The Road to Obesity: Life Events
Monday, April 22, 2013
How do people become severely obese? Anyone, who thinks the answer is simply, “by eating too much and not moving enough”, is not only wrong, but is essentially missing the whole point of what it will take to find solutions.
A study 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, seeks to better understand what causes some people to gain weight.
The researchers conducted extensive interviews with individuals seeking bariatric surgery regarding their perspectives on their histories of weight gain and their explanations for weight gain as well as the emotions surrounding their weight gain experiences.
In today’s post, I would like to touch on what the authors describe as, “important life events”, which in some cases, interestingly enough, begin with being born.
Thus, for many participants, weight gain struggles began in childhood:
“Sam, an unemployed laborer in his 20s, said that he had been big since the age of 9: “It’s hereditary. A lot of people in my family are big.” Deirdre, an educator in her 40s, said, “I have never been slim. I have never been below a size 18, 20. Never. … I don’t remember as a child being small.” She added, “I know that part of it is genetics, because I really do believe that. I have a set of grandparents who were huge … I guess it is my metabolism.”
This is very much in line with my own clinical experience, where patients often describe always having been large for as long as they can remember with bullying and name calling belonging to their earliest childhood memories.
Others, on the other hand, describe a previous slim childhood or adult life, prior to rapid weight gain. In women, the most common life event likely to precipitate irreversible weight gain was pregnancy:
“Annie, a retired caregiver in her 60s, reported that she now weighs over 300 pounds, but recalled, “I only gained weight after I had my daughter … I was 127 pounds when I got pregnant … I went up to 181 and I never went below that after.”
But it was not just the course of pregnancy itself that was held responsible:
“…increased childcare and domestic workloads—that followed. Heidi, a customer service worker in her 30s, explained, “You don’t have the ‘you time’ to do what you need to do to try to take care of yourself a bit better. Everything is your children.”
Another major life event is loss of a dear one:
“Theresa, a retired educator in her 60s, talked about gaining weight after her husband died: “I ate my way through … That was my comfort I didn’t go the gym and I didn’t exercise … grief is strange. I was angry for a long time.”
This observation is also very much in line with the findings in my own practice, where I often see unresolved grief and trauma (emotional, physical or sexual) as a driver of dramatic weight gain. In my experience such negative life experiences can occur at any age (and virtually in anyone) and it is often possible to narrow down the exact temporal relationship between the event and subsequent weight gain.
For some, the life event was “simply” a change in “circumstances”:
“Jennifer, a manager in her 40s, said that when she moved from her rural home to an urban center for university, “I gained 90 pounds in about 9 months. … I was going to school so I wasn’t active at all, and I was eating takeout twice a day for my meals because it was cheap. I ate for free where I worked and I ate deep-fried food for all that time.”
This scenario is likewise not unusual – especially amongst the migrant and immigrant population, where adapting to a new life can often have profound effects on body weight for no reason other than having switched from one environment to another.
And then there was injury and illness:
“Derek, a customer service worker in his 30s, suffered a sports injury in his late teens: “I had a hockey injury, actually, is what started it. … I put on a lot of weight.” He said that his weight gain was exacerbated by a changing lifestyle as he entered the workforce: “Sports stopped. … My weight just ballooned. The only way I know to describe it is it’s like I went to bed being fairly active and in half decent shape and waking up and being 150 to 200 pounds overweight.”
Again, this scenario is not uncommon – I have previously posted on the remarkably high number of former competitive athletes in our bariatric clinic.
While life events were deemed an important contributor to developing severe obesity, this was not all that the interviewees had to offer.
More on other aspects of these investigations in the coming posts.
If certain life events have led to your weight gain – I’d certainly appreciate hearing about them.
AMS
Vancouver, BC
Monday, April 22, 2013
To add to this list other factors that you often discuss- lower socio economic status or a decrease in economic status are strongly associated with obesity, as is serious mental illnesses and the sdie effects of many of the medications for these conditions. I hope there will be additional research along these lines, it helps to reduce weight bias and stigma.
Monday, April 22, 2013
I am a 58 year old woman, not obese but somewhat overweight at 154 pounds. Until my 40’s I never weighed more than 130 pounds at the most. I had my son at age 40, and when weighed in the obstetrician’s office at my first prenatal appointment I was 126 with my clothes on. While breast feeding I became extremely thin. Then, after my son was weaned at 20 months I slowly gained weight, and I remember feeling concerned because my weight had gone up to 135 and I resolved to eat less, without a lot of success. When my son was three I was prescribed Paxil and it had a huge effect on my appetite. I would go to choir practice and eat four pieces of cake. By the time I made the connection and asked to be put on a different antidepressant I was 150 pounds. Ever since it has been a struggle to stop the upward creep of my weight. I don’t eat junk food and try not to overindulge. I try, not always successfully, to avoid foods which trigger over eating, like white bread and sweets. After an early menopause I gained weight around my abdomen. My BMI is on the cusp between normal and overweight, but for my small frame I do look a bit hefty. My point is that although I am not obese, merely thirty pounds or so over my early adulthood weight, I understand the “road to obesity.” I feel that if my life circumstances were different, I could easily be obese. If I had a different social milieu, less money, a less supportive spouse and family and friends, less self knowledge, less knowledge of physiology and nutrition, worse depression and anxiety, I could find myself weighing a great deal more. I often hear people who are actually overweight themselves reviling people who are obese. From fear, repressed guilt? I don’t know, but I do know that some solidarity and compassion would go a long way towards improving the life of larger people.
Monday, April 22, 2013
Ive been relatively chubby my whole life, I was the fat kid in school. But only chubby, think the chubby guy in “full metal jacket”. ( im male )
Then when I was 16-18 I actually lost weight and got down to a normal size. Then at 19 I went through severe trauma, both academic and romantic trauma put me into a case of severe depression and I then gained weight rapidly, like 120lbs in about 18 months. I remember eating alot of Doritos and curry. Since then, ive been fighting constantly to get my weight back down to the 175lb normal range, ive yoyo dieted many times, but it all feels so futile, my body just wants to get to 290lbs and stay there. right now I am 230lbs. I feel like im fighting myself EVERYDAY to control my weight.
Monday, April 22, 2013
This also happened to me following an injury I received. It was an acute back injury with fracture to one or two vertebrae. I was still able to do some exercise, although minimal, but it was like my metabolism came to a screeching halt after the injury. I gained 30 pounds while doing physical therapy. It took a year to fully recover, but my weight never did.
Most people think I just got lazy after I was injured but that’s not the case. I continued to watch what I ate and was not overeating. My own theory is that the shock of the injury caused an excess of stress hormones which ultimately caused the weight gain. That was 5 years ago and I’m still looking for answers to prevent it from happening again.
Monday, April 22, 2013
I am a primary care MD and have been following your blog for at least a year. My two weight gain events have been menopause and cancer. I gained starting in perimenopause with a major move and decreased activity and eating changes. I lost about half of that weight and held till last fall when I was diagnosed with an aggressive cancer. I’ve just finished 5 months of chemo which included decadron from nauseau and gained weight during my chemo. I’m now post chemo and will have cancer surgery this week and having what I call “will power fatigue”. I am now close to the pre weight loss high weight and gaining. I’m doing great from the cancer perspective and hope to get back on track after the surgery.
Monday, April 22, 2013
Thank Peggy for sharing your story – weight gain in cancer survivors is not an uncommon phenomenon – the physiology of this is poorly understood – much work on this remains to be done.
Monday, April 22, 2013
Excellent post today, Arya. Kudos to the researchers and you for sharing. Wonderful insights in the responses. Will look forward to the rest of the week. Thanks again.
Monday, April 22, 2013
Extreme Poverty and trauma, which I believe led to a complete endocrine collapse. Pseudo-Cushings from the cortisol being pumped out like gangbusters under extreme stress? {Ive tested with high cortisol too along with the other endocrine problems}
http://fivehundredpoundpeeps.blogspot.com/2010/07/my-350-400-pound-weight-gain.html
Please read this too.
http://fivehundredpoundpeeps.blogspot.com/2012/01/poverty-wolf-at-door-trying-to-gobble.html
I have a theory about the specialized acute stress felt in this society, time and place and how it can fatten people up.
I’ve never met anyone who gained as much weight as me in so fast of a time. 400lbs in 28 months. They never outruled a pit tumor and blame the hypothyroidism and severe PCOS the most though I am sure intermittent steroid use for the lungs and untreated sleep apnea didn’t help. I had extreme sleep disturbances during the weight gain. THat is one thing I remember too along with the things I talk about in my article. I wonder if trauma affects the hypothylamus and in the rare person, disturbs the entire balance of weight. Sure I was fat from the family genetics, but I took things way beyond where they were at.
Tuesday, April 23, 2013
I have no doubt that life events have an impact on weight gain having experienced this myself on several occasions. However, the underlying theme appears to be that with the trauma, whatever it may be, comes an increased intake of calories along with a decrease in physical activity. At the end of the day the energy balance is out of kilter and skewed towards weight gain.
Tuesday, April 23, 2013
I’m very interested to read these articles on stress and trauma related weight gain. Thank you for including this in your posts! I left a decent job and 4 yr relationship in my late twenties to go to university. I knew I was susceptible to gaining due to my German heritage, an obese grandmother, my family using food as reward and to show affection, etc. I thought I could control things with activity even after going on the pill in my teens, so was very active. I managed to get tendonitas in my knees at the time I moved to the big city, left all family and friends behind, stopped being active and lived in a residence with an amazing cafeteria cook, and at the same time managing a large engineering course load. I managed to reach 180 lbs by the time I graduated at 31. There was just too much happening to me by then; stress recovery, worse knees, lower self esteem, etc to find the strength to reverse the trend. Now at 53 and 230 lbs (down recently from 250) I wonder if there is any hope at all of being my early 20s weight. My brain is overloaded with theories (conspiracy and otherwise), solutions, research and treatments to the point I don’t know what to do or where to start. I appreciate this blog so much and will continue to stay tuned.
Wednesday, April 24, 2013
magscraig – the energy balance argument is too simple. Some people gain weight because of emotional eating due to trauma and some don’t. While a simplistic energy balance equation might explain why, it doesn’t explain why some people can gain weight on 1600 cals a day and others lose weight on 2000 while keeping the same rate of energy expenditure. There is way more going on. The problem the blog is addressing over the long term is why some bodies react differently to food than others. People with my metabolism don’t have the luxury of emotional eating because every calorie will turn into more weight. My spouse on the other hand can chow down on an endless pile of chocolate bars and not gain an ounce. Thus, trauma actually affects people differently.
Wednesday, April 24, 2013
All of the personal testimonials from this series are incredibly heart wrenching and moving as evidence of the varieties of human interpretation of obesity causality, but mostly as evidence of variations on human struggle.
The Polyvagal Theory (Stephen Porges) also suggests that early or chronic traumatic experiences “rewire” neurological pathways (and hence endocrine/metabolic) as an adaptive means of survival, and that brain and nervous system functions may change dramatically in response to early environmental and social influences (at young ages), before individuals have the capacity in fact to choose between alternative (and also limited) options. Thus, as this series suggests, it is tragic for individuals to blame themselves for responses to stress that are beyond their conscious control.
As a nursing student, one of my most memorable experiences involved the admission and observation by a Diabetes expert who had come to believe that Type 2 diabetes is often a physiological and adaptive response to overwhelming emotional stress (one of her examples involved a young female patient who became diabetic within a couple months after both her parents were killed in a car accident). The whole neuroendocrine metabolic cascade of events in conjunction with polyvagal adaptive responses may eventually yield profound knowledge related to why some people become fat in response to severe or chronic trauma while others do not.
Friday, May 3, 2013
I was overweight starting in grade school and then lost 60 lbs (195 to 135) with Weight Watchers when I was 20. I kept that off with diet and lots of exercise until I was about 30, then I started to have increasing difficulty with my weight. I was gaining weight even though I seemed to be eating less than usual, but I gradually had to stop exercising due to severe fatigue and weakness.
Over a period of 2-3 years, I gained the 60 lbs back, then I was diagnosed with hypothyroidism. When I started taking thyroid medication, I stopped gaining weight and stabilized at that new (old) weight of 195. Over the next 8 years, I gained a further 20 lbs the “normal” gradual way.
About a year and a half ago, I decided to start Weight Watchers again and have lost 60 lbs, so I am now about 20 lbs over my previous low weight. I am not sure if I will be able to reach 135 lbs again, but I think I will be able to maintain this weight loss without too much difficulty.
I think the medical research tends to minimize the contribution of hypothyroidism to weight gain in patients diagnosed with hypo because treatment does not cause the weight to return to normal, it only brings about weight stabilization. Also in my case it may have had a greater-than-normal impact on my weight since I was “reduced obese” when the disease process began.