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Why Men and Women Gain Weight



In my interactions with patients, I always ask them to tell me when their weight problems began and what they believe contributed to their weight gain.

Broadly speaking, there are two categories: people, who were big (or were considered big by others) as long as they can remember and those, who can often clearly pinpoint when their weight problem started. Individuals in the latter group can often recall a specific event or situation that led to their weight gain (e.g. when I miscarried, when I entered puberty, after my second child, when I moved to Canada, etc.).

After hearing hundreds of such stories, common themes emerge, which in the past have led me to make statements such as, “Many roads lead to obesity” or, “Obesity can happen to anyone – no one is immune”.

So how exactly do people with obesity tend to explain their excess weight and do men and women differ in their explanations?

This fascinating topic was now explored by Louise Smith and Lotte Holm from the University of Copenhagen, in a paper just published in the Scandinavian Journal of Public Health.

The researchers conducted extensive in-depth interviews of 20 Danish middle-aged men and women who had experienced obesity, randomly selected from a representative nationwide dietary survey.

While some of the participants had lost weight, others were weight stable. Some reported being overweight from childhood, others reported steady or sudden weight gain later in life.

Most interestingly, there were clear gender differences in the explanations offered for weight gain between men and women.

In men, the following central themes emerged: Firstly (and most commonly), men reported life-course transitions (usually from youth to adulthood), whereby they perceived education or work-related obstacles that prevented or reduced physical activity levels as most relevant. Men also frequently referred to injuries that reduced their physical activity.

Some men reported eating for comfort or due to personal problems, most often related to work, unemployment, or financial concerns – rarely to social or relationship problems.

Some men also mentioned work environments that promoted overeating (e.g. when I began work as a cook).

The stories that women told were strikingly different. Although women also presented “life-course” explanations, these were less frequently related to shifting living conditions or social obligations, but rather to transitions in the female biological cycle such as puberty, pregnancy, and menopause.

The second theme in women was related to changes in social relationships (e.g. when I met my husband, when we moved in together, etc.).

The third theme in women was overeating related to personal problems, in all cases related to intimate social relationships (e.g. I did not receive adequate love in my childhood, I was brought up in a family with an alcoholic father, etc.).

The fourth theme in women was related to the use of psychopharmaca (e.g. for depression, when I began having lithium, etc.).

As the authors point out, it is perhaps not all that surprising that women are more likely to relate the beginning of their weight problems to their biology (which is clearly far more striking and eventful in women than in men) and to problems in their intimate and personal relationships.

In contrast, men look at both life-transitions and emotional stressors more in the context of work (e.g. new job, retirement, unemployment, financial trouble) or blame injury or other circumstance for reduced activity levels.

Thus, as previous research has shown, when it comes to overeating, women typically invoke family obligations, whereas men allude to obligations outside the family.

The fact that the use of psychopharmaca came up as a distinct theme in women but not in men, may be related to the fact (as the authors suggest) that these drugs are far more commonly used in women than in men.

These gender differences are not only striking but may also have important implications for addressing obesity both in populations and in individuals.

Firstly, nowhere in this discourse of life stories, did “lack of knowledge” come up as a driver of weight gain. Thus, it is perhaps not at all surprising, that the public health strategies focussing on “educating” the public on healthy eating and activity, have thus far had virtually no impact on obesity rates.

Rather, based on their findings, the authors suggest that obesity prevention strategies need to target men and women differently and must take into account their very different life histories:

In women, obesity prevention strategies are perhaps best focussed at key times during their biological lifecycles (e.g. at puberty, around pregnancies and menopause) and emotional eating may be best dealt with by addressing and improving coping skills in personal relationships (i.e. at home, within families, etc.).

In men, obesity prevention efforts are perhaps best targeted at periods of educational or professional transition. Emotional eating in men may be best dealt with by addressing social stressors related to work and livelihood and are probably best offered in the workplace.

Certainly a lot for the public health folks to chew on.

In light of these findings I cannot but help emphasize just how important it is to engage and listen to the people who actually have the problem, which we as researchers and health professionals are trying to help solve.

This is exactly the intention of the Canadian Obesity Awareness and Control initiative for Health (COACH), which I blogged about earlier this week.

If you have not yet taken the COACH survey but would like support this initiative, please take three minutes to complete this survey now.

Click here to take survey

As always, I would love to hear from my readers as to whether or not they can relate to these findings – Copenhagen may not be as far away as we think.

AMS
Edmonton, Alberta

Hat tip to Nathalie for bringing the study to my attention.

Smith LH, & Holm L (2011). Obesity in a life-course perspective: An exploration of lay explanations of weight gain. Scandinavian journal of public health PMID: 21270139

5 Comments

  1. I was grossly obese as a child. It would not of mattered what I knew or did not know. All there was to eat some winters was a lot of bread, raw whole milk, (sometimes still warm from the cows), grains, some years cull fish (usually net damage or lings), potatoes and rabbits. We ate what there was. Summers were better, there was a big garden. Occasionally there would be part of a moose. Once in a while there would be a old cow. The rest of the produce was sold for cash. We ate the stuff that could not be sold.

    Education would not have helped. My recovery has been based on knowledge. It started the day I realized that I did not know what I should be eating. I found a tremendous source of free information on the net among those of us who are recovering from a life of obesity. The following clip from Dr. Lustig is a sample of why I now know that sugars, grains, lubricants, and manufactured eatable products must be avoided.

    “The First Law of Thermodynamics is routinely interpreted to imply that weight gain is secondary to increased caloric intake and/or decreased energy expenditure, two behaviors that have been documented during this interval; nonetheless, lifestyle interventions are notoriously ineffective at promoting weight loss.

    Obesity is characterized by hyperinsulinemia. Although hyperinsulinemia is usually thought to be secondary to obesity, it can instead be primary, due to autonomic dysfunction. Obesity is also a state of leptin resistance, in which defective leptin signal transduction promotes excess energy intake, to maintain normal energy expenditure. Insulin and leptin share a common central signaling pathway, and it seems that insulin functions as an endogenous leptin antagonist. Suppressing insulin ameliorates leptin resistance, with ensuing reduction of caloric intake, increased spontaneous activity, and improved quality of life.

    Hyperinsulinemia also interferes with dopamine clearance in the ventral tegmental area and nucleus accumbens, promoting increased food reward. Accordingly, the First Law of Thermodynamics can be reinterpreted, such that the behaviors of increased caloric intake and decreased energy expenditure are secondary to obligate weight gain. This weight gain is driven by the hyperinsulinemic state, through three mechanisms: energy partitioning into adipose tissue; interference with leptin signal transduction; and interference with extinction of the hedonic response to food.”

    At any meal, if I eat over about 75 calories of carbs, I am craving more food in an hour or two. Now there is a real reason explained why I cannot eat carbs. This is the type of education that I needed. A real reason. Until I learned it, I did not know that I needed it.

    Clarity about grain came the day that I realized that with 2egg & 2Bacon I could go 5 hours before hunger and 2egg & 2bacon & toast I could go 3 hours before hunger.

    I have pealed away the emotional, social, pleasure layers, the usual vitamin and mineral deficiencies and was left with a real physical issue which has been ignored by the medical community, and all the doctors that I have seen over the years. I now know the evil of sugars, grains, lubricants, and manufactured eatable products.

    But what do I know.

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  2. The group that intrigues me is the, shall we say, naturally overweight cohort. Throughout my life, I have been either slightly or somewhat more than slightly overweight. I was brought up by a mother who believed in whole grain bread while all my friends were eating Wonder Bread. White sugar and bakery products made extremely rare appearances in our home. I don’t think I knew what mayonnaise was until I left home. Mom moistened the egg with milk (usually skim) for egg sandwiches. My mother stayed at home and everything was cooked from scratch. We had very few fried foods, and fat and salt content were kept to a minimum.

    I am not a binge eater, nor am I a particularly acute overeater. I admit to sometimes having a little too much to eat out of boredom. Yes, I can just eat one (or perhaps two), as the saying goes. If junk food makes its way into our home (I’m not perfect and I have two normal weight teenage boys at home), it goes untouched by me (aside from a spoonful of ice cream from time to time).

    I do have some health problems that prevent me from doing strenuous exercise (I can’t use a stationary bike or the elliptical trainer, for instance, nor can I swim without being in pain), but my pedometer is my best friend and I always try to add steps when I can. 10,000+ step days are fairly common.

    And yet, I’m overweight. I lose weight under two conditions: severe restriction and constant hunger or illness (specifically hyperthyroidism, which I have put into remission twice in the past 18 years).

    I am not a bad person, I do not indulge in unhealthy eating behaviours, I am not lazy or slovenly. I am not grossly overweight; I’m just somewhat fat and always have been.

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  3. I can pinpoint my 100-lb weight gain to beginning antidepressants when I was suicidal in high school (I am male). I went from 6’8″, 185 to 6’8″ 300. Due to my large frame, I don’t ‘look’ obese, but most measures classify me so.

    Despite being 10 years out of secondary school, and peaking at 311 lbs, right now I am at 296 and feel good. My goal weight is to get down to 240ish, but I am not sure if that will ever happen. I am currently losing at the rate of a pound of two a week, but some weeks I lose nil, and others 3 or 4 eating similar meals and getting similar exercise. It’s really perplexing.

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  4. When I started the Weight Wise program and listened to the nutritions There were only a few things that were truly “new” to my knowledge base:
    1. Fiber added saiaty because it filled you up with out stuffing you full of calories.
    2. What the ratios of caories to fiber were to be rated fair, good, high, or excellent.
    3. That fruits and vegetables were calorie low but filled the plate with more nutrients.
    4. That my biggest problem was food service portion sizes-being a food service worker this really hit hard.

    Considering there were 5 modules one nutrition and these were the 4 new things that I had learned education is deffinatly not the problem. I have learned since then that there are no sugar added friuts, and jams/spreads, and name brand products have few calories that the no name brand (which are considerably cheaper).

    By resorting to weighing my food to learn what a portion looks like in various dishes I have managed to reduce my calorie intake and thus my weight

    As far as when I started to gain weight the time I can point to is back when I first really started noticing symptoms of depression. The weight gain really became noticable when I started group tharopy and medications; even though the claim is made that SSRI’s do not cause weight gain. Thanks for the insight.

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  5. To begin, unhealthy weight gain can have serious negative implications on a person’s body image and self esteem. When body image and self esteem drop, a person can slip into depression. One of the things that contribute to weight gain is eating to make someone feel better about themselves. This is a vicious cycle that will only cause negative health implications.
    Reference:
    http://www.metforminweightloss.org/metformin-weight-gain-and-its-effects-on-lipids-and-blood-pressure/

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