116 Million Adults Dieting

Separating Fat from Fiction: Exploring Myths, Realities, and Assumptions

Ellen Perrella MS, ATC, CSCS Head Athletic Trainer Mount Holyoke College Sobering Statistics  116 million adults dieting

 80% US teenage girls have dieted

 Age 13, 1/2 girls unhappy with bodies ‘Unreal’istic Images

 Average model, dancer, or actress is thinner than 95% of population

 A generation ago models weighed 8% less than avg. woman; today,23% less http://www.dove.us/#/feature s/videos/default.aspx[cp- documentid=7049579]/  Women, weight, and feminism Is Obesity a disease? Is body fat pathological?

 Who benefits from obesity being considered a disease?  Scientists and academics researching obesity  Pharmaceutical companies  Bariatric surgeons  Public health establishment Is Obesity a disease? Is body fat pathological?

 Who benefits from obesity being considered a disease?  Scientists and academics researching obesity  Pharmaceutical companies  Bariatric surgeons  Public health establishment

 $50 Billion Diet Industry Fat Phobic Society

 Diet Drugs  Usage among female adolescents (Journal of Preventive Medicine Feb. 2007)  Fen-Phen Fiasco Fat Phobic Society

 Diet Drugs  Usage among female adolescents  Fen-Phen Fiasco

 Bariatric Surgery: Liposuction  Elective surgery, high mortality rate.  Hospitalization rate doubled in the year post- surgery compared to year prior to surgery. At Least 20% will need more surgery.  Health benefits? (Klein, Samuel, M.D., 2004) Fat Phobic Society

 Diet Drugs  Usage among female adolescents  Fen-Phen Fiasco

 Bariatric Surgery: Gastric Bypass  AHRQ (w/in 6 months); 4 in 10  13-15 years out  Post surgery-3 ounces fills stomach  800-1200 cal/day. MYTH #1: Eat Too Much; Exercise Too little?

 Food environment  Increased portion size, Snack-foods heavy on refined sugars and saturated fats.  Most studies: overweight people eat fewer calories than those of normal weight. (Nat’l Academy of Sciences, Diet and Health, 1989) MYTH #1: Eat Too Much; Exercise Too little?

 Physical environment  Technology has stripped our lives of natural exercise.  Screen time=video games, computers, TV  1970’s Fitness Revolution  SES, income, and education are inversely related to obesity.  Poor people more likely to work in physically demanding jobs, yet have much higher obesity rates. MYTH #1: Eat Too Much; Exercise Too little?

 The relationship between exercise and food and obesity is not clear. Intervention school studies

 5,106 3rd graders from 96 schools  56 schools-2 year Intervention: healthy foods, nutrition instruction, extra physical activity.  Students decreased fat in diet, exercised more, …  No difference in weights from 40 control schools  Nader, PR., Stone, EJ, Lytle, LA et al. What is the cause of obesity?

 Intrinsic metabolic, enzymatic, or hormonal abnormality induces + caloric balance…..fat accumulation.

 Defect of fat metabolism; hormonal and metabolic, release of fat is impeded, or the deposition/synthesis of fat is promoted.

 Appetite and weight regulation have strong biological underpinnings. Myths and Misconceptions

 People can control their body size; they can lose weight if they really want to. Myths and Misconceptions

 People can control their body size; they can lose weight if they really want to.

 You will lose weight when you exercise

 Heritage Family Study (Wilmore, Jack H. , et al)  500 men and women; 20 weeks, stationary bicycle 3x/week  55%-75% of VO2 Max; 30-50 min.  Lost < 1 lb.; % body fat < 1% More Myths

 People are thin or fat based on a simple relationship between ‘calories in and calories out’  “no basis in medical science”  Overfed 12 sets of identical twins 1,000 cal./day, 6 days/week, 12 weeks  identical levels of physical activity  7 weeks later; weight gain among 24 men varied 300%, from 9-30 lbs.

(Bouchard, C., Despres, J.P., Nadeau, A., et al. ) More Myths

(Bouchard, C., Despres, J.P., Nadeau, A., et al. )  Obesity causes poor health and increased mortality Obesity is a poor predictor of:

 Hypertension.  No history of dieting; 125/79  History of yo-yo dieting (5 + weight losses of 10 + pounds last 5 years);147/90  BP positively correlated with total lbs. yo-yo-ers had regained. (Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. 2000) Obesity is a poor predictor of:

 High Cholesterol  31 obese women put on 6 month aerobic program. most lost avg. 6 lbs.; 11 gained 6 lbs  Both gainers and losers improved cv fitness the same amount  Also improved cholesterol levels and insulin sensitivity (Lamarche, B, J-P Despres, M-C Pouliot, et al. 1992) Obesity is a poor predictor of: (continued)

 Atherosclerosis (“clogged arteries”)  1960 (Int’l Atherosclerosis Project). 23,000 autopsies; concluded “no association”.

 1991. Dr. Applegate (U. of Tenn.) 4,500 angiograms of middle aged and elderly. Fattest people had cleanest arteries.

 NOTE: individuals that are overweight/obese and have atherosclerosis have lower risk of heart attack, stroke or early death. Obesity is a poor predictor of: (continued)

 Type II diabetes: condition improves with changes in diet and exercise, independent of weight changes  Insulin resistance (IR)is the most important metabolic factor relating to weight, diet, and health.  Obesity and diabetes: consequences of the same underlying defects; hyperinsulinemia and IR Weight and Cardiometabolic Abnormalities

 5440 subjects; 1999-2004  Wildman, R.P. et. al. 2008

 “A considerable proportion of overweight and obese US adults are metabolically healthy, whereas a considerable proportion of normal weight adults express a clustering of cardiometabolic abnormalities.” Correlation is not Causality

 “The mere presence of 2 or more variables in the same individual does not infer an inherent causal relationship.”

 Dr. Glenn Gaesser “…it is absolutely unjustifiable to equate behavioral patterns (poor diet and physical inactivity) with a physical characteristic (obesity).” Myth: Obesity Kills  Cooper Institute for Aerobics Research  1970. 26,000 men; 8,000 women (ages 20-90)  Being heavy did not increase the risk of premature death  = fitness levels  being overweight better than being underweight  Obese fit men and lean-fit men: similar low death rates -1/2 that of lean-unfit men- Myth: Obesity Kills  Cooper Institute for Aerobics Research  1970. 26,000 men; 8,000 women (ages 20-90)  Being heavy did not increase the risk of premature death  Fitness levels  being overweight better than being underweight  Obese fit men and lean-fit men: similar low death rates -1/2 that of lean-unfit men-

 Harvard Alumni Study  17,000 men who attended Harvard between 1916-1950  Who has the best chance of living a long life? BMI vs. Relative Risk of Death

Flegal, Katherine, Graubard, Barry, Willamson, David, et al. 2005 Diets: Atkins to Zone

 Dieters: 18x more likely to develop an eating disorder Diets: Atkins to Zone

 Dieters: 18x more likely to develop an eating disorder

 Recidivism rate from 90-98% Diets: Atkins to Zone

 Dieters: 18x more likely to develop an eating disorder

 Recidivism rate from 90-98%

 Needs deprivation leads to overcompensation  Dieting begets bingeing.  Dieting intensifies preferences for high-fat and sugar-loaded foods.  Starving……… Stuffed. Landmark diet study

 Keys Study (1944)  32 conscientious objectors  24 weeks caloric restriction/one-half of what they were used to eating  All lost weight, all gained it back plus some (avg. 10 lbs.)  Men were irritable, depressed, apathetic, preoccupied with food Landmark diet study

 What do Treblinka and Jenny Craig have in common? Diet is a four letter word

 Emotional toll: disheartened, disillusioned, and depressed Diet is a four letter word

 Emotional toll: disheartened, disillusioned, and depressed

 Body conserves energy/survival mechanism  BMR (basal metabolic rate) accounts for 60-70% of total energy used by body  BMR drops within 24 hrs. of food deprivation, may reduce 20% in 2 weeks Diets

 Improves body’s ability to store fat and limits ability to burn it  Increases lipogenic (fat-storage) enzymes  Decreases lipolytic (fat-releasing) enzymes  Decreased muscle- used for energy and reduced to lower metabolism Diets

 Ideology reinforces split between dieter’s mind and body. Yo-Yo, Uh Oh

 Weight loss begets weight gain - serious health consequences

 Framingham Heart Study Yo-Yo, Uh Oh

 Weight loss begets weight gain - serious health consequences

 Framingham Heart Study

 Harvard Alumni Study (follow-up 1998)  Men with stable weights vs. those who had lost and gained the most pounds:  80% higher risk of heart disease  123% higher rate of type II diabetes  alumni who dieted frequently (compared to non-dieters):  2x risk of diabetes, hypertension, and coronary heart disease Consequences of weight loss/gain cycling  The observations confirm…a basic relationship between starvation, re- deeding diet, and cv disease. (Univ. of Illinois, 1964)

 “Weight cycling is associated with lower HDL cholesterol in women of a magnitude … associated with an increased risk of cardiac event”. (Marian B. Olson, MS 2000) Athletics

 Scales are scarce

 Educate the coaches/staff

 Mandatory Programming for athletes

 No weigh-ins or % body fats

Athletic Traits vs. ED Symptoms

 Mental toughness  Commitment to training  Pursuit of excellence  Coachability  Unselfishness  Performance despite pain Athletic Traits vs. ED Symptoms

 Mental toughness  Asceticism  Commitment to  Excessive exercise training  Perfectionism  Pursuit of  Over compliance excellence  Selflessness  Coachability  Denial of discomfort (Thompson and Sherman 1999)  Unselfishness  Performance despite pain Ready, Set Point, Go

 “Home” weight; where your body feels at home (homeostasis)

 Natural weight Ready, Set Point, Go

 “Home” weight; where your body feels at home (homeostasis)

 Natural weight

 Vermont State Prison. Set out to make thin men fat. Concluded “marked difference in their ability to gain weight”. Ready, Set Point, Go

 “Home” weight; where your body feels at home (homeostasis)

 Natural weight

 Vermont State Prison. Set out to make thin men fat. Concluded “marked difference in their ability to gain weight”

 70% of our weight is genetically determined Location, location, location

 Upper-body fat (abdomen)

 More prevalent in males

 Visceral (or deep) body fat- metabolically hyperactive, high levels of FFA (free fatty acids) released in the bloodstream, etc.

 Increased risk for atherosclerosis and diabetes. Location, location, location  Lower body fat (hips and thighs)

 More prevalent in females

 Subcutaneous fat

 Associated with a lower risk of heart disease and diabetes  Stanford University, 1991. 133 men and 130 women, ages 25-49. Fatter thighs = lower heart disease risks (low LDL, high levels HDL, i.e. blood fat profiles). Popular Torture Devices Discrimination…...Humiliation

 Acknowledge the anxiety, pain, and grief this issue elicits for so many.

 150 Science Studies: noted stigmatization of obese adults by employers, educators, health care providers, the media, etc. (Rudd Center for Food Policy and Obesity/Yale)

 Weight bias is a social injustice as well as a public health issue.

 See Cynthia’s words (handout) HAES (Health At Every Size)  Accept and respect the diversity of body shapes and sizes.

 Health and well-being are multi-dimensional including physical, social, spiritual, occupational, emotional, and intellectual aspects.

 Promoting all aspects of health and well- being for people of all sizes.

 Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.

 Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise focused on weight loss. New Year’s Resolutions

 #1 wish every year-to lose weight New Year’s Resolutions

Climb a mountain.

Drink more Watch more sunsets. champagne. Listen to more music. Suggestions, Solutions, Solace

 Marcia Germaine Hutchinson, “Feminist Perspectives on Eating Disorders”, “So what does it mean to have a healthy body image?....” Suggestions, Solutions, Solace

 Marcia Germaine Hutchinson, “Feminist Perspectives on Eating Disorders”, “So what does it mean to have a healthy body image?....”

 What if??? What if everyone collectively woke up tomorrow morning and was happy and content with their bodies? More Suggestions, Solutions, Solace

 Substance over image. More Suggestions, Solutions, Solace

 Substance over image.

 Redefine beauty. Accept your size.

 Challenge the images/media. More Suggestions, Solutions, Solace

 Substance over image.

 Redefine beauty. Accept your size.

 Challenge the images/media.

 Be critical consumers of information.  Influence of the weight loss industry  Food industry and nonprofit health organizations More Suggestions, Solutions, Solace

 Substance over image.

 Redefine beauty. Accept your size.

 Challenge the images/media.

 Be critical consumers of information.  Influence of the weight loss industry  Food industry and nonprofit health organizations

 Avoid mentioning weight. Peace with food

 Shift focus: weight & dieting  enhanced quality of life & health.  Reject diet mentality

 Unconditional permission to eat

 “Enjoy a variety of real food, primarily plants” Linda Bacon

 “Gentle Nutrition” Intuitive Eating

 Honor your hunger Intuitive Eating

 Honor your hunger

 Feel your Fullness Intuitive Eating

 Honor your hunger

 Feel your Fullness

 Eating with Pleasure Intuitive Eating

 Honor your hunger

 Feel your Fullness

 Eating with Pleasure

 Respect your Body Accept your genetic blueprint

Wonderful Websites

 www.bodypositive.com  www.naafa.org (National Association to Advance Fat Acceptance)  http://www.sizediversityandhealth.org (Association for Size Diversity and Health)  www.bbwmagazine.com  www.melpomene.org  http://www.haescommunity.org  www.healthyweight.net  http://loveyourbody.nowfoundation.org/ Resources

 Bacon, Linda. Health at Every Size: The Surprising Truth about your Weight. Dallas, TX: Benbella Books, Inc. 2008.  Bouchard, C., Despres, JP, Nadeau, A., et al. The Response to Long-term Overfeeding in Identical Twins. New England Journal of Medicine. May 1990. 332 (21): 1477- 1482.  Campos, Paul. The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health. New York, New York: Gotham Books, 2004.  Diet and Health: Implications for Reducing Chronic Disease Risk / Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences, National Research Council. Washington, D.C. : National Academy Press, 1989.  Flegal, Katherine, Graubard, Barry, Willamson, David, et al. Excess Deaths Associated with Underweight, Overweight, and Obesity. Journal of American Medical Association. 2005. 293(15): 1861-1867. Resources (Continued...)

 Flum, DR, Salem L., Broeckel Elrod, JA, Dellinger P., Cheadle A., Chan, L. : Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures. Journal of American Medical Association. 2005; 294:1903- 1908.  Gard, Michael and Jan Wright. The Obesity Epidemic: Science, morality, and ideology. New York, New York: Routledge, 2005.  Gaesser, Glenn A. Big Fat Lies: The Truth about Your Weight and Your Health. Carlsbad, CA: Gurze Books, 2002.  Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. Risk factors for hypertension in obese women. The role of weight cycling. European Journal of Clinical Nutrition. April 2000. Vol. 54: 356-360.  Kater, Kathy. An Effective Model for Preventing the Full Spectrum of Body Image, Eating, Fitness and Weight Problems. The Renfrew Center Foundation Perspective. Winter 2006: pgs. 15-18. Resources (Continued…)

 Klein, Samuel, M.D., Luigi Fontana, M.D., Ph.D., V. Leroy Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W. Patterson, Ph.D., and B. Selma Mohammed, M.D., Ph.D. Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 17, 2004. Vol. 350: 2549-2557.  Kratina, K. A Compassionate Alternative to the ‘War on Obesity: Clinical Applications of Health At Every Size (HAES). Lecture: Feminist Perspectives and Beyond: Hungers, Health, and Healing. Renfrew Center Foundation Conference for Professionals. Philadelphia, PA. November 4-7, 2004.  Kolata, Gina. Rethinking Thin: The New Science of Weight Loss-and the Myths and Realities of Dieting. New York, New York. Farrar, Straus, and Giroux. 2007.  Lamarche, B, J-P Despres, M-C Pouliot, et al. Is body fat loss a determinant factor in the improvement of carbohydrate and lipid metabolism following aerobic exercise training in obese women? Metabolism, Vol. 41, 1992, pgs. 1249-1256 Resources (Continued)

 Lewis, Katharine, Man, Lynne. Overweight and Obesity in Massachusetts: Epidemic, Hype or Policy Opportunity? The Massachusetts Health Policy Forum. 2007.  Matz, Judith, MSW, LCSW, Frankel, Judith MSW, LCSW. “Attitudes towards Disordered Eating and Weight: Important Considerations for Therapists and Health Professionals.” The Journal of Health at Every Size, Volume 19, No. 1. Spring 2005.  Nader, PR., Stone, EJ, Lytle, LA et al. Three-Year Maintenance of Improved Diet and Physical Activity: The CATCH Cohort. Archives of Pediatric Adolescent Medicine. 1999; 153: 695-704.  Oliver, Eric. Fat Politics: The Real Story Behind America’s Obesity Epidemic. New York, New York. Oxford University Press, Inc. 2006.  Romero-Corral, Abel, Victor M Montori, Virend K Somers, Josef Korinek, Randal J Thomas, Thomas G Allison, Farouk Mookadam, Francisco Lopez-Jimenez. Lancet 2006; 368: 666–78 Resources (Continued)

 Sherman, R. T, & Thompson, R.A. (2001) Athletes and Disordered Eating: Four Major Issues for the Professional Psychologist. Professional Psychology: Research and Practice, v32(1), 27-33.  Sherman, R. T, & Thompson, R.A. (2001) Athletes and Disordered Eating: Four Major Issues for the Professional Psychologist. Professional Psychology: Research and Practice, v32(1), 27-33.  Seid, Roberta Pollack. Never Too Thin: Why Women Are at War with Their Bodies. New York, New York. Prentice Hall, 1989.  Spake, Amanda. Stop Dieting. US News and World Report. January 16, 2006: 61-66.  Taubes, Gary. Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. New York. Random House, 2007.  Thompson, RA, Sherman, RT. Good Athlete Traits and Characteristics of Anorexia Nervosa: Are they Similar? Eating Disorders: Journal of Treatment and Prevention (1999), 73: 181-190. Resources (Continued)

 Tribole, Evelyn, Resch, Elyse. Intuitive Eating: A Revolutionary Program that Works. New York. St. Martin’s Press, 2003.  Waterhouse, Debra. Outsmarting the Female Fat Cell. New York. Hyperion, 1993.  Wildman, R.PhD, Muntner, P. PhD, Reynolds, K. PhD, McGinn, A. PhD, Rajpathak, S. DrPH, Wylie-Rosett, J., Sowers, MR, PhD. The Obese without Cardiometabolic risk Factor Clustering and the Normal Weight with Cardiometabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Among the US Population. Archives of Internal Medicine. Volume 168 (15). August 11, 2008: 1617-1624.  Wilmore, Jack H. , et al, “Alterations in Body Weight and Composition Consequent to 20 Weeks of Endurance Training: The Heritage Family Study, “ American Journal of Clinical Nutrition 70, no. 3 (1999): 346-52. Resources (Continued)

 Yoho RA, Romaine JJ, O'Neil D. Review of the liposuction, abdominoplasty, and face-lift mortality and morbidity risk literature. Dermatol Surgical. 2005 Jul;31(7 Pt 1):733-43; discussion 743.  Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W. Patterson, Ph.D., and B. Selma Mohammed, M.D., Ph.D. Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 17, 2004. Vol. 350: 2549-2557.