Wednesday, August 20, 2014

Healthy Obesity: Losing Weight Won’t Make You Happy

sharma-obesity-depressionThere is ample evidence for improvements in mood and other aspects of mental health with weight loss in people with excess weight, who have these problems to begin with.

But whether or not weight loss in otherwise healthy people living with obesity is associated with any such benefits remains unknown.

This question in now addressed by Sarah Jackson and colleagues from the UK in a paper published in PLOS | ONE.

The researchers examine data from 1,979 overweight and obese adults, free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing.

Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%.

The proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the than weight stable or weight gain groups, respectively.

Compared to the weight stable group, the weight loss group was almost 2 times as likely to report mood problems.

Similarly, individuals in the weight loss group were also more likely to report lower wellbeing.

All effects persisted in analyses controlling for demographic variables, weight loss intention, and baseline characteristics and despite adjusting for illness and life stress during the weight loss period.

Given the longitudinal nature of this study, it is impossible to determine causal relationships in these observations but the findings do suggest that the issue of psychological harm in otherwise healthy individuals undergoing weight loss may warrant closer study.

For the event that there is indeed a causal relationship between weight loss and adverse pychological outcomes, the authors have the following explanation to offer:

The poor long-term maintenance of weight loss is notorious, and in itself could be interpreted as demonstrating that the personal costs of losing weight exceed the benefits. Resisting food in environments that offer abundant eating opportunities requires sustained self-control, and given that self-control appears to be a limited resource, other areas of life may suffer as a consequence. Loss of fat stores may also initiate signals for replenishment of adipocytes, thereby stimulating hunger and appetite and making weight control progressively more difficult. These observations suggest that weight loss is a significant psychobiological challenge, and as such, could affect psychological wellbeing.”

On the other hand, weight loss could also result from adverse changes in mood:

Evidence from the clinical literature is suggestive of a causal relationship in this direction, with major depressive disorder often associated with significant weight loss, and treatment with antidepressant medication leading to weight gain. Population studies have also demonstrated longitudinal associations between depressive symptoms and weight loss. Depressed mood may cause weight loss directly or indirectly through changes in appetite or level of physical activity.”

Thirdly, these correlational findings may be entirely unrelated to each other.

Which ever the true relationship, these findings should perhaps caution us against simply advising all overweight or obese people, irrespective of whether or not they actually have weight-related health issues (or are otherwise unhappy with their weight), to try losing some weight.

@DrSharma
Edmonton, AB

ResearchBlogging.orgJackson SE, Steptoe A, Beeken RJ, Kivimaki M, & Wardle J (2014). Psychological Changes following Weight Loss in Overweight and Obese Adults: A Prospective Cohort Study. PloS one, 9 (8) PMID: 25098417

 

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Tuesday, August 19, 2014

Can a Non-Profit Urban Food Initiative Alleviate Food Insecurity?

Doug Rauch, former President of Trader Joe's

Doug Rauch, former President of Trader Joe’s

Healthy eating (especially produce) is well out of reach for many who have hungry mouths to feed (despite ivory tower experts who proclaim that you can eat healthy for under $2 a day if you only follow their “tips”).

As food insecurity is certainly one of the key drivers of obesity especially within the lower socioeconomic strata, I was very interested in a paper by Deepak Palakshappa and colleagues, who describe a non-profit initiative to address food insecurity, in a paper published in JAMA Pediatrics.

This initiative, that has yet to open its first store, is to be launched by Doug Rauch, former president of Trader Joe’s grocery chain, who believes that nonprofit supermarkets in low-income neighborhoods can help provide nutritious low-cost foods by selling food gathered from the fresh produce and perishables that are discarded from other supermarkets. (The first store, named the Daily Table, has been proposed to open in Dorchester, a low-income neighborhood in Boston, Massachusetts.)

Indeed, there is an incredible amount of food that goes waste because it either does not meet the high standards of appearance of supermarket chains or is close to or past its “best-before” date.

As the authors point out,

“While most people believe these dates are based on safety, manufacturers and retailers focus on a product’s shelf life, which is based on peak freshness, which is a function of how the food looks and smells. Many manufacturers date their products earlier because of concerns about protecting their brand image. The US Department of Agriculture states the labels are not safety dates and if food is handled and stored properly, it should be safe to consume even if it is past the date. The confusion specifically regarding date labeling is estimated to lead to 32 billion pounds of avoidable food waste a year.”

The paper also discusses whether such an approach would be deemed ethical. As the authors are quick to point out, the first store has yet to be opened so exactly how things will play out in real life awaits to be seen. 

However, there are good reasons to assume that this initiative has the potential to increase the consumption of fruits and vegetables and offers option of purchasing low-cost healthy foods rather than mandating their consumption of healthy foods. The location of these stores in low-income neighbourhoods should help addresses the disparity in access to healthy foods by providing a convenient place for individuals who otherwise may not have healthy foods readily available.

The stores will also offer cooking and health eating classes to promote the autonomy of clients to determine with items to purchase.

The authors also hope that this approach, rather than blaming the individual, will provide an environment conducive to healthier eating while also respecting local social and cultural values.

Of course, whether all of this will work and whether or not such an initiative can be economically viable in the long term remains to be seen. Nevertheless, the initiators of this idea should at least be commended on giving this a shot.

@DrSharma
Edmonton, AB 

Hat tip to Geoff and Ximena for bringing this article to my attention

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Monday, August 18, 2014

Hormonal Responses to Food Intake Begin in Your Mouth

ChewOnThisLogoIn my current show at the 33rd Edmonton International Fringe Theatre Festival, I joke about the importance of chewing your food. This has classically been noted to be of importance to allow the enzymes in saliva to begin the process of digestion.

However, now a fascinating study by Yong Zhu and colleagues from Iowa State University, published in Physiology and Behaviour shows that chewing prompts hormonal changes that vary based on the composition of the food.

In their study, ten healthy males volunteers underwent a sham-feeding experiments (you chew but do not swallow your food) after an overnight fast with 3-min chewing of water, high-fat (nuts), high-carbohydrate (cereal) or high-protein (cheese) food provided in a randomized order (on four separate occasions).

While plasma glucose levels increased slightly and plasma lipids decreased slightly after all test foods, the high-carbohydrate food elicited significantly higher insulin, and the high-protein food resulted in higher ghrelin compared to other test sessions.

The authors attribute these changes in part to neuronal signals transmitted through the vagal nerve, which can for e.g. stimulate glucagon release, thereby explaining the observed increase in plasma glucose levels after all foods.

This study shows that short-term oral exposure to different foods can result in metabolic and hormonal changes that are partly dependent on diet composition.

If nothing else, this study points to the fact that chewing is not simply about mechanically preparing food for swallowing – it is far more a process that puts the organism into a nutritive state with distinct metabolic and hormonal changes.

Chew your food!

@DrSharma
Edmonton, AB

ResearchBlogging.orgZhu Y, Hsu WH, & Hollis JH (2014). Modified sham feeding of foods with different macronutrient compositions differentially influences cephalic change of insulin, ghrelin, and NMR-based metabolomic profiles. Physiology & behavior, 135, 135-42 PMID: 24952264

 

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Sunday, August 17, 2014

Obesity Weekend Roundup, August 15, 2014

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

@DrSharma
Edmonton, AB

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Friday, August 15, 2014

Obesity Guru – Fringed and Confused

header_Fringe_festival2014As I look forward to a wild and crazy week of performances and shenanigans at North America’s largest and longest running 33rd International Fringe Theatre festival here a short glimpse of a few TV interviews about my “Obesity Guru” show.

If this is a way to get scientific messages about obesity to the public – so be it! I for one plan to have as much fun with this as I can.

Given that all 7 shows for next week are sold out (they were sold out 3 days before start of the festival), I can only assume that a lot of Edmontonians are interested in this rather quirky approach to science communication.

(Note to my international readers – some of these links may not work in your country)

CTV Edmonton News

Global TV News Health Matters

Shaw Television Go Edmonton!

City Breakfast TV

Yours fringed and confused,

@DrSharma
Edmonton, AB

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Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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