Wednesday, June 25, 2014

Social Anxiety As A Deterrent To Physical Activity

sharma-obesity-distored-body-image1Social anxiety, defined as persistent fears of one or more social situations in which the person is exposed to others and expects to be scrutinized, has been reported in as many as one in ten individuals with overweight or obesity.

Now, a paper by Abbas Abdollahi and Mansor Abu Talib, published in Psychology, Health and Medicine, examines the relationship between social anxiety and sedentary behaviour in this population.

The researchers surveyed 207 overweight and obese students (measured heights and weights) using a number of validated instruments to assess social anxiety, sedentariness and body esteem.

As one might expect, social anxiety was associated with lower body esteem and higher sedentary behaviour.

The key mediator in this relationship was body dissatisfaction and poor body esteem.

Thus,

“…obese individuals with poor body esteem are more likely to report social anxiety, because they are concerned about negative evaluation by others; therefore, obese individuals indicate avoidance behaviour, which, ultimately, leads to social anxiety.”

The implications of these findings are obvious,

“First, when assessing the social anxiety in individuals, it is important to account for the presence of sedentary behaviour in addition to other psychological risk factors. Second, reducing sedentary behaviour can alter the effect of social anxiety factors; this may be a significant factor to incorporate into social anxiety treatment programmes. Reducing social anxiety in individuals is a main part of any clinical intervention. Third, the findings of the current study suggest that health professionals should encourage obese individuals with social anxiety to reassure their value and abilities regardless of their weight or body shape, and assist them to recognize that everybody is unique and that differences between individuals are valuable.”

This will take more than simply telling people with overweight to be more active. It will certainly require targeted and professional help to overcome body dissatisfaction and low self esteem.

Or, even better, we need to do all we can to help people gain more confidence and be accepting about their own bodies in the first place.

@DrSharma
Vancouver, BC

ResearchBlogging.orgAbdollahi A, & Talib MA (2014). Sedentary behaviour and social anxiety in obese individuals: the mediating role of body esteem. Psychology, health & medicine, 1-5 PMID: 24922119

 

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Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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Wednesday, May 21, 2014

Does Calling You Fat Make You Fat?

sharma-obesity-discriminationOne of the most troubling aspects of weight-bias and discrimination is that it has strong negative emotional and physical consequences for the individuals, who perceive these negative attitudes.

Now a study suggests that simply being labeled “fat” in childhood may be a strong predictor of obesity ten year later.

Thus, according to a longitudinal study by Jeffrey Hunger and Janet Tomiyama, published in JAMA Pediatrics, girls who reported being called “fat” at age 10 were about 60% more likely to have a BMI in the obese range at age 19.

Kids in this study were considered as “labeled”, if they responded “yes” to the question, whether they had ever been called fat by their father, mother, brothers, sister, best girl friend, boy you like best, any other girl, any other boy, or teacher.

Interestingly enough, this finding is not explained by the possibility that the labelled girls were indeed heavier – there was in fact no difference in BMI at age 10 between the kids who responded “yes” and those, who did not.

Indeed, the findings remained robust even after correction for various demographic confounders.

These findings are concerning, as they suggest that simply being called “fat” as a kid, may put you on a track to weight gain irrespective of whether or not you actually carry excess weight to start with.

I am sure many of my readers will relate to these findings and can tell their own stories of how being “labelled” fat may have influenced their weight journeys.

@DrSharma
Edmonton, AB

ResearchBlogging.orgHunger JM, & Tomiyama AJ (2014). Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years. JAMA pediatrics PMID: 24781349

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Wednesday, April 16, 2014

Shame And Blame Has No Role In Addressing Obesity

Balancing the scales Kirk et alAs a regular reader you will be well aware of my recent excursions into the use of comedy to promote a better public understanding of obesity.

A very different (and I dare say more scientific) approach to harnessing the performing arts to promote a discourse on obesity is that taken by Sara Kirk and colleagues, Balancing The Scales, now described in a paper published in Qualitative Health Research.

Their approach is based on the recognition that,

“…individuals living with obesity are caught in the middle, facing judgment by society if they fail to manage their weight successfully and exposing themselves to health professionals who are unable to fully support them…if an individual is unable to make the changes prescribed for weight loss, resentment builds on both sides of the therapeutic relationship.”

This led Kirk and colleagues to extensively explore the issue of obesity from a variety of perspectives resulting in rather unique insights into similarities, differences, points of consensus, and tension associated with values, beliefs, perceptions, and practices among key stakeholders.

The 42 semistructured interviews were conducted in 22 individuals living with obesity, 4 policy makers, and 16 health professionals (8 dietitians, 4 family physicians, and 4 nurses).

Three major themes emerged from the analysis of the interviews:

Blame as a Devastating Relation of Power

“Individuals living with obesity shared feelings of shame and embarrassment with their inability to control their weight on their own. This blaming discourse can easily be seen in messages of “eat less, move more” promoted by health professionals, the health system, and wider society.”

“Individuals living with obesity spoke about the complexities of trying to lose weight, inclusive of cultural, social, and organizational barriers. Despite this insight, however, they placed the final explanation for their weight status on themselves and expressed immense feelings of guilt and shame.”

“All of the individuals living with obesity had tried multiple methods to manage their weight, with limited or no success. This was extremely frustrating for them and compounded their tendency, wholly or at least partially, to blame themselves for this perceived failure.”

“Similar to individuals living with obesity, health professionals struggled to understand the complexity of the issue, which often led to blaming the individual. Health professionals commented on the unrealistic expectations of people who wanted to lose weight quickly and how their role as a health professional could not possibly be supportive of this.”

“The health professionals we interviewed also blamed themselves for not having the answers, and described feeling ill-equipped to assist individuals to make successful changes.”

Tensions in Obesity Management and Prevention

“Both the individuals living with obesity and the health professionals did not feel supported by the health care system. Health professionals [and policy makers] also struggled to know how to approach the issue.”

“Individuals living with obesity also experienced exclusion when attempting to find appropriate support within the health care system. Most individuals in the study began to access this system when they believed they could no longer manage their weight by themselves.”

The Prevailing Medical Management Discourse

“Health professionals experienced many frustrations and contradictions in their experiences with obesity management, and at times questioned the notion of obesity as a disease. Being obese was often in itself not enough to receive health care. Health professionals in this study found it easier to work with individuals living with obesity when they also had another diagnosed chronic condition, such as diabetes or cardiovascular disease. They could then more confidently prescribe a specific treatment regime.”

As for policy makers,

“[One] policy maker questioned whether medical treatment for individuals living with obesity is necessary…. As an alternative to medicalizing obesity, the policy maker suggested addressing the issue of population health and using health promotion to support the majority of people who are not morbidly obese but are still struggling with weight problems.”

“Overall, individuals living with obesity sought validation for requiring support in a system that currently does not provide the support they need.”

Based on these findings, the authors note that,

“…our findings highlight the need to reframe the public debate on obesity. However, we suggest that rather than choosing one discourse over another (management vs. prevention; system vs. individual), we should engage aspects of both. This requires not only consideration of socioecological perspectives, but also a greater awareness among health professionals of the need to offer support, not advice.”

“Furthermore, relationships between patients and health care providers should be supportive (not blaming), recognizing the widespread prevalence of weight bias in society and working hard to challenge the stereotypes that dominate the discourse on body weight”

“It was also evident in the language and experiences provided by health care providers that training, resources, and support for weight management were a substantive part neither of their professional training nor of the health care system.”

To facilitate improved training of health professionals, the authors have developed the rich narratives obtained in this study into a dramatic presentation, depicting the relationship between a health professional and an individual living with obesity.

This narrative can be viewed here.

For interviews with the researchers – click here.

Clearly, it is work like this that is essential to understanding the current discourse (or rather lack of it) about obesity and finding strategies that do justice to those living with obesity.

There is simply no room for “shame and blame” in such a discourse.

@DrSharma
Edmonton, AB

ResearchBlogging.orgKirk SF, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, Vallis TM, Curran J, & Aston M (2014). Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management. Qualitative health research PMID: 24728109

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Wednesday, October 3, 2012

Why Comments on What Christina Aguilera Did Not Say Still Matter

Yesterday, the popular media threw a hissy fit after Christina Aguilera was first reported by US Weekly to have told Billboard magazine that she is through with being a “skinny white girl” (or words to that affect), which Billboard magazine then said never happened, leading to a retraction by US Weekly and other outlets that picked up this quote.

More interesting than the ‘who-said-what-to-whom’ episode are the comments left on Billboard magazine’s website.

Here are two examples of the diametrically opposing views on this issue:

Mac: Oh COME ON!!…she was never “skinny”…she had a PERFECT body. But now she’s just plain FAT! Face it Christina, you got lazy, stopped working out, and have just been stuffing your face with junk food. And now this is your B.S. way of justifying it.”

Linda: She looks great. Big ups Christina!!!! I love how she is embracing her body at its natural state for her at this point in her life. We need more women in the limelight to do just that, it frees society and humans to be themselves and happy. Haters are gonna hate. Love will eventually set us all free.”

These comments pretty much sum up the public discourse on body weight.

One camp thinks it is all self-inflicted (lazy, stuffing your face), the other is in the positive body image size-acceptance (embracing her body, natural state, good for you) camp.

Like it or not, these discussions in the context of Christina Aguilera’s (or for that matter any celebrity’s) shape and size, do more to shape the public discourse and perception of what body weight may or may not be, than any academic discussions that we may be having about this issue at public health agencies or elsewhere.

Ignoring this discourse means being irrelevant – you cannot influence a discussion if you refuse to join it.

AMS
Edmonton, Alberta

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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