WPWI Perspective Jennifer K. Hendrix

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) = 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 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***

**************************************************

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