A New Blog in Town

Sandy Szwarc, a registered nurse (and researcher), recently sent me a heads-up on her new blog, "Junkfood Science." I've had a chance to review it and have found her presentation of research informative and accessible and her message congruent with mind/body health. The site tackles body/weight issues, but also provides a wealth of information on food science and health policy concerns.

Sandy's blurb: "Junkfood Science -- The truth about food, fat and health. It's not what you’ve been led to believe. Learn the science that mainstream media doesn’t report and how to critically think about the junk they do that's not fit to swallow."

Check it out.

Cultured?

This past weekend's The New York Times Magazine features an article written by a Harriet Brown, the mother of a 14-year-old girl diagnosed with anorexia. Ms. Brown's personal account of healing her daughter describes the Maudsley approach, a family-based approach for treating anorexia, and pays tribute to the genetic factors associated with eating disorders. Brown cautions us against socio-cultural explanations: "If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved." Brown's point is well-taken--a number of factors have been associated with the development of eating disorders; however, when you turn the page after the article's end, it's hard to discount the critical role that cultural images and dialogues play in women's thoughts about their bodies.

(Lest there be any uncertainty, the image illustrates a Times feature subtitled, "An Artful Homage to this Season's All-Important Acessory: The Hat.")

Calorie Restriction

(from The New York Times: two rhesus monkeys about the same age, one fed a CR diet,left, the other fed a normal diet)

A number of people have asked about my thoughts on calorie restriction, the movement that follows the notion that the less you eat, the more years you’ll live. The idea is that giving up those hearty meals, those decadent treats, those full-plate or even half-plate servings, you may up your chances at living a longer, healthier life. And, so on the almost-eve of America’s national overeating challenge, I offer some thoughts on calorie restriction. Please keep in mind that these observations/interpretations are from a psychological, not nutritional or biomedical perspective, and that the fact that a clipping on calorie restriction (CR) that I had saved for this post just caught fire on a candle I’m burning at my desk does in no way reflect on my thoughts about CR.

CR involves consuming about 30% fewer calories per day than is generally recommended for one’s height, weight, and body type. The key, though, is that amounts of vitamins, minerals, and other essential nutrients are kept constant (or even enhanced), resulting in a kitchen laboratory of sorts, where scales, measures, and computer monitoring ensure adequate levels of nutrients on a largely barren plate. From what I understand about nutrition, this may not be the easiest task.

Support for CR dates back to 1935, when Dr. Clive McKay, a researcher at Cornell University found that rats fed a CR diet lived approximately 40% longer than their normally-fed counterparts. Similar results have been found in primate populations, where like in mice, scientists are seeing reduced incidences of diabetes, heart disease, cancer, and other ailments with the introduction of CR.

Does CR work in humans? They’re not so sure. The truth is, the scientific community isn’t exactly sure how CR works at all. Still, several hundred thousand people have swapped their cookbooks for cooking scales, their large serving plates for the ceramic equivalent of “just a little bit.” A New York magazine article focuses on Michael, a bona fine calorie restrictor, who at 6’ feet tall and 115 pounds consumes 1,913 calories per day. Exactly 1,913. His dinner, his girlfriend (also a CR devotee) explains, is “‘always 639 calories.’” Other CR followers profiled in the article skip meals or consume a single meal per day.

A New York Times article reports that scientists at Washington University who have studied a group of calorie restrictors have found that “the dieters had better-functioning hearts and fewer signs of inflammation, which is a precursor to clogged arteries, than similar subjects on regular diets.” According to the Times, research published in JAMA has also suggested that those on CR diets have lower body temperatures, lower insulin levels, and fewer indices of chromosomal damage linked to the aging process.

On other hand, the Times reports that:

A mathematical model published last year by researchers at University of California, Los Angeles, and University of California, Irvine, predicted that the maximum life span gain from calorie restriction for humans would be just 7 percent. A more likely figure, the authors said, was 2 percent.

Is it really worth it, to give up (for a lifetime) the decadence, the luxury, the indulgence of food for an extra couple of years? One of the paper’s authors, Dr. Jay Phelan at UCLA says: “‘Calorie restriction is doomed to fail, and will make people miserable in the process of attempting it.’”

As with many enterprises (especially surrounding food and weight), the research may be confounded. People who subscribe to CR are likely to be those who don’t smoke, who don’t drink to excess, who exercise, and who generally engage in a host of other behaviors designed to promote their health. Their results on medical tests do not indicate that CR is ultimately responsible for their good health.

Regarding Phelan’s point above, it’s unclear what the long-term effects of CR in human populations may be. From a psychological perspective, CR does not look much different (at least superficially) from a weight-loss diet. For those who are approaching CR for weight-loss purposes, we may see similar failure rates to other organized approaches that focus on deprivation. CR also looks a lot like the restriction associated with anorexia. Those involved in the CR movement emphasize that the goal is not weight loss and that nutrition takes a paramount role, unlike in anorexia. The Calorie Restriction Society takes a special look at CR vs. anorexia here. Still, eating-disordered thoughts and behaviors may creep up on the unsuspecting CR follower, particularly someone who focuses primarily on the associated weight-loss benefits. We may also see, as Phelan indicates, difficulty adhering to CR and compensatory bingeing, as a result of hunger and a reaction to a constricting, depriving diet without an end in sight.

Your thoughts?

More or Less

In most aspects of life, we’re always yearning for more: more time, more money, more love, more knowledge, more space, more insight, more sleep, more hope, more light. With regard to weight and shape and size, however, less is more—to weigh less; to have a smaller frame; to approximate zero as best we can; to come, in some cases, as close to nothingness as possible, while still claiming to exist.

“I want to be less.” Deconstructing the sentence, it’s interesting how it maintains meaning as it shrinks:

I want to be less.
I want to be.
I want to.
I want.
I.
.

For women, how did less become a synonym for more?

VCR/DVR Alert

Tomorrow night at 9pm ET, HBO airs Thin, a documentary on eating disorders by filmmaker Lauren Greenfield. Click here here for an interview with Ms. Greenfield.

The Fault of the Fat

As if having to endure public ridicule and self-reproach weren’t enough, now the obese population is being blamed for one of our planet’s most harrowing crises—global warming. The New York Times recently reported that in an issue of The Engineering Economist, researchers calculated the extra gasoline costs use to transport our growing nation, to the tune of a billion gallons per year. Similar research regarding airline fuel use was published a year earlier in The American Journal of Public Health, which suggested that the extra 10 pounds Americans now schlep around is responsible for 350 million gallons of fuel, resulting in significant increases in environmental carbon dioxide.

So, does the drama of global warming tip the scales to the point where the obese population will finally have an a-ha moment, the personal turning point, when sudden insight leads to miraculous weight-loss? Not really. As the Times reporter Gina Kolata notes, “It’s not that the obese don’t care. Instead, as science has shown over and over, they have limited personal control over their weight. Genes play a significant role, the science says.” And, we know what typically happens when we raise the stakes in the obesity game—those stigmatized, blamed for their personal (and now environmental and sociopolitical) ills and compelled to lose weight will actually. . . eat more. It’s akin to yelling at a stuttering child. What do we think is going to happen?

So far, scholars are also not taking bait. In the Times article, Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale says, “‘People are out scouring the landscape for things that make obese people look bad.’” Katherine Flegal of the Centers for Disease Control and Prevention offers a tonge-in-cheek response: “‘Yes, obesity is to blame for all the evils of modern life, except somehow, weirdly, it is not killing people enough. . . . In fact, that’s why there are all these fat people around. They just won’t die.’”

Addictions

I’ve been thinking a lot recently how eating-disordered thoughts and behaviors mimic other addictions. Just like a drink or drug, an eating-disordered action can be compulsive (or impulsive), can rescue us (temporarily) from difficult feelings, and can create a host of new problems that obscure what originally led us to these behaviors in the first place.

With addictions, we often use functional analyses to understand the patterns associated with alcohol/drug use. In its simplest form, a functional analysis looks like this:

Triggers-->Behaviors-->Consequences

That is, certain situations or events lead us to respond in a certain way, and these responses have various consequences. With alcohol/drugs, we often focus on the triggers (people, places, things) that lead us to drink/use (or not), and the positive and negative consequences of using (or not). To apply this to eating-disordered behaviors, we first need to identify the behaviors in question. Here are some examples:

1) Restricting
2) Bingeing/purging
3) Emotional eating
4) Excessive exercise
5) Excessive weighing/mirror-gazing
6) Engaging in critical thinking about our bodies
7) “Feeling” fat
8) Desperately turning to the next diet

As for triggers, to expand upon people/places/things, they are often thoughts we have, emotions we experience (the concept of “emotional eating” itself addresses 2/3 of the equation above), stimuli we encounter (e.g., a fashion magazine, gaining weight/losing weight, a picture of ourselves, a bad day), physical symptoms (e.g., feeling overly full, tense, lethargic), etc. What other triggers do you experience?

Once we encounter these triggers, we have a number of behavioral responses that we may employ (some repertoires may be larger than others). For the purpose of this discussion, the critical distinction ultimately occurs between engaging in an eating-disordered behavior (see above) or not, instead relying on a more adaptive coping resource. Each option is associated with consequences, good and bad. Bingeing might make us uncomfortable, but having access to unlimited, tasty food feels good in the here-and-now. Berating ourselves for the size of our stomachs may cause us to experience anger or grief, but it potentially distracts us from even more uncomfortable thoughts and feelings. Examining some of the other consequences—good and bad—of engaging in these behaviors may help elucidate our decision-making processes.

Cheers!

Recent research out of Harvard Medical School and the National Institute on Aging suggests that an ingredient found in red wine, resveratrol, may reduce the incidence of the health-related consequences typically associated with obesity. When obese mice were administered heavy doses of resveratrol, their fat-related deaths dropped by 31%.

As for the resveratrol-enhanced mice? “‘They’re chubby, but inside they look great,’” says study co-author David Sinclair of Harvard in a Metro report. Sinclair’s co-author, Rafael de Cabo, with the National Institutes on Aging, states in a Harvard Medical School News Release, “‘After six months, resveratrol essentially prevented most of the negative effects of the high calorie diet in mice.’”

Preliminary results indicate that resveratrol may be associated with lower incidences of diabetes, heart disease, and liver dysfunction, even in obese populations, when the prevalence of these diseases, historically, has been thought to be directly related to patients’ weight. Again, we’re confronted with data suggesting that it’s impossible to posit a one-to-one correlation between weight and health, that a multitude of factors (e.g., physical fitness, genetics, even mass amounts of red wine consumption) may moderate this relationship.

BMI Not TMI

A little more on the BMI: The index was “invented” by Belgian man named Adolphe Quetelet, who’s identified as a “polymath.” I’m not exactly certain what a polymath is, but it sure doesn’t sound fun.

During the course of this writing, Lancet medical journal published meta-analytic research (of 40 studies) out of the Mayo Clinic suggesting that those with too-low BMIs were at greater risk for heart disease-related death than those who had BMIs in the normal range. Moreover, those considered “overweight” by classic BMI standards actually had a higher rate of survival (with fewer heart problems) than those in the “normal” BMI range.

Head researcher Francisco Lopez-Jimenez says “Rather than proving that obesity is harmless, our data suggests that alternative methods might be needed to better characterize individuals who truly have excess body fat compared with those in whom BMI is raised because of preserved muscle mass.”

It took the Mayo Clinic until 2006 to come up with this? Our gold standard isn’t so golden, after all.

In another article in the same issue of the Lancet, Maria Grazia Franzosi states, “BMI can definitely be left aside as a clinical and epidemiological measure of cardiovascular risk.” Instead, it seems that waist-to-hip ratios are, for now, the way to go. And Grazia Franzosi’s research suggests that these ratios are good prognostic indicators of cardiovascular health. Still, we seem glued to a number (from pounds to BMI to ratios) that is, at best, a gross estimate of an individual’s unique biology. When it comes down to it, it’s easier to address a number than a person.