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.
Archive for the ‘Obesity’ Category
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.
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.
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.
I hope you’ll all head over to Healthy Urban Kitchen to read Sarah Lord’s guest post on the recent meta-analysis about whether or not you can be healthy and obese. Sarah, a PhD candidate in biological sciences, tips her hand with the title: Obesity – How the Media Misleads You.
In the original study (actually a meta-analysis of previous studies), the authors calculated the “relative risk” of dying for various populations. Here is what Sarah discovered in the full study, ranked in order of risk:
|Metabolically healthy, normal weight||1|
|Metabolically healthy, overweight||1.21 (0.91 – 1.61)|
|Metabolically healthy, obese||1.24 (1.02 – 1.55)|
|Metabolically unhealthy, obese||2.65 (2.18 – 3.12)|
|Metabolically unhealthy, overweight||2.70 (2.08 – 3.30)|
|Metabolically unhealthy, normal weight||3.14 (2.36 – 3.93)|
Look at the folks at most risk!
Now, it’s possible that the confounds are things like eating disorders, smoking, and other negative health behaviors. And Dr. Sharma’s work suggests that the number of metabolically healthy and obese is not particularly high, perhaps 10-15%. But what we don’t really know, largely because of the cultural acceptance that obesity is the only marker for health, is how many metabolically unhealthy, normal weight people there are.
Maybe I am a bit slow, but I thought HAES was about adopting health-promoting behaviors. Regardless of your weight. Is it not?
Those health-promoting behaviors might include avoiding junk food, being active and getting enough sleep, or they might focus on drinking in moderation, not smoking and buckling your seatbelt. Regardless of your weight.
If you chose to change your weight for medical reason, well, good luck. You don’t control your weight. You control your behaviors. The behaviors you chose to adopt might have an impact on your weight, but they might not.
I am not a HAES evangelist, but I do think that their focus on healthy behaviors rather than weight loss is hard to argue with.
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:
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.