Emotional Eating
A new study from Miriam Hospital’s Weight Control and Diabetes Research Center in Providence, Rhode Island, has just been published in the journal Obesity. The research suggests that dieters who tend to eat in response to external factors like parties and celebrations, have fewer problems with their weight loss than those who eat in response to internal factors such as emotions. The study also found that emotional eating was associated with weight regain in people who had successfully lost weight
The researchers analyzed individual’s responses to questions in a well-known research tool called the Eating Inventory which is designed to assess three aspects of eating behavior:
- Cognitive restraint
- Hunger
- Disinhibition
The main focus was on the third item, since some previous research has suggested that disinhibition as a whole is an accurate predictor of weight loss.
The disinhibition scale evaluates impulsive eating in response to emotional, cognitive, or social cues.
There were two groups in the study. The first consisted of 286 overweight men and women who were currently participating in a behavioral weight loss program. The second group included 3,345 members of the National Weight Control Registry (NWCR), an ongoing study of adults who have lost at least 30 pounds and kept it off for at least one year.
The investigators found that the components within the disinhibition scale could be grouped into two distinct factors: external and internal disinhibition.
An example of external disinhibition would be the person who overeats when they are with someone who is also overeating, or the person who just overeats at a party, picnic or celebration.
The person with internal disinhibition eats in response to thoughts and feelings such as loneliness, upset or anxiety.
In both groups internal disinhibition was a significant predictor of weight over time. For participants in the weight loss program, the higher the level of internal disinhibition, the less weight an individual lost over time. The same was true for maintainers in the NWCR: Internal disinhibition predicted weight regain over the first year of registry membership.
Before starting a weight management program it is very helpful to know which group you are in. It provides us with a quick and easy method of tailoring the program to the individual, and tells us where to put our efforts.
More Genes Involved in Obesity
I am impressed by the progress being made by some of my former colleagues who are busily unraveling the complex genetics of obesity.
In a paper in the journal Science a group of British scientists including Chris Ponting of the Medical Research Council Functional Genetics Unit in Oxford and Stephen O’Rahilly’s group at the University of Cambridge, has made a second breakthrough in twelve months in understanding how a gene triggers weight gain in some individuals. In May we looked at the first piece of work on the gene called “FTO.”
At that time we learned that variations in the FTO gene influence people’s risk of becoming obese. This particular gene was of great interest because the genetic variant in FTO that predisposes to obesity is very common in the population.
About half the British population carries a copy of the variant and they are on average 3-4 pounds heaver than those who do not have it. The 16 per cent of the population who carry two copies of the variant and are on average 6-7 pounds heavier. We also learned that carriers of the variant have an increased risk of diabetes. However the function of FTO was completely unknown.
The new paper shows that the FTO gene codes for an enzyme – 2-Oxoglutarate-Dependent Nucleic Acid Demethylase – that can act directly on DNA. This strongly suggests that FTO might have a role in controlling how and when genes are turned on and off.
The investigators also found that FTO is highly expressed in the hypothalamic region of the brain, which has important roles in the control of hunger and satiety. In certain areas of the hypothalamus, the levels of FTO are influenced by feeding and fasting.
This is a remarkable finding. That a gene involved in obesity and diabetes has a direct effect on DNA in specific regions of the brain is very exciting. It suggests that the gene is involved in influencing how well the brain senses hunger and fullness. Small molecules derived from metabolism can modulate the activity of FTO, so we can see a direct link form food to metabolism to DNA in the brain.
The findings raise all kinds of treatment possibilities and also confirm something that I have been teaching for three decades: weight control does not start with a diet. It starts between the ears. Until you have been shown how to re-program your brain, thoughts and emotions, your chance of successfully controlling your weight is, ahem, slim.
He That Enjoys His Portion
Having grown up at a time and in a culture where it was expected that everyone would finish every morsel of food on his plate, it was quite a shock to come to the United States and to be confronted by mountains of food. During my first few months I dutifully consumed everything on my plate and soon noticed the effect on my waistline. But it brought home to me the power of social and cultural factors in eating.
Though each of us is responsible for how much we eat, research suggests that cultural and social norms can make it hard for us to choose appropriate portion sizes. The November 2007 issue of Harvard Women’s Health Watch has published an interesting article about the way in which misperceptions about portions can affect calorie intake.
A first point is that many of us tend to treat portions as equivalent to nutritional servings. A serving is a specific quantity of food designated on the basis of nutritional need. However, a portion–the amount you actually get on your plate, in the package, or at the counter–is often much larger. Many of us do not always read the Nutrition Facts label, and may find ourselves eating two or three servings’ worth. Studies suggest that we might be satisfied with smaller portions if larger ones were not so easily available. Other research has shown that the more plentiful the food, the more we eat. I know form my own experience that both of those are true.
The Harvard Women’s Health Watch offers some advice for “keeping portions in proportion:”
- Train your eye: Measure out servings – not portions – of the food you commonly eat so you know what a single serving looks like
- Change your tableware: Use a smaller bowl or a mug for cereal and a smaller plate at dinner
- Control portions at home: To discourage second helpings, serve food in the kitchen and take it to the table on plates
- Eat at regular intervals throughout the day: Do not wait until you are hungry, since you are then more likely to overindulge at the next meal
- Control portions while eating out: Avoid buffets and salad bars. Instead of a dinner, order a low-fat appetizer and a large salad with dressing on the side
These are all simple and straightforward pieces of advice that will be familiar to anyone working in the weight and metabolism field.
On another occasion I shall give you a few more of my own tips, including “Perimeter shopping”
The Neurology of Eating
Any attempt at weight management that fails to address the whole person is doomed to failure.
It is not enough to diet and exercise, and whatever the truth of manifesting, you cannot think yourself thin. Success demands an approach that integrates every system of your body, mind, social and subtle systems. For many people there is even an important role for integrating their spirituality into a plan for healthy living.
So we need to learn as much as we can about each component. Some fascinating new research has added some important pieces to the puzzle.
Writing in the journal Nature a group of scientists from University College London and King’s College London used peptide YY (PYY), a naturally occurring hormone that regulates appetite, to investigate which areas of the brain are involved in controlling food intake.
PYY is released into the bloodstream from the intestine after we eat something. In animals PYY signals the appetite control centers in the hypothalamus and brainstem that food has been eaten. Injections of this hormone have been shown to decrease food intake both in healthy volunteers and in people with obesity.
The hypothalamus and brainstem are ancient regions of the brain involved I te most basic functions. But humans have complex, highly developed brains, and the question was to discover how PYY regulates eating in humans.
The study involved eight normal weight men in a double blind placebo-controlled study. After 14 hours without food the subjects were given an intravenous infusion of either PYY or placebo for 100 minutes. During all this their brains were scanned continuously using functional Magnetic Resonance Imaging (fMRI). Thirty minutes later they were offered an unlimited meal. Each subject was tested twice one week apart, once with PYY and once with the placebo. PYY infusion reduced food consumption in all 8 subjects and on average caused a 25% reduction in the calories eaten.
Now it gets interesting. The fMRI scans showed that PYY not only targets the primitive parts of our brain that control feeding but it also acts in the corticolimbic brain regions that are involved in the rewarding and pleasurable aspects of eating.
The greatest change in brain activity in response to PYY was within the orbitofrontal cortex (OFC), a region that acts as an integrative center in the brain and is also implicated in reward processing. The change in OFC activity predicted how much food the volunteers subsequently ate. The greater the activation, the less people.
When we are hungry, brain activity within the hypothalamus predicts how much food we should eat. However an infusion of PYY tricks the brain into thinking that it has eaten, and switches on the circuits that control eating. The activity in the orbitofrontal cortex now predicts how much people will eat in the future.
If you have not eaten for a long time, you get full very quickly. It is not that your stomach has shrunk; it is that the production of hormones like PYY has been turned down. When you eat, they are over-produced and switch off more eating. When someone has gastric bypass surgery, their levels of PYY go up and stay up.
An important aspect of weight management is to retrain and reprogram the mind and body.
This research helps to show us how the approach works.
The Evolving Obesity Pandemic
Here is something that is not too much of a shock. At least it isn’t until you look at the numbers.
People are getting heavier throughout the world, with the possible exception of south and east Asia. These are the conclusions of a one-day global “snapshot:” a single day in 2006 when doctors and nurses in 63 countries across five continents – not even including the United States – found that between half and two-thirds of men and women in were overweight or obese.
The study is being published in the journal Circulation and included 168,159 people. The initial results were published http://eurheartjsupp.oxfordjournals.org/cgi/content/abstract/8/suppl_B/B26 last year in the European Heart Journal, but this new report puts more “flesh” on the original report.
The International Day for the Evaluation of Obesity (IDEA) study looked at two measures of fatness – waist circumference and body mass index or BMI.
A BMI (weight in kg divided by square of height in meters) of 18.5 to 25 is considered healthy. A BMI over 25 is considered overweight and greater than 30 is obese. I shall have something to say about BMI in a moment.
In Eastern Asia 7% were obese, compared with:
- 36% of people in Canada
- 38% of women in Middle Eastern countries
- 40% in South Africa
Canada and South Africa led in the percentage of overweight people, with an average BMI of 29 among both men and women in Canada and 29 among South African women.
In Northern Europe men had an average BMI of 27 and women 26. In other words they were just into the overweight “category.” In southern Europe, the average BMI was 28. In Australia BMI for men was 28 and 27.5 for women. In Latin America the average BMI was just under 28.
Waist circumference was also high – 56% of men and 71% of women carried too much weight around their middle.
The overall frequency of heart disease was 16% in men and 13% in women. In Eastern European men, many of whom still smoke, the rates of heart disease, 27%, and women, 24%. By comparison in Canada the rate of heart disease in women was 8%, and in men 16%.
The rates of diabetes varied across regions. Overall, 13% of men and 11% of women were diagnosed with diabetes.
This means that the rest of the world is catching up with the United States, long considered the country with the worst weight problem.
An estimated two-thirds of Americans are overweight and a third of these are obese. In the US, the lifetime risk of developing diabetes, is also high – 33% for men and 38% for women.
In studies like these, a BMI over 25 is considered to be overweight and greater than 30 is obese. I have commented before about the limitations of using BMI, but it remains a way of getting an overall picture of what is happening in the body.
The findings are deeply worrying.
It is well known that increasing weight, particularly the amount of fat carried inside the abdomen – not the “lovers’ handles!” – increase the risk of coronary artery disease, Type II diabetes and other diseases including some cancers. That point about the “intra-abdominal” fat I all important. For years we have been told that even small increases in weight can do us harm, but that is not completely accurate. It is where the fat is deposited, not only how much we have. It is only when people become extremely obese all over that the risks of many diseases begin to climb.
The moral of the story?
Watch you the size of your abdomen, and stay tuned as I give you more advice about the Whole Person ways to control you weight.
It's Not the Food, It's the Size of the Plate
I grew up in a culture where the aftermath of the Great Depression and the Second World War meant that every child was expected to eat everything on their plates. That created a bit of a problem when I first moved to the United States: my conditioning led me to try and eat every morsel of those huge American portions. Fortunately I quickly noticed the impact on my waistline.
I love simple but practical and important experiments. I have just read about some very nice research from the University of Calgary in Alberta, Canada that fits the bill. It appears that simply using plates and cereal bowls with markers for proper portion sizes can help obese patients with diabetes lose weight. As a result, some can even decrease their use of glucose-controlling medications, according to a report in the Archives of Internal Medicine.
Between 1960 and 2000, the proportion of U.S. adults who were obese increased from 13.4% to 30.9%. There is clearly an association between type 2 diabetes and obesity although it is not quite as simple as saying that obesity causes diabetes, at least not until the obesity becomes extreme. But we have known for half a century that calorie restriction may improve blood sugar control in diabetics, partially by contributing to weight loss.
The enormous increase in obesity has closely paralleled the explosion of portion sizes of both food and soft drinks.
The researchers conducted a six-month controlled trial of commercially available portion control plates and bowls in 2004. The plates were divided into sections for carbohydrates, proteins, cheese and sauce, with the rest left open for vegetables. The sections approximately totaled an 800-calorie meal for men and a 650-calorie meal for women. The cereal bowl was designed to allow a 200-calorie meal of cereal and milk. The subjects consisted of 130 obese patients with diabetes with an average age 56, half of whom were randomly assigned to use the plate for their largest meal and the bowl when they ate cereal for breakfast. The other half of the participants received usual care, which consisted of dietary assessment and teaching by dieticians.
At the end of the six-months, 122 patients remained in the study. Individuals using the portion-control dishes lost an average of 1.8 percent of their body weight, while those receiving usual care lost an average of 0.1 percent. A significantly larger proportion of those using the dishes – 16.9 percent vs. 4.6 percent – lost at least 5 percent of their body weight.
In addition, at the end of the six months, 26.2% needed a decrease in their diabetes medications compared with 10.8% in the control group.
These results are important: a 5% weight loss has been shown to be clinically significant in terms of decreasing morbidity and mortality associated with obesity-linked disorders.
Simple, straightforward and very practical.
Try it!
Neurological Complications of Gastric Bypass Surgery
Our bodies are highly complex systems. They are not just bags of randomly assorted organs. So tinkering with one part of the system can have an impact in an entirely different part of the body. Many of us have worried for some time about the long-term consequences of gastric bypass surgery for weight loss. We know that some people who have had the surgery develop “substitution addictions.” If they had a real addiction to food before the surgery, after it they may begin to develop an addiction to something else, such as drugs or alcohol.
Now neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock have reported the results of a ten-year study found a link between gastric bypass surgery and several serious neurological conditions.
The study was published online May 22 in the medical journal Neurology and concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and as a result may develop a variety of neurological symptoms.
We know that ever more of these operations are being done every year, and so long as people are motivated they are usually successful in reducing weight. But they are not without risk, and we always have to balance that risk against the risk of being morbidly obese. This work is important because it suggests that there is an extra risk about which we previously knew very little. Many of the complications that patients experience affect the nervous system, and they are often disabling and irreversible.
More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients a link between the surgery and their neurological condition was found.
All of the patients involved in the study had previously undergone what is known as the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.
The neurological problems involved many different parts of the nervous system, and the symptoms included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.
Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.
This study underlines something very important. Many heavy people are actually malnourished, because they eat the wrong things and an excess of fat in the diet can create problems in the absorption of some vitamins and minerals. In addition, surgery like this can cause a form of malabsorption.
It is therefore essential to make sure that people who have this kind of surgery have an adequate long-term intake of vitamin and mineral supplements to prevent these neurological complications. It is important for everyone to know about these potential problems and to be on the lookout for neurological symptoms.
Diets Make You Fat
Most people who have tried dieting know a sad truth: they do not usually work for very long. Our bodies are designed to form and retain fat stores and millions of years of evolution have created sophisticated and elegant systems to thwart any attempt at self-starvation. That is the real reason why most quick fix promises are doomed to failure. As day follows night, every time that a scientist somewhere publishes another piece of the obesity puzzle, a flurry of articles and books will follow, claiming that they have The Answer, never realizing that there are several hundred interlocking pieces to the puzzle.
Yet more research has confirmed that diets rarely help. A group of investigators from UCLA published their findings in the April issue of American Psychologist, the journal of the American Psychological Association.
Traci Mann and her co-authors have conducted the most comprehensive and rigorous analysis of diet studies that I have ever seen. They analyzed 31 long-term studies in which people were followed for two to five years. What they found clearly mirrors clinical experience. Most people can initially lose 5 to 10 percent of their weight on any number of diets: low carb; low fat; high protein or pretty much anything else. But then the weight comes back: in the majority of people they regained all the weight plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority.
Their conclusion: diets do not lead to sustained weight loss or health benefits for the majority of people. And since people who regain weight usually have the “bounce” where they regain with interest, most people would have been better off not going on the diet at all. This is important: aggressive dieting can be dangerous to the body. It has been suggested that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function. So if people had not dieted, their weight would be pretty much the same and their bodies would not have suffered the wear and tear from losing weight and gaining it all back.
Over the years, many diet studies have looked good, but the results have often been skewed by a number of factors. For example, in some studies participants self-reported their weight by phone or mail rather than having an objective weight measurement. Many studies also had very low follow-up rates: eight of the studies had follow-up rates lower than 50 percent.
Traci Mann, the lead investigator was asked, “If dieting doesn’t work, what does?”
“Eating in moderation is a good idea for everybody, and so is regular exercise,” Mann said. “That is not what we looked at in this study. Exercise may well be the key factor leading to sustained weight loss. Studies consistently find that people who reported the most exercise also had the most weight loss.”
Happily there ARE genuine solutions to the problems of weight, but they do not begin with a diet. They begin with a totally new understanding of how our bodies operate, how to deal with the psychological and social barriers to health and how to activate the natural abilities of the body balance and heal itself.
I am going to talk about those a little more in the next post.
“I’ve been on a diet for two weeks and all I’ve lost is fourteen days.”
–Totie Fields (American Comedian, 1930-1978)
“The Diet Mentality has come about because there is agreement in our society that the only way to lose weight is by dieting. But dieting produces absolutely no permanent, positive results. In fact, it makes you feel worse about yourself and probably does more damage than good to your health.”
–Bob Schwartz (American Health Expert and Author)
“Gluttony is the source of all our infirmities and the fountain of all our diseases. As a lamp is choked by a superabundance of oil, and a fire extinguished by excess of fuel, so is the natural health of the body destroyed by intemperate diet.”
–Robert Burton (English Cleric and Writer, 1577-1640)