Monday, March 22, 2010

Obesity: A matter of willpower?

People who died obese: Carol Yager peak weight 1,600 lbs died at 34, Rock 'n' roll legend Elvis Presley died of a heart attack at 42, two-time Academy Award winning actor Marlon Brando, Rapper Christopher Rios “Big Pun.” Others who have battled with obesity: Khaliah Ali, Kirstie Alley, Roseann Barr, Joseph R. Gannascoli, Jennifer Holliday, Jennifer Hudson, Randy Jackson (American Idol), Star Jones, Wynonna Judd, Ricki Lake, Courtney Love, “Monique,” Jack Osbourne, Marie Osmond, John Popper, Al Roker, Sherry Shephard, Raven Symone, Carnie Wilson, Oprah Winfrey to name a few.

President Obama said, obesity is the “most urgent” health issue facing the country. At last count, there are over 64 million adult Americans who are obese and thousands of deaths have been associated with this condition. The Center for Disease Control reported Blacks had 51 percent higher prevalence of obesity, and Hispanics had 21 percent higher obesity prevalence compared with whites. A recent study even found that 3-year-olds who were obese already had one of the symptoms of heart disease ( and the Daily FLOTUS).

The common morbidities associated with obesity include: (a) coronary heart disease, (b) hypertension and stroke, (c) type 2 diabetes, (d) high cholesterol levels, (e) high blood pressure, (f) abnormal glucose tolerance, and (g) certain types of cancer. The other health related consequences for obesity include: (a) asthma, (b) sleep apnea, and (c) social discrimination, (d) low self-esteem, (e) poor grades, and (f) social functioning for children. Data from National Health and Nutrition Exam Surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 17.0%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.

President Obama signed a Presidential Memorandum in conjunction with Mrs. Obama’s “Let’s Move” strategy, to launch a nationwide campaign tackling childhood obesity. The President states, “We think that this has enormous promise in improving the health of our children, in giving support to parents to make the kinds of healthy choices that oftentimes are very difficult in this kind of environment.” The memorandum creates a 90-day plan creating a task-force to provide “optimal coordination” between private sector companies, not-for-profits, agencies within the government and other organizations to address the problem of childhood obesity (

Obesity is associated with many factors. Below are a few reasons obesity has become a matter of social concern:

• Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity.
• Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status.
• Behavior and environment play a large role causing people to be overweight and obese. These are the greatest areas for prevention and treatment actions

Until recently, the medical profession has failed obese people. Many doctors still believe obesity is simply a matter of will power. As long ago as the 1970s, studies showed that doctors felt fat people deserved everything they got. Others showed perceptions of fat people as being weak and less intelligent than thin people. Many studies have confirmed that fat people fare less well in interviews than equally qualified thin people; that they are promoted less frequently; and, are less likely to be made leaders, according to Felding

The American Psychiatric Association has never regarded overeating or excess weight as a psychiatric disorder, and most obese people do not qualify for a psychiatric diagnosis. In fact many studies find no clear relationship between mental health and weight. Nevertheless there are Psychological disorders which obesity may trigger, which include: depression, eating disorders, distorted body image, and low self-esteem. There are several research studies that suggest obese patients report unexpectedly high rates of depressive and anxiety disorders, and that clinician should be careful to screen for these conditions, even if they are not suggested by the initial complaint.

Obese people have been found to have higher rates of depression. For example, David A. Kats, MD and colleagues at the University of Wisconsin-Madison assessed quality of life in 2,931 patients with chronic health conditions including obesity. They found that clinical depression was highest in very obese participants (Body Mass Index (BMI) over 35). Depression that is elevated to indicating psychiatric morbidity was more often seen in the obese, and that obese individuals, even those who are seen for treatment of a condition unrelated to their weight, are at increased risk of suffering from eating disorder. This research suggests it is crucial to assess among other presenting problems patient’s attitudes toward his or her weight, shape and identity. Clinicians should determine if the patient’s obesity is a source of low self confidence, and does the patient avoid particular day to day activities.

Treatments for obesity include self-help groups like Overeaters Anonymous and commercial programs like Weight Watchers. A common approach is behavioral therapy often in groups directed by a dietitian or clinician. The focus for therapy are self-monitoring and stimulus control. Self-monitoring means carefully recording weight, physical activity, type of food, and the amount of food eaten. Stimulus control means avoiding occasions of temptation. Exercise is also important, not only to expend energy, but to set the weight balance point at a lower level. Cognitive therapy may help dieters repel self-defeating thoughts and reject unrealistic goals (they will not likely achieve an “ideal” body weight). Psychotherapy or pharmacology can relieve depression and anxiety and help obese people live as full a life as possible no matter what their weight.

Healthy Eating Tips:

1. Provide plenty of vegetables, fruits, and whole-grain products.
2. Include low-fat or non-fat milk or dairy products.
3. Choose lean meats, poultry, fish, lentils, and beans for protein.
4. Serve reasonably-sized portions.
5. Encourage your family to drink lots of water.
6. Limit sugar-sweetened beverages.
7. Limit consumption of sugar and saturated fat.

Other Resources:

Kirstie Alley's Diet Plan
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Tuesday, March 9, 2010

Suicide: Has it become the prescription for depression?

Recently countless famous people have committed suicide: Michael Osmond, Joshua Andrew, Koenig,Lee, Alexander McQueen, James Victor "Vic" Chesnutt, Ryan Alexander Jenkins, Roh Moo-Hyun, Lucy Gordon, Phyllis Hyman, and David B. Kellermann to name a few.

Many have attempted suicide: Halle Berry, Alexa Ray Joel, Greg Louganis, James Stockdale, Donna Summer, Drew Carey, Mike Wallace, Paul Robeson, Elizabeth Taylor, Fred “Rerun” Robert Young, Maxene Andrews, Adam Ant, Mary Astor, Tai Drew Barrymore, Brigitte Bardot, Danny Bonaduce, Maria Callas, Martine Carol, Diana, Princess of Wales, Walt Disney, Micky Dolenz, Patty Duke, Eminem, Marianne Faithfull, Peter Fonda, Clark Gable, Stan Getz, Dwight “Doc” Gooden Mariette Hartley, Susan Hayward, Houston, Betty Hutton, Michael Jackson, Billy Joel, Elton John, Sally Kirkland and countless others. Why so many people who seem to have it all feel helpless? What does this say about our ability to handle life’s pressures? Did anyone hear their cries for help?

In addition to fame, these celebrities have in common various forms of depression and a cry for help. Most people with depression, particularly those with extreme depression, don’t commit suicide; however, it is important that it is addressed. Depression is a neutral disease that is unbiased to gender, race, or class. Depression does not exempt even celebrities with all the fame and fortune from falling victim. In fact, these deaths and attempts of suicide are a microcosm of larger mental health and social problem.

What is depression?
According to the National Institute of Health Publication and Dept of Health and Mental Hygiene, depression is a disorder of the brain and body's ability to biologically create and balance a normal range of thoughts, emotions, and energy. It is a potentially life-threatening mood disorder that affects up to 12% of the population or approximately 17.6 million Americans each year. Unfortunately, depression can lead to suicide. It’s important to recognize one doesn’t need to be diagnosis with chronic depression to attempt or commit suicide. The following data from the National Institute of Health Publication and Dept of Health and Mental Hygiene provided context for suicide prevalence in the United States:

• 15% of those who were clinically depressed died from suicide.
• In 1997, suicide was the 8th leading cause of death in the United States. 10.6 out of every 100,000 persons died by suicide. The total number of suicides was approximately 30,535.
• In 1996, there were an estimated 500,000 suicide attempts.
• There are an estimated 8 to 25 attempted suicides to 1 completion; the ratio is higher in women and youth and lower in men and the elderly.
• More than four times as many men than women die by suicide. However, women report attempting suicide about twice as often as men.
• In 1997, suicide by firearms was the most common method for both men and women, accounting for 58%.
• 72% percent of all suicides and 79% of all firearm suicides were committed by white men. The highest suicide rates were for white men over 85 years of age-65 per 100,000 persons.

Why do some individuals who suffer from depression commit or attempt suicide and others do not? This is a complex question. There is a variation in people with suicidal ideation and various demographics have been correlated with certain suicidal behaviors. Research suggests that 90 percent of those who commit suicide have depression or another diagnosable mental, emotional, or substance abuse disorder. Further research points to physiological reasons, such as the alterations in neurotransmitters like serotonin are associated with the risk for suicide. Decreased levels of serotonin have been found in patients with depression, impulsive disorders, a history of violent suicide attempts, and also in postmortem brains of suicide victims. The highest risk factors for attempted suicide in adults are depression, alcohol abuse, cocaine use, and separation or divorce.

Forlornly, life’s challenges in combination with other strong risk factors, such as depression may lead to suicide. It’s important to know that suicide ideation and attempts are not normal responses to life’s stress and the average person who experiences challenges in life don’t commit suicide. The following is a list of potential risk factors for suicide:

• One or more diagnosable mental (e.g., major depression) or substance abuse disorders
• Impulsivity
• Adverse life events
• Family history of mental or substance abuse disorder
• Family history of suicide
• Family violence, including physical or sexual abuse
• Prior suicide attempt
• Firearm in the home
• Incarceration
• Exposure to the suicidal behavior of others, including

Be aware of possible signs of depression and seek help. Many of the signs can be the result of other health related problems, contact your health care provider. However, people with depression have certain visible behavioral symptoms that, generally affect the body’s feelings, thoughts, and actions. The following is a list of potential signs of depression:

• Persistently sad, anxious, or empty moods
• Loss of pleasure in usual activities (anhedonia)
• Feelings of helplessness, guilt, or worthlessness
• Crying, hopelessness, or persistent pessimism
• Fatigue or decreased energy
• Loss of memory, concentration, or decision-making capability
• Restlessness, irritability
• Sleep disturbances
• Change in appetite or weight
• Physical symptoms that defy diagnosis and do not respond to treatment (especially pain and gastrointestinal complaints)
• Thoughts of suicide, death, or suicide attempts
• Poor self-image or esteem (as illustrated, for example, by verbal self-reproach).

Durkheim in his seminal work on Suicide (1897) asserted that it's the lack of social integration which may induce suicide. This means when social integration of a person is at a high level it could prevent the person from committing suicide and that small levels of integration implies the predispose to suicidal behavior. It is believed that people need social supports; however, alienation and isolation are clearly social conditions that contribute to possible suicide.

Lastly, because there is a strong correlation between depression and suicide, seek help and encourage those you know to seek help from a mental health professional. Another drink or using illicit drugs will not heal the internal pain of depression. Confronting depression and treating it like any other disease is the only attempt for cure. Life challenges will continue to occur, but how one handles and responds to these challenges make living with them less stressful. Many people think it's impossible to be helped, but a combination of treatments to include therapeutic and pharmacological approaches are available.

American Psychiatric Association
1400 K Street, NW
Washington, DC 20005
phone: (202) 682-6220
web site:

American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
phone: (202) 336-5500
web site:

National Suicide Hotlines USA
United States of America
1-800-SUICIDE 1-800-784-2433
1-800-273-TALK 1 (800)-273-8255
Deaf Hotline 1 (800)799-4TTY (4889)
Toll Free 24 hours a day 7 days a week