Wednesday, May 13, 2009

More Food for Thought: What's Behind the Obesity Epidemic?

May 13, 2009 

Perhaps our search for the causes of obesity has been channeled into a narrow medical mindset; perhaps the answers are locked in a more elusive integrated understanding.

The obesity epidemic rings all sorts of cultural bells, but our focus should be understanding the causes. The "lifestyle" killers are all well-known: smoking, alcohol abuse, poor fitness and diet, stress and obesity.

In our usual reductionist "scientific" mindset, we have sought a single mechanism or cause for the rapid and truly unprecedented rise in obesity in the U.S. and Mexico: the actions of leptin and ghrelin, for instance, or a diet consisting largely of fast-food. Various restrictive diets are researched in double-blind studies, usually with inconclusive results.

Perhaps this single-minded search for a single "medical" explanation is doomed to fail because the actual cause is a complex, integrated chain of factors which include but are not limited to diet and exercise.

Before I weigh in, let's turn to a fascinating personal account from correspondent A.R.:

I wanted to share with you (and your readers, if you think my message worthwhile) my experience with food and weight.

The long and short of it is that I used to exercise very vigorously (200 miles per week of bicycling year-round) and yet struggled with weight, food cravings, binges on carbs and sweets. I was an unhappy, very fidgety person who couldn't sit still or concentrate, even though I was a vegetarian, who developed lactose intolerance, so I cut out dairy products a few years before:

A decade ago we moved to a farm and began growing our own organic vegetables on a grand scale. We supplement our home-grown with store-bought organic rice and other grains, olive oil, spices and a few condiments (avoiding HFCS and anything with potential GMO, such as soy). I cut out almost all sugar. (My spouse still eats sweets and I occasionally eat one of his home-baked cookies.) We have our own chickens, so I eat eggs and chicken sparingly as a condiment.

Due to time constraints I stopped cycling and get little exercise beyond gardening and farm maintenance. My BMI is a steady 19, cholesterol well under 200. I have no food cravings at all and eat only when hungry. I still think about food a lot, but only because I am planning and managing my garden and meal preparation. I am no longer fidgety, and can concentrate, even when reading technical blogs about economics!

Thank you, A.R., for this report. A.R.'s experience suggests that diet is perhaps even more critical than exercise in maintaining a healthy mind/body (recalling the ancient Asian wisdom that the mind and body are one.)

Her report also suggests that total caloric intake is less important than the kinds of food one is eating or not eating; it also draws a distinct line between a "normal" American diet, even a vegetarian one, and the presence of cravings/binges and a fidgety lack of concentration--the very traits reported nowadays as ADD (attention deficit disorder) or similar "clinically approved" syndromes.

Next up: Dr. M.H. who shared these comments based on his own medical experience:

I am a physician who has practiced medicine through the emergence of the obesity plague. Years ago a possible source was put forward in the (obscure) Journal of Medical Hypotheses. It is well understood that insulin (secreted by our body or injected) makes fat. (Hence, in managing diabetes one goal of treatment is to normalize blood glucose with a minimum of insulin.)

Heavy, rapidly ingested meals lead to excess net insulin secretion and may be important in the accumulation of fat deposits. The way we are habituated to eat (especially by economic forces in a position to dominate culture rather than serve as a constituent and servant of it) may be fundamental to the virtual pandemic of obesity.

This research cited by Dr. M.H. suggested that wolfing down heavy (carbo, fat and protein-rich, i.e. typical fast-food) meals is a key behavioral element in obesity-- that is, that insulin disorder wasn't simply a matter of caloric intake exceeding caloric expenditure.

This set me thinking, as there have been a number of times in my own life when I ate meals quickly--usually in the midst of heavy manual labor. So I wondered if strenuous exercise shortly after the meal wouldn't offset the negative effects of rapid ingestion. I replied thusly:

As a layperson interested in these topics, I do wonder if someone eating a bowl of bok choi or Swiss chard and brown rice could gain as much weight as someone eating at MickeyDs. Thus I wonder if the glycemic content and caloric density of the food being wolfed down has a major impact on weight gain.

I picked pineapple as a 15-year old in the fields of Lanai, Hawaii, and it was very physically demanding work. I think we all ate rather quickly because we were hungry (and thirsty). Needless to say their were no fat workers.... So I suspect there may well be some mechanism triggered by the resumption of hard labor which modifies the insulin?

Dr. M.H. offered this thought-provoking response:

The obesity plague is both a distinct medical phenomenon and a symptom of the times. These things are almost always the expression of a multitude of forces. In the case of some obesity there is good evidence for an infectious source (antibody evidence in American women of past exposure to a subtype of adenovirus). Video displays have been associated with trance-like changes in neural activity which likely have links to appetite, metabolic regulation and mood.

The atomistic, deadened social setting most Americans must endure and adapt to clearly influences cognition, mood and impulse. Dead linguistic forms, lack of authentic evolved cultural forms (folk culture), the dying off of great art, the lack of living aesthetic contact with the forms, colors, textures of the natural world all, I believe, play a role in this public health catastrophe.

I have worked in the Third World (western Honduras) and with mostly impoverished people in the US. The majority of my current practice is psychiatry and addictions. For reasons that are hard to briefly articulate, reflection on my experience has convinced me that there is only one world; that culture, including language, music, painting etc. are part of the fabric of evolutionary forces which generate states of consciousness, for better and for worse.

I suspect you have read the Oil Drum--Nate Hagens' contributions accurately distill much of what is known of the neurophysiology of our current dilemma. But the brain tunings he describes are imbedded in the body in toto, and the insulin overshoot I mentioned is probably only one element in a fabric of forces, endocrine and otherwise. So, I suspect insulin, overfast overeating and obesity are causally linked as I described but, like everything real, it is complicated and always in a living context. I've written this ( to my own surprise) in the midst of a roaringly busy morning of seeing patients. I hope it is of some use.

Thank you, Dr. M.H. for sharing your experience and knowledge. What immediately struck me about the Doctor's conclusion was its integration of factors most research on obesity ignores as unworthy of study or dismisses as impossible to study: the world we inhabit in toto, not just as consumers of calories.

Furthering this train of thought, correspondent/blogger Nina at the wonderful Deep Into Art Life West sent me the link to Charles Eisenstein's monumentally provocative essay: Reuniting the Self: Autoimmunity, Obesity, and the Ecology of Health (Part 2)

While this essay may seem overly long to our sugar-stomped ADD culture of sound bites and factoid propaganda, these excerpts will give you the flavor of what awaits a full read:

All the individual is aware of is a hunger, a need for something more. The fact that obese people often eat when they are not physically hungry offers a clue to what is going on. Indeed, they are hungry -- they just aren't hungry for food. They are hungry for connection.

Food is the most tangible, direct confirmation of our connection to a living universe that loves us. On a primal biological level, the act of eating tells us, "I exist" and "I am loved." Indeed, food is the most basic expression of love, a token of intimacy, of bringing an outsider into the realm of self. That is why it is customary in most countries to offer food to a guest, and why it is rude to refuse it. To feed another is, in this sense, an intimate act, an opening of the sacred boundaries of self.

When, as today, this intimate act has become a subject of commerce, and food a commodity, the entire food system reeks of obscenity.

This nails something causally profound which ontologically slips through the fingers of all "research" into the obesity epidemic. More on that later; here's another taste:

Obesity is usually taken as a symptom of excess, but in fact the reverse is true. Obesity, and the other enlargements I have mentioned, are actually symptoms of the most profound destitution ever to visit the human race. The bloated lifestyles of the American rich harbor an inner poverty exactly equal to the Third World poverty that enables those lifestyles. Half the world cannot get enough to eat, and the other half cannot get enough no matter how much they eat. It is a complete tapestry, perfect and horrifying.

Consigned by modern civilization to a tiny, isolated self, we suffer from a powerful unmet need for love and connection. To meet this need is more important than life itself. People will do almost anything to meet it. It is time to release our condemnation of the people with bloated bodies, or bloated bank accounts, houses, egos, or other enlargements of the separate self. They are merely trying to meet their most beautiful needs. They are trying to connect and find love, in whatever tiny way is available at the end of the Age of the Machine.

Here is Part 1 of the series:

Reuniting the Self: Autoimmunity, Obesity, and the Ecology of Health

And another essay by Eisenstein:

Wood, Metal, and the Story of the World.

If you've forgiven me for using the word "ontological" (y'know, like inherent or "an a priori category of being", but it sounds better) then perhaps you'll let me unleash derealization.

While this Wikipedia entry defines derealization as a clinical term for a feeling of unreality, I am using it to describe the disconnect between what we experience and what the propaganda/marketing complex we live in tells us we should be experiencing.

How does this relate to obesity? Like this: I contend that all the garbage being passed off/marketed as "food" by the packaged food and fast-food industries is more accurately a simulacrum of nutrition wrapped around carefully engineered doses of powerful exciters of the deepest reward centers in our brains: fat, sugar and salt. In essence, the "food" being hyped and pitched 24/7 is the edible equivalent of crack cocaine.

Let me describe how food has been derealized by a supremely profitable industry: try to eat a package of cold french fries. I don't mean luke-warm, I mean hours old cold french fries. Needless to say, the appeal of the "chips" is now limited.

Our actual experience of eating the fast food delight is masked by what we expect to experience. The happy-happy adverts and the physical setting of the fast-food outlet (hard bright lighting, hard bright plastic, etc.) set up the expectation that we're not only going to enjoy the mouth-feel experience of chomping that hot greasy bundle of fries but that we're supposed to feel the warm happy sensation of sated appetite after the meal has been gobbled.

But what if instead of that happy feeling we actually experience a sense of nausea? Yikes, that would be most unprofitable. So the entire worldview behind the marketing (including the government's collusion at many levels) is designed toderealize the actual experience of eating junk food.

Were it possible to break free of this carefully marketed mindset, you might find virtually all the foods you're supposed to crave are actually revolting.

I say this as someone who will eat ice cream or pizza or a fast-food hamburger a few times a year and enjoy it. But I am aware that it is not in my best interests to eat such "food" more than occasionally, and I am alive to the weird drugged-out sensations such meals cause.

Here's an ad for facsimile-food which I "re-realized" for you:

Acknowledging that I'm a monomaniacal manic/depressive who needs exercise to maintain my thin grip on mental health, I also think exercise has been derealized into a bizarre either/or world of extreme sports or TV-induced sloth/torpor. Extreme risk and extreme conditioning are glorified (again, for the purposes of selling you something, be it a "sports drink" of sugar water and cheap vitamins or a costly bicycle, etc.) while a more normal pattern of enjoyable exercise has been positioned as "too difficult," onerous, burdensome, etc.

Meanwhile, if you can escape this derealization, you will find that exercise, yes, even occasionally strenuous exercise, releases all sort of endorphins and mood enhancers--and not just extreme/insane conditioning (which is often if not always destructive to overall health) but movement as simple as walking a few blocks here and there for 20 minutes.

The experience of walking, running, martial arts, digging, hunting, etc. has been derealized into a marketable "product," i.e. a gym which requires membership and familarity with all sorts of costly machines. From what I gather from outside, the experience is completely derealizing: one mounts some contraption, puts on one's "my stuff, my world" iPod and then watches CNN or some other mindless loop of bogus "news" while maintaining a heart rate of X (as demanded by one's personal trainer as the "optimum" key metric of the whole experience. Never mind how you feel; keep it at 99, pal, or you "failed.")

Personally, I'd rather dig a ditch (yes, I've dug plenty of ditches, so I know exactly what's involved) than sit on some contraption lost in a cocoon of sensory override. I'd rather take a walk or get on my bike or do anything in the real world than go to a room of machines occupied by people ignoring each other. I know many of you feel the gym is a key element in your fitness program, and I understand it's practical; but I don't "get it" and would rather do katas or play around with my bamboo staff.

If this is what's pitched as required for "fitness" (and exactly what metric do we use to define that?), no wonder most people prefer lounging on the sofa watching cooking shows.

It seems to me a key cause of obesity, attention deficit disorder and a dull lethargy devoid of the fun and zest of exercise/physical motion is that our experience has been derealized in order to sell us some product or service.

Here are a few recent books and films of interest on the subject:

The End of Overeating: Taking Control of the Insatiable American Appetite.)

The Omnivore's Dilemma: A Natural History of Four Meals

Rats in the Grain: The Dirty Tricks and Trials of Archer Daniels Midland, the Supermarket to the World

The Informant: A True Story

Fast Food Nation (film)

Super Size Me (film) 

In Readers Journal: Thought-provoking New essay by Zeus Y. 

Tortured Democracy (Zeus Y.) 

"Good faith" may have limited application in contract law, but it has no place in constitutional law. If you flout the highest law of the land, especially if you are a top-level decision-maker, you should be brought to justice. If you provably condoned, approved, and justified torture against established national and international law, you should be prosecuted.

And a darned clever new poem by Mike Dakota:


I bet if Romeo and Juliet
had a phone they would have text'd
and their early demise not met
or let
two families suffer regret
full of tears salty and wet
and William's plot made thinner yet.

Our previous list of hot reading (check them out at your local library if you don't want to own a copy) can be found at Books and Films

Thank you, Rodney M. ($10), for your much-appreciated generous contribution to this site. I am greatly honored by your support and readership.

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