Myths, Assumptions, Nuances and Obesity

I have been writing about health and wellness in one form or another for 13 years. During that time I have gone to graduate school twice.  
My plan for the blog has always been to present information to the public that goes beyond the headlines.
My goal is to educate the reader in the hopes that he or she will take new science and recommendations for better health into consideration.   These recommendations include consuming a quality diet, getting sufficient exercise, limiting sedentary activity and maintaining a weight lean enough to prevent diseases that are associated with adiposity - or over fatness.

My understanding of research has improved over the years, especially the last few, but the science into the causes of obesity (adiposity) has been plagued with flaws.  Scholars far more experienced and critical than I, have begun to point out these flaws.
I tell you this because I am sensitive to the fact that I may have perpetuated false claims in my own blog or given too much credibility and attention to tenuous claims.  This exactly opposite my goal.  

Here I am speaking about diet quality and healthy weight.
It IS still about calories and the sources of those calories, but it is much more nuanced.  By nuanced, I mean that numerous factors are independently and interdependently related to health and weight.  

There are many problems with the methods used in obesity research and that makes it hard to pull together evidence that can suggest a solution.  Science has taught us a lot. We now need to use more precise measurement methods (e.g. with dietary recall, and body fatness), be consistent with our definitions (what is obesity?) and have more open minds about what the causes could be (is it really just too many calories ?).

This was wonderfully explained by Herbert et al (2013) in a commentary published in the journal Mayo Clinic Proceedings.  The summary can be found here.  They give good advice for improving research.  I will apply this advice in my career.

I will continue to talk about calories (food energy availability) and policies, but these are small parts of a very complex, multi -facted system.

Let me quote from the Herbert article.  I assure you that I believe every word in this paragraph.

...obesity arises from the dynamic interplay of the external environment, inclusive of the social milieu, built environment and food energy availability, behavioral and development processes and a variety of genes and epigenetic effects that, in turn, control a myriad of metabolic systems and subsystems that regulate energy intake, energy expenditure and nutritional partitioning.   

Now I will do my best to restate this in simpler terms:

There are many factors both inside and outside of our bodies that work together to create a condition where obesity is likely.  As one factor changes one or more others reacts and these changes and interactions are continual (dynamic). The external environment can make it easy or hard to be physically active (built environment) and easy or hard to eat too many calories (especially nutrient poor ones) (i.e., food energy availability). These two factors are also impacted by social cues (preferences, norms, advertising, ' peer pressure' - i.e., the social milieu).  Behavior is what we do - exercise or not, choose certain foods or drinks, and development is the body changing over time.  Genes, or heredity, are usually activated by some interaction with the outside environment (epigenetics) and together impact how the food a person eats is processed by the body - whether or not one gets high cholesterol, or diabetes for example.

That is a lot to process.  The simplest truth is that one should not eat too much, and a very complex set of circumstances determines if one eats too much and whether their eating too much causes a bad outcome (illness).   I would point out one last thing from the article.. the authors say that it is social and environmental factors, NOT genes, that have had the greatest influence.

So here are 3 interesting links about calories.
Link 1 This is a story about peoples desire for calorie information and how some restaurants are starting to provide lower calorie meals.  It actually summarizes a lot of the research I have used in my literature reviews and in this blog.  I love how it mentions Dardens Restaurants use of nutritionists and calorie counts when creating new entrees.  Also, it points out some REALLY high calorie entrees ~ over 2000.  Oh one problem, the writer keeps referring to the national menu law as a proposed law.  The law is a law.  It has been passed.  The rule - how to follow the law, is being proposed. 
Link 2  This links to a 3 item quiz on which item has the lowest amount of calories... I scored 100.
Link 3  This links to a story about smoothies and juices, both of which I personally avoid at all costs.

A Case for a Junk Food Tax

I, personally, do not need to read any one's research to convince me that raising the price on soda and sweets is a good idea. I enjoyed the economic scenario that was presented some time back by the NY Department of Health and appreciated that the tax, if nothing else, would be a great source of revenue. And YES it sounds like the cigarette tax because it is the same type of thing. Of course, like cigarettes, the first few years of the tax will bring in the most money, so good for the budget, but at the same time and over time, the result could be less money spent on those non nutritive items and ideally, obesity rates would decline.

But this week, there was another bit of news about the issue. A researcher from the University of Buffalo, Dr. Leonard Epstein, has completed at least a little experiment, but I am not finding any publication. Some of the major news outlets reported on it, but the University website does not have anything. (I did see that Dr. Epstein had a lot of published work regarding both obesity and tobacco. And he created the basis for the GoSlowWhoa programs, which I think are awesome)

Anyway, he and I imagine some of his research students, set up a very small study of 42 women who went "virtual" shopping. The stores they set up had pictures of items, not real items. They were given budgets and told to shop for the week as if there were no food at home. The grocery stores were then set up in a few different ways. One had the items all priced at current retail costs. In other words, the junk food cost what it cost and so did the healthier items, fruits, vegetables, yogurt, sugar free beverages, etc. Another scenario had the junk food prices the same as usual but the healthier items cheaper and another had the healthier items constant but the junk food items MORE. Only in the last scenario did the researchers see a change in behavior for the better. It appeared that when the shoppers saved money on the healthier food items, they used the extra cash to buy more junk food. (WHAT?!)

This is not a conclusive case for raising the junk food tax, but an interesting little study none the less.

Investing in Obesity

This is a follow up to a post earlier this week that mentioned the standards that obesity drug makers had to meet for FDA approval of their drug.

There are three drugs that are showing promise these days. They are all in late stage trials and so have proved safety, minimal side effects and efficacy. They now have to meet the FDA standard of at least 5% weight loss in a third of the study group and a doubling in the number of weight loss experiment “losers” compared to the placebo group.

Recently Arena Pharmaceuticals had noted some success and were due to release results of their most recent trial, today. Yesterday there was a lot of buying of the company’s stock, ahead of the report.

I tell you this because obesity is big business and investors go nuts over the thought of owning shares of that true block buster drug.

It is said that the results related to lorcaserin were not as significant as hoped and some shares were promptly sold this morning. The problem being that the placebo group also lost weight with a comparison of 6.5% body weight lost in subjects to 3.9% in placebo. Perhaps too close to get FDA approval.

What I found interesting in the Miami Herald article I read was this statement, “a program of moderate diet and exercise is standard for all patients in late-stage studies of obesity drugs.” REALLY? Why will a person participate in this safe and effective weight loss “concept” in a drug trial but not in real life?

The other two drugs that are vying for market share and FDA approval are Contrave and Qnexa. Where do these names come from?