Monday, September 1, 2014

Guest Post: Emotional Distress And Weight Gain

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Erik Hemmiingsson, PhD, Obesity Research Centre, Karolinska Institute, Stockholm, Sweden

Today’s guest post comes from Erik Hemmingsson, PhD,  a Group Leader at the Obesity Center, Department of Medicine, Karolinska Institute, Stockholm, Sweden. His group studies the role of psychological and emotional distress in weight gain and obesity by mapping life events that influence stress, metabolism and body weight. Erik has a PhD in Exercise and Health Sciences from the University of Bristol (2004) and a PhD in Medicine from Karolinska Institutet.

I work as a researcher in a specialized obesity treatment center at a university hospital in Sweden. My job is to develop new and more effective treatment and prevention methods so that we can hopefully confine obesity to the history books some day.

For many years I mostly did studies on behaviour therapy combined with low energy diets. Since this did not result in any major breakthroughs, I decided to try something a little different.

I had been aware of that many of our patients had experienced difficult childhoods. There were so many sad stories, but I didn’t fancy doing any research on the topic, it was too painful. But then my attitude gradually started to change about a year ago. It was clear that our current treatment methods were woefully ineffective, but I also became more receptive to all those troublesome stories from the patients. Enough was enough, it was time act. So, like Neo in the Matrix movies, I decided to take the red pill, and delve deeper into the very uncomfortable subject of childhood abuse and adult obesity.

I searched the literature and quickly saw that there were more than enough studies for a systematic review and meta-analysis. I enlisted the help of Dr Kari Johansson and Dr Signy Reynisdottir, and got to work.

What we found very much confirmed all those clinical observations, i.e. there was a very robust association between childhood abuse and adult obesity. The association was also very consistent across difference types of abuse, with an increased risk of about 30-40%. There was also a dose-response association, i.e. the more abuse, the greater the risk of obesity.

While this study confirmed something very important, it was also clear that not everyone who suffers childhood abuse develops obesity, or that all obese individuals have suffered childhood abuse, or the effects would have been even more pronounced. But for me, the study proved that stressful childhood experiences can easily manifest as obesity many years later. This led me even deeper down the rabbit hole. I wanted to know why.

I decided to try and piece together different ideas about how obesity develops in relation to stressful life events. This resulted in a new conceptual causal model consisting of six different developmental stages. Like many diseases, obesity development is more likely when there is socioeconomic disadvantage (applies mainly to Europe and North America). Socioeconomic disadvantage can very easily trigger a chain of events that include adult distress, a disharmonious family environment, offspring distress, psychological and emotional overload, and finally disruption of homeostasis through such mechanisms as maladaptive coping responses, stress, mental health problems, reduced metabolism, appetite up-regulation and inflammation.

Much more research is needed to validate the model, but if there is some truth to this theory, which the childhood abuse meta-analysis clearly suggests that there is, then my hope is that we can use this information to develop more effective treatment and prevention methods.

My other hope is that some of the truly horrendous stigma, shame and discrimination that the obese experience can gradually be alleviated, since there is clearly a lot more to obesity etiology than the commonly held preconception that obese individuals are merely lazy and overindulgent.

After having done all this work on obesity etiology, I would say that my top-3 reasons we have an obesity epidemic (in no particular order) are socioeconomic inequality, the junk food invasion, and psychological and emotional distress patterns (usually established at an early age). And when you combine all three you have the perfect storm for weight gain.

You can find more information at my blog at www.holisticobesity.com

Erik Hemmingsson,
Stockholm, Sweden

References:

Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obesity Reviews (epub 15 August 2014).

Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obesity Reviews 2014, 15:769-779.

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Sunday, August 31, 2014

Obesity Weekend Roundup, August 29, 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
Berlin, Germany

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Friday, August 29, 2014

2014 Scopinaro Lecture

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

This morning, at the XIX World Congress of the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO2014), I have the great honour of presenting the 2014 Scopinaro Lecture.

This lecture is named after Nicola Scopinaro, who in 1976 performed the first biliopancreatic diversion for the treatment of obesity.

The Scopinaro Lecture is the highest recognition for a non-surgeon to be awarded by IFSO.

In thinking about what to present, I settled on discussing the topic of whether or not obesity is a disease. Looking back over the work that I have done over the past 25 years, I came to realise that the issue of why some people with excess weight develop health problems and others don’t, has indeed fascinated me for a long time.

Initially, this interest was focussed on trying to understand why some people with obesity develop high blood pressure and others don’t. We were indeed able to show that part of this may be explained by differences in the expression of hormones involved in blood pressure regulation from fat tissue.

More recently, as many regular readers are well aware, I have broadened this interest in describing the limitations of BMI and advocating for a clinical staging system that classifies overweight and obese individuals based on how “sick” they are rather than how “big” they are.

Clearly, this work is of considerable interest to those involved in bariatric care (including bariatric surgeons), as it provides a framework for better prioritizing and assessing risk/benefit ratios than BMI or other anthropometric measures alone.

As I point out in my talk,

- The etiology of obesity is complex and multifactorial.

- The physiology of energy regulation is complex and subverts volitional attempts at weight loss.

- Access to obesity prevention and treatments must be driven by the recognised medical needs to address this condition.

- Multidisciplinary management of this life-long disorder requires resources similar to those required for other chronic diseases

In receiving this honour, I am fully aware that all of my work stands on the shoulders of the many researchers and clinicians who came before me and the considerable support and help that I have been fortunate enough to receive from my many students, trainees, colleagues and supervisors.

This award will certainly serve an a strong incentive to continue my work and advocacy for better treatments for obesity and the advancement of bariatric care.

@DrSharma
Montreal, QC

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Abstract submission deadline: October 23, 2014
  • Notification of abstract review: January 8, 2014
  • Early registration deadline: March 5, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Wednesday, August 27, 2014

XIX World Congress on Obesity Surgery, Montreal

ifso14 logoFor the rest of this week I will be reporting from the XIX World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) here in Montreal, Canada.

Although I am not a surgeon, staying up to date on all aspects of bariatric surgery is essential for anyone working in the field of bariatric care – and advances there are.

But I am not just here to listen. This morning, together with my colleague Sean Wharton, I will be presenting a 4 hour masters course on obesity management for allied health professionals and later today, I will be presenting a talk on the use of the Edmonton Obesity Staging System as a better way to determine the risk and prognosis of bariatric patients.

I certainly look forward to an intense week of learning and networking in this wonderful city.

@DrSharma
Montreal, QC

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Recommended Web Sites

Leading information on COPD. Receive new GOUT treatment information and find clinical trials at www.discoverclinicaltrials.com

Colleagues
Dr. Shafiq Qaadri - Official Site
Dr. Richard Tytus - Official Site
Dr. Stuart Weprin - Official Site

In The News

Diabetics in most need of bariatric surgery, university study finds

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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