Oprah Through the Years, Part 21

Courtesy of the Oprah Winfrey Network, March of 2011 brought the TV audience a new reality show, “Addicted to Food.” It was recorded on location at the Shades of Hope Treatment Center, a facility specializing in eating disorders and addiction. Shades of Hope founder and CEO Tennie McCarty has found that addicts come from homes affected by dysfunction, abuse, addiction, or some combination of all three. The work that must be done is “to delve deep within and confront not only the outward behaviors of addiction, but also the secrets, pain, self-loathing, and blame that lie beneath.”

How long does that take? At minimum, 42 days, which is the length of the Intensive Residential Program. This has been shown to be enough time to dig into the psychological issues, learn the tools of recovery, and achieve a solid state of abstinence. The process is not easy, and the rules are strict, for good reason. No alcohol, no smoking, no other types of addictive substances are allowed, because to run a program meant to end one sort of addiction while allowing other addictive substance to be used is just plain silly.

While a client’s weight may be tracked, it is not revealed. The point is to get away from the idea that “it is always about the numbers and the connection of worth/control/success to the number on the scale.”

And that’s not all…

Oh — and no TV, or books or magazines are allowed either, because people need to be thinking about their own issues, not about the larger world or some imaginary characters. McCarty explains that the goal is to allow all the negative feelings to emerge and “slap the client in the face.” Hopefully, that blow will metaphorically knock the mask right off, exposing the anger and all the other stuff. When this happens, the client is said to be “showing up.”

The Intensive period includes Family Week, and then another week in which to process whatever transpired during that time, and to figure out what’s next — which might be a transitional period, either still at the Shades of Hope, or at another facility. Or perhaps it is time to return home, and get back to school, work, or whatever.

But… and this is a big but…

None of these stages can be regarded as an end point, because this is not a race where a person breaks through a ribbon at the end of the course. Nope, says McCarty. It’s all about a lifelong commitment, during which the individual must be constantly on guard because that inner void still cries out to be filled, and “switching” addictions is definitely a real possibility, to be avoided at all costs. Day by day and minute by minute, the commitment — to use new attitudes and new tools to change old patterns — must be scrupulously kept.

McCarty offers five helpful “tips” for recovery, more thoroughly described on her page, and worth looking into:

1. Be conscious of what you eat.
2. Eat with intention.
3. Maintain a healthy meal plan.
4. Eat by the clock.
5. Recovery is not a diet, but a way of life.

The show made at this “extremely difficult rehab center” involved eight clients, and it must have been edifying for Oprah to recognize which one (or ones) she most closely identified with. Seven years later, InTouchWeekly.com made an attempt to follow up on the participants, which proved to be rather half-hearted and largely unsuccessful. But their website also contains the trailer for the original show, which is pretty interesting. SocialWorkersSpeak.org also took note of the series and made some comments.

In the next chapter of Oprah Winfrey’s life of up-and-down weight shifts, we will see things take off in a whole different direction.

Your responses and feedback are welcome!

Source: “Addicted to Food Q&A: Tennie McCarty and Tough Love,” Oprah.com Source: “Remember Oprah’s Reality Show ‘Addicted to Food’? Here’s What the Cast Is up to in 2018,” InTouchWeekly.com, 03/01/18
Source: “Oprah Winfrey Network’s ‘Addicted to Food’ Tackles Emotions Behind Eating Disorders,” SocialWorkersSpeak.org, 05/12/11
Image by Pat Hartman

Oprah Through the Years, Part 20

We left off last time by mentioning how the rules change. This is one of life’s little jokes. As soon as you get used to one condition or set of circumstances, it will probably be necessary, before too long, to readjust to something else. For humans, the primary survival trait is adaptability, and the young are better at it. This is one reason why, when correctly applied, being like a little child is a very desirable state.

Youth is when many people are easily able to swallow and assimilate anything without suffering a physical penalty. As the body ages, it becomes less tolerant and… the rules change. When something else is going on at the same time, this fact might be easy to ignore. In the case of Oprah Winfrey, trainer and friend Bob Greene pointed out that her thyroid issue was an easy excuse to fall back on, and that she had “absolutely” done so on more than one occasion.

People are usually pretty good at generating excuses for not achieving their dreams. Just like a regular human, the global influencer and star had a particular and individual issue to deal with. In her case, it was a medical condition that required expert management, as well as patient compliance.

At the same time, like billions of regular people, Oprah was getting older every minute. As time goes on, and even with dedicated effort, it becomes more and more difficult to stave off weight gain.

In human history, this has rarely been the case. For obesity to become a significant problem, a society has to reach the stage of having food surplus to its needs. The civilization advances to where it can afford to have some members unable to defend themselves, and dependent on others for their continued well-being. When the society has abundant food, and physical fitness is not a priority requirement, people can become obese.

The Bob Greene worldview

Greene theorized that no one, be they an anonymous teenager or a world-famous star, would ever be able to completely overcome food addiction; that the problem would never completely disappear, and would always need conscious and diligent management. He also suggested that no one could properly start the recovery journey without squarely facing five crucial questions:

What are you hungry for?
Why are you overweight?
Why have you been unable to maintain weight loss in the past?
What in your life is not working?
Why do you want to lose weight?

The last query is a particular challenge, because the seeker is quite likely to come up with the wrong answer. “Then I’ll be happy” is not the right one, because it encompasses only two possible outcomes, neither of which can satisfy, as Greene explains:

You never reach that size or weight and you’re never happy. And even worse, you reach that size and weight and realize it has nothing to do with your happiness.

The following year, 2010, was when Oprah famously stated for publication that she was not fond of the term “food addict,” but…

I realize that I really have been one. And believe me, I — like so many of you — have punished myself for that. But I know that I’m not alone, and I know that the battle hasn’t ended.

This admission seems to cover two bases: First, it pleads guilty to the same fat-hate that dwells in the heart of even the most compassionate person. Also, it appears to confirm that the last person anyone is ever able to forgive is their own self.

Your responses and feedback are welcome!

Source: “Oprah’s Weight Loss Confession,” Oprah.com, undated
Image by Oprah.com/Fair Use

Oprah Through the Years, Part 19

As we learned, during a decade or so of time the weight issue was not a major problem for Oprah. She had found a large amount of inner peace in not hating any part of herself, not even the pockets of cellulite. But old mental habits die hard, and there are contradictions involved in embracing the self, no matter how calorically challenged, while also carrying out public activities (on national television, for instance) that might be regarded by the cynically minded as the very embodiment of fat-hate.

Imagine this scenario: The problem you overcame, and so triumphantly buried with a great deal of ceremony (and publicity), has clawed its way out of the grave, hitched a ride on a garbage truck, and is now demolishing your front door. What could be more disheartening? Oprah Winfrey, after a lot of emotional ups and downs, had reached a pretty good emotional equilibrium and, if there was any justice, ought to have been able to coast.

Instead, after being advised to “learn to embrace hunger,” she gradually gained back 40 pounds. Some of the difficulty was simply due to nature taking its course. As a human body ages, multiple processes are responsible for making it less resilient. It does not mend itself like it used to, and pain occurs in parts you never even knew you had. The entire organism might suddenly begin to demonstrate an uncanny propensity to grow.

O, the publication

At the beginning of 2009, the cover of Oprah’s very own slick magazine showed her current self next to an earlier, much slimmer version, and the words “How did I let this happen again?”… all of which looked like a pretty clear case of fat-hate. The inside pages held her musings on that subject, including a strong suspicion that the ultimate cause was a life out of balance, “with too much work and not enough play, not enough time to calm down… I let the well run dry.”

The conclusion seemed to point in a productive direction:

I don’t have a weight problem — I have a self-care problem that manifests through weight.

In that same year, a segment of the immensely popular “The Oprah Winfrey Show” featured 16 teens participating in “a grueling eight-hour intervention where they confront the reasons why they’re overweight.” Author Natalie Flynn described it as “humanizing” and as a way for booth the participants and the audience to grasp “what living with obesity truly entails.”

A recent Salon.com article looked back over that time with a congratulatory pronouncement:

[W]hat Winfrey has largely consistently managed to get right is her approach to childhood obesity. In her recent special and in old episodes […] Winfrey allows children to speak candidly about their weight, often showing in raw detail how obesity takes a toll on them mentally, socially and physically.

Cynics might have identified it as just another, though perhaps superficially compassionate, demonstration of how obsessed society is with maintaining a standard of fat-hate, while at the same time blaming the victims for “abusing food.” That in itself is a tricky phrase, which could logically encompass chaining up food in a basement and striking it with a belt.

Meanwhile, Bob Greene was also in the public eye, providing for the official website “Oprah’s Weight Loss Confession.” Some of the problems in the media star’s case, not relevant to most teenagers, were the concurrent challenges presented by worldwide success. Oprah had met and overcome so many obstacles, he theorized, that it was difficult for her to grasp the inevitable challenge of aging, which means “the rules change.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” EOnline.com, 03/24/24
Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Oprah’s Weight Loss Confession,” Oprah.com, 01/05/09
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 18

We have discussed the concept of displacement and its various manifestations. In the most primitive sense, displacement is an escape valve for the mental energy generated by a threatening situation. In the most elemental case, the choices might be limited to “fight” or “flight.”

In the simplest terms, someone with a threatening food addiction might opt to fight, by getting into a program of some kind; or to flee by ignoring the threat and by putting all that mental energy into (for instance) online gaming, a very sedentary occupation that offers a lot of opportunity for snacking.

But we humans are more complicated than that, and sometimes our wires get crossed. A previous post offered the example of the so-called “fitness freak,” who trades in their doughnut habit for an obsession with working out, losing fat, and gaining muscle — to a degree that bystanders might call obsessive. But as long as a displacement activity keeps the person away from their drug of choice, while at the same time doing no harm, and while actually achieving good results, why not just accept it and move on?

The fly in the ointment

For Oprah Winfrey, however, no amount of activity could displace her craving for bread and potatoes and a whole lot of other edibles. For decades, she was a whirlwind of energy, constantly involved with professional obligations and thoroughly invested in charitable efforts.

Going back to the most elementary definition of displacement behavior, she focused on helping people flee or fight; to escape or defeat obesity. One of her 1995 TV episodes on “fattertainment” was optimistically described like this: “By providing solutions, rather than showcasing problems, the show hopes to use the power of broadcasting in a positive manner.”

Three young girls had written to the host about their uncomfortable feelings and experiences around excess weight. Oprah’s crews filmed their families and the girls and their mothers appeared on the show to talk about the “emotional roadblocks” that contribute to obesity among the young.

On the personal level

In 1995, at age 47, Oprah started to work with trainer Bob Greene, because like any sane person, she realized that having an intellectual realization is not the same thing as living the newly revealed truth. Still, it took a few more years and some unnerving heart palpitations to really jolt her into high gear. Eventually, it occurred her that “taking care of my heart, the life force of my body, had never been my priority” — and then proceeded to organize life differently with an eye toward shrinking the influence of the three ominous O’s — “Overeating. Overstressing. Overdoing.”

Furthermore — and this appears to be a vital element of the whole equation — to quote Oprah, “I no longer hated any part of myself, including the cellulite.” Ten years later, the cover of O magazine feature a toned 160-pound Oprah. By this time, she thought the actual battle with excess weight had been won. Looking back later, she said,

I’d conquered it. I was so sure, I was even cocky. I had the nerve to say to friends who were struggling, ‘All you have to do is work out harder and eat less! Get your 10,000 steps in! None of that starchy stuff!’

Not long afterwards, puzzled medical professionals diagnosed her first with hyperthyroidism, then with hypothyroidism, and what with one thing and another, exercise began to seem less of a priority, and she was warned by a doctor that it would be necessary to “learn to embrace hunger,” which she was in no way prepared to do.

Your responses and feedback are welcome!

Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Making Peace With My Body,” Oprah.com, 08/01/02
Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 03/24/24
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 17

This post picks up from where an earlier one left off: with Oprah Winfrey in the late 1980s. She was an incredibly popular show-biz figure and media icon, whose global fame spread partly because of her wide variety of interests. Her opinions were respected, her tastes admired, and droves of people relied upon her judgment in such matters as which books to read. Fans responded to her empathy, spontaneity, generosity, and numerous other attractive personal qualities, and related to her like a sister or dear friend.

People, especially women, trusted Oprah and felt understood by her. As both a television host and a sympathetic surrogate friend, she must have felt strong pressure to cover the issue of overweight and everything connected with it, because such a large portion of her audience was dealing with the specter of obesity, and needed help. At the same time, a person in her position would be well-advised to tread carefully, and avoid promoting the anti-obesity culture or appearing as an anti-obesity crusader. Coming from her, any hint of blame or shame could alienate the audience.

An ancient shadow

These conditions resembled an ancient philosophical and theological conflict that so many individuals and institutions over the centuries had to face, and somehow reconcile: how to love the sinner but hate the sin. How to deplore the existence of too much fat, without insulting those who grew too much fat and then suffered for it.

Oprah was not yet the mega-wealthy star she would eventually become, but one thing was clear, and worth repeating :

All the fame and the success doesn’t mean anything if you can’t fit into the clothes. If you can’t fit into your clothes, it means the fat won. It means you didn’t win.

Also, on the personal level, for Oprah to actively campaign against obesity was at the same time to wage war against herself. This was especially evident in the aftermath of the much-regretted 1988 “wagon of fat” TV appearance. To continue wearing those skinny jeans, it would only be necessary to remain on a liquid diet for the rest of her life.

The winds of change

A couple of years later, she told a magazine reporter about the four months of enforced starvation that preceded the wagon stunt and confessed, “I thought I was cured. And that’s just not true. You have to find a way to live in the world with food.” At which point, she did a 180-degree turn and decided to never diet again. By 1992, her weight had reached a peak 237 pounds, too much for a 5’7″ frame to carry. At some point she met trainer Bob Greene and they had a conversation which she recalled years later for her O magazine.

He asked why she was overweight; she replied that she loved food. This was not the exact answer Greene was hoping to elicit, however, and it was quite some time before Oprah was comfortable with admitting that the purpose of eating so much food was to numb her emotions.

As we have mentioned, the investigation into any one person’s obesity needs to include several aspects of family and individual history. Of course their habitual dietary practices are a big factor, but so are their other customary activities, including purposeful exercise. Also to be considered are the psychosocial environment, medications, and their idiosyncratic pattern of weight loss and gain.

Oprah had never consulted a psychiatrist, but subsequent conversations with Greene turned out to be, in her words, “priceless therapy.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 2024
Source: “Top 10 Oprah Moments,” TIME.com, 05/25/11
Source: “Oprah Winfrey’s Weight Loss Journey,” EOnline.com, 03/24/24
Image by Pat Hartman

Genes, From Must to Maybe — Continued

Up until recently, genes and epigenetic variations have dictated how the inheritance of obesity works. Sure, they “contribute to obesity by influencing the function of metabolic pathways in the body and regulating neural pathways and appetite centers.” Certainly, they “influence insulin resistance, dyslipidemia, inflammation, hypertension, and ectopic fat deposition.”

Of course, genetic mutations “can be inherited in an autosomal dominant or autosomal recessive manner and are influenced by genetic mechanisms of deletion, genetic imprinting, and translocation.” So far all these factors, as described in the book Genetics and Obesity, have been unrelentingly true.

Multiplicity of causation

But, as previously discussed, genes and their complex epigenetic mutations no longer hold the monopoly on defining or deciding fate for all humans, all the time.

First, science learned a lot about how epigenetic modifications happen during the development of the fetus. Of course, such a possibility had been suspected. But we have come a long way from the days when, for instance, the grotesque physique of the so-called Elephant Man was blamed on his pregnant mother having been frightened by the sight and behavior of an elephant.

The advance of science caused such beliefs to be dismissed as mere superstition. Then, science progressed even further to discover that disorders actually can grow from the horrors of war and other emotionally devastating roots.

Things that can happen

Epigenetic development, including changes to the insulin metabolism of a fetus, can be influenced by maternal over-nutrition and also by maternal under-nutrition. For the unborn child such disturbance can be a survival adaptation, but once born and exposed to other nutrition sources, it can lead to inescapable difficulty in survival.

The authors of Genetics and Obesity mention how…

The rising prevalence of obesity and type 2 diabetes in developing countries like India and sub-Saharan Africa confounded epidemiologists for the longest time and is now known to have its origins explained by the theory of fetal programming.

Another source of trouble, quite understandably, is maternal exposure to toxins like those introduced by cigarette smoking, and other endocrine-disrupting chemicals now recognized as obesogens. Maternal stress, caused by such events as natural disasters and their grievous consequences, is strongly suspected. Fetal metabolic derangement can stem from the mother being very young, or seriously underweight, or suffering from diabetes.

Multifactorial, again

The nourishment absorbed by a person as a baby and as a small child are both, of course, very influential in either a positive or negative way. Treatment with antibiotics in the first year of life has been linked to subsequent obesity, as well as non-alcoholic fatty liver disease and other conditions later in life. Even paternal over-nutrition, low protein intake, pre-diabetes, and other conditions can affect a child’s development. Mind you, this is the father! These causes have recently been looked at much more closely than ever before.

Then, there is syndromic obesity, so named because it results from syndromes with such distinctive names as Prader-Willi, WAGR, SIM1, Bardet-Biedl, and Fragile X. Also, there is monogenic obesity, which “generally involves mutations in the leptin signaling pathway leading to suppression of anorexigenic and activation of orexigenic pathways.” Furthermore, around 60% of inherited obesity is now understood to be of polygenic origin, affecting appetite control, energy balance, and many other factors.

Your responses and feedback are welcome!

Source: “Genetics and Obesity,” NIH.gov, 07/31/23
Source: “Joseph Merrick — The Elephant Man,” LondonMuseum.org, undated
Image by Cory Doctorow/Attribution-ShareAlike 2.0 Generic

Genes, From Must to Maybe

DNA is the instruction book that directs the activities of cells. Epigenetics is the field of knowledge about the heritable changes in the workings of genes, and more importantly, about how their actions can be modified without disturbing the DNA sequence itself.

The epigenome consists of all the genes in the body, plus everything else that influences them for better or worse; and it is malleable. Here is a quotation from the National Human Genome Research Institute:

The epigenome consists of chemical compounds that modify, or mark, the genome in a way that tells it what to do, where to do it, and when to do it. Different cells have different epigenetic marks. These epigenetic marks, which are not part of the DNA itself, can be passed on from cell to cell as cells divide, and from one generation to the next.

Shockingly, over recent decades, it has begun to look as though a person’s genetic makeup does not actually imply inexorable Fate, but resembles something more like a set of very strong suggestions. Even without crazy science-fictional editing tools like CRISPR (clustered interspaced short palindromic repeats), unsatisfactory genes can be outsmarted and over-ruled by the human organism itself.

Moreover, the person who inhabits the body is clueless about the remodeling project. It seems nothing short of miraculous, that thousands of genetic diseases are now seen as potentially fixable by a one-time CRISPR treatment. But all along, Nature has been busy re-arranging the genetic furniture. This quotation is from the Cleveland Clinic:

[The epigenome] changes over time. That can be both good and bad. It’s good in the sense that things like nutritious food, exercise and manageable stress can result in epigenetic changes that can promote health. But other factors like processed foods, smoking and lots of stress can cause epigenetic changes that can harm health.

Various epigenetic changes affect the metabolism, the aging process, brain disorders, inflammatory and autoimmune diseases, the tolerance for neoplasms, and even susceptibility to substance use disorders. It comes as no surprise that these alterations also make a difference around the heritability of obesity. Here are words from the book Genetics and Obesity, by Ekta Tirthani, Mina S. Said, and Anis Rehman:

About 50% of the time, obesity in childhood is carried into adulthood in a phenomenon known as “tracking.” Around 250 genes are now associated with obesity. The FTO gene on chromosome 16 is the most important and carries the highest risk of the obesity phenotype.

So, this is a serious matter, and what are we doing about it? Genetically predisposed obesity can now be treated with “early lifestyle interventions, bariatric surgery, and medications.” Better yet, the discipline of endocrinology “can help treat and control diabetes and other cardiometabolic parameters that cause epigenome changes passed on from generation to generation.”

Out in the world, however, researchers do need to deal with some complications:

In genome-wide association studies done so far, most subjects have European ancestry. However, 47% or the vast majority of patients grappling with the burden of obesity in the United States are of African-American and Hispanic/Latino descent.

Obviously, other countries might also face such problems when attempting to study variegated populations. But the future of the field shows incredible promise in the areas of obesity and metabolic disorders. For instance,

The use of histone deacetylators is now being suggested […] for its use in lifestyle medicine, and research in this field is ongoing. Methylation Quantitative Trait Locus (meQTL) studies are now being used to further epigenetic studies. New Nutri-pharmacogenomic studies are expanding our understanding of how nutrition affects genetics.

The heritability of obesity is easier than many other characteristics to observe and verify with the naked eye. It also is relevant to a very large chunk of the population, and thus likely to attract research grants and generate useful publicity. It should not be a chore to convince the public and the relevant institutions and funding sources of the vital importance of this kind of research, and of the financial support necessary to make it all happen.

Your responses and feedback are welcome!

Source: “National Human Genome Research Institute,” Genome.gov, undated
Source: “Epigenetics,” ClevelandClinic.org,” undated
Source: “Genetics and Obesity,” NIH.gov, 07/31/23
Image by National Human Genome Research/Public Domain

Oversize Bodies and Itty-Bitty Genes, Continued

Nature is able to circumvent expectations and even reason, and science should not be blamed for underestimating that possibility, because cause and effect are not always blatantly obvious. Previously we mentioned a Netherlands study showing that “men who were still in the womb when their mothers experienced malnutrition tended to have children with a tendency to become overweight adults.”

In other words, the effect carries on into the third generation. Such weirdness can be explained by accepting that genes do not interact only with one another, but with such environmental factors as temperature, acidity, and nutrients, as well as elements that are not yet recognized.

War, separation from loved ones, and many other types of stress can cause a person’s physiology to change in ways that are heritable, while their genetics remain unchanged. In Greek, “epi” means over, on top of, or in addition to. In this case, it signifies that cell function can change in a way that will be stable and is heritable, while the DNA sequence remains unchanged. This happens because of the world around us, when “our environment influences our genes by changing the chemicals attached to them,” and sometimes because of choices we make such as “what we eat, our physical activity level, access to resources and more.”

All this implies that, since some characteristics are changeable, we are better off figuring out how to play a deliberate and purposeful role, rather than heedlessly accept whatever random experiments some corporation wants to perform on us, and especially in preference to letting things happen to us through our own neglect. Sadly, depending on one’s gender, age, parental status, state of health, and many other factors, the average grownup does not like to think too much about this whole subject.

What moms do matters

Many women like to learn about the best veggies to eat while pregnant, but very few would enjoy an in-depth analysis of how their habits during and even before pregnancy quite possibly messed up the lives of their existing children. Guilt alone is oppressive enough, but guilt for something that can never be taken back or corrected is a potentially catastrophic burden. For a mother in that position, blame can come from three directions: herself, the child, and the biological father. If the child is born with, for instance, a problem that her smoking habit probably caused, there is the recipe for a lifetime of misery.

With maternal smoking alone, possible consequences include miscarriage, premature birth, stillbirth, placental abruption, placenta previa, low birth weight, and increased risk of defects like cleft lip and cleft palate. The fetus might not get enough oxygen, and lung problems are a possibility. There could be abnormal bleeding during pregnancy or delivery. Even after a seemingly successful delivery, the chance of Sudden Infant Death Syndrome is increased.

It transcends the personal

There is another problem. The entire health insurance industry is already a nightmare for patients and families to deal with. When a baby shows up with medical problems, a thorough study of all the epigenetic possibilities could cause a horrific situation. If detectives were to compile cases against mothers who, for instance, smoked cigarettes while pregnant, this could lead to, among other consequences, court battles capable of consuming fortunes and lifetimes.

What about childhood obesity, and a mother’s liability if her child turns out to be dangerously obese? A report titled “The Effect of Maternal Overweight and Obesity Pre-Pregnancy and During Childhood in the Development of Obesity in Children and Adolescents: A Systematic Literature Review” examined 11 studies on the subject. Some looked at maternal overweight or obesity before conception, and found “consistent positive associations with childhood obesity,” while others reported “positive associations between childhood obesity and maternal overweight/obesity during childhood.” The paper goes on to say,

This review has confirmed the multifactorial etiology of childhood obesity, indicating that maternal overweight and obesity has an important role in the development of childhood obesity, regardless of its occurrence (i.e., before the child’s conception or during childhood).

Still, the book we discussed, Genetics and Obesity, named factors that can overrule the gene pool and cause positive deviations. Bariatric surgery affects micro-RNA and can cause epigenetic changes. A staunchly maintained exercise schedule “can cause widespread changes in DNA methylation.” So can fasting.

And if positive epigenetic modification is what we want, it can be obtained with prebiotics and probiotics and even with fecal transplants to build up and perk up the gut microbiome. In other words, a conscientious prospective mother can plan ahead, and quit smoking or lose weight or otherwise “clean up her act” and provide a safe and welcoming womb for a fetus to inhabit.

(To be continued…)

Your responses and feedback are welcome!

Source: “Epigenetics,” ClevelandClinic.org, undated
Source: “Genetics and Obesity,” NIH.gov, 07/31/23
Source: “Smoking During Pregnancy,” WebMD.com, 10/04/24
Source: “The Effect of Maternal Overweight and Obesity Pre-Pregnancy and During Childhood in the Development of Obesity in Children and Adolescents: A Systematic Literature Review,” NIH.gov, 12/02/22
Image by The 5th Ape/Attribution 2.0 Generic

Oversize Bodies and Itty-Bitty Genes

The big complicating factor here is epigenetics, for which the Cleveland Clinic offers an elegant definition:

Epigenetics is the study of how our environment influences our genes by changing the chemicals attached to them. What we eat, our physical activity level, access to resources and more affect those chemicals, in turn shaping our health.

As it turns out, a lot of aspects of the human condition which were assumed to be hardwired, or totally determined by genes, are actually malleable, whether or not we currently understand the processes behind how all of this works.

So, on one level, the genes we inherit say “This is how it’s gonna be.” Then, the science of epigenetics comes along and says, “Except when it isn’t, and boy oh boy, do we ever still have a lot to learn about that!”

Today we consult the National Library of Medicine for an overview of contemporary knowledge and thinking about the relationship between obesity and genetics. The authors are Ekta Tirthani, Mina S. Said (both of Rochester General Hospital), and Anis Rehman (Northern Virginia Medical Center). There is, to use a non-technical and totally accurate phrase, a lot going on. The only factor that is a bedrock certainty is maternal health — and just to deal with that one aspect requires “a team of obstetricians, pediatricians, nutritionists, geneticists, psychologists.”

Diagnosis of genetic and/or epigenetic origins of obesity

Here is an abbreviated version, just the highlights, of the authors’ explanation of how to figure this out in any individual case, and it is no walk in the park:

Endocrine causes of obesity […] must be ruled out early with history, physical examination, and lab work. Syndromic obesity can sometimes be distinctly diagnosed based on the presence of physical features… After basic lab work is done […] physicians can check leptin, insulin, and proinsulin levels. If all the above blood work is negative genetic testing can be carried out.

This is where it gets really complicated, involving arcane lab work that is only available in a few advanced facilities, and costs a bundle because of the expensive equipment required, along with the detailed high-level knowledge in obscure fields. But wait, there is more.

Research is necessary into the individual’s family history and personal history, as well as several other areas of life: psychosocial environment, habitual dietary practices, everyday activities, purposeful exercise, medications, and the subject’s (or patient’s) unique pattern of weight gain and loss thus far.

Two drugs are FDA-approved for treating genetically caused obesity, while several others (like the semaglutide and liraglutide we hear so much about) are working hard to prove their worth in that arena.

Even when obesity is passed down through the genes, various interventions can make a difference. The implementation of many different interventions can eliminate, at least partially, the validity of “I can’t help myself, it’s genetic” as a rationale. Sometimes the problem is clearly not genetic.

Or is it? An entire branch of philosophy could be based on arguing that, ultimately, everything and anything in the realm of human behavior might be genetic in origin. The manuscript describes these areas in much greater detail. The interventions that are mentioned and their mechanisms include:

— Bariatric surgery can cause changes in adipocyte-derived exosomal micro-RNA and cause epigenetic changes in differential methylated regions…
— Regular exercise can cause widespread changes in DNA methylation… For patients who maintain their weight loss, the DNA methylation profiles resemble lean individuals…
— Fasting can cause changes in DNA methylation of genes…
— The use of probiotics, prebiotics, and fecal transplant can restore gut flora and cause positive epigenetic modifications…

One principle is impossible to overemphasize: Obesity is multifactorial. In this area of human health, genetic factors do not equal the Implacable Hand of Fate or any such fatalistic notion. There is, in other words, plenty of room for improvement.

(To be continued…)

Your responses and feedback are welcome!

Source: “Epigenetics,” ClevelandClinic.org, undated
Source: “Genetics and Obesity,” Genetics and Obesity, nih.gov, 07/31/23
Image by Kevin Simmons/Attribution 2.0 Generic/

Oprah Through the Years, Part 16

The previous post discussed a stressful event from when Oprah Winfrey’s career was just taking off — her interrogation and public shaming by comedian Joan Rivers who was, on that day, not very humorous at all.

We do not presume to read Oprah’s mind. But a rudimentary understanding of human psychology (and especially, personal experience with therapy) could inspire a person to imagine how the effects of such strenuous and ubiquitous harping on weight could cultivate a preoccupation with the subject that would carry into the future.

It could set up an ongoing conflict between being perpetually overweight oneself, and the seeming necessity to buy into the fat-hating, fat-shaming culture that America and many parts of the world had converted to. This is what appears to have happened to Oprah, while at the same time, over the ensuing years, she also had learning experiences and personal revelations about the harm caused by the whole anti-fat zeitgeist.

The path of twisted reasoning

It might make sense to perceive that 1985 event as something that loomed large in her subconscious, drawing her more and more into the fat-despising state of mind, while at the same time coping with the mental conflict that demanded she must of course despise herself. It would, after all, be a logical conclusion. If you are required to hate Fat, and yet also supposed to love yourself, well, that is simply too much cognitive dissonance for the mind to handle. Therefore, if you hate fat and and are fat, you must necessarily hate yourself — which somehow turns out to be easier than exploring the illogical root of the contradiction.

Aunt Joanie really cares

Also, logically, if such a prominent person as Rivers took the trouble to give advice — rough as that widely broadcast counseling session had been — it must mean that she truly cared, and only wanted the best for this TV guest who aimed for a career in entertainment. It was as if a respected aunt warned a troubled teenager that she had better straighten up and fly right, before she encountered the juvenile justice system and wound up in the reformatory.

If fat is bad, then as an honest and upright person you must hate all the fat, even your own. And if that awful stuff is part of you, you must be pretty awful. So to redeem yourself, the least you could do is become a missionary for the abolition of fat — which might account for the many shows having to do with overweight that Oprah produced and hosted over the years. Who knows? It might even connect to her later alignment with WeightWatchers, which could, uncharitably, be read not only as an investment opportunity, but also as “virtue signaling.”

In 1986, with the humiliation by Rivers still fresh, Oprah told her TV audience, “I still hate myself because of my weight.” Soon afterward came the quotation we already mentioned, which included the damning words,

If you can’t fit into your clothes, it means the fat won. It means you didn’t win.

And it’s not as if Oprah had never recognized the issue. For at least a decade, it had already loomed large in her mind. As far back as 1977, when she first consulted a diet doctor, she had been striving to win. Whenever a new fad diet came along she tried it, with consistently unsatisfactory results.

The session with Joan Rivers was later confirmed to be connected with the incident (three years later, in 1988) that Oprah eventually came to recognize as the “biggest, fattest mistake” of her career. In an article published only last year, Clare Stephens wrote,

Oprah recently acknowledged her role in perpetuating diet culture during a livestream for Weight Watchers. “I’ve been a major contributor to it.” she said… The wagon of fat has gone down in pop culture history as an example of our pathological obsession with weight loss…

[T]he wagon of fat seems like the insidious start of it all. A moment of stigmatizing fat, and telling an audience of primarily women that if they just cared enough, theirs could be set aside too, rather than attached to their bodies.

Your responses and feedback are welcome!

Source: “In 1985 Joan Rivers asked Oprah a Question,” MamaMia.com, 05/13/24
Image by Pat Hartman

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources