Emotions trumps rational thought

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).

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.  

Hidden in plain sight

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. 

New study: Childhood abuse and adult obesity

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.

Mindful of your feelings you must be

When obesity prevention experts get together it seems all they talk about is changing diet and exercise habits, i.e. things like removing vending machines from schools or building more parks. These are obviously good things to do, but they have not proven to be very effective. And pretty much the same goes for treatment, the main difference being that bariatric surgery is talked about a lot more. What many people fail to grasp, including the experts, is that there are very powerful forces that get in the way of behavioral control of diet and exercise.

At the very top of that list are negative emotions, such as sadness, anger, frustration, hopelessness, shame, guilt, fear and apathy. These are highly effective wrecking balls of diet and exercise initiatives.

Another factor very high up the destructive list is stress. Stress also triggers negative emotions in a highly effective way, making any conscious effort to eat more healthy food almost utopian. The same can also be said of thoughts. Negative or pessimistic thoughts will get you into a deeper and deeper hole, it’s that simple.

What experts need to focus on a lot more  – in terms of both treatment and prevention – is how to help people who have a lot of negative emotions, negative thoughts (especially about themselves), and stress. A good starting point could be to write a diary of all those situations when negative emotions, feelings and thoughts start racing, or situations when you often experience stress. Once you become more aware, you can start to devise a plan for feeling better, happier and more relaxed. That is when you can make real progress.

Socioeconomics, Mazlow and the obesity epidemic

The association between socioeconomics and obesity is strongly inverse in countries that have gone through the nutrition transition (from healthy food to junk), mainly the US and Europe. Basically poorer people have more obesity than rich people in these countries. And that goes for a lot of diseases and adverse outcomes, including depression, diabetes, anxiety, suicide, alcoholism, inprisonment, caries, and so on.

Poor people are at the bottom of the socioeconomic pyramid. This is when you are more or less in survival mode, fighting to make sure that your basic needs are cared for. This has a wide range of adverse physiological effects, such as increased stress, sleep disturbances, metabolic disturbances, reduced immune function, reduced cognitive function, and so on. This is when the path of least resistance becomes very appealing (think junk food and TV), and choices such as buying and cooking nutritious (expensive) food and exercise become harder.

Having spent considerable time in the US and UK, I have not seen such clear examples of the socioeconomic pyramid anywhere else in the Western world, and this is very much reflected in the more or less disastrous obesity statistics for those two countries. Indeed, studies now show that poverty is increasing in the US and elsewhere, the middle class is shrinking, and the rich have become even more rich. This very skewed distribution of wealth is certainly no way to fight the obesity epidemic.

Unless the US and Europe can help people towards the higher dimensions of Mazlow’s hierarchy of needs, for example through better living conditions and a redistribution of wealth, we should not expect any great progress in terms of obesity prevention and treatment.