Separating Fat from Fiction: Exploring Myths, Realities, and - PowerPoint PPT Presentation

Separating Fat from Fiction: Exploring Myths, Realities, and Assumptions Ellen Perrella MS, ATC, CSCS Head Athletic Trainer Mount Holyoke College

Sobering Statistics  1 1 6 m illion adults dieting  8 0 % US teenage girls have dieted  Age 1 3 , 1 / 2 girls unhappy w ith bodies

‘Unreal’istic Images  Average m odel, dancer, or actress is thinner than 9 5 % of population  A generation ago m odels w eighed 8 % less than avg. w om an; today,2 3 % less http:/ / w w w .dove.us/ # / feature s/ videos/ default.aspx[ cp- docum entid= 7 0 4 9 5 7 9 ] /  W om en, w eight, and fem inism

Is Obesity a disease? Is body fat pathological?  W ho benefits from obesity being considered a disease?  Scientists and academ ics researching obesity  Pharm aceutical com panies  Bariatric surgeons  Public health establishm ent

Is Obesity a disease? Is body fat pathological?  W ho benefits from obesity being considered a disease?  Scientists and academ ics researching obesity  Pharm aceutical com panies  Bariatric surgeons  Public health establishm ent  $ 5 0 Billion Diet I ndustry

Fat Phobic Society Diet Drugs   Usage am ong fem ale adolescents (Journal of Preventive Medicine Feb. 2007)  Fen-Phen Fiasco

Fat Phobic Society Diet Drugs   Usage am ong fem ale adolescents  Fen-Phen Fiasco Bariatric Surgery: Liposuction   Elective surgery, high m ortality rate.  Hospitalization rate doubled in the year post- surgery com pared to year prior to surgery. At Least 2 0 % w ill need m ore surgery.  Health benefits? ( Klein, Sam uel, M.D., 2 0 0 4 )

Fat Phobic Society Diet Drugs   Usage am ong fem ale adolescents  Fen-Phen Fiasco Bariatric Surgery: Liposuction   Elective surgery, high m ortality rate.  Hospitalization rate doubled in the year post- surgery com pared to year prior to surgery. At Least 2 0 % w ill need m ore surgery.  Health benefits? ( Klein, Sam uel, M.D., 2 0 0 4 ) Bariatric Surgery: Gastric Bypass   AHRQ ( w / in 6 m onths) ; 4 in 1 0  1 3 -1 5 years out  Post surgery-3 ounces fills stom ach  8 0 0 -1 2 0 0 cal/ day.

MYTH #1: Eat Too Much; Exercise Too little?  Food environm ent  Increased portion size, Snack-foods heavy on refined sugars and saturated fats.  Most studies: overw eight people eat few er calories than those of norm al w eight. ( Nat’l Academ y of Sciences, Diet and Health, 1 9 8 9 )

MYTH #1: Eat Too Much; Exercise Too little?  Food environm ent  Increased portion size, Snack-foods heavy on refined sugars and saturated fats.  Most studies: overw eight people eat few er calories than those of norm al w eight. ( Nat’l Academ y of Sciences, Diet and Health, 1 9 8 9 )  Physical environm ent  Technology has stripped our lives of natural exercise.  Screen time= video games, computers, TV  1 9 7 0 ’s Fitness Revolution  SES, incom e, and education are inversely related to obesity.  Poor people m ore likely to w ork in physically dem anding jobs, yet have m uch higher obesity rates.

MYTH #1: Eat Too Much; Exercise Too little?  Food environm ent  Increased portion size, Snack-foods heavy on refined sugars and saturated fats.  Most studies: overw eight people eat few er calories than those of norm al w eight. ( Nat’l Academ y of Sciences, Diet and Health, 1 9 8 9 )  Physical environm ent  Technology has stripped our lives of natural exercise.  Screen time= video games, computers, TV  1 9 7 0 ’s Fitness Revolution  SES, incom e, and education are inversely related to obesity.  Poor people m ore likely to w ork in physically dem anding jobs, yet have m uch higher obesity rates.  The relationship betw een exercise and food and obesity is not clear.

Intervention school studies  5 ,1 0 6 3 rd graders from 9 6 schools  5 6 schools-2 year I ntervention: healthy foods, nutrition instruction, extra physical activity.  Students decreased fat in diet, exercised m ore, …  No difference in w eights from 4 0 control schools Nader, PR., Stone, EJ, Lytle, LA et al. 

What is the cause of obesity?  I ntrinsic m etabolic, enzym atic, or horm onal abnorm ality induces + caloric balance…..fat accum ulation.  Defect of fat m etabolism ; horm onal and m etabolic, release of fat is im peded, or the deposition/ synthesis of fat is prom oted.  Appetite and w eight regulation have strong biological underpinnings.

Myths and Misconceptions  People can control their body size; they can lose w eight if they really w ant to.

Myths and Misconceptions  People can control their body size; they can lose w eight if they really w ant to.  You w ill lose w eight w hen 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 sim ple relationship betw een ‘calories in and calories out’  “no basis in m edical science”  Overfed 12 sets of identical twins 1,000 cal./ day, 6 days/ week, 12 weeks  identical levels of physical activity  7 w eeks later; w eight gain am ong 2 4 m en varied 3 0 0 % , from 9 -3 0 lbs. ( Bouchard, C., Despres, J.P., Nadeau, A., et al. )

More Myths  People are thin or fat based on a sim ple relationship betw een ‘calories in and calories out’  “no basis in m edical science”  Overfed 12 sets of identical twins 1,000 cal./ day, 6 days/ week, 12 weeks  identical levels of physical activity  7 w eeks later; w eight gain am ong 2 4 m en varied 3 0 0 % , from 9 -3 0 lbs. (Bouchard, C., Despres, J.P., Nadeau, A., et al. )  Obesity causes poor health and increased m ortality

Obesity is a poor predictor of:  Hypertension.  No history of dieting; 1 2 5 / 7 9  History of yo-yo dieting (5 + weight losses of 10 + pounds last 5 years); 1 4 7 / 9 0  BP positively correlated w ith total lbs. yo-yo-ers had regained. ( Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. 2 0 0 0 )

Obesity is a poor predictor of:  Hypertension.  No history of dieting; 1 2 5 / 7 9  History of yo-yo dieting (5 + weight losses of 10 + pounds last 5 years); 1 4 7 / 9 0  BP positively correlated w ith total lbs. yo-yo-ers had regained. ( Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al 2 0 0 0 )  High Cholesterol  31 obese women put on 6 month aerobic program. most lost avg. 6 lbs.; 11 gained 6 lbs  Both gainers and losers im proved cv fitness the sam e am ount  Also im proved cholesterol levels and insulin sensitivity ( Lam arche, B, J-P Despres, M-C Pouliot, et al. 1 9 9 2 )

Obesity is a poor predictor of: (continued)  Atherosclerosis ( “clogged arteries”)  1 9 6 0 ( I nt’l Atherosclerosis Project) . 2 3 ,0 0 0 autopsies; concluded “no association”.  1 9 9 1 . Dr. Applegate ( U. of Tenn.) 4 ,5 0 0 angiogram s of m iddle aged and elderly. Fattest people had cleanest arteries.  NOTE: individuals that are overw eight/ obese and have atherosclerosis have low er risk of heart attack, stroke or early death.

Obesity is a poor predictor of: (continued)  Type I I diabetes: condition im proves w ith changes in diet and exercise, independent of w eight changes  I nsulin resistance ( I R) is the m ost im portant m etabolic factor relating to w eight, diet, and health.  Obesity and diabetes: consequences of the sam e underlying defects; hyperinsulinem ia and I R

Weight and Cardiometabolic Abnormalities  5 4 4 0 subjects; 1 9 9 9 -2 0 0 4 W ildm an, R.P. et. al. 2 0 0 8   “A considerable proportion of overw eight and obese US adults are m etabolically healthy, w hereas a considerable proportion of norm al w eight adults express a clustering of cardiom etabolic abnorm alities.”

Correlation is not Causality  “The m ere presence of 2 or m ore variables in the sam e individual does not infer an inherent causal relationship.”  Dr. Glenn Gaesser “…it is absolutely unjustifiable to equate behavioral patterns ( poor diet and physical inactivity) w ith a physical characteristic ( obesity) .”

Myth: Obesity Kills  Cooper I nstitute for Aerobics Research  1 9 7 0 . 2 6 ,0 0 0 m en; 8 ,0 0 0 w om en ( ages 2 0 -9 0 )  Being heavy did not increase the risk of prem ature death  = fitness levels  being overw eight better than being underw eight  Obese fit m en and lean-fit m en: sim ilar low death rates -1 / 2 that of lean-unfit m en-

Myth: Obesity Kills  Cooper I nstitute for Aerobics Research  1 9 7 0 . 2 6 ,0 0 0 m en; 8 ,0 0 0 w om en ( ages 2 0 -9 0 )  Being heavy did not increase the risk of prem ature death  Fitness levels  being overw eight better than being underw eight  Obese fit m en and lean-fit m en: sim ilar low death rates -1 / 2 that of lean-unfit m en-  Harvard Alum ni Study  1 7 ,0 0 0 m en w ho attended Harvard betw een 1 9 1 6 -1 9 5 0  W ho has the best chance of living a long life?

BMI vs. Relative Risk of Death Fle legal, Kath therine, G , Graubard, Barry, Willa illamson, D , David id, e , et t al. l. 2005

Diets: A tkins to Z one  Dieters: 1 8 x m ore likely to develop an eating disorder