Obese because your grandparents were in a famine?

Epigenetics, a very hot topic in bioethics and public health, may provide an explanation for the current obesity epidemic. Epigenetics deals with how gene activity is regulated within a cell - which genes are switched on or off, which are dimmed and how, and the transgenerational effect -- the implications for public health could be huge.

In this clip from the NOVA special, the Ghost in Your Genes, researcher Marcus Pembrey of the Institute of Child Health at University College London and his colleagues analyzed records from an isolated community in northern Sweden and found that men whose paternal grandfathers had suffered a famine between the ages of 9 and 12 lived longer than their peers; they also found that the mother's nutrition might affect a child's risk of obesity, too -- women in the Netherlands who were in the first two trimesters of pregnancy during a famine in 1944 and 1945 gave birth to boys who, at 19, were much more likely to be obese. The implication is that extended periods of feast or famine might trigger a switch to a pattern of gene expression that results in different metabolic states for future generations.



The realization that individuals can acquire characteristics through interaction with their environment and then pass these on to future generations of offspring will likely forcue us to rethink evolutionary theories such as Dawkins' selfish gene theory.

That's One Fat Baby!

by Emily Stephens

According to a recent study, child care may lead to rather chunky infants. A University of Illinois study collected data on more than 8,100 nine-month old babies, who were weighed and measured repeatedly between 2001 and 2002.

Fifty-five percent of the infants received daily care from someone other than a parent. Infants in part-time care gained 0.4 more pounds over nine months that those cared for by parents, and even those cared for by relatives gained 0.35 more pounds. Researchers believe this is primarily due to lack of breast-feeding and early introduction to solid food. In fact, other studies suggest breast-feeding for the first year of life may actually instill a physical protection against obesity.

Dr. David Katz, director of Yale’s Prevention Research Center warns that the threat of obesity is a new challege in America's nurseries. "Studies show obesity emerging as a problem even in the first year of life. This, in turn, results in a higher risk of diabetes in youth, and lifelong obesity and its many consequences."

Just how many infants are placed prematurely into day care? Back in March 1970, 24% of working mothers had children under two-years old enrolled in some form of care. By March 1984 that figure jumped to 46.8%. More currently, it is estimated that only 25% of infants are cared for by a parent in their own homes. The other 75% are watched by a baby-sitter or local family day care group (most often run out of a neighbor’s home). More startling is that only 6% of infants and 12% of children under two-years-old are enrolled in licensed center-based day care (U.S. Dept. of Commerce, June 1982). Furthermore, the choice of care is most often based upon affordability and convenience rather than quality.

After reading all those statistics, you can imagine how child care obesity could become a very real problem. Low-income families don’t necessarily have their pick’o’the litter when it comes to affording day care. Quality infant rearing can understandably take a back seat to making ends meet. Some studies do show, however, that average day care can benefit low-income children by preventing the IQ drop that typically takes place between the ages of 12 and 30 months for those living at home. At least these children have some room to benefit from the situation. The bottom line, however, is that the choice of care is more often determined by cost and availability, than quality.

Food choices served at day care also play a critical role in intellectual development of children. The July issue of the Archives of Pediatrics & Adolescent Medicine reported a study where Guatemalan children were given a protein-rich enhanced nutritional supplement between 1969 and 1977, and other children received sugary beverages. Between 2002 and 2004, almost 1,500 participants were given intelligence tests. As it turns out, the adults who were given the supplement early in their youth scored better on intelligence tests regardless of how many years they spent in school.

Food Wars, Part XIV: Conflict on the Menu

We've been posting a lot about food ethics in the last couple of months, so it is fitting that from the NY Times today: "New York City’s new rules for menu labels at chain restaurants have set off a food fight among the nation’s obesity experts.

Most support the theory of the city’s health commissioner that forcing chain restaurants to list the calories alongside menu items — flagging that a Double Whopper With Cheese has 990 calories, for example — will make patrons think twice about ordering one. The rules are set to take effect at the end of March."

However, in a court affidavit seeking to block implementation of the regulations, Dr. David B. Allison, the incoming president of the Obesity Society, argues that more harm could be done than good -- either by contributing to the 'forbidden-fruit allure of high-calorie foods or by sending patrons away hungry enough that they will later gorge themselves even more.'

Whether or not the injunction filed will be successful remains to be seen: The new labeling rules by NYC's Board of Health have support from a number organizations, such as Center for Science in the Public Interest, the American Medical Association, the American Academy of Pediatrics, the American Diabetes Association and the American Heart Association.

Full article and PDF link to the court filings here.

Good Idea, Bad Idea - Ban Serving Obese Customers

In today's edition of Good Idea/Bad Idea:
Good Idea: Educating people about healthy eating and activity, and why it's necessary for body health to be active in a variety of ways (cardio, strength training, etc).

Bad Idea: proposing a law to ban restaurants from serving obese people.

Republican Rep. John Read of Gautier, Mississippi has done just this - but assures everyone that he's just doing it to raise awareness of Mississippi's expanding waistline. Mississippi 'boasts' one of the largest populations in the country, as well as one of the fastest growing in size - something that's a concern to everyone from doctors and health policy advocates to the politicians in charge of things.

But actually pushing a bill in order to highlight the issue, when it's guaranteed not only that the bill will be vetoed right out of there, is nothing more than a waste of tax money that should be going for other issues - like, say, nutrition education programs. Or maybe that's just me...
-Kelly

In Blogging, Big is In

Is bigger better? Is fat 'in'? Is there an anti-obesity hysteria? Is the 'obesity epidemic' a hype, and the best thing would be to just accept our bodies as is and move on with life, rather than dieting, exercising, and trying to change our shape?

Well, if you look at the blogging universe, all indications are yes. And it's important to note that these bloggers, many of whom see nearly 4,000 unique pageviews a day, aren't just arguing that 'big is beautiful'. They're actually arguing that the medical experts are wrong and there's no obesity epidemic, that people come in all shapes and sizes, and as long as you exercise, eat sensibly, and are healthy (a philosophy known as 'Health At Every Size'), it shouldn't matter what your physical measurements are, or what size clothing you fit into.

The bloggers argue that changes in definitions over time, along with flaws in the body mass index formula, have pushed more Americans into the “fat” and “obese” categories, and they point to provocative studies suggesting that there may be benefits to being overweight, including a large study that found that underweight Americans are more likely to die than those who are moderately overweight.

Several other recent studies on heart patients and dialysis patients have also reported higher survival rates among heavier patients, suggesting that the link between body size and health may be more complex than generally acknowledged. Another study of people over 60 found that being fit has more bearing on longevity than simply being thin.

The bloggers’ main contention is that being fat is not a result of moral failure or a character flaw, or of gluttony, sloth or a lack of willpower. Diets often boomerang, they say; indeed, numerous long-term studies have found that even though dieters are often able to lose weight in the short term, they almost always regain the lost pounds over the next few years.

These are certainly complicated and often sophisticated arguments coming from people who are both vested in their interest, and are lay people who've done a remarkable job at educating themselves in a subject that many medical professionals don't full understand. But I see several inherent dangers in the fat-acceptance movement in the blogging universe.

First and foremost is a tendency to not separate out the difference between overweight and obese - and these are terms that, in medical parlance anyhow, do have different meanings. And while these bloggers have gone and educated themselves, their issue with the concept of BMI to determine health of weight has led them to lump the reports they cite, the ones that indicate being moderately overweight might have health benefits, with those who are morbidly obese. And there is a big difference to your health and body between being 20lbs overweight and being 100lbs overweight.

I'll be the first to agree that there is a problem with the BMI scale - but also the first to point out that you'd be hard pressed to find someone whose health would not improve if they were to lose 100lbs of extra weight.

The second, and perhaps more serious, problem I see with this fat-acceptance movement is that people are notoriously bad at underestimating the amount of food they eat. It is because of this typical tendency to underestimate the calories we consume that the New York City health commissioner, Dr. Thomas Frieden, is once again pushing to have calorie information clearly labeled on menus in the City. He believes (and I tend to agree) that people will quickly stop ordering their favourite appetizers when they realize that appetizer has 2500 calories.

It's very easy to say that you eat right and exercise and cannot lose weight - but in my experience, at least, I've found that most people who make this claim (myself included) tend to "forget" a lot of the calories they consume over the course of the day, or overestimate how many calories their exercising should burn. And without a strict log of what you're eating, and the help of a nutritionist, it's often difficult to know both of these numbers.

We do need to be careful that there is not a moral judgment when talking about people's weight. Shaming doesn't work as a weight loss tactic, and people shouldn't be shunned or ostracized for weighing more than normal. But at the same time, most people who are overweight are, at least in the eyes of people who work in this field for a living, like Dr. Walter C. Willett, professor of nutrition and epidemiology at the Harvard School of Public Health, overweight because of their lifestyle and not their genetic predispositions. I think we're doing a disservice to everyone by coddling feelings and pretending that weight doesn't have the ability to negatively impact health.

Now to be clear, I don't think everyone should be a size 6, nor do I think being ultra-thin is any better than being seriously overweight. But the condemnation of the so-called "thinspiration" blogs is pretty universal; no one seems to think they are a healthy concept, no one seems to think that they are standing up against some great medical conspiracy or anti-thin hysteria. In fact, just about everyone seems to think they are very unhealthy mentally and physically, and something should be done about them. I just wonder why blogs on the other side, making the argument from a "fatspiration" rather than "thinspiration" point of view don't receive the same critiques.
-Kelly

(Lack of) Popularity Linked to Obesity?

A new study from the Archives of Pediatrics and Adolescent Medicine says that how popular a girl perceives herself to be will affect how she gains weight - and how much. The study asked girls aged 12 - 18 a series of questions to rank their own assessment of their popularity, recorded the girls' BMI, and then came back two years later to repeat BMI measurements. The researchers apparently adjusted for a host of variables, including "age, race/ethnicity, baseline BMI, diet, television viewing, depression, global and social self-esteem, menarche, height growth, mother's BMI, and pretax household income" and still found that "adolescent girls who placed themselves on the low end of the school subjective social status scale had a 69% increased odds of having a 2-unit increase in BMI during the next 2 years compared with other girls."

While a part of me wants to react with the "well, yes... of course" reaction of the sort of obvious science that people do where you already know the answer, someone just had to quantify it, another part of me wonders if they're really looking at the right thing at all. If the researchers looked at an earlier age, would they find the same thing, or would they find other causes of weight or social ostricization that lead to either increased weight gain or feeling unpopular? Perhaps the girls who feel they're popular feel like they have to keep up an unhealthy physical image, or partake in disordered eating habits (anorexia, bulimia, etc). I don't know, it just seems a little too neat.

The other thing that seems a little too neat is the suggestion that schools and parents should work on fostering social skills in girls, as if this alone will increase their popularity. I think by very virtue of the concept, some girls will be more and some less popular - improving social skills isn't likely to change that. As far as I recall being a teenager, there's always something to ostracize someone with. Either they're too tall, too short, have developed faster than the rest of the class (or slower), look different, move oddly, aren't coordinated enough for cheerleading, spend too much time with computers or games or any number of things that kids look for as defining differentials. Suggesting that there's a way to eliminate a popularity battle seems to indicate that it's definitely been a while since the researchers were in high school themselves.
-Kelly

The link between weight and likely cause of death

As our bloggers have commented several times before, the science of obesity is contested, uncertain, and as Medical Humanities Blogger Daniel Goldberg said, 'heavy with value-laden beliefs'. Confirming this uncertainty, today, Gina Kolata of the NY Times reports that an article in the Journal of the American Medical Association shows overweight people are much less likely to die from diseases such as Alzheimer’s, Parkinson’s, infections, and lung disease, and that the lower risk is not counteracted by increased risks of dying from any other disease, including cancer, diabetes or heart disease.

Of course, the study cannot speak to cause and effect -- but it certainly underscores that science has a lot to learn when it comes to studying optimal weight.

Obesity in the News, part two (or 'Can Fat Be Fit?')

In light of Kelly's earlier post about the media's obsession with obesity being more epidemic than obesity itself, I thought it was timely that this article just came out in Scientific American:

"Can Fat Be Fit?

A well-publicized study and a spate of popular books raise questions about the ill effects of being overweight. Their conclusions are probably wrong.

By Paul Raeburn

Two years ago Katherine M. Flegal, a re­search­er at the Centers for Disease Control and Prevention, did a new statistical analysis of national survey data on obesity and came to a startling conclusion: mildly overweight adults had a lower risk of dying than those at so-called healthy weights..."[Full text here]

The article goes on to explain that the states are high in this debate...that a "major thrust of the nation’s disease prevention efforts are aimed at ending what orthodox researchers say is an epidemic of obesity." And if obesity is not the primary cause of heart disease and other serious illnesses, then efforts to trim American waistlines are entirely misplaced.

Language does matter -- I've heard it said that obesity is the last bastion of socially acceptable bigotry. I recently overheard some young women in Europe, standing outside a hotel having a cigarette break, saying that the reason they smoke is so that they don't 'get fat'. But there are worse than being 'fat' -- likely being sedentary. Or dead from lung cancer.

One the things that so many of the articles fail to mention is the importance of regular physical activity -- that the fitness that results from regular exercise confers a variety of health-related benefits in obese patients even if they lose no weight. It seems to me that regular exercise is a far more reliable indicator of health than simple body mass -- based on BMI alone, Brad Pitt, Keanu Reeves, and Michael Jordan are all overweight. And George Clooney and Matt LeBlanc are obese. In fact, a quick review of literature revealed this gem of a study, by Warburton, Nicol, and Bredin: "We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death." All that, with barely a mention of BMI.

To which I say, let's do a celebratory jig.

Obesity in the News (or, Why Language Matters)

Obesity research is all over the news today:

From the BBC, obesity is linked to birth defects and health risks: a large scale study in the journal Archives of Pediatrics and Adolescent Medicine says that women who are obese when they conceive are more likely to have chronic diseases, fertility problems, miscarriages and complications during pregnancy, as well as birth defects including missing limbs and malformed hearts.

Then there's a study reported in Cell, which suggests that the skeleton is part of the endocrine system, specifically helping with the regulation of osteocalcin, which in addition to regulating mineralization appears to regulate glucose and deposits of body fat. This likely explains, at least in part, the connection between obesity and type two diabetes; researchers will move forward to look more closely at this link, next.

Following that, a study out of UPenn says that obese kids are more absent from school than others, and in fact suggests that obesity is more an indication for how much school a child will miss than any other factor, including race, gender, or socioeconomic status. The lead researcher is pretty succinct about why this is, too: the kids don't want to be teased or bullied over their weight.

According to a report at an American Physiological Society meeting, estrogen loss leads to weight gain, as well as hypertension, suggesting that estrogen treatment is beneficial for both the heart and the body.

And finally, it looks like people overeat due to another hormone-gone-wonky. People who don't manufacture leptin tend to overeat, becoming chronically obese. People who are deficient in leptin have the same areas of their brain react, at the sight of food, that react to rewarding emotions/desires.

So what's the point to all the fat talk? For some people, fatness, being overweight, obesity, is simply a medical issue. You are overweight for a reason, be it medical or psychological, it is bad for you, you should work on not being overweight, which is good for you. There are clear concepts of good and bad tied to this model of viewing weight, and it tends to be a part of the general medicalization of weight we see - to be thin (but not too thin) is healthy, to be fat is to be unhealthy. And within healthy/unhealthy there are specific moral and value-laden beliefs that tie into good and bad; to be healthy is to be good, to be fat is to be bad.

But there are people out there, often people who are overweight, that reject this sometimes value-laden, binary attitude towards weight. They are comfortable with their weight, and don't appreciate being "bullied" by society to adhere to an ideal they don't believe is accurate. These folks often espouse the motto "healthy regardless of weight", placing an emphasis on health outside of weight. After all, the reasoning goes, if someone is 65 lbs overweight, but perfectly healthy otherwise, what business is it of anyone just what that weight is? People come in all sizes, and as long as the individual is healthy, what that size is shouldn't matter to anyone. While this group, often known as fat activists, embrace the notion of being healthy, they reject the idea that healthy is thin is good, and unhealthy is fat is bad.

How news reports discussing obesity are received tends to depend on how they are written. If they are written, as most are, in the medicalized and moralized language of the first model, a group of people - perhaps the group of people most affected by the research being reported on - are alienated from the outset by the language, and judgment, being used. People are sensitive to the language being used to describe them, and very few people respond positively to being preached at.

A healthy body is a goal that is hard to argue with, and if we communicated consistently in such a manner, we might very well discover that many of the medicalized concerns about the overweight/obese would be addressed to everyone's satisfaction.