Is this what the solution for obesity looks like?

keep-calm-and-stop-obesity-3

Obesity has been a major medical, psychosocial and economical problem for decades. It really took off in the US in the 1950-60 and went from there all over the world, and now the problems are stacking up all over the world. I just read a report saying that Kuwait now the world leader in obesity prevalence:

But the rest of the world is obviously not very far behind the Arab countries, and I have yet to see any major breakthroughs in either prevention or treatment of obesity worldwide. That’s not to say that everything is gloomy: there are some encouraging signs that obesity prevalance rates are starting to level off in places. But it does appear as if the levels of obesity are quite high (around 30-40% but this probably depends on how obesogenic the environment is) before the curve starts to flatten. In short, we have not coped very well with obesity, and I haven’t really seen much that could start to reverse this trend.

We obviously need some major reforms to the way we live if we want to get rid of obesity, so what do we need to do? What does the solution for obesity look like?

Firstly, we need to drastically reduce stress levels. This means a major reform of the economy, so that we eradicate poverty and make sure that everyone enjoys a much greater measure of abundance and freedom. Contrary to what most of the media is telling us, I actually don’t think that there is a shortage of money, it’s just that the distribution of money is mind-bogglingly skew, leading to stress and other problems.

Getting rid of fiat currency, and reintroducing a gold standard will help to stabilize the economy and reduce rampant corruption. It would also help if our politicians realized that war never solves anything, and spent our taxes on rebuilding our societies instead. This would undoubtedly create a more stable, prosperous and harmonious living environment, as opposed to a society burdened by increasing debt levels, conflict and corruption, where many (if not most) are more or less in survival mode on a regular basis.

Personally I would also reform the school system, which seems eerily set up like a factory to create obedient worker bees. All children needs to be given much greater freedom and opportunity to cultivate their own unique talents and interests. Teachers’ principle assignment should be to inspire their students, as opposed to constantly pressuring them with never ending exams and grades from increasingly younger ages.

Improved nutrition for everyone is a no-brainer in this context, including a ban on many (if not all) of the current pesticides, steroids, preservatives and other toxins that we regularly consume. Processed junk food likewise needs to be seriously reduced, and hopefully people will not be drawn to this type of food once stress levels are lower. Nutritious food should be cheap and affordable for everyone, whereas junk food should be expensive, not the other way around.

Increased physical activity is likewise a no-brainer, and includes measures like more parks and play areas, and more bike lanes and less cars in our cities. We would also reform our school and workplaces so that we are more physically active during the day.

The list of possible solutions could go on, but I stop there for now. If you think that this list is completely unrealistic, I would encourage you to think about what the prize of obesity now (and the prize for other obesity comorbidities like diabetes, arthritis and depression) and is likely to be in the future.

Let me know what else you would like to see introduced as a solution to obesity. We can’t afford not to act.

Erik Hemmingsson

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How can we possibly prevent obesity when there is so much inequality?

Make no mistake about it: wealth inequality is one of the main drivers of health and disease generally. Inequality is strongly associated with outcomes such as obesity, depression, diabetes, cancer, heart disease, arthritis, etc. The list is very long.

Given that inequality is reaching new heights every day it seems, we have to ask ourselves how we can possibly hope to prevent obesity, and other major diseases, in the face of this massive inequality? Please watch this short and very informative video of how skew the distribution of wealth really is.

http://consciouslifenews.com/viral-video-us-wealth-inequality/#

If you have the time, you can also listen to self-confessed plutocrat Nick Hanauer talk about how the pitchforks will come out soon if this situation is not remedied.

Indeed, the situation in the US, the UK and elsewhere is not unlike the pre-revolution situation in France some 225-230 years ago. The good thing is that a financial crisis like we have today can act as a very powerful catalyst for replacing the current dysfunctional economy, that only works for the wealthy few, with something that allows everyone to thrive.

Because obesity mostly affects the poor, it is not surprising that the epidemic is doing so well, since more and more people are crossing the poverty line and the middle class is being squeezed. How would you react if you were below that poverty line, and you were being told to buy more vegetables and exercise more, when you are working 2-3 jobs just to stay alive and put food on the table, and not knowing if you are going to have any job next month or even next week?

If governments were really serious about preventing disease, they should first do their utmost to reduce wealth inequality. Only then will it be realistic to expect our prevention programs to have any kind of positive effect on the obesity epidemic.

Erik Hemmingsson

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

 

“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.

Guest blog post at Dr Sharma’s Obesity Notes: Emotional distress and weight gain

Today I am a proud guest blogger at Dr Sharma’s Obesity Notes on the topic of psychological and emotional distress in weight gain and obesity development, see http://www.drsharma.ca. I have been subscribing to Dr Sharma’s blog for years, and I strongly recommend you do the same if you are interested in real solutions for obesity. Arya M Sharma is a Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, and a tireless researcher, clinician, debater and overall supporter for people with obesity.