Edmonton Obesity Staging System as BMI Alternative

Rain in the Piazza

Dr. Arya Sharma, who holds the opinion that “Health cannot be measured by stepping on a scale,” looked into the history of the body mass index standard of measurement.

Like many other public health conventions, this one began with the military, way back in the mid-1800s. The Belgian mathematician, astronomer, and social statistician Adolphe Quételet published a book about the average measurements of French soldiers. His ideas were very influential, and what was originally called the Quételet index became the Body Mass Index.

For an opposing view, Dr. Sharma references a paper written by Stuart Nicholls of the University of Ottawa. Apparently, there are some problems:

While Nicholls also discusses the misuse of BMI as a (rather poor) surrogate for body fatness, his main argument against the use of BMI rests on the overly simplified usage of BMI-based obesity classifications and the problematic application of population level standards to individuals.

Nicholls points out that it is naïve to treat everyone within category as a homogeneous group, for technical reasons that he explains. More significant are the psychological effects, as people tend to misuse and abuse such classification, which can lead to stereotyping and other undesirable social outcomes. Placing people in arbitrary pigeonholes “may affect whether we wish to associate with the individual or how we do so. “

Oversimplification that ignores complexity can lead to inaccurate conclusions, especially when standards are applied broadly across races, cultures, and nations. Nicholls warns:

Definitions of overweight using the BMI provides only a crude population-level measure, and while valuable for its convenience and simplicity in public health surveillance, screening, and similar purposes it lacks the sensitivity or specificity to be used as a diagnostic tool.

Like the Social Security number, which used to exist for one purpose only, BMI has suffered from mission creep and, according to Dr. Sharma, “found its way into clinical, bureaucratic and regulatory guidelines for which it was never intended.” He suspects that classifying people by BMI alone leads to the over- or under-treatment of large numbers of patients. He prefers the more nuanced Edmonton Obesity Staging System (EOSS).

For MedScape.com, Nancy A. Melville acknowledges that BMI and waist circumference (WC) are the most popular methods…

But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.

For one thing, any obesity classification system really needs to distinguish between lean tissue and fat. EOSS also takes into account a person’s basic health status (including any underlying conditions) and is said to be more useful, especially as a calibrator of cardiometabolic risk and predictor of mortality.

The EOSS tool ranks obese and overweight people according to a five-point scale based on factors relating to an individual’s underlying health status (as revealed by blood pressure and serum lipid and fasting glucose test results, among other indicators). Taking into account not just weight but the presence or absence of underlying health conditions is said to make EOSS a better predictor of mortality.

Of the five points on the scale, 0 is the best possible score, meaning no apparent risk factors. Obviously, 5 is the worst and includes “severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being.”

Your responses and feedback are welcome!

Source: “How BMI Obfuscates Public Health and Clinical Approaches to Obesity,” DrSharma.ca, undated
Source: “Obesity Ranking System Predicts Mortality,” MedScape.com, 08/15/11
Image by Barney Moss

Assessing the Flab Quotient

Shores Pediatrics

Last time, Childhood Obesity News looked at body mass index as the standard of obesity measurement. A study published in the American Journal of Clinical Nutrition examined the specific question of whether BMI or waist circumference (WC) measurement is best. When someone is apparently healthy, albeit chubby, that person’s system may still betray early warning signs of cardiometabolic risk.

Will this person eventually develop diabetes or heart disease? Blood tests reveal certain chemical markers that throw a shadow of doom over a person’s health picture. Scientists wondered whether those lab results match up more with overall obesity as measured by BMI, or central obesity as measured by WC. The answer is, both “indexes of excess adiposity” correlate with bad news in the test tube.

Actually, there are several ways to calculate the ratio of body fat to whatever else is in there. One problem is, these methods may be too complicated and expensive to implement on a large scale, such as all across the USA for all children. Jeremey DuVall of Men’s Fitness has catalogued them.

How to measure

Fanciest of all is the DEXA or Dual-energy X-ray Absorptiometry Scan, which can “estimate lean tissue, bone, mineral, and fat across regions of the body with amazing accuracy.” Of course the potential cost for use in schools is unimaginable. Underwater weighing is quite accurate, but totally impractical in most situations. The space and equipment needed are problematic, and the minute anyone in a position of authority tells a child to strip down and get underwater, trouble will ensue.

And then there is Whole Body Plethysmography, which “measures air displacement to estimate body composition” — basically, underwater weighing without the water. In terms of widespread use in schools and similar institutions, this would be much more culturally acceptable. But the equipment is prohibitively expensive, and of course the method also requires trained personnel.

Skinfold measurement, by comparison, is downright primitive. All you need is a pair of calipers. Once the amount of subcutaneous fat is determined, that amount can be extrapolated to the rest of the body to estimate total fat percentage, including the lard strangling our kidneys and livers. Du Vall says:

The most common variations are the 3-site and 7-site skinfold tests. Sites are slightly different between men and women, but the protocol remains the same. Skinfold measurements remain as a popular and widely used method of measuring changes in body composition since calipers are easy to use and found at almost any gym.

Of course you also need someone wielding the calipers who knows what they’re doing and what it means, but the skill is easier to learn than, for instance, DEXA technology. The last suggestion, Bioelectrical Impedance Analysis (BIA) is cheap and widely available. Electrical signals travel through fat differently than through lean tissue. The hitch is, variable factors like hydration level can skew the results.

Your responses and feedback are welcome!

Source: “Cardiometabolic risk factors and obesity: does it matter whether BMI or waist circumference is the index of obesity?” Nutrition.org, 07/24/13
Source: “Top 5 Ways to Calculate Body Fat,” MensFitness.com, undated
Image by Ines Hegedus-Garcia

Doubts About BMI

chracter-fat kid

Science marches on, which sometimes causes embarrassment when new information emerges. This might be the case with body mass index or BMI, which is generally taken to be the best feasible way of measuring the risk and degree of obesity in children.

A downloadable PDF file from Shape Up America! describes how a screening program should be set up and implemented. (Aside from any other factors, frequent repetition of the word “surveillance” is likely to ruffle the feathers of some citizens.) The topmost authorities try to get everybody to test every kid within reach, according to uniform criteria. Every bureaucracy is bribed and/or coerced into following what seems like a perfectly reasonable policy. They are also urged to make accurate and timely reports, so the situation can be assessed on a national scale.

This record-keeping can be an uphill endeavor because many school districts, rural health clinics, and other facilities simply do not have the resources to do these things. With luck, the ponderous machinery of government funding is geared up, perhaps supplemented or replaced by foundation grants, and eventually, one way or another, conditions are created where everybody is pretty much on board.

But then… various factions start to question the supremacy of BMI as a universal language of obesity. As Childhood Obesity News has noted before, Elizabeth Waters in Preventing Childhood Obesity: Evidence Policy and Practice wrote:

The lack of consensus about obesity-related illnesses is evidenced by differences between studies in terms of the range of co-morbidities included. Studies vary in terms of the BMI cut-off points used to define obesity, as well as the perspective employed from which to measure costs.

Also, different research projects look at things from different perspectives. When studies of any social phenomenon are compared, a plus-or-minus factor is built into the informed guesses.

Nature’s way

The UK’s Daily Mail obligingly provides a bullet-pointed summary at the beginning of a story. A recent one began with the headline, “Quarter of obese children missed by BMI tests could be at risk of diabetes and heart disease, scientists warn,” which pretty much says it all. The problem, as described here, is that what really should be measured are the person’s waist circumference and percentage of body fat.

The waist measurement appears to be the physical statistic most directly relatable to diabetes and heart disease. To borrow a line from an old pop song, “It’s nature’s way of telling you something’s wrong,” in the most simple and direct way.

Now, here’s the clincher:

Scientists at the Mayo Clinic say 25% of obese children could be missed by BMI tests because they appear to be a normal weight but have high body fat.

Lizzie Parry explains in more detail how researchers wanted get a handle on the diagnostic abilities of the BMI measurement, as compared to other methods. Published in Paediatric Obesity, the meta-study accessed data on 53,521 individuals between the ages of 4 and 18, collected by a total of 37 different studies. Parry quoted Dr Lopez-Jimenez, who warns:

[W]e need additional research in children to determine the potential impact of having high fat in the setting of normal BMI to recognize this issue and perhaps justify the use of body composition techniques to detect obesity at an early stage.

Your responses and feedback are welcome!

Source: “Assessment of Children – How to Use Repeated Measures of Body Mass Index (BMI) To Assess and Prevent Obesity in Children,” ShapeUp.org, 2010
Source: “Preventing Childhood Obesity: Evidence Policy and Practice,” Books.Google.com
Source: “Quarter of obese children missed by BMI tests could be at risk of diabetes and heart disease, scientists warn,” DailyMail.co.uk, 10/17/14
Image by piza so

The Culture of Too Much Information

St. John's  International School Meet

Here is a point of view whose focus ties in with another recent Childhood Obesity News topic, motivation. By now, everyone knows that for a person interested in health-enhancing change, self-monitoring can be useful. For instance, a 2008 study indicated that a person who keeps a food diary has a good chance of achieving twice as much weight loss as a person who doesn’t.

A report by Melissa Dahl reminds us that an overview of 26 separate studies proved that wearing a pedometer actually motivates people to take more steps. Not surprisingly, people who use more casual methods, or don’t keep track at all, tend to overestimate the amount of activity they engage in.

An optimistic market researcher estimates that in another few years it’s likely that one person in 10 will be hooked up to wearable health devices, of which wristbands are the most practical and popular. Max Hirshkowitz of the National Sleep Foundation may have originated the term “biometric selfie” for the composite picture of vital signs revealed and recorded by the devices. An old saying was, “The camera doesn’t lie,” and now it is the wearable health device that records the inexorable truth.

It gets old

People who have fancy technological devices sometimes lose interest after a while, or seem to. It may simply be that they don’t understand how to interpret or use the flood of detailed information they receive. And then there’s this:

Even though 60 percent of U.S. adults track their weight, diet or exercise routine — using either technology or good old pen-and-paper — more than half of them say that keeping track of their health habits hasn’t actually led to a change in their behavior….

When asked, such a person’s typical response might be, “Interesting, but not motivating.” Cardiologist James Beckerman, MD, of the Providence Heart and Vascular Institute, is dismayed by the extent to which users’ interest seems to center around having their devices post their results to their online social media.

It’s all part of a trend that includes the self-congratulatory album sections of local print publications, those that still exist. They devote an increasing number of pages to photos of citizens at events designed to raise charitable funds, or just out raising a little well-mannered hell at various night spots. It’s as if people need the visual proof that they had a good time, or the blessings of strangers for their fitness efforts. Beckerman says:

I think we’re unfortunately in a culture where the validation of the experience is somehow a stand-in or a more important entity than the experience itself, and that’s so lame.

The antidote suggested by health experts is to set a definite, concrete health goal and use the self-monitoring gizmo as an assistive device to reach it because, Dahl says,

[T]racking the numbers of miles you ran purely for the sake of tracking the number of miles you ran may not ultimately be an effective motivator.

Your responses and feedback are welcome!

Source: “Healthy or TMI? The rise of the ‘biometric selfie’,” Today.com, 01/18/14
Image by Roman Boed

What Is This BMI?

Elephants love Kit-Kats

What exactly is this BMI we hear so much about? A definition proffered by MedifastArizona.com goes like this:

Obesity is defined as an excessive amount of body fat in relation to lean body mass. This is generally calculated by physicians as body mass index (BMI), a formula that takes into account height. This is calculated by taking your weight in pounds and dividing that by the square of your height in inches and then multiplying that figure by 703.

The resulting figure is used by pediatricians, schools, and weight-loss programs of every stripe. The American Academy of Pediatrics recommends early childhood measurement of the BMI percentile, in order to identify children at risk for obesity.

A child in the 95th percentile is in the top 5%, weight-wise, because that child weighs more than 95% of the other children of comparable age and gender.

Heart.org. explains that children older than two years are defined as severely obese “if they either have a body mass index that’s at least 20 percent higher than the 95th percentile for their gender and age, or a BMI score of 35 or higher.”

Indeed, severe obesity is a newly defined risk classification, which includes around 5% of kids in America. Their future holds type 2 diabetes and heart disease, and treatment options seem, at present, to be limited. Or perhaps only the vision of the medical establishment is limited.

At any rate, this heart connection is not just a figment of the imagination. For instance, the Million Women Study showed, as no other large-scale study had done, that coronary heart disease increases progressively with BMI. Also, the correlation, which means an increased risk of death, is present in all subgroups. Which subgroups were those? The ones defined by “age, smoking, physical activity, alcohol consumption, and socioeconomic class.”

In Preventing Childhood Obesity: Evidence Policy and Practice, edited by Elizabeth Waters, the point is made that in the past, morbidity and mortality
related more to infectious diseases, until a “dramatic shift” took place. Now, more deaths result from causes related to lifestyle, like obesity. This brings up the whole question of what “lifestyle” means, and whether all the people who try so hard and unsuccessfully to control their weight through diet and exercise are really choosing that “lifestyle.” But those are questions for another day.

Your responses and feedback are welcome!

Source: “Psychological Effects of Obesity on Adolescents,” medifastarizona.com, 04/16/14
Source: “5 percent of U.S. children, teens classified as ‘severely obese’,” Heart.org, 09/09/13
Source: “Body mass index and incident coronary heart disease in women: a population-based prospective study,” BioMedCentral.com, 04/02/13
Source: “Preventing Childhood Obesity: Evidence Policy and Practice,” Books.Google.com
Image by Andrew Malone

The Motivation Puzzle

Burdened by Shame

Last time, Childhood Obesity News considered why kids might lack motivation to take part in a free program that could help them achieve healthy weight; or why, once enrolled in such a program, they might drag their feet and hold back from full participation. Similarly, last month we sighted a headline that read, “Obesity program offers free groceries but lacks participants.” (Maybe people thought it actually was an “obesity” program, when what they really wanted was an “anti-obesity” program.)

Gil Corsey reported for WDRB News on this effort in Louisville, Kentucky, the state that “leads the nation in childhood obesity and preventable death.” The initiative originated with the Shawnee Christian Healthcare childhood obesity study, and is described thus:

The doctor’s office won a $200,000 grant to design a program for the whole family. The program includes free cooking classes, one-on-one workouts, doctor’s visits and even free groceries for six weeks.

Sounds great, right? But Sandy Marshall-King, who deals directly with patients, told the reporter that although 50 or 60 people might register for the program, only a few would show up. This is particularly frustrating because in order to meet the terms of the grant that finances the project, a certain number of people had to sign up. This necessitated going beyond the Shawnee neighborhood and recruiting from the entire city, which is not a bad thing in itself, but it did add a note of discouragement for the health care workers trying to get it off the ground.

Motivation needed

Many solutions for obesity have been suggested and tried, including the ones listed in Slide 99 of Dr. Pretlow’s presentation, “What’s Really Causing the Childhood Obesity Epidemic? What Kids Say.” They include camps and live-in weight-loss centers and programs modeled after substance-dependence programs and family education programs like the Louisville one mentioned above. But all need to start with motivation.

Somebody, preferably the obese patient herself or himself, has to want to do it. We have talked about second-hand motivation in its various guises — nagging, bullying, bribery, threats, etc. What those approaches have in common is that they don’t work, notwithstanding the suggestion by Dr. Callahan of the Hastings Center that maybe more stigmatization is needed.

His theory is based on the fact that social pressure was a very powerful stimulus in his own resolution to leave behind the “reprehensible behavior” of smoking cigarettes. The rationale is that societal disapproval successfully shamed him into giving up that habit, so it might be effective on the habit of overeating. Things are desperate indeed when health professionals, at their wits’ end, are tempted to advance such extreme solutions. Besides, as Dr. Pretlow says:

Education on the effects of smoking doesn’t have very much effect on kids. Kids, particularly teenagers, tend to feel invincible. Motivations such as attracting the opposite sex and being able to wear cool clothes have more effect.

Yes, other motivations have more effect, but too often not enough. However, shaming — even if it appears to work in a few isolated cases — is too risky and damaging to adopt as a policy. Recommendations from the STOP Obesity Alliance include this one:

Address and Reduce Stigma as a Barrier to Improving Health Outcomes –

In fact, stigmatization may postpone and even prevent these individuals from getting treatments that could improve their health. Similarly, providers without effective treatments to offer may avoid discussions about obesity…. Stigma and fear of offending people with overweight and obesity can silence patients and providers and keep them from addressing obesity directly and constructively.

Your responses and feedback are welcome!

Source: “Obesity program offers free groceries but lacks participants,” WDRB.com, 09/02/14
Source: “Policy Recommendations,” TheHill.com, undated
Image by John Hain

Kids and Motivation

Not Motivated

Here is a peek into the process of setting up the trials of Dr. Pretlow’s smartphone app, as he describes it:

Recruiting and engaging youth for our two W8Loss2Go app pilot studies has been extremely challenging. We offered $50 per month compensation, as well as free use of an iPhone 4S for the 4-month duration studies. We do require that prospective recruits complete an application and a motivation questionnaire: But, we’ve found little correlation with the results of this questionnaire and the success with the app program.

There were also exit questionnaires, which produced some interesting answers. The second study included 27 participants. They were asked to rate the relative importance of the possible reasons for joining, and according to their replies, the biggest reason was to lose weight. The second biggest reason was for the financial compensation, and the third was the opportunity to have free use of an iPhone for the duration.

There was also a write-in category for “other” answers. Among them were a desire to gain confidence and a boost in mood, and a wish to find ways to eat better even if it didn’t result in weight loss. The newness of the approach and its apparent convenience were attractive features, and one person expressed a general desire to “feel like i am doing something to help lose weight.”

For an uninvolved observer, it might seem as if every child and youth offered such an opportunity would leap at the chance and regard it as the best thing that ever happened to him or her. If obese kids are as unhappy as they seem — and many indeed are — it seems like they would be lining up around the block for the chance to change their lives, not only for free, but with a little extra reward for their time thrown into the bargain. In proportion to what is offered, the response seems almost tepid.

What is going on?

The same puzzling question appears to exist everywhere, all over the country and the world, where increasing numbers of obese children are morphing into obese teenagers. Sometimes it seems to go beyond a simple lack of motivation, into active resistance.

Is it actual resistance? Or is it just that too much else is happening, an overwhelming flood of physical, intellectual, and emotional demands, to the point where no mental energy remains to deal with this particular issue? And as usually happens in the teen years, the rebellion thing kicks in, and suddenly whatever anybody else tells them is good for them, they’re going to automatically reject just on principle — because that’s what adolescents do.

Thought experiment

Imagine being an obese teenager, dragging along the emotional consequences of childhood obesity: low self-esteem from being teased or bullied; depression, anxiety, and loneliness. In middle school, the odds are good that teasing and bullying will continue. You can’t participate in sports, or psychologically bring yourself to even try. At the beach, everybody else is catching a tan while you’re swathed in a giant T-shirt to hide the rolls of fat. In the summer, sweat pours out and drips into places where you can’t politely swab it in public. In the winter, you can’t find a jacket big enough to fit around your middle and zip up.

Clothes don’t fit, or if they do, you still look like a fat kid. Body parts that aren’t meant to rub against each other do. Chafed skin can be an unrelenting annoyance. Like most kids, you don’t think about diabetes and heart disease, but walking up a short flight of stairs, huffing and puffing, you have a foretaste of what it’s like to be a geriatric emphysema patient.

Visiting at a friend’s house, you sit down and break a chair. If you get on a plane to visit relatives, you have to bring a seat belt extender and put up with a lot of other inconvenience. Maybe you’re old enough to drive, but good luck fitting into a car. Your social life is in the pits, because who wants to date a whale?

To make such a life bearable, the forces arrayed against change must seem formidable and the possibility of change must seem beyond imagining.

Your responses and feedback are welcome!

Image by Leon Fishman

What’s Up with Motivation?

Shame for Mihaha

The question of motivation, or lack of it, is endlessly provocative. A while back there was a media kerfuffle when a man thought he could motivate a Wisconsin TV news reader to lose weight by offering his critique of her ample figure. It bothered him even more that Jennifer Livingston had been overweight for many years and did not appear to be improving. Part of the message read:

I hope she’ll finally take advantage of a rare and golden opportunity to influence the health and psychological well-being of Coulee region children by transforming herself for all of her viewers to see over the next year.

Among other things, the complainer wrote, “Surely you don’t consider yourself a suitable example for this community’s young people, girls in particular.” That observation implied that Ms. Livingston was not even a fit mother to her three daughters, a suggestion that neither she nor her husband appreciated. Bullying is an issue they take an interest in. Ms. Livingston filmed a four-minute reply, which her station aired, including these thoughts:

That man’s words mean nothing to me, but what really angers me about this is, is there are children who don’t know better — who get emails as critical as the one I received or in many cases, even worse, each and every day…. If you are at home and you are talking about the fat news lady, guess what? Your children are probably going to go to school and call someone fat.

Yesterday, Childhood Obesity News examined the very atypical story of a man who responded to a friend’s disapproval and scolding by getting his act together and turning his life around. Any mental health professional would caution that such an outcome is extremely rare, and the approach would never be recommended for use on a child. Or would it?

The Hastings Center is described by journalist JoNel Aleccia as a nonprofit think tank, whose mission is “to address fundamental ethical issues in the areas of health, medicine, and the environment as they affect individuals, communities, and societies.” Its president emeritus, bioethicist Daniel Callahan, is over 80 — an age at which many people give up worrying about what others may think.

Dr. Callahan proposes that social pressure is not necessarily a bad thing, especially since the avoidance of stigmatization has not seemed to accomplish any reduction in the obesity rate. He advocates an edgier approach, like putting up posters that ask, “If you are overweight or obese, are you pleased with the way that you look?” But as in many other areas of public life, the asking of a simple and seemingly innocent question is met with outrage.

Dr. Callahan’s iconoclastic suggestion originates from the most convincing argument of all: personal experience. He used to smoke cigarettes, and being treated like a pariah helped him to quit. He says:

The force of being shamed and beat upon socially was as persuasive for me to stop smoking as the threats to my health. The campaign to stigmatize smoking was a great success, turning what had been considered simply a bad habit into reprehensible behavior.

He wonders if there could be such a thing as “stigmatization lite” — a happy medium between outright shaming and pretending that no problem exists. With the right amount of social pressure, perhaps people would stop overeating, just as so many have quit smoking. Needless to say, it is a very controversial notion.

Your responses and feedback are welcome!

Source: “ ‘I’m in no position to bully her’: Man who shamed ‘fat’ news anchor finally apologizes,” DailyMail.co.uk, 10/05/12
Source: “Fat-shaming May Curb Obesity, Bioethicist Says,” today.com, 01/24/13
Image by Gabriel

Fat Shame as Motivation

The Rest of Your Life

In the latest trial of Dr. Pretlow’s W8Loss2Go smartphone app, the buddy feature turned out not to be one of the most popular tools. Perhaps its true potential was not fully explored by the participants, who had many other things on their minds. The news story we look at today concerns adults, not children. The subject is an American whose British friend would not be described as a weight-loss buddy, but who definitely is a healthy-living ally. The unusual thing about the story, told by Alex Greig, is that it describes efficacious fat-shaming that worked an incredible change.

It started in 2012 with 30-year-old Brian Flemming, who weighed 625 pounds and had a drinking problem. Flemming was taking in 7,000 calories worth of food and beverages per day, along with a fifth of vodka. A college dropout who had lost his job, Flemming was a mess and spent most of his time playing video games.

Through one of the online games, he was randomly assigned to an opponent named Jackie Eastham, age 50, a woman with myotonic muscular dystrophy, which “causes progressive wasting of the muscles and other symptoms.” The two began to chat online, and Flemming revealed his dire situation to Eastham. If he expected sympathy, it was not forthcoming. As his new friend told a CNN reporter, “I just thought bloody hell, you’re a guy who’s 30… and you’re wasting your life.”

And she told him so, in no uncertain terms. Here was a person with a serious medical condition, doing her darnedest to fulfill every tenet of healthful conduct in order to function — and trying to feel well enough to even care whether she functioned or not. And there was a young man with a promising future before him, throwing it all away.

Flemming’s self-pity morphed into anger and shame, but rather than sever the relationship, he used those emotions as fuel to turn his life around. The first step was to quit the booze cold-turkey, and that alone brought about a 100-pound weight loss in a month — probably largely due to giving up the liter of soda pop he habitually chased the liquor down with.

Baby steps

Next, Flemming started to move. At first, just walking in place inside his home was all he could handle. Then, he started going out at night (to be seen by fewer people) and walked around the neighborhood. Soon he was cycling, and he even found employment.

Feeling better made him feel better, and his chronic depression lightened. Weekly therapy sessions helped maintain the momentum. After slightly more than a year, he had managed to shed an amazing 365 pounds, amounting to almost a pound a day. At last report, his weight was down to 234 and he was making plans to “pay it forward” by returning to school to become a psychotherapist specializing in depression, anxiety, and weight loss. The journalist captured a wonderful quotation from him:

Jackie is the best thing that’s ever happened to me. I feel that she saved my life, even though she would never take credit…. I also plan to return to Cedar Point [amusement park] this year. I haven’t been able to fit on the rides in 14 years!

This may be the one case in history where fat-shaming worked, and then only because of the remarkable qualities of the friend who wanted to help. Or maybe Flemming was simply ready. At any rate, the technique is not recommended for use, especially with children or youth. This fascinating tale is an anomaly, not an endorsement.

Your responses and feedback are welcome!

Source: “American man loses almost 400lbs in just over a year with help from UK friend he met randomly on game app, DailyMail.co.uk, 04/28/14
Image by Simon James

Some Theories of Motivation

Pull Your Own Weight

A child is obese who can’t lift herself or himself off the ground, even with a jumping assist. So says coach and physical educator Rick Osbourne, who proposes a straightforward strategy that is said to motivate kids to “naturally immunize themselves against obesity for life.”

Every school and community center needs relatively cheap equipment — pull-up bars with height-adjustable straps — and adults trained in the very simple utilization of them. In explaining the nutritional and physiological basics, Osbourne says that pull-ups intrinsically reward children for being strong and light. Participating in the Operation Pull Your Own Weight program also helps others. Kids give each other positive reinforcement as they improve, and there is strength in helping others grow strong.

Other benefits accrue, because the good eating and exercise habits promoted here improve performance in a way that is obvious and measurable. As measurable performance milestones are passed, that provides even more incentive to eat clean and stay active. It’s all about building confidence and self-esteem, which result from experiencing frequent success that is built on small increments of improvement. Osbourne says:

The systematic motivational basics of Operation Pull Your Own Weight are as follows: All kids want to be strong at everything and weak at nothing. Nothing motivates kids like growing stronger (succeeding) in front of friends. Self-competition enables all kids to win almost all the time. Winning frequently is a highly motivating habit that can be actively cultivated.

At the University of Georgia, researchers are working with mixed reality — a combination of the real world and a virtual environment. They recruited 60 kids, ages 9 to 12, in a study “designed to increase awareness and reduce childhood obesity.”

Half of the kids were given the opportunity to interact with a virtual obese dog, and the average child in that group achieved an hour more of exercise per day than the dogless group. Their motivation? Altruism. They did it all for the sake of the poor chubby pup. Kyle Johnsen’s story says:

For the group with the virtual pet, if their goal had been met, their dog would give them a congratulatory message and allow them to use controls to cause the dog to perform a trick. For example, if a child set a goal to complete 30 minutes of physical activity and met that goal, then the child would see a real time change in the pet’s physical appearance and response rate and be able to teach the pet to sit or roll over.

On the other hand, Dr. Deborah Cohen of the RAND Corporation suggests an innate human propensity that might quash motivation. Her book, A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic — and How We Can End It, was reviewed by Susannah Cahalan, in a piece that describes the research behind the problem. Explaining Cohen’s argument that the human cognitive system is sadly feeble and can get tired just like a flabby muscle, Calahan writes:

The tug-of-war between gluttony and self-discipline takes place in the brain between the higher cognitive processing systems, responsible for planning and long-term problem solving, and the base, more instinctual, non-cognitive processing system, which might as well have a ‘Feed Me’ sign.

Unfortunately for mankind, the cognitive processing system, the seat of self-control, is itty-bitty and only functions ‘less than 5% of the time,’ leaving the non-cognitive system with the reins the rest of the time.

Your responses and feedback are welcome!

Source: “The New: Operation Pull Your Own Weight,” YouTube.com, 06/23/12
Source: “Virtual pet leads to increased physical activity for kids, research says,” MedicalXpress.com, 05/14/14
Source: “Why gov’t should regulate food like tobacco & alcohol,” NYPost.com, 12/28/13
Image by Rick Osbourne

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