Obesity

Obesity

Comfort vs. Discontent

David F Marks

Copyright © 2016 David F Marks?

Published: 18 April 2016

Yin and Yang Books

Distributed by Smashwords

ISBN-13:978-1532762963

ISBN-10:1532762968

The right of David F Marks to be identified as author of this Work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in retrieval system, copied in any form or by any means, electronic, mechanical, photocopying, recording or otherwise transmitted without written permission from the author.

Ebook formatting by www.ebooklaunch.com

Table of Contents

Dedication

Preface

Summary

List of Abbreviations

One: Obesity

Two: Dyshomeostasis

Three: Evidence

Four: Neurobiology

Five: Addictions

Six: Motivation

Seven: Prevention

Eight: Questions

Nine: Conclusions

References

The Author

Dedication

To the two-point-one billion people who are overweight or living with obesity. Please take note. It is not your fault. You are not to blame. You are the victims. Be informed, be empowered, and, above all else, resist. This book is for you.

Preface

Inside every one us there exists a tension between comfort and discontent. When we assuage the discontent, we find comfort. When we resist comfort, the discontent builds stronger. This eternal struggle is an aspect of the human condition that creates a vicious and unforgiving circle. Within it lies a significant key to human nature, and to the nature of all sentient beings, the 'Yin and Yang' of life. Of relevance to the topic of this book, it helps to explain the human struggle with overweight, obesity and the addictions.

Once the causes of obesity are fully understood, the obesity epidemic can be stopped. This book takes a step towards that goal. I propose an explanatory theory of an objective issue of undeniable importance to human beings - the obesity epidemic. The ideas are drawn from a range of disciplines including economics, endocrinology, epidemiology, neurobiology, nutrition, physiology, policy studies and psychology. The theory focuses on a universal feature of living beings, homeostasis, and the potential for its disruption, dyshomeostasis.

The evidence points to 'Obesity Dyshomeostasis' as a problematic human response to contemporary conditions of living. Similar to racism, sexism and ageism, the current trend towards 'blaming and shaming' individual sufferers of obesity and overweight contributes to the problem. Only by reversing this form of prejudice, and the associated environmental conditions, will the obesity epidemic have any chance of being resolved (Marks, 2015a, 2016).

My interest in the social and political significance of obesity grew when a Special Issue I edited of the Journal of Health Psychology on Food, diets and dieting was published (Marks, 2015b). The topic generated so many high quality articles that we published, not one but, two large special issues. In spite of all this scholarly work, however, it became clear that no genuinely explanatory theory of obesity actually existed. This stimulated two pieces in Health Psychology Open in which I proposed the theory of the 'Circle of Discontent'.

I thank my colleagues on the Editorial Board of Journal of Health Psychology and Health Psychology Open, two journals for which I serve as Editor, and Kerry Barner for her support. I also warmly thank the following scholars for their insightful comments on an earlier version of obesity Dyshomeostasis Theory: Rachel Annunziato, Kristin August, Lindzee Bailey, Laszlo Brassai, Emily Brindal, Janine Delahanty, Carlo DiClemente, Stephanie Grossman, Camille Guertin, Charlotte Markey, Patrick Markey, Jennifer Mills, Christopher Nave, Luc Pelletier, Bettina Piko, Paige Pope, Meredith Rocchi, Kaley Roosen, Diane Rosenbaum, Kamila White and Gary Wittert.

Summary

Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium using feedback loops for optimum functioning of the organism. Dyshomeostasis, a disturbance of homeostasis, causes overweight and obesity, estimated to be present today in more than two billion people world-wide. In a new theory, Obesity Dyshomeostasis is associated with a 'Circle of Discontent', a system of feedback loops connecting weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent is consistent with an extensive evidence-base. Obesity Dyshomeostasis occurs when homeostatic control of eating is overridden by hedonic reward. Appetitive hedonic reward is a natural response to an obesogenic environment containing endemic stress and easily accessible, high-energy foods and beverages. In a time of plentiful and cheap food, people eat more to comfort their discontents than purely for hunger. The comfort foods and beverages that are snacked on almost limitlessly are nutritionally deleterious to the health.

The objectives of this book are: (i) To define, describe and discuss the concepts of psychological homeostasis and dyshomeostasis and their relevance to overweight, obesity, the addictions and chronic stress; (ii) To propose a General Theory of Well-Being founded on the construct of psychological homeostasis; (iii) Within the general theory, to specify the Obesity Dyshomeostasis Theory (ODT) of overweight and obesity; (iv) To summarize the body of evidence that is supportive of the general theory and the ODT; (v) To describe interventions for preventing overweight and obesity based on the ODT.

Obesity dyshomeostasis is mediated by the prefrontal cortex, amygdala and HPA axis with ghrelin providing the signalling for feeding dyshomeostasis, affect control and hedonic reward. Dyshomeostasis plays a causal role in obesity, the addictions and chronic conditions and is fueled by negative affect and chronic stress. Prevention and treatment efforts that target dyshomeostasis provide strategies for reducing adiposity, ameliorating the health impacts of addiction, and raising the quality of life in people suffering from chronic conditions and stress.

A four-armed strategy to halt the obesity epidemic consists of eliminating the causes of overweight and obesity: (1) Resisting and putting a stop to a culture of victim-blaming, stigma and discrimination; (2) Resisting and devalorizing the thin-ideal; (3) Resisting and reducing consumption of energy-dense, low nutrient foods and drinks; (4) Improving access to plant-based diets.

If fully implemented, these interventions should be competent to restore the conditions for homeostasis in billions of people and the obesity epidemic could be halted.

List of Abbreviations

BMI: Body Mass Index

COD: Circle of Discontent

CODT: Circle of Discontent Theory

CRF: corticotropin-releasing factor

EBT: Energy Balance Theory

ED: eating disorder

EWCB: extreme weight-control behaviour

F/V: fruit and vegetable

GH: ghrelin

GTW: General Theory of Well-Being

HPA axis: hypothalamo-pituitary-adrenal axis

nAChRs: nicotinic acetylcholine receptors

OD: Obesity Dyshomeostasis

ODT:Obesity Dyshomeostasis Theory

PFC: prefrontal cortex

PLWO: people living with overweight or obesity

RCT: randomised controlled trial

SDT: Self-Determination Theory

UCT: Unhealthy Commodities Tax

WIC: Special Supplemental Nutrition Program for Women, Infants, and Children

One: Obesity

Since the time of Hippocrates, the dictum of a good diet, exercise, a proper night’s sleep has been a prescription for a healthy life. Illness prevention has been a popular idea ever since. The first president of the American Public Health Association stated in 1874: …the customs of society must be so changed that the physician is employed to prevent rather than cure disease (Smith, 1874). Many editorials have addressed obesity, dieting, weight control, and related issues (e.g. Gold & Graham, 2011; Yanovski, 2011; Pagadala & McCullough, 2012; The PLOS Medicine Editors, 2012; Edmonds & Templeton, 2013; Stuckler & Basu, 2013; Drewnowski, 2014; Fitzgerald, 2014; Ndisang, Vannacci & Rastogi, 2014; Potenza, 2014; Sniehotta, Simpson & Greaves, 2014). The obesity epidemic rolls on, unabated. Today the obesity epidemic is ‘Public Health Enemy Number One’.

Globally, between 1980 and 2013, the prevalence of overweight and obesity rose by 27.5% for adults and 47.1% for children. The number of people living with overweight and obesity (PLWO) increased from 921 million in 1980 to 2.1 billion in 2013 (Ng et al., 2014). A recent collaborative international study included more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made (NCD Risk Factor Collaboration, 2016). Global age-standardised mean BMI was found to have increased from 21·7 kg/m2 (95% credible interval 21·3-22·1) in 1975 to 24·2 kg/m2 (24·0-24·4) in 2014 in men, and from 22·1 kg/m2 (21·7-22·5) in 1975 to 24·4 kg/m2 (24·2-24·6) in 2014 in women.

According to Dobbs et al. (2014) obesity is responsible for around 5 percent of global deaths and the global economic impact is $2.0 trillion, or 2.8 percent of global GDP, roughly equivalent to the impact from smoking or armed violence, war, and terrorism. In the US in 2004, direct and indirect health costs associated with obesity were $98 billion (CDC, 2013). Depending on the source, it is reported that the direct medical cost of overweight and obesity combined is 5 to10% of US health care spending (Tsai, Williamson & Glick, 2010). Forty-two million children under the age of 5 were overweight or obese in 2013. Prevalence of overweight or obesity in adults doubled from 6% in 1980 to 12% in 2008 (Stevens et al., 2012). By 2050, it is predicted that obesity will affect 60% of adult men, 50% of adult women and 25% of children making the US, Britain, and much of Europe a mainly obese society (Figure 1. Reproduced by permission).

The World Health Organisation estimates that around 3.4 million adults die each year as a result of overweight or obesity (WHO, 2014). The WHO (2013) plans to halt the rise in diabetes and obesity by creating a world that is free of the avoidable burden of non-communicable diseases. WHO interventions revolve around mobilizing sustained resources…in coordination with the relevant organizations and ministries that consist of high level meetings between governmental representatives and publication of position statements. In other words, a lot of talking but no real action! Leading authorities have concluded that obesity is a normal response rather than a pathological condition:

…obesity is the result of people responding normally to the obesogenic environments they find themselves in. Support for individuals to counteract obesogenic environments will continue to be important, but the priority should be for policies to reverse the obesogenic nature of these environments (Swinburn et al., 2011, p. 804).

It has been observed that the food and beverage industry ('Big Food') does not much care about the health of consumers. Big Food cares about big consumption of cheap food that leads to big profits (The PLOS Medicine Editors, 2012). The lack of effective interventions to date suggests that civil governments have been impotent to stem the tide of health detriments created by the food and beverage industry.

The obesity epidemic is of comparable importance to the smoking epidemic. Arguably, obesity will prove to be even more significant in the history of human suffering than smoking. It took 50 years of consolidated pressure to reduce the prevalence of smoking-related diseases. There is enough scientific knowledge now to tackle the obesity epidemic. That systems of governance are market-led with health policies compromised by the interests of multinational industries means that food policy and regulation are not based on scientific evidence but on economic imperatives. There can be little doubt that if the food chain could be rationally developed, and resources were targeted to the most significant causal links of obesity, the epidemic could be solved within a decade from now. The prospects of a targeted approach to prevention based on science rather than politically motivated assumptions and industrial interests would be very exciting.

All conditions of health and illness are regulated by homeostasis. In this book, I present a new theory of obesity that I call the 'Obesity Dyshomeostasis Theory' and explain its relevance to the worldwide obesity epidemic. 'Dyshomeostis' may seem a bit of a mouthfull, in more senses than one, but its meaning becomes clear as we shall explain the ideas behind the theory. The epidemic is driven by contemporary social, economic and environmental conditions that actively create a vicious 'Circle of Discontent' that is difficult for individuals to control. The neurobiological foundations of Obesity Dyshomeostasis Theory (ODT) present interesting possibilities for new therapeutic targets and prevention strategies. Because the ODT receives strong empirical support and explains all of the principle features of the epidemic, it has the potential to enable the epidemic to be halted.

Until now, the accepted explanation of overweight and obesity has been the Energy Balance Theory (EBT) in which weight gain is a consequence of energy expenditure being less than energy intake. This mechanistic approach has led to a modern obsession with calorie counting and dieting (Marks et al., 2015). It is true that short-term weight loss can be achieved by any calorie-reducing diet but, in the long-term, studies show that calorie-counting is not associated with significant weight loss. One reason for this outcome is that all calories