Obesity Week Begins with Lessons in History, Calories, and More
Attending a conference like The Obesity Society's (TOS)ObesityWeek Annual Society Meeting meant exposure to daily sessions highlighting new studies as well as the unique approaches to obesity treatment from professionals both nationwide and worldwide. I was able to learn about state of the art obesity therapies, the new drugs coming down the pipeline not to mention obesity care programs that professionals like myself hadn’t even been aware of. Lastly, it meant the opportunity to interview noted obesity researchers and experts for their take on it all. The next shareposts will recap day one and two of the ObesityWeek2014 conference.
New Studies Shed Light on Obesity but….
Long before they were the muses for the Rubenesque paintings of the seventeenth century, Dr. C. Ronald Kahn of Harvard University says Grecian statues showcased pear-shaped and apple-shaped women of history. Of course one could say that larger women may have been appreciated throughout time, but it seems the size of men, women and even children has since gone beyond “a bit meaty” or “plump” to frank or morbid obesity. But in his opening keynote, Dr. Kahn proposed a new showcasing role for fat: as an accumulator of the body’s response to environmental stressors. This would make fat a major player in our ability to ward off stress and age related-diseases, and enable longevity.
For example, complicated cell programming based on genes helps to explain the role of certain fats in nudging insulin resistance. Dr. Kahn explained how genetic mechanisms help determine the different functions of brown fat vs. white fat. He hopes that once better understood, these findings and their applications will help the body better adapt to stress, and advance the treatment and prevention of obesity in the future.
Teen weight study
One of the many studies presented at the conference, Weight Misperception among Overweight Adolescents Protective Against Excess Weight Gain, had some surprising results. The study used data from the National Longitudinal Study of Adolescent to Adult Health or Add Health study, one of the longest ongoing teen studies from grades 7-12 in the U.S. It began in late 1994 and the most recent home-interview was in 2008. The current study determined how notifying teens of their current weight status of either normal weight or overweight – something already done as part of clinical and school BMI screening – affects future weight. One would assume that sharing the information with the teens, would be a good action, and helpful in possibly preventing additional (and anticipated) excess weight gain through early adulthood. So the specific question became, “if the teen has ‘accurate weight perception,’ does it impact their future weight gain?”
Consider that if you are overweight as a teen, but think that you are “normal weight,” one might expect that you would continue to overeat and gain significant amounts of weight by adulthood. The study results actually showed the opposite. Female teens who were not given the reports, and categorized themselves as “normal weight” (a significant number of participants did so) despite being overweight, actually gained less weight than teens given their actual weight information. Boys were less likely to categorize themselves as underweight or normal (without the report) – maybe they feel more comfortable thinking of the excess weight as muscle, so they are less uncomfortable accepting their size reality and coping with it.
There’s no clear explanation as to why these teens, and specifically the girls, did not gain as much weight as expected in early adulthood with their false sense of body size. They were overweight as teens, and clearly the expected trajectory - especially if they were in denial - would be to continue to gain too much weight. I discussed these confounding results with Amanda Staiano, Ph.D, M.P.P., Director of Pediatric Obesity and Health Laboratory at the Pennington Biomedical Research Center. She and I agreed that one explanation might be that the girls, in identifying themselves as normal weight despite being overweight, had less angst and body image issues because of their personal body size belief, and therefore engaged in less emotionally-driven eating. Whatever the reason, one still has to wonder if it is a good idea to share the actual BMIs with teens.
This study suggests providing the weight measurements might actually drive teens to eat more because of dissatisfaction and unhappiness with their body size and image. Dr. Staiano did point out that when we talk about obesity or excess weight and individual goals, her own clinical experiences suggest focusing on health goals and habit changes, rather than specific weight-loss goals. She added that sending home a "report card" with a child or teen’s BMI, weight, or even weight comments is one thing...but what are parents then supposed to do with that information? That may be the biggest missing link and a problem with our current healthcare system.
Protein Intake and Metabolic Rate Study
High-protein diets have been the rage for some time, though maybe they got bumped a bit by the gluten-free trend. Regardless, the contention of most dieters who go high protein is that the weight loss is rapid and profound. Research presented at ObesityWeek2014 by doctoral student, Elizabeth Frost, ties these diets to driving an increase in the metabolic rate, and producing more lean muscle mass. But even a normal protein diet (about 1 gram of protein per killogram of body weight) is tied to those findings. So it appears that in the presence of protein the body burns extra calories, and stores less of the excess calories as fat. But the study also found that the higher metabolic rate does not sustain itself when protein levels fall . That's what typically happens when the high-protein dieter finally succumbs to eating grains (and fruits) again. They don’t just add in grains and fruits –they typically replace loads of protein with loads of carbohydrates. So unless you stay “normal to normal-high protein” for life, you'll end up losing that metabolic edge.
I interviewed Stephen Smith M.D., outgoing President of The Obesity Society - the leading professional society dedicated to better understanding, preventing, and treating obesity. He had a few choice comments about this study and protein in general. The typical U.S. diet has about 15-16% protein content. A diet like The Atkin’s Diet raises that level to about 25%. Though high-protein diets nudge weight loss, Dr. Smith offers that the study has more merit (and application) when you look at the senior population who needs to maintain muscle mass. Keeping their protein levels at high-normal may really boost their overall health. Certainly true for post-menopausal women, a higher protein diet may also help to support muscles mass and provide satiation - limiting that inevitable fat gain in the midsection that so many women complain about. Anyone with kidney or liver disease needs to have their doctor or a nutritionist weigh in on appropriate amounts of protein, since a diet too high in protein can present a danger to those organs. But in terms of obesity and weight loss, there’s unfortunately no magic bullet with a high-protein diet - unless you stay on it, pretty much, forever. However, increasing your protein consumption a bit can help satiate you, especially when cutting down on overall calories to lose weight.
Other studies that have since released
A series of other studies were also released during the conference. Some quick mentions:
- Using tools like tapping on your forehead or earlobe, or tapping your toe on the ground, or staring at the wall for a period of time (30 seconds each), may help to reduce (intercept) cravings.
- Thinking about the long term impact of your food choices (really, really pondering them) may help to control food cravings.
- US adult consumption of added sugars has increased by 160% over the last three decades.
- A high fat diet during pregnancy could influence the brain function and behavior of offspring. These children may prefer a diet higher in fat (the current American diet), they may weigh more, and they may have a higher risk of impaired glucose tolerance (This was a rat study). I interviewed Kelly C. Allison, Ph.D., Associate Professor of Psychology in Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania. She cautioned that this study should not encourage doctors to berate pregnant women with regards to their diet, but she did point out that highlighting the importance of healthier eating to provide the best health outcomes for the baby should be the goal. Dr. Allison pointed out the importance of studies that “follow a woman during pregnancy to explore the pre-wiring of offspring.” Hopefully the notion that one can “let go” during pregnancy and have a food fest, because you’re going to gain weight anyway, is being replaced by nutrient-dense eating habits that support a healthy pregnancy and healthy offspring.
Applying These Studies in Real Life
In the world of science it can sometimes be baby steps of progress, intercepted by conflicting research, and then more follow up research, in order to ultimately come to viable conclusions and recommendations. The pace of discovery in obesity has been slow. Most of the experts, scientists, healthcare professionals, and researchers feel that we are still in the infancy of understanding the many causes of obesity. Most agree that regardless of the cause, dietary choices and exercise have to be a significant part of ANY treatment plan. We already know that the rate of recidivism in obesity is high; Because most patients who weigh a lot, can lose some, much, or even all the excess weight. This can even happen even many times. But it’s maintaining a healthy goal weight that seems to be the biggest part of the problem. It is crucial to now recognize that a variety of different mental and physiological causes contribute to obesity. Understanding their mechanisms will take time, money and patience. But we are beginning to recognize that obesity is a chronic disease that needs long-term care and personalized therapeutic solutions.
Next Up: Are We Making Progress in this Disease Called Obesity?
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