For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd.
To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here.
To register – click here.
In 2011, The Lancet dedicated a special issue to the topic of obesity – the general gist being that obesity is a world wide problem which will not be reversed without government leadership and will require a systems approach across multiple sectors. The Lancet also noted that current assumptions about the speed and sustainability of weight loss are wrong.
This week, The Lancet again dedicates itself to this topic with ten articles that explore both the prevention and management of obesity.
According to Christina Roberto, Assistant Professor of Social and Behavioural Sciences and Nutrition at the Harvard T H Chan School of Public Health and a key figure behind this new Lancet Series, “There has been limited and patchy progress on tackling obesity globally”.
Or, as Sabine Kleinert and Richard Horton, note in their accompanying commentary, “While some developed countries have seen an apparent slowing of the rise in obesity prevalence since 2006, no country has reported significant decreases for three decades.”
As Kleinert and Horton correctly point out, a huge part of this lack of progress may well be attributable to the increasingly polarised false and unhelpful dichotomies that divide both the experts and the public debate, thereby offering policy makers a perfect excuse for inaction.
These dichotomies include: individual blame versus an obesogenic society; obesity as a disease versus sequelae of unrestrained gluttony; obesity as a disability versus the new normal; lack of physical activity as a cause versus overconsumption of unhealthy food and beverages; prevention versus treatment; overnutrition versus undernutrition.
I have yet read to read all the articles in this series and will likely be discussing what I find in the coming posts but from what I can tell based on a first glance at the summaries, there appears to be much rehashing of appeals to governments to better control and police the food environments with some acknowledgement that healthcare systems may need to step up to the plate and do their job of providing treatments to people who already have the problem.
As much as I commend the authors and The Lancet for this monumental effort, I would be surprised if this new call to action delivers results that are any more compelling that those that followed the 2011 series.
I can only hope I am wrong.
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 using the scale have shown that there is a wide spectrum of people who present with addictive eating behavior, especially in those who are overweight/obese, female, over 35, or who have existing disordered eating patterns such as binge eating disorder or bulimia. Ongoing investigations have noted that among women, there is a 90 percent association between food addiction and prior history of abuse, especially in childhood and adolescence. As well, the incidence of addictive eating in women increases with post-traumatic stress syndrome.
As scientific evidence continues to mount clarifying the connection between food and addiction, attention is now beginning to focus on treatment options. Treatment for addictive eating behavior is of particular interest to me as a scientist and a clinician. I recall one of my patients, a former alcoholic with a disabling sugar addiction, declaring, “If drinking is black and white – I drink or I don’t– sugar is more shades of grey than there are books.” Indeed, in contrast to drugs and alcohol, treatment for the psychobiological challenges of addictive eating is far more complex. In a prior blog, Dr. Vera Tarman addressed abstinence as one treatment option.
Who is the target treatment population? It’s not just obese, compulsive overeaters. It also includes thin, average and mildly overweight men and women experiencing a full range of eating disorders (ED), mood syndromes and substance abuse. Within these groups there are numerous intricate interconnections, interrelationships and co-occurrences. For instance, current research suggests that approximately 50% of those with an ED are also substance abusers, including 57% of men with binge eating disorder experiencing long-term drug and alcohol abuse. Cross addictions abound as people transition from drugs to cupcakes, from alcohol to sugar, and from bariatric surgery to alcohol. This complicated web of interrelationships is one reason that determining the precise prevalence of food addiction is such a challenge.
In essence, the larger the treatment population, the wider the spectrum of therapeutic modalities required, and thus, the greater the need to individualize and customize treatment for addictive eating behaviors. To address this challenge, I have created the Integrative Nutrition and Holistic Lifestyle Program at Malibu Vista in California. This women’s residential treatment program treats women, many of whom have co-occurring mood and food conditions, specifically addictive eating. This pilot program has garnered national attention including a recent NBC Today Show segment.
The program’s blueprint is based upon my three pronged, customized approach to: 1. mental/spiritual wellness (MIND); 2. whole food nutrition (MOUTH); and, 3. physical activity (MUSCLE). Therapists use a wide range of cognitive psychotherapeutic methods to treat mental health conditions including trauma. Body movement modalities include yoga, tai chi, and meditative walks to foster an improved mind-body association. Nutritionally, the chefs have eliminated any refined or processed foods, including table sugar and artificial sweeteners. Our culinary nutritionist, who is both a certified chef and registered dietitian, assesses each woman. This includes completion of the Yale Food Addiction Scale, a metabolic evaluation, and documentation of any history of substance abuse and disordered eating. An individualized plan is created and refined during the typical 4-5 weeks in-residence. Through hands-on cooking lessons and nutrition education sessions, individuals can reframe and redefine their relationship with food. Group fellowship is critical to ongoing support and success. Continued coaching continues upon discharge. For example, Sandie, featured in the Today Show segment, is now off her anti-anxiety medications, no longer binges, has halved her diabetes medication, and has thus far removed over 50 pounds of excess weight.
In honoring each woman’s unique story and the complexities of treating addictive eating behavior, the Malibu Vista team draws upon elements found from a multitude of resources, including but not limited to 12-step programs. Individualized strategies are designed to use a wide range of interventions to optimize body-brain-mind healing. The end goal is to help each person manage the triple challenge posed by the food-mood-addiction triad, and in doing so, create a blueprint for long term recovery, and success in navigating addictive eating’s many shades of grey.
Since its inception in 2006, the Canadian Obesity Network (CON) has grown into a 10,000 member strong organisation of researchers, health professionals, policy makers, and anyone working in the private or public sector with an interest in obesity.
In short, CON as we know it, is a professional network – all you have to do to become a member is to sign up on the website and state your professional expertise and area of interest.
While CON has undeniably changed the landscape of obesity research, practice and policy in Canada, the most important voice in this dialogue has been missing – the voice of people living with obesity and their families.
As decided by CON’s Board of Directors, this is about to change. It is now time for CON to engage directly with people who have the problem – not just experts who study or treat it.
To help guide CON on this new venture, anyone living with obesity or working with individuals living with obesity (of any age and in any setting) is requested to complete this brief survey (4 questions – takes less than 2 minutes).
Your response will help inform a Bariatric Patient Engagement Workshop to be held on April 27, 2015 at the upcoming 4th Canadian Obesity Summit in Toronto.
The purpose of the Bariatric Patient Engagement Workshop is to hold a focused conversation and seek insights about the need for and function of a public engagement strategy to inform, support, and empower individuals affected by obesity in Canada.
This workshop is CON’s first step towards building a Canada-wide community of individuals affected by obesity that is willing to participate in public engagement initiatives in support of patient-oriented research, practice, and policy.
Your help and support is very much appreciated as CON prepares itself for this next chapter of its commitment to engage all relevant stakeholders towards its mission to prevent and reduce the physical, mental and economic burden of obesity on Canadians.
To take the survey click here.
Unfortunately, most people have rather simplistic views of genetics – either you have a gene for disease X and you get it, or you don’t have the gene for disease X and so you’re safe.
In reality, this is not at all how genetics works (with the few rare exceptions of single-gene disorders – and even there is not at all as straightforward as most people imagine).
In fact, whether or not a gene (or group of genes) actually results in a specific phenotype is highly dependent on the environment.
As a simple example: I could be genetically highly predisposed to salt-sensitivity (i.e. having a blood pressure increase on a high-salt diet) – but unless I am actually exposed to a high-salt diet, I can go my entire life without ever developing high blood pressure.
This is pretty much the case for all complex (and even some single-gene) disorders – it is only when you put the susceptible “disease gene(s)” in the wrong environment, that the gene does what it does. This is why most “nature vs. nurture” debates lead nowhere – it is virtually never one OR the other – it is mostly BOTH!
A good example of how changing environments may be important when studying the genetics of diseases is suggested in a new study by James Niel Rosenquist and colleagues, published in the PNAS.
The researchers examines the association between the FTO gene and BMI using longitudinal data from the Framingham Heart Study collected over 30 y from a geographically relatively localized sample in the US.
What they found was that the well-documented association between the rs993609 variant of the FTO (fat mass and obesity associated) gene and body mass index (BMI) varies substantially across birth cohorts, time period, and the lifecycle, with a apparently increasing impact of this gene for those born after 1942.
As the authors point out,
“Such cohort and period effects integrate many potential environmental factors, and this gene-by-environment analysis examines interactions with both time-varying contemporaneous and historical environmental influences.”
“These results suggest genetic influences on complex traits like obesity can vary over time, presumably because of global environmental changes that modify allelic penetrance.”
In other words, as the environment changes, certain genetic “phenotypes” may become more (or less) common.
It is however important to remember in this context that the term “environment” is rather broad and may include biological drivers that include changes in the epigenome, bacteriome or even virome, all of which will have substantially changed over time (and continue to change as we we speak).
On a more practical level, this is also why genetic testing for complex genetic diseases (and so-called “personalized” medicine) will likely be nothing more than a pipe dream and a money grab, at least for the foreseeable future.
Rosenquist JN, Lehrer SF, O’Malley AJ, Zaslavsky AM, Smoller JW, & Christakis NA (2015). Cohort of birth modifies the association between FTO genotype and BMI. Proceedings of the National Academy of Sciences of the United States of America, 112 (2), 354-9 PMID: 25548176