Monthly Archives: November 2011

Certainty = Happiness

I’m reading a fascinating book by Timothy D. Wilson called Redirect — the Surprising New Science of Psychological Change.  In it, he discusses what makes us happy.  What is scientifically proven to make us happy, and the results of the studies to date are illuminating.

For example, one might think that a devastating medical diagnosis would make people unhappy, and one would be right — at first.  For the first few months following a life-changing diagnosis, people are more depressed and anxious than they were.  But if the diagnosis is clear, within a year most people return to their emotional baseline.

The case discussed in the book is people who might be carrying the genes for Huntington’s disease, a neurodegenerative illness that kills people in middle age.  If you have the gene, you will get the disease.  If not, no worries.  A study was designed to follow different cohorts of people — people tested in their 20s and 30s for the gene and found to have it or not.  The results were referenced above — the group told that they have a mid-life death sentence suffered for a time, then found a way to rationalize and understand their illness, and returned to normal psychological functioning.  Perhaps some of them were spurred to do things they had put off, knowing that their time on Earth was going to be particularly limited.

The really interesting thing, though, is that a third group was followed — those who might be carrying the gene but who chose not to get tested.  These people suffered the most.  Their depression and anxiety grew over time, and at one year they were faring the worst.

Think about that for a moment — someone with a 50% chance of dying of an illness is feeling much worse than a person with a 100% chance of dying of the same disease.

What’s can account for this strange state of affairs?  In a word, uncertainty.

Uncertainty kills.  It’s much more stressful than certainty, even if the thing one is certain about is one’s own mortality.  Bringing this back to my favorite topic, I do think this resonates with weight control.  Many people’s pursuit of weight control and fitness are plagued by uncertainty — diets started in a halfhearted way, leading to waffling between strict adherence and indulgence.  Gym memberships established on a whim, without a plan, used inconsistently resulting in frustration, self-recrimination, etc.

Most people have mixed feelings regarding changing behavior and losing weight. The ones who succeed are able to resolve the uncertainty and make a plan of action.  A plan that is simple, direct and aligns with their values.

Being vs. Having

Here is a simple exercise for those looking to shed unwanted weight. Think for a moment about the extra pounds you are carrying around, and say out loud:

“I am fat.”

Let that marinate for a moment.

Now let’s try again. Close your eyes and concentrate:

“I have fat.”

Okay, eyes open. What did you feel? If you are like most people, the first statement felt terrible, an indictment of yourself as a person, in your entirety. In fact, for some people, this statement indicates that “fat” is all they are and ever will be. What a downer.

What about that second statement? What an amazing difference one word can make! This statement clearly separates “fat” from “me.” It isn’t who I am, it’s a description of what I am carrying. And just as we wouldn’t stand there with an armload of firewood and declare “I am wood,” it makes no sense to do the same with weight.

When you use the second method, you retake control over the situation. Just as a person with OCD succeeds when she declares OCD to be the outside, the visitor, and not her identity. She is now in a position to drive her recovery, “talk back” to OCD, and take steps to limit its influence in her life.

Once we have declared ourselves to be whole people who are carrying extra weight, we are in the position to fight against the problem behaviors that have brought this situation about. We no longer have to fight against ourselves.

When we put down arms against ourselves, we are free to fight the real battle.

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Let’s complicate a simple message to the point of uselessness

Here’s a terrifying new study. It states that by 2030, fully 50% of Americans will be obese, of we stay on our current path. However, as part of this article they take pains to “debunk” the simple idea that running about a 500 calorie deficit per day will result in losing one pound of fat per week, on average. In place of this simple message, the authors advocate that the public consider the following:

The report said that weight loss should be viewed over a longer period of time and proposed a new “approximate rule of thumb” for an average overweight adult. It said that “every change of energy intake of [about 24 calories] per day will lead to an eventual bodyweight change of about 1 kg (just over two pounds) . . . with half of the weight change being achieved in about 1 year and 95 percent of the weight change in about 3 years.”

Then academics and public health officials wonder why people throw their hands up and eat a cheeseburger.

We have got to do better.

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To lose weight, start in the basement

“Forgiveness is the key to action and freedom.” – Hannah Arendt

I came across his quotation today (tweeted by Brian Tracy) that encapsulated an idea that had been percolating for a while. Much of what we do and fail to do hinges on a lack of forgiveness. Stubbornness. Anger. These all push us into a state closer to emotion and further from action. When it comes to the issue of obesity and how we act, I believe that forgiveness is a much of what allows significant action.

For example, I have had patients describe to me how their anger at a parent or a friend drives eating behavior.

What could you do if you said these simple words, and meant them — “I forgive you.” To a hurtful parent. To an unsupportive spouse. To a maddening child.

How about to ourselves?

What old grudges against ourselves are we hanging on to, keeping us stuck? Anger about where we find ourselves is very common, and has been voiced to me on countless occasions. “I can’t believe I let myself get this heavy.” “How could I gain that weight backagain?” “Why can’t I resist that treat that always sabotages my plans?”

We must first accept our current status before we can look to the future and take any meaningful, helpful action.

To extend the analogy, we must build the foundation, the basement that will support a solid structure of healthy action to reach our goals.

What has been your personal “basement?” Who has helped you to get there?

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Successful weight loss postpartum

Here’s a quick study, of note for women looking to lose weight postpartum and raise children of normal weight. Women who focused their efforts on dietary changes instead of exercise were more successful in this goal. Here’s the abstract:

The effect of maternal attempt to lose weight during the postpartum period on later child weight has not been explored. Among 1,044 mother–infant pairs in Project Viva, we estimated longitudinal associations of maternal attempt to lose weight during the postpartum period with child weight and adiposity at age 3 years and examined differences in associations by type of weight loss strategy used. Using covariate-adjusted linear and logistic regression models, we estimated associations before and after adjusting for maternal weight-related variables including prepregnancy BMI. At 6 months postpartum, 53% mothers were trying to lose weight. At age 3 years, mean (s.d.) child BMI z-score was 0.44 (1.01) and 8.9% of children were obese. Children whose mothers were trying to lose weight at 6 months postpartum had higher BMI z-scores (0.30 (95% confidence interval (CI) 0.18, 0.42)) and were more likely to be obese (3.0 (95% CI 1.6, 5.8)) at 3 years of age. Addition of maternal prepregnancy BMI to the models attenuated but did not eliminate the associations seen for BMI z-score (0.24 (95% CI 0.12, 0.36) and obesity (2.4 (95% CI 1.2, 4.7)). Attempting to lose weight by exercising alone was the only weight loss strategy that consistently predicted higher child BMI z-score (0.36 (95% CI 0.14, 0.58)) and odds of obesity (6.0 (95% CI 2.2, 16.5)) at age 3 years. In conclusion, we observed an association between maternal attempt to lose weight at 6 months postpartum, particularly through exercise alone, measured using a single item and child adiposity at age 3 years. This association should be thoroughly examined in fu

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Fat but fit — protected from cancer?

Take two women, one overweight or obese, and one of average weight. Who is at higher risk of death from cancer? Easy, right? The heavier woman is at higher risk. So far, so good.

Now, take two more women. From the outside, they appear the same — both are obese. However, one is sedentary and the other does brisk walking and spin classes a total of five times per week. Now who is at higher risk of cancer death? Could the second woman’s improved cardiopulmonary fitness level actually protect her from death from cancer?

The simple answer: yes.

In a remarkable study, researchers found that an overweight or even obese woman who has achieved increased cardiopulmonary fitness can completely normalize her cancer risk. Here’s the abstract:

The objective was to examine associations among cardiorespiratory fitness (CRF), adiposity, and cancer mortality in women. Healthy women (N = 14,256) without cancer history completed a baseline health examination 1970–2005. Measures included BMI, percent body fat (%Fat), and CRF quantified as duration of a maximal treadmill test. CRF was classified as low (quintile 1), moderate (Q2–3), and high fit (Q4–5) by age. Standard BMI cutpoints were used, while participants were classified by %Fat quintiles. Cancer mortality rates were calculated following age, exam year, and smoking adjustment. During a mean follow-up period of 15.2 ± 9.4 years, 250 cancer deaths occurred. Adjusted mortality rates across BMI groups were 4.6, 5.7, and 8.8 (P trend 0.08); %Fat 3.0, 4.9, 2.9, 3.8, and 6.9 (P trend 0.17); and CRF 7.9, 5.5, and 2.9 (P trend 0.003). When grouped into categories of fit and unfit (upper 80% and lower 20% of CRF distribution), and using BMI as the adiposity exposure, cancer mortality rates of unfit-obese women were significantly higher than fit-normal weight women (9.8 vs. 4.1 deaths/10,000 woman-years; P = 0.02), while fit-overweight and fit-obese women had no greater risk of mortality than fit-normal weight women. Using %Fat as the adiposity exposure, unfit-obese women tended to have higher cancer mortality than fit-normal weight women (7.0 vs. 3.3 deaths/10,000 woman-years, P = 0.10). Higher levels of CRF are associated with lower cancer mortality risk in women and attenuate the risk of cancer mortality in overweight women. Using adiposity measures to estimate cancer mortality risk in women can be potentially misleading unless CRF is considered.

The take-home message is clear:

Exercise is good — it helps keep you healthy even if your weight does not change.

So get out there and work out!

Click for the abstract

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Anti-obesity drug! Yay?

You’ve probably seen the headlines from this week — monkeys who were allowed to overeat and become obese were given an injection that targeted their fat tissue. They lost a good deal of fat. Read a summary here. Scientists are “encouraged” and hope to bring the fat-zapping drug to market.

Well, who wouldn’t? The first medication that selectively destroys fat cells without onerous side effects will make billions and billions of dollars for its parent company. Will this be a good thing for society? I’m not convinced.

Let’s play out the scenario. Assume that the pharmaceutical company can overcome the hurdles to prove safety and efficacy in humans (the study drug damaged the monkeys’ kidneys after only 60 days. Humans would have to be on this drug for years), and it comes on the market with an indication to treat obesity. Everyone and their brother is going to line up to be treated with this medication. Some obese, some just overweight. Will people take this medication in addition to doing all of the necessary steps to reduce the intake of high caloric weekends foods, increasing physical activity, increase their sleep, and limit their stress in order to alleviate obesity? Unlikely.

Most likely, folks will feel that now they are taking a targeted medicine it’s going to eliminate their obesity, while at the same time giving them license to eat just about any foods they want and moon exercise their bodies as much or as little as they like. Many people are going to behave as if the only thing that matters is taking the medication and they’re no longer responsible for their health choices.

Furthermore, with the Obesity Society’s push to have obesity categorized not as a health condition or consequence of poor health choices, but as a medical illness, there will be tremendous pressure on all insurance companies to cover the medication. Lawsuits and capitulation will follow, as will billions in costs.

Once we have millions of people taking the medication, it’s likely that some adverse health effects will be found, possibly limiting its use, and surely launching a mini-industry among lawyers trolling for medical damage cases. Even if this doesn’t come to pass, as a society we will be spending billions on a new med without doing the challenging but necessary work to make ourselves truly healthier.

I welcome your feedback and critique. What do you think would be a better alternative? How should society make healthy behaviors easier, cheaper and more attractive? How should we approach medications for obesity?

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Do overweight mothers benefit from breast-feeding?

Recent research has indicated that overweight and obese mothers give birth to children at increased risk for overweight and obesity themselves. However, breast feeding has been shown to be protective against overweight in both mothers and their offspring. Does it work as well for those mothers who are overweight?

A paper from a group at the University of South Carolina sheds some light on this question. In their 2006 paper they conclude:

CONCLUSIONS- Breast-feeding was inversely associated with childhood obesity regardless of maternal diabetes status or weight status. These data provide support for all mothers to breast-feed their infants to reduce the risk for childhood overweight.

All practitioners should discuss these findings with their patients, to facilitate their decision-making regarding the benefits of breast-feeding for their children’s health.

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How fast can I lose fat?

People can and do lose weight in different ways — for some, it’s regular exercise. For others, it’s an eating plan that enables them to consume fewer calories each day, leading to weight loss.

But every successful plan takes time. A lot of time. We don’t (generally) gain weight quickly, and we can’t lose it quickly. Why? Evolution. The human body has evolved over millennia a finely-calibrated system for figuring out how much fat to hold on to, in order to facilitate survival in the event of starvation in the future. We have survived as a species because of these so-called “thrifty genes,” which favor consumption of calorie-rich foods and very slow burning of the resulting fat stores, because food sources were few and far between back then.

How slow does fat loss have to be? In general, no faster than one pound per week.

I know, I know, “That sucks!” It does. It’s slow and boring. Maybe you could get away with two pounds per week. But weight loss faster than that will trip the hormonal signals that shut down our metabolism and hold on to that fat even more tightly.

(Incidentally, this fact of nature provides what blogger John Gruber describes as a great “bozo filter.”  That is, when we hear someone touting fat loss of 4, 5, 8 or even 10 pounds per week, we know that person is completely full of it.  We can ignore all the rest of his or her nonsense with impunity.)

We have to go under the radar for this operation, people. The good news is that when you come up with a plan that gets you into that one pound per week range, the body will throw up very few roadblocks to continued fat loss. You should be able to do this as long as you need to, to achieve your goal weight.

Cornell University researcher Brian Wansink, Ph.D., has a great book that explains this issue in great detail. Do yourself a favor and read his book Mindless Eating.

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Does stigmatization work?

This groundbreaking study out of Yale’s Rudd Center for Food Policy and Obesity directly contradicts most of what society and medicine has been attempting for years. Namely, the idea that by making people feel badly about their body image, food choices, etc. we can influence their choices on a positive direction.

Survey says — BZZZZZZ.

This study divided overweight individuals into two groups, half of whom watched a neutral video, the other half watched a video containing weight-stigmatizing material. Contrary to the notion that stigma generates motivation and interest in behavioral change, the stigmatized group consumed three times as many calories as the neutral group.

Time for a new approach. More on that soon.

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