Monday, October 23, 2017

Finally … The Answer to The Obesity Crisis

After years, decades … there is finally an answer.

Yes.  THE answer.

An answer to the most talked-about, feared, revered (?) epidemic that has hit our communities, our kids, our schools, our culture in decades.

What is this answer?  Well, before we can get to the answer, let’s further investigate the question.

Wait.  …

What was the question, again?question-marks-300x300www.caraklee.com

Is the question: “What is the answer to the obesity crisis”?

If that IS the question, then what are we really asking … (the question within the question)?

Are we asking, “how do we create smaller individuals?” or … better yet … “how do we create more thin people?” — is this really the question that we are asking?  In the case of childhood obesity, is it:

“How can we create more thin kids?”

Because I’m pretty sure I have the answer, but first, we need to agree on the question.

If the question is: “How do we create more thin people,” then we currently may be addressing it in the right way.  Aren’t we?  I mean, it seems that every school I have visited in the last 8 years has now adopted a regimented food and exercise program.  So — if all we are trying to do is just create “thin” kids — then I suppose restricting intake, limiting food choices and increasing exercise could be the way to go.  Unless …

Oh … Well … wait …

What if research tells us that restricting food actually increases risk for obesity and weight gain?

What then?

According to registered dietician and eating disorders specialist, Elyse Resch, MS, RD, CEDRD, FADA, Fiaedp, co-Author of Intuitive Eating:

“Studies have shown that 49% of people who go on diets experience post-diet binging. Young people who go on diets have an eight times greater risk of developing an eating disorder by the age of 15.”* 

So, if our goal is to create more THIN KIDS, our approach of restricting food intake and increasing exercise isn’t actually working.  In fact, restricting food increases risk, not only for obesity, but for eating disorders and serious psychological illnesses.1

Not to mention the psychological repurcussions of teaching kids they can’t have a certain food.  The more we say “don’t eat that cookie” the more the brain says “I want that cookie” and it sets a child up to fail.

In addition, restricting an individual’s diet and increasing their exercise in an effort to “manage their obesity” is based on a glaring and erroneous myth about individuals who are obese.  Our cultural assumption is that individuals in larger bodies are lazy, inactive and are eating too much food.  This assumption leads to the logical intervention of restricting food and increasing exercise.

This assumption points to a grave lack of understanding of THE ROOT CAUSES OF OBESITY.

What are the risk factors FOR obesity?

I have read countless obesity guidebooks and toolkits written by national child psychiatrists, endocrinologists, physicians and public health officials — all of whom are discussing obesity WITHOUT discussing the myriad risk factors that cause it.  Nowhere on the Center for Disease Control’s website will you find a list of the factors that CAUSE obesity.  Only the risk factors caused BY being obese.2  If the lists exist, they focus only on physical health factors and not social, emotional or psychological.

THIS OVERSIGHT IS A GLARING ERROR THAT IS CAUSING HARM TO MANY INDIVIDUALS and is adding to the obesity epidemic and other health complications in our country.

Evaluating the risk factors that lead to obesity (or thinness, or medium sized body shape) is essential in managing an individual’s overall health.

When we look at the myriad of psychological, social and physical risk factors for obesity, as Diane Neumark-Szteiner, Rebecca Puhl, and others are doing … we can start to understand the complexity of the condition… and new ways to address it.

This, then, leads to another question: when — how — did food become a mental health issue?

According to recent research, the day we started attaching shame to a child’s body, shape, weight, food choice and exercise habits, is the day we created the problem that we are now trying to solve.  In our field, we call this weight shame … and research coming out of the Yale Rudd Center is telling us that the more we increase weight shame, the more we increase risk for obesity.3, 3a

A report published in last month’s JAMA Pediatrics concluded that “being labeled too fat in childhood was associated with higher odds of having an obese BMI nearly a decade later. 4  Similarly, Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.5

When it comes to the significance of addressing risk factors that aren’t being considered by most medical professionals — especially in schools — I’d like to share two practical examples from my work in South Carolina.

Our “obese child” is a little girl from a free-and-reduced-lunch district.  She is struggling with poverty.  Let’s say she goes to school and can barely afford the backpack that she is carrying, let alone a robust meal that morning.  Our little girl arrives at school and sees all of the other kids eating from their polished lunch pails.  How do you think she is doing in terms of her shame levels right about now?

How does she feel when she sees the “Biggest Loser” or “War on Obesity” signage on the walls of the school?  How does she feel when she is measured for her BMI?  And we can probably guess that it isn’t helping her shame levels to be reminded of her economic status every meal time, when she has to be the one to take the free-and-reduced lunch… or go home at night without dinner waiting for her.

When we focus solely on a child’s body and obsess about her food and exercise habits, we are increasing risks for mental health complications that drive the disordered eating and exercise behaviors.  We are, in effect, decreasing the child’s overall health.

And yet, the above have become the primary tactics and measures being employed in schools and communities nationwide.

When we increase shame levels, we decrease a child’s ability to cope with difficult experiences.  We literally affect the shape of the brain and its ability to function, when we increase shame in a person.6

And then there’s the “good food, bad food” strategies being employed in schools.  School nurses have told me that children are coming into their offices to ask for snacks because they are hungry — starving.  In some cases, this starvation is caused by their economic status.  In some cases, these kids fill their backpacks with the snack foods in order to go home at night and feed their family.  These snacks may be the only food the family has.  I am also learning that children are not coming forward to take their free-and-reduced lunch because they don’t want to suffer the humiliation.  They are, therefore, skipping lunch.

When we tell these kids that sugar is bad, junk food is bad, X food is BAD — when these foods may be the only choices a child has that day — we are not serving these children or families.  In fact, we are increasing risk and causing harm.

Second example from our work in South Carolina schools.  A group of teachers attend a training on eating disorders and afterwards, we learn that a teacher who was encouraged to diet and exercise as part of her school wellness program, now has anorexia.  The cause of her obesity was due to an eating disorder (for reference, a person can have any of the 6 types of eating disorders and still be in a large body).

So my answer — THE ANSWER — to the obesity crisis is this:

Stop the war on obesity.

Yes. That’s the answer.

It’s time to stop the war and start asking an entirely new question:

“How do we increase overall health in all kids?”

Some answers to this question:

Let’s start looking at the research-driven protective factors that we can start building in every child in America that are known to increase resilience against obesity, weight disorders, eating disorders and addictions alike.  In my company, we call this mentalfitness, which includes:

— increasing a child’s self-acceptance

decreasing weight stigma

— increasing body esteem (sample evidence-based programs include Reflections, The Body Project, Healthy Bodies)

— empowering kids through media literacy skills (sample evidence-based programs include, National Girls CollaborativeCenter for Media Literacy‘s System for Learning, MediaLit Moments! and Media Detective)

— increasing mindfulness skills (evidence-based treatment styles include MB-EAT, MBSR, MBRP)

— supporting kids through community connections, mentoring and role modeling (sample evidence-based mentoring programs)

— building healthy communication and assertiveness in all youth (sample evidence-based programs: CASEL)

— increasing awareness of ACTUAL DIETETICS (for example through evidence-based Intuitive Eating principles: according to a recent meta analysis of studies on Intuitive Eating published by the Journal of the Academy of Nutrition and Dietetics, there is strong “support of shifting the focus from dieting for weight loss to adopting an intuitive eating lifestyle.”)7

— build self-esteem in every child in America (sample evidence-based programs: G-SEP, Self-Esteem Boston, Lion’s Quest Skills for Adolescence)

— offer healthy coping and stress-management techniques (sample evidence-based healthy coping programs, evidence-based stress-management programs: TM (Transcendental Meditation), RR (Relaxation Response), BB (Belly Breathing))

 

The answer to the “obesity crisis” lies in shifting the primary questions that we are asking and focusing on mental fitness as well as physical fitness in addressing overall health.

Robyn Hussa Farrell, Founder and CEO of mentalfitness, inc.

 

For more information about obesity prevention, grab a copy of the AED Guidelines for Childhood Obesity Prevention Programs.

Our nonprofit organization, Mental Fitness, Inc., offers evidence-based professional development trainings for educators and medical professionals.  We link educators to the other programs that exist that enhance mental fitness in youth. To bring our qualified experts into your district, contact me directly at rfarrell@mentalfitnessinc.org.  Learn more about our work in collaboration with national researchers at www.mentalfitnessinc.org.

1. For more information on Intuitive Eating, see this handout created for our ThinkEatPlay program, by Elyse Resch, co-Author of Intuitive Eating: http://www.thinkeatplay.org/wp-content/uploads/2013/06/IntuitiveEatingFinal.pdf

2. http://www.cdc.gov/healthyyouth/obesity/facts.htm

3. Puhl, R.M, & Heuer, C.A. (2009). The stigma of obesity: A review and update. Obesity, 17, 941-964 (courtesy of Weight Stigma Stakeholder’s Group task force)
3a. Sutin, A., Terraciano, A., (2013). Perceived Weight Discrimination and Obesity.  PLoS ONE 8(7): e70048. doi:10.1371/journal.pone.0070048

4. Hunger, MA; A. Janet Tomiyama, J. (2014) Weight Labeling and Obesity: a Longitudinal study of Girls Aged 10 to 19 years.  JAMA Pediatr. Published online April 28, 2014. doi:10.1001/jamapediatrics.2014.122
5.  Neumark-Szteiner, D., Wall, M., Guo, J., et. al., (2006).  Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?  J Am Diet Assoc. 2006 Apr;106(4):559-68.  
6. retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907379/
6a. Neurobiological underpinnings of shame and guilt: a pilot fMRI study
http://www.ncbi.nlm.nih.gov/pubmed/23051901

7. For more information on Intuitive Eating, see this handout created for our ThinkEatPlay program, by Elyse Resch, co-Author of Intuitive Eating: http://www.thinkeatplay.org/wp-content/uploads/2013/06/IntuitiveEatingFinal.pdf

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