Getting patients to adopt healthy lifestyle choices can be challenging. By this time many New Years Resolutions have been broken. This newly released TEDTalk by Sandra Aamodt (neuroscientist) has a compelling argument for making positive lifestyle choices if an individual is overweight or clinically obese. After the video is a list of articles that touch on the concepts and ideas she presents in her talk.
Sandra Aamodt: Why dieting doesn’t usually work [12 minutes 42 seconds]
Articles
- Int J Obes (Lond). 2010 Oct;34 Suppl 1:S47-55. doi: 10.1038/ijo.2010.184.
Adaptive thermogenesis in humans.
Rosenbaum M, Leibel RL.
The increasing prevalence of obesity and its comorbidities reflects the interaction of genes that favor the storage of excess energy as fat with an environment that provides ad libitum availability of energy-dense foods and encourages an increasingly sedentary lifestyle. Although weight reduction is difficult in and of itself, anyone who has ever lost weight will confirm that it is much harder to keep the weight off once it has been lost. The over 80% recidivism rate to preweight loss levels of body fatness after otherwise successful weight loss is due to the coordinate actions of metabolic, behavioral, neuroendocrine and autonomic responses designed to maintain body energy stores (fat) at a central nervous system-defined ‘ideal’. This ‘adaptive thermogenesis’ creates the ideal situation for weight regain and is operant in both lean and obese individuals attempting to sustain reduced body weights. Much of this opposition to sustained weight loss is mediated by the adipocyte-derived hormone ‘leptin’. The multiple systems regulating energy stores and opposing the maintenance of a reduced body weight illustrate that body energy stores in general and obesity in particular are actively ‘defended’ by interlocking bioenergetic and neurobiological physiologies. Important inferences can be drawn for therapeutic strategies by recognizing obesity as a disease in which the human body actively opposes the ‘cure’ over long periods of time beyond the initial resolution of symptomatology. - Can Fam Physician. 2013 Jan;59(1):27-31.
Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care.
Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y.
OBJECTIVE: To adapt the 5 As model in order to provide primary care practitioners with a framework for obesity counseling.
SOURCES OF INFORMATION: A systematic literature search of MEDLINE using the search terms 5 A’s (49 articles retrieved, all relevant) and 5 A’s and primary care (8 articles retrieved, all redundant) was conducted. The National Institute of Health and the World Health Organization websites were also searched.
MAIN MESSAGE: The 5 As (ask, assess, advise, agree, and assist), developed for smoking cessation, can be adapted for obesity counseling. Ask permission to discuss weight; be nonjudgmental and explore the patient’s readiness for change. Assess body mass index, waist circumference, and obesity stage; explore drivers and complications of excess weight. Advise the patient about the health risks of obesity, the benefits of modest weight loss, the need for a long-term strategy, and treatment options. Agree on realistic weight-loss expectations, targets, behavioural changes, and specific details of the treatment plan. Assist in identifying and addressing barriers; provide resources, assist in finding and consulting with appropriate providers, and arrange regular follow-up.
CONCLUSION: The 5 As comprise a manageable evidence-based behavioural intervention strategy that has the potential to improve the success of weight management within primary care. - Public Health Nutr. 2012 Dec;15(12):2272-9. doi: 10.1017/S1368980012000882. Epub 2012 Mar 23.
Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. [request from us]
Madden CE, Leong SL, Gray A, Horwath CC.
OBJECTIVE: To examine the association between eating in response to hunger and satiety signals (intuitive eating) and BMI. A second objective was to determine whether the hypothesized higher BMI in less intuitive eaters could be explained by the intake of specific foods, speed of eating or binge eating. DESIGN: Cross-sectional survey. Participants were randomly selected from a nationally representative sampling frame. Eating in response to hunger and satiety signals (termed ‘intuitive eating’), self-reported height and weight, frequency of binge eating, speed of eating and usual intakes of fruits, vegetables and selected high-fat and/or high-sugar foods were measured.
SETTING: Nationwide study, New Zealand.
SUBJECTS: Women (n 2500) aged 40-50 years randomly selected from New Zealand electoral rolls, including Māori rolls (66 % response rate; n 1601).
RESULTS: Intuitive Eating Scale (IES) scores were significantly associated with BMI in an inverse direction, after adjusting for potential confounding variables. When controlling for confounding variables, as well as potential mediators, the inverse association between intuitive eating (potential range of IES score: 21-105) and BMI was only slightly attenuated and remained statistically significant (5.1 % decrease in BMI for every 10-unit increase in intuitive eating; 95 % CI 4.2, 6.1 %; P < 0.001). The relationship between intuitive eating and BMI was partially mediated by frequency of binge eating.
CONCLUSIONS: Eating in response to hunger and satiety signals is strongly associated with lower BMI in mid-age women. The direction of causality needs to be investigated in longitudinal studies and randomized controlled trials. - JABFM: Journal of The American Board of Family Medicine. 2012 Jan-Feb; 25(1): 9-15.
Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals
Eric M. Matheson, MS, MD, Dana E. King, MS, MD and Charles J. Everett, PhD
Background: Though the benefits of healthy lifestyle choices are well-established among the general population, less is known about how developing and adhering to healthy lifestyle habits benefits obese versus normal weight or overweight individuals. The purpose of this study was to determine the association between healthy lifestyle habits (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking) and mortality in a large, population-based sample stratified by body mass index (BMI).
Methods: We examined the association between healthy lifestyle habits and mortality in a sample of 11,761 men and women from the National Health and Nutrition Examination Survey III; subjects were ages 21 and older and fell at various points along the BMI scale, from normal weight to obese. Subjects were enrolled between October 1988 and October 1994 and were followed for an average of 170 months.
Results: After multivariable adjustment for age, sex, race, education, and marital status, the hazard ratios (95% CIs) for all-cause mortality for individuals who adhered to 0, 1, 2, or 3 healthy habits were 3.27 (2.36–4.54), 2.59 (2.06–3.25), 1.74 (1.51–2.02), and 1.29 (1.09–1.53), respectively, relative to individuals who adhered to all 4 healthy habits. When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group.
Conclusions: Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index. - Am Psychol. 2007 Apr;62(3):220-33.
Medicare’s search for effective obesity treatments: diets are not the answer. [request from us]
Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J.
The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.
