Monday, September 1, 2014

Guest Post: Emotional Distress And Weight Gain

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Today’s guest post comes from Erik Hemmingsson, PhD,  a Group Leader at the Obesity Center, Department of Medicine, Karolinska Institute, Stockholm, Sweden. His group studies the role of psychological and emotional distress in weight gain and obesity by mapping life events that influence stress, metabolism and body weight. Erik has a PhD in Exercise and Health Sciences from the University of Bristol (2004) and a PhD in Medicine from Karolinska Institutet.

I work as a researcher in a specialized obesity treatment center at a university hospital in Sweden. My job is to develop new and more effective treatment and prevention methods so that we can hopefully confine obesity to the history books some day.

For many years I mostly did studies on behaviour therapy combined with low energy diets. Since this did not result in any major breakthroughs, I decided to try something a little different.

I had been aware of that many of our patients had experienced difficult childhoods. There were so many sad stories, but I didn’t fancy doing any research on the topic, it was too painful. But then my attitude gradually started to change about a year ago. It was clear that our current treatment methods were woefully ineffective, but I also became more receptive to all those troublesome stories from the patients. Enough was enough, it was time act. So, like Neo in the Matrix movies, I decided to take the red pill, and delve deeper into the very uncomfortable subject of childhood abuse and adult obesity.

I searched the literature and quickly saw that there were more than enough studies for a systematic review and meta-analysis. I enlisted the help of Dr Kari Johansson and Dr Signy Reynisdottir, and got to work.

What we found very much confirmed all those clinical observations, i.e. there was a very robust association between childhood abuse and adult obesity. The association was also very consistent across difference types of abuse, with an increased risk of about 30-40%. There was also a dose-response association, i.e. the more abuse, the greater the risk of obesity.

While this study confirmed something very important, it was also clear that not everyone who suffers childhood abuse develops obesity, or that all obese individuals have suffered childhood abuse, or the effects would have been even more pronounced. But for me, the study proved that stressful childhood experiences can easily manifest as obesity many years later. This led me even deeper down the rabbit hole. I wanted to know why.

I decided to try and piece together different ideas about how obesity develops in relation to stressful life events. This resulted in a new conceptual causal model consisting of six different developmental stages. Like many diseases, obesity development is more likely when there is socioeconomic disadvantage (applies mainly to Europe and North America). Socioeconomic disadvantage can very easily trigger a chain of events that include adult distress, a disharmonious family environment, offspring distress, psychological and emotional overload, and finally disruption of homeostasis through such mechanisms as maladaptive coping responses, stress, mental health problems, reduced metabolism, appetite up-regulation and inflammation.

Much more research is needed to validate the model, but if there is some truth to this theory, which the childhood abuse meta-analysis clearly suggests that there is, then my hope is that we can use this information to develop more effective treatment and prevention methods.

My other hope is that some of the truly horrendous stigma, shame and discrimination that the obese experience can gradually be alleviated, since there is clearly a lot more to obesity etiology than the commonly held preconception that obese individuals are merely lazy and overindulgent.

After having done all this work on obesity etiology, I would say that my top-3 reasons we have an obesity epidemic (in no particular order) are socioeconomic inequality, the junk food invasion, and psychological and emotional distress patterns (usually established at an early age). And when you combine all three you have the perfect storm for weight gain.

You can find more information at my blog at www.holisticobesity.com

Erik Hemmingsson,
Stockholm, Sweden

References:

Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obesity Reviews (epub 15 August 2014).

Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obesity Reviews 2014, 15:769-779.

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Abstract submission deadline: October 23, 2014
  • Notification of abstract review: January 8, 2014
  • Early registration deadline: March 5, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Tuesday, August 26, 2014

Does Facebook Use Promote Eating Disorders?

facebook_button_eu3gSocial media are not just a means of sharing your life with the world – they also open your life to praise (likes and positive comments) or criticism.

Thus, it is easy to see how avid use of such platforms (especially those with ample picture posts) can potentially promote body image and weight obsessions in those who may not be quite confident and happy about their appearance.

That this may not just be an interesting theory is suggested by two studies by Annalise Mabe and colleagues from Florida State University, published in the International Journal of Eating Disorders.

In the first study 960 female college students completed an Eating Attitudes Test that included Dieting and Bulimia/Food Preoccupation subscales with items such as “I eat diet foods” and “I give too much time and thought to food.”

Duration of Facebook use was assessed with the question “How much time do you spend on Facebook per week?” with options ranging from 0 to >7 hours (average used tended to be just over 2 hours per week).

This study found a small but statistically significant positive relationship between the duration of Facebook use and disordered eating.

In the second study, 84 women, who had participated in the first study and endorsed Facebook use on a weekly basis were randomization to either spending 20 mins on their facebook account or finding information about the ocelot on Wikipedia and YouTube.

Participants with greater disordered eating scores endorsed greater importance of receiving comments on their status, and greater importance of receiving “likes” on their status. Those with greater eating pathology reported untagging photos of themselves more often and endorsed comparing their photos to their female friends’ photos more often.

Participants in the control group demonstrated a greater decline in weight/shape preoccupation than did participants who spent 20 min on Facebook. Furthermore post hoc comparisons supported a significant decrease in weight/shape preoccupation in controls.

Facebook use resulted in a preoccupation with weight and shape compared to an internet control condition despite several multivariate adjustments.

As the authors discuss, their finding,

“indicates that typical Facebook use may contribute to maintenance of weight/shape concerns and state anxiety, both of which are established eating disorder risk factors.”

In terms of practical implications of these findings, the authors suggest that,

“Facebook could be targeted as a maintenance factor in prevention programs. For example, interventions could address the implications of appearance-focused comments such as “you look so thin” or “I wish I had your abs,” in perpetuating the thin ideal on Facebook, much as “fat talk” perpetuates this ideal in everyday conversations. An adaption of the “Fat Talk Free” campaign as well as adaptations of media literacy programs could encourage girls and women in the responsible use of social media sites.”

Clearly, this appears to me as a rather fertile area for further research.

I’d certainly be interested in hearing about your experience with facebook and any effects it may have had on your body image or eating behaviours.

@DrSharma
Edmonton, AB

ResearchBlogging.orgMabe AG, Forney KJ, & Keel PK (2014). Do you “like” my photo? Facebook use maintains eating disorder risk. The International journal of eating disorders, 47 (5), 516-23 PMID: 25035882

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Wednesday, August 20, 2014

Healthy Obesity: Losing Weight Won’t Make You Happy

sharma-obesity-depressionThere is ample evidence for improvements in mood and other aspects of mental health with weight loss in people with excess weight, who have these problems to begin with.

But whether or not weight loss in otherwise healthy people living with obesity is associated with any such benefits remains unknown.

This question in now addressed by Sarah Jackson and colleagues from the UK in a paper published in PLOS | ONE.

The researchers examine data from 1,979 overweight and obese adults, free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing.

Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%.

The proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the than weight stable or weight gain groups, respectively.

Compared to the weight stable group, the weight loss group was almost 2 times as likely to report mood problems.

Similarly, individuals in the weight loss group were also more likely to report lower wellbeing.

All effects persisted in analyses controlling for demographic variables, weight loss intention, and baseline characteristics and despite adjusting for illness and life stress during the weight loss period.

Given the longitudinal nature of this study, it is impossible to determine causal relationships in these observations but the findings do suggest that the issue of psychological harm in otherwise healthy individuals undergoing weight loss may warrant closer study.

For the event that there is indeed a causal relationship between weight loss and adverse pychological outcomes, the authors have the following explanation to offer:

The poor long-term maintenance of weight loss is notorious, and in itself could be interpreted as demonstrating that the personal costs of losing weight exceed the benefits. Resisting food in environments that offer abundant eating opportunities requires sustained self-control, and given that self-control appears to be a limited resource, other areas of life may suffer as a consequence. Loss of fat stores may also initiate signals for replenishment of adipocytes, thereby stimulating hunger and appetite and making weight control progressively more difficult. These observations suggest that weight loss is a significant psychobiological challenge, and as such, could affect psychological wellbeing.”

On the other hand, weight loss could also result from adverse changes in mood:

Evidence from the clinical literature is suggestive of a causal relationship in this direction, with major depressive disorder often associated with significant weight loss, and treatment with antidepressant medication leading to weight gain. Population studies have also demonstrated longitudinal associations between depressive symptoms and weight loss. Depressed mood may cause weight loss directly or indirectly through changes in appetite or level of physical activity.”

Thirdly, these correlational findings may be entirely unrelated to each other.

Which ever the true relationship, these findings should perhaps caution us against simply advising all overweight or obese people, irrespective of whether or not they actually have weight-related health issues (or are otherwise unhappy with their weight), to try losing some weight.

@DrSharma
Edmonton, AB

ResearchBlogging.orgJackson SE, Steptoe A, Beeken RJ, Kivimaki M, & Wardle J (2014). Psychological Changes following Weight Loss in Overweight and Obese Adults: A Prospective Cohort Study. PloS one, 9 (8) PMID: 25098417

 

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Tuesday, August 5, 2014

Evidence for Benefit of Psychological Intervention Before Bariatric Surgery

sharma-obesity-psychotheralyCurrent bariatric surgery guidelines recommend psychological assessment prior to undergoing bariatric surgery. In some centres, this assessment is less than rigorous and, in cases where patients have been denied surgery because of psychological findings, providers have been accused of bias and discrimination.

Nevertheless, most people working in the field, tend to agree that, when present, emotional drivers of weight gain are best dealt with before rather than after surgery.

Now, a randomised controlled trial by Hege Gade and colleagues from Tromsø, Norway, published in The Journal of Obesity, shows the benefit of 10 weeks or cognitive behavioural intervention in patients seeking bariatric surgery, who present with dysfunctional eating behaviours.

A total of 98 (70% females) patients with a mean age of 43 years and BMI of 43.5 kg/m2 were randomly assigned to 10 weeks of weekly CBT-group therapy or usual nutritional support and education (controls).

The CBT sessions were included learning to recognize triggers of dysfunctional eating, identifying associated cognitions and emotions, initiating plans for change, and home-work tasks between sessions.

Compared the controls, the CBT-group showed a remarkable improvement in eating behaviours as well as improvements in depression and anxiety scores at the end of the intervention. They also experienced some modest weight loss (~3 kg).

While these benefits speak for the effectiveness of CBT, the study does not provide any outcome data post-surgery to show that these patients do better after surgery than the controls – that, I believe, remains to be shown.

Nevertheless, common sense suggests that dysfunctional (emotional) eating (when present) is perhaps best dealt with prior to surgery than after the procedure.

@DrSharma
Edmonton, AB

 

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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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