In his welcome address to the 9th Annual Nutrition and Health Conference 2012, Integrative Health pioneer Dr. Andrew Weil described the current industry landscape with an apt Dickens quote: “It was the best of times, it was the worst of times.” He explained that, while there is increased awareness of nutrition-related issues, our culture is increasingly inundated by nutritional perversions: noxious food chains, excessive sugar use, sedentary tendencies . . . all of which contribute to skyrocketing rates of heart disease and obesity.
These are problems that physicians treat, and yet physicians are seldom educated on new diet and nutrition research that could preclude the epidemic. The mission of the Conference, sponsored by the Arizona Center for Integrative Medicine, was to provide a collection of international health professionals the information and strategies to effectively implement nutrition in their practices and use it as co-therapy for the treatment and management of various conditions.
One of the most prevalent themes of the conference was identifying the shortcomings of the Western diet as they contribute to obesity. According to the National Health and Nutrition Examination Survey (NHANES), 35.7% of U.S. adults are obese. But, more disturbingly, U.S. children and adolescents are on the fast-track to exceeding that number, with 17% already obese. This is perhaps the most blatant indication that society needs to restructure its approach to nutrition; and that health professionals need to be driving the movement.
The Conference proved to be an effective launchpad. Dr. Robert Lustig, Professor of Clinical Pediatrics in and Director of the Weight Assessment for Teen and Child Health Program at UCSF, broached the subject at its very origin. In his presentation “The trouble with fructose: a Darwinian perspective,” he traced the biological function of obesity back to our ancestors. There is some selective advantage to obesity in that food was not always as copious as it is today. Our predecessors would rely on a seasonal binge of carbohydrate-rich grains and fruit to pack on weight for the winter, a time when food would become scarce. During those times, the body’s capacity to slow down its metabolic functions and store fat was nothing more than a survival technique; but now our system can’t differentiate between eating to live and loving to eat! Because our bodies have not evolved to cope with the increased calories, we are becoming increasingly overweight . . . and staying such.
Dr. Lustig attributes the recidivism of obesity to this evolutionary lag, citing “a mismatch between our environment and our biochemistry.” This mismatch specifically boils down to the conditions of Leptin Resistance and Insulin Resistance, which each contribute to the effects of metabolic syndrome (increased blood pressure, a high blood sugar level, excess body fat, and abnormal cholesterol).
Leptin is a protein hormone produced in the fat cells that helps to regulate body fat. It interacts with the areas of the brain that control hunger and tell the body when it is satiated. Insulin, produced in the pancreas, helps to regulate the metabolism of carbohydrates and fat in the body. It causes cells to retrieve glucose from the blood and store it as glycogen, the body’s secondary energy source. Without the insulin to remove it, the excess glucose would be toxic to the body.
When individuals are resistant to and/or lacking these hormones, their bodies lose the ability to metabolize effectively. According to Dr. Lustig, the body perceives leptin deficiency as a state of starvation, even if the body is taking in large amounts of food. In that state, energy expenditure and thermogenesis decrease, thyroid levels decline, and myocardial oxygen is reduced; all creating an environment in which it is nearly impossible to lose weight. The body will not receive the same signals to stop eating or start metabolizing; on the contrary, it will believe it has to eat more and exert less energy to cope with the perceived starvation. He gave the example of giving a cookie to a child of normal weight vs. an obese child. A child of normal weight will experience what we commonly refer to as a “sugar-high,” exhibited through fidgeting, running around and an overall spike in energy. An obese child with leptin resistance will not experience that spike and will, instead, look for another cookie to satisfy the sensation that he/she is still hungry. And so the cycle continues.
Insulin resistance, or more specifically hyperinsulinemia, is equally detrimental to metabolism. This condition can be traced back to five primary causes: Genetics and Epigenetics, Social Environment (stressors that bump up our cortisol levels), Exercise Environment, and Food Environment (not enough fiber and too much fructose).
Fructose is a four-letter word to Dr. Lustig. He impugns it as the primary cause of hepatic insulin resistance, thereby driving weight gain and consumption and perpetuating the obesity epidemic.
Fructose is a natural sugar derived from tree fruits, honey, berries, and many root vegetables; but its pervasiveness in the modern diet as sweet additive to food products has turned this once-harmless substance into a formidable enemy. Whereas once we only binged on fructose during seasonal harvest, we now have unlimited access. Commercially, fructose is usually derived from sugar cane, sugar beets and corn, and is added to various products to exploit society’s acquired taste for sweetness. It even hides in salty and sour products that we might not perceive as “sweet,” so we are often oblivious consumers. Based on Dr. Lustig’s theory, eradicating our diets of excess fructose in its commercial form may preempt leptin and insulin resistance and help us beat the odds against obesity and disease.
Pediatrician and researcher Dr. David Ludwig agrees that this is the starting point. Sugar, in any form, has become an addiction. For many of us, our brains interpret sugar as pleasure, emitting endorphins and dopamine in the brain that make us feel good. We have become programmed to eat in accordance with the underhanded tactics of the food industry and our health will depend on our ability to buck these habits. In his presentation “An Integrative, Family-Based Approach to Childhood Obesity,” Dr. Ludwig offers his suggestions for a long-term treatment of obesity focusing on three key factors: biology, behavior and environment.
Many conventional approaches to obesity restrict major classes of nutrients, like carbohydrates or fats, which may temporarily prompt weight loss only to end in relapse. Instead, Dr. Ludwig suggests diets that emphasize food quality, and not just nutrients, so that it encourages metabolism while decreasing the hunger that could sabotage any weight-loss program.
The most effective diet, according to the Doctor, has a low glycemic load, which has been shown in studies to decrease hunger, sustain energy and decrease cumulative food intake. This might include foods like eggs and egg whites, low-fat cheese, spinach, tomatoes, apples, and grapefruit. Studies on these diets show weight loss that can be sustained long-term because it can be realistically implemented. According to Dr. Ludwig, these diet changes are most effective when paired with an activity plan that works with the mechanisms inherent in the child that govern their weight.
Behavior is one of the biggest challenges in overcoming obesity. According to a report by the Kaiser Foundation, adolescents spend over six hours in sedentary pursuits, like watching TV or surfing the internet, and less than 1.5 hours per day doing physical activity. In a culture where everything is automated or easily accessible, vigorous movement seems like a lost art.
But Dr. Ludwig points out that when we try to implement exercise regimens among obese patients, they are not successful; in part because they cannot be maintained and in part because they can’t put a dent in the calories of our super-sized meals.
He says a more innovative approach to changing our behavior is to focus on activities throughout the day rather than conventional “exercise.” This might include parking farther from destinations, encouraging fast-paced games like “Tag” or scavenger hunts, dancing or engaging in low-intensity sports, requiring chores like gardening or mowing the lawn, and taking family outings to the beach or the park. The Doctor also suggests removing TVs from bedrooms and limiting screen time to only two hours per day at the most. Prohibiting television during meals will also encourage more mindful eating, so children (and adults) will be less likely to overeat.
In all of these adjustments, the cooperation of the family is critical. The parenting style will have a significant impact on how successful the treatment is. A NICHD Study of Early Child Care and Youth Development found a correlation between the tone of the parenting and the child’s risk for being overweight. For parents who were authoritative, maintaining respect while setting clear boundaries, the risk was 4%; for parents who were permissive, with no discipline, the risk was 10%; the same went for those parents her were neglectful, with no boundaries and no emotional involvement; and for parents with a strict authoritarian approach without sensitivity to the child’s feelings, the risk was 17%. The most successful approach would be one that encourages praise and reward, setting goals, self-monitoring, empowerment, and most importantly, provides a role model and a peaceful home environment.
This parental involvement and supportive approach will create a setting that is conducive to good health, but it will require a shift from the norm. According to Dr. Ludwig, “For now, the family remains the last bastion of protection for children in a world seemingly designed to make them fat. However, families can come together, uniting with health care providers, teachers and community leaders to help make the country a healthier place for everyone to live.”
Because obesity is a collective problem, it is our collective responsibility to encourage change. The doctors and professionals at the Nutrition and Health Conference are leading the charge, but the most critical change begins in our homes and in ourselves. It may be an uphill battle, but it is not a losing one, and information and nutrition literacy are our most promising weapons.
Lustig M.D., Robert H. "The trouble with fructose: a Darwinian perspective." 9th Annual Nutrition and Health Conference. Westin Boston Waterfront Hotel, Boston, MA. 16 April 2012.
Ludwig M.D., David. "An integrative, family-based approach to childhood obesity." 9th Annual Nutrition and Health Conference. Westin Boston Waterfront Hotel, Boston, MA. 16 April 2012.