Obese Kids are Not Causing the Obesity Epidemic
The math is simple – of the one in five adults in most Western countries, who are now considered ‘obese’, very few of them were obese as kids or even as young adults. In fact, most obese adults are 40 or older. And, despite the alarming increase in childhood obesity (now affecting about one in twelve kids), obesity rates in younger adults remains at about 10% or less. Indeed, the greatest increase in obesity is seen in 45-54 year old men. These numbers alone, should tell us that most obese adults (and thus, the vast majority of obese people alive today), developed obesity as adults – not as kids! This is not to say that excess weight in childhood is not a major predictor of excess weight in adulthood – many of my patients recall being teased and bullied about their weight 30 years ago, when they were growing up in rural Alberta, helping with chores around the farm, riding their bikes to school everyday, and playing shinny hockey on a frozen pond all winter. But the majority of my patients did not have a weight problem till well into adulthood. Why do I bring this up? Simply because, I believe that better understanding, or even fully preventing, childhood obesity is unlikely to have a noticeable impact on adult obesity rates anytime soon. The problems that lead to obesity for the vast majority of obese adults occurred during their adult years. Their obesity was not caused by lack of phys-ed classes, poor school lunch programs, hallway vending machines, or parents too busy to cook dinners from scratch. Their obesity was probably also not caused by too much video gaming, too much TV watching, or not playing outside till the lights came on. Remember, the demographic group with currently the highest obesity rates (almost one in three) were kids in the 50s and 60s – an era, when a 6 oz serving of pop was considered a rare treat. Why is any of this important? 1) Focussing all of our efforts solely on better understanding the drivers of childhood obesity and trying to prevent it likely means continuing to ignore the drivers of adult obesity, which account for the vast majority of obesity in the population. 2) Even if we successfully eliminate childhood obesity, by say, changing our kids’ lifestyles back to the lifestyles of kids back in the 1960s, we… Read More »
Weekend Roundup, July 13, 2013
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Another Nail in BMI’s Coffin? All About The 3rd ‘M’ Inspiring My Interest in Visceral Fat Edmonton Obesity Stage in Italian Workers The Limitations of Checklists in Assessing Mental Health Have a great Sunday! (or what is left of it) AMS Vancouver, BC
Hindsight: Recognition and Management of Obesity in Primary Care
In 2004, we published the results of a study in the International Journal of Obesity, looking at recognition and management of overweight and obese patients in primary care settings across Germany. The goals of this study were to examine (1) the point prevalence of overweight and obesity in primary care patients, (2) prevalence patterns in patients with high-risk constellations (diabetes, hypertension, cardiovascular disease, etc.), (3) doctors’ recognition and interventions, as well as patients’ use and perceived effectiveness of weight-loss interventions and (4) factors associated with non-treatment. This cross-sectional study included 45,125 unselected consecutive primary care attendees recruited from a representative nationwide sample of 1912 primary care practices across Germany. While almost 40% of all primary care attendees were overweight, 20% were obese. Rates for overweight and obesity were highest in patients with diabetes (43.6 and 36.7%) and hypertension (46.1 and 31.3%). Rates of overweight/obesity increased steadily by the number of comorbid conditions. Doctors’ recognition of overweight (20-30%) and obesity (50-65%) was low, and patients’ actual use of weight control interventions even lower (past 12 months: 8-11%, lifetime: 32-39%). Co- and multimorbidity were predictors for better recognition of obesity but did not appear to have a noticeable influence on the use of any weight-loss interventions. Thus, back in 2004, this representative sample of German primary care patients showed a high prevalence of overweight and obesity but primary care management of excess weight was largely non-existent. The key factors for this lack of intervention was predominantly due to doctors’ poor recognition of patients’ weight status, doctors’ inefficient efforts at intervention, patients’ poor acceptance of such interventions, and general dissatisfaction with existing life-style modification strategies. It is probably fair to say that in the past eight years probably not much has changed and a similar study today will likely produce very similar results. As in 2004, doctors today, are probably no more vigilant or enthusiastic about recognising and managing obesity than back then. According to Google Scholar, this paper has 63 citations. AMS Valemount, BC
The Limitations of Checklists in Assessing Mental Health
An assessment of mental health (the first ‘M’ of obesity) should be part of every assessment for obesity. Not only can virtually all mental health problems (from mild to severe) promote weight gain, but they can and, in virtually all severe cases, will, present significant barriers to weight management. Unfortunately, most practitioners, who are called upon to give weight management advice, have little to no formal training in diagnosing, let alone dealing with, mental health disorders. This is when they sooner or later fallback on checklists – often self-administered – to screen for the presence of mental illness. In a ‘perspective’ piece recently published in the New England Journal of Medicine, Johns Hopkins University’s Paul McHugh and Phillip Slavney, discuss the limitations of overly relying on checklists for mental health assessments. As they explain, the use of checklists to assess the presence of ‘symptoms’, proliferated in psychiatric practice following the introduction of the Diagnostic and Statistical Manual (SDM), which introduced a much needed ‘standardisation’ in the assessment of mental health disorders. As a downside however, simply counting or checking off symptoms on a list has resulted in a shift towards ‘phenomenology’ rather than to consideration of etiological differences in clinical symptoms that may appear similar both to the patient and to an observer. Thus, for example, simply counting off symptoms, may lead to the ‘diagnosis’ of depression in someone who is bereaved, has classic melancholia or is simply ‘demoralised’ by circumstances. (I would add untreated sleep apnea to the list of potential confounders) As the authors note: “The mixing of similar-appearing patients who have conditions that are distinct in nature probably explains why the use of this diagnostic category expanded over time and suggests why the effectiveness of antidepressant medications given to people with a diagnosis of major depression has, of late, been questioned.” “This tendency to blur natural distinctions may explain why other DSM diagnoses – such as post-traumatic stress disorder (PTSD) and attention deficit disorder – have been overused if not abused.” Indeed, as the authors explain, the introduction of the DSM with, “Its emphasis on manifestations persuaded psychiatrists to replace the thorough ‘bottom-up’ method of diagnosis, which was based on a detailed life history, painstaking examination of mental status, and corroboration from third-party informants, with the cursory ‘top-down’ method that relied on symptom checklists.” Thus, although “checklist diagnoses” cost less time and money, “they fail woefully to… Read More »
People who are obese face higher rates of pain: study
Chronic, daily pain affects every dimension of a person’s life, says Dr. Arya Sharma, scientific director of the Canadian Obesity Network. “It affects your sleep, it affects your quality of life, your energy levels, your professional life. “It’s a major barrier for someone trying to manage their weight — and a major driver of weight gain in a lot of patients.”
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