In the face of an encroaching obesity epidemic pundits constantly resort to simplistic and judgmental solutions, many of which blame sufferers, and worse, prescribe treatments and solutions that don’t work and don’t tackle the roots of the problem. Indeed our culture is rife with judgemental attitudes about weight and shape. Few of us are immune to preoccupations with our bodies, our kilo count, fat rolls, thigh sizes or belly width. Diet and food books consistently make the top 10 bestseller lists in the UK while rising obesity levels are seen as a huge threat to the NHS budget. While pubs serve ‘heart attack’ 2000 calorie burgers
, rising numbers of ‘super-obese’ young people are being prescribed surgery
. With all the angst, guilt and powerful opinionating we are too often left with a plethora of one-dimensional solutions and strident ideas, yet with too little understanding of what might lead to ‘issues’ of weight.
I want to return to basic research and scientific understandings which find little place in most discussions about food, weight and obesity. This is not about the effects of some of the worst excesses of advertising in which we are sold images of pre-pubescent bodies as the ideals we should all aim for. There is already a substantial literature about this, from the likes of Susie Orbach and others. Nor is this about the extraordinary profiteering of companies using substances like corn syrup which can induce addictions, nor the excessive use of sugar and salt and fats in our foods. Both media hype and frankly immoral selling of unhealthy addictive substances badly need addressing and certainly add to the problem but the story is bigger than that.
There is a danger that our discourses about food and obesity become another way of blaming the poor for their poverty and its effects. People are criticised for being lazy, greedy, lacking control or being selfish yet often what drives eating is far outside consciousness and has sensible explanations. Research has shown that stress and an uncertain future makes us attracted to fattening foods (Laran and Salerno 2013). If you subliminally give people messages suggesting that harsh economic times are around the corner and then you offer them both high and low calorie food, they tend to choose more fattening food than those given more hopeful messages. Indeed when both groups are offered exactly the same food, but some are told that this food is high calorie, those receiving messages of economic trouble or hard times consume considerably more of the supposedly high rather than low calorie food. Why? This makes sense from an evolutionary perspective. In our hunter gatherer pasts when the environment and food sources were uncertain and there was little sustenance available, our bodies pushed to stock up on calories and fats. These are not conscious decisions but bodily-led non-conscious and almost instinctual ones, and were successful strategies over tens of thousands of years of evolution. The people who did this and survived would have passed on their genes. The flip side of course is that when we feel at ease, safe and under no threat then we tend to eat more healthily.
Other studies have shown that during the recent recession food spending reduced, and people spent more on foods which were higher in calories and saturated fats (Griffith et al. 2014). I assume such choices were influenced by similar non-conscious preferences for conserving calories in times of need. To make matters worse, amazingly if we have a stressful or depressing event that takes place about 6 hours before eating a high fat meal then our metabolism slows down and we are more likely to put on weight. Those not experiencing stressors six hours before the very same high fat meal had metabolisms which did not slow down. This can translate to around an 11kg weight difference over a year for stressed or depressed people compared to a non-stressed control groups (Kiecolt-Glaser et al. 2014). One must assume that the psychobiological drivers are similar here, the world is scary and uncertain and we need to stock up now.
Stress and anxiety of course have many other worrying psychobiological effects, including the likelihood of a range of diseases as people get older, and indeed earlier death (Van Niel et al. 2014; Dube et al. 2003). There are of course many other powerful links, such as between stress and poor sleep and poor sleep and higher body mass index and also less healthy eating (Kjeldsen et al. 2013) and greater risk for obesity (Dweck et al. 2014).
Indeed there is a growing literature on the relationship between stress and trauma and obesity, with childhood trauma associated not only with obesity but also with a hugely increased likelihood of diseases loosely grouped under the heading of metabolic syndrome, including heart disease, diabetes and strokes (Farr et al. 2014). One huge study, analysing 112,00 subjects found a very clear link between early childhood trauma and adult obesity (Hemmingsson et al. 2014). How might this happen? It seems that high stress levels disrupt our metabolisms, having an effect on our body chemistry and on weight-regulating hormones such as leptin, adiponectin and irisin, particularly in people who suffered childhood abuse or trauma (Dalamaga et al. 2013).
Obesity is of course also related to the stressors that occur due to low socio-economic status, with people, especially women, raised in poorer circumstances being considerably more likely to be overweight as adults (Pudrovska et al. 2014). The socio-economic status of the neighbourhood one is brought up in seems to be a powerful determinant of weight (Rossen and Talih 2014).
This happens of course on a micro, family level too. For example parents with an insecure attachment style who struggle to regulate their own emotions have been found to be more likely to have kids who indulge in foods that are less healthy, and who are likely to become obese (Bost et al. 2014). This is partly due to using food as a comforter to compensate for unhappy feelings of course, but the stress in itself is likely to drive both children and adults to not only comfort eat but also to store fat.
Feeling good about our lives and what we are doing will inevitably mean consuming less calories. In fact people who do the same activity, such as running a race, and find it pleasurable are less likely to eat high calorie foods than those who are dissatisfied or unhappy about the same run (Werle et al. 2014). Indeed if you get people to do some physical activity and tell some it is a pleasurable, relaxing activity while others are told it is exercise, the latter afterwards tend to consume more calories and less healthy foods. Basically feeling good comes with eating healthily.
What are some of the lessons from this kind of research? Firstly it does not mean that we should not continue to campaign against advertising which suggests that skinny prepubescent looking bodies are what is attractive. Nor should we let up on arguing that companies who basically sell addictive products should be brought to rights. Such practices are as pernicious and dangerous as selling cigarettes and other addictive health damaging substances. Indeed it might well be the combination of the availability of high calorie, high fat foods with the biological predisposition to consume these in times of stress that has given rise to such an obesity epidemic. Possibly in previous historical periods obesity did not ensue because such unhealthy foods were not so freely available.
Nonetheless this research should be taken seriously. It can help halt the tendency of certain already marginalised sectors of society to be blamed for what are basically the effects of stress, fear, unhappiness, worrying parenting, poverty and bad luck. There are also big socio-political issues here that need addressing.
Of course this does not mean we should not be intervening to help people. This might be with a variety of community interventions, improving neighbourhoods as well as helping people feel better about their lives through wellbeing enhancing help such as mindfulness, therapy, yoga, exercise and the like. Enhancing emotional understanding has, for example, been shown to help people make healthier food choices and eat more mindfully (Kidwell et al. 2014). One Danish model has been very successful in tackling obesity in children, and this has focussed a lot on the child’s loneliness and unhappiness as well as better routines. Such interventions can make a huge difference. Happier people are likely to eat more healthily and enhancing wellbeing and happiness reduces obesity. However we need also to be aware of and address the wider, macro socio-political issues such as poverty, inequality, poor economic prospects for so many, degraded neighbourhoods and the lack of hope for increasing numbers of our population. The stress and anxiety linked to having a worrying and uncertain future has a direct impact on eating and on obesity levels
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