Attacking the Overweight

Harriet Brown writes so articulately about the stigma and prejudice experienced by people who are overweight, it’s hard to say anything other than link to it. She highlights how well accepted it is to disparage the overweight, despite the increasing evidence that weight loss and regulation is not simply a matter of self-control and discipline. Unfortunately, doctors can be as guilty of this as anyone, routinely attributing health problems to weight without looking further. When people feel that disdain from their doctor, they are less likely to get consistent medical care or comply with their recommendations. For some reason, weight and fat remains one of the few areas where people feel free to disparage others. Surely, there must be ways to address issues of health and weight without also demeaning those who wrestle with it.

How Not to Talk About your Child's Weight

This week, Michelle Obama, trying to promote efforts to combat obesity, described taking her kids to the pediatrician and being told that they were overweight. She also mentioned that President Obama had referred to one of their daughters as “chubby.” These remarks caused consternation among eating disorders professionals, because of their apparent overemphasis on weight and dieting, rather than on healthy eating and health in general. Too often, when people talk about the obesity epidemic, it sounds like an attack on the overweight.

There are better ways to promote healthful eating than to call a youngster “chubby.” Those who treat eating disorders strive to help their patients move away from dieting and strict rules about good and bad foods. They aim to help their patients be less rigidly focused on a number and a weight and instead aim for healthy behaviors. One of the challenges in treating people with eating disorders is when the culture at large supports exactly the same attitudes that get in the way of fighting an eating disorder. In this link, Laura Collins, the executive director of FEAST (Families Empowered and Supporting Treatment of Eating Disorders), writes about how some of the First Lady’s comments sound in the eating disorders world. In a later post, she also mentions speaking to a member of the First Lady’s staff and explaining these issues. It will be interesting to see if this will have any effect on the way Michelle Obama talks about her daughters’ eating habits in the future.

Making your New Year’s Resolutions Stick

It’s a new year, which means that people are already making (and possibly breaking) their New Year’s resolutions. A useful article on Time.com takes advice from addiction experts on how to make your resolutions stick. What are the main points?

-Be honest with yourself about what you’re doing. If you’re trying to moderate your drinking and every time you plan to have 2 drinks, you end up having 5, then this should signal to you that your drinking may be more problematic than you’re acknowledging.

-Start out by trying to temporarily go cold turkey. For example, if your ultimate goal is to drink less, it might be easier to stop completely for a designated period of time rather than trying to taper off.

-Think before you act. Expect to get urges or cravings for whatever you’re trying to change. When you feel an urge, try to delay acting on it immediately. Try to reflect on the craving and think about the trigger. This may enable you to resist it better. The more you practice resisting or delaying giving in to cravings, the easier it will become.

-Give yourself a break. Be positive in your approach. Rewarding yourself for making a small change is far more effective than punishing yourself for not being able to do it. In fact, learning to tolerate imperfection in yourself may be the most useful change of all.

-Try to surround yourself with people who are doing what you want to be doing. It’s hard to stop smoking when you are only around smokers or to drink less when you mainly hang out in bars. It can be tough to change friends or to change the way you socialize, but it will make it easier for you to achieve your goals.

A last point (and this part is from me, not Time.com) is that change can be very hard. We all know what is good for us--eating right, exercising regularly, and not smoking, for example. Yet it can be very difficult to give up something that we know is not in our best interests. Be honest with yourself about what payoff you get from this habit you are trying to break. If you can’t acknowledge what you like about it--what it does for you, or the loss you will feel if you do give it up--it will be more challenging to achieve the change you want.

New Research About Handling Stress

Two recent articles discussing studies of animals in stressful situations shed light on some valuable lessons about the role of stress in people’s lives.

In today’s New York Times Magazine, Gretchen Reynolds writes about an experiment in which two groups of rats ended up reacting differently to the same unpleasant situation. One group of rats exercised regularly for several weeks; the other group didn’t exercise at all. When both types of rats were exposed to stress -- specifically, forced to swim in cold water -- the brains of the exercising rats weren’t affected as negatively as those of the active rats. A related study indicated that, after an injection with chemicals designed to increase their stress level, active rats were less anxious than the idle ones. The studies support the idea that the physical stress of exercise helps the brain better handle emotional stress. But the payoff isn’t immediate. For rats, when it comes to seeing the benefits of exercise, the magic number is apparently between three and six weeks.

Meanwhile, in The Atlantic, David Dobbs writes about the insights of Stephen Suomi, a prominent researcher who has studied the emotional development of rhesus monkeys. Suomi has shown that when monkeys who are genetically handicapped in their ability to process a chemical in their brain known as serotonin -- a risk factor for anxiety and depression -- are raised as babies in poor environments, they grow up to process serotonin less efficiently as adults and are more likely to end up anxious and depressed. But when these genetically-handicapped monkeys are raised in ideal environments, they don’t just grow up to process serotonin efficiently; they do it more efficiently than those monkeys without the initial deficit. Monkeys who thrive despite this genetic weakness may in fact be more likely to prosper than your average monkey.

What does this mean for humans? Suomi’s research with monkeys is relevant to the study of what are sometimes known as “orchid children” -- children who possess gene variants that increase their susceptibility to problems such as depression, anxiety, and attention-deficit hyperactivity disorder. Given a stressful or abusive childhood, these kids are more likely to suffer negative consequences (versus “dandelion kids” who can pretty much thrive anywhere). But the article suggests that if these orchid children are raised in a more favorable environment, then these genetic variants can contribute to enhanced functioning. In short, what has usually been seen only as a liability can, under the right circumstances, be a strength.

As for the stressed-out rat experiments, it adds to a growing body of research indicating that exercise helps not only our physical health, but our mental health as well. As is the case with the rats in these studies, these stress-reducing benefits aren’t immediate. But there’s one important difference between people and the lab rats: Unlike the rats, no scientists are forcing us to exercise. People, unlike rats, need their own motivation. To reap enrichment from an exercise routine, they have to overcome inertia and push themselves to do something they might find unpleasant initially. But if they can stay the course until they start enjoying the returns, it’s worth it.

Positive Psychology Has Its Limits

Last week, I read the book Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America, by Barbara Ehrenreich. What got me interested was hearing a radio interview in which the author, who was diagnosed with breast cancer several years ago, talked about her reaction to the breast cancer culture she encountered during her treatment. Cancer was a gift, people would say. It’s the best thing that ever happened to me.

Ehrenreich wasn’t soothed by the cheeriness that people had in reaction to their cancer, and that they expected from her. Rather, this relentless focus on maintaining a positive attitude felt stifling to her. And when she expressed anger about her diagnosis, about the effects of chemotherapy, and about the frustrations of dealing with her insurance company, people responded by suggesting that she was too angry. Run, don’t walk, someone told her, to some counseling.

Ehrenreich points out that certain assertions that are often accepted as truth -- such that a positive attitude lessens your chances of getting cancer and improves your chances of surviving it -- are actually simplifications of the relevant research. While stress can weaken your immune system, that doesn’t mean that if you’re stressed, you’re more likely to get cancer. Similarly, while therapy and support groups may be good for people's emotional health, therapy, or support groups won't extend their lives. The problem, Ehrenreich points out, is that sometimes this research trickles down in such a way that people end up blaming themselves unnecessarily for their illness or for their inability to prevent its spread.

Another part of the book addresses the spread of positive psychology, a relatively new area of psychology that focuses on the study of positive emotions, happiness, and resilience. In her view, this research, along with some other New Age ideas, is being misused to foster the belief that what happens to us is our fault. For example, rather than focus on systemic issues (such as income inequality or a crumbling economy) as reasons why you lost your job, these disciplines focus on attributing what happens to you on internal, individual characteristics, and essentially blame the victim for what happens to him or her.

It’s an interesting argument that relates to the tension in people's lives between denial of reality on the one hand and debilitating, excessive pessimism on the other. If you have breast cancer, being told that your anger and sadness about the cancer is going to make it worse would most likely fill you with both rage and guilt. At the same time, if all you can think about is what is out of your control, it will be difficult to work to change anything about your situation. Sometimes, it’s important not to minimize the bad, or sad things that happen to us, or that we feel. You can recognize them and acknowledge them in a way that enables you to move forward.

Anxiety Disorders Are Treatable

Are some people destined to suffer anxiety as adults? That’s one of the questions explored in an interesting article in the October 4 issue of The New York Times Magazine. The story focuses on the work of Jerome Kagan, a developmental psychologist who has studied how children adapt to new situations. In his work, he found that some babies had a particularly negative reaction to unfamiliar stimuli. These babies, it turned out, were more likely to develop into anxious or fearful children. As they reached adolescence and adulthood, their anxiety dropped somewhat and they functioned seemingly well -- making friends, for example, and getting good grades. But more so than other children, they reported a lot of anxiety and nerves.

These subjects are among the people that Kagan and other researchers have identified as responding intensely to new stimuli and stressful situations. They’re known as “high reactives.” Physically, this is reflected in MRI scans of their brains, as well as through a higher heart rate and faster breathing.

But being anxious by temperament does not always correlate how people function in the world. Someone who starts out as a “high reactive” may grow up in a family that helps him or her manage anxiety constructively. Someone else of similar temperament, however, may have experiences that reinforce a predisposition toward anxiety and may end up with an anxiety disorder.

In addition, being anxious by temperament may not always be such a bad thing. Too much anxiety can paralyze you, but having some anxiety can be helpful. It can motivate us to accomplish something that we need to do. It can help us to consider the consequences of a particular course of action that we think of taking.

The message of the Times article is that anxiety is complex, and not necessarily the life sentence that some people think it is. Sometimes people who start therapy will describe themselves as having a “chemical imbalance.” That’s often shorthand for believing that they are born with whatever symptom they are describing and that their temperament has nothing to do with the way they grew up or have learned to cope with their emotions. It’s also shorthand for believing that there is nothing that they can do about their problem other than take medication. But I am more hopeful about the possibility of change. There is a lot we can do to understand ourselves and the way we think, and to modify those ways of thinking so that they are not so debilitating.

An Unhelpful Attitude About Dieting

The New York Times this week ran a fascinating story related to food and eating, one that has provoked some strong opinions on the paper’s web site. The subject of the article is MeMe Roth, a Manhattan woman who has clashed with administrators at her children’s public elementary school. Ms. Roth, reports the Times, strongly objects to the sugary snacks and baked goods that her kids and others have been offered at school, such as the cupcakes that parents bring into class for birthday celebrations. “I thought I was sending my kid to P.S. 9, not Chuck E. Cheese,” the Times quotes her as saying.

It is true that it is tough for kids to make healthy choices when they are constantly exposed to sweets. It’s tough for adults, too, to make those healthy choices if their own refrigerator is packed with ice cream and cake. Reducing children’s exposure to junk food makes it easier for kids to avoid eating it.

But in trying to eradicate all traces of snacks and sweets from a child’s (or adult’s life), a person can go too far. By going to extremes in making a diet healthy for oneself or someone else, one can end up perpetuating an eating disorder that can be just as harmful as a steady diet of Tootsie Rolls.

One unhelpful approach is to categorize foods as good or bad. A cupcake by itself, for example, is not intrinsically evil. But if it is demonized and taboo--think of the tree in the Garden of Eden-- it becomes more seductive and desirable. In the likely event that a person eventually does yield to temptation and eat the forbidden fruit (or junk food), he or she ends up feeling terrible and guilt-ridden -- and, feeling defeated, keeps on eating. A key goal in working with people with eating disorders is to help them prevent one slip from turning into a binge. And one way to do that is to stop demonizing certain kinds of food.

Another unhelpful approach is to fast for long periods during the day. Often, people with eating disorders will eat little during the day -- letting themselves get extremely hungry -- and then binge at night. Feeling horrible and guilty, they decide to start dieting the next day -- and begin the cycle anew. So part of treating people with eating disorders is to help them get comfortable with eating regularly, to not let themselves get too hungry and to move away from dieting and deprivation.

For people with food and weight issues, it is not easy to navigate all the external cues and social pressures to eat. At the same time, outlawing fat and food are hardly the way to help.