Extreme Obesity, And What You Can Do About It

Too much weight can take a toll on your body, especially your heart. The good news is that there are steps you can take to get healthier — and even losing a little body weight can start you on the right path.

Why lose weight?
If you’re extremely obese, losing weight can mean “less heart disease, less diabetes and less cancer,” said Robert Eckel, M.D., past president of the American Heart Association. “Metabolic improvements start to occur when people with extreme obesity lose about 10 percent of their body weight.”

Losing weight can reduce your risk of heart disease and stroke; risk factors like high blood pressure, plasma glucose and sleep apnea. It can also help lower your total cholesterol, triglycerides and raise “good” cholesterol — HDL.

Understanding Extreme Obesity
A healthy BMI ranges from 17.5 – 25 kg/m2. If your body mass index is 40 or higher, you are considered extremely obese (or morbidly obese.) Check out the American Heart Association’s BMI calculator for adults to determine if your weight is in a healthy range. (Note: BMI in children is determined using a different BMI calendar from the CDC.)

A woman is extremely obese if she’s 5 feet, 4 inches tall and weighs 235 pounds, making her BMI 40.3 kg/m2. To reach a healthy BMI of 24.8, she would have to lose 90 pounds to reach a weight of 145 pounds.

A man is extremely obese if he’s 6 feet, 2 inches tall and weighs 315 pounds, making his BMI 40.4 kg/m2. To reach a healthy BMI of 25.0, he would need to lose 120 pounds to reach a weight of 195 pounds.

Doctors use BMI to define severe obesity rather than a certain number of pounds or a set weight limit, because BMI factors weight in relation to height.

How to Get Healthier
If you’re extremely obese, taking action to lose weight and improve your health may seem overwhelming. You may have had trouble losing weight or maintaining your weight loss, been diagnosed with medical problems and endured the social stigma of obesity.

“The key to getting started is to find a compassionate doctor with expertise in treating extreme obesity,” said Dr. Eckel, who is also professor of medicine and Charles A. Boettcher II Chair in Atherosclerosis at the University of Colorado Anschutz Medical Campus in Aurora, Colo. “Bonding with your physician is the best way to get past first base and on the path to better health.”

If you’re extremely obese, Dr. Eckel recommends that you become more active, but not to start a vigorous workout program without getting physician advice and not until you’ve lost about 10 percent of your body weight.
“You can continue the level of physical activity that you’re already doing, but check with your physician before increasing it,” Dr. Eckel said. “Some people with extreme obesity may have health issues like arthritis or heart disease that could limit or even be worsened by exercise.”

Treatment Options
Talk to your doctor about the health benefits and the risks of treatment options for extreme obesity:

  1. Change your diet. You may be referred to a dietician who can help you with a plan to lose one to two pounds per week. To lose weight, you have to reduce the number of calories you consume. Start by tracking everything you eat.

    “You have to become a good record-keeper,” Dr. Eckel said. “Reduce calories by 500 calories per day to lose about a one pound a week, or cut 1,000 calories a day to lose about two pounds a week.”

  2. Consider adding physical activity after reaching a minimum of 10 percent weight-loss goal.
  3. Medication. Some people can benefit from medication to help with weight loss for extreme obesity. Keep in mind that medication can be expensive and have side effects.
  4. Surgery. If changing your diet, getting more physical activity and taking medication haven’t helped you lose enough weight, bariatric or “metabolic” surgery may be an option. The American Heart Association recommends surgery for those who are healthy enough for the procedure and have been unsuccessful with lifestyle changes and medication. Risks can include infections and potentially dangerous blood clots soon after the operation, and concerns about getting the right amount of vitamins and minerals long-term.

Get The Social Or Medical Support You Need
Although some people can modify their lifestyle and lose weight on their own, many need extra help. A social support system can help encourage your progress and keep you on track. Decide what support best fits your needs — either a weight-loss support group or one-on-one therapy.

Some people with extreme obesity suffer from depression. Talk to your doctor about the best treatment, as some anti-depressant medications can cause weight gain.

Learn more:

  • BMI Calculator
  • BMI in Children
  • 5 Goals to Losing Weight
  • Losing Weight With Life’s Simple 7 Infographic
  • Preventing Childhood Obesity: Tips for Parents and Caretakers

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.

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


  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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Hunt for perfect mix of diet and exercise to beat diabetes

The largest study of its kind is to be carried out to find the right lifestyle to prevent Type 2 diabetes, which is threatening to become a medical “disaster” in Britain.

Experts aim to work out not only the best way to eat, drink and exercise but even how to sleep.

It could lead to people at risk of developing the condition being given a detailed diet and exercise regime, much like a prescription, to help protect themselves.

Professor Anne Raben, the project’s chief coordinator at the University of Copenhagen, said: “We would like to find out if our current dietary and exercise recommendations are optimal or whether another lifestyle and regimen is more effective.

“It could save billions in health care costs for society if we are able to find a formula for how to best prevent Type 2 diabetes.”

The three-year study will start at the end of the year and involve 2,300 adult volunteers and 200 children aged from 12 to 18.

Eight countries will be involved including the UK, where the trial will be run by the University of Nottingham and Swansea University.

Professor Raben said: “We already know that a diet which follows current dietary guidelines can prevent diabetes. What’s unique about this project is that we are testing two diets against one another to find out if there might be a more effective alternative.

“We will include two types of exercise to determine if there is one that is more suitable. Finally we will also study the importance of stress and sleeping patterns.”

There's an Obesity Epidemic Among America's Dogs

It’s only natural that, being a nation of fatties, our lifestyle is directly reflected on our pets. More than half of American dogs are overweight, according to the Association for Pet Obesity Prevention, and while it might be kind of cute, it’s definitely not healthy.

Just like with humans, canine obesity puts dogs at a heightened risk for diabetes, high blood pressure, arthritis, and respiratory diseases, so vets are advising that their patients be put on strict diet and exercise regimens. After all, dogs tend to be overweight because of “lazy owners who confuse food with affection and attention.”

“Dogs today have butlers and maids,” Cesar Millan said. “They don’t hunt for their food anymore, but they should work for food.”

It also has to do with a carb-heavy diet. Dogs apparently don’t really possess a need for carbs unless they are pregnant or nursing. Ideally, they should be on a raw-foods diet, which actually means “a whole rabbit…or a whole squirrel for a fox terrier” which is completely disgusting.

What’s sad is that fat dogs have less of a chance of being adopted.

Indigo Ranch in Vernonia, Ore., is a kennel that offers what it calls a doggy fat camp. The camp began about two years ago, shortly after a county shelter contacted Indigo Rescue, the nonprofit rescue organization financed by Indigo Ranch, about a 3-year-old Lab aptly named Butters. At 142 pounds, he was considered unadoptable and was about to be euthanized, said Heather Hines, the director of Indigo Ranch…

…About five months after he arrived, he had slimmed to 84 pounds.

“He didn’t know he could run or jump until he lost the weight,” Ms. Reed said.

Poor Butters.

Image via WilleeCole/Shutterstock

Roll Over? Fat Chance [NYT]

Obesity could be caused by bacteria: French study

Is obesity caused by something other than the common explanations of a bad diet and lack of excercise? According to a new study carried out in France the probelem could be linked to levels of bacteria in the gut.

Obesity and the medical problems it causes could be linked to a lack of good bacteria in the gut according to findings of a new study in France.

Many believe obesity is caused by nothing other than poor diet and lack of exercise but the findings of the latest French-Danish study by the National Institute of Agricultural Research (INRA), based in Paris point to a low count of a certain kind of “good” bacteria in the gut as another possible cause.

The study, carried out in both France and Denmark and published in scientific journal Nature, found a link between obesity and people with a low number of good bacteria present in their intestinal flora. Good bacteria are those which help digest food and fight against bad bacteria. People with a lower bacteria count were shown to be more susceptible to becoming obese.

“If you have less good bacteria, the risk of developing serious illnesses such as diabetes or cardiovascular problems is a lot higher” said Professor Dusko Erlich, the coordinator of the study.

Erlich added that the results were important because “we think that if we manage to replace these bacteria, it could help prevent excessive weight gain.” However, he admits that scientists first need to learn “how to cultivate the bacteria, which we are unable to do right now.”

Researchers studied 123 non–obese and 169 obese Danish people. They discovered that amongst the subjects studied, the people who had a greater presence of good bacteria in their intestines, had a greater resistance diseases like diabetes.

They also found that the obese people with less bacteria put on more weight than obese people with more intestinal bacteria.

Obesity is a major issue for Western countries, who are undertaking new studies to tackle the problem. In 2005 it was estimated that 500 million people were obese and this number looks set to rise to 700 million by 2015, reported French TV station Europe 1.

In a second study published in the same journal, researchers found that a diet rich in fibre and fruit and vegetables followed over a course of 12 weeks could significantly improve intestinal flora and increase the good bacteria in the gut, thus reducing some health complications linked to obesity.

This supports previous research showing that changes to diet can have direct effects on bacteria in the gut.

by Naomi Firsht


What do you think? Leave your comment below.

Whole fruits protect against diabetes, but juice is risk factor, say researchers

Eating blueberries, grapes, apples and pears cuts the risk of type 2 diabetes but drinking fruit juice can increase it, a large study has found.

Researchers including a team from Harvard School of Public Health in the US examined whether certain fruits impact on type 2 diabetes, which affects more than 3 million Britons.

People who ate three standard servings a week of blueberries had a 26% lower chance of developing the disease, they found. Those eating grapes and raisins had a 12% reduced risk and apples and pears cut the chances by 7%. Prunes also had a protective effect, giving an 11% drop in the risk of developing type 2 diabetes.

Other fruits such as bananas, plums, peaches and apricots had a negligible impact but drinking fruit juice increased the risk by 8%, according to the study.

People who replaced all fruit juice with eating whole fruits could expect a 7% drop in their risk of developing type 2 diabetes.

For individual fruits, replacing three servings a week of fruit juice with blueberries cut the risk by 33% while replacing juice with grapes and raisins cut the risk by 19%. The risk was also 14% lower if juice was replaced with apples and pears, 13% lower if replaced with bananas and 12% lower if replaced with grapefruit.

The research, published in the British Medical Journal, includes data on 187,382 people taken from three separate studies, of whom 12,198 developed type 2 diabetes.

Food questionnaires were used every four years to assess diet and asked how often, on average, people consumed each food in a standard portion size.

The relatively high glycaemic load of fruit juice along with “reduced levels of beneficial nutrients through juicing processes” may explain why juice increases the risk of type 2 diabetes, the authors suggest. “Fluids pass through the stomach to the intestine more rapidly than solids even if nutritional content is similar. For example, fruit juices lead to more rapid and larger changes in serum levels of glucose and insulin than whole fruits,” they said.

More research was needed, they added, but concluded: “Greater consumption of specific whole fruits, particularly blueberries, grapes and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”

About 2.7 million people in the UK are diagnosed with type 2 diabetes and a further 850,000 are thought to have it but not know. Another 7 million people are estimated to be at high risk of developing the disease, which is linked to obesity and inactive lifestyle.

Complications of type 2 diabetes include limb amputation, blindness, kidney failure, heart disease and stroke.

Dr Matthew Hobbs, head of research for Diabetes UK, said: “The best way to reduce your risk of developing type 2 diabetes is to eat a balanced, healthy diet that includes a variety of fruits and vegetables and to be as physically active as possible.

“This research provides further evidence that eating plenty of whole fruit is a key part of the balanced diet that will help you to achieve a healthy weight and so minimise your risk of developing type 2 diabetes.

“However, the associations between type 2 diabetes and specific types or fruit or fruit drinks must be treated with much more caution. Some of the findings are based on a number of assumptions and models which may have distorted the results significantly.

“For example, the researchers used surveys to ask participants how often they ate certain foods. This type of survey can often be unreliable as people are more likely to remember certain types of food.”

Your Gut Bacteria May Predict Your Obesity Risk – WebMD

Your Gut Bacteria May Predict Your Obesity Risk

By Randy Dotinga

HealthDay Reporter

WEDNESDAY, Aug. 28 (HealthDay News) — Bacteria in people’s digestive systems — gut germs — seem to affect whether they become overweight or obese, and new research sheds more light on why that might be.

The findings, from an international team of scientists, also suggest that a diet heavy in fiber could change the makeup of these germs, possibly making it easier for people to shed pounds.

“We know gut bacteria affect health and obesity, but we don’t know exactly how,” said Dusko Ehrlich, a co-author of the two new studies and coordinator of the International Human Microbiome Standards project.

The research finds that “people who put on the most weight lack certain bacterial species or have them at very low levels. This opens ways to develop bacterial therapies to fight weight gain,” he said.

Experts believe the gut, where the body processes food, is crucial to weight gain and weight loss.

“It is now well known that bacteria in our gut play an important role in our health and well-being, possibly as important as our own immune response and proper nutrition,” said Jeffrey Cirillo, a professor at Texas AM Health Science Center’s department of microbial pathogenesis and immunology. “This means that disruption of the bacteria in our gut by use of antibiotics or eating foods that help only particular bacteria grow can have effects upon our entire bodies.”

A study released last March in the journal Science Translational Medicine suggested that gastric bypass surgery led to weight loss — in mice — because it changed the makeup of the bacteria in their intestines.

In one of the new studies, which are both published in the Aug. 29 issue of the journal Nature, researchers analyzed the gut bacteria of 169 obese Danish people and 123 Danish people who were not obese.

The gut germs in the obese people were less diverse than in the others, and had more abnormalities in terms of metabolism. Also, obese people with a less diverse supply of germs gained more weight.

It’s not clear how the bacteria and obesity are related. But the research suggests that the metabolisms of the germs themselves are connected to the overall metabolism in the humans where they live, Cirillo said.

The finding could also have a practical application, the researchers said.

“The study lays ground for a simple test, which should tell people what their risk for developing obesity-linked diseases is,” study co-author Ehrlich said. If they are, he said, diet changes may be necessary.

In a second study, researchers monitored gut bacteria as 49 overweight and obese people tried to lose weight with diets that were low-fat and low-calorie but high in protein plus fiber-rich foods like vegetables and fruits. The diet appeared to actually change the bacterial makeup in the guts of the participants.

“Although these are relatively early and small studies on the topic, they suggest that management of our own diets can improve the richness of the flora within our guts and decrease our chances of becoming obese,” said Cirillo. “This does not mean that changes in diet will be effective for all people or that they can prevent obesity no matter how much someone eats, but that they can help the situation.”

Fat profits: how the food industry cashed in on obesity

When you walk into a supermarket, what do you see? Walls of highly calorific, intensely processed food, tweaked by chemicals for maximum “mouth feel” and “repeat appeal” (addictiveness). This is what most people in Britain actually eat. Pure science on a plate. The food, in short, that is making the planet fat.

And next to this? Row upon row of low-fat, light, lean, diet, zero, low-carb, low-cal, sugar-free, “healthy” options, marketed to the very people made fat by the previous aisle and now desperate to lose weight. We think of obesity and dieting as polar opposites, but in fact, there is a deep, symbiotic relationship between the two.

In the UK, 60% of us are overweight, yet the “fat” (and I include myself in this category, with a BMI of 27, slap-bang average for the overweight British male) are not lazy and complacent about our condition, but ashamed and desperate to do something about it. Many of those classed as “overweight” are on a near-perpetual diet, and the same even goes for half of the British population, many of whom don’t even need to lose an ounce.

When obesity as a global health issue first came on the radar, the food industry sat up and took notice. But not exactly in the way you might imagine. Some of the world’s food giants opted to do something both extraordinary and stunningly obvious: they decided to make money from obesity, by buying into the diet industry.

Weight Watchers, created by New York housewife Jean Nidetch in the early 1960s, was bought by Heinz in 1978, who in turn sold the company in 1999 to investment firm Artal for $735m. The next in line was Slimfast, a liquid meal replacement invented by chemist and entrepreneur Danny Abraham, which was bought in 2000 by Unilever, which also owns the Ben Jerry brand and Wall’s sausages. The US diet phenomenon Jenny Craig was bought by Swiss multinational Nestlé, which also sells chocolate and ice-cream. In 2011, Nestlé was listed in Fortune’s Global 500 as the world’s most profitable company.

These multinationals were easing carefully into a multibillion pound weight-loss market encompassing gyms, home fitness, fad diets and crash diets, and the kind of magazines that feature celebs on yo-yo diets or pushing fitness DVDs promising an “all new you” in just three weeks.

You would think there might be a problem here: the food industry has one ostensible objective – and that’s to sell food. But by creating the ultimate oxymoron of diet food – something you eat to lose weight – it squared a seemingly impossible circle. And we bought it. Highly processed diet meals emerged, often with more sugar in them than the originals, but marketed for weight loss, and here is the key get-out clause, “as part of a calorie-controlled diet”. You can even buy a diet Black Forest gateau if want.

Diet 2
We think of obesity and dieting as polar opposities, but there is a deep relationship between the two

So what you see when you walk into a supermarket in 2013 is the entire 360 degrees of obesity in a single glance. The whole panorama of fattening you up and slimming you down, owned by conglomerates which have analysed every angle and money-making opportunity. The very food companies charged with making us fat in the first place are now also making money from the obesity epidemic.

How did this happen? Let me sketch two alternative scenarios. This is the first: in the late 1970s, food companies made tasty new food. People started to get fat. By the 1990s, NHS costs related to obesity were ballooning. Government, health experts and, surprisingly, the food industry were brought in to consult on what was to be done. They agreed that the blame lay with the consumer – fat people needed to go on diets and exercise. The plan didn’t work. In the 21st century, people are getting fatter than ever.

OK, here’s scenario two. Food companies made tasty new food. People started to get fat. By the 1990s, food companies and, more to the point, the pharmaceutical industry, looked at the escalating obesity crisis, and realised there was a huge amount of money to be made.

But, seen purely in terms of profit, the biggest market wasn’t just the clinically obese (those people with a BMI of 30-plus), whose condition creates genuine health concerns, but the billions of ordinary people worldwide who are just a little overweight, and do not consider their weight to be a significant health problem.

That was all about to change. A key turning point was 3 June 1997. On this date the World Health Organisation (WHO) convened an expert consultation in Geneva that formed the basis for a report that defined obesity not merely as a coming social catastrophe, but as an “epidemic”.

The word “epidemic” is crucial when it comes to making money out of obesity, because once it is an epidemic, it is a medical catastrophe. And if it is medical, someone can supply a “cure”.

The author of the report was one of the world’s leading obesity experts, Professor Philip James, who, having started out as a doctor, had been one of the first to spot obesity rising in his patients in the mid-1970s. In 1995 he set up a body called the International Obesity Task Force (IOTF), which reported on rising obesity levels across the globe and on health policy proposals for how the problem could be addressed.

It is widely accepted that James put fat on the map, and thus it was appropriate that the IOTF should draft the WHO report of the late 90s that would define global obesity. The report painted an apocalyptic picture of obesity going off the scale across the globe.

The devil was in the detail – and the detail lay in where you drew the line between “normal” and “overweight”. Several colleagues questioned the group’s decision to lower the cut-off point for being “overweight” – from a BMI of 27 to 25. Overnight, millions of people around the globe would shift from the “normal” to the “overweight” category.

Professor Judith Stern, vice president of the American Obesity Association, was critical, and suspicious. “There are certain risks associated with being obese … but in the 25-to-27 area it’s low-risk. When you get over 27 the risk becomes higher. So why would you take a whole category and make this category related to risk when it isn’t?”

Why indeed. Why were millions of people previously considered “normal” now overweight? Why were they being tarred with the same brush of mortality, as James’s critics would argue, as those who are genuinely obese?

I asked James where the science for moving the cut-off to BMI 25 had come from. He said: “The death rates went up in America at 25 and they went up in Britain at 25 and it all fits the idea that BMI 25 is the reasonable pragmatic cut-off point across the world. So we changed global policy on obesity.”

James says he based this hugely significant decision, one that would define our global understanding of obesity, partly on prewar data provided by US insurance company Met Life. But this data remains questionable, according to Joel Guerin, a US author who has examined the work produced by Met Life’s chief statistician Louis Dublin.

“It wasn’t based on any kind of scientific evidence at all,” according to Guerin. “Dublin essentially looked at his data and just arbitrarily decided that he would take the desirable weight for people who were aged 25 and apply it to everyone.”

I was interested in who stood to gain from his report and asked James where the funding for the IOTF report came from. “Oh, that’s very important. The people who funded the IOTF were drugs companies.” And how much was he paid? “They used to give me cheques for about 200,000 a time. And I think I had a million or more.” And did they ever ask him to push any specific agenda? “Not at all.”

James says he was not influenced by the drug companies that funded his work but there’s no doubt that, overnight, his report reclassified millions of people as overweight and massively expanded the customer base for the weight-loss industry.

James rightly points out that he needed the muscle of drugs companies to press home the urgency of the unfolding obesity problem as a global public health issue, but didn’t he see the money-making potential for the drug companies in defining obesity as an “epidemic”?

“Oh, let us be very clear,” he says. “If you have a drug that drops your weight and doesn’t do you any other harm in terms of side-effects, that is a multibillion megabuck drug.”

The Men Who Made Us Thin
Former GSK sales rep Blair Hamrick with Jacques Peretti. Photograph: Brendan Easton/BBC/Fresh One Productions/Brendan Easton

I asked Gustav Ando, a director at IHS Healthcare Group, how important this decision to define obesity as a medical epidemic was for the industry. “It really turned a lot of heads,” he said. “Defining it as an epidemic has been hugely important in changing the market perception.” The drugs companies could now provide, Ando explained, “the magic bullet”.

Paul Campos, a legal expert with a special interest in the politics of obesity, saw the decision to shift the BMI downwards as crucial not just in making a giant new customer base for diet drugs but in stigmatising the overweight. “What had been a relatively minor concern from a public health perspective suddenly was turned into this kind of global panic,” he told me. “I think when you look at this issue what you see is a combination of economic interests with cultural prejudice which led to a toxic brew of social panic over weight in our culture.”

But guess what? The drugs wheeled out to clean up the “epidemic” didn’t turn into the blockbusters the industry had hoped for.

Since the 1950s, the great dirty secret of weight loss was amphetamines, prescribed to millions of British housewives who wanted to lose pounds. In the 1970s, they were banned for being highly addictive and for contributing to heart attacks and strokes. Now drugs were once more on the agenda – in particular, appetite-suppressants called fenfluramines. After trials in Europe, the US drugs giant Wyeth developed Redux, which was approved by the Food and Drug Administration (FDA) in spite of evidence of women developing pulmonary hypertension while taking fenfluramines. Dr Frank Rich, a cardiologist in Chicago, began seeing patients who had taken Redux with the same symptoms. And when one, a woman in Oklahoma City, died, Rich decided to go public, contacting the US news show Today.

“That was filmed in the morning and when I went to my office, within an hour later I got a phone call from a senior executive at Wyeth who saw the Today piece and was very upset. He warned me against ever speaking to the media again about his drug, and said if I did some very bad things would start happening, and hung up the phone.”

The Wyeth executive concerned has denied Rich’s version of events. But once legal liability cases began, evidence emerged from internal documents that Wyeth knew of far more cases of pulmonary hypertension than had been declared either to the FDA or to patients. Redux was taken off the market and Wyeth set aside $21.1bn for compensation. The company has always denied responsibility.

But with Wyeth out of the game, obesity was now an open door for other drugs companies.

British giant GlaxoSmithKline (GSK) found its antidepressant Wellbutrin had a handy side effect – it made people lose weight. Blair Hamrick was a sales rep for the company in the US tasked with getting doctors to prescribe the drug for weight loss as well as depression, a move that would considerably widen its market and profitability. In the trade, this is called “off-labelling”.

“If a doctor writes a prescription, that’s his prerogative, but for me to go in and sell it off label, for weight loss, is inappropriate,” says Hamrick. “It’s more than inappropriate – it’s illegal; people’s lives are at stake.”

GSK spent millions bribing doctors to prescribe Wellbutrin as a diet drug, but when Hamrick and others blew the whistle on conduct relating to Wellbutrin and two other drugs, the company was prosecuted in the US and agreed to a fine of $3bn, the largest healthcare fraud settlement in US history.

Drug companies had attempted to capitalise on obesity, but their fingers got burnt.

Still, there was a winner: the food industry. By creating diet lines for the larger market of the slightly overweight, not just the clinically obese, it had hit on an apparently limitless pot of gold.

Diet 3
In the late 1990s the cut-off point for being “overweight” went from a BMI of 27 to 25

There now exist two clear and separate markets. One is the overweight, many of whom go on endless diets, losing and then regaining the weight, and providing a constant revenue stream for the both the food industry and the diet industry throughout their adult lives. (As former finance director of Weight Watchers, Richard Samber, put it to me – “It’s successful because the 84% [who can’t keep the weight off] keep coming back. That’s where your business comes from.”) The other market is the genuinely obese, who are being cut adrift from society, having been failed by health initiative after health initiative from government.

As Dr Kelly Brownell, director of the Rudd Centre for food policy and obesity at Yale University, explained, the analogy must now be with smoking and lung cancer: “There’s a very clear tobacco industry playbook, and if you put it next to what the food companies are doing now, it looks pretty similar. Distort the science, say that your products aren’t causing harm when you know they are.”

But the solution to obesity could also follow the cigarette trajectory too, according to Brownell. It was only after a combination of heavy taxation (price), heavy legislation (banning smoking in public places), and heavy propaganda (warnings on packets; an effective, sustained anti-smoking advertising campaign; and most crucially, education in schools) was brought to bear on a resistant tobacco industry that smoking became a pariah activity for a new generation of potential consumers, and real, lasting change took place. Similar measures, Brownell says, could provide an answer to obesity.

And it’s funny, that analogy with smoking. Because deep in the archive at San Francisco University is a confidential memo written by an executive at the tobacco giant Philip Morris in the late 1990s, just as the WHO was defining obesity as a coming epidemic, advising the food giant Kraft on strategies to employ when it started being criticised for creating obesity.

Titled “Lessons Learnt From the Tobacco Wars”, it makes fascinating reading. The memo explains that just as consumers now blame cigarette companies for lung cancer, so they will end up blaming food companies for obesity, unless a panoply of defensive strategies are put into action. You might conclude that there was a good reason why the food industry bought into dieting – it was nothing personal, it was just business.

Jacques Peretti presents The Men Who Made Us Thin, 9pm, BBC2, Thursday 8 August.

Diet soda won't save you from obesity or diabetes | Grist

Diet cokes
Niall Kennedy

Bad news for everybody who drinks diet sodas instead of the sugary varieties to help stay healthy.

In an opinion piece [PDF] in the journal Trends in Endocrinology and Metabolism, Purdue University professor Susan Swithers writes that drinks containing such chemicals as aspartame, sucralose, and saccharin have been found to contribute to excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Her piece summarizes studies on the health effects of artificial sweeteners:

Recent data from humans and rodent models have provided little support for ASB [artificially sweetened beverages] in promoting weight loss or preventing negative health outcomes such as [type 2 diabetes], metabolic syndrome, and cardiovascular events. Instead, a number of studies suggest people who regularly consume ASB are at increased risk compared with those that do not.

How is this possible? Swithers describes a number of theories, some of them relating to the effects of such sweeteners on metabolism. “Sweet tastes are known to evoke numerous physiological responses,” she writes. “By weakening the validity of sweet taste as a signal for caloric post-ingestive outcomes, consumption of artificial sweeteners could impair energy and body weight regulation.”

NPR’s Alison Aubrey put Swithers’ piece into some context:

Not everyone is convinced that diet soda is so bad.

For instance, a study I reported on last year by researchers at Boston Children’s Hospital found that overweight teens did well when they switched from sugar-laden drinks to zero-calorie options such as diet soda.

But it’s also hard to ignore the gathering body of evidence that points to potentially bad outcomes associated with a diet soda habit.

One example: the findings of the San Antonio Heart Study, which pointed to a strong link between diet soda consumption and weight gain over time.

“On average, for each diet soft drink our participants drank per day, they were 65 percent more likely to become overweight during the next seven to eight years” said Sharon Fowler, in a release announcing the findings several years back.

Another bit of evidence: A multi-ethnic study, which included some 5,000 men and women, found that diet soda consumption was linked to a significantly increased risk of both type-2 diabetes and metabolic syndrome.

If you’re choosing between a diet soda and a regular soda, then it’s probably healthier to go for the former. But these studies are a reminder that such a choice won’t keep you healthy.

It’s also worth remembering that some scientists have found that artificial sweeteners can be toxic. Some countries even require health warnings on drinks containing such products, such as this one on a can of Diet Coke sold in India:

Warning on a can of Diet Coke sold in India
John Upton

Fitly launches pilot program to tackle America's growing obesity …

American children are getting fatter.

Fitly launched its pilot program today that takes on the childhood obesity epidemic by making it easier for families to eat healthy. Parents subscribe to Fitly’s weekly healthy meal planner and choose from a list of nutritious meals. They can order their groceries through Fitly’s website, and Fitly sends the order to a nearby store. Groceries are delivered (for free) every week to a pickup location like an office, school, or recreation center.

Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years, and more than one-third of children and adolescents are overweight or obese. Obese youth are at a higher risk for cardiovascular disease, cancer, and diabetes as well as bone and joint problems, sleep apnea, and social and psychological problems. These are alarming statistics, and yet obesity is highly preventable through healthy eating and physical activity.

Founder Anthony Ortiz was inspired to start Fitly after witnessing two of his nephews become at-risk through bad eating habits, his brother and sister-in-law struggle with their weight, and his father go through a triple bypass surgery. He wanted to make it as easy as possible for families to adopt healthy eating habits together.

Fitly also offers featuring dietitian-approved meals that promote a 50 percent plant-based diet. Parents select meals and have their groceries delivered with simple preparation instructions. All they have to do is prepare the meals.

Fitly also applies gamification techniques to make maintaining a nutritious diet more fun for kids, with weekly competitions and prizes for making healthy choices.

Fitly participated in DreamIt health accelerator and has established partnerships with Independence Blue Cross and Penn Medicine. It is also working with The Fresh Grocer, an online supermarket chain to deliver the groceries, and Ortiz said that the cost is comparable to going to a local grocery store. The pilot program will be available in the mid-Atlantic region, and the goal is to expand nationally within a couple months.

Food startups are attracting more attention from consumers, entrepreneurs, and venture capitalists as people are beginning to make better choices about what they eat and are looking for technology solutions to help them do so. VCs like Khosla Ventures, Kleiner Perkins Caufield Byers and noteworthy folk such as Bill Gates and Dave McClure have called for innovation in this area. Along with Fitly, there are other startups out there like Good Eggs, Farmigo, and Relay Foods that are working on more new models for a sustainable food system.

These models can be difficult to set up and scale, however. They deal with complicated supply chains, perishable products, and every market has different retailers to work with. Plus the profit margins are often slim. But the obesity epidemic is looming larger and larger and the American population is increasingly concerned about the dangers of Monsanto and processed food. The organic, local, seasonal food movement has taken off and consumers are more interested in buying quality ingredients  and eating well.

There are certainly challenges, but this is an issue that can’t be ignored.