Saturday, December 22, 2007

Roundup - What's the Problem?

"... as an adult, we understand even if you ruin an appetite, there's another appetite coming right behind it. There's no danger in running out of appetites. I've got millions of them." --Jerry Seinfeld. The "Heart Attack" episode.

Fact: When food is in short supply, obesity as a public health problem does not exist. As a matter of fact, being obese under those circumstances signifies being wealthy or of higher economic status than the average population. Look at countries where some are living in poverty, and others are more affluent. Which segment of that society has a problem with obesity?

Fact: When food is made available and affordable, in the presence of abundance, the average person will eat more. Much more. Bigger portions. It is surprising to see people who immigrated as adults from less affluent countries continuing to eat the portions and at the times that they were used to, and stay slim. They have already developed the habits and controls and they stay satisfied with the portions and types of food that they used to consume. Their first generation kids, however, who were not raised in such a controlled environment, may become overweight or obese.

Fact: When food is not only made available in abundance 24 hours a day, but is also advertised all day long, people tend to consume even more. And branding does affect their choices.

Fact: Social networks can strongly enhance the spread of obesity.

One conclusion I can draw here is that: External influences tend to have a stronger effect on controlling how much we eat than spontaneous internal influences, in the average person. It takes a conscious effort and proper habit building and modifications to overcome those external influences. That we are victims of an environment and a culture that facilitates (or may even encourage) habits that will make us unhealthy, the only true refuge is our own ability to change habits and behaviors that developed under those circumstances. Although I stress on over-eating as a deadly habit, it is important to notice that serious under-eating as in anorexia nervosa is at least as deadly, if not more.

Remember, weight control is achieved through three elements:

1. Diet (portion acontrol and quality control)

2. Exercise or physical activity

3. Behavioral change towards healthy habits

Everything else (a diet program, a trainer, a pill, a surgical operation) is a tool that helps you control your energy storage (and, consequently, the weight of fat) through one or more of the above mechanisms.

Stay healthy! Happy Holidays!

Saturday, December 15, 2007

Childhood and Adolescent Obesity - A Real Concern

Well, this is another blog entry that is not a bariatric surgery issue, but a real public health and epidemiology concern. The New England Journal of Medicine issue of December 6, 2007, has three excellent articles:

1. Childhood Obesity — The Shape of Things to Come by Dr. D.S. Ludwig (Link) from Harvard Medicalo School
2. Childhood Body-Mass Index and the Risk of Coronary Heart Disease in Adulthood by Dr. J.L. Baker and others (Link) from Copenhagen, Denmark
3. Adolescent Overweight and Future Adult Coronary Heart Disease by Dr. K. Bibbins-Domingo and Others (Link) from the University of California, San Francisco

The Journal is making the full text of those articles (not just the abstracts) available for free.

In the perspective article "Childhood Obesity — The Shape of Things to Come", Dr. David Ludwig (Director of the Optimal Weight for Life Program, Children's Hospital Boston, Harvard Medical School) views the obesity epidemic as consisting of four phases. The first phase (began in the early 1970s) witnessed a progressive increase of the average weight among children from all socioeconomic levels and geographic areas in the United States.

The second phase, which we are now entering, is characterized by the emergence of serious weight-related problems in adolescents, including type 2 diabetes, fatty liver, orthopedic problems, sleep apnea, social isolation, anxiety, and depression.

Phase 3 will signal opening the doors for the medical complications of obesity to lead to life-threatening or limb-threatening disease. There will be an increased risk of coronary heart disease in adulthood, a high risk for limb amputation, kidney failure requiring dialysis, and premature death. The article quotes that the risk of dying by middle age is already two to three times as high among obese adolescent girls as it is among those of normal weight. Dr. Ludwig has predicted that pediatric obesity may shorten life expectancy in the United States by 2 to 5 years by midcentury, which would be equal to that of all cancers combined.

Phase 4 of the epidemic, if allowed to take place, will lead to even higher obesity rates because of transgenerational mechanisms.

Those articles are a highly recommended reading for anyone who feels that childhood obesity is hitting home.

Tuesday, December 4, 2007

CDC: Adult Obesity Prevalence - No Significant Increase

The Centers for Disease Control and Prevention (CDC) has announced the new obesity prevalence statistics in a report titled, "Obesity Among Adults in the United States -- No Change Since 2003-2004". There was no "significant" change in obesity prevalence between 2003-2004 and 2005-2006 for either men or women. I would consider this "encouraging", but far from being exactly "good" news.

Some have declared that the media headlines should, at the very least, be shouting: “Obesity Epidemic Over!” (1). In literal terms, and based only on this piece of information, an obesity epidemic may, indeed, be over. After all, the definition of "epidemic", according to Webster's New World Medical Dictionary is "The occurrence of more cases of a disease than would be expected in a community or region during a given time period." Well, so what? Should we be proud of the current number of 34% being obese, knowing of the adverse health effects of obesity? According to the news release, more than one-third of U.S. adults -– over 72 million people -- were obese in 2005-2006. This includes 33.3 percent of men and 35.3 percent of women. The reality is that the lack of statistically significant increase in prevalence does not mean at all that we are OK. At the very best, we are just maintaining a peak high prevalence of obesity. Actually, the 2007 report of the Trust of America's Health (posted in the Bariatrics Lounge blog), using a different methodology, concluded that adult obesity rates showed an increase in 31 states last year. So, where is the truth. I would say, at the very best, and if we take only the CDC report, we are maintaining a dangerously high prevalence of obesity. And that all is about obesity in adults. Folks, we are not even talking about childhood obesity. Epidemic or not, it is already pretty bad.

(1) Please note: This blog does not endorse the Junkfood Science blog, which is mentioned here purely as a reference to an article that indicated one point of view.