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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Lasting weight loss comes from the inside, not the outside

It’s quite remarkable just how much we continue to search for well-being and happiness from outside sources, such as a new job, new relationship, new car, hairstyle, watch, suit, dress, shoes, and the list goes on. If you take a step back and look at our general way of life, it kind of feels like we are conditioned to run around the treadmill of life constantly in need of outside things and gadgets to make us happy. Of course, we rarely get any lasting fulfillment in getting those new shoes, or whatever we long for, yet we keep doing it over and over again.

Einstein

The same can definitely be said of dieting. The pattern of weight loss and regain will be very familiar to all those who struggle with weight problems. A very large part of why dieting fails is that we don’t get to the bottom of why the weight gain occurred to begin with, and, even though there are different ways of looking at this, my view is that the vast majority of weight gain comes from the inside in the form of negative thoughts and emotions. The origins of those negative thoughts and emotions can be very complex but there is no doubt that they usually make their debut during childhood and stay with us as adults, consciously or not.

Negative thoughts and emotions have a huge influence on our health and well-being, and obviously our weight, both in terms of regulating stress, metabolism and inflammation, but also lifestyle choices and habits. This is why I am convinced that any lasting weight loss is very unlikely to come from outside sources, it needs to come from within. Once you start to understand more about your thoughts and emotions, you can shed the weight in a very natural way, because, in a sense, your body will no longer have its fat storage programs activated (set-point theory) as a result of psychological and emotional distress.

Obviously it could take a while to go through such an internal cleaning process, but I also believe that it does not have to take years or decades, it’s really up to you how hard you work at it. And you should certainly get qualified support if you need it.

But if you skip working on your internal issues and instead go for what you perceive to be the easy way out, i.e. trying a solution from outside sources such as a diet, you are not likely to be successful long-term since those fat storage programs will still be activated, and the weight will likely come back on. Or you will need to be super disciplined in terms of what you eat and how much you exercise for the rest of your life. Some people manage this, but not very many (I know I wouldn’t).

get-skinny-on-fad-diets_e

 

In terms of losing weight long-term, I believe it’s about time we stopped fighting against our bodies and instead realized that we need to work with our bodies instead. If you are carrying excess weight, it probably means that your body has activated fat storage programs as a result of your internal distress (fat is basically a survival mechanism, and your body is reacting quite naturally to stress). Your best bet in deactivating those programs will be to find out why they are activated to begin with, and then gradually turn them off by releasing those internal distress factors.

Erik Hemmingsson

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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:

 

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.

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.