The Powerlessness of Obesity "Treatment"

I would like you to take a look at this two-page editorial which was published in the New England Journal of Medicine - NEJM - in 2009.  It is in response to a research study, which we probably discussed at some point, which reviewed the impact of different macro nutrient combinations on weight loss in  a reduced calorie situation. 

I have always contented and made arguments regarding, the futility of diets.

Here are two specific points in the article by Dr. Martijn Katan that I want to bring to your attention:

Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices (p924)

AND

 ...we may need a new approach to preventing and to treating obesity and it must be a total-environment approach that involves and activates entire neighborhoods and communities. ... because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery(p924)   (YIKES!!)

 In the article, Dr. Katan gives an example of an intervention in France where one of the strategies used was "cooking workshops."  To which I say, "Volumetrics anyone?"  My You Tube channel is ready to hit the road :)

Referenced Editorial by:

Martijn B. Katan, Ph.D.

Published here:

N Engl J Med 2009; 360:923-925

 February 26, 2009

A Telling Definition

The terms health education and health promotion have several definitions,no agreed upon definition and are sometimes used interchangeably.  

Though I use this blog and other venues to educate people on health related issues - I still consider myself someone who primarily promotes health and wellness.

In a reading for one of my classes, I came across this definition of health education and thought, "Well - that is it then isn't it?"  And I wanted to share:

Attributed to Griffiths(1972) from the text listed below:

" health education attempts to close the gap between what is known about optimum health practice and that which is actually practiced."

In other words - the difference between what we know will keep us healthy and what we actually do.

From : Glanz, K., Rimer, B.K., & Viswanath, K. (eds). (2008). Health behavior and health education: 

Theory,  research and practice (4^th Edition). San Francisco: Jossey-Bass.  [page 10]

SSBs - HD, TG, WC, IFG and that is not what the headline said......

The American Heart Association held a conference in Orlando Florida over the weekend.  Many sessions were held during the event and new research was presented during some of them.  The conference topics were broken into large core groups and one of them, Epidemiology and Prevention of CV Disease: Physiology, Pharmacology and Lifestyle contained several presentations regarding sugar sweetened beverages and added sugar. A particular session titled, You Are (mainly)What You Eat, regarded a new (not yet published) study,  by Christina Shay.  Dr. Shay is from Northwestern University.   The findings that she reported at the conference have been making headlines all over the place in the last two days.  I have read the abstract and you can too, as well as some of the news stories themselves.  

There is a little bit of a disconnect between the two and as I LOVE to share truth - I will do so now.

I will start by deciphering my title.  SSBs you should know from reading my blog.  It stands for Sugar Sweetened Beverages.  For the study in question, the researchers compared the number of sugar sweetened beverages a person consumed in an average day to cardiovascular risk factors they later developed.  I will spell those out in a moment.  The amount of SSBs was determined through self report in a Food Frequency Questionnaire.  A sugar sweetened beverage was defined as sodas, teas and coffees - a health professional interviewed by one of the news agencies referred to the coffee drink as a dessert more than a beverage.  (I am not sure what they did about fruit, energy and sports drinks)  

The people involved in the study were part of a bigger study but we won't get into that just now.  For this analysis, the study included men and women of several ethnic backgrounds (US).  All were  between the ages of 45 and 84 at the beginning of the study which lasted from 2002 to 2007.  

At the start (or baseline), none of the participants had been diagnosed with heart disease (HD).  They were evaluated or measured at two additional times.  Associations between a person's intake of certain nutrients was compared with incidence of several outcomes.  (I imagine that SSB was not the only thing they looked into, but it is the only behavior they made associations with in this report).
The outcomes for which they found a statistically significant difference between groups include WC or waist circumference, IFG or impaired fasting glucose (a sign of insulin resistance and possible risk for diabetes), and TG or triglycerides (blood fats).  
They compared groups by SSB status.  The group that they considered a reference included persons who had one or less SSB per day.  Compared to that reference group, women in the study who drank 2 or more SSB a day, had more of an increase in waist size (WC), IFG and TG.  One of the results that is getting a lot of attention is that the 2+ a day SSB group was 4 times more likely to have clinically high TG.  Triglycerides are blood fats and it appears that excess sugar in the diet can lead to increased TGs.
I am not sure what the news stories were trying to articulate, but the emphasis they made was on increasing TG levels related to sugary beverage consumption, "even in skinny girls."  This may be related to the finding in the actual study or the truth that the 2+ group had increased waist size whether or not they had increased weight.  Increased WC is the risk factor for heart disease not increased weight - so the headline is misleading. 

It is also worth reminding people that sugar consumption is one of the main contributors to obesity because it is easy to consume more calories than you need or even realize your consuming with sugar products.
It is also important to note that refined sugar, in drinks or sweets, spikes the blood sugar.  Having this type of action in the body several times a day every day is a great risk for insulin resistance.  Diabetes is a cardiovascular (heart) problem.  We do not often think of it that way, but the condition leads to heart damage.  
The soft drink case is especially pronounced in women. 

Sex Ed Video

I showed my college level class a video tonight.  I  then began a discussion with these prompts:

Like/Dislike

Realistic?

As an educator or parent, would you show it to children?

A great dialogue ensued along with more thoughtful questions.  (i.e. does knowledge lead to action? Is the physical information accurate even if the context is not?)

Before we watched the video, I asked them to write down two things 1) their very first memory of where babies come from and then 2) their memory of when and how that belief was changed, expanded or shattered.  I haven't read their cards yet but I am looking forward to it. A few students did share part one - I shared mine as well.  A seed that grows in the belly (your whole life) until you are married and then a baby comes out :)

With that - I leave you to click this link and watch the video - which is created to educate children.

You might want to note my above questions before you do so you can play along!