As a clinician often dealing with patients presenting with binge-eating disorder (BED), I am quite aware of the often pathological cognitive and emotional relationship to food, eating, and body image presented by patients with this syndrome.
Whether or not this impairment in thinking and feeling also extends to other behavioural or emotional domains is the topic of a systematic review by Kittel and colleagues from the University of Leipzig, published in the International Journal of Eating Disorders.
The paper is based on the review of almost 60 studies and shows that, individuals with BED consistently demonstrate higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues) – in contrast, cognitive functioning in the context of neutral stimuli appear to be less affected.
With regard to emotional functioning, individuals with BED also report greater emotional deficits when compared to obese and normal-weight controls.
Thus, these findings confirm the clinical observation that patients with BED tend to have specific difficulties in cognitive and emotional functioning when it comes to food, eating or body image, however, appear to function adequately in other domains.
For clinicians these finding are relevant as they show that while people with BED may benefit from help in changing their cognitive and emotional response to food cues, such problems are indeed more often encountered in people with BED rather than in everyone living with obesity.
Screening for BED should be an essential element of workup in anyone presenting with excess weight gain.
Before you respond “of course” – you may wish to take a look at the systematic review by Laura Cobb and colleagues from Johns Hopkins University, published in OBESITY.
The authors looked at 71 Canadian and US studies that examined the relationship between obesity and retail food environments and concluded that,
“Despite the large number of studies, we found limited evidence for associations between local food environments and obesity. “
To be fair, the researchers also concluded that much of the research in this area lacks high-quality studies, that would lead to a more robust understanding of this issue.
In fact, the authors had to slice and dice the data to tease out “positive” findings that included a possible relationship between fast food outlets and obesity in low-income children or an inverse trend for obesity with the availability of supermarkets (a supposed surrogate measure for availability of fresh produce).
Of course, not finding a robust relationship between the food environment and obesity should not be all that surprising, given the many factors that can potentially play a role in obesity rates.
(Readers may recall that there used to be similar enthusiasm between the role of the built environment (e.g. walkability) for rising obesity rates, till the research on this issue turned out to be rather inconclusive. )
None of this should be interpreted to mean that the food or built environments have nothing to do with obesity – however, we must remember that these type of studies virtually never prove causality and that the factors that determine food and built environments are in fact almost as complicated as the factors that determine individual body weights, so finding a robust relationship between the two would be rather surprising.
Allow me to predict that with the increasing trend of fast food outlets offering healthier (or rather less-unhealthy) choices and supermarkets offering ample amounts of “fast food” and a vast array of unhealthy packaged foods, any relationship between retail food environments and obesity (even if it does exist), will be even harder to prove that ever before (outliers are no better than anecdotal evidence and should generally be ignored).
Changing food environments to provide better access to affordable healthier foods should be a “no-brainer” for policy makers, irrespective of whether or not the current environment has anything to do with obesity or not (the same could be said for walkability of neighbourhoods and the prevention of urban sprawl).
This interesting question was the topic of an intriguing study by Eric Robinson and Paul Christiansen from the University of Liverpool, published in the International Journal of Obesity who examined whether women’s preferences for larger men can be influenced by prior exposure.
The researchers conducted a series of four studies. Studies 1 and 2 looked at how exposure to men with obesity vs. normal weight had on female attraction toward a man with overweight. The findings of these two study showed that exposure to obesity can alter visual perceptions of what normal body weights were resulting in greater attraction toward an overweight man.
Study 3 found that women who are regularly exposed to males of heavier body weights reported a greater attraction toward overweight men.
Study 4 showed that after exposure to images of men with overweight or obesity, females in an online dating study were more likely to choose to date an overweight man than a man of normal weight (Study 4).
Thus the researchers conclude that even brief exposure to men with obesity can increases female attraction toward overweight men and may affect mate choice.
However, as the researchers note, the findings are limited to single women rating caucasian males – whether exposure to women with overweight has a similar effect on male preferences remains to be studied.
Perhaps the results of this study can lead to the following dating advice – if you’re a big man, surrounding yourself with people of your size may just make you seem more attractive.
Irrespective of the fact that bariatric surgery has now become so safe (at high-volume centres) that it compares well with other common surgical procedures like having your gall bladder removed, it is still surgery.
As even the safest surgery carries risk, it should never be taken lightly and thus the question of whether or not people with obesity but no related comorbidities stand to benefit from bariatric surgery is an important question.
One of the key outcomes (at least for patients) is the impact on quality of life which is why Hilde Risstad and colleagues from the University of Oslo, studied the effect of bariatric surgery on patients presenting with obesity related comorbidities and those without, published in Obesity Surgery.
They studied 232 patients with severe obesity before and 2 years after Roux-en-Y gastric bypass.
Obesity related disease was defined as having at least one of the following conditions: type 2 diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, obstructive sleep apnea, gastroesophageal reflux disease, or osteoarthritis.
Not only was baseline quality of life similar in patients with and without obesity-related disease prior to gastric bypass but it also improved equally in both groups.
This may not be entirely surprising.
Readers may recall that the Edmonton Obesity Staging System (EOSS), specifically designed to asses obesity related health risks, does not just consider medical comorbidities (as in this study) – EOSS gives as much importance to mental and functional health (not assessed in this study).
Thus, it is not surprising, that even without the presence of an obesity related medical complications like diabetes or sleep apnea, health (and thus quality of life) can be significantly affected by mental health and/or functional status, both of which can markedly improve after bariatric surgery.
This is why, pre-assessment or triaging patients for bariatric surgery should not only consider medical problems but also mental and functional health – as in EOSS.
If the lively response to last week’s post on the question of whether or not Sarah Hoffman is qualified to serve as Alberta’s health minister based on how people judge her size teaches us anything, it sure makes eviden the simple-minded thinking about obesity that is so pervasive in our society (thanks to all my bold readers, who stepped in to share their stories).
The problem, however, is not just that adults get judged by the general public (who may be forgiven for their ignorance) – the problem goes much deeper.
Thus, a study by Kenney and colleagues from the Harvard School of Public Health, published in the International Journal of Obesity, shows that worse educational outcomes for children living with obesity may be simply due to how teachers perceive them, rather than their objective performance.
The study includes 3362 children participating in the Early Childhood Longitudinal Study—Kindergarten Cohort (ECLS-K), who were studied longitudinally from fifth to eighth grade.
While an increase in BMI z-scores (a measure of childhood weight gain) from 5th to 8th grade showed no association to actual academic ability in standardized test scores, teacher’s perceived kids with higher BMI z-scores as to be poorer at math and in reading.
Interestingly, it was not just the teachers who rated heaver kids as poorer students, the larger students rated themselves as being less capable than they actually were – perhaps a reflection of how their teachers’ attitude towards them was reflected in their self-worth.
Here is how the researchers put it rather bluntly,
“From 5th to 8th grade, increase in BMI z-score was significantly associated with worsening teacher perceptions of academic ability for both boys and girls, regardless of objectively measured ability (standardized test scores).”
The implications of this finding are self-evident.
If teachers, who should know better, misjudge academic ability based on kids body weights (despite the lack of difference in objective tests), which in turn leads the kids to have less confidence in their own abilities, it is easy to see how this may well set them off on a trajectory leading to lower academic performance and thus a less bright start – a self-fulfilling prophecy, if I ever saw one.
Even if we do not care about adults being judged or discriminated against because of their size (and we should), the fact that our kids are also being judged by their teachers, who should know better, must set off all kinds of alarm bells.
Have you experienced weight-bias or discrimination in educational settings? I’d love to hear your story.