Experts berate government for lack of action on childhood obesity
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5476 (Published 14 October 2015) Cite this as: BMJ 2015;351:h5476All rapid responses
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The usual explanation for obesity is a breakdown in energy homeostasis: too much energy in, not enough energy out. The energy balance theory (EBT) has led to stigmatisation and victim blaming of people with obesity who may be perceived to be greedy and lazy. The trouble is there is no real explanation of who develops obesity and why. After fifty years of interventions designed using the EBT, the obesity epidemic is running out of control. The current offerings for treatment and prevention have shown dismal results.
A new theory proposes that obesity is caused by a breakdown of homeostasis at a psychological level (Marks, 2015). Homeostasis is the fundamental process for the maintenance of the healthy organism and is the principle process regulating energy. A parallel system influencing energy regulation is the hedonic reward system. According to the theory, obesity occurs when the hedonic reward system disrupts or overrides homeostasis.
Over-consumption of high-caloric, low-nutrient foods, combined with stressful living and working conditions, have caused loss of equilibrium, overweight and obesity in more than one billion people. There is a significantly higher prevalence of the condition in low socioeconomic groups.
Research on different diets suggests that a plant-based diet containing low amounts of sugar, little or no red meat and the minimum of fats promotes weight-loss and prevents obesity, diabetes, metabolic syndrome, coronary heart disease, and cancer. A vegan diet with no meat, fish or dairy is especially anti-obesogenic.
The 'thin ideal' pervades popular culture with narratives and images of thinness. This influence has an entirely negative effect on youth the world over. Discrimination against people who are overweight or obese causes stress and socio-economic disadvantage. Approaches to the epidemic that invoke a narrative of 'blame-and-shame' exacerbate the problem. There are very few people who deliberately become obese through conscious effort or who would not like to avoid it if they possibly could.
Homeostatic imbalance in obesity establishes a 'Circle of Discontent' (COD), a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption (Figure 1). Homeostasis COD theory is consistent with a large evidence-base of cross-sectional and prospective studies (Marks, 2015, 2016).
Disruption of energy homeostasis causes disorders including obesity, the addictions, chronic conditions including stress in persons with diverse bodies. All such conditions entail the self-reinforcing activity of a vicious Circle of Discontent. Hedonic reward overrides weight homeostasis to produce Obesity Dyshomeostasis.
A preliminary model suggests that OD is mediated by the prefrontal cortex, amygdala and HPA axis with signalling by the peptide hormone ghrelin which simultaneously controls feeding, affect and hedonic reward.
The totality of evidence within current knowledge suggests that obesity is a persistent, intractable condition. Prevention and treatment efforts targeting sources of dyshomeostasis provide ways of reducing adiposity, ameliorating addiction, and raising the quality of life in people suffering chronic stress. Methods of prevention are needed which diminish the importance of processes in the Circle of Discontent, namely Body Dissatisfaction, Negative Affect and Overconsumption of High-Energy Foods.
Governmental actions independent of corporate interests are required at all levels of society to reduce the prevalence of obesity and related diet-based conditions. A four-armed strategy to halt the obesity epidemic consists of: (i) Putting a stop to victim-blaming, stigma and discrimination; (ii) Devalorizing the thin-ideal; (iii) Reducing the consumption of energy-dense, low nutrient foods and drinks; (iv) Improving access to plant-based diets. If fully implemented, the proposed measures would help to restore homeostasis and halt the obesity epidemic.
Current treatments of obesity are ineffective. New treatments which target the ghrelin axis have potential to offer long-lasting treatments.
References
Marks, D F (2015). Homeostatic theory of obesity. Health Psychology Open 1(2) doi:2055102915590692.
Marks DF (2016) Dyshomeostasis, obesity, addiction and chronic stress. Health Psychology Open Mar 2(2) (in press).
Competing interests: No competing interests
This response is not to the article regarding allegations of government inaction on childhood obesity but with regard to the image that accompanied the article. It showed two smiling children with BMIs clearly in the overweight or obese range looking into the camera. They were laying on a sofa with take-away food in front of them and a gaming console on the sofa. My guess is the children ranged in age from about 6 years to 11 years of age. Here is my question(s) (and it truly is a question - I don't have an answer) - is it appropriate to use these children in this way?
These children are not old enough to give informed consent to be featured beside an article that presumably features them as indicative of the childhood obesity problem. Now first is this a problem? I don't know - perhaps it could stigmatise these children - or is it stigmatising to suggest that their body form could be considered a source of stigma in this context? Perhaps the image came from a commercial image service such as shutterstock and perhaps the children's parents signed a release for the commercial reuse of the image but could they know all of the uses and contexts it would be put to? Even if they did know the use it would be put to does it make it OK for the BMJ to use the image? Perhaps the children will never see this image used in a way that is stigmatising - although it is downloadable as a powerpoint file and their friends could come across it on the web or in a slideshare presentation and repost it to social media. Does the image assist the story? Does this matter - I don't know.
Competing interests: No competing interests
Re: Experts berate government for lack of action on childhood obesity
Experts berate governments for lack of action on childhood obesity.
There seems to be an automatic general reaction to blame ‘everything’ on the government, or the patient.
The experts referred to in the original article are no exception in berating government for lack of action on childhood obesity.
Even though I agree with David F Marks on two things, namely that
“effective action on obesity required better understanding of its causes”,
and that there is a general stigmatisation and ‘’victim blaming of people
with obesity who may be perceived to be greedy and lazy”, I’d like to
make a point that there is a valid medical, explanation of who develops
obesity and why years of interventions designed using the EBT (energy
balance theory) the obesity epidemic is running out of control.
He suggests “A new theory [which] proposes that obesity is caused by the breakdown of homeostasis at a psychological level (Marks 2015). According to DF Marks’ theory, “A parallel system influencing energy regulation is the hedonistic reward system. According to the theory, obesity occurs when the hedonistic reward system disrupts or overrides homeostasis.”
The “hedonistic reward system” seems to me to, again, putting the blame on the patient.
The published medical research evidence points to an increasing general problem of hyperinsulinism of childhood onset which may persist into adulthood.
Hannik and Cohen (1978) documented that very young babies developed slight but significant increase in plasma insulin concentration within 8 hours of the first DPT [and polio] vaccination. They suggested that “infants who show serious reactions following pertussis vaccination suffer from a failure to maintain glucose homeostasis…Low blood sugar level and increased extremely low CFS-glucose concentration have been reported in children who developed convulsions 3 and 36 hours after receiving pertussis vaccine.”
Zametkin et al. (1990) demonstrated that adults with hyperactivity of childhood onset suffer derangement of cerebral glucose metabolism affecting exactly those parts of the brain which control attention and motor activity: prefrontal cortex and superior prefrontal cortex.
Hyperinsulinism became a major problem of infancy (Glaser et al.1993).
Hughes et al. (1997) demonstrated a significant increase in both the height and weight of 5-11 year old English and Scottish children.
Freedman et al. (1997) dealt with secular increases in relative height and adiposity among children over two decades (1973-1994) in Ward 4 of Washington Parish, Louisiana, a biracial community: a 50% greater increase in mean levels of weight and skinfold thickness by 1994 compared with those born between 1973 and 1982 [in my opinion, reflecting increased vaccination compliance and more vaccines being added to the recommended schedule.]
Scott et al. (1997) demonstrated a close connection between obesity and youth-onset of both non-insulin-, and insulin-dependent, diabetes mellitus.
The Royal Australian College of Physicians Annual Meeting in Wellington (New Zealand; October 2005) was presented with evidence that the study of nearly 200 children showed that weight problems were significantly associated with sleep disorders, headaches, musculoskeletal pain, depression, anxiety and bullying.
The epidemic of diabetes in small children was documented by Classen JBV (1996) and Classen JBV and Classen DS (1999).
Acetaminophen (paracetamol) was shown to be hepatotoxic even in therapeutic doses, yet parents are often advised to use it ”as needed” to alleviate pain and fever after vaccination, although orthodox medical research warns about the fallacy and dangers of such efforts. Hull (1989) wrote that high body temperatures may assist in the controlling pathogenic microorganisms and Havinga (1997) warned that giving paracetamol for fever in unnecessary.
According to Medical Observer (2005; May 17), there are alarming levels of hyperinsulinism, fatty liver, dylipidaemia and other complications present in Australian primary school children with high body mass index (BMI).
Antibiotics are used in animal industry to enhance the protein (flesh) production and weight in food animals. Children develop ear infections and upper/lower respiratory and urinary tract infections after vaccination (Craighead 1975) and may be given several rounds of antibiotics by the age of one year. It is not difficult to see that these have the same effect on children as they have on young food animals: they make them fat and muscular (beefy).
The fattening effect of prophylactic antibiotics used to prevent pneumonia and other complications after measles in Guinea-Bissau, a developing country, was, unwittingly, demonstrated by Garly et al. (1996). They wrote, The group that received prophylactic antibiotics had less pneumonia and conjunctivitis and had significantly higher weight gains in the months after inclusion [into the study].
For more details see Scheibner (2014).
In summary, obesity is a medical condition, and the possible accompanying psychological problems are a consequence rather than the cause.
References.
Marks DF, 2015. Homeostatic theory of obesity. Health Psychology Open 1(2)
Hannik and Cohen. 1978. Changes in plasma insulin concentration and temperature of infants after pertussis vaccination. Third International Symposium on Pertussis.
Zametkin et al. 1990. Adults with hyperactivity of childhood onset suffer derangement of cerebral glucose metabolism. NEJM; 323(2): 1361-1366.
Glaser et al. 1993. Persistent hyperinsulinism/hypoglycemia of infancy- long term octreotide treatment without pancreatectomy. Pediatrics; 123: 644-650.
Hughes et al.1997. Trends in growth in England and Scotland 1972-1994. Arch Dis Child; 76: 182-189.
Freedman et al. 1997. Secular increases in relative weight and adiposity among children over two decades from 1973 to 1994, residing in Ward 4 of Washington Parish, Lousiana, a biracial community. Pediatrics; 99(3): 420-426.
Scott et al. 19978. Characteristics of youth-onset of non-insulin dependent diabetes mellitus and insulin-dependent diabetes mellitus at diagnosis. Pediatrics; 100: 84-91.
Classen JBV. 1996. The epidemic f diabetes in small children. NZ Med J; 24 May:195.
Classen JBV and Classen DS. 1999. Association between type1 diabetes and Hib vaccine. BMJ; 319: 1133.
CFM 1973. Acetaminophen: potential pediatric hazard. Pediatrics; 52(6): 883.
Hull 1989. Fever – a fire of life. Arch Dis Child; 64: 1741-1747.
Havinga 1997. Giving paracetamol for fever is unnecessary. BMJ; 314: 1692-1693.
Craighead. 1975. Disease accentuation after immunisation with inactivated microbial vaccines. J Infect Dis; 1312(6): 749-754.
Garly et al. 1996. Prophylactic antibiotics to prevent pneumonia and other complications after measles: community based randomized double blind – placebo controlled trial in Guinea-Bissau. a developing country. BMJ,doi:10.1136/bmj.38989.AE published 23 October 2006).
Scheibner 2014. Obesity and childhood vaccines: is there a connection? WWW.hormonesmatter.com .
Competing interests: No competing interests