Do Bite Counters Count Bites?
With the current electronic self-montioring craze, it was only a matter of time before someone would try to come up with a device that counts the number of bites it takes you to finish a meal. The device (Bite Counter), is worn no the wrist of the dominant hand and contains a tri-axial accelerometer that detects an upward, arcing motion from the table to the mouth. Now a study by Jenna Desendorf and colleagues from the University of Tennessee, tested the accuracy and validity of this device in 15 adults (23–58 years old) while eating a meal consisting of foods/beverages, each consumed with different utensils: meat (knife and fork), side items (fork), soup (spoon), pizza (hands), can of soda (hands), and a smoothie (straw), while being observed them through a one-way mirror and counted the number of bites taken. As the paper, published in Eating Behaviors reports, the overall accuracy of the device was around 80%. However, this varied substantially between foods: meat (127%), side items (82.6%), soup (60.2%), pizza (87.3%), soda (81.7%), and smoothie (57.7%). So, while this device may well underestimate the number of bites taken during a mixed meal, the real question is what people will start monitoring next – number of chews? (I joke about this on my show) Saliva flow? Numbers of swallows per bite? Oesophageal transit time? I can perhaps see some research applications but as a way to help improve your eating? The company claims that limiting your number of daily bites to 100 will help you lose weight. I am yet to be convinced. @DrSharma Edmonton, AB Desendorf J, Bassett DR Jr, Raynor HA, & Coe DP (2014). Validity of the Bite Counter device in a controlled laboratory setting. Eating behaviors, 15 (3), 502-4 PMID: 25064306 .
Your Body Thinks Obesity Is A Disease
Yesterday, the 4th National Obesity Student Summit (#COSM2014) featured a debate on the issue of whether or not obesity should be considered a disease. Personally, I am not a friend of such “debates”, as the proponents are forced to take rather one-sided positions that may not reflect their own more balanced and nuanced opinions. Nevertheless, the four participants in this “structured” debate, Drs. Sharon Kirkpatrick and Samantha Meyer on the “con” team and Drs. John Mielke and Russell Tupling on the “pro” team (all from the University of Waterloo) valiantly defended their assigned positions. While the arguments on the “con” side suggested that “medicalising” obesity would detract attention from a greater focus prevention while cementing the status quo and feeding into the arms of the medical-industrial complex, the “pro” side argued for better access to treatments (which should not hinder efforts at prevention). But a most interesting view on this was presented by Tupling, who suggested that we only have to look as far as the body’s own response to excess body fat (specifically visceral fat) to determine whether or not obesity is a disease. As he pointed out, the body’s own immunological pro-inflammatory response to excess body fat, a generic biological response that the body uses to deal with other “diseases” (whether acute or chronic) should establish that the body clearly views this condition as a disease. Of course, as readers are well aware, this may not always be the case – in fact, the state of “healthy obesity” is characterized by this lack of immunological response both locally within the fat tissue as well as systemically. Obviously, it will be of interest to figure out why some bodies respond to obesity as a disease and others don’t – but from this perspective, the vast majority of people with excess weight are in a “diseased” state – at least if you asked their bodies. While this is a very biological argument for the case – it is indeed a very insightful one: it is not the existence of excess body fat that defines the “disease” rather, how the body responds to this “excess” is what makes you sick. As readers, are well aware, there are several other arguments (including ethical and utilitarian considerations) that favour the growing consensus on viewing obesity as a disease. Of course, calling obesity a disease should not detract us from prevention efforts, but, as… Read More »
Mountain Living Reduces Obesity?
Living not too far from the Canadian Rockies, you cannot help but notice how vegetation gets short and stunted at higher elevations. The same is apparently true for humans – while moving to higher altitudes may not make your shorter, it certainly appears to reduce your body fat and perhaps risk of obesity. Indeed, there is ample evidence from both animal and human studies demonstrating that hypobaric hypoxia (lower oxygen levels combined with lower athmospheric pressure) may have a profound affect on body composition. Now, a large epidemiological study by Jameson Voss and colleagues, published in PLOS|One provides strong evidence to support this hypothesis. The researchers looked at all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 stationed in the United States and compared obesity related ICD-9 codes between those stationed at high altitudes (>1.96 kilometers above sea level) with those at low altitudes (<0.98 kilometers). It turns out that service members stationed at higher altitudes were about 40% less likely to become obese than those stationed at lower altitudes. Although one must always be careful to infer causality from epidemiological evidence, these findings are certainly in line with the experimental evidence on hypobaric hypoxia. In light of these findings, I can already see the next opportunity for commercial weight loss – hypobaric hypoxic chambers at your local tan studio. @DrSharma Edmonton, AB Voss JD, Allison DB, Webber BJ, Otto JL, & Clark LL (2014). Lower Obesity Rate during Residence at High Altitude among a Military Population with Frequent Migration: A Quasi Experimental Model for Investigating Spatial Causation. PloS one, 9 (4) PMID: 24740173
Should Governments Concern Themselves With Obesity?
Yesterday, I blogged about the right-wing Fraser Institute’s report, which claims that the obesity problem is overstated and that government policies are misguided. An interesting discussion in the report pertains to the fundamental issue of whether governments should at all concern themselves with obesity (even if the problem were really as big as is generally assumed). The report looks at this from the perspective of whether or not obesity places an economic burden on society and whether or not it would be in the Government’s interest to intervene with the aim to reduce this burden. Here is how the report views this: “What is interesting here—and what is important in public policy terms—is the burden of the costs of obesity. A closer examination of the consequences of excess weight…finds that the majority of the costs of obesity are borne directly by the individual in terms of lower income, reduced employment opportunities, reduced enjoyment of life, greater illness, and a potentially shorter lifespan. The only area where these costs are not borne almost entirely and directly by the individual is the increased burden on Canada’s tax-financed health care system….From an externality perspective then (though this is not the only justification used for government intervention, as we shall discuss in the next section) the only area of the “obesity epidemic” where governments may have a legitimate role to intervene is to resolve the costs imposed by the obese [sic] on all taxpayers through the tax-funded health care system.” However, as the report goes on to argue, the lifetime health care costs for obese individuals may not be all that much higher – in part, because of a shorter life-span. Here the report quotes studies showing that, “…while obese individuals incurred higher health care costs than normal-weight non-smokers during their lifetimes, over an entire lifetime normal-weight non-smokers incurred greater health care costs in total because of differences in life expectancy and the costs of care associated with additional years of life….These findings suggest that obese individuals may in fact not be a net burden to all taxpayers over their entire lifetimes, despite imposing a cost burden while they are alive. That finding is bolstered by considerations of reductions in costs associated with public pensions and other old age income supports .” Thus, economic arguments that governments need to intervene to reduce the burden of obesity may not hold water – while being obese is… Read More »
Obesity Left, Right, and Centre
Much of the obesity debate – its causes and solutions – is heavily tainted by conflicts of interest – the most important one perhaps lurking among those, who put their beliefs and ideologies before scientific fact. An essay by Kathleen Kendall-Tackett, published in (of all places) Clinical Lactation, nicely summarizes how conventional political ideologies and belief systems colour this discourse. Apart from commenting on the often “moralistic” nature of the obesity debate (thin = good, fat = bad), Kendall-Tackett also reflects on the racist, gender and class overtones of this discussion. With regard to political ideologies, she notes that, “For some on the right, the obesity epidemic merely reinforces their beliefs about the cause of the ever-widening gap between the rich and poor or between whites and minorities. After all if African Americans, Latinos, or the poor are becoming fatter than America’s predominantly white elite, it is only more proof that they lack responsibility to take care of themselves…if middle-class Americans, particularly middle-class children, are getting fat, it surely indicates the frailty of their own class status.” “And for those on the left, the growth of obesity is further proof that large, multinational corporations are running amok, fattening a hapless public with their billion-dollar advertising campaigns and super-size value meals. The American people, particularly the poor and minorities who have the highest obesity rates, they argue, need to be protected from these corporate behemoths.” Both positions reek of, “…paternalistic condescension towards fatness and fat people—not only do people with this view assume that fatness is inherently bad, but they also presuppose that fat people (that is, minorities and the poor) are too ignorant to know that they should be thin.” Or, in words of Paul Campos, “And what is it with these skinny uptight Anglos, anyway? Who exactly deputized them to be the fat police at their local fast-food emporium?” Indeed, it is easy to see these ideologies reflected in the political discourse around obesity. In prevention, policies run the gamut from de-regulation (“consumer choice” and “free market forces”) on the right to “shame, blame, tax and ban” policies on the left. Never mind that neither one of these approaches is supported by hard evidence – indeed, most of the evidence is so poor that it may as well be ignored when it comes to deciding who is right and who is wrong. While the anti-sugar witch hunt is nearing its… Read More »
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