Online Course on Weight Bias With Dr. Sara Kirk

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). For your FREE registration, please visit the course listing and registration page here. @DrSharma Copenhagen, DK

Full Post

All Behavioural Interventions Carry Risks

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… Read More »

Full Post

Guest Post: Treatment For Addictive Eating: Many Shades of Grey

Continuing with the theme of food addiction, here is another guest post – this one by Dr. Pam Peeke, a Pew Foundation Scholar in Nutrition, Assistant Clinical Professor of Medicine at the University of Maryland, and Senior Science Advisor to Elements Behavioral Health, the USA’s largest network of residential addiction treatment centers. She is author of the New York Times bestseller The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction. Her website is http://www.drpeeke.com/ For years, the popular culture has embraced the relationship between food and addiction. It permeates our daily vernacular— “I’m hooked on bread”, “I need a candy fix”, “I can’t get off the stuff”, “I’m a carb addict”. Grocery store shelves are filled with colorful cereal boxes labeled “Krave”, as the food industry capitalizes on the consumers’ never ending hunger for another fix. History was made when a major weight management company aired its first Super Bowl commercial, choosing a “food as drug” theme, narrated by Breaking Bad actor Aaron Paul. Close your eyes, listen to the words, and you’d never guess that food, not drugs, was the focus. Companies and communities, however, cannot validate the phenomenon of addictive eating behavior—only science can do that. Heeding the call to arms, nutrition and addiction researchers, led by Dr. Nora Volkow, Director of the National Institute of Drug Abuse, have spent the past ten years generating a critical mass of valid and credible science associating specific food products and addictive eating behavior. A tipping point was reached in 2012, when the peer reviewed and edited professional textbook Food and Addiction was published. A month later my consumer book, The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction, was released and the single most common response from my readers was “What took you so long?” We needed, and finally benefited from, new groundbreaking research. We now know that certain foods, namely the “hyperpalatables”–sugary, fatty, salty food combinations— affect the brain’s reward center in a way identical to drugs and alcohol, triggering an abnormally high level of release of the pleasure chemical dopamine. Repeated hyper-stimulation of these reward pathways can trigger neurobiological adaptations that can lead to compulsive consumption despite negative consequences. In 2009, Yale researchers developed the first assessment tool, the Yale University Food Addiction Scale, or YFAS, to identify individuals who demonstrated an addictive response to specific foods. Subsequent studies… Read More »

Full Post

Does Food Addiction Require Abstinence?

Recently, I had the opportunity of meeting Vera Tarman, a Toronto addiction physician, who is also a self-proclaimed “food addict” and author of the book, “Food Junkies: The Truth About Food Addiction“. It is fair to say that talking to Tarman and reading her book (of which she happily gave me a copy) has definitely given me food for thought. To start with, her book “Food Junkies” is not a typical diet book or even a treatment guide to food addiction. Rather, it is a rather compelling treatise in support of the existence of  a discrete and definable subset of obese (and non-obese) individuals who may well be considered “food addicts” and for whom the only viable treatment is complete abstinence from their respective trigger foods. To put things simply, Tarman (and her co-author Philip Werdell) describes three categories of “eaters” (the following words my attempt at paraphrasing the central ideas as I understand them): Normal Eaters: this is by far the largest group of individuals with obesity, who may overeat for no other reason than that they like food, are surrounded by food, pay little attention to food, let themselves go hungry, have food pushed on them, and/or really don’t obsess or worry about food at all. Normal eaters can learn to control their eating through education and coaching and by changing the circumstances that foster poor willpower: better sleep, stress management, improving social skills, changing their personal food environment, etc. People with Eating Disorders: for this group of individuals, obesity is not the primary problem, rather it is just another symptom of the underlying emotional disturbances that drives their “pathological” eating behaviour. The “spectrum” of these disorders ranges from rather mild “emotional eating” to full blown “binge eating syndrome”. The primary driver of their overeating is psychological (e.g. trauma, grief, abuse, etc.). Once the psychological problem is identified and resolved (or managed, e.g. though cognitive behavioural therapy), they can gain control over their eating behaviour, which in turn can help them control their weight problem. Food Addicts: this group of individuals is literally “addicted” to certain foods (usually foods high in sugar, flour, fat and/or salt) in the same manner that a drug addict would be considered addicted to their drug, with the same clinical signs that range from denial and loss of control, to physical symptoms on “withdrawal” and relapse that can be prompted by minimal exposure, even years after being “clean”… Read More »

Full Post

Does The Media Depiction Of Obesity Hinder Efforts To Address It?

A study by Paula Brochu and colleagues, published in Health Psychology, suggests that the often unflattering depiction of people living with obesity in the media (as in the typical images of headless, dishevelled, ill-clothed individuals, usually involved in stereotypical activities – holding a hamburger in one hand and a large pop in the other or pinching their “love handles”), may well play a role in the lack of public support for policies to address this issue. The researchers asked participants to read an online news story about a policy to deny fertility treatment to obese women that was accompanied by a nonstigmatizing, stigmatizing, or no image of an obese couple. A balanced discussion of the policy was presented, with information both questioning the policy as discriminatory and supporting the policy because of weight-related medical complications. The findings of the study show that participants who viewed the article accompanied by the nonstigmatizing image were less supportive of the policy to deny obese women fertility treatment and recommended the policy less strongly than participants who viewed the same article accompanied by the stigmatizing image. Given that negative and stigmatising images of people with obesity are the rule rather than the exception in media reports about obesity, the authors suggest that simply eliminating stigmatizing media portrayals of obesity may help reduce bias and foster more support for policies to address this problem. Readers may wish to visit the Canadian Obesity Network’s image bank Picture Perfect At Any Size of non-stigmatizing images of people living with obesity that are available for free download for educational and media purposes. @DrSharma Copenhagen, DK

Full Post