Mental Health And Childhood Obesity: A Note to Policy Makers and Clinicians
Earlier this month, the Canadian Obesity Network, in partnership with IASO and CAMH, released the Toronto Charter on Obesity and Mental Health. Although the Charter acknowledges the importance of recognising the rather close relationship between obesity and mental health both in adults and children, the focus of this Charter (and the conference leading up to it) was largely on adults. Now, Shelley Russel-Mayhew (U of Calgary), who spoke a the Toronto Obesity and Mental Health Conference, and colleagues, publish a comprehensive overview of mental health, wellness and childhood overweight and obesity in the Journal of Obesity. The researchers performed a systematic literature search of peer-reviewed, English-language studies published between January 2000 and January 2011 on this issue. They identified 759 unique records, of which 345 full-text articles were retrieved and 131 articles included in their analyses. Based on these findings, they propose a theoretical model that reflects the current state of the literature and includes psychological factors (i.e., depression and anxiety, self-esteem, body dissatisfaction, eating disordered symptoms, and emotional problems); psychosocial mediating variables (i.e., weight-based teasing and concern about weight and shape), and wellness factors (i.e., quality of life and resiliency/protective factors). Based on their findings, they recommend a number of possible solutions to addressing the rise in childhood obesity rates without (importantly!) further marginalize overweight and obese children and youth. These include increasing mental resilience, stopping the focus on weight, recognising that many weight-related issues are socially constructed and maintained, promoting healthy body images (regardless of size or shape), and targeting positive adult role models. Thus, the authors conclude that, “…intervening for the psychosocial emotional health of overweight/obese children should be a focus in and of itself and not just an “add-on” measure to a primary outcome that is targeting weight reduction or the cessation of weight gain. Public health policy in the area of childhood obesity needs to encourage healthy body image, advocate that healthy behaviours come in every shape and size, and consider weight bias and weight and shape concerns as fundamental. In terms of mental health and wellness, this type of shift in paradigm could benefit all children and youth potentially for generations to come.” Readers will find many of these thoughts reflected in the Toronto Charter and will certainly recognise many of these principles in many of the posts throughout these pages. AMS Edmonton, Alberta Russell-Mayhew S, McVey G, Bardick A, & Ireland A (2012).… Read More »
Obesity and Mental Health, Day 3: First Do No Harm
The 3rd and final day of the Hot Topics Conference on Obesity and Mental Health focussed on the potential obesogenic side effects of medications commonly used to manage mental health disorders. As pointed out by Rohan Ganguli (Toronto), persons with schizophrenia, bipolar disorder, and other psychotic illnesses, have rates of obesity 2-3 times that of the general population. They also have 2-3 times the rates of diabetes, heart disease, and premature mortality, when compared to the general population. The increased prevalence of these chronic conditions are due to multiple factors, but it has become clear that certain antipsychotics, particularly some of the newer antipsychotics, mood stabilizers, and antidepressants, contribute to the increased risk of obesity. His presentation provided a succinct overview of the evidence from controlled clinical trials regarding the risk of weight gain for different psychotropic medications. He also proposed prescribing strategies, which would minimize the exposure to these risks. This presentation was nicely complemented by Tony Cohn’s (Toronto) talk on the importance of metabolic monitoring for adults prescribed antipsychotic medications This problem, unfortunately, is also relevant in the treatment of mental health disorders in kids. In her presentation on the Canadian Guidelines on Monitoring and Management of Metabolic Side Effects of Second Generation Antipsychotic Medications in Children, Tamara Pringsheim (Calgary) discussed the considerable evidence that second generation antipsychotic medications are associated with metabolic side effects in children, including weight gain, increased waist circumference and body mass index, as well as elevations in cholesterol, triglycerides, glucose and insulin levels. These metabolic complications can have long-term adverse effects on cardiovascular health. With the more widespread use of antipsychotic medications in children, there is a need for formal guidelines on how to monitor children for adverse effects of these medications. The Canadian Alliance for monitoring Safety and Effectiveness of Antipsychotic medications in Children (CAmESA) guidelines seek to provide health care providers with evidence based recommendations on what, when and how to monitor children started on an antipsychotic medication for metabolic and extrapyramidal side effects. Companion guidelines have also been created which provide evidence based recommendations on the management of metabolic and extrapyramidal side effects if they are detected over the course of monitoring drug safety in kids. The considerable problem of obesity and mental health in the Aboriginal population was discussed by Piotr Wilk from London, Ontario. The issue of first doing no harm, especially in public messaging about obesity, was… Read More »
Obesity and Mental Health: Day 2 – ‘Stressed’ is ‘Desserts’ Spelled Backwards
On the day 2 of the Hot Topics Conference on Obesity and Mental Health, Zul Merali and Alfonso Abizaid from the University of Ottawa (working as a tag team) discussed the importance of stress as a driver of overeating. They described a a fascinating possible role of ghrelin as an important mediator that allow organisms to meet the energetic challenges of stress (which generally does require the organism to spend more energy). Thus, ghrelin, a hormone that increases hunger and adiposity, is not only secreted when energy stores are low, but also in response to stressors. Chronic stress leads to chronically elevated levels of this hormone in tandem with increases in appetite and weight gain. These effects are prevented by pharmacological blockade of ghrelin receptors and are absent in mice with targeted mutations to the ghrelin receptor. These ghrelin receptor deficient mice, however, are more susceptible to stress-induced depressive like behaviors. Thus, although ghrelin response to stress may induce hunger and overeating, organisms that do not (or cannot) elicit this response may be more likely to develop depression like symptoms in the face of stress. Shelly Russell-Mayhew (U Calgary) spoke on body dissatisfaction and weight and shape concern, two components of body image that have particular relevance for obesity and mental health. Body dissatisfaction is a consistent correlate of obesity in youth. While this may well be seen as a negative consequence of obesity, it is also important to recognise that body dissatisfaction often leads to dieting/unhealthy weight control practices. In youth, dietary restraint, or the vigilant restriction of caloric intake, in turn is associated with obesity and is predictive of future weight gain. Overweight children are even more concerned about weight than their normal-weight counterparts and normal-weight children with high weight and shape concern report higher body dissatisfaction and depressive symptoms. A focus on the promotion of healthy body image for children of all weight statuses could reduce the impact of multiple negative psychological outcomes. This is particularly important because of evidence that perceived weight rather than actual weight is more predictive of psychological distress and body satisfaction predicts less weight gain over time. Ronnie Kolotkin, the developer of the Impact of Weight on Quality of Life questionnaire (IWQoL-Lite), a widely used questionnaire that assesses quality of life in obese persons and has been translated into over 60 languages, emphasized that assessing quality of life in obesity may be… Read More »
The UK Has An All Party Parliamentary Group On Body Image
Interestingly enough, it is not the obesity epidemic that drives the weight loss industry – it is people unhappy with their body shapes and sizes. Yes, I know all too well that there are good medical reasons for addressing ‘excess’ body weight, but not everyone who exceeds the so-called ‘ideal’ body weight is sick (or even at risk for sickness), and even for those, who do have medical problems caused by ‘excess’ body fat, even very modest (e.g. 5%) weight loss, which, in contrast to losing larger amounts of body weight, is very doable AND sustainable, can confer substantial health benefits. But, these health benefits is simply not why the majority of people trying to lose weight are trying to lose weight. Most are doing this simply to look and feel better about themselves (and, as my colleague Tim Caulfield would say, ‘to increase their chances of getting ‘laid’”). In fact, there is an epidemic of body dissatisfaction out there – a problem that can not only be detrimental to emotional but also to physical and economic health (when people engage in unhealthy weight loss behaviours and spend money on them). This issue has now brought together an all party parliamentary group formed by UK MPs and Peers of any political party, who have a common interest in the issue of body image. While not part of the UK Government, the group contains members from at least the three biggest political parties in the House of Commons. The secretariat and other support for this group is provided by the UK Central YMCA, a national health and education charity. As the group notes on its website: “Early in 2011 Central YMCA commissioned COMRES, an independent market research company to find out what MPs think about body image issues. Some of the key findings include: Celebrity culture (68%), the fashion industry (53%) and advertisers (52%) are the three elements that MPs view as being the most responsible for negative body image among the British public MPs support Government facilitating a voluntary code of conduct (56% agree) and policies for more responsible marketing and advertising (52%) to address body image issues Over one third (40%) of MPs agree that Secondary schools should have mandatory lessons on body image as part of either Personal Social Health and Economic education (PSHE) or through the core curriculum” Accordingly, the group aims to bring together interested parties,… Read More »
Quebec Public Health Agency Conference Warns Against Weight Obsession
The mantra about the benefits of weight loss seem to be gospel in most discussions about solutions to the obesity epidemic. It was therefore quite refreshing to follow the presentations and discussions at yesterday’s session on weight bias and discrimination at the Journées annuelles de santé publique (Québec). One of the most innovative presentations was in fact a review of the many programs and initiatives by ÉquiLibre, a Québec non-profit organization with the mission: “to prevent and reduce problems related to weight and body image in the population, through actions encouraging and facilitating the adoption of healthy lifestyle and developing a positive body image.” For the past 20 years, this organization has been providing “Choose to Lose Weight?“, a program for women concerned about their weight, that focusses on size acceptance and ending the cycle of ‘yo-yo’ dieting. For people fluent in French, the site provides ample advise on myths regarding weight loss, the potential risks of dieting and weight obsession, and tips on how to recognize ‘ethical’ weight management programs. The ÉquiLibre site also links to an most interesting interactive site called ‘Behind the Mirror” aimed at youth, that most engagingly challenges weight and appearance stereotypes. For non-French speaking readers, I recommend exploring the site in the Google translation mode, which does a remarkably efficient job of translating the content of these pages. French speakers should of course browse the original site for information on ÉquiLibre. I’d love to hear from anyone, who has participated in their courses. AMS Montreal, QC
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