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    More about Bariatric Surgery for Adolescents

    November 25th, 2015

    IMG_6273In her very thorough 2010 article for Reuters about teens and weight-loss surgery, Debra
    Sherman referenced a study done by Dr. Susan Woolford, a specialist in the area of medicine where pediatrics and obesity meet. When she surveyed 381 doctors, almost half of them responded that “they would never refer an adolescent for any type of bariatric surgery.”

    At the time, this kind of surgery for teens was still classed as experimental, and many young patients had not done well. Several high-level institutions were working toward mainstreaming the idea and practice of bariatric surgery for adolescents.
    Early in 2011, Liz Kowalczyk collected information on several prominent medical centers, including Children’s Hospital Boston, home to a very well-regarded weight loss program. It had just initiated a new program under which kids from 13 to 19 would have bariatric surgery, but only if strict conditions were met, such as weighing over 300 pounds.

    The candidates were also evaluated for their motivation levels and general maturity, which had to be in place before a life of very restricted behavior could be contemplated. At the time, it was felt that this population would benefit most from the Roux-en-Y gastric bypass. The plan was to start conservatively, with only 20 to 25 procedures in the first year.

    Other Teenage Bariatric Surgery Pioneers

    Massachusetts General Hospital had by this time done bariatric surgery on 11 severely obese teens, all of whose BMI numbers were in the 99th percentile. By comparison, having started in 2001, Cincinnati Children’s Hospital Medical Center had performed 160 teenage bariatric surgeries. Elsewhere, Kowalczyk reported, the path was not as smooth:

    Tufts Medical Center found that insurers were a barrier to surgery in children. The hospital, which has a large adult weight-loss surgery program, had begun performing pediatric obesity surgery in the early 2000s and then stopped. “The gastric bypass is an operation that makes many families and pediatricians uncomfortable because of the long-term issues,’’ said Dr. Scott Shikora, chief of general surgery at Tufts and a bariatric surgeon.

    A huge teaching institution with an adolescent obesity clinic was one thing, and probably a good thing. Teenagers are difficult to deal with at the best of times, and if a program could provide more awareness and sensitivity to the needs of this age group, so much the better. In 2011, some professionals believed such programs belonged only in big hospitals. Some looked into the future and confronted the specter of advertising aimed directly at teenagers, followed by an epidemic of operations performed on young people who probably didn’t need such a degree of intervention.

    The critics did not want to see bus benches adorned with ads targeting teenagers. They did not welcome the vision of a bariatric surgery storefront in every strip mall, next to the tattoo and piercing parlor. Any step in that direction seemed dangerous, including such benign commercial messages as, to take a random example, the one issued by a Colorado clinic with a special teen obesity program. Before operating, it promised to teach the skills that a post-surgical patient needs in order to maintain a healthy weight in the long run, including psychological skills learned through months of counseling for the entire family.

    One question unavoidably comes to mind. What if those kids and their families would seriously engage in the training programs, and then put off the surgery for a year and just see how things went? Can enough new habits be learned, and enough relationship skills practiced, to bring about deep changes and make surgery unnecessary?

    Your responses and feedback are welcome!

    Source: “Special Report: Targeting Teens for Gastric Bands,” Reuters. com, 07/26/10
    Source: “Cuts in childhood obesity,”, 04/11/11
    Source: “Rose Medical Center is First to Offer Teens Lap Band Surgery in Colorado.”, 10/10/11
    Image by Tiffany Bailey

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    Bariatric Surgery for Adolescents – Good Idea?

    November 24th, 2015

    Shut up stomach

    In his Huffington Post article, Dr. Pretlow mentioned that although bariatric surgery has been successful for some teens, there are inevitable risks, and when the long-term outcome is considered, there is a 20% – 30% failure rate. Even this is not certain, because it depends on how failure is defined, and even more important, it depends on how “the long term” is defined. Since the use of these surgical procedures for teenagers is a relatively recent phenomenon, not enough time has passed to provide a real grasp of the possible outcomes.

    Failure comes in two forms: either no significant amount of weight loss takes place, or an initial weight loss goes into reverse and the pounds return. Relative to this discouraging situation, Childhood Obesity News looked back at an important historical document, the piece Debra Sherman did for Reuters in 2010. It included a comprehensive overview of the state of the art in those days. If bariatric surgery was deemed necessary for an adolescent, popular opinion held that the gastric band was the best option, because it is reversible.

    To make most of the stomach unavailable is an extreme step, especially in the type of surgery where the unwanted part is permanently removed. But as we have seen, with the lap-band method the larger portion of the stomach is not surgically removed, but merely cordoned off with a very small (adjustable) opening remaining. So it has the capacity to be undone, which is a big plus.

    Still, negative elements are present. For instance, there is “symmetric pouch dilation,” a formal way of saying the person has stretched out the tiny pouch that she or he is supposedly confined to. The stomach, like other types of human flesh, can be quite malleable. If the post-surgical patient ignores the discomfort of a full stomach and continues to eat, the organ will enlarge to accommodate the resulting demand for extra space. In one study, this happened with more than 1 out of 5 adolescent patients. Sherman pointed out the problem:

    Gastric banding demands that teens do something they often aren’t very good at—sticking to a rigorous follow-up routine.

    In support of that sentiment, she quoted Dr. Roberta Maller Hartman, who said:

    The band doesn’t reduce the desire to eat emotionally. That has to be addressed. Teens tend to need more hands-on, one-to-one support.

    How might the earlier, pioneering attempts at bariatric surgery for teens have been affected if all the young patients had W8Loss2Go available to them? They might have found it much easier to adhere to the difficult post-op routine, in a circumstance where that post-op routine never comes to an end, but continues to be necessary for the remaining years and decades of their lives.

    Because five years ago, there was even less information available on long-term outcomes, the existing data counted for more, and according to some experts at the time, the lap-band method was even less effective for teens than for adults, and created more problems for teens than it did for adults. As Dr. Pretlow observed, for a while there it looked as if the health profession had written off young people, leaving morbidly obese teens with only two options, so the choice was between a residential addiction recovery program and a surgical procedure that did not appear very promising.

    Your responses and feedback are welcome!

    Source: “Eating Addiction: There’s an App for That,”, 09/11/15
    Source: “Special Report: Targeting Teens for Gastric Bands.” Reuters. com, 07/26/10
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    Miscellaneous Causes of Obesity

    November 23rd, 2015

    78_365+1 PopcornHere, as observed and reported by a variety of researchers, are some factors thought to contribute to obesity. Childhood Obesity News does not vouch for the accuracy of any of these reports, but merely passes on the information that these factors are considered, by someone, to be suspect.

    Overweight Cartoon Characters

    Childhood Obesity News has mentioned the attention given by obesity researchers to cartoon characters. A study done at the University of Colorado (Boulder) and published by The Journal of Consumer Psychology found that visual images could influence children:

    Researchers first randomly showed 60 eighth graders a svelte jelly-bean-like cartoon character or a similar rotund character and asked them to comment on the images. Then they thanked them and gestured toward bowls of Starburst candies and Hershey’s Kisses, saying, “You can take some candy.”

    Children who had seen the rotund cartoon character helped themselves to more than double the number of candies as children shown the lean character.

    Another experiment involved 167 elementary school kids who viewed two different cartoon characters and participated in a cookie taste test. Depending on whether they were asked to “think about things that make you healthy” before or after the taste test, they ate more or fewer cookies.

    Pthalates in Hygiene Products

    At the New York University School of Medicine, Dr. Leonardo Trasande examined the composition of shampoos, soaps, lotions and other hygiene and grooming products and found them to be full of phthalates. This particular class of chemical has, in other studies, been linked to obesity, allergies, asthma, type 2 diabetes, and some kinds of cancer. Any such product with artificial fragrance probably has phthalates in it. If a bottle of moisturizer lists “fragrance” or “parfum” as an ingredient, we are advised to stay away from it. This means avoiding the great majority of household cleaning products, as well as giving up scented candles and air fresheners.

    Sad Movies

    The Cornell Food and Brand Lab wanted to know what kinds of movies inspire people to eat, or not eat, popcorn. Experiments were conducted both in a lab and in commercial theaters in seven American cities (on Thanksgiving weekend, when you’d think people would already be stuffed enough). The results were published by JAMA Internal Medicine.

    As compared to the comedy Sweet Home Alabama, viewers of the tragic Love Story consumed 28% more popcorn. With another cinematic pairing, the difference was much greater. Watchers of the sad Solaris ate a whopping 55% more popcorn than those who attended the humorous My Big Fat Greek Wedding. A similar study had already demonstrated that action and adventure movie fans tend to eat a lot, but only if the food is set in front of them. Apparently, consumption drops if the preparation and serving are not done by someone else.

    An interesting footnote came from Prof. Brian Wansink, author of Slim by Design: Mindless Eating Solutions for Everyday Life, who believes that the effect would be the same if moviegoers ate fruits and vegetables, rather than popcorn. Unfortunately, theaters don’t allow food to be brought in from outside. It would probably not be practical to sell fresh produce at the snack bar, because it is expensive to stock for the reason inherent in its name—it does not stay fresh for long. There is also the danger that, like school kids rebelling against healthful cafeteria fare, the customers might rise up and show their displeasure.

    Your responses and feedback are welcome!

    Source: “‘Fat’ Cartoon Characters May Make Children Eat More,”, 07/28/15
    Source: “How Lotions and Shampoos Fuel Childhood Obesity,”, 02/06/13
    Source: “Sad movies are fattening,”, 03/02/15
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    The Wacky World of Fatlogic (Roundup)

    November 20th, 2015

    Jack Barton tweet humorHumans are so clever, they can talk themselves into just about anything. The fatlogic mindset is not just one set of beliefs, but a spectrum that ranges from hostile defensiveness on one end to self-deprecating humor on the other. Some fat-logicians are militant spokespeople whose rhetorical skills would be envied by any ideological movement. They flip the script to make anyone who cares about optimal health appear to be a self-hating masochist.

    Others are amiable and adequately self-aware strugglers who seem to realize how much they are kidding themselves. The latter group can be amusing, because they will wryly poke fun at themselves and acknowledge at least some fatlogic as the baloney it is. This can be accomplished, for instance, by using the made-up word “condishun” to signify a chronic disease that causes mysterious and unaccountable weight gain. When someone jokes about her or his condishun, it’s a tacit admission that deep down inside, the stark reality is known.

    “Hamentality” is another fun word, and a cruise through online forums devoted to weight issues can reveal a whole alternate vocabulary that is used by people trying to come to grips with their weight issues. “Fatlogic Can Be Weird” discusses them, and gives proper respect to the seekers who can lay aside their vulnerability and be so fearlessly self-assessing. In the past few years, fatlogic has become much easier to engage in because it lines up with perceived reality. When an overweight person looks around and sees wall-to-wall overweight people, everything looks normal. It’s very easy to think, “What’s the problem?”

    In “The Fatlogic Mindset,” we quoted someone very familiar with that mental state, who nevertheless went ahead and lost more than 100 pounds with the help of lap-band surgery. To assemble a set of beliefs that add up to a fatlogic mindset, a person has to ignore quite a few plain facts and distort a few quasi-reasonable assumptions. “Rejecting Fat Logic” examines some of the justifications and rationalizations that can be employed to this end. “Fatlogic Marches On” mentions one of the thousand mental traps:

    Many people have heard that 95% of smokers who quit on their own will return to the habit, and they extrapolate this to a conviction that 95% of all people who attempt weight loss will fail—so what’s the use? Why even try?

    More complete information has become the norm in the labeling of processed foods. This change was supposed to help, but has actually become harmful in many cases. Food manufacturers have become quite skilled at enabling fatlogic by providing information that may be accurate, but at the same time doesn’t tell the entire story.

    A person might read enough of the package information to ascertain that the treat only contains 20 calories per serving, and then skip the part where it says a serving amounts to two tablespoons. When a “zero fat” message is emblazoned on the package, a customer might not stop to think or consult the fine print, which would reveal that the thing is full of sugar. Conversely, a “zero sugar” imprint can obscure the fact that the thing is full of fat.

    Since all positive change begins in the mind, people could use a special training course in how to see through fatlogic, whether it originates in their own twisted psyches or is imported from outside.

    Your responses and feedback are welcome!

    Image by Jack Barton

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    Teens and Bariatric Surgery – Even More History

    November 19th, 2015

    Doctor's Office - Scale blueEarly in 2011, the Food and Drug Administration obligingly began to allow the marketing of laparoscopic gastric banding surgery  to people who were not morbidly obese and whose lives were not immediately threatened by their weight. As the L.A. Times put it:

    The approval allows Allergan to market the device to patients with a body mass index, or BMI, as low as 30 if they have at least one weight-related medical condition, such as diabetes or high blood pressure, the company said. For a 5-foot-9 patient, that translates to a weight of about 203 pounds…The approval also means that, according to company officials, 45.6 million Americans meet the criteria for Lap-Band surgery. That’s more than 1 in 7.

    It was quite a coup. Overnight, the product went from a rarity with stringent qualifying conditions to a surgical possibility that might be contemplated by almost 15% of Americans. The Allergan share price flew to its highest point of the year.

    In 2012, Allergan withdrew its application for FDA approval of lap-band surgery starting at 14. However, the company was known to have been conducting clinical trials on teenage patients all along, which was legal if the parents gave their consent (and still is). The National Research Center for Women and Families, a nonprofit organization that scrutinizes the safety of medical devices, spoke up. It urged Allergan to publish the results of its research, but this request was not granted.

    Readers of Tuesday’s post will remember Dr. Christine Ren and Dr. George Fielding of New York University’s Langone Medical Center, both of whom were on Allergan’s payroll, installing the Lap-Band System in patients and reporting to the corporation on the results. The unfortunate Dr. Neelu Pal worked with them, complained to the hospital administration about what she perceived as slipshod and hazardous methodology, and was fired.

    She sued the institution for wrongful termination, a case that had not yet been adjudicated when, early in 2013, a TV commercial appeared in which that same Dr. Fielding extolled the virtues of the Lap-Band System. He stated that he had personally lost 120 pounds with its help, and testified that although he performed every type of bariatric surgery, lap-band was the best.

    In April of 2013, Dr. Pal won a court victory over a different employer—not Langone Medical Center—that had also unjustly terminated her employment. This is mentioned to show that she was not a crazy lady who went around gratuitously suing people, but someone who had enough credibility to be awarded more than $1.5 million in damages by a jury.

    Right around that time, New Jersey governor Chris Christie had lap band surgery, and it was performed by none other than Dr. George Fielding, chief of the Langone Weight Management Program. In an online exposé, attorney Gerry Oginski informed the public that Dr. Fielding had been the defendant in 12 malpractice suits filed in New York State,

    …including former Mets baseball player, Lee Mazzilli, after his teenage daughter suffered from stomach tears resulting from careless care.

    Oginski mentioned a couple of specific cases in which Dr. Fielding failed to detect danger signs and patients died. He recalled the publicity that ensued when Dr. Neelu Pal crossed swords with Fielding and his practice partner Dr. Christine Ren. He also revealed that those two bariatric surgeons are married. (Someone with a suspicious mind might leap to the conclusion that this was done so neither one could be forced to testify against the other.) But wait, Oginski has more surprises in store:

    This is not the first time Doctor Fielding is being sued. In Australia, where he previously practiced, he was sued in eleven cases. A thorough investigation discovered that one of the patients, Shannon Tang, 21 who also passed away due to the operation, had only met once with Fielding, one day before the surgery.

    In all fairness, the attorney’s blog does add that although his source material had identified the several lawsuits against Dr. Fielding, there was no mention of how the cases were resolved. The point here is that despite public knowledge of these many serious charges against Dr. Fielding, when Dr. Pal’s wrongful termination case came to court in August of that year, she lost.

    The bigger point is that, no matter what state of perfection might currently be enjoyed by laparoscopic gastric band surgery, its history is far from spotless, and it should still be considered a desperate last resort.

    Your responses and feedback are welcome!

    Source: “FDA’s Lap-Band decision is a boon for Allergan,”, 02/17/11
    Source: “Allergan drops bid for FDA approval to promote Lap-Band for teens,”, 10/03/12
    Source: “Governor Chris Christie’s Lap-Band Surgeon Has a History of Lawsuits…Does it matter?,”, 05/15/13
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    Teens and Bariatric Surgery – More History

    November 18th, 2015

    Doctor's Office - Scale goldYesterday, we started to examine a lengthy article by Debra Sherman, part of which concerned two bariatric surgeons who ran a clinic under the auspices of New York University, and another doctor who brought them unwelcome publicity. A reader might have wondered, “But what does this have to do with teenagers?” That part is coming up.

    Quick review: Dr. Christine Ren and Dr. George Fielding supervised the lap-band surgery department of the Langone Medical Center. For a short time in late 2005 and early 2006, Dr. Neelu Pal worked under their direction. She objected to procedures that seemed unsafe, and warned patients to stay away. After being fired, she sued, charging wrongful termination.

    (While that lawsuit was taking shape, Dr. Pal went to work for a different medical center, from which she was also fired. She sued that institution for unlawful retaliation, and won, early in 2013. A few months later, in August, the Langone case finally made it to court, and Dr. Pal lost that one. Of course, neither of those legal outcomes was known back in 2010, when Sherman wrote her extensive piece for Reuters.)

    “Special Report: Targeting Teens for Gastric Bands”

    Sherman learned that Dr. Pal’s misgivings about the lap-band clinic were shared by the New York State Health Department, which had some kind of investigation underway when she worked there. More importantly, a crucial matter hung in the balance. The appropriateness of laparoscopic gastric band surgery for adolescents was still being evaluated by the Food and Drug Administration. It had been done, but rarely, and was considered “experimental.” The bureaucratic decision would mean the gain—or loss—of millions in potential profits. The reporter’s inquiries revealed that:

    [Dr.] Ren was an investigator in an Allergan-sponsored clinical trial studying the use of bands on teens. And the company has an application…seeking approval to market the device to teens as young as 14…Winning regulatory approval for the gastric band in teenagers would allow the companies that make the devices…to target that specific age group.

    At the time when Sherman filed her story, Drs. Ren and Fielding were both still on the payroll of the giant pharmaceutical corporation that manufactured the Lap-Band apparatus.

    Six months later, Allergan petitioned the FDA to loosen the strict requirements around patients’ body weight, which would expand the potential customer base from 15 million Americans to more like 42 million. They also wanted insertion of their device to be officially declared acceptable for patients as young as 14.

    Adolescent patients could already have the surgery with parental consent, but an okay from the FDA would have cleared the way to advertise it specifically for the teenage demographic. Wanting the surgery to remain a last-resort medical option, the government balked at that idea, and reacted hard against the notion of undertaking it merely for cosmetic purposes. Associates of the company thumbed their noses at authority and powered ahead with the cosmetic angle, filling Southern California with 1-800-GET-THIN billboards that skated around medical advertising rules on a technicality.

    (More next time…)

    Your responses and feedback are welcome!

    Source: “Special Report: Targeting Teens for Gastric Bands,” Reuters, 07/26/10
    Source: “Allergan seeks bigger market for Lap-Band weight-loss device,”, 01/16/11
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    Teens and Bariatric Surgery – Some History

    November 17th, 2015

    Doctor's Office - Scale redBy way of tracing the recent history of bariatric surgery as applied to teenagers, Childhood Obesity New looked at a comprehensive special report compiled by Debra Sherman for Reuters more than five years ago. It begins by recounting the ordeal of a courageous whistleblower (or possibly a misguided troublemaker) who worked at the Langone Medical Center, which is affiliated with New York University.

    General surgeon Dr. Neelu Pal approached the hospital administration with concerns about the lap-band surgery performed there, specifically “about the lack of care given after surgery and incomplete or inaccurate medical forms that were taken prior to surgery.” She later told the Reuters journalist that the Langone Medical Center was a “hectic lap-band factory” where her supervisors, Dr. Christine Ren and Dr. George Fielding, rushed through as many as 20 surgeries per day.

    When her complaints were ignored, Dr. Pal went so far as to call patients who were scheduled for the procedure, warning them to back out. Not surprisingly, she was fired, and reacted by suing the facility for wrongful termination. As Sherman was unable to do at the time, we peered into the future and followed up by reading a court document filed in August of 2013. The University said Dr. Pal was let go because of the indiscreet and unprofessional phone calls. But apparently that was not the real issue, as her immediate superiors had not originally planned any disciplinary action. Her attorney outlined the problem:

    The real reason Pal was fired was because of Pal’s complaints to Dr. Bernstein about the conditions in NYU’s bariatric surgery program run by Drs. Fielding and Ren… As soon as Drs. Fielding and Ren learned of Pal’s disclosure to Bernstein, they began to malign, disparage and discredit her, accusing Pal of “erratic” and “weird” “psychotic” behavior.

    The attorney also pointed out that even if the phone calls had been the sole cause for the firing, it would be wrong, because the institution had tolerated far more transgressive behavior from other employees. So basically, Dr. Pal was claiming that the hospital did not have a good reason for the firing—only a terrible one, that an insider had betrayed the institution by trying to protect patients from bad practices.

    There had been a patient death that was traumatic for everyone, but the hospital’s point of view was that Dr. Pal was more worried about being blamed for it than upset about patient well-being in general. In their view, the real danger to patient safety was the person who had voiced concern. The decision to fire Dr. Pal had been made by the chair of the Department of Surgery, and the court ruled that, “he discharged his responsibilities in a fair and proper way, in accordance with NYU’s written procedures.” Dr. Pal lost her wrongful termination suit.

    Another Chapter to Dr. Pal’s Story

    While the case against New York University Medical Center was wending its way through the legal system, Dr. Pal entered the cardiothoracic surgery program at the University of Medicine and Dentistry of New Jersey (UMDNJ). There she was discriminated against and harassed because of her gender and ethnic background, and quite possibly because suing her former employers gave her the reputation of not being a team player.

    After leaving this impossible situation, Dr. Pal instituted an entirely different and separate lawsuit claiming Unlawful Retaliation, this time against UMDNJ, and won. So the loss of the NYU suit was cushioned by the fact that only five months earlier, a jury had awarded her $1.6 million, plus attorney fees and court costs, to be paid by UMDNJ.

    But that is not the most interesting outcome of this story, not by a long shot. Remember the bariatric surgeons whose methods Dr. Pal complained about when she worked under them at NYU’s Langone Medical Center? Tomorrow, we check back in on Drs. Ren and Fielding.

    Your responses and feedback are welcome!

    Source: “Special Report: Targeting Teens for Gastric Bands,” Reuters, 07/26/10
    Source: “Neelu Pal, M.D. v. New York University – Memorandum Opinion and Order,”, 08/06/13
    Source: “UMDNJ Hit with $1.6 Million Jury Verdict for Unlawful Retaliation,”, 04/16/13
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    Who is Steve Miller and Why Does He Want to Incarcerate Parents?

    November 16th, 2015

    Cumming Regional Readiness CenterOver in the United Kingdom, Steve Miller is known for several activities. As a Weight Loss Master, he teaches mindset and motivation, and is a great believer in willpower as the impetus and fuel for weight loss. A person can buy a series of personal coaching sessions via phone or Skype.

    Miller’s homepage says he will help in the process of letting go of all excuses, as he and the client focus on solutions to any challenges. His straight-talking style and positive, ‘can-do’ spirit will, he promises, imbue a person with excitement and the strength to regain control over food, leading to fast weight loss. Here are two of his slogans:

    It’s time to shout FAT OFF!!! You deserve better!!!

    My Goal Is To Help Your Body Be What Your Clothes Desire

    Isn’t that second one a bit weird? His goal is to help your body be what your clothes desire. Out of all the reasons a person might have to lose weight, satisfying the wishes of her clothes is a strange one to emphasize. Or maybe not, because another interesting aspect is that the Master’s clientele is almost entirely female. Among the photos of satisfied customers, only one lone male is pictured. Gender exclusivity is included in his pitch:

    I am a qualified Weight Loss Coach and Mind Programming expert and have trained in clinical hypnosis and coaching which I use to help women achieve their weight loss result.

    Late in 2014, Miller ruffled plenty of feathers by publicizing the letter he wrote to Britain’s health secretary asking that January 7 be officially declared “Warn a friend they’re fat day.” In the Telegraph, Claire Cohen responded to this proposal:

    I know people who have ‘fat shamed’ others. It rarely turns out well. Even when approached sensitively (‘look how unhealthy we’ve become recently, eating all this chocolate. Shall we go to the gym together?), the recipient is rarely ‘grateful’ or spurred into life-changing action as Miller predicts. If anything, the cruelty can push people into comfort eating.

    Not all of Miller’s ideas are wild. For instance, he thinks that no junk food ads should be shown on TV before 9PM. Other statements are harder to swallow:

    Show me a fat kid and I’ll show you a miserable, bullied child. Yet almost always it’s the fault not of the child but of their lazy, misguided parents who are often too fat themselves.

    It is tempting to dismiss this as prejudice and bigotry. But apparently his opinions are based on life experience. He hosted the 2010 television series Fat Families, in which he investigated and advised families with weight issues. He has also appeared as a guest Weight Loss Expert on two other TV shows.

    Are Parents of Obese Kids Criminals?

    This past summer, Miller stirred up even more controversy by suggesting that legislators pass the Child Obesity Act, under which the parents of a morbidly obese child would receive three warnings and then be prosecuted. The charge would be child abuse, and they could be imprisoned for two years. Or the kid could simply be taken away from the parents and entered into the foster care system or possibly some institution. Miller seems to have proposed weight-loss boot camp for the children.

    One problem with this idea is that there barely seems to be enough social infrastructure in the UK to support kids who are in desperate trouble, such as those who are already homeless. Due to “Warn a Friend They’re Fat Day,” Miller has been called insensitive, crass, and an idiot who wanted to issue an open invitation to bullying. Now, he has also become known as a publicity hound who merely seeks to shock.

    When Amy Packham wrote about this controversy for Huffington Post, she contacted the UK’s Department of Health, whose spokesperson said “We have no plans to jail parents of obese children.”

    Your responses and feedback are welcome!

    Source: “Steve Miller’s Weight Loss Master,”, undated
    Source: “Fat-Shaming Tell a Friend They’re Chubby Day,”, 12/11/14
    Source: “Over-feeding the kids? Steve Miller’s Child Obesity Act could see YOU in prison,”, 07/20/15
    Source: “Weight Loss Campaigner Calls For Parents Of Obese Children To Be Jailed,” HuffingtonPost,, 07/21/15
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    Sugar Roundup, Continued

    November 13th, 2015

    Day of the Dead Cookies

    This is a continuation of the collection of various Childhood Obesity News posts about sugar, a substance considered by some to be a white drug as dangerous as cocaine or heroin.

    When Practice Does Not Make Perfect” looked at the historical significance of sugar in the context of Christianity—specifically the ecclesiastical season of Lent. Traditionally, for the forty days leading up to Easter, people would give up something they were very fond of. Throughout most of history, people lived with such limited resources that there wouldn’t be a lot of leeway for choice. Sugar was about the only thing available for giving up, so people had the opportunity to become very familiar with the feeling of deprivation.

    Looking back from a contemporary perspective, it is easy to wonder why, having already gone through weeks of withdrawal, people would not take advantage of that head start to make their sugar abstinence permanent. But, given the shortage of luxuries for most people in most places, it is not so difficult to understand why a person would go right back to sugar after the religious obligation had been fulfilled. Also, until relatively recent times, most people didn’t realize what a seriously destructive substance sugar can be.

    Sugar Is Everywhere

    We went on to discuss the insidious availability of sugar in the modern world, hidden in food products where the presence of extra sweetener might not even be suspected. Even when the sugar content of a food was known, people could be misled about it. For the post “Everything You Know About Sugar is Wrong,” we found an old advertisement that urged the consumer to have an ice cream cone just before lunch! Why? Because, “Sugar can be the willpower you need to undereat.”

    Probably the inspiration came from ad copywriters’ memories of their mothers saying “Don’t spoil your appetite.” The pitch here was to go ahead and spoil your appetite. According to the text, the energy boost provided by a sugar rush would provide a person with the willpower to eat a smaller lunch, and still lose weight while enjoying ice cream cones. What’s not to like about that proposition?

    This post also looked at the ongoing controversy about high fructose corn syrup, which has its dedicated fans. One of the marketers’ tactics is to hide behind the acknowledged complexity of obesity causation to let their own products off the hook. They will also bring up the inappropriateness of using lab rodents to learn about human responses—something they don’t seem to mind when the experiments go in their favor. They will even try to suggest that people are somehow in danger of not getting enough sugar in their diets. Fat chance! On the roster of nutritional problems that people ought to worry about, insufficient sugar is way down at the bottom of the list.

    Starting Sugar Addiction Early

    The post “Cake Babies” was also headed by a fascinating graphic—a composite of the photos Google will reveal in answer to the inquiry “cake + baby.” Here, anyone who is delighted by pictures of babies diving face-first into frosted cakes will find plenty to enjoy. Grownups seem to especially adore pictures of babies having their first encounter with sugar. Surely this level of adult enthusiasm could only be matched by a crack dealer finding a brand new customer. Dr. Pretlow once estimated that “probably 2/3 of our country is addicted to sugar in one form or another.” Imagine being a heroin pusher who can bank on the certainty that two out of three people he meets are potential junkies!

    Your responses and feedback are welcome!

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    Globesity – How Bad Can It Get?

    November 12th, 2015

    GlobesIt is a challenge to find a source that has a good word to say about the future of globesity. Mostly, the prognosis is grim and the predictions are dire. The World Obesity Federation predicts that by the year 2025, one billion of Earth’s grownups will be obese. According to projections made by the McKinsey Global Institute (MGI):

    If the prevalence of obesity continues on its current trajectory, almost half of the world’s adult population will be overweight or obese by 2030.

    The Institute’s discussion paper, “Overcoming obesity: An initial economic analysis,” is described as presenting “an independent view on the components of a potential strategy” based on information gathered about 74 different interventions that are being either talked about or tried, somewhere in the world. The highlights of the report are not encouraging. If we look at the evidence, “no single intervention is likely to have a significant overall impact.”

    The report also points out that while education and personal responsibility mean a lot, they don’t mean everything. They are necessary but not sufficient conditions. The new understanding is that lifestyle modification is not the whole picture. The Obesity Society, for instance, says:

    We must ensure that appropriate attention is paid to the many factors that influence weight and health.

    Or as the MGI phrased it:

    Obesity is a complex, systemic issue with no single or simple solution.

    Earlier this year, a series in the journal Lancet examined public health programs that exist in different parts of the world. In avoiding obesity, it is important to have fresh natural fruits and vegetables, and to expend an appropriate number of calories. But the international anti-obesity establishment has moved beyond the energy in/energy out paradigm.

    In The Atlantic, Olga Khazan told readers about a study from York University in Toronto, which was published by Obesity Research & Clinical Practice:

    It’s harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise…In other words, people today are about 10 percent heavier than people were in the 1980s, even if they follow the exact same diet and exercise plans.

    How can this seemingly inexplicable condition exist? Think of the implications. A lot of the “personal responsibility” rhetoric goes out the window. Being obese is not necessarily a person’s fault, or even a person’s mother’s fault.

    What are the factors other than diet and exercise? Professor of kinesiology and health science
    Jennifer Kuk offered three hypotheses. One of them is that chemicals in the environment change our hormones in ways that induce weight gain. People take in a lot of antibiotics and hormones indirectly. It’s like second-hand smoke, and very difficult to avoid in this modern world. Artificial sweeteners are probably an obesity villain—although it is one that could be avoided if people really wanted to pay attention and limit their menu choices a lot.

    Also, millions of people are taking prescription antidepressant meds, whose propensity to cause weight gain is now beyond doubt. The third suspect Prof. Kuk mentions is the controversial microbiome. The world of gut bacteria has just begun to reveal its secrets, and once the optimal balance of populations can be understood, it can be manipulated for benign purposes. So it may be too pessimistic to assert that Americans’ BMIs are “influenced by factors beyond their control.” That particular inner universe appears to be amenable to an extensive amount of control.

    The World Obesity Federation’s main candidate for obesity villain, by the way, is Big Food, the conglomeration of international food corporations that sell untrustworthy products and advertise shamelessly to children. Indeed, there is plenty of blame to go around.

    It has become impossible to deny that the puzzle has many levels. It isn’t tic-tac-toe, it’s three-dimensional chess. Like quantum physics, the obesity puzzle contains some mind-boggling discoveries that continually demand further research, because some things just don’t seem to make sense. On the other hand, as MGI says, “while investment in research should continue, society should also engage in trial and error, particularly where risks are low.”

    Your responses and feedback are welcome!

    Source: “Global obesity rise puts UN goals on diet-related diseases ‘beyond reach’ ,”, 10/09/15
    Source: “How the world could better fight obesity,”, November 2014
    Source: “A Broader, Global Approach to Obesity Treatment and Prevention,”, 02/20/15
    Source: “Why It Was Easier to Be Skinny in the 1980s,”, 09/30/15
    Image by Paul L Dineen

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