Obesity and Mental Illness: Are They Linked?

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Depressed Overweight WomanWhen the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was being put together, a proposal was received that obesity and overeating be included as mental illnesses. Although this proposal was rejected, it does raise some interesting questions about the mental health of obese individuals.

Weight loss is a complicated process. People who have never had problems with obesity tend to think that losing weight is merely a matter of eating less and moving more. When obese people have trouble losing weight, others think they’re just not trying hard enough. This is the main reason for the hostility that is directed at obese people in our society: they are seen as lazy whiners who cost the health care system billions of dollars a year because of health problems that “they bring on themselves.”

The fact is, it’s not that easy to lose weight. There are myriad factors that play into weight gain. Some people inherit the tendency to gain weight. Others become heavy from poor eating habits, often instilled in childhood. Still others gain weight because of medications they’re on. Certainly lack of exercise plays a role as well. But the main reason obese people have trouble losing weight is that their obesity is all mixed up with mental health issues.

That’s not to say that obese people are mentally ill. But they are often depressed, have low self-esteem and lack confidence because of the way society judges them. If you were constantly being beaten down by “normal” weight individuals who see you as inferior, you’d have trouble mustering the courage and motivation to embark on a weight loss program, too.

That’s why it’s extremely important to have a mental health assessment if you find that you’re constantly trying and failing to lose weight. Clinical or bi-polar depression, anxiety disorders, PTSD, even ADD (Attention Deficit Disorder) can cause overeating. Sometimes medication and/or therapy can bring you up to a healthy level of functioning which in turn can be critical to your success.

This can be a two-edged sword, however. Most psychotropic medications cause weight gain, making it that much harder to accomplish your weight loss goal. Your doctor or therapist needs to be sensitive to the mental anguish this can cause. And you need to be aware that this is not your fault.

Even talk therapy can bring up issues that upset you and make you want to turn to food for comfort or to alleviate anxiety, further complicating your efforts to lose weight. It’s important to not get caught in a cycle of self-recrimination when you have these setbacks. It’s all part of the learning process.

In at least one study, obesity was associated with a 25-50% increased risk of lifetime psychiatric disorders (depression, mania, panic attacks, social phobia, agoraphobia), any lifetime mood or anxiety disorder, suicidal ideation, and suicide attempts. These issues must be dealt with or the obese person will find it nearly impossible to lose weight and maintain that weight loss, let alone be a fully functioning individual.

For more information about the DSM-5 and eating disorders, see this report by the American Psychiatric Association.

See also this article by Dr. Arya Sharma, “Obesity is Not a Mental Illness.”

 

 

 

 

 

Fasting as a Weight Loss Technique

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Recently I heard about a new weight loss technique called intermittent fasting. The interesting thing about this technique is that the fast can be for as “little” as 16 hours. That leaves you eight hours a day when you can eat. You could fast, for instance, from 6 at night till 10 the next morning and then have a normal breakfast, lunch and dinner in the time between 10 AM and 6 PM. Of course, you’d still want to eat a healthy diet and not just pig out for eight hours. But you don’t have to starve yourself during your eating hours, because you’ve already done that during the night.

I hit upon a variation of this technique when I was making the rules for my new eating program. In my last post, I listed these rules as:

  1. Practice mini-fasting.
  2. Only eat at set meal and snack times.
  3. Cut down on portion sizes.
  4. Weigh-ins once a week only.

I had never heard of intermittent fasting. But I was familiar with the practice of fasting because as a Muslim I have fasted during Ramadan. The goal there is spiritual, but it occurred to me that I could use the same technique for those stretches of times between meals when I get especially hungry.

I’ve always failed at diets because I don’t handle hunger well. All I can think about is not being able to eat. But when I apply fasting techniques to a diet plan, I find that I can get through those periods relatively easily. All I do is remind myself that if I could fast for anywhere from 12-17 hours a day during Ramadan, then I can surely fast for four to six hours between meals, especially if I allow myself a very small snack somewhere in that period. That’s what I mean by “mini-fasting.”

Four to six hours may not seem like a “fast.” But when you’re eating 1200-1500 calories a day, the time between meals can seem like it will never end. Telling myself that I’ve gone longer—and asking God for strength to get through it—takes the edge off and makes the whole diet plan possible.

It works for me. I’m not saying that it would work for everyone. But I have found it relatively easy to implement and not as taxing as a 16-hour or longer fast would be. Combined with the other three rules above (and a few more refinements I’ve made along the way), I’ve been able to lose fourteen pounds in ten weeks without exercising.

My goal has never been to lose weight as quickly as possible. I just wanted an eating plan that was sustainable; that I could follow for the rest of my life even. Because my main goal has always been to get control of my eating so that it stops affecting other areas of my life. As long as the number on the scale keeps going downward, I’m happy. Because I know that I can keep doing this until I finally reach my goal weight.

For more about intermittent fasting, go here. This is an article geared toward men. Please be aware that there is some question about whether women should fast intermittently. I myself don’t see the necessity of extra-long fasts (like 16/8) since I’ve seen that “mini-fasting” as I practice it is effective enough for weight loss.

 

The Obesity Epidemic – How This Fat Person is Losing Weight

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I am one of the statistics of the obesity epidemic. When I was younger I weighed around 125 and I’m only 5’3″, so I was never skinny. But as of last May 26th, my weight had topped out at 204.

Since then I’ve lost thirteen pounds.  I’m not following a specific diet and I rarely exercise (in fact my lifestyle is basically sedentary). But still I’ve been able to lose almost a pound a week. What changed? My attitude.

First, what made me fat in the first place? 1) I stopped working; 2) I started taking medications that can cause weight gain; and 3) I went through menopause. A triple whammy. But I had also been overweight as a child and my mother struggled with obesity all her life, so I had a predisposition to gain weight. I just never expected to gain so much.

I used to have nightmares that I became so fat I couldn’t hold my arms down to my sides. Even after I slimmed down in the 6th grade, I thought of myself as fat, especially once my body started to develop. (I have a “womanly” body, which means I have more curves than angles.)

Still, when I really started to gain weight, I barely noticed at first. My first inkling that something was up (my weight) was when I tried on my winter coat and it felt tight. I thought it had shrunk. I know it’s hard for thin people to believe, but weight can sneak up on you, especially if you haven’t been weighing yourself. It wasn’t until I went to the doctor’s that I was hit with the awful truth: I had gained a total of forty pounds. But at that point I wasn’t even as fat as I would eventually become.

A few months later, when I started taking courses at the local university and started doing a lot of walking, I lost thirty pounds. But after I graduated, my weight started inching up again, literally. Especially in my waist, which got as wide as 44 inches. (Yes, I have the infamous “apple” shape.)

It’s funny how once you start thinking of yourself as really fat, it almost doesn’t matter how fat you get. Fat is fat, you figure. What’s ten more pounds? I kept thinking that way until I hit 204 and my 40DD bras started getting too tight.

Around the same time, I started going to counseling about my eating problems. (I have a tendency toward bulemia.) And during the course of that therapy, I realized that I had the means to do something about my weight. In fact, I was the only one who could do it. My therapist helped me to see that I was putting the blame for all my faults everywhere but on myself.

This tied into my religious beliefs which emphasize personal responsibility. (I converted to Islam three years ago.) If God holds us accountable, then we, too, have to hold ourselves accountable. We have to face who we really are and assess our strengths and weaknesses. But that doesn’t mean putting ourselves down, which is what I’d been doing.

I had settled into the “fat person” mindset: No matter what I was when  I was younger, I’m a fat person now and there’s nothing I can do about it. I’m old, my meds make me gain weight, and I’m post-menopausal. What’s the use of trying to change?

One day I was writing in my journal about how my parents’ deaths had affected me. It seemed as though once I made it through the grief experience, I wasn’t the same person anymore. It was as if I had died with them and been born again as a new person.

I realized then that I could use that process to reinvent myself. I could die to the self who was keeping me from attaining my goals. All I had to do was pinpoint the most negative things that person was doing, and resolve to turn them around.

And because my preoccupation with my weight and over-eating was the worst culprit, I decided to start killing off those attitudes and behaviors first.

I sat down and wrote a list of things I do that contribute to my eating and weight problems.

  1. I hated going hungry.
  2. I ate all day long (also known as “grazing.”)
  3. My portion sizes were out of control.
  4. I judged myself by what I weighed each day.

Then I made up some rules that would counteract those behaviors and attitudes.

  1. Practice mini-fasting.
  2. Only eat at set meal and snack times.
  3. Cut down on portion sizes.
  4. Weigh-ins once a week only.

I made up my mind that I would stick to those rules no matter what.

See my next post on “Fasting as a Weight Loss Technique.”

 

 

 

 

 

 

 

The Obesity Epidemic – Are We Targeting the Wrong Age Group?

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Today’s post is borrowed from “Dr. Sharma’s Obesity Notes.”

Obese Kids are Not Causing the Obesity Epidemic

The math is simple – of the one in five adults in most Western countries, who are now considered ‘obese’, very few of them were obese as kids or even as young adults.

In fact, most obese adults are 40 or older. And, despite the alarming increase in childhood obesity (now affecting about one in twelve kids), obesity rates in younger adults remain at about 10% or less. Indeed, the greatest increase in obesity is seen in 45-54 year old men.

These numbers alone should tell us that most obese adults (and thus, the vast majority of obese people alive today), developed obesity as adults – not as kids!

This is not to say that excess weight in childhood is not a major predictor of excess weight in adulthood – many of my patients recall being teased and bullied about their weight 30 years ago, when they were growing up in rural Alberta, helping with chores around the farm, riding their bikes to school everyday, and playing shinny hockey on a frozen pond all winter.

But the majority of my patients did not have a weight problem till well into adulthood.

Why do I bring this up?

Simply because, I believe that better understanding, or even fully preventing, childhood obesity is unlikely to have a noticeable impact on adult obesity rates anytime soon.

The problems that lead to obesity for the vast majority of obese adults occurred during their adult years.

Their obesity was not caused by lack of phys-ed classes, poor school lunch programs, hallway vending machines, or parents too busy to cook dinners from scratch.

Their obesity was probably also not caused by too much video gaming, too much TV watching, or not playing outside till the lights came on.

Remember, the demographic group with currently the highest obesity rates (almost one in three) were kids in the 50s and 60s – an era, when a 6 oz serving of pop was considered a rare treat.

Why is any of this important?

1) Focusing all of our efforts solely on better understanding the drivers of childhood obesity and trying to prevent it likely means continuing to ignore the drivers of adult obesity, which account for the vast majority of obesity in the population.

2) Even if we successfully eliminate childhood obesity, by say, changing our kids’ lifestyles back to the lifestyles of kids in the 1960s, we may still see obesity affecting as many people in 50 years as it does today.

3) Adults with obesity today will live another 30-40 years (or longer) – many more adults not obese today, will become obese tomorrow – this is why preventing and treating ADULT obesity must be the most important priority for any health care system.

4) While childhood obesity is certainly a risk factor for adult obesity – the main driver of childhood obesity is ADULT obesity – having just one obese parent markedly increases the risk for childhood obesity – having two obese parents is virtually a guarantee. Thus, any solution to childhood obesity must focus on the ‘root cause’ of kids’ excess weight, i.e. having obese parents – these parents need treatment.

5) As far as I can tell, the strongest ‘halo’ affect of treating adult obesity is on their kids (the most extreme examples of this come from the kids of parents who have undergone bariatric surgery). Simply stated: successfully treat the parents and you ‘automatically’ prevent obesity in the kids.

I am not implying that childhood obesity is not a concern and that improving the lifestyles of all our kids (irrespective of their shapes and sizes) should not be an important goal.

All I am saying is that we need to stop ignoring the adults if we hope to make any dent in the obesity epidemic in our lifetime.

Imagine if the obesity epidemic was due to a virus that mostly affects adults – would we just be vaccinating the kids?

Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.

 

A Victory for Women’s Health: Why Isn’t Everybody Happy?

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After years of trying to get birth control covered to the same extent that health plans cover Viagra, our country will finally have nearly universal coverage of contraception.

On January 20, 2012, Health and Human Services Secretary Kathleen Sebelius announced that most employers will be required to cover contraception in their health plans, along with other preventive services, with no cost-sharing such as co-pays or deductibles.

Being able to prevent unwanted pregnancies (and abortions, by the way) is now going to be an achievable goal for all women who have health insurance. That is, unless your health insurance provider is one that has been excepted because of religious objections to birth control.

What I can’t figure out is why any health insurance provider would allow its policies to be dictated by religion, especially when not providing full coverage for birth control will elevate its costs and eat into its profits. Women who can’t get or afford birth control tend to have more babies, which costs insurance providers much more money than providing birth control would have in the first place.

Apparently, some providers are willing to shoot themselves in the financial foot in order to attract clients who believe that life begins at fertilization. They must believe that the number of clients they can attract outweighs the costs associated with having children. However, the odds are that those clients are going to have more children because of their stance against birth control and abortion. If that just meant the cost of prenatal care and routine labors and deliveries that would be one thing. But what about high-risk pregnancies, premature babies, birth defects and complications that require expensive measures like C-sections and neonatal care?

Naturally there are those who aren’t happy with this decision, most notably the Catholic Church. What they fail to see is that it is the woman’s individual choice to use birth control. No insurance company is going to force a woman to use it. It’s just going to be covered in case she wants to.

The Catholic Church wants to change society to fit its standards, as if all people in our society agree with its stance on birth control. It really has no business telling non-Catholics what they can and cannot do. And that goes for anyone who is anti-birth control. If they have a problem with the use of contraception, I have a simple solution for them: Don’t use it. But don’t try to tell me that I can’t use it.

Organizations that will be able to opt out of providing full coverage for contraception are those whose employees all have the same anti-birth control views as the employers. This means that the Catholic Church can’t claim the exemption, because many of its employees aren’t even Catholics. So either they stop hiring non-Catholics, or they resign themselves to abiding by the HHS ruling.

Of course the decision has set off a firestorm of political posturing. Sen. Marco Rubio of Florida introduced a bill, named the “Religious Freedom Restoration Act of 2012,” to repeal the policy.

“The Obama Administration’s obsession with forcing mandates on the American people has now reached a new low by violating the conscience rights and religious liberties of our people,” Rubio said in a statement.

In an appearance on “CBS This Morning,” Newt Gingrich called it “an attack on Christianity.”

I’m sorry, but where is it written that Christians don’t use birth control? And how is it an attack on religious liberties if no one is being forced to use contraception?

What amazes me is that the movement against abortion has now escalated into a movement against contraception. Doesn’t contraception lessen the number of unwanted pregnancies, and therefore the number of abortions?

Instead of criticizing the decision, the Catholic Church and others should be applauding the fact that low-income and under-insured women will have better and more affordable health care. But of course they’re not going to do that, because everyone knows that pro-lifers want to force their views on others, no matter what the consciences or religious beliefs of others tell them about contraception.

My conscience and religious beliefs tell me that I am to be responsible about family planning and the use of the earth’s resources. An unstemmed tide of unwanted pregnancies is a recipe for disaster for individual women, their families and their societies. The impact would be global (and already is, in areas where birth control is not available or utilized). If the pro-life constituent had its way, people with beliefs similar to mine would be prevented from acting on them.

Isn’t that a violation of our  conscience rights and religious liberty?

Rethinking Abortion

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A friend of mine recently told me that she used to be strongly pro-choice but now, because of experiences she’s had in her own life and seeing what other women have gone through, she’s decided that she’s pro-life. She said she’s concerned about the psychological damage to women who have abortions. She also feels many women have abortions for selfish reasons and there are very few good reasons for having one.

To tell the truth, I was surprised at how much I agreed with her. I’ve never felt comfortable about women having abortions just because they don’t want to be inconvenienced or stressed out. I’ve even wondered if there’s ever a good reason to abort a baby other than rape, incest, severe birth defects or the health of the mother. I have four children myself and two grandchildren (with one more on the way) and I know how precious a new life is.

The problem is, the abortion debate forces you to pick sides. You’re made to feel that you have to be pro-life OR pro-choice. You can’t be both. But as I listened to my friend, I realized that I am both.

I believe that abortion should be a last resort. No woman should use abortion just because she was too lazy or irresponsible to use birth control. (However, this belief doesn’t address the issue of what to do when a mistake has been made.)

I also believe that once a fetus is viable (i.e., it can live outside the womb without heroic efforts to keep it alive), it should not be aborted. If you’ve gone eight months with a baby inside you, what’s another month? That child has a right to live; even if you don’t want to be its mother, there is almost always someone who does. Let’s face it: newborn babies are in demand. It’s the older child who is harder to place. So if you don’t think you want to be a mother, don’t “give it a try” for a few years. Make the responsible choice while the baby still has a chance to grow up from birth in a loving home.

When I had my abortion at the age of 19, I was a freshman in college, I didn’t want to marry the father and I was afraid to tell my parents. I was also pretty sure that I couldn’t give the baby up for adoption and I knew my life would be changed irrevocably if I kept him or her. I thought I’d have to drop out of college and depend on my parents even more than I already did (and which I hated). And I didn’t want to have to deal with custody and visitation issues with a man I didn’t want to be with.

Also, this was 1971 and unmarried mothers were not as accepted as they are now.

None of these reasons justified my “killing” my baby, but they added up to a compelling argument at the time. And since the man who’d gotten me pregnant was completely supportive of my getting an abortion, I have to believe that he had similar reasons.

So how did I feel after having the abortion? Was I overwhelmed with guilt and grief? No. I can honestly say that all I felt was relief, especially since I pulled it off without having to tell my parents.

But now that I’m almost 60 and can look back on a long life of mistakes and regrets, I realize that just because something feels right doesn’t mean that it is right. I was a moderately religious person, but I didn’t have a well-developed sense of morals or ethics. I didn’t approach the problem from that perspective at all. I didn’t go to a counselor or a trusted adult. I felt like I got myself into this mess, it was up to me to get myself out.

I have had feelings of guilt and grief over the years, but they’ve never been overwhelming. My main feeling was that the abortion was regrettable, but the right thing for me at the time. But I had some bad moments during each of my subsequent pregnancies, especially once the babies were born. I couldn’t help but think that I would have had another child three years older than my oldest daughter if I hadn’t been so selfish. Who knows what that baby might have been like? Was it the boy I never managed to have later on? He or she would have been forty years old this year. Would I have had other grandchildren? How would he or she have turned out?

Having an abortion puts you in a tricky situation. You can ask God for forgiveness, but you can’t ask your aborted baby to forgive you. Some people get around this by not believing that the fetus was a baby. Technically and medically, the fetus isn’t a baby (that is, it can’t live outside the womb). But is it a life?

One debate surrounding abortion is over whether life begins at fertilization or implantation. Medical science has always favored the latter. You’re not pregnant until implantation occurs and you can’t be carrying a new life until you’re actually pregnant.

People who hold the former view have arbitrarily decided that life begins at fertilization.  Some pro-life advocates are against birth control because they think that the contraception itself causes abortions. But what happens when a fertilized egg passes out of the uterus naturally? Is that an abortion? Carry that a step further: does that mean that even God “murders” babies?

Strong words, I know. But the point I’m trying to make is: Is it ever right to make decisions that only God used to make? If the answer is no, you might as well do away with medical science and research. No more transplants, no more medicines, no more fertility treatments, no more heroic measures. Who are we to decide whether someone should live or die?

The Bible says that God gave man dominion over the earth. You could argue that this doesn’t just mean that he is supposed to tend plants and animals. It could also mean that God gave us jurisdiction over questions of life and death. He gave us the intellect to develop those things that help to extend life. But the flip side is that we’re also allowed to decide when things can or should be prevented from achieving viability, or life.

There are many good reasons for not allowing an embryo to develop into a fetus, or a fetus into a baby. What about when the number of children a family has prevents those children from having a good quality of life? What if the resources and support systems don’t exist to ensure that a child will be raised in a loving environment?

And that’s not even taking into account the health of the pregnant woman. What if she has other children she needs to be there for? Is it right to allow a woman to die just to allow the birth of another motherless child?

There is no consensus about these issues. That means is there is no one position that is more popular than the others. And for that reason, I believe it is against everything this country stands for to allow one group’s opinion to prevail.

Being pro-choice doesn’t mean that women will be forced to have unwanted abortions. But being anti-choice does mean that some women will be forced to have unwanted babies.

Which is right: force or freedom?

For a doctor’s views of when life begins and the abortion debate, go here at “The Moderate Voice.”