Food insecurity and eating disorders in obese children

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Today Dr June Tester presented the first qualitative study I have seen at Obesity Week ever, on the very interesting topic of disordered eating in children growing up with food insecurity. There is quite a marked association between food insecurity and obesity, which may seem paradoxical, but makes perfect sense to me. Subjects were 47 focus groups from a paediatric weight management clinic. Grounded theory was used to describe themes surrounding food insecurity and eating problems in the children.

There was a lot of secretive eating practices and food hiding, as one would expect. There was also a high frequency of hidden candy wrappers in the children’s rooms. Likewise, food insecure parents also hid food, i.e. fending for themselves: “Otherwise I don’t get any”. It was striking to me the low quality of food that these very poor families can afford to buy. All members of the family tend to binge eat food when there is food insecurity. Parents describe how they want to put locks on their fridges or anywhere there is food. These behaviors certainly complicate treatment of obesity.

Given the marked association between socioeconomics and obesity, we could certainly do with more of this type of studies.

New exciting frontiers in obesity research

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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

 

Polarity abounds and why it’s time for a new way of doing things

It appears to be a human condition to react very slowly, if at all, to adverse changes that happen very gradually (think the obesity epidemic). If bad things happen very quickly, then we have no problem mobilizing at all, such as what happened during the SARS outbreak just over a decade ago. Moreover, the factors that are feeding the obesity epidemic, such as processed junk food, stress, and socioeconomic adversity, have changed steadily but very gradually as well, making for one gigantic slippery slope that we have apparent problems reacting to.

It seems as if many things in society, including the drivers of the obesity epidemic, are now reaching some kind of peak polarity, i.e. you are either very poor or very rich, you either eat only nutritious organic food or only junk food, and you either exercise 7 times per week according to the latest hype, or you refuse to exercise at all. In terms of socioeconomics the middle class is disappearing fast, and the 1% seemingly flourishes at the expense of the rest of society.

Polarities abound in the present time, and this makes it very difficult to make any inroads into creating the conditions we need in order to produce successful obesity prevention and treatment programs. In short, it is very difficult to separate the fortunes of the individual from the rest of society, and society is not in a happy place right now.

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

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Politically, there is much current upheaval in the world, possibly with some kind of peak fear with war in the middle east, ebola outbreaks, water shortages, extreme weather, and an economy in tailspin – can it get any worse?

The good news is that more and more people are waking up to the fact that the current systems, i.e. politics, finance, food environment, lifestyles, etc, are obviously in need of major reform. Maybe we are even getting close to some kind of breaking point for the current dysfunctional way of doing things. I thick that we are, and when enough people wake up to this reality, that is when we can create the conditions we need for preventing obesity globally.

Do we, for example, want to keep eating junk food when it is abundantly clear that such food is very harmful to our health, do we want to keep the current financial system that only seems to work for the 1%, and do we want politicians that are heavily influenced by corporate interests. Or do we want something better? It’s not as utopian as many people think that it is.

 

Erik Hemmingsson

 

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We need to unite

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There are many things we need to do in order to banish the obesity epidemic, such as flushing the junk food and sugar industry down the toilet (please watch this trailer for the movie Fed Up), reform the economy so that we can create equal opportunities and prosperity for all as opposed to the current system that creates more wealth for the already wealthy 1% and more debt for the rest of us, reduce stress levels, reduce toxicity in our land, air and sea, and create a social environment where people feel happy, balanced and in harmony. This can obviously take a while, but I am convinced that by standing together and saying enough is enough to the things listed above, we can truly move mountains together.

Conversely, if we remain isolated and uninformed, we are sitting ducks for the mega corporations and others who would like nothing better than to keep the status quo. Many people are understandingly frustrated with the current situation and are expecting and waiting for a top-down solutions to our problems. But I have become less optimistic about the ability of governments and organizations to rectify these problematic situations, which have grown increasingly worse during the last 2-3 decades.

I have become more and more convinced that lasting and genuine change needs to come from the bottom up, from the people, the grassroots, the 99%, i.e. people like you and myself. For example, through this simple blog I have connected with so many people I would never have come into contact with before, demonstrating that it’s so easy to communicate these days. The ultimate aim of my work is to get rid of obesity, quite a grand ambition for sure, but it is certainly possible if enough people believe that it is.

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In order to accomplish this goal, it is very important that we collaborate more, unite more. This is not exactly something academics are renowned for, myself excepted of course… (Yeah, right!). We have to get rid of our egos (should be fun) and do this together. I just started using a Twitter account to alert you to good things around the web, because there are very clear signs that many people are uniting and changing things together. And please send good things back to me and I will be very happy to pass them along. So let’s stay connected, and together we will achieve lasting change for the better.

Erik Hemmingsson

 

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Where next for obesity in the US?

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It is quite startling to see just how much the US has more or less surrendered to the obesity epidemic. Given how strong the association is between socioeconomic factors and obesity, I don’t think there can be many more powerful drivers of the epidemic than the gradual dismantling of the middle class in America, and the increasingly skew distribution of wealth.

The US is obviously a very unique country in many respects, but it seems that there are some very disturbing signs of unrest and tensions bubbling under the surface, partly as a result of this massive inequality in wealth. Earlier I posted about the water shortage in Detroit as one example of this. Another example is the current situation in Ferguson, Missouri, where there National Guard has been deployed this week for the first time since the 1992 riots in LA, and where regular police forces look like military (very Orwellian if you ask me).

Race unfortunately appears to be a critical factor in these clashes, which is not new to the US. And the black population as a whole is at the bottom of the socioeconomic pyramid, which is a veritable breeding ground for frustration, anger, hopelessness, fear and other very potent negative emotions. Negative emotions plays a major role in weight gain, which is very much reflected in the ethnicity-stratified obesity statistics for the US.

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Indeed, the black, non-hispanic population have about twice as high obesity rates as whites, with over 50% of black women having obesity, a startling number.

A good starting point for the US, and any other country, that wants to minimize obesity rates, would be to minimize these tensions and inequalities, and create more equal opportunities for everyone. This is obviously not done without making some tough decisions, but it is certainly doable. The current trajectories for the US certainly suggests that they have a lot to gain from trying something new.