Obesity Weekend Roundup, February 20, 2015
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: The Lancet’s 2015 Take On Obesity Even Modest Weight Loss Is Associated With Improved Health Status in Patients With Severe Obesity Guest Post: Food Abstinence for Food Addicts: Deprivation or a New Freedom? Guest Post: Treatment For Addictive Eating: Many Shades of Grey How To Tell If You May Be A Food Addict Have a great Sunday! (or what is left of it) @DrSharma Edmonton, AB
The Lancet’s 2015 Take On Obesity
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. @DrSharma Edmonton, AB
Even Modest Weight Loss Is Associated With Improved Health Status in Patients With Severe Obesity
The title of this post may sound like a “no-brainer”, but the research literature on the long-term health benefits of weight loss from longitudinal intervention studies in people with severe obesity is much thinner than most people would expect. Thus, a new study from our group, that looks at the relationship between changes in body weight and changes in health status over two years in patients with severe obesity enrolled in the Alberta Population-based Prospective Evaluation of the Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, published in OBESITY, may well be of considerable interest. As described previously, APPLES is a 500-patient cohort study in which consecutive, consenting adults with BMI levels > 35 kg/m2 were recruited from the Edmonton Adult Bariatric Specialty Clinic. The 500 patients enrolled were between 18 and 60 years old and were either wait-listed (n=150), beginning intensive medical treatment (n=200) or had just been approved for bariatric surgery (n=150). Complete follow-up data at 24 months was available for over 80% of participants. At study enrollment, the proportion of patients who reported >2 and >3 chronic conditions was 95.4% and 85.8%, respectively. The most common single chronic conditions at baseline were joint pain (72.2%), anxiety or depression (65.4%), hypertension (63.4%), dyslipidemia (60.4%), diabetes mellitus (44.6%), gastrointestinal reflux disease (35.4%), and sleep apnea (33.5%). After 2 years, just over 50% of participants had maintained a weight loss > 5%, with a mean weight change for the entire cohort of about 13 kg. Losing > 5% weight was associated with an almost 2-fold increased likelihood of reporting a reduction in multimorbidity at 2-year follow-up, whereby outcomes varied between treatment groups: in the surgery group, the top three chronic conditions that decreased in prevalence over follow-up were sleep apnea (43% at baseline vs. 25% at 2 years,), dyslipidemia (60% vs. 47%), and anxiety or depression (59% vs. 47%); in the medically treated group anxiety or depression (69% vs. 57%) and joint pain (77% vs. 67%); and none in the wait-listed group. As expected, any reduction in multimorbidity was associated with a clinically important improvement in overall health status. In summary, this paper not only documents the considerable multimorbidity associated with severe obesity, it also documents the clinically important improvement in health status associated even with a rather modest 5% weight loss over 2 years in these individuals. @DrSharma Edmonton, AB
How To Tell If You May Be A Food Addict
Following the recent guest posts by Drs Vera Tarman and Pam Peeke on food addiction, many readers have left comments about how this notion rings true to them and how the ideas of treating their “eating disorder” as an addiction has helped them better control their diet and often lose substantial amount of weight. Others have asked how to tell if they might be food addicts. For them, I am reproducing the following list of 20 questions taken from Food Addicts in Recovery Anonymous. Although it is important to note that “food addiction” has yet to be officially recognized as a medical/psychiatric condition and the following questions are by no means “diagnostic”, I would still support the idea that the more of these questions you answer with yes, the more likely you may benefit from discussing this problem with someone who has expertise in addictions (rather than simply going of on another diet or exercise program). 1. Have you ever wanted to stop eating and found you just couldn’t? 2. Do you think about food or your weight constantly? 3. Do you find yourself attempting one diet or food plan after another, with no lasting success? 4. Do you binge and then “get rid of the binge” through vomiting, exercise, laxatives, or other forms of purging? 5. Do you eat differently in private than you do in front of other people? 6. Has a doctor or family member ever approached you with concern about your eating habits or weight? 7. Do you eat large quantities of food at one time (binge)? 8. Is your weight problem due to your “nibbling” all day long? 9. Do you eat to escape from your feelings? 10. Do you eat when you’re not hungry? 11. Have you ever discarded food, only to retrieve and eat it later? 12. Do you eat in secret? 13. Do you fast or severely restrict your food intake? 14. Have you ever stolen other people’s food? 15. Have you ever hidden food to make sure you have “enough?” 16. Do you feel driven to exercise excessively to control your weight? 17. Do you obsessively calculate the calories you’ve burned against the calories you’ve eaten? 18. Do you frequently feel guilty or ashamed about what you’ve eaten? 19. Are you waiting for your life to begin “when you lose the weight?” 20. Do you feel hopeless about your relationship with food?… Read More »
Guest Post: Treatment For Addictive Eating: Many Shades of Grey
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… Read More »
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