This past weekend I gave a lecture at the Physician Moms Group medical conference covering the pathophys behind obesity. While I still will put something more technically together, today I had an interesting conversation that gave me the idea of posting about how this information is can be used and explained in "real-life" terms.

 

As always these audio recordings are for education purposes only, and not meant to act in any way as medical advice. Please consult your personal physician for your personal medical advice.

Ok, my new little speaker kind of stinks. I could have been hitting it with my hand as I paced around speaking though!?! But, the good news is I know out of all the people out there, my group knows nothing is perfect. #nofancybellsorwhistleshere ;)

Obesity Paradox

The idea that a high BMI appears to be protective and decreases death in people, but also is associated with increased risk of death. 

 

***More simply put - there is data out there that shows being overweight can be a good thing for some, yet a bad thing for others***

Acronyms

HTN : hypertension

Normal BMI (Nml) <25

Overweight (OW) BMI 25-29.9

Obese (Ob) >= 30

Evidence showing OW+ is bad for our health:

Tons of it out there, I don't think I need to list too many. But here are some as it is still important to remember this.

Arch Intern Med. 2002 Sep 9;162(16):1867-72. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.Wilson PW1, D'Agostino RB, Sullivan L, Parise H, Kannel WB.

Looked at relationships between BMI and CVD risk factors, CVD endpoints prospectively from the Framingham HEart Study of ppl 35-75 who were followed for up to 44 years.

CV endpoints the looked at: Angina, MI, Coronary hrt dz, or stroke.

Conclusions: the overweight category is assoc with increased relative and population risk for HTN, and CVD.

Ob risk of HTN was 42%

OW risk of HTN was 27.8%

Nml  risk of HTN 15.3%

 

NHANES III (1988-1994) to NHANES III (1999-2000)

Showed increase prevalence of Metabolic Syndrome (MetSyn) and that weight was associated with increased risk of MetSyn:

Nml 5%

OW 22%

Ob 60%

http://care.diabetesjournals.org/content/34/1/216.long

N Engl J Med. 2002 Aug 1;347(5):305-13.Obesity and the risk of heart failure.Kenchaiah S1, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS.

5881 participants in Framingham. Used Cox proportional-hazards model

Found: For each 1 unit increase in BMI women’s risk of heart failure increased by 7%, 5% in men.

Nurses’ Health Study

https://www.ncbi.nlm.nih.gov/pubmed/7872581

114,281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976. Over 11 states.

Findings:

BMI <22 assoc with lowest risk of T2DM

BMI >35 was associated with 6X higher “relative risk” of T2DM

Look AHEAD study and others

Have shown that even a 5% weight loss can improve risk profiles for diabetes and cardiovascular health

Lancet. 2014 Aug 30;384(9945):755-65. doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13.Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults.Bhaskaran K1, et. al.

“Assuming causality, 41% of uterine and 10% or more of gallbladder, kidney, liver, and colon cancers could be attributable to excess weight. We estimated that a 1 kg/m(2) population-wide increase in BMI would result in 3790 additional annual UK patients developing one of the ten cancers positively associated with BMI.”

***granted i’m not sure any paper should have been published that uses the world “assume.” After all that just makes a “bleep” out of you and me. But as other studies do seem to show an assoc we’ll let it slide***

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So there is a lot of data out there that shows associations between excess fat mass and MetSyn, HR, cancers, and 200+ diseases. From some evidence you would conclude that obesity does cause health problems.

The Obesity Paradox:

The strange thing is of the people getting diseases, the people who have the better prognosis are the ones overweight!!! And while all the above more talk about risk factors, we still do see patients of normal weight getting HTN, having coronary hrt disease, T2DM, getting the other 200+ diseases.

Am J Med. 2007 Oct;120(10):863-70.Obesity paradox in patients with hypertension and coronary artery disease.Uretsky S1, et. al.

22,576 ppl with HTN and CAD

Why Feast And Famine Might Not Be Working

****definition of a diet “working:” ability to lose weight and then maintain that weight loss. So in this instance will people be able to lose weight using this theory AND then maintain it.

The quick and dirty if you don’t have time:

To quote Dr. Jason Fung’s website, “Eating is a celebration of life. Any diet that does not acknowledge this fact is doomed to failure.”

These two sentence he argues support his theory, I would actually argue are the downfall of his theory.

My rebuttal would be any diet that does not acknowledge the potential for food addiction, binge eating disorder, and or hedonic obesity is "doomed for failure” to use the above quote.

A.) Food “Addiction”

The thing is for people who been exposed to “adiposity” maintaining the sense of food as a reward is quite often dangerous. This sort of mentality can maladaptively accidentally place food up on some pedestal, when really food should “just be food.” Especially with those out there who know, but may not want to admit that food, and more likely carbs, are addictive.

Currently, we have not technically “proven” food is addictive in humans, but we are finding it more and more true in mice. Unfortunately we may never be able to actually prove it in humans, as the dirty truth is we can’t do trials on humans as we can on tiny little animals, who take up a small amount of space, eat a relatively small amount of food, who then can be sacrificed to an autopsy at the end of the the study. So we likely are going to more just go on, and lean towards an educated guess that food, especially hyper caloric carbohydrate food is addictive. And if you still can’t get yourself to say it, if you are a, “but how can food be addictive, we need it to live,” at the very minimum you could maybe admit that some food has addictive qualities.

The question is will you really be able to fast the next day, I mean really? With food still be around everywhere, will you be able to? It may not just be in your house, but it still is likely within about 5 mixtures of your house. Will you be able to just cold turkey say no to food, especially after you just showered you brain with all kinds of “feel” good hormones released from being exposed to those “celebration foods” you just feasted on?  Some might say yes, I can totally do it. Others, I am betting if you think about it, really sit and be honest with yourself, the answer is likely going to be “no.” One thing I love to point out is to think to yourself, “will one night’s sleep change me as a person.” Will sleeping with this belly full of food really stop me from eating tomorrow?” Haven’t I gone to bed with a full belly in the past? Did I wake up the next morning not hungry? Or have I ever noticed the more I eat the more I become hungry?

Interesting studies I will interject here:

Basically, in this study obese and non obese participants where allowed to eat at a buffet, no meal before. Then they came back to the same buffet, on another day, but this time they were all given a chocolate shake to drink before the buffet. The non obese people ate less, the obese people ate more!

[Finding study link…my bookmarks where erased!!!! :( ]

Others:

Brain Cogn. 2016 Dec;110:53-63. doi: 10.1016/j.bandc.2015.08.006. Epub 2015 Oct 1.

Eating with our eyes: From visual hunger to digital satiation. Spence C1, Okajima K2, Cheok AD3, Petit O4, Michel C5.

“In the fasting state, obese individuals demonstrated increased neural activation in those areas that are known to be associated with the anticipation of reward.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864961/

 

Effects of binge eating on satiation, satiety,

Bone Broth Vs Regular Broth

This is about trying more eat food for food, less eat food based on emotional pressure. Being able to practice the ability to see the entire truth behind an eating scenario, and then having our thoughts lead us to a more positive outcome. #wearewhatwethink

Vacation

Perspectives to Ponder

Goal evaluation:

Why do we go on vacation?? Do we go to de-stress, to gain some sort of mental health back, to relax, ultimately decrease stress, to extend life?

Or do we vacation to eat? Some people may say life enjoyment does involve eating. But the question to be asked is…

Will the overindulging that is associated with vacation actually bring happiness? Or does it actually bring more stress, more guilt, more struggle?

Should we eat for pleasure on vacation, or should we eat good quality tasty food so we can be happy at that moment, feel pride in taking care of ourselves, and promote happiness when we go back home?

The vacation yo-yo sabotage

I see many people use vacation as a motivation to lose weight, weddings are another one that falls into this category. And using vacation as a motivational tool does absolutely work, but it comes with a real danger.

Many to do anticipate or realize that after a weight loss your body will have adaptive changes that will promote weight gain!! Your body will release more hunger hormone, it will decrease satiety hormones, and can even decrease your metabolic rate. All three are the perfect storm for putting back on weight at a faster rate than before.  But then if you combo these 3 with the “I deserve this I am on vacation” or the “effit I am on vacation” type of thinking, you can imagine the devastation that can occur

 

***little side note: did you know your body(your GI tract) can upregulate fructose receptors after 3 days of having an increased exposure to fructose. Meaning if you were on a weight loss regimen and you have been eating low sugar, after going back on sugar for 3 days your body will be able to absorb a larger percentage of what you actually eat!!! Just another way you can continue to even have the same caloric intake, but gain weight!!***

 

Vacation and family

I personally think one of the most difficult parts of losing weight is trying to break the habit of using food as a reward. So if you need an extra level of motivation think of your kids. If you take them on vacation and just eat a bunch of junk all the time you are teaching them:

-to associate junk food with happiness

-to create behavioral pathways that promote using food as a reward

Instead show them how to go on vacation, and more enjoy food to enjoy the vacation. Not the enjoy food, just because food brings us enjoyment.

If nothing, else help them not have the same food reward system you might have. Make it normal to go on vacation, have fun, and just eat to eat.

 

Is vacation about eating hyper-palatable hyper-caloric food? Or is a vacation a way to improve your life. Will the food you eat improve your life?

FOMO

"Fear Of Missing Out"

Biggest example: FREE FOOD

When the plate of cookies is sitting there, you start to feel a bit anxious. There is an underlying anxiety of missing out on something that is “free.”

This is really all based on FEAR. But the thing is this is not an actual thing...it is YOUR anticipation of something. You anticipation of “missing out.”

Goal: work on your perception

Perception of seeing things fearfully VS from a place of love

Perception of missing out on something. What are you REALLY missing out on? What is the ENTIRE picture here?

Ex: The Pharm Rep Lunch

Is that pharm rep lunch really free? Or did it come with the price of having to sit and listen to a stranger try to sell you something. To have to sit there and act interested even though you really know this pharm rep is entirely biased and you are just trying to be nice, not to call them out on their bias. Plus you feel pressure as the staff usually loves the type of food the pharm rep brings in #hyperpalatable #hypercaloric as even the staff gets to splurge..."after all it is 'free.'"

Ex: Food at a conference

“I paid for this conference, the food was included, I don't want to miss out on this food I already paid for.”

-but is that food actually good food? Or is it the cheapest thing they could serve because they are trying to save money...is that plate of food really only worth maybe $3 (one serving of the giant volume of lettuce maybe 20 cents, dressing, 10cents, one chicken breast bought in bulk $1.50, some pasta something 75cents, one roll made in bulk 10cents, cookies at the end 20 cents).

Is this $3 really worth it? Or is this plate of food actually causing you to miss out on something else?

Ex: The Sale

“I am missing out on XYZ sale.” (this applies to anything, shoes food, anything)

---> Or, am I missing out on money I likely wouldn’t have spent if it were not on sale. If this was full price would I have bought it?  If it was normally $7 and now it’s on sale for $4, I am saving $3!!! Really or did you just waste $4 on something you didn’t really need. 

“Those wings are half off tonight”

---> Would you really be missing out if you knew that basket of wings really cost the restaurant next to nothing to provide..that is why they can afford selling them half price!! That or they know you will likely also buy a soda, or dessert too, they just need to get you in the store. Have you noticed there is never "half of salmon night," or half off chicken breast with quinoa night.  Some may superficially say, oh well there is not a market for that….but I would disagree. It is these are expensive to buy, expensive to prep, and "coincidently" the better/healthier food options. But a restaurant cannot have sales on these items, as they will lose money. 

 

FOMO = narrow perspective.

Fear is suppose to protect you, but are you really in trouble?

Open up your perspective...will you act out of fear, or act from a place of love?

 

If having trouble flipping from a fearful motive to a loving motive than open up that fear and make the fear actually adaptive, instead of maladaptive. Examples:

I could have wine, but I'm afraid I will miss out on all the benefits of being "on point" with my plan. I am missing out on my progress if I have that wine. 

I could have those cookies, but then I am missing out on being happy tomorrow. I am missing out on hitting my goal.

The ultimate…"I could ‘effit’ and eat whatever, but will I miss out on an opportunity to change.”

Mechanisms of obesity, why many programs won't work. A look at what factor you might need to take into consideration.

DISCLAIMER: This podcast is meant to share information, perspectives, and experiences. It does not provide medical advice, and it is not a substitute for advice from your physician or healthcare professional.

So we have gone over self evaluation of the reasons WHY we eat. But we did also go through this skill being something that has to be trained, it has to be strengthened...so in the meanwhile you still are eating, not losing weight, maybe even gaining, so what do I do now???

 

Ok so first we need to talk about “over promising” and “expectations.” Too many of us have that mindset of 100%. I am going to wake up tomorrow and 100% do it..I’l going to wake up at 5:30, do an hour workout...even though I have never done this...I am going to stick to my entire nutritional plan...I am going to be positive the entire day!! We in general are “go getter” “high expectationers of ourselves.” That when we do something we have do it all, all at once, as fast and perfectly as humanly possible!!

 

But have you ever done this...or are you stuck.. You find yourself saying..

“I just can’t do it”

“It is too hard”

“That is not the lifestyle for me”

 

But this way of trying to make a change make no sense on many FUNDAMENTAL levels!!

So I try to stick to evidence-based info when I bring you things, because we are evidence-based people. Decisions we make for other people can change that other person’s life, so we try as much as possible to make an educated decision basing it on evidence.

 

So apply your evidence to yourself. The beauty is it does not matter that it is an N of one….because it is your “one.” should you give your evidence of you based on your one to someone else...probably not, they are not you. I hope that made sense….

 

Anyway, how many times have you started a program “all in.” Breakfast, lunch, dinner, snack...all in...and in the end at 1 month, 3 months, 6 months how did that work out? I imagine not great as you are listening!  

 

Buuut

 

How many times have you gone 1/4th in, and did the ¼ bit of the plan daily most days of the week….. I’m going to go out on a limb here and say the answer for 99% of people is going to be never.

 

Why….because we are “all in people,” “all or nothing” people.

The crazy part when it comes to weight loss doing “all” ends up leading to nothing!!! I know...mind blown right!!!

 

So with that in mind think about this small change…

When you want to eat, eat at the table! Huh, what that’s too simple, it won’t give me the changes I want…...and there it is...kipping over the simple things!!

So please hear me out on this…. if you want to have a snack get a plate or a bowl out, nothing paper, a legit plate that can be broken and has to be washed (ie something that will create a bit of work for you down the line).  Go to the store “Ross” super cheap plates that match this description there.”

 

So get out the plate, utensils you will need, and EAT IT what you are wanting to eat!

BUT….no distractions!! No TV, no music, no podcasts, NO PHONE.

 

And boom...You are officially eating “mindfully!” You are eating what you wanted, and eating it mindfully!!! You can’t ignore your thoughts on it, you can’t overlook how it tastes!! You are sitting there bite after bite paying attention to your food. I don’t even need to tell you what question to answer while you eat your food...you will have revelations about your food as you eat it.

 

Revelations that hopefully help you make future choices about what was worth taking the time to sit, eat and wash a dish vs food that is not worth it!!!

 

This SIMPLE thing can work on different levels, and does not have to be “all or nothing.”

You will work on putting time into “working on yourself,” caring for yourself.