A paper by Such and German, published in Veterinary Record, shows that a significant proportion of show dogs in the UK would be considered to have overweight or obesity.
The researchers did internet searches to identify 40 pictures per breed of 14 obese-prone dog breeds and 14 matched non-obese-probe breeds that had appeared at a major national UK show (Crufts). Of 1120 photographs initially identified, 960 were suitable for assessing body condition using a previously validated method, with all unsuitable images being from longhaired breeds.
None of the dogs (0%) were underweight, 708 (74%) were in ideal condition and 252 (26%) were overweight with pugs, basset hounds and Labrador retrievers were most likely to be in the latter category.
In contrast, standard poodles, Rhodesian ridgebacks, Hungarian vizslas and Dobermanns were least likely to be overweight.
In the discussion, the authors wonder whether or not breed standards should be redefined to be consistent with a dog in optimal body condition (read – body weight).
As someone, who could not really care less about breed standards and pedigrees (having shown dogs at dog shows myself as a kid), I find this paper of interest, as it reflects our thinking about appearances, that is by no means limited to animals.
The mental health and physical benefits of owning a dog are well-documented – whether they meet show standards or not, is probably not what determines their usefulness as (wo)man’s best friend.
As a clinician often dealing with patients presenting with binge-eating disorder (BED), I am quite aware of the often pathological cognitive and emotional relationship to food, eating, and body image presented by patients with this syndrome.
Whether or not this impairment in thinking and feeling also extends to other behavioural or emotional domains is the topic of a systematic review by Kittel and colleagues from the University of Leipzig, published in the International Journal of Eating Disorders.
The paper is based on the review of almost 60 studies and shows that, individuals with BED consistently demonstrate higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues) – in contrast, cognitive functioning in the context of neutral stimuli appear to be less affected.
With regard to emotional functioning, individuals with BED also report greater emotional deficits when compared to obese and normal-weight controls.
Thus, these findings confirm the clinical observation that patients with BED tend to have specific difficulties in cognitive and emotional functioning when it comes to food, eating or body image, however, appear to function adequately in other domains.
For clinicians these finding are relevant as they show that while people with BED may benefit from help in changing their cognitive and emotional response to food cues, such problems are indeed more often encountered in people with BED rather than in everyone living with obesity.
Screening for BED should be an essential element of workup in anyone presenting with excess weight gain.
This interesting question was the topic of an intriguing study by Eric Robinson and Paul Christiansen from the University of Liverpool, published in the International Journal of Obesity who examined whether women’s preferences for larger men can be influenced by prior exposure.
The researchers conducted a series of four studies. Studies 1 and 2 looked at how exposure to men with obesity vs. normal weight had on female attraction toward a man with overweight. The findings of these two study showed that exposure to obesity can alter visual perceptions of what normal body weights were resulting in greater attraction toward an overweight man.
Study 3 found that women who are regularly exposed to males of heavier body weights reported a greater attraction toward overweight men.
Study 4 showed that after exposure to images of men with overweight or obesity, females in an online dating study were more likely to choose to date an overweight man than a man of normal weight (Study 4).
Thus the researchers conclude that even brief exposure to men with obesity can increases female attraction toward overweight men and may affect mate choice.
However, as the researchers note, the findings are limited to single women rating caucasian males – whether exposure to women with overweight has a similar effect on male preferences remains to be studied.
Perhaps the results of this study can lead to the following dating advice – if you’re a big man, surrounding yourself with people of your size may just make you seem more attractive.
Regular readers will be well of the very real social and health impact of weight bias and discrimination.
Now, Sara Kirk of Dalhousie University, Halifax, NS, invites you to join her free Massive Open Online Course (MOOC), on weight bias and stigma in obesity, which will be starting on April 20th 2015 (just a week before the Canadian Obesity Summit in Toronto).
The course builds on Kirk’s extensive research in this area and the dramatic presentation that was created from her findings.
Participants will be able to explore some of the personal and professional biases that surround weight management and that impact patient care and experience.
This will hopefully give health professionals better insight into how to approach individuals experiencing obesity in a respectful and non-judgmental manner and provide strategies to build positive and supportive relationships between health care providers and patients.
While targeted at health care providers, the course should also be of interest to anyone interested in learning more about what weight bias is and how it can impact health and relationships.
Participants who complete the course requirements can apply for a citation of completion (for a nominal fee).
Following the recent release of the Canadian Task Force on Preventive Health Care guidelines for prevention and management of adult obesity in primary care, the Task Force yesterday issued guidelines on the prevention and management of childhood obesity in the Canadian Medical Association Journal (CMAJ).
Key recommendations include:
- For children and youth of all ages the Task Force recommends growth monitoring at appropriate primary care visits using the World Health Organization Growth Charts for Canada.
- For children and youth who are overweight or obese, the Task Force recommends that primary health care practitioners offer or refer to formal, structured behavioural interventions aimed at weight loss.
- For children who are overweight or obese, the Task Force recommends that primary health care practitioners not routinely offer Orlistat or refer to surgical interventions aimed at weight loss.
The lack of enthusiasm for the prevention of childhood obesity is perhaps understandable as the authors note that,
“The quality of evidence for obesity prevention in primary care settings is weak, with interventions showing only modest benefits to BMI in studies of mixed-weight populations, with no evidence of long-term effectiveness.”
leading the Task Force to the following statement,
“We recommend that primary care practitioners not routinely offer structured interventions aimed at preventing overweight and obesity in healthy-weight children and youth aged 17 years and younger. (Weak recommendation; very low-quality evidence)”
Be that as it may, the Task Force does recommend structured behavioural interventions for kids who already carry excess weight based on the finding that,
“Behavioural interventions have shown short-term effectiveness in reducing BMI in overweight or obese children and youth, and are the preferred option, because the benefit-to-harm ratio appears more favourable than for pharmacologic interventions.”
What caught my eye however, was the statement in the accompanying press release which says that,
“Unlike pharmacological treatments that can have adverse effects, such as gastrointestinal problems, behavioural interventions carry no identifiable risks.” (emphasis mine)
While I would certainly not argue for the routine use of orlistat (the only currently available prescription drug for obesity in Canada) in children (or anyone else), I do take exception to the notion that behavioural interventions carry no identifiable risks – they very much do.
As readers may be well aware, a large proportion of the adverse effects of medications is attributable to the wrong use of these medications – problems often occur when they are taken for the wrong indication, at the wrong dose (too high or too low), the wrong frequency (too often or too seldom), and/or when patients are not regularly monitored. In a perfect world, many medications that often lead to problems would be far less problematic than they are in the real world.
Interestingly, the same applies to behavioural interventions.
Take for example diets – simply asking a patient to “eat less” can potentially lead to all kinds of health problems from patients drastically reducing protein, vitamin and mineral intake as a result of going on the next “fad” or “do-it-yourself” diet. Without ensuring that the patient actually follows a prudent diet and does not “overdo” it, which may well require ongoing monitoring, there is very real potential of patients harming themselves. There is also the real danger of promoting an eating disorder or having patients face the negative psychological consequences of yet another “failed” weight-loss diet. Exactly how many patients are harmed by well-meant dietary recommendations is unknown, as I am not aware of any studies that have actually looked at this.
The same can be said for exercise – simply asking a patient to “move more” can result in injury (both short and long-term) and coronary events (in high-risk patients). Again, ongoing guidance and monitoring can do much to reduce this potential harm.
In short when patient apply behavioural recommendations at the wrong dose (too much or too less), wrong frequency (too often or too seldom), and/or are not regularly monitored, there is indeed potential for harm – I would imagine that this potential for harm is of particular concern in kids.
This is not to say that we should not use behavioural interventions – we should – but we must always consider the potential for harm, which is never zero.
I’d certainly be interested in hearing from anyone who has seen harm resulting from a behavioural intervention.