Separating Fat from Fiction: The Truth about Obesity, Exercise, and

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Separating Fat from Fiction: Exploring Myths, Realities, and Assumptions Ellen PerrellaMS, LAT, ATC, CSCS Head Athletic Trainer Mount Holyoke College Mount Holyoke College South Hadley, MA The Situation Food environment Decreased food prices Increased portion size Increased eating out Snacking Physical environment Remote controls, cell phones, garage door openers, leaf blowers, lawn mowers Screen time=video games, computers, TV Urban sprawl; need for car to get anywhere Society that worships thinness and abhors fat Is Obesity a disease? Is body fat pathological? Who benefits from the concept of obesity being considered a disease?

Scientists researching obesity Pharmaceutical companies Bariatricsurgeons Public health establishment 50 Billion Dollar Diet Industry New Year 9s Resolutions #1 wish every year-to lose weight Sobering Statistics 116 million adults dieting at any given time 80% of teenage girls in the US have been on a diet by age 13, approx. 1/2 of girls said they were unhappy with their bodies Sobering Statistics Continued The average model, dancer, or actress is thinner than 95% of the population A generation ago fashion models weighed 8% less than the average woman; today,23% less http://demo.fb.se/e/girlpow er/retouch/ Women, weight, and feminism Fat Phobic Society Diet Drugs usage among female adolescents Fen-PhenFiasco BariatricSurgery (liposuction ... more. less.

and gastric bypass) Liposuction. JAMA (Oct. 2005). Mortality rates: 30 day follow-up (2%), 90 day (2.8%), and 1 year (4.6%). As elective surgery, high mortality rate. Complications 1 in 347. Hospitalization rate doubled in the year post-surgery compared to year prior to surgery. At least 20% will need further surgery. Health benefits? I will exercise everyda y Can 9 t e a t that, haven 9t exercise d t od ay If I could lose 5lb I would b e be a u t i f ul Myths and Misconceptions People can control their body size You will lose weight when you exercise People are thin or fat based on a simple relationship between calories in and calories out (expended calories) Obesity causes poor health and increased mortality Obesity is a poor predictor of: Hypertension. 96 obese women per group: no history of dieting; 125/79 history of yo-yo dieting (5 or more weight losses of at least 10 pounds in the last 5 years);147/90 High cholesterol Low fat diet (6 weeks) and weight loss resulted in improved cholesterol levels. (National Public Health Institute) Exercise or weight loss? 31 obese women were put on a 6 month aerobic program. (Laval University, Canada) most lost weight; average of 6 pounds 11 gained 6 pounds during the program Obesity is a poor predictor of: (continued) Atherosclerosis ( cclogged arteries d) 1960 (Int 9l Atherosclerosis Project). 23,000 autopsies; concluded cno association d. 1984 (NIH). Autopsies of morbidly obese (300-500 lbs.). Found they had the same coronary vessels of non-obese, same age. 1991. 4,500 angiograms of middle aged and elderly&. Type II diabetes: condition markedly improves with changes in diet and exercise, independent of weight changes Dr. Glenn Gaesser c& it is absolutely unjustifiable to equate behavioral patterns (poor diet and physical inactivity) with a physical characteristic (obesity). d Fat and Fit Cooper Institute for Aerobics Research 1970. 26,000 men; 8,000 women (ages 20-90) being heavy did not increase the risk of premature death when you consider fitness levels, being overweight seemed to be better than being underweight obese fit men and lean-fit men had similar low death rates and death rates 1/2 that of lean-unfit men Harvard Alumni Study 17,000 men who attended Harvard between (1916- 1950) Who has the best chance of living a long life? BMI vs. Relative Risk of Death Lose weight but s t il l eat w h a t y ou w a n t No carbs 20 d a y t rial, mon e y b ack, gu a ran t e e Lose 20lbs in 3 weeks DIETS: A tkins to Z one Dieters are 18x more likely to develop an eating disorder than non-dieters. Recidivism rate ranges from 90-98% Needs deprivation leads to overcompensation Dieting begets bingeing. Dieting intensifies preferences for high-fat and sugar-loaded foods. Starving&&&Stuffed . Keys Study (1944) 32 conscientious objectors 24 weeks of caloric restriction/one-half of what they were used to eating All lost weight, all gained it back plus some, and all in the form of fat. Men were irritable, depressed, apathetic, and preoccupied with food. What to Treblinka and Jenny Craig have in common? Diet is a four letter word Emotional toll. Leaves one disheartened, disillusioned, and depressed. Body conserves energy/survival mechanism BMR (basal metabolic rate) accounts for 60- 70% of total energy used by body BMR drops within 24 hrs. of food deprivation, may reduce a full 20% in 2 weeks Burner analogy DIETS Dieting improves your body 9s ability to store fat and limits your ability to burn it Increases lipogenic(fat- storage) enzymes Decreases lipolytic(fat- releasing) enzymes decreased muscle-used for energy and reduced to lower metabolism Ideology of a diet reinforces the split between the dieter 9s mind and her body. Yo-Yo, Uh Oh Weight loss begets weight gain -with serious health consequences Framingham Heart Study. Harvard Alumni Study (follow-up 1998) compared with men who maintained fairly stable weights, those who had lost and gained the most total pounds: 80% higher risk of heart disease 123% higher rate of type II diabetes alumni who dieted frequently (compared to non- dieters): 2x risk of diabetes, hypertension, and coronary heart disease Consequences of weight loss/gain cycling Just one weight-loss/gain cycle can impair glucose metabolism and elevate cholesterol, triglycerides, and blood pressure, even if the weight regain takes up to 4 years. (Big Fat Lies) Leningrad, before and after the siege of 1941 cWeight cycling is associated with lower HDL cholesterol in women of a magnitude & associated with an increased risk of cardiac event d. (Journal of the American College of Cardiology, November 2000) Athletics Scales are scarce Educate the coaches/staff Programming for athletes No weigh-ins or % body fats Ready, Set Point, Go chome dweight; where your body feels at home natural weight cwhen you are not doing anything to control your weight, but are eating a relatively low-fat, fiber-rich diet abundant in fruits, veges, and whole grains, and being physically active d(Big Fat Lies) 70% of our weight is genetically determined Location, location, location more upper-body accumulation of fat (abdominal area) more prevalent in males visceral (or deep) body fat-metabolically hyperactive, results in high levels of FFA (free fatty acids) released in the bloodstream, etc. associated with increased risk for atherosclerosis and diabetes. Location, location, location lower body accumulation of fat (hips and thighs) more prevalent in females subcutaneous fat associated with a lower risk of heart disease and diabetes Stanford University, 1991. 133 men and 130 women, ages 25-49. The fatter the thighs, the lower their heart disease risks (low LDL, high levels HDL, i.e. blood fat profiles). 20/20 (Dr. Glen Gaesser, PH.D. Big Fat Lies ) Fat intake: 20% of diet (% of daily caloric consumption) 2, 500 calorie-per-day diet=56 grams of fat 2,000 calories=44 grams of fat Mediterranean Diet: fruit and vegetables, whole grains, olive oil, seafood, nuts, lean meats (small portions), red wine. Eat slowly and pleasurably. Compared to typical American Diet: 2x the fruit and seafood, 2/3 more veges, 1/5 more grains and beans, and only ½as much meat High fiber 20/20 Fitness CARDIOVASCULAR 60 minutes cno pain, no gain d cworking out d/exercise how well your body can deliver O2 to the muscles structured activities, often at a gym (aerobic classes, stairmaster,&) METABOLIC 20 min./day average (140 min./week) physical activity spontaneous, unstructured (natural part of daily life) increases insulin sensitivity, thereby reducing blood insulin levels One Voice cThat weight figure is a guess, because I haven 9t actually been on a scale in 10 years or so. I was a fat baby, a fat kid, a fat teen, a fat adult, and now I 9m nearing my dotage as a fat old bat. I no longer attempt to lose weight. At this point in my life I am unapologetically and unrepentantly fat&.It 9s what I am 3but not who I am. d Cynthia, 52 yrs. old, weight 375. (The Obesity Myth) HAES (Health At Every Size) People who engage in normal healthy eating (balanced diet; eat in response to hunger; stop eating when satiated) and who are physically active-vary enormously in weight 1990. Journal of NE Medicine. overfed 12 sets of identical twins 1,000 cal./day, 6 days/week identical levels of physical activity 7 weeks later; weight gain among 24 men varied 300%, from 9-30 lbs. Suggestions, Solutions, Solace Marcia Germaine Hutchinson, cFeminist Perspectives on Eating Disorders d, cSo what does it mean to have a healthy body image?.... d What if? What if women collectively woke up one morning and felt good about themselves, and were happy and content with their bodies? More Suggestions, Solutions, Solace Substance over image. Redefine beauty. Challenge the images/media. Be critical consumers of information. Avoid mentioning weight. Peace with food Shift focus from weight and dieting to enhancement of quality of life and health. Healthy foods. Listen to your body. Honor your hunger. Recognize satiety. (www.intuitiveeating.org) Set point theory (role of genetics) Resources Campos, Paul. The Obesity Myth: Why America 9s Obsession with Weight is Hazardous to Your Health. New York, New York: Gotham Books, 2004. Flum, DR, Salem L., BroeckelElrod, JA, Dellinger P., CheadleA., Chan, L. : Early Mortality Among Medicare Beneficiaries Undergoing BariatricSurgical Procedures. Journal of American Medical Association . 2005; 294:1903-1908. Gard, Michael and Jan Wright. The Obesity Epidemic: Science, morality, and ideology . New York, New York: Routledge, 2005. Gaesser, Glenn A. Big Fat Lies: The Truth about Your Weight and Your Health. Carlsbad, CA: GurzeBooks, 2002. Resources (Continued..) Kater, Kathy. An Effective Model for Preventing the Full Spectrum of Body Image, Eating, Fitness and Weight Problems. The Renfrew Center Foundation Perspective. Winter 2006: pgs. 15-18. Klein, Samuel, M.D., Luigi Fontana, M.D., Ph.D., V. Leroy Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W. Patterson, Ph.D., and B. Selma Mohammed, M.D., Ph.D . Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 17, 2004.Vol. 350: 2549-2557. Kratina, K. A Compassionate Alternative to the 8War on Obesity: Clinical Applications of Health At Every Size (HAES). Lecture: Feminist Perspectives and Beyond: Hungers, Health, and Healing . Renfrew Center Foundation Conference for Professionals. Philadelphia, PA. November 4-7, 2004. Resources (Continued..) Lewis, Katharine, Man, Lynne. Overweight and Obesity in Massachusetts: Epidemic, Hype or Policy Opportunity? The Massachusetts Health Policy Forum. 2007. Oliver, Eric. Fat Politics: The Real Story Behind America 9s Obesity Epidemic. New York, New York. Oxford University Press, Inc. 2006. Seid, Roberta Pollack. Never Too Thin: Why Women Are at War with Their Bodies. New York, New York. Prentice Hall, 1989. Spake, Amanda. Stop Dieting. US News and World Report. January 16, 2006: 61-66. Waterhouse, Debra. Outsmarting the Female Fat Cell. New York. Hyperion, 1993. YohoRA, Romaine JJ, O'Neil D. Review of the liposuction, abdominoplasty, and face-lift mortality and morbidity risk literature. DermatolSurgical . 2005 Jul;31(7 Pt 1):733-43; discussion 743.

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