Reducing Infant Food Reinforcement Through Music
Even infants know to pick one reward over the other – but obviously, as in adults, the one they pick depends on the choices available to them. Given the highly rewarding nature of food, picking a favourite food over. almost anything else appears the natural choice. Thus food reinforcement is generally established at an early age and tends to continue throughout life. One hypothesis is that the development of obesity is due to a lack of access to pleasurable alternatives in one’s environment, thereby increasing the reinforcing value of eating Now, Kai Ling Kong and colleagues, in a paper published in OBESITY, test the hypothesis that conditioning infants as young as 9-16 months to an cognitively stimulating alternative reinforcer may reduce the appeal of food as the default goto reward. The researchers studied 27 infants, who were found to have rather high food reinforcing ratios at baseline, half of who were randomised to 6 weeks of a program that provided them with a rich variety of music and playful activities, which encouraged infants and parents to participate at their own level in singing, moving, listening, or exploring musical instruments. Participating parents and infants attended weekly, 45-min classes as a group for 6 weeks and parents were encouraged to listen and sing together with their infants at home during everyday home activities such as bath time, meal time, and bed time using the CD and instructional song book provided by the program. The remaining infants in the active control group consisted of weekly, 45-min play dates held during the same 6 weeks as the music group and were provided with a variety of age appropriate toys (no musical toys) and books for participating parents and infants to play with and enjoy during everyday home activities such as bath time, meal time, and bed time using the toy provided by the program. The reinforcing value of food and music was assessed using a computerized task by having infants press a mouse button to earn rewards (either food or 10 secs of a song) both before and after the interventions. The song used for both pre- and post-intervention assessments was not used in the 6-week music program to avoid familiarity and biases. While the researchers found a significant decrease in the food reinforcing ratio (a measure of food preference) for the infants in the music group, the food reinforcing ratio in the control group actually increased. As the authors note, “Our findings provide initial evidence that alternatives to food may be cultivated at a young age to alter… Read More »
Leading The Charge In Addressing Weight-Bias in Canada
In 2008, the Canadian Obesity Network’s Board of Directors identified weight bias and stigma as one of the Network’s top strategic priority. The board firmly believes that everyone deserves to be treated with respect and dignity independent of size. To this end, the Network is working hard towards reducing weight bias and stigma through research, education and action. The following are just some of the examples resulting from the Network’s many collaborates with researchers, patients, knowledge users and partners to develop education initiatives and practitioner resources to address weight bias in health care settings, the media and public policies: Incorporated weight bias and stigma in all CON-RCO education and knowledge exchange programs such as the Canadian Obesity Summits (2009, 2011, 2013, 2015 and biennially thereafter); Dietitian Learning Retreats (2010-present); Canadian Obesity Student Meetings (2010, 2012, 2014); Obesity Research Summer School (formerly known as Obesity Research Boot Camp); Obesity Management Certificate for Post-Graduates (2013-2015). In collaboration with health services and primary care experts, CON-RCO has developed the 5As of Obesity Management framework to support primary care practitioners in their interactions with patients with obesity. This was a two-year initiative supported by the Canadian Institutes of Health Research (Knowledge Translation Supplement Grant) and the Public Health Agency of Canada (Innovation Strategy Grant). The resources incorporate weight bias sensitivity training and have now been adapted for pediatric and pregnancy populations. CON-RCO under the leadership of Dr. Mary Forhan, associate professor, University of Alberta, Faculty of Rehabilitation Medicine, Department of Occupational Therapy, coordinated the first Canadian Weight Bias and Discrimination Summit in Toronto, Ontario (January 2011). The purpose of the summit was to raise awareness about weight bias and discrimination as it relates to obesity and its association to the health and well being of Canadians. The event drew a capacity crowd of 150 health professionals, students, policy makers, industry representatives, and educators who heard from an expert panel of eight speakers from Canada and the United States. CON-RCO partnered with the Canadian Institutes of Health Research to inform a Canadian Bariatric Research Agenda, which included a priority on weight bias and discrimination. CON-RCO and the Public Health Agency of Canada collaborated to poll CON-RCO members to identify and counteract some of the most common obesity myths. Results of this study were published and disseminated to CON members and partners. CON-RCO partnered with the Rudd Centre for Food Policy and Obesity to develop an image bank to combat stigmatizing images of people with obesity in the media. In 2012, CON-RCO partnered with the World Obesity Federation (formerly known as International Association for the… Read More »
Just How Much Weight Do You Gain When You Stop Smoking?
The fact that smoking cessation is almost regularly associated with weight gain is common knowledge. But just how much weight can one expect to gain? Now, an analysis from a large randomised controlled trial of smoking cessation by Charles Courtemanche and colleagues published for the National Bureau of Economic Research, that this weight gain may be more that most people think. The researchers look at data from well over 5,000 participants in the Lung Health Study. Using various statistical models, they conclude that the average weight gain is about 12 pounds, with the effect being greatest in the young, women and those starting out with a ‘normal’ weight. They also calculate that the reduction in smoking over the past decades accounts for about 15% of the obesity epidemic. From the longitudinal analysis they also conclude that the weight gain is not temporary nor likely reversible. If anything, the impact of smoking cessation on weight becomes greater as time passes. Thus, while the authors remind us that the benefits of smoking cessation on health still by far outweigh any health detriments from a 12 lb weight gain. Nevertheless, the data should remind us that smoking cessations efforts should always go hand in hand with efforts to prevent excessive weight gain. @DrSharma Gurgaon, Haryana
Building Health Research Capacity in Metabolic Disease
The past two days, I’ve been at a young investigator’s meeting convened by the Canadian Institutes of Health Research Institute for Nutrition, Metabolism and Diabetes, in Kelowna, BC. This annual event brings together promising and emerging young investigators working in the fields of metabolic, renal and digestive disease from across Canada. The talks by experienced faculty are given on topics ranging from grant writing, finding a good mentor and building partnerships (my topic), to the importance of not forgetting about work-life balance. There is no doubt that every year, the research environment for funding becomes yet more competitive. Thus, it is always refreshing to see the enthusiasm, passion and enthusiasm with which young researchers approach the many research questions that desperately need answers. Finding better ways to prevent and treat obesity are certainly among the top issues on the list, and it was therefore not surprising to see several of the research projects presented by the young attendees focusing on various aspects of obesity. I found attending this event particularly rewarding as this was a reunion with several past “bootcampers” (attendees of the Canadian Obesity Network’s annual Obesity Research Summer School), who, I am happy to say, have progressed nicely into junior faculty and new investigator positions. Congratulations to the organisers and all who had the privilege of attending. @DrSharma Edmonton, AB
Mental Health Issues In Patients Seeking Bariatric Surgery
There is no doubt that bariatric surgery is currently the most effective long-term treatment for severe obesity, however, there is also some evidence to suggest that patients seeking bariatric surgery (or for that matter any kind of weight loss) are more likely to have accompanying mental issues that individuals with obesity who don’t and that such issues may affect the outcomes of surgery. Now, a paper by Aaron Dawes and colleagues from Los Angeles, CA, published in JAMA presents a meta-analysis of mental health conditions among patients seeking and undergoing bariatric surgery. They identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, each affecting about one-in-five patients were depression and binge eating disorder. However, neither condition was consistently associated with differences in post-surgical weight outcomes. Nor was there a consistent relationship between other mental health conditions including PTSD or bipolar disease and post-surgical outcomes. Interestingly, bariatric surgery was consistently associated with a significant decrease in the prevalence and/or severity of depressive symptoms. So what do these findings mean for clinical practice? As the authors note, “Guidelines from the American Society for Metabolic and Bariatric Surgery and the Department of Veterans Affairs/Department of Defense recommend routine preoperative health assessments, including a review of patients’ mental health conditions. Other groups advocate for a more comprehensive, preoperative mental health examination in addition to the general evaluation currently performed by medical and surgical teams. The results of our study do not defend or rebut such a recommendation.” So why are these data not clearer than they should be? Here is what the authors have to offer: “Much of the difficulty in determining the effectiveness of preoperative mental health screening is due to the limitations of current screening strategies, which use a variety of scales and focus on mental health diagnoses rather than psychosocial factors. Previous reviews have suggested that self-esteem, mental image, cognitive function, temperament, support networks, and socioeconomic stability play major roles in determining outcomes after bariatric surgery. Future studies would benefit from including these characteristics as well as having clear eligibility criteria, standardized instruments, regular measurement intervals, and transparency with respect to time-specific follow-up rates. By addressing these methodological issues, future work can help to identify the… Read More »
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