obesity

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Study: Despite Weight Gain, Quitting Smoking Improves Heart Health For Mentally Ill After A Year

(kenji.aryan/flickr)

(kenji.aryan/Flickr)

The health profile for people with serious mental illness is pretty grim. In general, they have a lower life expectancy — 25 years less than the general population — which is largely due to cardiovascular disease related to high rates of obesity and smoking.

But a new study by researchers at Massachusetts General Hospital found that after one year, seriously mentally ill patients who quit smoking — even though they gained about 10 pounds — had a lower risk of developing heart disease compared to those who didn’t quit. That’s the good news part of the research, published online in The Journal of Clinical Psychiatry. The bad news is that if those people — who already have high rates of obesity — continue to gain weight, it’s fairly likely they will develop a slew of other health problems, including cardiovascular disease, said the study’s lead author, Dr. Anne Thorndike, an assistant professor at MGH and Harvard Medical School.

“Quitting smoking is the single most important behavior change that anyone, [including] people with serious mental illness, can do to reduce their risk of developing cardiovascular disease,” Thorndike said in an interview. “But the weight gain is a red flag. The story’s not over at one year … If they continue to gain weight, all the health factors will worsen and contribute to higher rates of cardiovascular disease.”

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Narrating Medicine: How Cultural Differences Challenge Doctors

By Dr. Marjorie S. Rosenthal
Guest Contributor

The pediatric resident was frustrated.

On the exam table was a 6-month-old baby — quite overweight. In fact, the child was heavier than an average 1-year-old. But his mother just laughed when the resident asked how she was feeding the baby.

When the resident and I looked at the medical record, we saw that for months residents had been discussing feeding with the mother. Telling her that she should stop formula feeding because her breast milk was more than sufficient. Telling her not to give solid foods because her breast milk was enough. And telling her that if she was going to give the baby formula or solid food, she should try to pay attention to when the baby’s cry means hunger and when it means a wet diaper or a need for attention.

Over one-third of adults and about 17 percent of children in the United States are obese. And since people who are obese have more high blood pressure, diabetes and heart disease than their peers, it’s not surprising that there are 11 million office visits per year for adults with obesity.

Yet according to a new CDC report, only 40 percent of these 11 million visits for obesity include a discussion of diet and exercise.

Dr. Marjorie Rosenthal (Courtesy)

Dr. Marjorie Rosenthal (Courtesy)

Many health care providers don’t want to talk to their patients about diet and exercise because they think the patients may feel judged. And sometimes doctors don’t talk about fitness and nutrition because they actually think talking won’t change anything. Which makes it safe to assume that office visits for obesity rarely include a discussion about the life experiences of the patients and the parents of patients. This suggests that a critical issue — and a key part of any treatment plan — is never addressed.

Parents’ medical history has always been an important aspect of a child’s medical care. But the central importance of all this has only recently emerged: New research has shown how life experiences affect brain development and hormone responses and how that affects parenting behavior and the health of the child in the next generation.

It’s hard enough to do this with families who speak English and come to the doctor’s appointment ready to talk about themselves. With this overweight 6-month-old, it was even harder: The resident was using a Swahili phone interpreter and the mother was a refugee.  Continue reading

Even Before Pregnancy, Your Health Matters: Mom’s Obesity Linked To Higher Risk Of Baby’s Death

(Ernesto Andrade/Flickr)

(Ernesto Andrade/Flickr)

You know how it goes: The moment the pregnancy test is positive, you give up alcohol, you cut out coffee, you try to make every bite count and limit your weight gain to healthy norms. You’re suddenly responsible for two.

That’s the usual strategy. But new data suggest that perhaps it’s time to rethink that logic — it could be, by the time you get that pregnancy test result, you’re already late for the train.

Why? According to a recent study based on a sweeping analysis of more than 6 million births, there appears to be a robust link between a woman’s weight even before she gets pregnant and her baby’s risk of dying in her first year.

The numbers are small, but the researchers say they are significant:

Among normal-weight moms, about four in 1,000 babies die after birth; among moderately obese moms, that rises to nearly six babies per 1,000 and among morbidly obese moms, it’s more than eight babies per 1,000 live births.

(To be precise, “normal weight” for a 5-foot-4 tall woman before she’s pregnant is defined from 110-144 pounds; moderately obese is considered 175-204 pounds, and morbidly obese is 235 pounds or more.)

Obesity And Infant Deaths

Eugene Declercq, the study’s lead author and a professor at the Boston University School of Public Health, puts it this way: If you are truly obese, with a Body Mass Index of 40 or above before pregnancy, your baby has a 70 percent higher mortality risk compared with a normal weight woman. (This holds true even after controlling for a wide array of risk factors in the study, including race, ethnicity, education, insurance coverage, diabetes and hypertension, he said.)

“Since this involves pre-pregnancy obesity it emphasizes the importance of thinking of women’s health in general and not just when they’re pregnant, which has too often been the case.”

– Eugene Declercq

It’s the persistent association between BMI and infant mortality that makes the research compelling, Declercq said: As BMI increases above normal, the infant death rate increases consistently too.

“This links up women’s health and kids’ health in a really important way,” Declercq said in an interview. What it suggests, he adds, is that pre-pregnancy BMI still had a pretty strong relationship to both neonatal mortality (death in the first 28 days) and post-neonatal mortality (death in the first 28-365 days). “No matter how you cut it, that relationship is robust.”

The researchers also wondered whether pre-pregnancy obesity was related to a specific cause of death: notably, prematurity, congenital abnormalities or SIDS. As it turned out, obesity was a problem in all of those categories.

“The really powerful finding would have been if all of the higher rates of infant mortality were explained by a single cause of death, but that wasn’t the case here,” Declercq said. “The implication, essentially, is it’s not one thing we have to worry about — obesity is a multifaceted problem in terms of outcomes.”

An ‘Alarming’ Rise In Obese Women

And clearly, the implications are broad. The American College of Obstetricians and Gynecologists recently reported an “alarming” increase in the number of obese women of reproductive age in the U.S.: More than half are overweight or obese.

“A major hope in initiating this project was to get the focus on women’s health throughout her life course and not just when she’s pregnant,” Declercq said.

Lizzie, a 32-year-old chiropractor in Medford, Massachusetts, who asked that her last name not be used, says although she’s not obese, she’s definitely above her ideal weight.

Recently, Lizzie’s ob-gyn told her that if she wants to get pregnant (which she does), losing 10 to 20 pounds would be a good idea. “Even though I knew it intellectually, it was very hard to hear,” Lizzie said in an interview. “What bothered me the most was she said it but didn’t give me anything else, she didn’t talk about what I should do, no specifics about exercise or nutrition.”

With a family history of diabetes and a sister who had gestational diabetes during pregnancy, Lizzie says she’s trying to lose weight before conceiving, but it’s not easy.

“I desperately don’t want to repeat what my sister went through,” she said. “But it’s been a challenge … I’m a big sugar person — that’s my downfall, and a daily struggle.”

A Fraught Discussion

Actually getting women to lose weight before they’re pregnant is far easier said than done, says Dr. Naomi Stotland, a co-author of the recent Declercq study, and an ob-gyn at University of California San Francisco.

About half of pregnancies are unplanned, she says, which makes it hard to get the message across at the right time.

In addition, says Stotland, also on the faculty at San Francisco General Hospital, pressuring women to lose weight can be tricky for both doctors and patients. “Even if a physician is motivated to talk about it, the woman might not be in the right place to hear it.” she said.

For example: If a patient has an appointment to get birth control, it may not feel appropriate for the gynecologist to say, ‘Hey, maybe think about losing weight for that future, theoretical birth you’re not planning to have any time soon,’ she said. Also, doctors’ own issues about weight complicate the matter: Thin doctors often feel awkward and non-compassionate urging patients to slim down, and overweight doctors feel they have little credibility, Stotland said.

A small 2010 study of pregnant overweight and obese women, called “What My Doctor Didn’t Tell Me,” concluded that women often don’t feel their doctors are providing appropriate or helpful (or any) information on weight.

A Too-Accessible McDonald’s

And the complications only increase when poverty is also in the mix, says Dr. Nidhi Lal, a primary care doctor at Boston Medical Center. She says in her practice, which includes hundreds of reproductive age women, with about 30 to 40 percent who are overweight or obese, access to healthy food is a major obstacle because many live in so-called “food deserts” where nutritious food is scarce and fast food and convenience stores proliferate.

“McDonald’s and Dunkin’ Donuts and 7-11’s are more accessible and affordable than shopping at Stop and Shop or Market Basket,” Lal said.

She said there are often deep misconceptions about food and pregnancy. For instance, some women assume that they need to start eating for two as soon as they start planning a pregnancy. “And these are women who are already overweight to begin with,” she said.

And there are cultural issues too.

“Women who are raised in the U.S. want to be thin, but they don’t always have the resources to get there and so they’re reluctant to talk about body weight,” Lal said. “They think I’m judging them or not being empathetic.” Women from certain other cultures, she says, prefer being heavy: “It’s a sign of attractiveness and prosperity.”

For doctors, then, it’s a tough path to navigate.

“It really requires a relationship of trust, a very non-judgmental kind of communication,” Lal said. “I try to make my patients well informed, tell them as many facts as I can: ‘This is why I want them to do this and how it can effect their pregnancy outcomes’ — a mother will do anything for the her baby. I try not to be negative, and say, ‘Oh no, you gained weight.’ It takes a lot pre-visit planning.”

Lal also tries to get her whole medical team involved, including consults with a nutritionist and prenatal nurse. Still, she adds: “It is hard to do everything in an empathetic manner in 15 to 20 minutes because despite what you say, they have their own sense of success and failure. Some are very discouraged because they are doing what they can but some things they can’t control.”

But the problem isn’t going away. A slew of recent studies suggest that obesity before and during pregnancy can cause enduring health woes.

A study published in January found that children born to mothers with a combination of obesity and diabetes before and during pregnancy may have up to four times the risk of developing autism spectrum disorder compared to children of women without the two conditions.

And late last year, the American College of Obstetricians and Gynecologists, calling obesity the “the most common health care problem in women of reproductive age,” issued new recommendations on obesity and exercise during pregnancy. It cited a list of problems associated with obesity mainly during pregnancy, including a higher risk of miscarriage, premature birth, stillbirth, birth defects, cardiac problems, sleep apnea, gestational diabetes, preeclampsia and venous thromboembolism, or blood clotting in the veins.

‘I’m Just A Fried Clams Girl’

But telling women to change their personal behavior in an across-the-board manner sometimes gets public health officials in trouble.

For example, there was a massive backlash against the Centers for Disease Control and Prevention when, earlier this year, it issued a blanket warning that sexually active woman of childbearing age and not using birth control should stop drinking alcohol — completely.

So, hitting the right tone when it comes to talking to women about their weight is key.

“Conveying the message is tricky since I wouldn’t want it to be another case of blaming mothers,” Declercq, the researcher, said. “Since this involves pre-pregnancy obesity it emphasizes the importance of thinking of women’s health in general and not just when they’re pregnant, which has too often been the case.”

Interestingly, his study, published online last month in the journal Obstetrics and Gynecology, also found that established recommendations from the Institute of Medicine on weight gain during pregnancy were largely not being followed. Those recommendations suggest that obese women limit weight gain to between 11 and 20 pounds during pregnancy, regardless of the severity of the obesity. However, there was essentially the same infant mortality risk among obese women who followed those guidelines compared to those who didn’t, the study found.

That finding raises several questions: Do the guidelines need rethinking? Or is there something about the genetics of obese women that persists through pregnancy even if some amount of weight is lost?

This study didn’t address those issues, but one thing is clear for any future public health efforts: Women remain far more motivated if they think they’re doing something for their babies, Declercq said. The trick is to get them to think about their own health as deeply as their kids’ — and well in advance.

Take Amy, a mom from Arlington, Massachusetts, who gave birth to three children through IVF (and also asked for confidentiality). Between pregnancies, she says, it got harder to lose the weight. Now, while considering a fourth child, she says she should lose about 22 pounds.

Like many moms, Amy is vigilant about feeding her children healthy meals, but when it comes to her own diet: “I can’t overcome my cravings for meatball subs…I don’t really enjoy eating a salad.” She said that while some people find pleasure in “racing cars or smoking” her downfall is high calorie foods. “You know what you’re supposed to do, but actually doing it is the hardest part,” she said. “If I have the choice between romaine lettuce and fried clams? I’m just a fried clams girl.”

Study: Maternal Obesity And Diabetes Bring ‘Multiple Hits,’ May Raise Autism Risk In Children

A provocative new study finds that children born to mothers with a combination of obesity and diabetes before and during pregnancy may have up to four times the risk of developing autism spectrum disorder.

On their own, obesity as well as pre-pregnancy diabetes or gestational diabetes increase the risk of autism slightly, researchers report. But the study suggests that co-occurring obesity and diabetes may bring “multiple hits” to the developing fetal brain, conferring an even higher risk of autism in the offspring than either condition on its own.

According to the U.S. Centers for Disease Control and Prevention, about 1 in 68 children has autism spectrum disorder, which also includes Asperger syndrome and other pervasive developmental disorders.

This new study — led by researchers at the Johns Hopkins Bloomberg School of Public Health and published in the journal Pediatrics — was based on analyzing the medical records of 2,734 children who have been followed from birth at the Boston Medical Center between 1998 and 2014. (Of that group, 102 of the children had a diagnosis of an autism spectrum disorder. )

So what might be leading to this increased autism risk? Researchers don’t really know, but they raise several theories in the paper. In general, the possible mechanisms relate to immune and metabolic system disturbances associated with maternal obesity and diabetes that might cause inflammation and other problems for the developing fetus.

One of the study authors, Daniele Fallin, an epidemiologist and chair of the Department of Mental Health at Hopkins’ public health school, said in an interview: “We know that both diabetes and obesity create stress on the body, generally, and a lot of that stress manifests in disruption of immune processes and inflammation. Once you have the disruption in the mom, that may lead to inflammation problems in the developing fetus, and inflammation during neurodevelopment can create problems that manifest as autism.” Continue reading

Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
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Health Analyst Scans New Obesity Options From Drugs To Devices, Heads Back To Gym

Dr. Fiona Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, writes in the journal JAMA Internal Medicine about her own struggle with obesity. (Courtesy)

Dr. Fiona Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, writes in the journal JAMA Internal Medicine about her own struggle with obesity. (Courtesy)

This will not be welcome news for all of us who resolved to eat less and move more this year, but still secretly hoped that maybe medicine would step in. Maybe some novel treatment would reach maturity just as our willpower waned — a drug, a device, some new twist on surgery.

Sigh. The journal JAMA Internal Medicine is just out with an up-to-date analysis of options for treating obesity, accompanied by editor Fiona Clement’s vivid personal account of her own struggles with weight. The conclusion she draws from the latest data: “After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit,” she writes. “I’m off to the gym.”

I spoke with Dr. Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, about her take on the data and her decision to discuss her own obesity — and even reveal her Body Mass Index — in print. “This is by far the bravest thing I’ve ever written, and perhaps ever done,” she says.

“After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit.”

– Dr. Fiona Clement

But first, a distillation of the data from lead author Dr. Dan Ollendorf, chief scientific officer at the Institute for Clinical and Economic Review in Boston. The review is actually geared for doctors, but here’s his summary for the general public:

Surgery: “The evidence is pretty consistent that these procedures do lead to significant weight loss in the short-term, up to about two years of follow-up. The challenge with the evidence available is that after two years, it’s a a bit of a black box. It’s unknown what actually happens. There’s some suggestion that in a pretty significant number of situations, patients actually regain weight. In cases where other conditions related to obesity, like diabetes, have improved or resolved as a result of surgery, that can be reversed in some individuals. And so that is the really big unknown with surgery: What are the longer term outcomes for patients?”

• New drugs: “The bottom line is that this is sort of more of the same. A number of drugs have been used — some FDA-approved and labeled for weight loss, others used off-label for weight loss. The new drugs result in relatively modest reductions in weight, really not very different from the existing medications that have been available for decades. They are very high cost and in some cases have the potential for really significant side effects. So there really is mixed evidence, and the benefit, if any, that appears to be available with the current evidence is pretty modest.”

Devices: “This is kind of a heart-wrenching situation because surgery is a major step for people. Most of the advanced surgical programs in the U.S. have been able to reduce their complication rates, but this is still a risky surgery, and there are some major complications that can occur. And given that medications have produced only modest weight reductions, there’s been a lot of interest in trying to produce something that may be less invasive than surgery but more effective than medication. Continue reading

Related:

Why To Exercise (During Pregnancy) Today: Ob-Gyns Say It's Best Time To Boost Health

il-young ko/Flickr

il-young ko/Flickr

Yes, they’ve told us this before: If you’re pregnant, you needn’t refrain from exercise. But now, the influential (and fairly conservative) professional group of U.S. obstetricians and gynecologists is saying it even more forcefully: If you’re pregnant and facing no complications, you really should exercise — it’s the ideal time to improve your health, including your weight.

In an updated committee opinion, the group, the American College of Obstetricians and Gynecologists (ACOG)says: “Women with uncomplicated pregnancies should be encouraged to engage in physical activities before, during, and after pregnancy.”

The list of recommended activities includes: walking, swimming, stationary cycling, low-impact aerobics, yoga (modified and not hot), pilates (also modified), running, jogging, racket sports and strength training, and all with the usual caveats to check with your doctor first.

Importantly, the opinion says: “Some patients, obstetrician–gynecologists, and other obstetric care providers are concerned that regular physical activity during pregnancy may cause miscarriage, poor fetal growth, musculoskeletal injury, or premature delivery. For uncomplicated pregnancies, these concerns have not been substantiated…” Continue reading

Fatal Fat Shaming? How Weight Discrimination May Lead To Premature Death

Jeff Newell, left, in November 2014, and then on Oct. 18 of this year, after finishing his first road race (Courtesy)

Jeff Newell, left, in November 2014, and then on Oct. 18 of this year, after finishing his first road race (Courtesy)

As soon as the chair broke under the weight of his 533 pounds, Jeff Newell knew he wouldn’t get the job.

With a background in customer service and a culinary arts degree, Newell, of Taunton, Massachusetts, had been searching fruitlessly for work for several years. Finally, a great job near his home opened up that seemed a perfect fit with his credentials. But then came the chair-breaking incident. Humiliating, yes, but even more infuriating because the interviewer, offering neither help nor an apology, simply shook her head and made a face.

“I knew what she was thinking: ‘This person is overweight and he’s going to be lazy and why should I hire him?’ ” Newell said. The situation was mortifying emotionally, but also took a physical toll. Newell broke out in a sweat, his heart racing.

The sort of weight-based discrimination that he says he experienced is not just unpleasant and stressful; it may actually lead to premature death, a recent study finds.

While earlier research has shown that weight discrimination is associated with poor health outcomes for a variety of reasons, the new study, led by researchers at Florida State University, concludes that in addition, “weight discrimination may shorten life expectancy.”

The new analysis found an association only, and no causal link between discrimination and life expectancy. Still, researchers in the field say the paper, published in the journal Psychological Science, adds to a growing body of literature pointing to the deep, long-term impact of weight bias and discrimination.

“I think this is one of the most important papers to come out in the research of weight stigma,” said A. Janet Tomiyama, Ph.D., assistant professor in the Psychology Department at the University of California, Los Angeles, where she studies weight stigma and directs UCLA’s Dieting, Stress, and Health Laboratory. “The finding itself is astonishing, but even more significant is that they were able to replicate the finding across two very high quality cohort studies. The crucial implication here is that the stigma alone of being heavy can be harmful to health — and we know that weight stigma is rampant in this country.”

The findings emerged after researchers analyzed data from two separate national studies: the Health and Retirement Study (HRS), with more than 13,000 participants, and the Midlife in the United States Study (MIDUS), with more than 5,000 participants. The two studies (conducted about 10 years apart) both included reports on perceived discrimination, including weight discrimination.

The new analysis found that weight discrimination was associated with an increase in mortality risk of nearly 60 percent among both HRS and MIDUS participants and also that the increased risk “was not accounted for by common physical and psychological risk factors.” In other words, the health effects of the discrimination were teased out from the health effects of the weight itself.

In an interview, Angelina Sutin, the study’s lead researcher and an assistant professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine in Tallahassee, said the big surprise was that even after statistically controlling for other factors such as body-mass index, level of disease, depression and smoking, among others, the experience of weight discrimination was linked with people dying earlier than expected.

“What was really surprising was that the association was there not just in one sample but in two, and the associations were almost identical,” Sutin said.

Weight discrimination and bias are widespread, according to an overview on the stigma of obesity, and that translates into inequities in employment, health care and education

And that stigma appears to contribute to a “vicious cycle,” according to Tomiyama, of UCLA, who writes about “a positive feedback loop wherein weight stigma begets weight gain.”

Indeed, in an earlier study, Tomiyama found that children labeled as “too fat” had an increased risk of having an obese body mass index nearly a decade later.

So why might stigma be causing such problems, and possibly contributing to premature death?

That question wasn’t addressed in the recent study, but Sutin offered some informed speculation.

“Part of it might be stress that people are carrying around with them,” she said. But sometimes it’s where the discrimination comes from that’s meaningful. For instance, she said: “Families are often the source of weight discrimination,” and that can be particularly painful, since “families are supposed to be a support.”

Also, several studies find that weight bias is rampant among medical students and other health care providers. Even eating disorder specialists are not immune to negative stereotypes about obese patients, according to a 2014 study. This attitude among health care professionals can lead to delays in care and treatment, and also misdiagnoses, experts say.

Much of the research on weight stigma and discrimination is led by Rebecca Puhl, Ph.D., deputy director of the Rudd Center for Food Policy & Obesity and a professor in the Department of Human Development & Family Studies at the University of Connecticut. She said there are several possible mechanisms at work that could contribute to premature mortality for people subject to weight discrimination.

“Other studies have found that when people are exposed to weight stigma or discrimination, that they actually experience elevated physiological stress responses (e.g., cortisol reactivity, blood pressure) which could contribute to poor health outcomes,” Puhl wrote in an email. “In addition, studies show that exposure to weight stigma can also lead to increased calorie intake, food consumption, and binge eating, which could play roles as well. The idea here is that weight stigma can induce emotional distress, which in turn becomes a trigger for turning to some of these maladaptive eating patterns as temporary coping strategies to alleviate those negative feelings.”

Sarah Bramblette, who has a master’s degree in health law, says even though she suffers from a medical condition called Lipedema that contributed to her current weight of over 400 pounds, she has been subjected to weight discrimination throughout her life. While she says some of the nasty comments hurt her feelings, it’s the bias from health professionals that has the greatest impact.

Here’s how Bramblette opened her recent TedxNSU talk at Nova Southeastern University in Fort Lauderdale:

When I first appeared on stage, what was your perception of me? Lazy, disgusting, perhaps depressed, unmotivated, unhealthy? Based on my appearance it’s usually assumed… that my weight and my condition in life are self-induced. That’s not true, but often I don’t get a second chance to make a first impression….Weight bias that I’ve experienced in health care has hurt me physically. When doctors and nurses have the perception that I’m lazy and unmotivated and noncompliant, that influences the care they provide and it has a negative impact on my health.

Continue reading

Peering Into The Placenta, ‘Least Understood’ And Respected Of Human Organs

(Wikimedia Commons)

(Wikimedia Commons)

If you’ve been pregnant, did you ever think about your placenta? Did you even have an image of it in your mind’s eye?

Your uterus, sure, especially as it grew and grew. Your fetus, of course, aided by grainy ultrasound print-outs. But your placenta, that essential life-support system, that unique biological bridge that is neither truly you nor your child — probably not so much, unless you faced a rare and risky complication. (Or you’re a member of the very small club that believes in eating bits of the afterbirth — please don’t make me go there.)

Personally, through a miscarriage and two pregnancies, I never gave my placenta a single thought. But new research suggests that by ignoring the placenta, we may miss out — not just on a personal level but a societal one.

“The placenta is basically the last frontier in human organs,” says radiologist Dr. P. Ellen Grant of Boston Children’s Hospital. “It’s the least understood, yet arguably one of the most important organs. For years it’s been neglected, and we’re only beginning to understand the complex role of the placenta in fetal development from conception to delivery, and in long-term outcomes not only for the fetus but also for the mother.”

Dr. Grant’s team has just won a nearly $5 million grant to develop better methods to image and monitor the placenta during pregnancy.

“The placenta is actually the Rodney Dangerfield of organs.”

– Dr. Diana Bianchi

It will focus in particular on pregnant women who are obese, a growing population that faces higher risks of complications, including pre-term birth, stillbirth and pre-eclampsia.

The grant is part of the Human Placenta Project, a major new federal effort that is funding a total of $46 million in research. The project aims to counter that longstanding neglect and increase understanding of the placenta’s role in disease.

“The placenta is actually the Rodney Dangerfield of organs,” says Dr. Diana Bianchi, executive director of the Mother Infant Research Institute at Tufts Medical Center, who was involved in the federal strategizing that led to the Human Placenta Project. (Note to young folks: Dangerfield was a comedian famed for his complaint, “I don’t get no respect.”)

“The placenta, until now, really hasn’t gotten respect by funding authorities and it hasn’t gotten a lot of attention,” Bianchi continued. As parents-to-be focus on the fetus, she said, most “don’t realize that the placenta is essentially the foundation for the normal development of the baby, because it supplies nutrients, it supplies oxygen, it takes the waste products away from the baby, and it also is an amazing machine for the production of hormones. So it’s doing an amazing amount of work during the entire pregnancy, and yet at the very end of it, it’s thrown out.”

Dr. P. Ellen Grant (courtesy)

Dr. P. Ellen Grant (courtesy)

Given all that critical work, surely if the placenta falls down on the job in any way, complications of pregnancy may result.

Pre-eclampsia, a potentially life-threatening complication of pregnancy that affects up to 8 percent of mothers-to-be, is directly related to the placenta, Dr. Bianchi said. It involves “an abnormal development of the placenta, in that the placenta doesn’t really invade the mother’s uterus correctly, and the consequence of that is abnormal blood flow between the baby and its mother.”

Obesity is so widespread in America that among some sub-populations of women, more than half are obese, Dr. Grant said. Continue reading

Study: Kids Are Dumping Fruits And Veggies Offered At School — But Don’t Give Up Yet

A study found that students put more fruits and vegetables on their trays, as required, but consumed fewer of them and increased waste by approximately 56 percent. (Courtesy of Sally McCay/UVM Photography)

A study found that students put more fruits and vegetables on their trays, as required, but consumed fewer of them and increased waste by approximately 56 percent. (Courtesy of Sally McCay/UVM Photography)

File this one under: You can lead a horse to water…

Researchers at the University of Vermont report what they characterize as a “heartbreaking” finding: Many schoolkids are trashing the fruits and vegetables they are now served as part of a federal law that was supposed to nudge the kids toward healthier food choices.

The study, published online in the journal Public Health, concludes that kids are putting more fruits and vegetables on their trays, as required by the Healthy, Hunger-Free Kids Act of 2010 (which took effect in 2012 and was championed by First Lady Michelle Obama). However, the children ate fewer of these items after the law took effect and often dumped the produce straight into the trash.

“It was heartbreaking to see so many students toss fruits and vegetables into the trash right after exiting the lunch line,” Sarah Amin, Ph.D, a UVM researcher in nutrition and food sciences and the study’s lead author, said in an interview.

For the study, researchers captured before-and-after images of school lunches. (Courtesy)

For the study, researchers captured before-and-after images of school lunches. (Courtesy)

As part of the study, researchers captured images of kids’ school lunches before they ate and then again right before they dumped uneaten foods into the trash. So, for instance, the child might choose a school lunch (pictured on the left) of chicken nuggets, mac and cheese, green beans and milk. But, when the child is done eating, it’s clear the greens beens remain untouched.

The study concludes:

Children consumed fewer (fruits and vegetables) FVs and wasted more FVs during the school year immediately following implementation of the USDA rule that required them to take one fruit or vegetable at lunch. Average waste increased from one-quarter cup to more than one-third of a cup/tray, with about one-eighth cup/tray more FVs discarded, or a total of about 56 cups/day/school (based on an average of 400 lunches served/day).

Researcher Amin, who will soon begin a post doctorate fellowship at Tufts, said that while the initial findings might seem disheartening and show some unintended consequences of the federal law, it’s worth remaining hopeful.

She pointed out that “this was the first update to these regulations in 15 years and kids were really acclimated to how the environment was before,” and not used to choosing either one fruit or one vegetable with lunch.

“Maybe you can’t just put these foods in front of them and expect them to eat,” she said. “But it may just be too soon.”

For younger kids entering kindergarten, for example, “this may work,” Amin said, because it’s all the children know. “But for older kids used to the old system, this may rock their world because they’re just not used to it.

“I still think the guidelines [which are up for reauthorization next month] are necessary,” she said. “We have a childhood obesity epidemic and the guidelines were put in place to address it. … A little bit of waste at the get go may be a sacrifice we have to make for the health and well being of children in the long term.” Continue reading

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