Our Canadian Love Story
Regular readers may recall a past post, in which I put in my plug for my daughter Linnie’s Indigogo campaign to support a children’s book venture (the script for which she famously wrote on a couple of Air Canada puke bags). “Our Canadian Lovestory” is now published and has turned out much better than even I imagined (and, believe me, I have a pretty active imagination). Here is what Linnie had to say about this venture on a recent interview she gave to the Cattail Chronicles: “I’ve always told stories and when my best friend was diagnosed with cancer in our early twenties I began writing them down to amuse her while I took our minds on excursions. We used my stories to carry our imagination away from the absurd, sterile hospital environment that had become our lives. For three years it was my writing that carried me through our days. It’s where I put my pain, digested my feelings and crafted my dreams. While the world around us stopped making sense it was in my writing that I found my comfort and strength. The fact that stories make me smile is the single reason I keep writing.” And here is how Linnie describes to the Cattail Chronicles how she discovered the importance of reading and being read to: “Where do I begin? I shared a room with both my younger sisters until I was 13. My parents read to us every single night and when we didn’t read my dad would make up stories that held us captive and made our imagination spin with excitement. I can’t ever remember not being read to. When we didn’t read we listened to stories on cassette tapes and records. Once a week the library bus would roll to the little Berlin corner where we lived and we’d trade in old tapes for new ones and pick up an entire world of written adventures. I still love the smell of library books.” On the surface, Our Canadian Love Story is the whimsical tale of two bunnies (one French, the other Mexican), who independently decide to move to Canada and happen to meet at Terminal 1 of Canada International Airport (the rest is history!). On a deeper level, this book is about the immigration experience (we all come from somewhere) and what just might happen when we decide to venture beyond what we know.… Read More »
The Stress Bomb – How Bombesin-Like Peptides Affect Appetite
Regular readers are well aware of the myriad of complex sociopsychobiological factors that control food intake. Not least amongst these is stress – I am sure many readers will attest to the impact that stress can have on their appetite (both positive and negative). Now, a paper by Zul Merali and colleagues from the University of Ottawa, published in Frontiers in Neuroscience, discusses the potential role of bombesin-like peptides (for my nerdier readers: bombesin, is a 14 amino acid peptide first isolated from the skin of the frog Bombina bombina) in linking stress to ingestive behaviour. As the authors note, “In humans, stress causes increased food intake in one subset of the population and conversely causes decreased food intake in another; why some people lose weight and other gain weight is not yet well understood.“ The paper discusses the dual effects of the bombesin family of peptides in regulating food intake as well as mediating stress response, which interact at the level of reward pathways. Evidence from animal studies suggests that bombesin-like peptides, under certain conditions are involved in stress-induces anorexia, while the same pathways, under other conditions, can lead to stress-induced overeating. Much of this has to do with the unique distribution of bombesin-like peptides in key cortico-limbic brain regions involved in food regulation, reward, incentive salience and motivationally driven behavior. The hope is that better understanding the functioning of this system may teach us much about how stress affects eating behaviour and may help identify pharmacological targets that can be harnessed to affect both. @DrSharma Berlin, Germany Merali Z, Graitson S, Mackay JC, & Kent P (2013). Stress and eating: a dual role for bombesin-like peptides. Frontiers in neuroscience, 7 PMID: 24298233 .
The Challenge of Obesity In Children With Physical Disabilities
Preventing and managing excess weight is hard enough in able-bodied adults. Imagine the challenges of addressing this issue in kids, especially those with physical disabilities. Just how difficult this problem is and how largely ineffective current behavioural approaches to dealing with this issue are is nicely outlined in a paper by McPherson and colleagues from the Holland Bloorview Kids Rehabilitation Hospital, Toronto, published in Disability and Rehabilitation. This scoping review examined the current evidence on interventions designed to facilitate weight management and/or weight-related behaviors (i.e. physical activity and/or healthy eating habits) in children with physical disabilities. None of the 34 articles included in the synthesis addressed the issue of long-term obesity prevention. The majority of research focused upon children with cerebral palsy, and had case study, quasi- or non-experimental designs. Of the 18 studies that reported positive outcomes, all included physical activity interventions using motivational strategies for the child and child self-direction. However, none of the studies targeting body weight/composition reported long-term successes. The authors conclude that we currently lack a robust evidence base for long-lasting obesity interventions for children with physical disabilities. Given the clear limitations of behavioural interventions in this population, one can only wonder about the efficacy of pharmacological or even surgical obesity treatments, at least for severely obese kids with such disabilities. I wonder if amy of my readers has any experience with this special population. @DrSharma Berlin, Germany McPherson AC, Keith R, & Swift JA (2013). Obesity prevention for children with physical disabilities: a scoping review of physical activity and nutrition interventions. Disability and rehabilitation PMID: 24308905 .
Are There Merits To Subtyping Obesity?
Regular readers may recall that several years ago we proposed that it was time to move beyond considering obesity a homogeneous entity (as defined by BMI alone) and suggested that clinicians may be better off using an “etiological framework” for assessing and addressing the diversity of factors that drive weight gain. This notion, that obesity is not a homogeneous condition, is something other researchers are now slowly catching up with. One example of how “mainstream” thinking is gradually embracing the concept of heterogeneity in obesity is a recent paper by Allison Field and colleagues from Harvard Medical School published in JAMA. In this paper the authors state that, “One reason for the lack of stronger associations with risk factors or more consistently successful treatment is that all types of overweight and obesity are often grouped together. This approach potentially obscures strong associations between risk factors and specific subtypes of obesity.” This is a problem that we have long lamented and regular readers will be well aware that this was the very basis for developing the Edmonton Obesity Staging System (EOSS) as a way to classify obese patients based on how “sick” they are rather than just on how “big” they are. While the authors of this paper may yet have to familiarize themselves with the literature on this issue, there is certainly no reason to expect why individuals with higher EOSS stages will not be the ones to benefit more from obesity interventions than those in the low-risk groups. Depite making a few good points about advances in molecular epidemiology, this article lacks sharp thinking in that it does not clearly distinguish between “etiological” and “phenotypic” heterogeneity of obesity. While the former applies to the many drivers of obesity (which we have categorized as predominantly affecting metabolism, ingestive behaviour and/or physical activity), the latter applies to the many consequences of obesity (which we have categorized as affecting physical, mental and functional health). As we have previously pointed out, the two are not necessarily related. Thus, two individuals, gaining weight for entirely different reasons (e.g. food insecurity vs. binge-eating syndrome), may well present with exactly the same amount of excess body fat and identical clinical complications (e.g. diabetes, reflux disease and urinary incontinence). On the other hand, two individuals, gaining weight for exactly the same reason (e.g. on anti-psychotic medications), may present with quite different complications (e.g. sleep apnea vs. osteoarthritis).… Read More »
Do Shame And Blame Tactics Make The Obesity Problem Worse?
A widespread misconception, even amongst well-meaning folks, is that spreading the word about the dangers of obesity and using overt or even just subtle social pressure to “nudge” people to improving their health behaviours for their own good, is a reasonable approach to solving the obesity problem. That such “shame and blame” tactics generally misfire should be no surprise to the many individuals actually affected by this condition. For those, who still think increasing social pressure on people with excess weight by emphasizing the many drawbacks of excess weight and by declaring it largely a matter of lifestyle “choice”, an article by Brenda Major and colleagues from the University of California, published in the Journal of Experimental Psychology, may prove a worthwhile read. In their experiments, the researchers randomly assigned women with a wide range of BMIs to read a news article about stigma faced by overweight individuals in the job market or a control article. Reading the article on weight stigma caused women who perceived themselves to be overweight (irrespective of their actual BMI), to consume more calories and feel less capable of controlling their eating than exposure to the non-stigmatizing article. The weight-stigmatizing article also increased concerns about being a target of stigma among both self-perceived overweight and non-overweight women. These findings are particularly concerning as many normal weight women perceive themselves to be overweight and may thus be prone to such messaging. As always, such findings pose a major dilemma for public health messaging around obesity where well-intended messages may have unintended negative consequences exactly for the people they are trying to help. It is certainly bad enough to have to suffer the negative emotional and physical consequences of excess weight – being blamed for the problem and being constantly reminded just how bad it is without being offered any reasonably effective solution can only make the whole situation even worse. If you have experienced a negative emotional response to weight bias or discrimination, I’d like to hear about it. I’d also be interested in suggestions on how this problem may best be dealt with in the public discourse about excess weight. @DrSharma New Delhi, India
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