The Road to Obesity: Gradual Weight Gain

scaleContinuing yesterday’s discussion of the paper by Julia Temple Newhook, Deborah Gregory and Laurie Twells from the Memorial University of Newfoundland, St. John’s, published in the Journal of Social, Behavioral, and Health Sciences, on what causes some people to gain weight, we turn to what the authors describe as, “Gradual Processes”.

Thus, in their extensive interviews with individuals seeking bariatric surgery the researchers found a group of patients, who neither started out as overweigh or obese kids but also were unable to identify specific “life events” that would have prompted their weight gain.

Rather, they describe their weight gain as a gradual but incremental process, most commonly attributable to subsequent cycles of “yo-yo dieting” or to a wide range of other factors that affected their eating (emotions, food addictions, cultural habits, irregular eating, or food quality and quantity) or activity behaviours.

The importance of weight cycle was illustrated by,

“As Vanessa, an office worker in her 30s, put it, “As good as I am at losing weight, after 5 or 6 months, I’m even better at finding it.” Elsie, a homemaker in her 50s, said that she had been dealing with this cycle since she was a child: “I remember when I was 8, I was always on a diet. … I think that’s what did it: watching your weight, adding it back on again, back and forth. Each time, you climb higher and higher.”

As for eating behaviour, both quality and quantity were mentioned, albeit not by the same people:

“Zoë, a customer service worker in her 30s, pointed the blame at food quality, referencing her enjoyment of fast food, and said wryly, “I’m 287 pounds. I didn’t get this way from eating soup broth.” In contrast, Elsie said, “I don’t eat a lot of junk anyway, but I guess I just eat too much of the good foods.”

This is in line with what I am always careful to point out – the nutritive quality of a diet has little to do with its caloric quantity. On the other hand, nutritionally poor diets are often also calorically dense, thereby making it far easier to consume excess calories.

While some participants reported emotional eating, this was often in response to “life events” (like losing a spouse), discussed in yesterday’s post. A more insidious form of emotional eating was reported as addiction to certain foods:

“Gladys, a disabled factory worker in her 50s, said, “I’m addicted to candy. I will not bring candy into my house ever again… I’ve gone now almost 2 months. …It’s almost like someone coming off drugs or something. You wean yourself off.” Vanessa said that she felt overwhelmed by her addiction to cheese: “I had a huge, huge, huge cheese addiction. A 500-gram [18-ounce] block of cheese I literally could eat in 2 days. … I feel really controlled by my thoughts for food.”

Cultural overeating was also described:

“Vanessa noted that as a child, “I wasn’t allowed up from the table until I cleaned my plate. … Every celebration is centered around food: potluck, buffet, jiggs dinner, everything. Our culture is really a food culture, and I guess most cultures are.”

Irregular eating patterns including meal skipping was also noted to contribute to weight gain:

“Heidi said, “I can go days without eating and … it doesn’t bother me at all. I can also have days where I’m like, ‘Oh my God, I can’t believe I just ate that—all of that.’ I go from one extreme to the other. … It’s like I never feel full.” Penny, a homemaker in her 30s, described similar experiences: “My biggest problem was never overeating, it was never eating enough. I would get up in the morning and not eat anything until supper time. It never, ever bothered me … I could go days without eating and it wouldn’t bother me.”

Finally in this category of Gradual Processes, the authors describe the issue of lack of physical activity or sedentariness:

“Jennifer said, “It’s the activity level. I work all day, and I’m sat on my butt all day long. I have two kids at home. So the story goes.” In addition, participants explained that once they had gained weight, it was very difficult to move comfortably. This was partially a physical problem, as Brian explained: “You get into a circle because you can’t [exercise] because you have the weight on. You need to do things to get the weight off, but you can’t do it because you got the weight on.”

In addition, once some weight has been gained, emotional factors can further limit physical activity:

“I want to be active. It’s something I’ve always wanted, but I feel [my size] is in the way. It ain’t that I can’t do it, because I can do it; it’s how I’m looked at while I’m doing it. … I can leave here and I can walk [3 miles] and back. I can do it. It’s just that when I’m doing it, it’s the fear I have that everybody is looking at me.”

Once again, all of these stories are quite typical of the many that I have heard before – it is evident that even with gradual progressive weight gain, reasons and interpretations differ widely.

If you have experienced progressive weight gain without this being prompted by any evident “life event”, I’d certainly love to hear from you.

London, UK


Does Weight Matter?

Some of you may have seen the news items in yesterday’s media – a new study by Flegal et al. from the CDC, published in the Nov 7 Issue of JAMA, finds that overweight individuals (BMI 25 to <30) have significantly reduced mortality from non-cancer and non-CVD deaths and no increase in risk for death from all cancers or CVD (compared to normal weight (BMI 18.5 to <25) individuals). The results are based on an analysis of NHANES I, II & III. I was interviewed on this paper by several media representatives and in general my take on this was:

1) BMI (a measure of weight) is a poor measure of overall health
2) More important than the amount of excess weight (especially for overweight individuals) is where it is located

Obviously, this study will lead to a lively discussion and provide to ammunition to all who claim that the obesity epidemic is being dramatized and overrated.

For us the implications are probably as follows:

1) let’s remember that weight is just a number on the scale
2) healthy eating and active living is possible (and advisable) at any weight
3) skinniness is not a guarantee for longevity

This however, should not distract us from the fact that excess weight (fat) can significantly impact on health and that therefore preventing or treating obesity in individuals where excess weight threatens or affects health is important.

Hope you’ll have time to catch the CFR,