More Evidence Ties Obesity to Disability in Older Women – WebMD

Evidence Ties Obesity to Disability in Older Women

By Dennis Thompson

HealthDay Reporter

MONDAY, Nov. 11 (HealthDay News) — Women who are obese as they near retirement age have a higher risk of early death and may find their remaining years blighted by disability, researchers say.

Obese women are three to six times more likely to suffer a disability late in life that will make it difficult for them to get around, with the risk rising with their level of obesity, according to a new study published online Nov. 11 in JAMA Internal Medicine.

A second study in the same journal issue found that being overweight or obese raises your risk of heart attack and heart disease even if you are otherwise healthy.

The number of women aged 85 years and older in the United States is increasing, according to study background information, with 11.6 million women expected to reach 85 by 2050.

Obesity rates also continue to increase, and nearly one-third of U.S. women 75 years and older are obese. This extra weight not only reduces life span, but also can severely harm an older woman’s quality of life.

“For dying and losing the ability to walk, the risks were alarmingly high — over threefold to upwards of over sixfold,” said study co-author Eileen Rillamas-Sun, a staff scientist at the Fred Hutchinson Cancer Research Center, in Seattle. “I believe that remaining mobile is very important to most older people, especially since it is useful for retaining one’s independence.”

The new findings aren’t that surprising, but they’re important, one expert noted.

Together, the two studies “verify something that we knew, but give us some more ammunition to craft more programs and pay more attention to women’s body weight and obesity overall,” said Dr. Georges Benjamin, executive director of the American Public Health Association (APHA).

“The obesity epidemic isn’t just our kids, and if you are thinking forward we are having this enormous growth as the baby boomers age through society,” he said. “We’re going to have to spend a lot of time encouraging women to achieve a sensible body weight.”

Rillamas-Sun’s study examined the health records of nearly 37,000 older women participating in the Women’s Health Initiative, a long-term study sponsored by the U.S. National Institutes of Health.

The researchers found that about 12 percent of healthy-weight women had become disabled by age 85, requiring a walker or some other assistance for getting around.

By comparison, between 25 percent and 34 percent of obese women were disabled, with incidence rising with the patient’s body mass index (BMI), a measurement of body fat that takes height and weight into account.

Overall, a waist circumference greater than 35 inches was associated with a higher risk of early death, along with new diseases developing during the study period and mobility disability, the researchers said.

One-day diabetes awareness festival attracts hundreds

AURANGABAD: Hundreds of people visited the ‘Madhumeha Anandnagari’ at the St Francis School ground here on Sunday. The event was aimed at creating awareness about diabetes and its complications and also to commemorate the World Diabetes Day on November 14.

Customized diet plans, diabetes management, sugar-free and oil-free cooking and a focus on effective detection of the disease in the early stages remained the crowd pullers at the fair, hosted by Udaan, a voluntary organisation working for the well-being of diabetic children.

The Anandnagari was inaugurated by television actor Anup Soni, along with deputy commissioner of police (zone-II) Arvind Chawria. The duo appealed to the people to take preventive measures before the lifestyle disease starts taking a toll on the health.

Noted chef Archana Atre from Mumbai gave a demo of over 10 oil-free and sugar-free nutritional dishes that could be easily cooked. The recipe books of the same were distributed by Udaan.

Chawria said, “I am a diabetic for about eight years. Initially I was reluctant in accepting it but gradually I brought the required discipline in my lifestyle and diet. Now, having a disciplined schedule makes me feel fitter than any of my non-diabetic colleagues.”

“The aim of the festival is to erase the fear of diabetes from the minds of people and create awareness in a joyful way to lead a healthy life. The focus of the fair is on detection of diabetes as early as possible and proper management for patients. There are stalls providing guidance on every aspect associated with it like a heart kiosk, exercise kiosk, etc,” said diabetologist Archana Sarda.

Sarda added that it was an attempt to spread awareness about the disease, which is fast spreading among the younger population and appealed to both the diabetics as well as non-diabetics to maintain a healthy lifestyle as cases of diabetes has been reported even in six-month-old babies.

Services such as measurement of blood glucose, blood pressure and body fat percentage, estimation of heart attack and stroke risk for diabetics, ECG, eye examination to detect diabetic retinopathy, were kept open at the fair. Street plays, games, tattoo making, bioscope watching, etc, were also arranged for visitors.

To bring awareness about the lifestyle disease, Udaan has conducted essay writing competitions on ‘Role of children and youth to control diabetes’ and ‘My dream – Diabetes-free India’ in about 140 schools, and around 300 students participated in the contest. Actor Soni judged the street plays for college students and awarded the best five winners.

“Often, people don’t realise the severity of diabetes and leave treatment after two or three months of the diagnosis, exposing themselves to various life threatening diseases. Diabetes is a lifestyle disorder, and stressful life together with unhealthy living is a major factor behind the huge diabetic population we have in our country,” Sarda said.

Let's link hands against diabetes

A 68-year old Mrs. S. developed high fever and had to be hospitalised since her blood sugars were very high. With no personal income or medical insurance, she had to depend on her son for paying hospital expenses for which he was not too willing.

Mr. S, 58, a watchman in a company, developed fever and infection in the foot. He had very high blood sugars and was hospitalised. Despite all efforts, his left leg had to be amputated and he had to use his entire savings which he had kept aside for his daughter’s wedding. This was a sad story of a man who lost his leg and his personal savings because he had diabetes, of which he was unaware. Innumerable are such pathetic cases.

Diabetes is one of the major health and development challenges of the 21st century. In India, it is estimated that around 62 million people have diabetes. One in two people with diabetes doesn’t know he/she has it. But diabetes and its complications are largely preventable, and proven, affordable interventions available. Everyone is concerned and everyone has a role to play in helping to turn the tide of diabetes to protect our future.

What can be done?

There are two major components of the burden of diabetes in India — genetic and environmental factors. Environmental factors such as physical inactivity and unhealthy diet pattern play an important role. There is an immediate need to seek the involvement of several stakeholders in prevention and control of diabetes.

To start with, the media plays a major role in not only creating awareness of the risk factors but also making policymakers and others focus on various avenues leading to a better living environment. The existing knowledge of prevention of diabetes can be disseminated to all with the help of the Ministry of Information and Broadcasting, NGOs and healthcare centres in both the private and public sectors.

Next, to put the knowledge into practice, it is necessary to create a conducive environment for the public to increase their physical activity. This needs earmarked funding for construction of parks, safe footpaths and cycle pathways.

In order to ensure healthy eating habits, retail shops, fast food outlets and chain restaurants should be encouraged to provide alternative healthy food choices. An additional tax could be levied on junk food. Regulation of pricing policy for fruits and vegetables is necessary.

The government should encourage small entrepreneurs to manufacture nutritious and palatable snacks for people belonging to different economic strata at an affordable cost. Agricultural research is also required for producing low glycemic cereals and grain. More operational research is necessary to develop strategies to reduce the burden of diabetes and its risk factors. Allocation of funds for such projects has to be given high priority by the funding agencies.

In order to help people with pre-existing diabetes, insurance companies should introduce policies which will cover both outpatient and hospitalisation costs.

This will help a large number of people in India with diabetes to have good control of their blood sugar levels and thus prevent dreadful complications.

Although various stakeholders are required to build the web of partnership for diabetes prevention, the most essential is individual commitment to a better living.

(The writer is Head and Chief Diabetologist, MV Hospital for Diabetes, and Prof. M Viswanathan Diabetes Research Centre, Chennai. Email: drvijay@mvdiabetes.com)

Beyond Obesity: Reframing Food Justice with Body Love by TC Duong

Oakland has been at the forefront of what many would call the food justice movement – a movement to ensure that disenfranchised communities have power over they foods they produce, sell and eat.  Organizations like People’s Grocery have led the way in identifying the intersections between race, income and health.  Phat Beets Produce and City Slicker Farms have been innovators in community-led urban gardening.

Being in one of the centers of food justice work has been exciting but as someone who has also been involved in body acceptance movement, I find myself increasingly uncomfortable with the frame of obesity prevention as a justification some use to enter this great work.  Many groups doing this work have to apply for funding (such as Michelle Obama’s Let’s Move) that frames food access as obesity prevention.  Researcher Linda Bacon coined the term “Health at Every Size” to challenge ideas that weight loss is desirable for everyone and I wanted to think further about the impact of the framework of obesity prevention of food justice and communities of color.  That’s when I read Sonya Renee’s post  Weight Stigma in Diverse Populations.

Sonya-Renee-Taylor-2

By stating “Our society tells us fatness is not beautiful.  Blackness is historically, not beautiful.  So even while battling weight stigma and reclaiming size diversity as beautiful, the presence of Blackness complicates the narrative,” Sonya Renee names the very real intersection between marginalization of women of size and black women.  Performance Poet, Activist and transformational leader, Sonya Renee is a National and International poetry slam champion, published author, and change maker.  As the founder and CEO of the The Body is Not An Apology, she is working to promote an international movement focused on radical self love and body empowerment. I asked Sonya more about the impact of the obesity prevention frame on food justice work.  Her responses are eye opening.

There are a lot of well-meaning people trying to do right by their communities by working on “food justice.”  Does that have relevance to size acceptance and body love?  Where do you see the intersections?  

I think food justice absolutely has relevance to size acceptance and body love or what The Body is Not An Apology calls Radical Self Love.  Radical Self Love is about being an advocate for your own well-being, your body and then allowing that advocacy to demand those things that aid well-being.  Asking for healthy food and access to nutrition is without question an element of radical self-love.  Also, when we think about who has access to good grocery stores, nutritious choices in their communities; we must look at the ways body impacts that.  There is a racial aspect that must be named which is about what bodies are valued and cared for systemically and which we do not. Those observations lead us directly to the way we further disenfranchise bodies of color, fat bodies, poor bodies.  Food justice is about ensuring all bodies have access and autonomy over their bodies.

How do community activists combat the obesity frame in public health, especially related to black communities?  There’s some real dollars attached to doing food justice as “combating obesity.”

I think it is essential to talk about the intersections of discrimination.  Asking how is a framework that makes someone’s body “wrong” an act of public health? We must ask who benefits from a war against people’s bodies.  Does it benefit communities to be at war with their bodies?  Does it benefit large people to view their bodies as a thing they must fight?  If the benefit is not to the communities we serve then what makes the model a justice movement?  Given that there are actual health indicators that can be assessed without size and size actually is not valid indicator of health unto itself, it is completely possible to talk about health without pathologizing bodies.  I also challenge public health professionals to be honest about the mental health aspects of having society be at war with your body or teaching people to be at war with themselves which is the translation of “combating obesity.”  Anything that reinforces inequity, bigotry, prejudice or shame IS NOT a justice movement.  Food justice work that does not include dismantling weight stigma in my opinion is not a justice movement.

There’s a lot of momentum around promoting health in marginalized communities (i.e. Michelle Obama’s work) but with the frame of ending obesity.  What frame would you recommend using to address what are real problems of accessibility for food and recreation?

I often just sit with the idea that the “ending obesity” paradigm is actually saying “we want to end Fat People.”  There simply is no health promotion in that framework.  The Body is Not An Apology operates from the framework that says injustice starts in many ways from the inability to make peace with the body, our own and others.  From that premise, the issue of promoting health is not about the failure of the body but the failure of our society to protect and care for EVERY BODY equally and the ways in which we as individuals and communities have internalized that lack of care.  If we cared for each person in our society we would have those things that are required for basic human sustainability in all communities.  We would have grocery stores with affordable healthy options; we would have playgrounds and recreation in all communities.  If we did not have recreation due to community violence we would be addressing and healing community violence.  We would be ensuring our media replicated images of all members of society in nuanced, dynamic, psychological healthy ways.  If we were using an intersectional community care model we would be addressing the myriad ways we could better care for each other and for ourselves.

How do we incorporate the historical analysis of the commodification of black bodies into our work as food justice advocates?

Understanding the commodification of black bodies helps understand why there is little investment in our community’s well-being and health.  I think it would also help black people understand how their demand to be treated humanely via Food Justice is as vital as the Civil Rights movement, abolition movement etc.  The value of black bodies was directly tied to unpaid labor.  When that unpaid labor was no longer a resource, we saw a complete divestment in the lives of black people.  Now that the commodification of black bodies comes via the criminal justice system there is an absolute necessity to foster the disrepair of black communities. The commodification depends on us growing up in such a way that increases our likelihood of engaging in criminal activity.  That is shown time and again to be directly tied to poverty and not having one’s basic needs met.  Food justice is about ensuring that all communities have their basic needs met so that they might thrive. The treatment of people in such communities is an illustration of the difference between commodifying bodies and valuing bodies. Food Justice is about demanding our bodies be valued!

Finally, how do we make the shift from shame and blame to love?

The question I ask that gets me to the answer of that question is always about who does blame and shame serve?  How does blame and shame make a world that creates positivity and possibility?  I reject the notion that there is some way that my body can be wrong.  And if there is nothing wrong with my body then there is no place for blame or shame.  From this space I can focus on how I can better LOVE my body and how I can better advocate that the world support me, my family, and my community in growing that love.

Written and Posted with permission from TC Duong

Thanks to TC for allowing us to share this wonderful article!  —First Read and Found on Oakland Local —

Safe foods – Lets take on childhood obesity | Grovelands Childcare

Parents are being urged to make practical changes to everyday lifestyle habits such as portion sizes, drinks and screen time to make a big difference to the health and wellbeing of children and combat the island’s high levels of childhood overweight and obesity. That was the message from safefood with the launch today of a new public health campaign to help parents take on childhood obesity. The campaign will feature on television, radio, poster and point of sale advertising and includes a free booklet for parents that will be available nationwide in crèches, health centres, GP surgeries, and from public health nurses and local libraries.

Launching the campaign, Minister for Health Dr James Reilly TD said: “Obesity presents a real clinical, social and financial challenge which will have a detrimental legacy lasting decades and which will undoubtedly lead Ireland to an unhealthy and extremely costly, if not unaffordable, future if action is not taken now. I want to encourage everybody to help create generations of healthy children who can enjoy their lives to the full and reach their full potential as they develop into adults by making healthier food choices, by being more active and taking the first steps towards reducing overweight and obesity.”

Speaking at the campaign launch, Minister for Children and Youth Affairs Frances Fitzgerald TD said “Childhood obesity has reached epidemic proportions in Europe and Ireland is one of the countries worst affected. The Growing Up in Ireland survey, 2011 which is funded by my Department found that 1 in 4 children as young as 3 years of age are overweight or obese. I particularly welcome this new campaign as it seeks to help parents with very practical tips and ideas for actions they can take. We know from research that tackling obesity in childhood requires a family-centred approach, that is part of a wide ranging multi-agency set of initiatives.

The safefood campaign emphasises the importance of taking on practical changes for the whole family which are sustainable for the long term. Dr Cliodhna Foley-Nolan, Director of Human Health and Nutrition, safefood said: “We have based our campaign on strong feedback from parents that they wanted a solutions-based approach. For this phase we’re focusing on reducing portion sizes for children, replacing sugary drinks with water and being realistic about foods that ‘should be’ treat foods. While parents may be somewhat aware of the sugar levels in fizzy drinks, they may not be as aware of the sugar content in juice drinks and cordials, and research tells us they are regularly given to children at mealtimes. The sugar content of these drinks varies enormously and parents need to consider replacing these drinks with water instead”, added Dr. Foley-Nolan.

The three year, all island campaign by safefood in partnership with the HSE and Healthy Ireland Framework in the Republic of Ireland and the ‘Fitter Futures for All’ Implementation Plan in Northern Ireland also reminds parents about the negative health impacts of excess weight in childhood and how this can impact on a child’s quality of life.

Dr Cate Hartigan, Head of Health Promotion and Improvement, HSE said “Parents want what is best for their children, however tackling overweight and obesity is a sensitive and difficult task. A fundamental goal of Healthy Ireland is supporting people to enjoy a healthy and active life. This campaign helps make this a reality by motivating and supporting parents to make healthier choices for their children, and by raising awareness and knowledge among health professionals.

Chair of the safefood Advisory Board, Ms Lynn Ní Bhaoighealláin said “We all want children to have a bright future and we get them into all sorts of healthy habits, like brushing their teeth or crossing the road safely. This campaign is about supporting parents in making small changes in their everyday family lives.” At present, approximately 1 in 4 primary¹ school children are overweight or obese. The prevalence of excess weight is also beginning earlier in childhood², with currently 6% of 3 year olds being obese. Speaking at the campaign launch, Consultant Paediatrician and Clinical Lead for the W82GO Healthy Lifestyles programme at Temple Street Children’s Hospital, Dr Sinead Murphy said “With a quarter of children overweight or obese, we need to tackle the issue of childhood obesity head on or our next generation will be beset with significant health problems later in life. Evidence shows that once obesity is established, it is both difficult to reverse and can track into adulthood”. “Sadly, children who are overweight are at serious risk of becoming adults who are obese. This increases the risk manifold of developing serious illnesses such as type 2 diabetes, heart disease, stroke, certain types of cancers and shortened life-expectancy”, she continued.

Welcoming this initiative by safefood, Dr Darach O’Ciardha, ICGP Spokesperson said “Obesity is one of the conditions where prevention is certainly better than cure. Any move to educate parents about the need to monitor and prevent bad dietary habits which will last a lifetime, from developing is welcome. This initiative is a first step in tackling the ticking time bomb that is rising obesity levels particularly amongst the young.”

The safefood campaign will also be supported on the safefood website www.safefood.eu and on social media, including Facebook and Twitter. To find out more about the campaign including how-to videos from health experts and practical advice and guides for parents, visit: www.safefood.eu.  – See more at: http://www.safefood.eu/News/2013/safefood-launches-campaign-to-take-on-childhood-ob.aspx#sthash.T41EWFAK.dpuf

Obesity rate falls in 19 states for low-income preschoolers | MSNBC

How heavy can one country get? Until recently, the sky seemed the limit. If recent trends continued, government researchers warned in 2008, some 86% of U.S. adults would be overweight or obese by 2030, and a third of our kids would be fully obese by the time they turned 20.

But the fever may finally be breaking. A wisp of good news came from the Centers from Disease Control and Prevention (CDC), which announced Tuesday that obesity rates have recently declined among low-income children in 19 states and territories.  “While the changes are small,” CDC Director Tom Frieden said in announcing the new findings, “for the first time in a generation they are going in the right direction.”

The new study isn’t definitive, but it suggests that conditions are improving even for the nation’s poorest and most vulnerable children.

The CDC researchers reviewed height-and-weight records for 12 million preschoolers who participated in WIC and other nutrition-assistance programs. Their analysis covered 43 states and territories, and it yielded good news for nearly all of them. Obesity rates either fell or held steady in 40 of the 43 jurisdictions after rising steadily in recent decades. Only three states—Colorado, Pennsylvania and Tennessee—saw upward trends from 2008 to 2011, and those increases were all minor.

Nationally, about 13% of preschoolers are overweight or obese, but the risk is still significantly higher among kids who are poor enough to qualify for nutrition assistance. In California, for example, 16.8% of the enrollees were obese in 2011, despite a significant three-year decline (the 2008 figure was 17.3%). New Jersey and Massachusetts still hover at similar levels (16.6% and 16.4% respectively), despite similar reductions in recent years.

Puerto Rico’s low-income kids had the highest obesity rate of any state or territory (17.9% in 2011), but the nearby U.S. Virgin Islands saw the steepest three-year decline (from 13.6% to 11%).

Child obesity progress (CDC 08-13 map)

What accounts for all these encouraging trends? The study didn’t identify causes, but health authorities believe that public policy and public awareness have both helped. “Many of the states in which we’re seeing declines have taken action to incorporate healthy eating and active living into children’s lives,” says Janet L. Collins, director of the CDC’s obesity division.

Specifically, the CDC points to growing community efforts to make nutritious food affordable and accessible and ensure that all kids have safe places to play. First Lady Michelle Obama’s Let’s Move! Child Care initiative has probably helped too, with 10,000 child care programs now embracing its prevention strategies.

“I think the main reason [rates are falling] is that people are rallying together as stakeholders in this battle,” Dr. Lindy Christine Fenlason of Vanderbilt University told NBC News Tuesday morning. “We’re talking about teachers and parents and caregivers, those in the media, those in government, and those in the medical profession. Everyone has come around to support people in making changes to have a healthy weight.”

That’s not to say the epidemic is anywhere near over. Obesity still affects 12.5 million children and teens in this country, and the potential consequences are devastating, ranging from arthritis and sleep apnea to heart disease, diabetes, stroke and several cancers. But the latest findings show that progress really is possible.

Beyond Obesity: Reframing Food Justice with Body Love « Oakland …

Oakland has been at the forefront of what many would call the food justice movement – a movement to ensure that disenfranchised communities have power over they foods they produce, sell and eat.  Organizations like People’s Grocery have led the way in identifying the intersections between race, income and health.  Phat Beets Produce and City Slicker Farms have been innovators in community-led urban gardening.

Being in one of the centers of food justice work has been exciting but as someone who has also been involved in body acceptance movement, I find myself increasingly uncomfortable with the frame of obesity prevention as a justification some use to enter this great work.  Many groups doing this work have to apply for funding (such as Michelle Obama’s Let’s Move) that frames food access as obesity prevention.  Researcher Linda Bacon coined the term “Health at Every Size” to challenge ideas that weight loss is desirable for everyone and I wanted to think further about the impact of the framework of obesity prevention of food justice and communities of color.  That’s when I read Sonya Renee’s post  Weight Stigma in Diverse Populations.

Sonya-Renee-Taylor-2

By stating “Our society tells us fatness is not beautiful.  Blackness is historically, not beautiful.  So even while battling weight stigma and reclaiming size diversity as beautiful, the presence of Blackness complicates the narrative,” Sonya Renee names the very real intersection between marginalization of women of size and black women.  Performance Poet, Activist and transformational leader, Sonya Renee is a National and International poetry slam champion, published author, and change maker.  As the founder and CEO of the The Body is Not An Apology, she is working to promote an international movement focused on radical self love and body empowerment. I asked Sonya more about the impact of the obesity prevention frame on food justice work.  Her responses are eye opening.

There are a lot of well-meaning people trying to do right by their communities by working on “food justice.”  Does that have relevance to size acceptance and body love?  Where do you see the intersections?  

I think food justice absolutely has relevance to size acceptance and body love or what The Body is Not An Apology calls Radical Self Love.  Radical Self Love is about being an advocate for your own well-being, your body and then allowing that advocacy to demand those things that aid well-being.  Asking for healthy food and access to nutrition is without question an element of radical self-love.  Also, when we think about who has access to good grocery stores, nutritious choices in their communities; we must look at the ways body impacts that.  There is a racial aspect that must be named which is about what bodies are valued and cared for systemically and which we do not. Those observations lead us directly to the way we further disenfranchise bodies of color, fat bodies, poor bodies.  Food justice is about ensuring all bodies have access and autonomy over their bodies.

How do community activists combat the obesity frame in public health, especially related to black communities?  There’s some real dollars attached to doing food justice as “combating obesity.”

I think it is essential to talk about the intersections of discrimination.  Asking how is a framework that makes someone’s body “wrong” an act of public health? We must ask who benefits from a war against people’s bodies.  Does it benefit communities to be at war with their bodies?  Does it benefit large people to view their bodies as a thing they must fight?  If the benefit is not to the communities we serve then what makes the model a justice movement?  Given that there are actual health indicators that can be assessed without size and size actually is not valid indicator of health unto itself, it is completely possible to talk about health without pathologizing bodies.  I also challenge public health professionals to be honest about the mental health aspects of having society be at war with your body or teaching people to be at war with themselves which is the translation of “combating obesity.”  Anything that reinforces inequity, bigotry, prejudice or shame IS NOT a justice movement.  Food justice work that does not include dismantling weight stigma in my opinion is not a justice movement.

There’s a lot of momentum around promoting health in marginalized communities (i.e. Michelle Obama’s work) but with the frame of ending obesity.  What frame would you recommend using to address what are real problems of accessibility for food and recreation? 

I often just sit with the idea that the “ending obesity” paradigm is actually saying “we want to end Fat People.”  There simply is no health promotion in that framework.  The Body is Not An Apology operates from the framework that says injustice starts in many ways from the inability to make peace with the body, our own and others.  From that premise, the issue of promoting health is not about the failure of the body but the failure of our society to protect and care for EVERY BODY equally and the ways in which we as individuals and communities have internalized that lack of care.  If we cared for each person in our society we would have those things that are required for basic human sustainability in all communities.  We would have grocery stores with affordable healthy options; we would have playgrounds and recreation in all communities.  If we did not have recreation due to community violence we would be addressing and healing community violence.  We would be ensuring our media replicated images of all members of society in nuanced, dynamic, psychological healthy ways.  If we were using an intersectional community care model we would be addressing the myriad ways we could better care for each other and for ourselves.

How do we incorporate the historical analysis of the commodification of black bodies into our work as food justice advocates?

Understanding the commodification of black bodies helps understand why there is little investment in our community’s well-being and health.  I think it would also help black people understand how their demand to be treated humanely via Food Justice is as vital as the Civil Rights movement, abolition movement etc.  The value of black bodies was directly tied to unpaid labor.  When that unpaid labor was no longer a resource, we saw a complete divestment in the lives of black people.  Now that the commodification of black bodies comes via the criminal justice system there is an absolute necessity to foster the disrepair of black communities. The commodification depends on us growing up in such a way that increases our likelihood of engaging in criminal activity.  That is shown time and again to be directly tied to poverty and not having one’s basic needs met.  Food justice is about ensuring that all communities have their basic needs met so that they might thrive. The treatment of people in such communities is an illustration of the difference between commodifying bodies and valuing bodies. Food Justice is about demanding our bodies be valued!

Finally, how do we make the shift from shame and blame to love?

The question I ask that gets me to the answer of that question is always about who does blame and shame serve?  How does blame and shame make a world that creates positivity and possibility?  I reject the notion that there is some way that my body can be wrong.  And if there is nothing wrong with my body then there is no place for blame or shame.  From this space I can focus on how I can better LOVE my body and how I can better advocate that the world support me, my family, and my community in growing that love.

The Five Stages Of Living With Obesity | Dr. Sharma's Obesity Notes

stages-of-grief-300x282Some readers may be well aware of the five stages of grief, the natural process of grieving, which, according to Kubler-Ross, move from denial to anger to fear to grief and finally to acceptance.

As others have pointed out, the same five stages apply to virtually every serious life event, including being diagnosed with a chronic or severe illness.

Now that we have come to appreciate that obesity is a chronic disease (for which we have no cure!), it should come as no surprise that these five stages also apply to obesity.

First comes denial: not denial that I am gaining or have put on weight – that is obvious enough. Rather, denial that this may be a real problem or may have serious consequences down the road. A normal response in this stage is to not want to know about it. I don’t see a doctor because I don’t want to hear that I have a problem. I don’t listen to advice because it doesn’t apply to me. I don’t weigh myself because I don’t want to know. Pseudoacceptance – it may be as it may, but if that’s the case, then that’s the case – don’t tell me I have a problem and don’t tell me I need to do something about it – leave me alone!

Second comes anger: often it is the anger that fuels the denial. Anger at my body. Anger at myself. Anger at the people around me (including those offering help or understanding). Anger at life in general. Why me? Why this? Why can I not stop myself? Why can I not stick with my diet or exercise plan? Nothing works!

Third comes depression: this phase is characterized by sadness, a sense of loss, despair, anxiety, fear of what is to come. What if this weight gain continues? What if my health problems get worse? I don’t want to be the “fatty” that people make fun of. I don’t want to be ridiculed in public. I don’t want my pains to get worse. I don’t want to end up in a wheelchair or have diabetes or sleep with a CPAP machine. There will be restrictions – giving up things I love. It will mean effort – doing things that I don’t care for. No longer can I live like I used to or like others continue to – lucky them!

Fourth comes bargaining: OK, I get that I have a problem but really, there must be some simple way out of this. If I can only find the right diet or right exercise or maybe cut my carbs or go vegan or get myself tested for food allergies. How about I just give up the white stuff, or the fat, or the pop? What if I buy a treadmill and religiously used it every day? How about I just share my story ? May be someone will help me – or I will find the strength. I have been successful in every other aspect of my life – so really – how hard can this be?

Fifth we reach acceptance: This is where I finally accept that I have this problem and reach the point where I am ready to move on. Once I accept that this problem is not simply going to go away, nor will it be fixed by another quick diet or weight-loss supplement, I reach the stage where I accept that I need to become more realistic about the solutions. I am now ready to find and accept the help I need (and fight for it if I have to) or I am ready to accept that this is what I will have to live with for the rest of my life – so let’s make the best of it and move on.

Research shows that these stages are not perfectly sequential – often they occur in parallel and even regress or sometimes flip-flop from one stage into another. That is perfectly natural. Some folks may never move beyond denial or anger, some may be stuck forever in depression or bargaining. Even those, who have accepted their situation may occasionally regress (e.g. the surgical patient who is in denial having to take his vitamins).

At this point it is important to point out that acceptance does not simply mean accepting the status quo.

Rather, acceptance means accepting the fact that I need to now deal with this problem the best I can. If I need to become a marathon runner to conquer this weight, so be it. If I need to open my soul to a psychologist to work through my childhood trauma, then that’s what I have to do. If in the end the only solution is bariatric surgery – bring it on. If this is what it will take – I am now ready to accept it, embrace it, use it to my advantage. I am now ready to stand up to bullies and the “wise guys” who have all the answers.

As health professionals, it is important that we recognise what stage our patients is at. The denial and anger stage are not the best time to discuss diet plans. Nor is the depression or bargaining stage the best time to bring up the topic of surgery or lifelong medication.

With true acceptance comes hope and a positive change that sets the foundation of whatever is to come next. This is no longer the time to point fingers, assign blame, nurse regrets,  hide in shame, dissolve in despair.

Things are as they are and I accept them. But, as they say, when life throws you lemons, reach for the tequila!

If you have experienced or can relate to these stages – I’d love to hear your story.

@DrSharma
Edmonton, AB

The Five Stages Of Living With Obesity , 10.0 out of 10 based on 4 ratings

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25 Responses to “The Five Stages Of Living With Obesity”

  1. EC says:

    I am slightly confused on the denial part where you say “that this may be a real problem or may have serious consequences down the road.” Do you consider it denial if someone is overweight or obese (by the BMI chart), is weight-stable, has good health measures, exercises and eats a mostly healthful diet? Or are you specifically referring to someone a little higher on the Edmonton Obesity Scale by this? That would be more in line with my understanding of your general message, but it’s not clear to me here.

    I guess I feel a little touchy on this one, because this smacks of the “Vague Future Health Threat” a lot of people get hit with by their doctors and pretty much all of society the instant they get above BMI 25.0. Any argument that says “really, I’m healthy,” is countered with the idea that we’re in denial.

  2. Nanette says:

    You hit the nail on the head every single time. This blog is full of win. Thank you!

  3. Arya M. Sharma, MD says:

    EC – if your weight is not really a problem then this is not a question of denial – after all there is nothing to deny. But, let us be honest, the vast majority of people with excess weight do have a problem – people who don’t, make up a rather small healthy minority of fat people. If this is where you belong, good for you.

  4. Dagny Kight says:

    I’ve gotten a lot of response to a section in my book where I write about how going on a diet takes a person through stages of struggling with a sense of control.

    You pick a day to start a new diet and make a plan. The planning gets you all motivated and excited.

    At first, you stick to the plan very specifically and it makes you feel proud of yourself. You have a sense you’re “doing something” to solve a problem and you’re being good at it.

    The diet plan imposes changes on your regular routine and lifestyle that are difficult to maintain so little by little, it starts to break down. The breakdown usually begins with a temptation to eat something off the diet plan so you bargain with yourself that you’ve “been good” up to this point so you deserve a treat and it’s OK.

    The diet plan becomes more difficult to maintain over time so the bargaining gets bigger. You fall off the diet one day so you consider that day a total loss, you might as well eat whatever you want. You do it because you bargain with yourself to be back “on” the diet tomorrow.

    Eventually you consider the diet a complete failure. You bargain with yourself to be “off” the diet and decide it’s over. You eat whatever you want in an “off” a diet manner until the day that you decide you will start your new diet. You feel OK about what you’re eating as long as you stick to the terms of the bargain you make with yourself.

    You start the cycle over again.

    People have written to me that they do this all the time and they realize they’ve used up months and years of their lives living like this. I know I did.

  5. DebraSY says:

    I would like to share a little correction to your premise, based on my limited time as a lay chaplain. These are the Kubler-Ross stages of death. They are what people go through from diagnosis to final chapter of life as they confront their own mortality (and, as you rightly point out, the order is not set — though bargaining is usually listed before depression). The stages of death are frequently confused with stages of grief, and often misapplied, especially in early grief. The first stage of grief — when one learns that someone dear has died — is chaos. The grieving person may bounce back and forth from feeling numb to feeling profound sadness to feeling uncharacteristic emotions. Often friends see the numb stage or an uncharacteristic emotion and inform the poor griever that he or she is in denial and must move on. This is unhelpful. It makes the grieving person feel guilty for something that is natural.

  6. Kelly. Proulx says:

    This is awesome Dr Sharma. Thank you for putting this together. As a Dietitian I see people battling with their weights all the time and some days I struggle to help them. I use the stages of change, but this is excellent. Thank you.

  7. Linda Fair says:

    I wrote this a couple of years ago and your article reminded me of it:
    The Many Layered Cake of Obesity

    1. The bottom layer is the pain that started it all. Whatever drove us to seek comfort, solace, numbness in food, over and over again. Most of this probably started very early in our lives and was not our fault.

    2. The next layer contains the real physical effects of being obese: diabetes, cholesterol, heart disease, fatigue, joint deterioration, etc.

    3. The next layer contains the self-loathing that we cannot control this thing that eats at us.

    4. Another layer is all the unkind judgmental things that others have said to us, well intentioned or not.

    5. …all the times and ways that others have tried to “help” or “fix” us by controlling us.

    6. …all the misinformation and unhelpful advice that we have received directly or indirectly.

    7. …the isolation we seek in order to avoid being hurt again.

    8. …all our other needs, wishes and desires that cannot be fulfilled because of our obesity and/or others’ attitudes.

  8. Melinda Munro says:

    I’m with EC. I am super healthy and fit but with a BMI over 30. So am I in denial? No, actually bargaining, most of the time and sometimes acceptance. But EC is right, there is a constant pushback to doctors that the BMI does not mean I have any illness which I am denying.

    But I am curious about your comment about numbers, Dr. Sharma. What is the percentage of EOSS 0 or 1 in the population of people who have BMI’s over 30? Are we a tiny minority or are we sizable enough to warrant attention to what genetic factors drive our ability to be fit, strong and fat?

  9. Pierre Trudel says:

    Pierrette I live with these steps everyday.We have “been there,done that”.When we talk to others that are still in denial we no longer try to convince them.
    Until they reach the other factors, we are talking for nothing.
    I know of “no” people that are obese and exercise regularly and eat properly.
    Those that say they do are full of it and are in real strong denial.
    People that are obese simply eat all the time because they are always hungry.I know.I did also.
    When I changed my lifestyle and realised that I can eat healthy foods and be totally satisfied, then and only then did I really join “my fight” to become healthy.
    My wife is 62 and I am 61 and we are both in the best health of our lives…..Wow
    Pierre Pierrette Trudel

  10. Arya M. Sharma, MD says:

    Melinda: The exact numbers based on NHANES III for population with BMI 30 to 35 is Stage 0 = 8%, Stage 1 = 19%. For BMI greater than 40, the numbers are Stage 0 = 5% Stage 1 = 14%

  11. Arya M. Sharma, MD says:

    Linda: The Layered-Cake of Obesity – interesting idea!

  12. Arya M. Sharma, MD says:

    DebraSY: You make an important point – all of these stages are “natural” and even “healthy” as part of the process. Thus, for e.g., although it sounds negative, “denial” is a very healthy initial response, so is “depression”. The problem is when people get stuck in one of the other stage or fail to eventually progress to acceptance. The notion of thinking of this as a staged process (not always linear) is for the professional to recognise where your patient is at and counsel appropriately. As I said, trying to talk someone, who is in the denial stage into addressing the problem will only create defensiveness.

  13. Arya M. Sharma, MD says:

    Dagny – you perfectly describe someone stuck in the bargaining stage. This person has not yet fully accepted that changes have to lifelong and that the expectations have to be realistic. I know hundreds of people (probably most people trying to lose weight), who are stuck in the bargaining stage and never make it to full acceptance.

  14. Valerie X Armstrong says:

    This is so much like a blog post I made on 11/13/12…great minds, you know

    http://thesurvivalofthefattest.blogspot.com/2012/11/the-five-stages-of-accepting-myself-as_13.html

  15. Elina Josephson says:

    As usual, I find myself offering a contrary voice. I believe from experience, that these stages are better understood as interwoven threads. Rather than experiencing them one at a time, a person who is gaining weight cycles through them often on a moment by moment basis. All the threads exist in the same time and space but the person is more focused on one or the other. This is not nearly as true for grief, but it is true for weight management. What this means for a qualified and caring CBT is that you are not required to wait for the client to transition into acceptance, you can help the client shift focus and change perspective. You can help the client find motivation, strength and purpose. We are complicated and powerful. Within each one of us, at every single moment,lives the potential to simply make another choice.

  16. Arya M. Sharma, MD says:

    Elina – you are bang on that these stages are interwoven (which is why I chose the image of the ribbon for the illustration). I also agree all all these stages can co-exist from minute to minute, from day to day. A skilled CBT counsellor will recognise this and provide the necessary support.

  17. DebraSY says:

    Pierre: you no of NO ONE who is obese and exercising regularly and eating properly? All obese people are “full of it” and “in real strong denial”? Wow, that’s harsh. Is Diana Nyad in denial? What about 75% of the Kansas City Chiefs (my team) or, for that matter, 75% of other people’s football teams. What about Oprah (also proof positive that no amount of accountability and resources can assure permanent weight-loss maintenance). What about Janet Cook, the first person to swim the Berring Straight? There are also many non-famous obese people who quietly exercise and eat well with no fanfare. I knew quite a few when I belonged to the YMCA.

    Please reconsider your judgments. Weight bias hurts people.

  18. Dagny Kight says:

    I don’t deal with weight because of “pain that started it all.” I don’t allow people to treat me like I am some weak, broken emotional wreck or to label me in that way. Some of us can have bodies that manage energy very efficiently and brains that want to think about food and connect it to everything in our lives. Fighting that to manage your weight in an intensely obesogenic environment is VERY DIFFICULT. Even if you think certain situations triggered certain habits, the struggle with weight itself becomes the difficulty.

    We have to get rid of this paradigm that says every fat person is a screwed up mess of emotional issues and “pain that started it all.”

    Food is its own driver.
    Weight is its own stressor.
    Fighting to control your body and mind is immensely difficult and can feel endless

  19. Benedetta says:

    Dagny, well said. Thank you!

  20. Sharon says:

    Very wise words. So how can one move on to that stage of acceptance, or help a client or loved one to do so? I find myself cycling between denial, depression and bargaining–and would love to be able to move to acceptance, so I can fix my weight and my life.

  21. Arya M. Sharma, MD says:

    Sharon – that’s a great question. I am not a counsellor but there are many who read this – they may wish to chip in with some advice.

  22. Elina Josephson says:

    This is at Sharon- You might just not be done cycling yet. Acceptance often comes when all the other possible versions of reality have been exhausted. When you get tired of running in circles and the reward of one more bite does not seem worth it. When the payoff from the denial and the depression and the bargaining no longer works for you. When that times comes, find a great CBT counselor, come in with a willing heart and and an open mind. Walk in to work, do not expect to be fixed, but rather to be empowered to fix yourself. When that day comes, your counselor will help you open the door and you will have found acceptance.

  23. EC says:

    Pierre’s comment is exactly why I brought up the “denial” issue, because this is the kind of thing I hear over and over. Thank you, Debra and Dagny, for pointing out the flaws in assuming that every fat person is an emotional wreck, or a lazy glutton, or “in denial” — an attitude I find frustrating and insulting.

    While the numbers of obese in EOS 0 or 1 are small, it is still enough that it’s not a total anomaly. I would guess that for people in overweight BMI (where I am — high side of it), those numbers are a bit higher. It needs to be addressed instead of doctors having the knee-jerk reaction of prescribing intentional weight loss to everyone above BMI 25, even if those folks are healthy and weight-stable with good enough habits.

  24. Melinda Munro says:

    You go Dagny!

    If we aren’t being judged as being lazy and deceitful (Pierre), we are judged as being broken emotional wrecks with childhoods laden with abuse.

    The reality is our bodies are hyper efficient and in some of our cases, due to external drivers to be thin, we engaged in behaviours, like yo-yo dieting, that made our bodies even more efficient.

    However, thin friends of mine face some of the same labels – if you are skinny, you must be anorexic with an unaccepted history of abuse.

    How about we agree that we can be healthy people whose genetics and body morphs are different from someone else’s.

    If we are struggling with mental illness that impacts our physical health, then focus on that and not make stereotypical judgements.

  25. Diane says:

    Dr. Sharma, I have bounced back and forth through all of these stages, spending lots of time in denial. It took a lot of work with an addictions counsellor to get me to the stage in which I was willing to go to any lengths to get healthy again. I am on the waitlist for surgery in BC and have been for 4 1/2 years. I don’t have a date yet but I have reason to believe I will have one soon. I appreciate that you recognize that it is sometime a battle to get what we need to get healthy. Thank you for all the work you do on our behalf.

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'Healthy Obese' Is Possible, But Maybe Not Forever

As many as a third of obese adults are considered metabolically healthy, meaning they have normal cholesterol and blood pressure levels and show no signs of developing diabetes. Still, they’re considered a medical mystery, but new research has shed some light on why some people can be healthy at any size, while others cannot.

It has to do with fat cells, according to a new study in the journal of Diabetologia. Compared to obese people who are healthy, those who are metabolically unhealthy have “impaired mitochondria” and a “reduced ability to generate new fat cells.”

What researchers found was that in a healthy obese person, new cells are generated to help store fat as it accumulates, whereas the cells of an unhealthy obese person “swell to their breaking point,” making their fat cells larger than any other group.

They were swollen and riddled with inflammation. The breakdown and mobilization of their fat stores was suppressed, and a closer look showed that their mitochondria were malfunctioning. Their ability to burn fuel and produce adenosine triphosphate, or ATP, the body’s energy currency, was reduced.

It leads to ectopic fat accumulation, meaning that fat gets into organs like the heart and liver. (A fatty liver is linked to Type 2 diabetes.)

However, for a healthy obese person, the fat doesn’t travel throughout the body, and remains just beneath the skin, where it doesn’t seem to cause any physical harm.

A study that appeared in the journal Diabetes Care in August found that metabolically healthy obesity is more frequently found in younger adults, but it may be a transition state, and that “some, if not many, people in this category will eventually develop the expected metabolic disturbances.”

Dr. Jussi Naukkarinen, the lead researcher in the fat cell study, said that anti-inflammatory drugs have been shown to “protect mitochondrial function and improve diabetic symptoms and glucose metabolism.” He also suggests that high glycemic foods (like sugar and white flour) play a role in spiking blood glucose and insulin levels.

But ultimately, he believes that studying healthy obese people will help those that are unhealthy.

“People haven’t really paid that much attention to metabolically healthy obesity, but I think it can teach us a lot about usual obesity,” he said. “It’s only recently that people studying depression have done happiness studies showing what goes right, and I’m thinking about the metabolically healthy obese phenomenon in the same way.”

Image via xrender/Shutterstock

The ‘Healthy Obese’ and Their Healthy Fat Cells [NYT]

Obesity Rate In NYC Up 25% Under Nanny Bloomberg | The Lonely …

bloomberg

Well, isn’t this weird? The obesity rate in New York City has skyrocketed since Nanny Bloomberg took control of the city.

Reduce the obesity rate in New York City? Fat chance!

More New Yorkers than ever are living large, despite Nanny Bloomberg’s war on sugary drinks and fast foods, statistics obtained by The Post reveal.

The city’s obesity rate among adults has skyrocketed 25 percent since Mayor Bloomberg took office in 2002, city Health Department figures show.

That year, nearly one in five New Yorkers was considered obese. Now almost one in four is.

The figures are surprising given Gotham’s residents are doing better according to other health indicators. (Read More)

Maybe all of the former smokers are compensating by overeating. Or maybe people now assume everything they eat is healthy because of Nanny Bloomberg’s efforts. Who knows?