First CDC Obesity Prevention Conference
Here it comes: The Centers for Disease Control and Prevention have turned their focus on obesity, apparently hoping that their first conference on the topic will ratchet up efforts to prevent it.
I'm just wondering if they'll have any voices from the eating disorder research and treatment community there. Hope so. It's those voices who can chime in saying that some efforts to prevent obesity can actually make it worse.
For example, researcher Walter Kaye, M.D., notes in a 2008 paper in the journal Physiology and Behavior that "loss of control with overeating in individuals with [bulimia nervosa] usually occurs intermittently and typically only some time after the onset of dieting behavior." Dietitians say that binge eating in those with bulimia is less prominent when they feed themselves more fully.
"Ah, but that's bulimia," you say. You're right, but research demonstrates that in general, dieting often leads to binge eating and weight gain rather than weight loss.
So here's the rub: If obesity prevention is all about telling people to eat less and "get healthy" by restricting their food intake, the efforts may create more obesity than they prevent.
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Comments
Well in the health community, obesity strategy isn’t just about telling people to eat less. And with 700 people from all sectors of research, academia, and health care expected to attend the conference, I’m sure that the issue of binge eating disorder and other disordered behavioral issues relevant to obesity are on the table, and very familiar concepts. The clinical guidelines for childhood obesity endored by the CDC are focused on weight maintenance rather than loss, with the goal of BMI gradually approaching the normal range, and focused on healthier food choices, increased physical activity, and decreased screen time rather than diet. The research and literature reinforces the idea that in the critical period when people are most prone to developing eating disorders, it is important to emphasize that food is not the enemy, and to use pro-health terminology as opposed to anti-obesity verbiage.
There will be a web cast of the conference if you want to see what issues will be specifically addressed. The inability to have a functional relationship with food and a corresponding healthy lifestyle is obviously an issue that involves many of the same components and considerations whether it results in obesity, anorexia, bulimia, or orthorexia.
ED’s are as serious as obesity. New evidence based treatments work, and are not being supported.
I attended this conference. The focus of the conference is environmental and policy changes to prevent and control obesity. These strategies include, 1) increasing consumption and access to fruits and vegetables in various venues (corner stores, worksite cafeterias, school lunch, etc.), 2) increasing daily physical activity by increasing access for safe places for people to be physically active, sidewalks, transportation planning that includes bike and pedestrian needs, 3) reducing intake of sugar sweetened beverages, 4) increasing initiation, duration, and exclusivity of breastfeeding, and 5) reducing consumption of energy dense foods, 6) limiting TV time to no more than 2 hours per day for children (good idea for adults too!). These are based on literature reviews of prevention studies.
Keep in mind that prevention is not treatment and although overeating (which can lead to overweight and obesity) may be considered disordered eating, we did not reach this epidemic of more than 65% of adults above a healthy weight (the average person is 23 lbs overweight) just by people overeating. Our environment has changed, portion sizes are bigger, we sit most of the day at computers, drive long commutes, drink more soft drinks (biggest reason for increased calorie intakes according to NHANES data), eat more meals away from home (which are higher calorie than home made meals) and go home to neighborhoods that are not designed for walking or biking, and we watch too much TV (28 hours per week for the average adult in the US – kids average nearly 5 hours per day). There are racial and geographic disparities, which also need to be addressed. For more information on the science behind obesity prevention go to:
http://www.cdc.gov/obesity/index.html
My concern lies with the implementation of policies. Tackling obesity itself is not the same as fostering health. It assumes that obesity is causal. It’s true that many who are “overweight” engage in unhealthy lifestyles that can lead to health problems. But it’s not a one-to-one correlation between obesity and poor health.
For those who are considered overweight and yet are in good health, what does it mean to them when they are told that their obesity should have been prevented?
Worse, what does it mean to a child who absorbs the ridicule of his peers which are then backed up by school policy?
These aren’t questions with easy answers, and health is a complex issue. I think it will be extremely challenging in practice to try to implement obesity prevention policies that don’t ultimately deepen shame and guilt (causing other problems), or, ironically, create more obesity.