” … that “it has produced huge amounts of scientifically robust information, and a number of effective therapies.”

Aye, but here’s the rub. There is still no “magic bullet” as of yet (emphasis mine):

The reason we don’t have a magic bullet is that obesity is a difficult problem. Preventing and treating obesity means fighting the natural tendency of the human body and mind in the context of our current culture. You can tell people to eat less sugar, white flour, added fats, and processed foods in general, but only a minority of people will actually alter their behavior significantly as a result. This is because people don’t eat junk food for its health benefits– they eat it because they like it, it’s cheap, and it’s readily available.

This is why I am frustrated by the well-meaning efforts of folks like Stephan (and partner Dan Pardi) and Armi Legge and James Fell and so on and so forth. It’s not that people don’t know what to do, it’s that they struggle to do so in their environment.

I am am starting to feel strongly that the written word — whether in the form of books or blogs — is not the solution. It doesn’t seem to matter if it’s in the form of what to eat or how to avoid overeating, knowing what we’re supposed to do is just not enough.

Update, 6/11: Here’s an interesting comment from Stephan re the potential harm of obesity research (emphasis mine):

I think it’s fair to consider the potential harm caused by obesity researchers, physicians, and public policy experts. There has certainly been a kernel of moral superiority in some of their behavior. Thin people like to think of reasons why they’re thin that make them feel morally superior. In fact, the main fundamental difference between lean and obese people in the US is genetics.

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Yoni Freedhoff doesn’t believe in the idea of an “ideal” weight and suggests instead your “best” weight:

Let me say it quite plainly (and forgive me for my language) – as a means to set personal goals BMI is bullshit. Sure it may be useful when considering a population and risks associated with weight overall, but it’s simply not useful to you as an individual as there are all sorts of weight-affecting realities that you simply won’t be able (or willing sometimes) to change.

Like every other area of your life, your goal with weight management or healthy living is to do your best, and whatever weight you reach living the healthiest life you honestly and actually enjoy – well that’s your “best weight.”

Here’s more:

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Michael Prager beat me to a blog post on a Twitter exchange from yesterday about skipping the movie Fed Up because “it’s built on the premise that fat bodies are wrong.” Michael’s response:

Some of that is partly true: The movie does come from the perspective that being fat isn’t a desirable, healthful condition. I also come from that perspective, and remain flummoxed that there is a very strong, very spirited movement that maintains otherwise. …

I support the HAES-ish perspective that says that fat-shaming is wrong, that no one deserves mockery or exclusion or worse based on body size. IMO, those tendencies are deeply ingrained in our society, and we’ll all be better off when they’re dialed down, then discarded. I still need a bunch of that excised from me, and I’ve been working on it for 20-30 years!

But also: A significant portion of obesity in the world exists because consumer-food corporations make more money when we eat too much. Also, when we eat the wrong types of food — usually more processed food.

Who could possibly defend that, or boycott those who point it out?

I’m not quite in the same place as Michael (I believe health issues are more directly attributable to things other than body fat). That said, I am definitely in the camp that says that one of those major health factors is diet, and the industrial food system is something that needs to be addressed.

Will Fed Up get it 100% right? Hardly … and especially if this is really going to be about demonizing sugar. Bleh. And I think that Dayna is right to be concerned that, however well-meaning, this movie will perpetuate stigma.

I support folks’ decisions to vote with their dollars. But I plan to see it for myself. Call me a cross-eyed optimist, but in order to get to a better place, I think we need to have these conversations. And if Fed Up can be part of that, then maybe that’s worthwhile.

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David Despain has a must-read post on food addiction over at his blog. He’s reporting a session at the recent meeting of the American Society for Nutrition, where the discussion seemed pretty much standard (“yes food addiction exists, look at the lights!” “no, food addiction doesn’t exist … we can’t make cheesecake illegal”).

Too bad researcher and Whole Health Source blogger Stephan Guyenet wasn’t part of the discussion. IMO, his comment on David’s post was spot on (emphasis mine):

At its heart, addiction is an excessive motivation to engage in a reward-seeking behavior, e.g. a drug, gambling, etc. Where do we draw the line between normal reward-motivated behavior and excessive reward-motivated behavior? That’s the tough part. There is no clear line for food, but there is also no clear line for drugs or gambling.

Currently, we say someone is addicted when the pull to engage in the behavior is having a serious negative impact on that person’s life. It’s a very subjective definition but it’s still the best one we have. There will probably never be a useful neurobiological definition of addiction, because fundamentally addiction is defined by behavior. …

In my opinion, arguing about whether or not fMRI data supports addiction is missing the point. If someone is stealing TVs to buy crack, who cares what the fMRI says? If someone is leading a normal constructive life with occasional controlled gambling, but his reward centers light up like a Christmas tree when he sees images of a slot machine, is that person an addict? Of course not. …

Some would say “how can you be addicted to a substance you need to consume, like food?” The key is that we aren’t talking about food in general. We’re talking about specific foods that are highly rewarding, and there is no dietary requirement for those foods just as there is no physical requirement for drugs of abuse. I’ve never heard of an oatmeal or lentil addiction. It’s cake, cookies, chips, candy, and that sort of thing that triggers addiction-like behavior.

In the end, I think food addiction is real, but it doesn’t fully explain obesity.

Yeah, well I hope Mark Hyman gets the memo!

Researcher Carl Hart recently pointed out that “80 to 90 percent of the people who actually use drugs like crack cocaine, heroin, methamphetamine, marijuana—80 to 90 percent of those people were not addicted.”

I suspect that if we’re going to make progress on our understanding of food addiction, we’re going to first have to make progress on our understanding of addiction in general. If discussions on food addiction help in this regard, then to paraphrase Martha, that’s a good thing!

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Dr. Walter Willett, nutrition chair at Harvard (among other things), has a new book — Thinfluence — coming out next month. In a promotional interview with The Atlantic, he talks about the “powerful and surprising effect” the environment and our social networks play (emphasis mine):

If you look around the world at wealthy countries like the United States, you see very different rates of obesity. In Japanese women, prevalence of obesity is under 5 percent; in Swedish women it’s about 6 or 7 percent. In the U.S., it’s between 35 and 40 percent—and we know that when people come from these countries to live in the United States, they fatten up. That’s a clue that there is something pretty important going on that’s related to where we live, and that there are very important factors operating [outside of us as individuals].

We’ve started to understand some of these; they’re often complex but it’s a clue that Americans aren’t simply completely irresponsible people. And looking at kids, too, their obesity rates have about tripled over the last four years, or quadrupled among some groups. It’s not that kids have become massively irresponsible in such a short time, but that there are obviously factors outside the kids’ inner-selves that are operating here.

So much of what people have been told is that weight is just about individual change. We’re not saying that there is no such thing as individual responsibility, but sometimes even very responsible people can have a hard time making the choice that’s in their best interest if there are a lot of barriers in their daily life and environment.

I might quibble with characterizing this as “surprising” … but I suppose it’s helpful when someone like Willett proclaims it so.

In the book, Willett talks about a very interesting program in Kentucky that leverages “contagious health” as a wellness tactic. The idea behind this program (see “microclinics“) is very, very compelling IMO!

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somee

From yesterday’s Facebook feed

Valerie had an interesting question in the comments from Wednesday’s post. I started to answer it there, but my response got so involved, I decided to bump it up to its own post.

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Quote of the day

Dr. David Katz is a busy guy! One of his many roles is Editor-in-chief of the journal Childhood Obesity. In an editorial in the February issue, he asserts that obesity is like drowning: “medically legitimate,” but not a disease. For him, this is not just semantics:

The importance of considering obesity a variety of drowning lies with the implied remediations. Whereas we do treat drowning when it occurs, our principal approach is directed at prevention. … We recognize the problem of drowning as a mismatch between our bodies and the environment, and direct our efforts at the interface. Diseases, in contrast, bespeak a problem within us, rather than all around us, and direct our efforts accordingly.

Obesity as disease implies that a large population of our sons and daughters are not just heavy, but diseased. I object to this, for the fault lies not with the bodies of our children, but with the body politic. The fault lies with a culture that sanctions junk as a food group, jettisons physical activity from the school day despite evidence of its myriad benefits, and, in general, leaves health to languish on a road not taken while neglecting much that might be done to put it on a path of lesser resistance. If ever more effort is directed at obesity as a disease, treated in the customary ways, none of these fundamental problems will garner the attention each deserves.

Obesity need not be a disease to be legitimate. If it is a disease, it is a social disease.

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snacks

Image from PaleoShoppe.com website mockup

Paleo is a diet/lifestyle that is based on how our Paleolithic ancestors ate. For some folks, this means a diet based on what we evolved to eat, foods that were consumed by our ancestors before the dawn of agriculture. You’d probably be forgiven for concluding that paleo was a whole foods diet.

But for many folks, “stone age eating for modern times” is mostly about excluding grains, legumes, and dairy. For them, processed foods like almond flour and coconut oil, or convenience foods with egg white and hemp protein powder, are fine.

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Quote of the day

Neuroscientist Sandra Aamodt on why asking “Is it OK to be fat?” is the wrong question:

Compare [the news that the healthy obese are at a slightly increased risk] to the much larger risk increase for unfit or metabolically unhealthy people at any weight, reported in both papers. The relative risks ranged from 2.42 to 3.55, or roughly a threefold higher risk than healthy normal-weight people. So if obesity does present an independent risk, it’s about one-tenth as large as the risk associated with poor fitness or poor metabolic health.

What would a sensible society do with that information? Perhaps encourage everyone to concentrate on the risk factors that have a huge effect and are relatively controllable, by exercising and eating their veggies. Or worry about the many people who face a high risk of death because of unhealthy lifestyles but aren’t concerned because they’re thin.

What do we do instead? Ignore the first study and use the second to argue about whether it’s (sometimes) OK to be fat, with headlines like “Healthy Obesity is a Myth, Report Says” and “Overweight And Healthy: A Combo That Looks Too Good To Be True.” Sigh.

Sigh indeed!

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