Emotions trumps rational thought

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Modern medicine is only just starting to understand the raw power of emotions. Yet the society we have created is very much geared towards rational thought, and using rational thought to plan ahead to get us where we want to be. For example, since the amount of adipose tissue we carry around is a function of the laws of thermodynamics, the rational person, i.e. the medic, will prescribe a combination of diet and exercise to prevent new cases of obesity, and the people will do as told. If it was only that easy. 

It’s not as if people don’t understand the logic behind the prescription, it’s probably more a case of the prescriber being a little naive, for example when it comes to emotions and how they guide us. And once emotions are involved, rational thought pretty much goes out of the window. If you are on a diet, for example, you may know (using your rational mind) that binging your favorite food would be a mistake, but if you feel sadness, shame, guilt, anger or frustration, and binging some of that favorite food would take away those negative emotions, then over time it is a very uneven contest (especially when the thrill of weight loss is past).

Vader cookies

Many people seem to not really understand how big a role emotions play in shaping their lives. Consider a major decision you have previously made, for example starting a new relationship or changing a job. Did you act according to rational thinking, or did you go by emotions and gut feelings.

Obviously you can act according to a combination of rational thinking and emotions, but whenever I use my brain too much in making a decision, I usually end up getting it wrong. When I listen to my feelings and emotions, if I feel really excited about something, I get it right 99% of the time. We ignore our feelings at our own peril.  

But in many ways it seems as if we have increasingly disconnected from our emotions, and labelled them as something taxing and difficult. If you have a lot of negative emotions in your life, such as sadness, anger or frustration, that is certainly true. Conversely, your life will be pretty good if you frequently experience happiness, love and gratitude. 

What seems to happen in our so called modern society is that we come up with a rational plan for how to get more of those positive emotions, for example, when I get that new job I will be so happy, or when I have some more money then I can finally have all those things I dream about. But this increasingly feels like a pipe dream. Will we ever be satisfied, will we ever stop chasing more? Perhaps the challenge is to just be happy with whatever we have and to be more in the moment, more in the now? And then we can perhaps enjoy more of those positive emotions and life will not be a struggle anymore.   

And once those negative emotions and worries are cleared out, observe how health and quality of life improves.  

New study: Stress lowers your metabolism

bewaredoug

Todays’s post will be quite short but very interesting. It’s about a new study showing that stress significantly lowers your resting energy expenditure and fat clearance after a meal. The work comes from Janice Kiecolt-Glaser and her group in Ohio, and I am sure there will be many more investigations into this highly interesting topic.

What they found was that women who reported a large number of stressful events within the last 24 hours had significantly lower resting energy expenditure following a meal. The effect was equivalent to 100 kcal over a 6 h period, which (in theory) adds up to about 5 kg per year of adipose tissue.

Those who experienced more stress also had lower lipid clearance after a meal, and higher levels of cortisol and insulin, which helps to promote appetite, weight gain and abdominal obesity.  

This study clearly indicates that the rampant levels of stress we have created for ourselves plays a huge role in the obesity epidemic, and that we need to do something about this if we are to successfully help prevent new cases of obesity. It also indicates a powerful role of reducing stress levels in terms of inducing lasting weight loss. 

On that note, I hope you have a nice stress-free weekend.

Erik

Reference:

Kiecolt-Glaser et al. Daily stressors, past depression, and metabolic responses to high-fat meals: a novel path for obesity. Biol Psychiatry 2014, epub 14 July.

Hidden in plain sight

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Yesterday I gave a presentation at the Nordic Ophtalmology meeting on the topic of weight loss in idiopathic intracranial hypertension (IIH). People with IIH have a large risk of going blind and they have frequent migraines, so treatment is obviously a priority. Patients are usually young women with obesity, and weight loss tends to result in drastic improvements of migraine frequency and strength for these patients, and they reduce their chances of sustaining permanent eye damage.

While the mechanisms for this debilitating disease are poorly understood, there is a clear link with obesity. But when the other speakers on the panel were speculating about why this disease develops no one hardly mentioned anything to do with environmental factors. Instead there was a very clear focus on biological risk factors, such as the increased mechanical pressure exerted by excess adipose tissue, anatomical factors, hormones and the like. While these factors can obviously be important they are likely to be a long way down the causal chain. 

When you consider than the vast majority of patients are young women with obesity, the things that come to my mind as potentially causal are a lot further up the potential causal chain, and include things like social pressures to be thin, body dissatisfaction, stigma, shame, childhood traumas, and stress. These, in turn, lead to drastic changes in inflammation, as well as substantial hormonal and metabolic changes, which could eventually trigger the intracranial hypertension. 

Personally, when it comes to obesity, I am very much leaning towards the environmental factors, specifically psychological and emotional factors/responses that we develop during the early years of our childhood as root causes of the disease. I would not be surprised if this applies to patients with idiopathic intracranial hypertension as well. That is why I think these patients can really benefit from a holistic treatment approach that includes things like weight loss, stress reduction, exercise, body acceptance, cognitive therapy, yoga, and mindfulness. 

Where next for obesity in the US?

US-Obesity

 

It is quite startling to see just how much the US has more or less surrendered to the obesity epidemic. Given how strong the association is between socioeconomic factors and obesity, I don’t think there can be many more powerful drivers of the epidemic than the gradual dismantling of the middle class in America, and the increasingly skew distribution of wealth.

The US is obviously a very unique country in many respects, but it seems that there are some very disturbing signs of unrest and tensions bubbling under the surface, partly as a result of this massive inequality in wealth. Earlier I posted about the water shortage in Detroit as one example of this. Another example is the current situation in Ferguson, Missouri, where there National Guard has been deployed this week for the first time since the 1992 riots in LA, and where regular police forces look like military (very Orwellian if you ask me).

Race unfortunately appears to be a critical factor in these clashes, which is not new to the US. And the black population as a whole is at the bottom of the socioeconomic pyramid, which is a veritable breeding ground for frustration, anger, hopelessness, fear and other very potent negative emotions. Negative emotions plays a major role in weight gain, which is very much reflected in the ethnicity-stratified obesity statistics for the US.

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Indeed, the black, non-hispanic population have about twice as high obesity rates as whites, with over 50% of black women having obesity, a startling number.

A good starting point for the US, and any other country, that wants to minimize obesity rates, would be to minimize these tensions and inequalities, and create more equal opportunities for everyone. This is obviously not done without making some tough decisions, but it is certainly doable. The current trajectories for the US certainly suggests that they have a lot to gain from trying something new.

New study: Childhood abuse and adult obesity

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This post will be about a very difficult topic: childhood abuse. Along with colleagues Dr Kari Johansson and Dr Signy Reynisdottir, I have just published a study that I hope will provide some much needed insight into a much-overlooked topic: how childhood abuse leads to an increased risk of weight gain and eventually obesity.

Having been an obesity researcher for 15 years, I have been fully aware since very early days at work that many (if not most) of our patients have had very difficult childhoods. Too many for it to be a coincidence. But for years I was very reluctant to look into this, the topic was just too much for me, too demanding, too hard. Then one day just over a year ago I decided enough was enough, I had heard one depressing story too many. I decided to follow my intuition and really have a look at the published literature to see what was out there.

I quickly came to the conclusion that there was more than enough data for a solid systematic review and meta-anaysis. I enrolled the help of some willing colleagues, and we started collecting everything that had ever been published, and then we quantified the risk of being obese as an adult in individuals who had experienced childhood abuse or not. Reading those papers and extracting the data was enough for me to go into some kind of reclusive state, it was definately a major emotional challenge.

What we found was a consistent elevation in risk of obesity in adults who had suffered childhood abuse compared to those who did not suffer abuse. Moreover, the pattern was very consistent, across all different types of abuse, such as emotional, physical and sexual, including a positive dose-response association, i.e. the more abuse, the greater the risk of obesity. These are clear signs of causality. Finally some vindication for all those who talked about this uncomfortable subject, including patients, but were pretty much ignored year after year.

The mechanisms behind why abuse leads to weight gain are multifaceted but include increased psychological and emotional distress, negative self-belief, low self-esteem, insecurity, shame and guilt, reduced metabolism (oh yes, stress substantially lowers your metabolism and lipid clearance, more on that soon), inflammation, HPA-axis dysregulation, appetite up-regulation, cognitive decline, sleep disturbances, maladaptive coping responses, and so on and on.

Modern medicine is thankfully starting to wake up to the fact that negative life experiences have markedly adverse effects on health. And yet the media and many others who should know better keep piling the guilt and shame on overweight and obese individuals by saying that they need to exercise more and eat less, when there is so much more to the story.

Reference:

Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obesity Reviews 2014, epub 14 August.