Chasing a different body weight: what are you trying to compensate for?

Arnold-Schwarzenegger

It seems that whenever we feel that we are lacking something, we usually try very hard to compensate for that lack. The kind of lack that we want to compensate the most is any type of inner lack, for example a lack of self-esteem, self-compassion or feeling inadequate in some way, for example by not conforming to current body shape ideals.

And when we have this much focus on bodies and appearance, it is more or less impossible to feel totally fulfilled in the way we look, because we are constantly bombarded with messages of how the “perfect” body should look, i.e. how you should look. This is all a cynical sham of course. Most if not all of those pictures of slim, toned and tanned bodies we see in advertising have been photoshopped beyond belief.

Companies are very good at making us feel a particular type of lack that their service or product can compensate for, maybe a new car (the old one is not good enough), plastic surgery (your body is not pretty enough) or weight loss (you don’t want to look fat while on the beach this summer), etc. Buying something for ourselves can obviously perk us up a bit but we also know that this effect is very short-lived, a mere rush, unless there is a genuine internal change (which usually takes time and effort).

Since body weight is very much influenced by our internal beliefs, thoughts, feelings and emotions, we can help ourselves improve on those internal factors by understanding more about what we are trying to compensate. For example, if we feel that our current weight is not appropriate, then we have negative thoughts, feelings and emotions about our body that we need to be aware of. Perhaps you were told as a child that you needed to lose weight by a parent, a teacher, a coach, i.e. you were told that there was something wrong with the way you looked. Maybe you then internalized those beliefs, which then started to influence your thoughts, feelings and emotions regarding your appearance and body weight.

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If you are running around from one diet to the next, perhaps it is time to look at those negative beliefs, thoughts, feelings and emotions, to see where they come from, and start practicing greater body acceptance instead to gradually reduce those negative internals factors. You will certainly feel better about yourself, and you will be much less vulnerable in the future to negative outside influences, e.g. advertising that promotes unrealistic body shape ideals.

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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:

 

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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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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.

Confused about food?

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Even though my work involves a lot of nutrition science, I admit to having been somewhat bewildered about food in the past. I certainly would not think less of someone who claimed to be confused about what to eat and what not to eat, given how the media continue to write contradicting messages to the point where I almost think they deliberately want to confuse us. I have a few points to get across here and if you can grasp them, I hope that you will find food less of a challenge in the future, and actually something to give you joy and not anxiety.

My first point is that the science of nutrition is not very robust. It is certainly a lot less robust compared to the science surrounding the health effects of exercise. Good science relies on good data, the building blocks of science. In terms of understanding how food affects our health, we as scientists need research participants to tell us about their eating habits in a very accurate way. This is the core problem: people are not very good at accurately reporting what they are eating, how much, and so on. Moreover, people often change their food habits, which further weakens the science and our ability to find notable associations. The building blocks of nutrition science are definitely lacking in quality, and this is the number one reason why this field of science is hard to understand. You therefore need to be a little careful in how you interpret food studies.

My second point is that there is so much food marketing and lobbying from the food and drink industry that consumers are in reality rarely told a straight story by the de facto producers. Moreover, journalists seldom have the time, competence or interest to accurately paint a balanced picture and they end up pushing angles that makes everything extreme, i.e. something is either very harmful or very beneficial one week and the next week it’s the other way around.

Academics can also be pretty confusing about what they go on record with, often using too much jargon or overly complicating the messages. The end result is often too complex for regular people to understand. Academics also tend to focus too much on the details, with more or less endless debates about the role of, say, sugars vs fat for weight gain (oh yeah, this debate is still on-going).

In short, I totally understand why people are confused about food. The good thing is that food really doesn’t have to be very complicated at all. Here are my two cents on what to eat and what we need to do differently:

Instead of breaking down food into molecules, which gets us close to nowhere, we need to focus more on the overall quality of the food we are eating. For example, is is loaded with pesticides and preservatives, or is it organic? Has it been deep-fried or just pulled out of the ground in your own back yard? Does it contain healthy nutrients or is it just empty calories? We don’t actually need a lot of calories, but we do need nutritious and natural food. Many people in affluent countries are now in a state of malnutrition these days as a result of eating junk food.

So, in theory it’s actually pretty simple and not complicated at all. Good food is something that has been growing in the ground without pesticides, preservatives and other harmful chemicals, and is free of industrial ultra processing. Basically think organic fruit and veg, nuts, beans and whole grains and drink plenty of water. It’s not that complicated, is it?

By now it should also be pretty clear what to avoid. That’s right, ignore the large-scale ultra-processed junk food that has gradually taken over our diets, especially in poorer areas. You will also do well to avoid meat where the animals lived in cramped spaces under appalling conditions and fed all kinds of junk and antibiotics – where do you think it’s going to end up?

If you want a bit of science behind this go ahead and read this new study by Wang et al. in the BMJ on the very powerful role of fruit and vegetables in giving us longer and healthier lives (http://www.bmj.com/content/349/bmj.g4490).

 

Why this blog?

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I guess it’s part excitement and part frustration behind my decision to start communicating much more directly with real people interested in obesity and weight loss, and not just other academics and media. Let’s start with the frustration and then round off with the happy bits.

The lack of progress in both prevention and treatment outcomes is quite frankly staggering. Sure, the epidemic appears to be slowing down in more affluent segments of the population, but it is still more or less a runaway train in poorer areas of the US and Europe, and this also goes for countries in the middle of the nutrition transition, such as China and India. There are in fact very few places in the world where the epidemic is not doing very well. This is a public health failure of monumental proportions.

Despite this, most of the obesity experts continue to advocate more of the same tired old strategies, i.e. increased dietary control and exercise, and the outcomes are very predictable: more failure.

Then the experts seemingly got desperate and started to drastically scale up the use of bariatric surgery with minimal follow-up afterwards, as a kind of advanced quick fix. This very large increase in bariatric surgery volumes is a bomb waiting to explode if you ask me, since the safety of such drastic procedures are far from fully understood. A review I am working on with former student Filippa Juul has so far identified 32 separate nutritional deficiencies after bariatric surgery, some of them quite serious. And this is just one type of safety concern.

Another major source of frustration is the almost total lack of balance in the media. Every day they keep pumping out the same tired fad diets, or similarly ineffective measures. And on the next page you can read up on recipes for all kinds cakes and sweets, complete with glossy photographs and smiling photoshopped models. It’s quite absurd, but we apparently fall for it, and so they keep doing it.

The media is nothing if not cynical when it comes to weight loss, and it has now basically gotten to the point where public health nutrition and lifestyle advice is largely controlled by the media. These are some of the biggest frustrations for me as an obesity academic.

So, what are the happy bits? Well, just over a year ago, I started to become very interested in some of the deeper underlying psychological and emotional reasons behind overweight and obesity. And what I have discovered so far has got me pretty excited. I guess I feel a little like Howard Carter when he was exploring the unknown parts of the pyramids.

If you are anxious to read more in-depth information right now you can read a conceptual review paper I just published (Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obesity Reviews, 2014, epub 16 June).

I am expecting to publish many posts on the topics covered in the review, for example how the very earliest years of our lives continue to affect our health as adults. I genuinely think that this type of information can be a concrete help for anyone wanting to lose weight permanently.

I actually think we are getting close to a genuine breakthrough in how we help people lose weight that actually works long term, and also in terms of preventing new cases of overweight and obesity. Sure, much more research needs to happen before the epidemic is confined to the history books. And that is why I go to work each day. Stay tuned of you want to find out more.

 

Sincerely,

Erik Hemmingsson