Something that is making the round of the media lately is the findings of a December 2010 CDC report, Obesity and Socioeconomic Status in Adults: United States, 2005–2008 (PDF). The CDC looked at survey data from their National Health and Nutrition Examination Survey (NHANES) and found that the link between obesity and poverty was hardly clear-cut:
Archive for the ‘Obesity’ Category
The Obesity Society, the American Heart Association, and the American College of Cardiology have recently release their 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (free full text available here). Dr. Arya Sharma has had a look and offers that the report is “big on how little we know” (emphasis mine):
[The report shows the] rather poor level of evidence that exists for virtually all of the dietary recommendations. …
Thus, low fat approaches appear no better than high-fat (strength of evidence: “moderate”), while the evidence in support of low-calorie diets, complex vs. simple carbs, glycemic load, Mediterranean-style diets, lower-fat lacto-ovo-vegetarian or vegan-style, or lower fat high dairy/calcium with added fiber and/or low glycemic index/load foods, use of liquid and bar meal replacements, or even very low calorie approaches is largely “insufficient” to make any reasonable recommendations in favour of any of these strategies versus any other.
Not that people do not lose on any or all of these diets as long as they are “energy restricted” – of course they do!
But, what is lacking is evidence that any of these countless dietary approaches confer any meaningful advantage (in terms of amount of weight lost, metabolic benefits or sustainabilty of weight loss) compared to any other.
So, whilst millions of “bestseller” diet books may continue to make millions for their authors and publishers by touting one revolutionary weight loss solution after another, they are essentially closer to religious belief systems than scientific fact. …
Perhaps, what we need to accept, is that there simply is no “superior” dietary approach to managing your weight – it’s whatever works best for you.
I suspect that the real trick is for susceptible folks to figure out a way to exist in an environment that strongly promotes obesity. Eliminating fat or carbs or meat may not be sufficient. And for some, it may not be worth perpetually tilting at windmills.
Harvard’s School of Public Health and the Huffington Post presented a forum last month titled Why We Overeat: The Toxic Food Environment and Obesity. The discussion is a bit long and a bit wonky, but it’s well worth a watch — especially for those who think this issue is primarily about personal responsibility.
I particularly liked the last few minutes where David Kessler pointed out that the panelists in the room (Kessler was on via satellite) are “too fit, too thin” and need to “talk with someone who really struggles with their weight.”
Looks like Daniel Lieberman, professor of human evolutionary biology at Harvard, has a new book coming out next week: The Story of the Human Body: Evolution, Health, and Disease.
As part of the pre-release publicity, he did an interview with The Guardian on why, given an evolutionary perspective, “diet and exercise really do matter.” Re obesity and the mismatch between how our bodies adapted to evolutionary pressures versus our modern environment:
We evolved to put on fat wherever necessary, and that was a good thing in human history. Most people until recently had to work hard and they lived just at the margin of energy balance, and a little bit more energy stored in fat meant that you could have more babies, and your babies were more likely to survive. That was pretty powerful stuff, right? Now we’re in this bizarre situation that for the first time in billions of years of evolution we have an organism that is not energy limited any more.
Why dieting “is a disaster” for us:
it takes superhuman effort to lose weight, it can be done but it isn’t easy. And that’s because we’re evolved not only to gain weight but to hold onto it. So if that overweight person starts dieting that’s just as hard as if an underweight person starts dieting, you go into a negative energy balance and all kinds of mechanisms kick in that cause us to become less active, to reshuffle energy around our bodies to defeat that effort to lose weight.
While he wrote the book to point out the problems, he’s not particularly optimistic:
The current gaze into the crystal ball doesn’t fill me with optimism. … So for example the US rates of childhood obesity have levelled off, so everyone’s patting themselves on the back. In actual fact they’ve levelled off to unacceptable rates and most of those kids who are overweight or obese have a much higher possibility of suffering a wide range of diseases. China has had a tenfold increase in type two diabetes. India’s a time-bomb of diabetes and obesity. The list goes on – Mexico is more obese than America. So I think the future of our planet is a lot more overweight people with a lot of very costly chronic diseases that will never be easily treated. So unless we really grapple with helping people change their diets and get them to be fit, these problems will continue to mount and cause economic woe and increased suffering.
I’m not sure that Lieberman’s book is going to be enough to stop the train wreck (I too am worried things are going to get far worse before they get better). In particular, I’m not on board 100% with what he’s described in the past as “socially acceptable coercion” as the public health strategy he recommends.
But I do think that understanding the problem is a pretty good first step. And his contribution is a big one over the traditional “eat less, move more” personal responsibility viewpoint.
Neuroscientist Sandra Aamodt looks at the ways that obesity is like nearsightedness (emphasis mine):
Obesity has also increased in the population much faster than genes could change. Weight is as heritable as height. And like nearsightedness, weight is influenced by the environment, with the strongest effects on the genetically vulnerable.
Scientists don’t yet know which environmental changes are most important for the increase in obesity. Candidates include processed foods, antibiotics, stress, sleep loss, prescription drugs, reduced exercise, and decreased cigarette smoking, among others. Whatever has changed over the past 50 years, it probably isn’t our collective willpower.
So why do we treat nearsighted and obese people so differently? You wouldn’t tell a person who wears glasses, “Well, it’s your own fault. You should have played outside more as a child.” But even health care professionals tend to blame their patients for being overweight, though they should know how powerfully the body fights against weight loss.
Maybe it’s time to rethink our cultural focus on individuals and their willpower as the cause of weight gain. In addition to being more fair, concentrating on the bigger picture might give us some ideas that actually work to promote health and fitness.
BTW, Aamodt did what looks to be a fab talk at TEDGlobal 2013 on why your brain doesn’t want you to lose weight. I can’t wait for that to be posted!
HT Linda Bacon.
You know what makes me grumpy? What looks to me like getting sloppy about causation and correlation. For example, Stephan Guyenet (who I think is fab) tweeted this yesterday:
Is this really evidence that obesity increases cancer risk? Or is it possible that what causes obesity, which bariatric surgery addresses, is what increases cancer risk?
This really matters. I get that the above is a tweet and there are character limitations, but this “obesity causes …” or “obesity increases …” concept is really rampant. And it seems, to me anyways, that this language shortcut (if that’s what it is) is potentially very flawed.
Check out the section in Weighing Success beyond the Scale (starting around the 20-minute mark) where obesity researcher Gary Foster talks about the benefits of small amounts of weight loss — the small kinds of weight loss that means that the person is still obese.
I’m not an obesity researcher, but I don’t know how you don’t translate this to a HAES-friendly argument that it’s not the weight, it’s what’s causing the weight. And what’s leading to the benefit is not the reduction of weight, but what’s leading to the reduction … typically more movement and a healthier diet.
Don’t get me wrong, I do not think that adipose tissue is benign. But I think we have yet to really disentangle how much of what leads to disease is the excess fat vs lifestyle factors that create all sorts of stress and inflammation (and one of those is weight stigma).
AHS wasn’t the only conference this past weekend. The Obesity Action Coalition held their Your Weight Matters national conference as well. What was very cool was that they live-streamed some of their sessions. I’ll be speaking to one of those sessions, Understanding and Managing Food Addiction, soon.
But today I’m writing about Weighing Success beyond the Scale: Identifying and Maintaining a Healthy Weight. In this session, research psychologist Gary Foster shared fascinating research (IMO) on expectations and weight loss. Here’s a bit from the abstract of one of the two studies he published several years ago and discussed in his presentation:
Expert panels and governmental guidelines now recommend that obese persons seek modest (i.e., “reasonable”) reductions in body weight rather than striving for “ideal” weights. Little is known, however, about patients’ views of what is a “reasonable” weight loss. This study assessed patients’ goals, expectations, and evaluations of various outcomes before, during, and after 48 weeks of treatment.
Ta-Nehisi Coates, a writer for The Atlantic, is spending the summer in Paris. His most recent “dispatch” looks at cultural differences between the US and France starting with how Paris requires effort:
There are stairs everywhere and the stairs are all but mandatory. In America the stairs are off to the side, and the elevator is prominent. Often, it’s the reverse here — the stairs are out front and often beautifully wrought. It almost feels sinful to take an elevator.
Re Parisians and weight, Coates notes (emphasis mine):
Before I came here, so many people told me, “There are no fat people in Paris.” But I think this misses something more telling. There are “no” stunningly athletic people either. There just doesn’t seem to be much gusto for spending two hours in the gym here. The people don’t seem very prone to our extremes. And they are not, to my eyes, particularly thin. They look like how I remember people looking in 1983. I suspect they look this way because of some things that strike me — the constant movement, the diet, the natural discomfort — are part of their culture.
I’ve been meaning to dig into Bruce Alexander’s The Globalization of Addiction for a while now. Alexander’s premise is that “societal determinants” of addiction are more powerful than individual tendencies. It’s interesting to consider the idea that the prevalence of “stunningly athletic” or “particularly thin” people might be a negative influence rather than a positive one.
HT Melissa McEwen.
This is the trial that was requested by the FDA in early 2011 after the phase II study was completed. The goal of the new trial was to “demonstrate that the risk of major adverse cardiovascular events in overweight and obese subjects treated with naltrexone/bupropion does not adversely affect the drug’s benefit-risk profile.”
Yes, it’s kinda important that an obesity drug not have adverse affects … remember fen-phen? It was relatively popular until the reports of potentially fatal “pulmonary hypertension and heart-valve abnormalities” started showing up.
It’s been more than a decade since the media and researchers wrote about fen-phen with the headline “dying to be thin” so it’s understandable that this time the FDA is being uber-careful about the next generation of obesity drug.
So what does the new study tell us?
Social policy researcher Helen Lee thinks food activism is leading public health astray (emphasis mine):
Much of the American public health and medical establishment came to believe that one of the most powerful ways to overcome the [obesity] epidemic was to radically remake our school and neighborhood food environments, reducing access to unhealthy foods and increasing access to healthy ones.
But in their rush to condemn corporate agribusiness, food marketers, and neighborhood food environments, public health advocates have too often allowed their policy and ideological preferences to race ahead of the science. This has fostered a reductive story about obesity that appeals to liberal audiences but doesn’t comport particularly well with much of what we know about why people choose to eat unhealthy foods, what the health consequences of being overweight or obese actually are, or why health outcomes associated with obesity are so much worse among some populations than others.
Against the current popular discourse, obesity is better understood as an unintended consequence of affluence than as a disease epidemic.
It’s a long read and I had a couple of knee-jerk responses in places, but I think it’s well worth a thoughtful read. In particular, I find one of her conclusions intriguing:
The focus on food environments also led school-based efforts themselves to be too limited. “If the framing of the public remains around individual willpower,” Wallack and Dorfman wrote in their analysis for the Robert Wood Johnson Foundation in 2004, “approaches that seek to improve environments are less likely to be understood by the public.” But if environments, as measured by food deserts and fast food proliferation, have little or no impact on obesity rates, and are unlikely to be expunged of unhealthy foods, the public health focus should rightly consider ways of empowering children to exercise more willpower.
… As such, nutrition education and school gardening programs are probably a lot less valuable than curriculums that show young people how to manage desires for unhealthy foods.
HT Linda Bacon.
Risk of obesity, increased body fat percentage, increase waist circumferences and waist to hip ratios all went up in lock step with degree of economic development.