Bullying and obesity go hand in hand in so many ways

If you have any working experience in an obesity treatment facility you would be very familiar with the many gut-wrenching stories of bullying that the patients have experienced. A routine question to ask the patients is if they have any clue as to why they gained the extra weight to begin with. It’s not unusual to hear that it all started with the bullying, usually from a young age.

bullies_kids

You may think that this is mainly peer-to-peer, but it can definitely be from parents as well. Usually this would be related to something they perceive to be not quite right with the child, perhaps carrying a tiny, tiny amount of extra weight. The child will then be told that there is something wrong with them. Obviously this is not the case, it’s the parent who is wrong for instilling the child with an erroneous negative self-belief (there is something wrong with me).

And how many stories have we not heard about  the completely insensitive bullying athletics coach/PE teacher who thinks that the child is overweight and needs to lose weight ASAP, and who always picks these children last for the teams, et cetera, et cetera.

The message for these bullied children is unbelievably negative: you are not good enough, there is something wrong with you, nobody wants to be with you. It’s not exactly strange that the obese in general have lower self-esteem and confidence than normal weight individuals, both as children and as adults.

Then there is the more classic case of bullying among children, sometimes from pre-school, because of a lack of tolerance and respect for what looks slightly out of the norm, particularly give our completely unrealistic body shape ideals. More and more studies are now confirming all those anecdotes about the toxic effects of bullying:

http://www.ncbi.nlm.nih.gov/pubmed/25157018

Indeed, obese children are much more likely to suffer bullying than normal weight children, which is confirmed by both the children themselves and also the teachers. But this does not mean that the bullying only happens during the childhood years. Studies on obesity bias and discrimination are becoming much more common, for example by Rebecca Puhl and colleagues at Yale. Please take the time to watch some if not all of this excellent talk, for example on how stigmatization has a profoundly negative effect on our physical, social, psychological and emotional health and well-being:

If we are serious about preventing obesity, we cannot emphasize enough the importance of zero tolerance towards bullying, in whatever form it comes in, and regardless of where it comes from. We also need to address all those negative self-beliefs and fears that arise as a result of bullying. This include things like body dissatisfaction because we perceived our body as the reason the bullying started in the first place.

antibullyinglogo3

I also firmly believe that anyone who wants to lose weight long-term needs to overcome their more or less inevitable body dissatisfaction, and connect in a more positive way with their bodies, as opposed to rejecting them and seeing them as the source of shame and discomfort. The more you have of negative thoughts and emotions in relation to your body, the more weight you are likely to trap. It’s not exactly a surprise that more and more studies are now confirming that bullying leads to weight gain, which leads to more bulling, which leads to more weight gain, which leads to more bullying…

Erik Hemmingsson

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New exciting frontiers in obesity research

microscopy

Some of you may be aware of that I used to do research on the role of behavior therapy and low calorie diets in the treatment of obesity, but that I realized some time ago that such treatment options did not provide any long-term solution to the treatment (or prevention) conundrum. Instead I decided to dig a little deeper and look into traumatic childhood experiences, which was very interesting, but to say that obesity is a result of childhood trauma would be a gross exaggeration and oversimplification.

Through a combination of listening more and more to patients as well as copious reading, I have come to focus my efforts on the early life (childhood) social environment. This also includes the time spent in the womb, and such factors as maternal distress and malnutrition, which has a huge effect on the baby.

The path to weight gain and subsequent obesity generally starts before the age of 5, so this is clearly the time we need to investigate more. What is becoming more and more clear is that any type of family dysfunction can very easily transfer to the child in the form of negative belief systems, negative emotions, stress, insecurity, low self-esteem, low self-worth, and so on. The real catalyst of family dysfunction is socioeconomic adversity, but obviously there are other factors as well, such as relationship discord, job insecurity, segregation, a lack of support and cohesion, disease, and food insecurity.

Let me stress that family dysfunction does not imply gross disturbances or failings, it can probably be quite subtle to have a negative effect, depending on factors like resilience and external support, perhaps from a significant other such as a grandmother or grandfather. More or less all families have some kind of dysfunction within them, it’s all shades of grey, perhaps not all the time but at least during critical periods. The effects is likely a balancing act between the amount, duration and type of adverse social exposure, combined with the above-mentioned protective factors.

What is clear is that as we grow older, we carry the effects of those early years with us, consciously or not. If someone is exposed to a lot of early life adversity, it will only be a matter of time before physical manifestations occur in the shape of increased stress, inflammation, as well as metabolic and endocrine perturbations. There is also likely to be behavioral disturbances, such as eating to suppress negative emotions. Eventually, this will lead to a disruption of homeostasis and weight gain.

This why I am very excited to dig deeper into this new field of research that focuses on the child’s social/family environment, and how those early years continue to influence us as adults many years later. The ACE study, which I wrote about recently, conclusively shows that adverse childhood abuseis the #1 cause of early mortality, numerous morbidities, addiction and functional limitations, so there can be no doubt about the very powerful effects that adverse childhood experiences has on us.

It really is time we took those early childhood years more seriously in the obesity field. Personally, I think there is a gold mine of information there, just waiting to be explored. Hopefully this will get us closer to the root causes of obesity, which should be of great benefit for eventually banishing the whole epidemic.

 

Erik Hemmingsson

 

Want to lose weight?

yoda_2“Ready, are you?”

Last week, there was a lot of focus on abuse. This is not the easiest thing to read about, but given how clear it has become that childhood abuse is probably our #1 cause of disease, disability and death, this is not a topic we can continue to ignore. We all have a responsibility to help prevent future cases of abuse, and therefore there really is no not-getting-involved-in-that option. I choose to get involved, and try to do something about it, and spreading awareness is one way of being part of the solution, I hope.

I was not particularly surprised that very few from the media were interested in publishing a story about a study showing an increased risk of obesity in those who suffered childhood abuse. All the media want these days is to sell the latest fad diet, one more extreme than the other, and hopelessly ineffective to boot, see a new study in JAMA on this topic. There have been so many studies on the futility of dieting that it is quite simply mind-boggling that the media obsession with dieting continues. As things currently are, the large media corporations are certainly not part of the solution, which is really sad.

If 15 years of research on weight loss and obesity treatment has taught me anything, it is that dieting generally does not work. And, yes, I have the data to back up that statement. Sure, the outcome will depend on the individual, and what caused the weight gain to begin with, so it is not an entirely black or white scenario. If you, for example, are one of those who experienced weight gain as an adult as a result of entertaining too many business clients, then you can probably have some small success with a diet and exercise program, with the caveat that you have to stick to it, or you will regain all the weight you have lost.

Obesity, however, is usually established at a very young age, and this is almost like a different disease compared to adult-onset obesity. Going on a diet for someone with childhood-onset obesity is very unlikely to succeed, although it could happen of course. It depends on how long you can adhere to the diet (whatever than diet is), but there is also a lot more to this particular story. What is of paramount importance for those of you who were overweight already as children is to try and figure out why you gained the weight to begin with, and this is where it gets tricky.

I have recently published a new 6-step model on how weight gain occurs from childhood (Obesity Reviews, 2014, September issue) and it looks like this:

 

obr12197-fig-0001

What this model suggests is that we have to go much, much deeper than merely going on a diet (or have bariatric surgery for that matter) in order to reach any lasting success. This means addressing things like your thoughts, i.e. core beliefs (e.g. pessimistic or optimistic), and issues related to self-esteem and self-worth. It also means looking at emotional issues and triggers like fear, frustration, anger, hopelessness, shame and guilt. Finally, you need to understand how and when you feel stressed and worry, as they will both wreak havoc with your emotions. And, as you may be aware of by now, when it comes to how we shape our lives, emotions trumps rational thought every time.

The thing you also need to understand is that all, if not most of these internal factors, are usually established at a very early age as a result of your family environment and upbringing. This does not mean that you can’t do anything about it now as an adult, not at all. There are many things you can do to improve things like self-esteem, core beliefs, negative emotions and stress, but it will take both time and effort on your part. Do it one small step at a time. Awareness is the first step.

And once you start to understand where your negative thoughts, emotions and stress come from (we all have them, it’s a tough planet…), and what triggers them, you will probably not have to enforce a restrictive diet and punishing exercise regime in order to get the results you want. Eating a healthy and balanced diet, as well as exercise, will come much more naturally once you start to feel better about yourself on the inside. Change is certainly possible, but I advice you to skip the dieting, as it only tends to increase frustration when the weight comes back on, and instead look more closely at your thoughts and emotions. This is where the real potential for improving weight loss outcomes truly lies.

 

Erik Hemmingsson

 

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“In my end is my beginning” TS Elliot

ACE pyramidThe ACE study pyramid.

Today I am saluting what I consider to be absolutely groundbreaking research which modern medicine has been ignoring for far too long. The work I am referring to is the ACE study (Adverse Childhood Experiences). This is a large study from the US that convincingly showed that difficult early-life experiences is arguably our leading cause of death, disease, disability, drug use and smoking.  

Let me be a little specific because this subject really fires me up. The researchers measured things like childhood abuse, violence in the family, drug addiction, mental illness, and criminal behavior in the family. Then they performed an analysis to see how such experiences were associated with a wide range of outcomes, including obesity, but also attempted suicide, numerous diseases, smoking, drug use and alcoholism. 

More than half of the participants reported at least one such adverse exposure, a quarter reported more than two, and six percent more than 4. And these were not people from a deprived area, they were predominantly white, college educated, middle class Americans.

Not surprisingly, there were very clear associations between number of adverse experiences and health outcomes. For example, when comparing those with 4 or more adverse exposures with those who had none, the odds ratio of being a smoker was 2.2 (i.e. an increased risk of 120%), 4.6 for depressed mood, 7.4 for being a alcoholic, 10.3 for injecting drugs, and a truly staggering odds ratio of 12.2 for attempted suicide (it’s very rare to see such high odds ratios in medicine, it’s like smoking and lung cancer). In terms of common medical diagnoses, the odds ratio was 1.6 for obesity, 2.2 for ischemic heart disease, 1.9 for any cancer, 1.6 for diabetes, and 3.9 for chronic bronchitis.  

I hereby challenge anyone to find another exposure that comes even close to these risk estimates for the leading causes of death where there is also a very high proportion of the population that is exposed, i.e. population attributable risk. But because of the stigma, shame and taboo surrounding this difficult topic, there is also a staggering lack of awareness of these facts, and hence very little help avaliable.

This has to change and can change if enough people become involved. Please take the time to watch this 13 minute youtube video by the first author Vincent Fellitti (give him and his coworkers the Nobel Prize, I say) on the truly remarkable ACE study findings. 

I wonder how much longer we can go on ignoring this topic and the fundamental role our childhoods play in determining our future health and well-being. Yet modern medicine would have you take next to meaningless drugs, where we sometimes have to treat hundreds for preventing one single case of myocardial infarction or diabetes, with numerous safety issues attached.

But drugs is where the money is, and medicine has shaped itself to a truly gargantuan business model. In many ways, this is an absurd way to practice medicine, especially given the very toxic role of early-life adversity, and the potentially huge beneficial impact of therapy and other holistic methods to overcome such hurts. 

Erik Hemmingsson

If you liked this post, you will have my thanks if you help to spread awareness even more by re-sending it to family, friends and colleagues.  

 

Reference

Fellitti et al. Relationship between childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse life experiences (ACE) study. Am J Prev Med 1998;14:245-258.

New study: Childhood abuse and adult obesity

child-abuse_1549637a

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.