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

change-since-1979-600

 

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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“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.

Where next for obesity in the US?

US-Obesity

 

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.

Where and why did the obesity epidemic start?

World-wide epidemic

Obesity has definitely gone global. Although it will be difficult to prove using scientific methods, which can be pretty blunt for this type of investigation, I have no doubt that the epidemic started in the US around 1950-1960. This is the era that saw the rise of the junk food industry, mechanized transport, more stress, increasing social disconnection, more aggressive marketing, and changed consumer habits. But the main change was undoubtedly the junk food invasion.

It did not happen overnight, and the epidemic did not get its breakthrough until around 1980. Like a snowball rolling down the hill, the epidemic was now fuelled even more by other changes to society. Both Reagan and Thatcher, for example, started to gradually dismantle the welfare system during this period, meaning that poor people got pushed over the edge financially and had no choice but to eat cheap junk food. The rise and rise of junk food marketing also reached new levels through TV, and use of colorful images and messages. We were told to consume and consume we did.

Trends in obesity, US

 

If you walk around major cities in Europe and the US today it is quite staggering how much food, transport, lifestyle, family, working hours, stress, etc has occurred during the decades when the epidemic really took off. There has also been a large disconnect from nature and a more balanced lifestyle through massive urbanization and who knows how much toxicity we are exposed to today in the cities compared to the days before the epidemic as a result of pollution, pesticides, steroids and antibiotics in our food. Children have also increasingly been growing up in environments where they see less and less of their parents, who both work full time to pay their mortgage. The increased stress levels is certainly a major factor that fuels the the epidemic more and more.

We are suckers for these types of very gradual changes, and the prize for this lack of vigilance is that one day we find ourselves in a hole that we struggle to get out of. And as always in epidemiology, it is the combination of causal factors that tip us over the edge. And those environmental changes I have mentioned as causal obviously also play a very prominent role in many other health epidemics, such as diabetes, cancer, heart disease, and depression. How much more of this will it take before we take action and get back to a more balanced lifestyle?