Arya M. Sharma, MD

Before, I get into the promised review of the obesity papers in the January issue of the Canadian Journal of Psychiatry, I would like to set the stage by clarifying that I certainly do not consider obesity to be a mental illness.

Thus, I very much opposed the notion (proposed by some) to include obesity as a diagnosis in the the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders and was very much relieved to see this proposal being rejected.

Although the brain is the ultimate regulator of energy balance and there is a significant and relevant relationship between mental health and the propensity for weight gain (as will be discussed in forthcoming posts), obesity itself is hardly a mental illness. In fact, the vast majority of overweight and obese individuals do not have any mental health problems that would be in any form or fashion differentiate them from the non-obese population.

This situation, however, is markedly different in the ‘weight-loss-seeking’ obese population, where an increased prevalence of mental health problems has been well documented. This is why clinicians dealing with obese patients, particularly those seeking obesity treatment need to be well versed in the diagnosis and basic principles of managing mental health problems.

What is also indisputable is the fact that for patients with mental health problems, weight management can prove particularly challenging.

When we consider how difficult implementing and maintaining the often complex regimens for weight management can be for most people, it should be no surprise that adding the additional burden of mental illness can make such efforts almost impossible.

Add to this the fact that many of the psychiatric medications can further promote weight gain, and we can easily see why obesity has become such an important challenge in light of the increasing use of such medications (whether indicated or not).

Remember, that in this discussion we are talking about significant and major mental health problems like depression, bipolar disorder, psychosis, anxiety, PTSD, or addictions. We are not talking about simple ‘overeating’ associated with stress, boredom, social pressures, or other factors that have little to do with severe mental health problems and should rather be considered completely normal and natural human behaviours.

Thus, it is important that in any discussion of the clinically important relationship between obesity and mental illness, we make sure that we do not add the stigmal of the latter to the already widespread stigma of the former.

In other words, while mental health problems can undeniably contribute to or complicate obesity, let us by no means assume that everyone with excess weight must somehow have a mental health problem - the vast majority of overweight and obese individuals do not.

Nonetheless, clinicians need to be well aware of this relationship, be able to identify it where it exists, and provide or refer individual obese patients, for whom this may well be a problem, to the appropriate services.

I would certainly love to hear from any readers who have experienced that addressing their mental health issues did indeed help them better manage their weight or from readers where their mental health problems are making contributing to their weight gain.

AMS
Saskatoon, Saskatchewan

At the 1st National Summit on Weight Bias and Discrimination organized by the Canadian Obesity Network in Toronto almost exactly a year ago, I learnt that weight-based bullying is one of the most common and pervasive forms of bullying experience by children and youth.

This topic is further examined by Obesity Network Bootcamper Atif Kukaswadia and colleagues from Queens University, Kingston, Ontario in a paper just published in OBESITY FACTS.

The researchers report on their findings in a longitudinal analysis of the Health Behaviour in School-Age Children Survey conducted in 2006 and then again in 2007, which included 1,738 youths from 17 Ontario high schools.

Based on self-reports, excess adiposity preceded bullying involvement and obese and overweight males reported 2-fold increases in both physical and relational victimization, while obese females reported 3-fold increases in perpetration of relational bullying over the observation period.

In addition, among those free of bullying at baseline (2006), significant increases in perpetration of relational bullying were reported by obese females in 2007 relative to normal-weight females (14.8 vs. 3.8% among normal-weight girls).

These findings support previous findings on the increased risk for bullying faced by overweight and obese youth and certainly suggest that this problem, if anything, is getting worse.

Given the many deleterious (and often lasting) effects of bullying on mental and physical health, this issue is certainly something that should concern us all.

Thus, it is certainly not surprising that one of the strategic priorities identified at CON’s Weight-Bias Summit was to “address weight-bias and discrimination in education settings”.

A full report of the Summit is available here.

AMS
Edmonton, Alberta

Kukaswadia A, Craig W, Janssen I, & Pickett W (2011). Obesity as a determinant of two forms of bullying in ontario youth: a short report. Obesity facts, 4 (6), 469-72 PMID: 22248998

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CBC Commentator, Rex Murphy

Regular readers will recall a host of previous posts on the issue of weight bias and discrimination.

Canadian Obesity Network members will hopefully also be aware that for the past four years, addressing weight bias and speaking out against weight-based discrimination has been the #1 strategic goal of the network.

Rather than listing all of the activities that the Network has undertaken to address this issues (the latest one being the launch of the image gallery “Picture Perfect at Every Size“), in today’s post I would like to share a story and explain why I continue to believe that this is the central problem at the the very heart of finding solutions to the obesity issue.

I remember this as though it was yesterday. I had just arrived with my family in Canada, having accepted a Tier 1 Canada Research Chair in Obesity at McMaster University. I was just discovering Canadian television and was quite impressed the first time I saw Peter Mansbridge on the CBC’s “The National”.

Interestingly, that evening one of the news items that caught my attention was an announcement by then Health Minister Anne McLellan, that the Government would spend $15 million to support obesity research - certainly good news for an obesity researcher just arriving in Canada.

This brief sense of having arrived in the right place at the right time, however, was shaken by what followed - a scathing, derisive, and contemptuous commentary by Rex Murphy, Canada’s premier TV commentator - not known to mince words.

In brief, as far as I can recall, the gist of his commentary was that this funding for obesity research was another perfect example of wasteful spending of tax-payer dollars.

To paraphrase his words, “so now the Government of Canada is spending millions of dollars to show that Canadians get fat by eating fast food and lounging in front of their TVs“.

I don’t remember the exact wording or the many ‘humorous’ angles that Rex Murphy took in this typical meandering monologue but I do recall the immediate effect it had on me. In my mind I could see Canadians across the country nodding and agreeing with Murphy, that spending any money on obesity research was indeed a complete waste - we already know the reasons: ‘gluttony and sloth’ - what’s there to research?

It became blindingly obvious that Rex Murphy was simply stating aloud what most people think - no wonder governments would be hesitant to support obesity research, or worse still, actually consider providing obesity treatments to Canadians.

I admit that prior to hearing this commentary, I had not given much thought to the issue of how weight bias ultimately stands in the way of finding solutions to the obesity epidemic.

Unfortunately, while Rex Murphy could perhaps be forgiven for failing to recognize the true psychosocial and biological complexity of this problem, I continue to be baffled that so many of my professional colleagues continue to trumpet simplistic notions of “eat-less-move-more” as a solution to the problem.

Frankly, I do not believe that they fully appreciate how, by reducing the entire problem of obesity to simply a matter of diet and exercise, they do little more than reinforce what most people already believe - obesity is simply a matter of ‘gluttony and sloth’.

No talk of food insecurity, abuse, depression, stress, time-pressures, addiction, genes, incretins, adipokines, hypothalamic pathways, adipostats, mitochondrial inflexibility, medications, or any of the other countless ’scientific’ intricacies that may indeed result in the ’symptoms’ of overeating or undermoving.

By reducing obesity simply to a matter of ‘lifestyle’, they provide the perfect excuse for funding agencies to rather fund research on ‘real’ health problems, for regulators to tighten the criteria for obesity medications, for payers to deny or limit the access to obesity treatments, and for health professionals to not see obesity management as part of their job.

This is why there will be no solution to obesity without first solving the issue of weight bias and discrimination.

This is why, addressing this issue remains the #1 strategic priority of the obesity network.

To anyone unhappy about how much funding is going towards supporting obesity research, unhappy about availability or access to obesity treatments, unhappy about lack of obesity training for health professionals, unhappy about reimbursements to health professionals for obesity counselling, unhappy about integrations and accommodation of people struggling with severe obesity, or even just unhappy about the surprising fact that Canada’s only national obesity organisation receives virtually no government funding to sustain its efforts - I have one simple suggestion: begin by showing zero-tolerance for ‘fat jokes’ or ‘fat talk’, do not use language, images, or messages in your presentations and writings that further promote stereotypes or reduce this complex problem to simply a matter of ‘lifestyle’, and please do stand up and speak out on the issue of weight bias and discrimination.

If the Canadian Obesity Network does nothing else but bring awareness to this aspect of the obesity problem  - it will have well been worth the ride.

AMS
Edmonton, Alberta

The mantra about the benefits of weight loss seem to be gospel in most discussions about solutions to the obesity epidemic.

It was therefore quite refreshing to follow the presentations and discussions at yesterday’s session on weight bias and discrimination at the Journées annuelles de santé publique (Québec).

One of the most innovative presentations was in fact a review of the many programs and initiatives by ÉquiLibre, a Québec non-profit organization with the mission:

“to prevent and reduce problems related to weight and body image in the population, through actions encouraging and facilitating the adoption of healthy lifestyle and developing a positive body image.”

For the past 20 years, this organization has been providing “Choose to Lose Weight?“, a program for women concerned about their weight, that focusses on size acceptance and ending the cycle of ‘yo-yo’ dieting.

For people fluent in French, the site provides ample advise on myths regarding weight loss, the potential risks of dieting and weight obsession, and tips on how to recognize ‘ethical’ weight management programs.

The ÉquiLibre site also links to an most interesting interactive site called ‘Behind the Mirror” aimed at youth, that most engagingly challenges weight and appearance stereotypes.

For non-French speaking readers, I recommend exploring the site in the Google translation mode, which does a remarkably efficient job of translating the content of these pages.

French speakers should of course browse the original site for information on ÉquiLibre.

I’d love to hear from anyone, who has participated in their courses.

AMS
Montreal, QC

Canadian Obesity Network

This morning, I am speaking on the issue of weight bias and discrimination at the Journées annuelles de santé publique (Québec), in a session called: Regard sur la discrimination et les préjugés à l’égard du pods.

It is perhaps only fitting, that today also marks the launch of an image gallery by the Canadian Obesity Network, Canada’s national network of obesity researchers, health professionals and other stakeholders.

The image gallery features the first set of a, hopefully growing, collection of non-stereotypical images representing Canadians living with overweight and obesity, which are intended for use by media and others, who report on or talk about obesity.

As noted in a previous post, the stereotypical depiction of ‘headless’ torsos that generally accompany mediate reports on obesity (and unfortunately even find their way into talks by obesity researchers and health professionals), are not only demeaning but very much promote and propagate the negative image of people living with excess weight, a key driver of the widespread weight bias and discrimination that obese people face everyday.

The purpose of the image gallery according to the Network’s website:

“In an effort to reduce pejorative portrayals of overweight and obese persons in media reporting, we have created an Image Gallery that provides a collection of photographs that portray obese individuals in ways that are positive and non-stereotypical. These images provide a fair and non-biased representation of youth and adults who are overweight and obese. Our gallery can help promote accurate coverage of obesity-related topics in news reporting and challenge harmful weight-based stereotypes.”

All of the depicted individuals have most enthusiastically volunteered their images to the Network (see terms of use). They are to be commended as it requires a considerable courage and commitment to step forward for such a cause.

The Network is also grateful to photographer Robert Tinga, who generously gave his time and expertise to these shoots.

My sincere hope is that we will soon start seeing more images like these, that reflect the fact that the obesity discussion is about real people, real families, real Canadians - not just anonymous headless torsos.

AMS
Montréal, QC