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A New Nosology, the RDoC
March 6th, 2015
A nosology is a system of disease classification, and the National Institute of Mental Health (NIMH) is promoting a new one, the Research Domain Criteria (RDoC). Yesterday, Childhood Obesity News outlined the basic characteristics of the systems already in place, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases and Related Health Problems (ICD). Karen Franklin, Ph.D., forensic psychologist and adjunct professor at Alliant University in Northern California, says:
Mental health professionals know not to take the DSM (or the ICD, for that matter) too seriously. It’s just convenient fiction, or at best “useful constructs,” mainly used to attain insurance reimbursement….
We also touched on case formulation, the preferred diagnostic approach of some healers. The illustration on this page is a chart from Dr. Adam Blatner’s “The Art of Case Formulation,” which serves to remind us of just how many different things might play a part in any given illness. Unfortunately, being such an art, case formulation is not eminently suited to the modern need for speedy and concise information delivery. NIMH realizes that diagnostic science is not keeping up. Because mental function depends on multi-layered systems, new ways are needed to classify mental disorders based on both observable behavior and neurobiological test results. Dr. Franklin reminds us:
Remember when they first announced work on the new DSM? It was going to be a revolutionary “paradigm shift,” aligning diagnoses with modern science. Disorders were going to be dimensional rather than categorical…
But it didn’t happen. To give an example of the difficulties that impact childhood obesity, here is a problem that did not disappear with the new DSM revision:
While the DSM-IV uses a categorical classification system of mutually-exclusive diagnoses, patients with eating disorders often develop symptoms consistent with more than one diagnosis over the course of their illness, demonstrating shifts between diagnoses known as diagnostic crossover.
According to those who want change, DSM and ICD are perceived as too rigid. In the legal system, which clings to the DSM with fervor, Dr. Franklin points out that “the consequences of error can be grave.” But the real burr under the saddle is that, in the United States, the DSM has a stranglehold on the research grant application process. Dr. Bruce Cuthbert says, “The whole machinery of science is governed by the DSM.” The call for change, then, is a demand for more useful research standards and criteria.
To educate mental health professionals about RDoC, the federal mental health agency set up a webinar to explain its preferred new way of categorizing mental disorders. The initiative is led by Dr. Cuthbert, who introduces, “the guiding principles… the role of the new RDoC unit, and frequent questions researchers have….” Here is the best part—the 47-minute presentation is viewable by the public!
The new RDoC is touted as a flexible tool capable of achieving a happy medium. At first blush, it does sound as if RDoC is more conscious of all the possibilities listed in Dr. Blatner’s chart of physiological and psychosocial factors. But there is another point of view, capably represented by Dr. Franklin, who opines that:
Switching to its biology-worshipping Research Domain Criteria is like jumping from the frying pan to the fire.
Your responses and feedback are welcome!
Source: “DSM-5: Forensic applications (Part II of II),” Blogspot.com, 05/30/13
Source: “The Art of Case Formulation.” Blatner.com, 09/15/06
Source: “NIMH Webinar Explains New Way of Categorizing Mental Disorders,” madinamerica.com, 12/06/14
Source: “DSM-5: Much ado about nothing? (Part I of II),” Blogspot.com, 05/29/13
Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Image by Adam Blatner, MD
Meet the Research Domain Criteria
March 5th, 2015
Not long ago, Childhood Obesity News considered two of the major structures under which medical professionals sort diseases. Many healers are not totally on board with either of these taxonomical schemes, but insurance companies and other bureaucracies insist upon them. Worldwide, 60 percent of psychologists use a diagnostic classification system. As we noted, the hallmarks of a good one are simplicity, reliability, and ease of use. The professional who uses the system makes important decisions about the management and treatment of patients’ health problems. A system with fewer categories is preferred—if they are the right ones.
Sections of the Diagnostic and Statistical Manual of Mental Disorders were vigorously disputed during revisions for the current edition, DSM-5. We are, of course, particularly interested in the parts that cover eating disorders and other conditions impacting childhood obesity. The National Institute of Mental Health (NIMH) believes that the DSM-5 diagnoses are inadequate because they are “based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” If NIMH has its way, the Diagnostic and Statistical Manual will no longer be the “gold standard.” The agency has announced its intention to no longer support DSM-based research.
It has been determined that fewer than half of the psychologists are in the DSM camp. However, 60 percent of them are said to routinely consult the International Classification of Diseases and Related Health Problems (ICD). Both publications have been referred to as bibles, but really the term should apply to a book that has a fair claim to being the only one in its class.
Other Contenders
Also there is the Research Domain Criteria (RDoC) project, a new government-approved research framework that incorporates genetics, imaging, and cognitive science. NIMH director Dr. Thomas Insel explains:
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior… Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment…RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders.
Some mental health specialists prefer a very un-system-like system called case formulation, in which each patient suffers from a unique condition. Dr. Adam Blatner says,
A good formulation should be a kind of story, weaving together many threads…The organization of a formulation would depend on whether the patient is suffering from chronic or acute symptoms, or both. Similarly, is the patient involved in complex family interactions or do the symptoms seem to be confined primarily only to the individual? Are there significant associated medical conditions or dysfunctions at the level of cortical neurotransmitters? Are the stressors obvious and significant or minimal and elusive?
Announcement
Dr. Pretlow’s paper, “Treatment of child/adolescent obesity using the addiction model: A smartphone app pilot study,” will soon be published by the journal Childhood Obesity (and also online, of course.)
Watch this space!
Source: “Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey
tandfonline.com, 2015
Source: “Director’s Blog: Transforming Diagnosis
NIH.gov, 04/29/13
Source: “The Art of Case Formulation
Blatner.com, 09/15/06
Image by Scott Dexter
W8Loss2Go Helps in Stages
March 4th, 2015
The W8Loss2Go smartphone application is designed to halt food cravings and stop the urge to snack between meals. The 5-month program starts by eliminating the most tempting “problem foods” one or two at a time, a process which was shown by the preliminary studies to be surprisingly free of withdrawal symptoms. Dr. Pretlow says:
Successful withdrawal from a food was defined as self-reported resolution of cravings for the specific food, with a minimum required withdrawal time of 10 days for each food. The respective food would then be designated as “In-control” by the app, and the participant would proceed to withdraw from the next food.
Next, the participant is helped to curb snacking. So far, it has been possible for 70% of study participants to quit snacking entirely, while 30% were able to greatly reduce snacking frequency.
The most essential function, excessive food amounts withdrawal, takes place over 12 weeks. The method is reduction of mealtime amounts by small stages, which the app guides a young person through in an incremental manner. This “baby steps” approach of subtracting a bit each time minimizes discomfort and helps the user to not miss the customary amounts or, eventually, the food itself.
Let’s invent a 14-year-old named Skip. What Skip will do is weigh every food amount he typically eats at meals with a wireless food scale and record it, up to a total of 20 foods. Given this information, the app guides Skip through the subsequent steps. At each meal he will place a plate on the scale, enter the food and its weight into the app, and let the app tell him how much to remove from the plate to achieve the next increment of reduction. He will repeat this for each different food that composes the meal, and then snap a picture of the plate, which is viewable by his mentor.
An Early Lesson
Of note from the W8Loss2Go pilot study is that the technique did not work well when the young person was allowed too much discretion. In the beginning, after taking a serving of food, the participant was asked to merely return one-quarter of the amount. But this led to indecision about how much to serve out initially, and about how much to put back. This uncertainty was stressful, and as we know, the result of that is “stress eating.” Much better results are obtained by handing these decisions over to the app.
The app allows no second helpings, of course, and the use of smaller plates or bowls has a helpful psychological effect. Parents are asked to lend a hand in several ways, including not keeping serving bowls on the dining table.
The concept of staged food withdrawal is shown to be easily acceptable by the kids who have tried it out, and quite feasible as an addiction-based treatment model. The smartphone platform, aided by input from health professionals, brings a lot of hope to the area of childhood obesity mitigation. So far, Skip is more likely than Sue to achieve real progress. Dr. Pretlow notes:
This approach has considerable potential to address a critical treatment gap in childhood obesity especially for boys. Future programs need to investigate tailored techniques to the addiction approach for girls and older adolescents.
So far, three pilot studies have been conducted of this intensive treatment using addiction medicine methods, and the potential is great for helping overweight and obese young people to help themselves.
The page titled Weight Loss App Pilot Study Information gives details on the upcoming study which starts in early fall of 2015. Any parents of obese kids in the area of Kirkland, Washington, might want have a look.
Your responses and feedback are welcome!
Everything You Know About Sugar Is Wrong
March 3rd, 2015
With one of the major eating festivals on the horizon, Childhood Obesity News looks to Scientific American’s Ferris Jabr for information on the toxicity (or not) of sugar. This topic also fits into the “everything you know is wrong” niche for contested theories, which seem to be particularly abundant in the field of obesity. As we have seen, a large number of health professionals are against sugar in any form, assigning it responsibility for the obesity epidemic, the rise in cardiovascular disease, and the surge in Type 2 diabetes and other metabolic disorders. However, there is contrary evidence. Jabr examined a 2011 study in which a team analyzed data collected from 25,000 Americans, noting:
They did not find any positive associations between fructose consumption and levels of trigylcerides, cholesterol or uric acid, nor any significant link to waist circumference or body mass index (BMI).
This result surprises no one, because the research was conducted by a big food processing company. But as it turns out, even some scientists who are apparently not backed by the high fructose corn syrup industry think that the widely-demonized HFCS is not so bad.
One such voice belongs to John Sievenpiper, of St. Michael’s Hospital and the University of Toronto, who conducted a series of meta-analyses in which he examined dozens of human-based studies. The research team found “no harmful effects of typical fructose consumption on body weight, blood pressure or uric acid production.” Sievenpiper suggests that a person with a weight problem would do well to cut back on sugars, but to expect a magic-bullet effect across the board, in all populations, would be unrealistic because, “obesity is more complex than that.”
Jabr gives a helpful explanation of the difference between fructose, glucose, and sucrose, and what High Fructose Corn Syrup is all about. Whether a person eats table sugar or HFCS doesn’t matter much, because it all breaks down into glucose and fructose molecules. But when a person’s diet is top-heavy with fructose, the liver has to work too hard because it is practically the only place where the body can convert the stuff into energy. A stressed liver pushes back by overproducing uric acid, which can lead to high blood pressure, kidney stones, gout, and medical bills.
Sugar’s Bum Rap
Fructose especially has a terrible reputation, being blamed for insulin resistance, stuffed-up arteries, and fatty liver disease. Jabr learned that, like many other laboratory explorations of substances, some of the major fructose studies bear little relation to reality. (Incidentally, some serious doubts have arisen in recent years about the diabetes mice.)
First of all, the subjects are rodents, which although similar to humans in some ways, are unalike in important respects. For instance, when fructose goes into rat bodies, their livers turn half of it into fats, whereas a human body only does this with one percent of the fructose it receives. This is only one example of differences in the metabolic processes of the two species.
Another factor is that humans rarely consume fructose molecules unaccompanied by glucose molecules, because food just doesn’t grow that way. Even table sugar contains both elements, and HFCS does too, only more of the fructose. But the lab animals get pure fructose, which is enough to make an experiment invalid in some critics’ opinions. Also, rodent experimenters tend to slam the subjects with grotesquely exaggerated doses of the substance being assessed.
How it All Adds Up
Jabr allows that one deleterious effect of fructose in humans might require further scrutiny. It seems to lead to production of the hormone grehlin, which makes people think they are hungry. Glucose, on the other hand, fosters the production of leptin, which makes people think they have been fed and are not currently hungry. To be in one or the other of those mind-states makes an enormous difference in eating habits. He seems to feel the appropriate response is to not worry about which kind of sugar is worse, but cut down on all of them. He says:
A small percentage of the world population may in fact consume so much fructose that they endanger their health… But the available evidence to date suggests that, for most people, typical amounts of dietary fructose are not toxic.
Exercising, favoring whole foods over processed ones and eating less overall sounds too obvious, too simplistic, but it is actually a far more nuanced approach to good health than vilifying a single molecule in our diet—an approach that fits the data.
Luc Tappy of the University of Lausanne sums up the argument in the phrase “entirely dispensable nutrient.” In other words, sugar is one nutrient we don’t need to worry about lacking. We get enough of it through ingesting a reasonably sane diet, and there is no need to sprinkle it on or stir it into anything. The adjective “dispensable” suggests a call to action: dispose of it.
Your responses and feedback are welcome!
Source: “Is Sugar Really Toxic? Sifting through the Evidence,” ScientificAmerican.com, 07/15/13
Image by: Very Inappropriate Vintage Ads
The Disturbing Truth about Emotional Eating
March 2nd, 2015
On this page is a link to a free chart that spells out the differences between physical (real) hunger and emotional (bogus) hunger. A book* called Constant Craving, by Doreen Virtue, introduced the chart with these words:
Emotional and physical hunger can feel identical, unless you’ve learned to identify their distinguishing characteristics. The next time you feel voraciously hungry, look for these signals that your appetite may be based on emotions rather than true physical need. This awareness may head off an emotional overeating episode.
The chart asks a series of questions, and Elizabeth Arnott recommends making a printout to hang on the wall for daily consultation. (These days, the questions could also be programmed into a smartphone.) Every time a hunger pang strikes, the checklist would be right there.
“Did a huge hunger just show up all at once?” the checklist might ask, because sudden onset is said to be a sure sign of emotional hunger. On the other hand, physical hunger impinges on the awareness gradually, sending out “steadily progressive clues.”
“Do you desire a specific food?” would be another question. The more specific the craving, the more likely it is to be emotional hunger. “Do you feel guilty about eating?” is always an excellent question to ponder, because chances are, guilt is the mind admitting to itself that what is involved here is pure emotional hunger.
Another thing to watch out for is automatic, absent-minded eating. Eating should always be conscious, and any lapse into robotic behavior is a danger sign. And a very pertinent question is, “Do you ever feel full?” Because if you don’t, something is not functioning correctly, and you are eating emotionally in an attempt to fill a bottomless hole.
Another Facet of Comfort Eating
But there is more to it. This comes as a surprise to many people, who only think of comfort eating as a method of self-medication to compensate for something that is missing, or to mask and smother negative psychological states. No doubt some people are astonished to hear a deeper truth from someone who has been there.
Actor and comedian Jeff Garlin, known to many from the TV series “Curb Your Enthusiasm,” reminisced in a recent interview (conducted by Marc Maron) about his days as a binge eater. His habit was to go to a favorite convenience store near a baseball stadium and “buy a bunch of crap and sit on the hood of my car by the left field wall, and just down it.”
Of course he realizes now, and probably did even then, that unhappy feelings can only be stuffed down temporarily, and as a result a person ends up feeling worse. But here is the surprise, in Garlin’s words:
It’s any feeling. It’s not bad feelings, it’s any feeling, anything you feel you want to shove down.
This obviously is much worse than a condition that only activates in response to unpleasant stimuli, and points the way to realization of how seriously debilitating emotional eating can be.
*“Constant Craving” was also the title of a 1992 k.d. lang song, which predated Virtue’s 1999 book.
Source: “Emotional Eating,” Elizabeth-Arnott.com, 11/28/12
Source: “Episode 567 – Jeff Garlin,” Wtfpod.com, 01/12/15
Image by kyknoord
How to Vanquish Controlling Influences
February 27th, 2015
Mardis Gras
Childhood Obesity News is exploring the idea that for a large part of the Western world, the religious season of Lent has served as a trial run for quitting sugar. For some, it has no doubt been inspirational, and led to permanently sugar-free lives. But for others, the thought never occurs – “I’ve been 40 days without sweets—maybe I should double down and go for 80!”
The season of devout abstention is not the ideal rehearsal hall in which to train for a sugar-free life. In some branches of Christianity, Sundays don’t count as part of Lent. A regular “cheat day” would mess up any serious attempt to become unhooked from a substance, so anyone following that schedule would never have the opportunity to taste real freedom from the addictor.
No doubt there are always people who have issues with other tenets of the religion, and who add the idea of giving up something for Lent to other dissatisfactions, feelings of being coerced, and so on.
Counterproductively (for potential sugar addicts), what follows Lent is the day when loving parents are encouraged to give their children baskets full of high-calorie treats. Weeks of deprivation are rewarded with a cache of confections. In fact, Lent also begins with a blowout. Fat Tuesday, more widely known as Mardi Gras, is a goodbye to pleasure before the six weeks of doing without. In this tradition, withdrawal pain is bracketed by two feast days, and the foreknowledge of the limited time period is an important element of the practice.
A Useful Comparison
Over the centuries, Lent has provided millions of people with the impetus to try giving up sweets. Sometimes the separation doesn’t work out, and sometimes it does. Either way, there may or may not be a direct, cause-and-effect relationship with weight loss.
Maybe giving up sweets for Lent will not result directly in immediate slimming. That would depend on a lot of individual and cultural factors. But consider it a psychological exercise equivalent to, well, physical exercise. There is even dissent over the usefulness of physical activity. For instance, The Early Bird Study seems to indicate that exercise does help not overweight children lose weight.
On the other hand, Dr. Colin Higgs, who founded the Active Start activity plan for children, lists the promotion of healthy weight as only one of many benefits gained from exercise, which also does 14 other things, and:
… a child who’s busy developing good brain function, coordination, social skills, gross motor skills, leadership, imagination, confidence, good posture and balance, a strong frame, a resistance to stress, and all those other positive attributes will consequently be a happy and well-coping kid.
The point is, all of those benefits create fertile ground for the growth of a desire to pursue a healthy weight. Likewise, a temporary period of abstinence from sweets can blossom, eventually, into a passion for health. Joshua Becker calls the things people give up for Lent “controlling influences,” and that very term might help to overcome resistance to change. When kids reach a certain age and begin thinking for themselves, they typically become, at least in theory, fiercely resistant to controlling influences.
When confronted with intervention designed to curb their obesity, it is likely that many young people perceive it as control imposed by adult authority figures. Even if they are miserably fat, the first impulse may very well be one of rebellion. Maybe one clue is to take that resistant energy and turn it back on itself. Maybe the secret is to re-frame the intervention as a key to the tools that can vanquish other “controlling influences” and put the child in the driver’s seat of her or his own life. Becker’s essay “The Opportunity of Lent” offers examples of the ways in which these indirect “side effects” can affect a person, and it isn’t even necessary to be religious.
Your responses and feedback are welcome!
Source: “Childhood Obesity and Activity,” ChildhoodObesityNews.com, 10/21/10
Source: “The Opportunity of Lent,” BecomingMinimalist.com, 02/22/12
Image by Infrogmation of New Orleans
When Practice Does Not Make Perfect
February 26th, 2015
Last time we talked about how, since sugar is one of the cheapest and most widely available worldly pleasures, it has historically been a popular substance for Christians to give up during the penitential season of Lent, which varies from 40 to 47 days depending on the denomination. It’s about 6 weeks, and for consistency in discussion we go with 40 days. Through this cultural mechanism, a lot of people have had a chance to grapple with the lure of sugar, and its addictive quality has become widely recognized on a “folk” level.
The degree of commitment makes a difference, of course. To only quit eating candy bars, or to just stop putting sugar in coffee, does not get the job done. The conscientious effort to expunge every gram of sugar from the diet is a fiendishly difficult task. It’s so easy to ingest without even knowing. To really, truly quit sugar requires study, because otherwise a person will be unaware of all the places it can lurk and all the aliases it hides behind. A webpage from the Harvard School of Public Health emphasizes the complexity of the problem, as these excerpts show:
Some ingredient lists mask the amount of sugar in a product. To avoid having “sugar” as the first ingredient, food manufacturers may use multiple forms of sugar—each with a different name—and list each one individually on the nutrient label.
Food makers can also use sweeteners that aren’t technically sugar—a term which is applied only to table sugar, or sucrose—but these other sweeteners are in fact forms of added sugar.
When reading a label, make sure you spot all sources of added sugars even if they’re not listed as the first few ingredients.
Surely there must be individuals for whom sugar abstention is a serious, deeply-researched project, and some even make it through to the end without caving. But then, the season of deprivation is over, and sugar’s identity as a major addictor probably accounts for why relatively few people use that victory as a springboard and go on to refrain for more than 40 days. So when Lent comes around again next year, they face the same withdrawal misery all over again—or pick something different to quit.
Then too, plain old human fallibility is a factor. However strong a person’s initial resolve, backsliding is always a possibility. Once that happens, the temptation is huge to simply forget the whole thing. As the jocular saying goes, “I gave up giving up.”
From the Outset
Intention is the infrastructure on which any such effort is built, and temporary abstention is not the same as a full-on commitment to quit. Psychologically, there is a vast difference between knowing that the deprivation will only be for 40 days, and knowing there will never be another cupcake. In the religious framework, the prohibition has a pre-determined end point, and a person can bolster determination with self-talk like “This is difficult, but it will eventually be over,” and “Only 10 more days.”
But never? That’s a long time and the concept of “never again” is very hard to face. Why haven’t more people taken advantage of the head start provided by Lent and given up sugar permanently? The short answer is that many have done so. But it may be that for a lot of people, the season is not long enough to produce convincing results. The physical body has to clear toxins, and its metabolism has to learn new ways of processing nutrients. The mind and emotions have to make big adjustments too. How long do cravings last? Ask experts, ask former sugar addicts, and either way the replies are all over the map, from five days to three weeks to three months—and 90 days is more than twice as long as Lent.
Your responses and feedback are welcome!
Source: “Added Sugar in the Diet,” Harvard.edu, undated
Image by Sascha Kohlmann
How People Discovered the Truth about Sugar
February 25th, 2015
Scientists often view anecdotal evidence with suspicion. What happens in laboratories is given more weight than reports from everyday people about things that happen in real life (referred to as “self-reported” evidence, and often taken with a large grain of salt). But perhaps the idea of sugar’s addictiveness was first taken seriously because the anecdotal evidence was so overwhelming. For hundreds of years, the world has contained millions of people who have deliberately given up sugar, with varying degrees of success.
One particular shared experience has generated much of the anecdotal evidence about the addictive properties of sugar: Lent. Many Christians observe the liturgical season of Lent, the 40 days leading up to Easter, when they try to quit something that is very hard to give up. What are the top ten choices for sacrificial deprivation? According to the Twitter Lent Tracker, which counted more than 125,000 responses, the top ten are:
school
chocolate
alcohol
social networking
swearing
soda
sweets
fast food
coffee
Okay, some of the answers are facetious—like giving up school. But as separate entities, chocolate, soda, and sweets are all predominant, along with fast food, which accounts for a lot of gratuitous sugar. Plenty more finds its way into coffee cups. When looked at by genre, food is the overall top category.
Historically, sweets would have been the obvious frill for people to give up, because they did not have a wealth of other choices. Throughout the two millennia since Christianity took hold, most people in most places have experienced not abundance but scarcity. When deciding what to give up for several weeks, they did not have a wide variety of luxuries from which to pick.
This has been especially true for children, who have always had a narrower range of available pleasures than adults. Most kids already did not swear, gamble, or smoke. What else but candy was there for them to give up?
The Science
It turns out, scientific research backs up anecdotes about the difficulty of giving up sugar. Jordan Gaines Lewis explained for The Conversation how the mesolimbic pathway operates.
When we do something pleasurable, a bundle of neurons called the ventral tegmental area uses the neurotransmitter dopamine to signal to a part of the brain called the nucleus accumbens…
Like drugs, sugar spikes dopamine release in the nucleus accumbens. Over the long term, regular sugar consumption actually changes the gene expression and availability of dopamine receptors in both the midbrain and frontal cortex…
Regular sugar consumption also inhibits the action of the dopamine transporter, a protein which pumps dopamine out of the synapse and back into the neuron after firing.
When confronted with sugar, part of the brain shrugs and asks, “What’s not to like?” We can prevail only by making determined use of other brain areas—the ones that think. A large percentage of the world’s inhabitants have come to know, first-hand, the difficulty of living without sugar. This is why so many clamorous, insistent voices can be heard affirming that it is indeed an addictive substance.
Your responses and feedback are welcome!
Source: “2015 Twitter Lent Tracker,” OpenBible.info, 02/15/15
Source: “Here’s what happens to your brain when you give up sugar for Lent,” The Conversation.com, 02/18/15
Image by Jeanny
Everyhow You Know Is Wrong
February 24th, 2015
Or maybe it isn’t. As Childhood Obesity News has discussed, a person is apt to occasionally think, “Everything I know is wrong,” especially when encountering contradictory headlines about the same topic. This is particularly true in the world of weight loss.
“Spin” is important in any aspect of life. Try telling the teacher, “The dog ate my homework.” Good luck with that. But, “The dog ate my homework, and then had a seizure and died,” throws a different light on the matter. It’s no longer just a kid trying to get away with something. It’s a kid whose pet just died, and any teacher insensitive enough to question such a claim from a child suffering grief might get into trouble. Especially if the dead pet story turned out to be true. (Okay, never mind the homework. Better to just let it go.)
Spin can make the difference between success and failure, between acceptance and rejection, between wealth and bankruptcy. Much of the spin we see out there is relatively innocent, but some is malevolent. Often, spin happens because to challenge it would be dangerous or disproportionately expensive. Sometimes it happens because people are just too busy to follow up on news items that sound a bit wonky.
Spin is Here to Stay
In the realm of news, spin is inevitable. In America, most people value the fact that various points of view and opinions can be heard. On the other hand, it doesn’t mean that all opinions and points of view are equally valid. We don’t get to decide what is objectively true. We do get to decide whether what we are hearing holds up to scrutiny. The point is, a lot of different cases are made regarding the “how” of weight loss. A person can fully intend to stop being obese and still not know what to do.
Small Changes
One widely-promoted concept is the idea of making small changes to everyday existence that can add up to better health and even weight loss. For instance, parents have been advised to ditch the baby stroller as soon as a toddler is capable of walking. Many professionals have advocated more walking, especially for children, and many cities have taken steps to make this possible for their residents. If at all possible, kids are advised to ride bikes to school, rather than buses.
For adults too, many experts recommend small lifestyle changes, like taking the stairs instead of the elevator, or even walking to work. But then, along comes a study with 20 attributed authors that calls the “small changes” trope a myth. These researchers consulted tons of scientific literature as well as everyday media, and came to the conclusion that, contrary to popular belief, small sustained changes cannot produce significant or lasting weight reduction. Their scholarly explanation begins:
Predictions suggesting that large changes in weight will accumulate indefinitely in response to small sustained lifestyle modifications rely on the half-century-old 3500-kcal rule…
This is truly discouraging. At the same time, another school of thought holds that small changes in human behavior are cumulative and synergistic, not additive, and somehow have a multiplier effect. Many motivational speakers and life coaches tell a parable of two entities traveling along next to each other. They might be ships sailing across the ocean or birds flying through the sky. The point is, if one of those individuals stops following a parallel route, and turns even a single degree toward either side, before long the two will be miles apart.
They will be as far apart as the old you and the new you, when you follow the slight adjustment plan. A page that explains this philosophy is “How to Establish New Habits the No Sweat Way.” As for who is right, each belief system has equally strong defenders. But as long as they can’t hurt, and might help, why not go ahead and make those small, healthful changes—just in case?
Your responses and feedback are welcome!
Source: “Myths, Presumptions, and Facts about Obesity,” nejm.org, 01/31/13
Image by Daniel Oines
Everything You Know About Food Is Wrong
February 23rd, 2015
In the spirit of the previous post, “Why Everything You Know is Wrong,” here are some contrarian viewpoints on various foodstuffs that are said to affect childhood obesity.
Carbohydrates: Kris Gunnars collected a number of “debunked nutrition myths,” one of which concerns the purported danger of the low-carb diet, which has been mistakenly considered either ineffective or dangerous. The writer says that more than 20 (fully footnoted) studies indicate otherwise—especially when a low-carb regime is compared with the more frequently recommended low-fat diet.
Actually, research shows that low-carb eating lowers triglycerides, lowers blood pressure, raises “good cholesterol,” improves blood sugar and insulin levels and leads to “significantly more weight loss.”
Eggs: Gunnars also challenges the received wisdom that eggs, because of their cholesterol content, cause cardiovascular disease. Apparently, this is another myth, and eggs have been “unfairly demonized.” Here is the evidence for which, again, links to the pertinent scientific studies are provided:
Studies show that egg consumption actually improves the blood lipid profile. They raise the HDL (good) cholesterol and change the LDL from small, dense to Large, which is benign…
Observational studies show no association between egg consumption and risk of heart disease… Additionally, some studies show that eggs for breakfast can help you lose weight…
Cereal: Breakfast cereal has been extensively blamed as a childhood obesity villain, both for its high sugar content and for its unrelentingly aggressive marketing aimed at children. Should we be surprised when the manufacturers claim that, on the contrary, cereal is an important element of the cure for the childhood obesity epidemic?
The manufacturers’ main argument seems to be that since breakfast is the most important meal of the day (which in itself can be disputed), and cereal is the obvious thing to eat for breakfast, their case is proven.
Actually, there is a bit more to it than that. Also unsurprisingly, they have studies. But other research, tons of it, says that consumers of cereal take in an awful lot of calories in the form of sugar. And calories are, of course, the enemy. Margo Wootan and David Ludwig wrote for The Atlantic:
Some observational studies have suggested that children who typically eat breakfast cereal are less likely to be overweight. However, this type of study cannot prove cause and effect, and most have been funded or conducted by the cereal industry… Consuming even modest portions of sugary cereals leaves no room for any other added sugars in a healthy diet for a child.
Furthermore, there is no logical or convincing reason why this breakfast staple must contain such a large proportion of sugar. The authors cite a Yale study which shows that “low-sugar, whole grain cereals are well accepted by children, and when they eat them, they eat more reasonable portion sizes.” So, why does the industry continue to insist on formulations with such high sugar content? Why does the industry work so hard to convince us that what we are pretty darn sure we know about cereal is wrong?
Your responses and feedback are welcome!
Source: “8 Ridiculous Nutrition Myths Debunked,” authoritynutrition.com, 05/22/13
Source: “Sugary Cereal: Breakfast Candy or Obesity Cure?,” TheAtlantic.com, 04/24/12
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