In the U.K., Pro- and Anti-Sugar Forces Contend

chocolate-coins-closeup

As we left off in following the progress of the sugar tax in the United Kingdom, a forum on sugar reduction policy was attended by Food and Drink Federation lobbyists and by public interest groups supporting the 20% by 2020 plan, and it seemed as if things might go smoothly for a while.

Then, in May, there were rumblings of discontent. Denis Campbell reported:

The Food and Drink Federation, which represents manufacturers, recently warned that the 20% cut in sugar content of most types of foodstuffs being sought by Public Health England by 2020 was highly unlikely to happen because it would not be “technically possible, or acceptable to UK consumers”.

In what universe would it be technically impossible for food manufacturers to cut down the amount of sugar in their recipes? That just seems silly on its face. As for being acceptable to consumers, that is why rules and limits are given the force of law, because people are unlikely to act that way on their own. In other words, governmental business as usual.

In July, trouble broke out in another quarter, as the All Party Parliamentary Group on a Fit and Healthy Childhood (APPG) came up with several dozen recommendations aimed at reducing the dangerous trend toward maternal obesity.

These include routine weighing of all pregnant women, not just those who appear obese, and some very aspirational suggestions, including:

More time to be allocated for healthcare professionals to have contact with prospective and new parents; discouragement of the “tick box” culture that impedes the establishment of personal relationships… Mandatory training of medical students and practising doctors in 7 evidence-based lifestyle interventions on the prevention and treatment of chronic disease…

There were also recommendations for other sectors of society, like:

Appropriate pictures and images of individuals affected by obesity should be used that do not contribute to the depersonalisation and stigmatisation of the individual with maternal obesity… Positive media portrayals of obese pregnant women need to be employed instead of using such images merely for the purpose of humour and ridicule…

The APPG report examined the roles of health visitors and midwives, both long-established roles in the National Health Service cast of public servants. It also asked for something very interesting (and contrary to commercial interests). The food and drink industries both strongly advocate personal responsibility, as we have seen. The party line in, if you’re overweight it’s on you, because you don’t exercise enough to burn the calories.

The APPG report suggests placing not so much focus on the concept of individual responsibility. More attention could and should be paid to the societal, biological and environmental factors that encourage maternal obesity, which is then passed along to succeeding generations.

Your responses and feedback are welcome!

Source: “Sugar tax must apply to sweets as well as drinks, say campaigners,” TheGuardian.com, 05/11/17
Source: “Maternal Obesity,” APPG via MailChimp.com, 2017
Photo credit: William Warby via Visualhunt/CC BY

More on Addiction Terminology

gentleman-dinner-restaurant-illustration

In a series of posts, Childhood Obesity News examined the premise that something is missing from the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The gap is where the existence of food addiction should be acknowledged in some form, going under some name.

But it doesn’t seem to be there. In the “substance use disorder” department, food isn’t named as a substance prone to disordered use.

Substance use disorder is an interesting term. Such a malady entails “negative consequences of continued and frequent use.” As addiction takes hold, the negative consequences multiply and solidify.

Frequently, overeating causes the negative consequence of obesity, which would seem to imply that overeating should be considered an eating disorder, or a behavioral addiction, or something. And even, possibly, that food can be an addictor, even if it’s only some foods, for some people, under some circumstances.

While DSM-5 noticeably shies away from using the word “addiction,” it does allow for “substance use disorder” and “substance induced disorder.” A number of arguments can be made for why disordered overeating could be either one of those.

One useful thought experiment would be to look at the end product and reverse-engineer it. Alcoholics, hard drug addicts, and obese people all seem to get better results from 12-step programs than anything else discovered so far. That they all benefit to such a degree could indicate that alcoholism, hard drug addiction, and disordered overeating are all basically the same phenomenon.

ASAM has a say

The American Society of Addiction Medicine (ASAM) publishes guidelines which include reflections on terminology. Their definition of addiction describes the inability to consistently abstain, or to control one’s behavior, or to recognize how being hooked on the substance or behavior makes all of life’s problems worse.

The definition includes dysfunctional emotional response cravings, cycles of relapse, and addiction. It’s a lot like what happens in disordered overeating. Also, addiction is progressive, and quite likely to end in disability and/or premature death. Again, that’s a lot like the obesity and associated co-morbidities summoned up by disordered overeating.

ASAM President Dr. Stuart Gitlow wrote an editorial that said:

We applaud DSM-5 for using the term “addictive disorders” within its overall framework. DSM-5 does not, however, speak to addiction but rather to some of the markers seen with addictive illnesses…

Ultimately, the definitions in DSM-5 are definitions for a new set of illnesses. They have different terminology and are accompanied by new defining structures…

Now it’s up to us to remember that addictive illness is still addictive illness; it remains unchanged despite the arrival of DSM-5…

DSM-5 has a section on “Feeding and Eating Disorders” which includes anorexia and bulimia, but not disordered overeating or obesity. But DSM-5 is strangely silent on the addictive potential of edible products, and also about the most prevalent eating disorder on the planet, the one that nobody seems able to get a handle on.

Announcement

Next month, Dr. Pretlow will attend the World Congress of Psychiatry, held in Berlin, Germany, October 8 through 13. He will speak on the topic, “Specific addiction-treatment methods for obesity with trials data, including audio clips of subjects describing feelings around overeating and experiences using addiction treatment methods” and chair a symposium whose subject is “The applicability of addiction-model methods for disordered-overeating and obesity intervention.”

Your responses and feedback are welcome!

Source: “Definition of Addiction,” ASAM.com, undated
Source: “Commentary: DSM-5: New Addiction Terminology, Same Disease,” DrugFree.org, 06/07/17
Photo credit: Internet Archive Book Images via Visualhunt/No known copyright restrictions

Potato Lore

potatoes-closeup

Potatoes got their start in South America, where their ability to grow at high altitude guaranteed their popularity. The indigenous people of the Andes have been cultivating potatoes for at least 4,000 years, and maybe as long as 7,000 years.

Monoculture = bad

Britannica.com calls potatoes a “hardy, nutritious, and calorie-dense crop and relatively easy to grow in the Irish soil.” By the 1840s, half of Ireland’s people — mostly the poor, of course — were dependent on spuds to live at all.

When a disease attacked the potatoes, a million people died, give or take, from starvation or communicable diseases that hitchhike along on a famine. Somewhere between one and two million people emigrated, and the vast majority of them came to the USA. That one food, and its deadly absence in Ireland, had influenced America immeasurably.

Eighty years ago, George Orwell (famous for Nineteen Eighty-Four and Animal Farm) embarked on what David Sharrock called “a classic literary journey.” Orwell set out to investigate the slums and rural poverty pockets of northern England, where the potato was one of the dietary staples, along with white bread, margarine, corned beef, and sugared tea.

Apparently, this nutritionally horrifying diet was not fully a matter of economic stress, but partly a preference. Orwell wrote:

The English palate, especially the working-class palate, now rejects good food almost automatically. The number of people who prefer tinned peas and tinned fish to real peas and real fish must be increasing every year.

The only thing on that Big Five list with healthful potential is the potato — a vegetable that has its defenders. The United Nations has recommended it as a potential cure for world hunger, although not everyone is willing to go that far. Although the potato’s claim to be the perfect food is neither verified nor refuted here, potato lore is interesting.

Take away the extra fat

The George Mateljan Foundation has a food ranking system that rates potatoes as…

[…] a very good source of vitamin B6 and a good source of potassium, copper, vitamin C, manganese, phosphorus, niacin, dietary fiber, and pantothenic acid. Potatoes also contain a variety of phytonutrients that have antioxidant activity… [T]ake away the extra fat and deep frying, and a baked potato is an exceptionally healthful low calorie, high fiber food that offers significant protection against cardiovascular disease and cancer.

An impressive resume.

Your responses and feedback are welcome!

Source: “Potatoes,” WHFoods.com, undated
Source: “Great Famine,” Britannica.com, undated
Source: “The road to Wigan Pier, 75 years on,” TheGuardian.com, 02/19/11
Source: “Man Eating Nothing But Potatoes for 2 Months,” LiveScience.com, 10/20/10
Photo via Visualhunt

Questions of Terminology for Obesity and Addiction

studying-in-scrubs

Fresh news!
Next month, Dr. Pretlow will attend the World Congress of Psychiatry, held in Berlin, Germany, October 8 through 13. He will speak on the topic, “Specific addiction-treatment methods for obesity with trials data, including audio clips of subjects describing feelings around overeating and experiences using addiction treatment” and chair a symposium whose subject is “The applicability of addiction-model methods for disordered-overeating and obesity intervention.”

Dr. Pretlow asks:

If (disordered) undereating is an eating disorder and a psychological malady, why isn’t (disordered) overeating an eating disorder and a psychological malady?

Since disordered overeating so often leads to obesity, it is equally important to ask:

Why isn’t obesity considered a psychological problem?
Why isn’t obesity considered an eating disorder?

Dr. Pretlow says:

My goal is to persuade the psychiatry/psychology field to take on the treatment of obesity, and further to consider disordered overeating and obesity as a psychological malady and an eating disorder.

There are quite a few ways to look at these issues. Some years ago, Dr. John Foreyt told Dr. Pretlow that he believed obesity was 99% a psychological problem. If so, wouldn’t that explain disordered overeating as an addictive process? If not, why not?

These definitions are very important for numerous reasons, so a lot of individuals and groups have a stake in seeing that the language is conscientiously applied. The Food Addiction Institute (FAI), for example, was created to “effectively address the food addiction crisis within the obesity epidemic.”

FAI aspires to be the place where people who think about public health policy and strategies can bounce ideas off each other while defining and expanding the body of scientific and medical knowledge about food addiction. Two items mentioned in a past vision statement have become reality:

Created a three year Professional Training program currently administered by ACORN Food Dependency Recovery Services. Organized an educational campaign to add food addiction as a Substance Use Disorder in the DSM5 of the American Psychiatric Association.

The very explicit title of a paper by Caroline Davis, Ph.D., is, “A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncratic clinical features.” In other words, the three entities are similar but not the same.

The author cites “semantic issues about the appropriateness of the food-addiction label.” On the one hand…

[…] there is accumulating evidence that some vulnerable individuals display addictive symptoms in relation to their consumption of certain highly rewarding foods.

On the other hand, even though obesity and addictive tendencies toward food often occur in the same individuals, “it is over-inclusive to model obesity as an addiction disorder.” There is, basically, too much else going on, too many other facets and factors.

Previous Childhood Obesity News posts that have addressed these questions are “Addicted to What?” and “The Possibilities of Obesity.”

Your responses and feedback are welcome!

Source: “Food Addiction as a part of the Obesity Epidemic,” FoodAddictionInstitute.org, undated
Source: “A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncratic clinical features,” ScienceDirect.com, 08/01/17
Photo credit: Aaron Jacobs via Visualhunt/CC BY-SA

Can Sub-Optimal Attitudes Change?

nursing-stamps

Childhood Obesity News discussed two types of bias in treating obesity, and touched on the troubling news that medical professionals are human like the rest of us, and are sometimes prone to unhealthy mental and emotional habits. The urge to prove others wrong is hard to eliminate.

In Sioux City, Iowa, journalist Dolly A. Butz told the story of a Morningside College academic’s conversation with a nursing student who had been caring for an obese child. Associate Professor Shar Georgesen was shocked by the tone of the other woman’s stereotypical and judgmental gossip about the child and the parents.

This is an illustration of why “anecdotal evidence” may deserve more credit from the establishment than it gets. In this case, the real-life incident led to Prof. Georgesen’s decision to find out just how much student nurses know about childhood obesity, and what attitudes they display to child patients and their parents. She was also interested to learn “how they perceive their own ability to work effectively with families of overweight children.”

As part of her doctoral dissertation, Prof. Georgesen created a survey that ultimately was responded to by 102 nursing students from 26 schools in three states. Once it was written up it became research, but, essentially, the study was the product of more than a hundred cumulative personal and subjective anecdotal experiences, inspired by one personal, subjective experience.

The survey participants were asked to read brief fictional stories about two children of different ages, activity levels, weights, and parental weights. Butz writes:

Survey participants were randomly assigned vignettes that varied, some included a normal weight child with an overweight parent, and others an overweight child with a normal weight parent. The nursing students were never told that the survey was specifically about childhood obesity.

The reporter quoted Prof. Georgesen:

When survey participants read vignettes about overweight adolescents who had an overweight parent, they viewed them negatively.

Obesity bias begins fairly early in childhood. There’s evidence that children as young as four or five respond differently to obese peers than normal-weight peers. By the time students come to nursing school, those ideas are pretty well developed.

This matters because when nurses have some kind of issue with overweight kids, the care the children receive is very likely to be affected, and not in a good way. Leaving the topic of attitude assessment, the journalist elicited some very frank comments about the conditions in this field of education:

About 10 percent of nursing students surveyed said their classes haven’t prepared them to talk about weight as a health problem at all, while about 25 percent said they’ve been taught about the health risks associated with obesity, but not how to talk about obesity.

Georgesen said nursing students spend more time in the classroom learning about smoking and alcohol addiction than weight management, even though they’re more likely to encounter a patient who is obese. She said the topic likely doesn’t get the attention that it should because 40 percent of nurse educators are overweight.

The study author does not necessarily claim that all parts of the country are training nurses with a bad attitude. There is, however, a regional cultural trope that demands personal responsibility for one’s own problems. In that paradigm someone, whether child or parents or both, has to accept blame. Asking for help for personal problems does not come easy to Midwesterners, and extending help non-judgmentally may be equally difficult.

Your responses and feedback are welcome!

Source: “Morningside College professor’s research identifies bias among nursing students,” SiouxCityJournal.com, 04/07/17
Photo credit: John Flannery (DrPhotoMoto) via Visualhunt/CC BY-SA

Types of Bias in Treating Obesity

doctor-hand-illustration

One of the big problems with treating obesity is the difficulty of getting some medical professionals on board with certain concepts — like compassion for the pain of obese patients and the challenges they face. An article by Dr. Dyan Hes begins like this:

“How do you do your job?” “I wouldn’t touch those kids with a 10-foot pole!” “Your clinic is a mini-psych ward!” “Nothing works!”

These are just some of the comments I’ve heard throughout my career as a pediatrician who specializes in obesity medicine. What’s worse is that these comments come from other members of the health care community.

Sadly, some doctor-patient relationships are marred by callousness, indifference, disrespect, prejudice, bias, aggression, and bigotry.

How Bias Stands in the Way of Addressing Childhood Obesity” is a presentation created by Ted Kyle, RPh, MBA, with the aim of defining and overcoming bias in the professions that concern obesity and nutrition because, as the Summary states:

Bias causes profound harm: to people, to science, and to health promotion.

The author defines the two types, one of which is weight bias that targets people with obesity, sometimes causing them to avoid the medical profession altogether. When personnel have preconceived notions that obese people are lazy, weak-willed, dishonest, or afflicted with any other undesirable trait, the result will probably not be good. That type of bias takes up only a small portion of the presentation.

The other kind is “intellectual bias favoring personal convictions,” and most of the content comprises issues that the author seems to have strong personal convictions about. Kyle points out that, nationally, to service five million severely obese children, there are only 36 specialized clinics in operation.

He classifies “Promoting breastfeeding prevents obesity” as a myth. On the other hand, he gives this idea the status of a testable hypothesis: “Taxes on SSBs and junk food will prevent obesity.”

None of these points has anything to do with face-to-face office visits, but are more like arguments designed to influence voters. One of the slides says, “Evidence-based care is mostly out of reach for people with obesity.” Perhaps the author has not heard of W8Loss2Go.

Kyle quotes Dr. Robert Doroghazi, who recommends telling patients the truth:

Sir or Madam, it’s not OK to be obese. Obesity is bad. You are overweight because you eat too much. You also need to exercise more. Your obesity cannot be blamed on the fast food or carbonated beverage industry or on anyone or anything else. You weigh too much because you eat too much. Your health and your weight are your responsibility.

Some would say that is only one version of the truth.

Your responses and feedback are welcome!

Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
Source: “How Bias Stands in the Way of Addressing Childhood Obesity,” ConscienHealth.org, 2017
Photo credit: Jared Rodriguez/Truthout.org via Visualhunt/CC BY

Ambivalence and Nutrition Education

medical-school-building-brisbane

Childhood Obesity News mentioned a few observations about the nutritional education that medical students receive, which is widely considered to be inadequate. Medical schools have been criticized. But, as with most obesity-related subjects, there is nuance.

Of course everyone should be aware of some basic things, like the destruction wreaked on the microbiome by antibiotics, which affects the metabolism deeply, which in turn affects the body’s nutritional needs and failures. An orthopedic surgeon might be particularly interested in the whether any nutrients tend to help bones heal faster.

But unless the physician aspires to dive all the way in and embrace functional medicine, nutrition info may not actually be that important in the overall scheme of things. For starters, dietary advice has the maddening habit of changing with ever-increasing frequency. Sometimes it turns out to be flat-out wrong.

Doctors tend to hold onto what they learned in med school — which is, after all, the purpose of going there. But those teachings might result in actually giving bad dietary advice to patients. Nobody has negative intentions, but when absorbed in her/his specialty, that orthopod will probably sign up for continuing education opportunities that feature the newest hip replacement hardware. Staying current with the nutrition scene may not be a high priority.

Buckle up, the ride gets rough

Pediatrician Dyan Hes writes:

Many parents ask me for a “diet” or a “print out” of exactly what their child should be eating daily. They’re often surprised that my reply is “No.” I’m not a nutritionist.

At first glance this is rather shocking. But maybe she is on to something. Taking this stand certainly doesn’t let doctors off the hook. They should learn as much as possible about nutrition. But maybe it shouldn’t be their responsibility to teach patients, or get bogged down by the many mundane tasks that effective anti-obesity therapy necessarily includes.

A convincing case is made, in some quarters, for increasing the number of professionals who do hands-on clinical obesity medicine. The point is for primary care physicians or any other specialists to refer patients to the obesity expert, just like they are referred to a physical therapist.

Another factor comes into play. As Dr. Pretlow found from listening to thousands of young people, they mostly feel like they have enough nutrition information. Cheeseburger, bad. Apple, good. Got it. Many parents echo this sentiment. They know what is supposed to be eaten. They just can’t get their kids to eat it. Hopefully, the obesity specialist has creative solutions.

Meanwhile, physicians can use their expertise in other ways. Dr. Hes says:

My job is to examine your child with a medical eye. I’ll point out complications from weight that you may not have been aware your child already had, like worsening asthma, acanthosis nigricans (a dark, velvety skin change commonly found around the neck, underarms, and groin), obstructive sleep apnea that can lead to school failure or school issues due to hypoxia (low oxygen levels) while sleeping.

Weigh the options

A parent who seeks nutritional education from a doctor might want to rethink the priorities. That knowledge is available through classes, online, and from children’s books and in many places in many forms. Why waste valuable face-time with a doctor to ask for information that is so freely accessible?

Granted, the Internet can be a wilderness of ignorance, so how does a parent know where to pay attention and give credence? Most parents don’t read journal articles. The primary care physician might pick a respected nutrition guru, and steer them in that direction. As for the rest, let the obesity consultant do the heavy lifting.

Your responses and feedback are welcome!

Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
Photo credit: bertknot via Visualhunt/CC BY-SA

Functional Medicine and Obesity

sugar-cookie-craving

Nothing beats the Western medical establishment when it comes to acute care. If you have a compound fracture, you want to be in a major American city. But once the bleeding is staunched and the leg is placed in a splint, subjectivity comes into play. Is this patient allergic to penicillin? How much anesthesia does he get, based on weight and other factors?

In a major outbreak of contagion, epidemiology has automatic, first-response answers, providing maybe the most fitting and practical example of the one-size-fits-all treatment paradigm. Later, the fact that a person survived a plague becomes just another piece of their individual health history.

Trauma and epidemics are different from chronic illness because nothing is more subjective than chronic illness, and every case is rife with individual factors. Take the autoimmune condition known as SLE, systemic lupus erythematosus, or simply lupus. Depending on the individual, it can manifest in a dozen ways.

The thing about functional medicine is, the individual angle is the important part. It stretches to take into account the most seemingly unrelated detail of a patient’s history and circumstances. It’s tailored, customized like a fine bespoke suit, and one size definitely does not fit all.

A strong proponent of functional medicine

Some members of the medical establishment consider “integrative” a naughty word, but the concept is an important one that fits comfortably with “science-based.” Childhood Obesity News has more than once quoted Dr. Mark Hyman, Director of Cleveland Clinic’s Center for Functional Medicine, who says the following of his specialty:

It treats the whole system, not just the symptoms… It seeks to identify and address the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties…

Functional medicine practitioners look “upstream” to consider the complex web of interactions in the patient’s history, physiology and lifestyle that can lead to illness. The unique genetic makeup of each patient is considered, along with both internal (mind, body, and spirit) and external (physical and social environment) factors that affect total functioning.

Dr. Hyman feels that most physicians have not received training adequate to fully understand complex, chronic disease. He sees in this particular area of medicine a “huge gap,” where practice may be as much as 50 years behind what research is revealing every day.

Practitioners of functional medicine often trace the root of a patient’s problem to nutrition, especially as it impacts the gut microbiome. Dr. Kara Fitzgerald published the inspiring story of Frieda, a 46-year-old with fatigue, anxiety, depression, sleep disorder, bronchitis, sinusitis, thyroid imbalance, multiple skin problems, PMS, and morbid obesity.

Over the years Frieda had tried various medications for the physical and emotional problems, as well as psychotherapy, but nothing led to significant or sustainable change. She had started bingeing in her 20s, especially on sweets, dairy products and bread.

Dr. Fitzgerald writes:

My strong suspicion was that in part, Frieda’s GI bugs were “running the show,” stimulating potent sugar cravings and contributing to depression, anxiety and metabolic syndrome… Giving into the cravings was, in turn, contributing to the metabolic syndrome, weight gain, inflammation, depression, anxiety, hyperlipidemia and estrogen dominance…

I was confident that as long as she was willing to endure the potentially difficult but very short-term journey of “sugar detoxing,” she’d get to the other side — her cravings would subside and her health would rebound.

And that is what happened. Dr. Fitzgerald relates in detail the other parts of the plan and includes Frieda’s “Baseline Medical Symptom Questionnaire” from both before and after treatment. According to the scoring system, less than 10 is optimal; 10-50 indicates mild toxicity; 50-100 is moderate toxicity; and over 100 is severe. Frieda went from 96 (right on the edge of severe) all the way down to 8. (Oh, and lost 79 pounds in half a year.)

Your responses and feedback are welcome!

Source: “About Functional Medicine,” DrHyman.com, undated
Source: “Recovering from Morbid Obesity, Depression and Metabolic Syndrome Using Functional Medicine: One Woman’s Inspiring Journey to Wellness,” DrKaraFitzgerald.com, 12/27/16
Photo credit: maxsheb/123RF Stock Photo

Professionals and Nutritional Awareness

medical-student-tag-joke

Two years ago, the American Medical Association reported that, although 25 hours of nutritional education are recommended for medical schools in the United States, only 27% of them actually offer that many. (The average is 19.6 hours, and most of the content concerns biochemistry, rather than practical food choices in everyday life.)

Some experts object because examinees for internal medicine certification are not asked a single question about nutrition. Cardiology as a specialty is no better, which is a shame because diet probably influences heart health. Some experts see this as an “educational void” and believe that better education in this area for medical professionals is key to the goal of changing trends on a societal scale.

Researchers who polled brand-new medical students discovered that:

71 percent think nutrition is clinically important. Upon graduation, however, fewer than half believe that nutrition is clinically relevant. Once in practice, fewer than 14 percent of physicians believe they were adequately trained in nutritional counselling.

There is a new trend toward involving medical students in actual kitchen-level food preparation involvement, and investigating local food availability conditions, so forth, which is all to the good.

These suggestions were made by the authors of the same Academic Medicine report. First, the students should take courses in nutrition, exercise, stress management, and sleep hygiene — all of which they will need for their own self-care, as well as to benefit their patients. Exams that lead to special certifications are proposed.

Different institutions come up with different ideas. The Tulane University School of Medicine, for instance, offers “clinical rotation at a professional cooking school.” One suggestion carries extra weight, in light of the bad publicity hospitals have endured because of unpopular affiliations with fast-food empires:

Create “hospitals and ambulatory care venues with exceptional cafeterias, restaurants, teaching kitchens, and inpatient menus showcasing foods that are healthy, delicious, affordable and easy to make,” the authors said, noting that nutritious foods should replace their processed predecessors in hospital eateries.

Because doctors are such highly-regarded authority figures, one last recommendation is very important, and that is to lead by modeling the desired behavior. In the anti-smoking movement, many physicians and other health professionals realized the importance of setting a good example. The fact that they quit smoking served as a catalyst for at least some patients, which can also be effective in the area of weight management.

Dr. Dyan Hes wrote:

Great strides are being made in the United States to try to educate physicians about preventive medicine — to talk your patients and their families about healthy nutrition at each visit in order to prevent them from becoming obese.

Your responses and feedback are welcome!

Source: “What’s at stake in nutrition education during med school,” AMA-Assn.org, 07/23/2015
Source: “8 ways med schools can take nutrition from classroom to kitchen,” AMA-Assn.org, 08/06/15
Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,” MindBodyGreen.com, 03/24/14
Photo credit: sylvar via Visualhunt/CC BY

Different Strokes for Different Folks

doctor-teamwork

The concept of a one-size-fits-all solution to obesity has pretty much vanished. Fortunately, the multi-disciplinary solution has stepped up to make some sense out of the whole mess. Late in 2013, the Obesity Society, American Heart Association and American College of Cardiology teamed up to publish a set of guidelines for doctors, to help them manage overweight and obesity in adults.

In order to glean the most current recommendations, 133 recent studies were examined. The subtitle of Nanci Hellmich’s article expresses the conclusion succinctly:

New guidelines say that there is no ideal diet — whatever works to help obese patients lose 5%-10% of their body weight.

Committee co-chair Donna Ryan told the reporter that the objective is “to get primary care practitioners to own weight management as they own hypertension management.” If such help were available everywhere and all patients could afford it, the ideal program would be “delivered by trained interventionists (not just registered dietitians or doctors) for at least 14 sessions in the first six months and then continue therapy for a year.”

Of course these intensive therapeutic resources are not available to everyone. But many people, Ryan says, can benefit from phone- and web-based interventions, and even from commercial weight-loss programs. Just like with individual reactions to foods, it’s different strokes for different folks. There are satisfied customers enough to endorse just about anything, because they sincerely believe it worked for them, even if some other dynamic was in play.

An interesting innovation

South Dakota State University has designed a program especially to produce desperately needed childhood obesity experts. It is based on the premise that:

The cause of childhood obesity is multifaceted and strategies to prevent and treat it need to be transdisciplinary.

It pulls from the Health and Nutritional Sciences department, whose students include aspiring nutritionists, registered dieticians, athletic trainers, occupational therapists, physical therapists, community and public health administrators, PE teachers, and managers and administrators in sports and recreation.

Graduate students in any of those fields have the choice to go after a TOP certificate, which stands for Transdisciplinary Childhood Obesity Prevention. The faculty includes experts who introduce additional perspectives from early childhood education, nursing, counseling, and statistics.

As a corollary, the program teaches that there is no one-size-fits-all solution to obesity, because its answers are drawn from “evidence based transdisciplinary approaches to prevention.” According to the program’s literature:

Experiences gained as a TOP student will prepare graduates for collaborations with individuals in other disciplines in a career aimed at reducing childhood obesity…. Students will obtain a TOP program certificate upon completion of the requirements for both the certificate and the Masters or Doctoral degree from their respective college.

Your responses and feedback are welcome!

Source: “Doctors urged to treat obesity like any other ailment,” USAToday.com, 11/12/13
Source: “Transdisciplinary Childhood Obesity Prevention (TOP) Graduate Certificate Program,” SDState.edu, undated
Photo credit: andreypopov/123RF Stock Photo

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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