The obesity and poverty paradox

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The recent TOS obesity congress in Boston was an excellent opportunity to catch up with the latest research. While it is interesting to hear about what other people are working on, it is also interesting to note what isn’t trending so much.

Many areas of research have obviously come and gone from the limelight as we naturally go through cycles and phases in research, with some topics having considerably more longevity than others.

Short-lived topics with rapid cycles of boom and bust include things like new diets or exercise fads, something many (if not most) obesity experts got fed up with a long time ago. The basic rule here is that the more extreme the new diets are, the more volatile the cycle. Such strategies rarely make sense if you are genuinely concerned about obesity, even though they can stir remarkable amounts of curiosity in the short term. The science eventually catches up.

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Obesity research is inevitably a mix of trending topics with shorter cycles, and less trendy but enduring topics that have withstood considerable scientific scrutiny over decades. While these long-lasting areas of research might not always be the most exciting for lay people, they arguably have a more robust potential for providing effective solutions.

For me, there was one such long-lasting topic I had hoped to hear much more about in Boston, namely the negative influence of low socioeconomic status. Obesity and poverty may appear to be a paradox but it was a long time ago, at least in developed nations, that obesity was a condition among the wealthy.

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It is now well established that obesity is much more common in individuals at the bottom of the socioeconomic pyramid, and rare towards the top. This particular association is also noted for its strength and consistency across populations in developed nations. Since such associations are rare in obesity research, socioeconomic adversity could well be the strongest risk factor we have for obesity development, hence its long-lasting appeal to researchers.

When we investigate causes behind the obesity epidemic we can obviously point to the junk food invasion and increasingly sedentary lifestyles, for example, but we also need to be aware of the quite dramatic changes in wealth distribution, with financial inequality now at its highest level in seven decades.

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So, since socioeconomic adversity is so well established as an obesity risk factor, the topic I wanted to hear much more about in Boston was why this association is so strong. In other words, what is it about being at the bottom of the socioeconomic pyramid that increases the risk of obesity so drastically?

While there were very interesting studies in Boston that touched upon the potential mechanisms, such as food insecurity, stress, junk food, mental health issues, addiction, lack of sleep, and malnutrition, I would have liked to have seen much more.

This is clearly an area where we can find many interesting pieces of the obesity puzzle and really develop our understanding of weight gain and body weight regulation. This work clearly needs to be multifactorial in nature and not just include experts on socioeconomics, but also experts on social interaction/family dynamics, psychology, emotion regulation, behaviour and lifestyle, diet and nutrition, sleep, fitness, metabolism, endocrinology, immunology, inflammation, genetics, epigenetics, and so on.

Once we start to identify the drivers of weight gain among the socioeconomically disadvantaged, the road to some much needed progress in terms of both treatment and prevention of obesity should be considerably wider.

Erik Hemmingsson

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Is this what the solution for obesity looks like?

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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

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.

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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).

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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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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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