Why Obesity IS a Disease and How This Helps, Not Harms

Forgive me for sitting on the sidelines for a week and watching the news from the bleachers. What I’m going to talk about is not the event, but the aftershocks.

Last week, the American Medical Association officially classified Obesity as a “disease state with multiple pathophysiological aspects requiring a range of interventions”, a hotly debated change that follows in the footsteps of the American Association of Clinical Endocrinologists (2012) and The Obesity Society (2008), and highly supported by the American College of Cardiology and the American Heart Association. It wasn’t a shoo-in: the AMA Committee appointed to the task recommended AGAINST the disease classification, but the AMA House of Delegates –  the providers – overruled that recommendation and passed the motion with a large  (no pun intended) majority (276-181: 60.4% to 39.6%).

The professionals arguing against the classification fell back on the same old sorry party line – there are no specific conditions associated with obesity, and that it is a risk factor for other diseases but nothing more.

The AMA made a kind and accurate comparison to other lifestyle-related diseases: “The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.” Or diet and hypertension, or alcohol and cirrhosis, or sex and HIV, or drugs and Hepatitis C, or motorcycle accidents and brain injury among others. We are imperfect beings and we seek physical experience, sometimes to excess and to our detriment.

When they declared obesity a disease, you may have heard me doing my happy dance in my office where I practice Functional Medicine and Integrative Psychiatry, and treat obesity daily. Finally, I thought, recognition that obesity is NOT simple thermodynamics of calories in = calories burned. If it was that simple, everyone who ever lost weight would still be thin.

Not Everyone is Happy with the New Classification

I was stunned at the subsequent backlash that occurred, especially since all of the scientific evidence over the last decade points toward obesity as a progressive metabolic, endocrine, toxic, nutritional, psychiatric and inflammatory disease that sabotages weight loss efforts, no matter what the diet. Why would you NOT want obesity classified as a disease?

On Twitter, hashtag “#IAMNOTADISEASE took over with a vengeance.  People worried about the new obesity disease classification as (1) being more stigmatizing than being fat in a supposedly thin society, (2) overmedicalizing obesity because not everyone who is obese is unhealthy, (3) catering to the pharmaceutical and device industry, (4) being inaccurate because there is debate about Body Mass Index as an inaccurate and fallible measure of obesity and (5) promoting racial discrimination based on the epidemiology of obesity.

Let me try and answer their concerns:

Re: Stigmatization: People were offended and suspicious, especially the community of fat advocates. Apparently the word “disease” is worse than the word “fat”. I’m not sure how an already stigmatized condition can be further stigmatized, but I understand how an oppressed group may be overly sensitive to any slight or comment that seems derogatory.

Re: Overmedicalizing: Sigh. I understand that part of fat advocacy has been the Health At Every Size (HAES) campaign, which includes healthy eating and movement and a healthy balanced lifestyle, all of which I support and work with my patients daily to achieve. At any size. However the scientific physiological data just doesn’t support long-term “healthy obesity” on a micro or macroscopic level. Fat cells are metabolically active, and too many of them are eventually harmful. Years of morbid obesity will eventually erode joints, and take its toll on organ systems. Maybe the advocates need to change the term to “healthy obesity at this moment, but maybe not in 20 or 30 or 40 years”.

Re: Industry Profit: Yes. Assuming the pharmaceutical and device industries, and the supplement industry, and the medical and nutritional and even organic food industries will benefit is a given. They all always find a way. But the argument about the pharmaceutical industry making money off fat people is just simply a cost shift from the multi-billion dollar supplement and fitness industry that victimizes the gullible and the desperate among us.

Re: Disagreement within the medical and scientific community: There will always be disagreement within the medical community on disease and treatment – that is the definition of evolution. In a brilliant Aeon magazine essay The Obesity Era, science writer David Berreby said this, “One possible response, of course, is to decide that no obesity policy is possible, because ‘science is undecided’. But this is a moron’s answer: science is never completely decided; it is always in a state of change and self-questioning, and it offers no final answers.”

Re: Racial Discrimination: Absolutely, I give a nod that poverty is indeed associated with obesity in the United States, and a caution to not overinterpret or universalize epidemiologic data. In other countries, it is the middle and upper classes that are associated with obesity (such as India). I’m hoping that underserved populations will be able to see professionals about their weight, and have it covered, instead of not being able to afford a diet program or a gym. In my real dreams, there are urban community gardens, and decent produce and quality protein and fresh fruit in the food deserts, and safe areas to exercise or walk. The causal paradox of hunger and cheap food and obesity are not being ignored by classifying obesity as a disease. To the contrary, this reclassification calls attention to ALL causes of obesity – physiological, psychological, social, environmental, genetic, hormonal, economic.

What really struck me was that people who were upset about the obesity disease classification said “I AM NOT A DISEASE”, not “I don’t HAVE a disease”.  Yet they don’t say I AM ASTHMA. The AMA didn’t say “you are a disease”. Those of you who have read my blogs before know that I am a fervent proponent of turning the word “diabetic” back into an adjective where it belongs, not a noun. You are NOT a diabetic. You HAVE diabetes. You are NOT a disease.

So what is this about?

Maybe, just maybe, calling obesity a disease implies it is hopeless.

So let’s look at the actual AMA proclamation and how it is helpful, not hopeless.

Is Obesity Really a Disease?

The AMA says these are the “common criteria in defining a disease: 1) an impairment of the normal functioning of some aspect of the body; 2) characteristic signs or symptoms; and 3) harm or morbidity”.

Re Impaired physiologic functioning: “there is now an overabundance of clinical evidence to identify obesity as a multi-metabolic and hormonal disease state including impaired functioning of appetite dysregulation, abnormal energy balanced, endocrine dysfunction including elevated leptin levels and insulin resistance, infertility, dysregulated adipokine signaling, abnormal endothelial function and blood pressure elevation, nonalcoholic fatty liver disease, dyslipidemia, and systemic and adipose tissue inflammation”.

Re characteristic signs and symptoms: “including the increase in body fat and symptoms pertaining to the accumulation of body fat, such as joint pain, immobility, sleep apnea, and low self-esteem.”

Re Associated Harm or Morbidity: “The physical increase in fat mass associated with obesity is directly related to comorbidities including type 2 diabetes, cardiovascular disease, some cancers, osteoporosis, polycystic ovary syndrome.”

In my opinion, the AMA made the case for obesity as a disease. It gets even worse scientifically. In a groundbreaking study published in PLOS ONE 6/26/2013, OVERWEIGHT may be a disease also. In a study of 200,000 people affected by a common genetic variant, even a ONE UNIT increase in BMI is associated with a 20 per cent increased risk of developing heart failure. Further, the study also confirms that obesity leads to higher insulin values, higher blood pressure, worse cholesterol values, increased inflammation markers, and increased risk of diabetes.”

How Does Classifying Obesity as a Disease Help Patients and Providers?

How does a disease classification help providers and patients give and receive treatment and help?

1) Insurance Coverage. In my world, a diagnosis of Morbid Obesity is not yet reimbursable. I find myself having to scratch out an explanation of an eating disorder or anxiety or irritable bowel syndrome to cover the time and appointments that are needed for someone to completely change their lifestyle. In addition, prescription medications that are sometimes helpful will be covered, as will surgeries for people who need drastic measures to prevent end-stage disease before they develop those diseases. Patients with obesity will be able to see the dietitian or nutritionist, unlike the present where those appointments are not covered unless you already have diabetes, and then, only once a year. Losing weight requires a great deal of support – people should be able to see their professionals as often as needed. And maybe, in an ideal world, physical therapy will be expanded to include physical fitness.

2) Reducing Weight Bias among Health Care Providers. One fact to consider is that currently many, if not most, physicians and medical students and nurses and other health care providers are biased against obese patients. Interestingly, health care professionals also freely admit they have no skill or training or knowledge in how to treat these patients’ obesity other than treating the associated late-stage diseases. We providers don’t like it when we have no idea what to do for someone. A formal disease classification opens the medical school curriculum floodgates with research, algorithms, evidence, and support.

3) Politics, Policy, and Funding The AMA decision does not have legal clout, but becomes a crucial guideline when setting medical policy and health regulations, and determining funding priorities. Honestly? I dislike the politicians legislating medical care as much as anyone, but at this point, I dislike lip service for obesity more. Fund us, and let us go to work.

How does Obesity as a Disease Benefit the Integrative Practitioner?

Functional Medicine combines the best of medical science with the newest of medical science, what some people consider “holistic”. I am just as likely to order labs, write a prescription for medication as I am to recommend a vitamin or herb, but the bulk of the healing occurs with lifestyle changes – one small change at a time – with lasting huge effects.  You can’t stop eating cheeseburgers and ice cream because you have an essential fatty acid deficiency and your brain is screaming for them. But once they are replenished in your body, using the correct ratio of fatty acids and a reputable brand which does not contain mostly junk fish oil, the cravings disappear. Not a thought, not a wish, not a command in your mind. Gone.

The more we learn, the more we have to offer. For some of the data, we’re currently working off of minimal research and findings, with a great deal of mainstream opposition. Remember the position of acupuncture 25 years ago? Now…acupuncture is totally mainstream, and covered by many insurers. We are in the early years with alternative obesity treatment. There is a dearth of substantial credible data, and we are relying mostly on observational or exploratory data or small studies lacking statistical power. And yet we know from those patients, one at a time, who have responded, that many alternative treatments have potential in the treatment of obesity.

Weight loss coach Steve Nicander, who lost 400 pounds through lifestyle changes, and promotes an holistic weight loss program, “Healthful Hope”, expresses this beautifully. Says Steve, “I may have lost a massive amount of weight, but in my mind I will always consider myself to be obese and have that potential to be again. What I think this will do is allow for better treatment methods starting with our chronic childhood obesity problem allowing them to feel more comfortable discussing it with their health care providers. I hope the best and biggest change coming from this new awareness is improved training in medical schools in dealing with this epidemic, where education is at a bare minimum. Holistic approaches and non-invasive measures, as you know, can still reverse the weight and cure the underlying diseases.”

Nothing works for everyone, most treatments work on someone.  Everyone needs to clean up their diet and increase their movement, but, as we now know, that may not be enough for people. Lately, I’m lying on my new pulsed electromagnetic stimulation device and running the obesity program to see if I lose weight with the same lifestyle (which is pretty organic but a little underexercised and overworked). So far down 7 pounds, is this for real? At the same time, I’m happy to share the latest animal data on green coffee beans which demonstrates absolutely no prevention of weight gain. I feel like I’m pitching blindfolded. It’s not enough. I need more, you need more, and just like the commercial with those adorable kids… I WANT MORE. The door just creaked open.

This blog was first published on the American Holistic Medical Association blog

Functional Medicine and Integrative/Bariatric Psychiatrist Sara Stein MD can be reached on her blog at obesefromtheheart.com/the-blog or in her office at Stein Wellness in Woodmere Ohio.

What do Angelina Jolie and Bariatric Surgery Patients Have in Common?

Angelina Jolie discovers she has a breast cancer gene, the same one that caused her mother to die an early death, and she decides on a proactive, and possibly radical, prevention – double mastectomy. By doing so, she lowers her risk of genetic breast cancer from 70% to 5%. No guarantees, but definitely improved odds of survival. Assuming she continues her lifestyle changes to support her good health.

So while everyone is debating the wisdom of either her decision or her open conversation, I find myself thinking about bariatric surgery patients.

Moderate to extreme obesity increases the odds of dying from all diseases exponentially. Just like having a gene for cancer increases the odds of dying from that cancer.

Before you start eye rolling and pulling an Abercrombie on me, let me state firmly that we have enough scientific evidence that obesity is NOT gluttony, but IS a chronic and difficult-to-control disease of altered physiology. Genetically things are not always working in your skinny favor. Physiologically your body wants to regain the weight you lost. Psychologically that struggle is exhausting.

Some people will make a decision that their weight is beyond their own control. They recognize the downhill course of associated illness, the march toward an early death, and choose a radical procedure to change that course. Bariatric surgeries are not without risk, and don’t always work, but the odds of survival improve dramatically when the surgery is successful. Assuming the patient can continue the lifestyle changes necessary to support their good health.

See the pattern?

It takes an extraordinary amount of courage to say I have a disease risk and I don’t want to succumb to it.

It takes an extraordinary amount of courage to have a radical surgery to prevent an early death.

It takes an extraordinary amount of courage to face your mortality, discard the wishful thinking, realistically assess the ability of modern medicine to save you, and move forward with a life-altering (and life-affirming) option.

It takes an extraordinary amount of courage to change your lifestyle and not look back.

Here’s the thing…

There isn’t a right decision here. The right decision is the one that works best for the individual patient, one they can adjust to and live with, one that fits into their lifestyle, one that moves them farther away from deadly illness.

I support Angelina Jolie and her surgery decision to save her life. No hindsight, only moving forward.

I support those of you who have bariatric surgery to save your lives. No hindsight, only moving forward.

There are no guarantees. Angelina may still need medical treatment for cancer, and bariatric surgery patients may still need medical treatment for obesity. To the scientists of the world, keep up the great research. To the doctors of the world, stay educated and open to possibility. To the patients of the world (and that is all of us), be proud of your courage, regardless of your decision, and stay vigilant.

That’s the only guarantee I have for you.

This post was originally published on kevinmd.com

#FitchtheHomeless and Why It’s NOT ENOUGH!

The CEO of Abercrombie & Fitch is a jackass, stuck somewhere in the 9th grade developmentally. He hates fat people and doesn’t want “uncool” people wearing his brand. He burns slightly defective clothes rather than distribute them to charity like most other clothiers. Plus… he’s butt ugly.

A genius filmmaker in LA, @gregkarber, a guy with an amazingly kind heart, the type that you want to meet his mother and congratulate her a thousand times over, made a video suggesting we give all of our A&F clothes to the homeless to REBRAND it. More than 6,000,000 people have watched this video thus far, with countless more opinion pieces written on the jackass CEO.

As a result of CEO stupidity, and social media, the A&F brand reputation has officially tanked.

Buzz: Abercrombie & Fitch, American Eagle, H&M

Buzz: Abercrombie & Fitch, American Eagle, H&M
Copyright © 2000 – 2013, YouGov plc is a company registered in England and Wales with company number 03607311. YouGov plc, 50 Featherstone Street, London, EC1Y8RT

So why is the frigging stock up? The guy’s a jerk, the product isn’t that great, the brand reputation is in the toilet… and the stock is up!

Abercrombie & Fitch Co.  NYSE: ANF – May 17 4:00pm ET

54.24 +0.92‎ (1.73%‎)

Open                    High                Low

53.14                    54.32              52.79

Google FinanceYahoo FinanceMSN Money

Here’s why… (disclaimer I am NOT a Finance expert, but I am a psychiatrist, and markets are made up of people).

People go where the attention is, they follow the hype,  they are impulsive, they buy what is a topic of conversation, they make their sell decisions later.

So what can you do?

Keep giving your Asscrombie and Fitch to the homeless. (Great idea Greg Karber!). But if you really want to hurt the guy… boycott and ignore. The goal is empty stores. Make them forgettable.

Viagra for Women: Why Your Doctor Might Prescribe 50 Shades of Grey

Could “mommy porn” have value in the doctor’s office? Unless you live in a cave (and we physicians sometimes do), you have heard of British author E.L. James’ modern erotic 50 Shades of Grey trilogy, 30-plus million copies sold, overwhelmingly to women. The trilogy is an erotic love story about a naïve college graduate who rescues an abused billionaire – a blend of the Story of O, Pretty Woman and a Danielle Steele novel. Not great literature, but clearly having some effect on the libido of millions of women. Do we finally have a safe and affordable clinical tool for women with blunted libidos and hypoactive sexual desire?

The prevalence of decreased female sexual desire and responsiveness has been estimated from 15 – 53%, higher in menopause and perimenopause. In one study, half of women with these symptoms spoke to their doctors about the problem, yet doctors have very few tools for women with hypoactive sexual desire. The phosphodiesterase inhibitors (nitric oxide agonists) such as Viagra increase genital circulation and can effectively treat erectile dysfunction in men, but have shown no benefit in women. Testosterone patches may increase sexual desire and satisfaction in both surgically and naturally menopausal women, but side effects can be uncomfortable, and long-term safety has not yet been established. The jury is still out on the effectiveness of adrenal hormone DHEA replacement, and herbal remedies such as gingko biloba.

So into the office walks a middle-aged female with a normal amount of stress, in a relationship that is comfortable but not passionate, and she wants her mojo back. Where does the doctor start and what is there to offer?

First, the differential diagnosis for diminished sexual desire and responsiveness in women: stress, relationship problems, depression, diabetes, endocrine (thyroid, prolactin, sex hormones), medication side effects (particularly antidepressants and blood pressure medication), vascular disease, nutritional deficiencies (and side effects of too much junk food), substance abuse, past history of trauma for starters. Eventually everything correctable has been corrected, you and your doctor have made a joint decision about the pros and cons of hormone replacement therapy … and still … no fire. Now what?

Think the missing hormone … oxytocin. That old induce-labor bag of pitocin IV hung on all those moms-to-be who weren’t progressing. Oxytocin, a major player in female sexual desire and responsiveness, released during any kind of cuddling – romantic, parental, puppies, and released during orgasm. And most importantly, released while reading romantic, erotic literature. But oxytocin blood tests are largely experimental and oxytocin replacement is not easily available at the pharmacy. How do you know if you have an oxytocin deficiency, and if it can be behaviorally corrected?

You take the oxytocin challenge test – read the entire Fifty Shades trilogy (all 3 books) in one week’s time, and see how you feel. (Don’t stop at the first book, it takes the next 2 books for the desired effect).

One middle-aged woman reported her animals sat next to her while she was reading, and she felt more connected and cuddly, but it didn’t save her relationship. She realized her lack of sexual desire was not physiological, but a result of relationship issues.

A younger woman reported more intense bonding with her young children and husband, and the “biggest orgasm” of her life.

A post-menopausal woman reported that she started to feel desire for her husband again, and had an increase in frequency of intercourse “like 20 years ago,” without hormone replacement, and with no change in their marriage. (He was delighted).

No meds, just books.

The key to the success of these books in women is not the abundant sex scenes, but the romance, and the massive release of oxytocin women experience as a result of immersing themselves in the “love” part of the book. Hearts and flowers increase desire in women; thus the success of the “chick flick” for dates.

Let’s face it. Pornography, written and visual, has existed forever, but remains a greater male stimulant than female. That difference is driven by physiology – women are not aroused by visual pornography to the degree that men are aroused. Male libido is stimulated more by visual and tactile erotic images and sensations – leading to a massive release of norepinephrine (energy/aggression) and dopamine (pleasure/reward). For men, increases in dopamine and norepinephrine appear to play a greater role in arousal than in women, whose arousal seems to be largely oxytocin driven.

What about men? Is there a diagnostic and treatment role for Fifty Shades and the like genre? As a sex manual, Fifty Shades has merit as a “touch here, kiss there, try this” benefit. As a male turn-on … maybe, but don’t count on it.  Cuddle? Pleasant, but not erection-inducing.

Is there anyone who should NOT read the Fifty Shades series? Yes – it may be too intense for younger women, even if sexually active, and it may be a trigger for women with sexual trauma or abuse histories, or it may simply be offensive. That said it’s certainly worth having a conversation with your doctor, and maybe getting a prescription for the bookstore or the library (if the waiting list isn’t too long!). You’ll love your doctor in the end.

This blog was originally posted on kevinmd.com

Dr. Sara Stein on the Medicinal Use for 50 Shades – Fox8 11-07-2012

WebMD’s Health Care Social Media Disaster – Read the Fine Print!

Occasionally, my vocation of treating obesity and my avocation of health care social media intersect.

This is one of those moments. This is the story of a health care social media betrayal in which obese children and e-patients are the victims. Nobody died, except medical ethics, good judgment, and trust in doctors. This is WebMD’s Health Care Social Media Disaster.

Big Cereal Comes to DC 5

Recently, WebMD published an “advertorial” from Kellogg’s: "Mums, kids & breakfast: The truth about sugar“ with a brief disclaimer, “This content is from our sponsor. The sponsor has sole editorial control.” The kind of disclaimer a casual visitor might easily overlook. Here are excerpts from the article, meant to convince you that sugary breakfast cereals are nutritious, and that sugar consumption is a healthy option for your children.

Myth #1 :Sugar is always responsible for tooth decay

The truth: Breakfast cereals eaten with milk, even pre-sweetened varieties, do not increase the risk of tooth decay.

Myth #2 : Sugar is bad for you

The truth: A panel of world health experts recently reviewed the scientific evidence and concluded that a high sugar intake is not related to the development of heart disease, diabetes, high blood pressure or cancer.

Myth #3: Some sugars are more nutritious than others

The truth: All sugars provide approximately 4 calories per gram. And despite popular belief, no type of sugar is more nutritious than any other.

Myth #4: Children should eat a lot less sugar than adults

The truth: Children do have different needs to adults, so they have different Guideline Daily Amounts (GDAs) for sugar. But not as different as you might think.

Because they are active and growing, children are not vastly different to the “average person” used on the front of the pack. In fact, for sugar, it is very similar indeed.

Guideline Daily Amounts (GDAs) for sugar: Average person – 90g; Children – 85g

Advertisers can claim pretty much anything as long as they can manipulate data. No surprise Big Food is fighting back on the attack on the nutrient value of processed food. The problem is not the advertisers. The problem is WebMD and the trust we want e-patients to have on the internet.

The main tenet of health care social media is to advise e-patients, also known as empowered patients, to seek out reliable and credible medical information, most often on major medical websites, including WebMD. We “soc med” docs are working hard to direct the 88% of patients getting healthcare information off the internet* to these sites. Our good faith and theirs. When a major medical site allows this level of misinformation in advertising, the average person is at serious risk.

Here are the tweets ….

@Appetite4Profit What happens when a medical site sells out to Big Food? Kellogg & WebMD report sugar’s good for you!

@AplusPaz Cigarettes are good for kids too, the nicotine kills bacteria within their stomach.

@MagWrites I guess that now really makes them cereal killers

@YoniFreedhoff Kellogg’s states 360 calories of sugar daily = good 4 kids. That’s 20-30% daily cals!

Obesity expert Dr. Yoni Freedhoff pondered the judgment of advertising authority in his blog, Weighty Matters, “I wonder who the WebMD genius was who decided giving sponsors sole editorial control over content was a good idea?”

I’m figuring it was the person who ate the sugared breakfast cereal, and was cognitively impaired for the rest of the day.

 

(This blog was originally published under the title “Sponsored content on health sites can mislead patients” on KevinMD.com 8-22-2011)

(Photo courtesy of Ted Eytan MD, http://tedeytan.com)

My Street Creds – The Real Medical Evidence Of Obesity

cropped fat Sara I am on an Obesity Mission. I’m going to single handedly (with lots of great help) change the way we treat obesity. And the way we treat obese people.  The following is an open letter to all the skinny doctors, trainers, dieticians and therapists in the world …

WITH ALL DUE RESPECT DOCTORS AND COLLEAGUES…YOU ARE WRONG ABOUT THE MEDICAL EVIDENCE!

Listen up. (That’s me BEFORE circa 2003). A fat doctor. Imagine. (Scroll down to see the AFTER).

Obesity is NOT simple thermodynamic imbalance. It’s not  how many calories we eat and how little we exercise.  That may be true for people who are overweight and have 20 or 30 or 40 pounds to lose. Any diet and exercise program that is basically healthy nutrition and movement will work for them; it’s just a matter of matchmaking – the right program for the right person.

For the rest of us, the obese…Eat Less Move More fails 95% of the time. Worse yet, severe restrictive diet and exercise may worsen, not improve, the obese person’s health. Emotional Eating and Behavioral Control don’t fare any better, but at least they don’t ruin someone’s health!  cropped thin Sara

Here’s me with a recent 2010 AFTER (down 100 lbs). Winning an award because I figured out how to lose weight and how to apply that knowledge to every patient I see and how to teach to anyone who will listen. (Thanks Kaiser!)

Here’s what I know about Obesity. I’ll share it all with you in the hopes that you will go back to your exam rooms and order some labs for starters.

Obesity is a medical condition of serious inflammation, chronic pain, disordered endocrine function, changes in insulin metabolism, altered brain chemistry, food sensitivities, serious vitamin and mineral deficiencies.

Obesity is a psychosocial condition of depression and hopelessness and isolation and loneliness.

Obesity is a spiritual condition of broken hearts and broken souls and broken families. It’s not how we feel inside, but it’s how the outside sees and reacts to us. It hurts to be fat. Physically, psychologically, socially and spiritually.

Now…does that sound like gluttony to you?

Yet, if I go to any one of you, even the most esteemed physician or medical center, you will tell me Eat Less, Move More.  Or you’ll send me to your behavioral health department because clearly there’s something wrong with me. There I will receive medication for depression and six weeks of therapy about how I’m a good person and I should love myself and not eat chocolate. Or you’ll throw up your hands and say I can have surgery, but I’m not sick enough to qualify yet. Wait a few years.

You can treat obesity, it’s easy. You already know how. But it’s not Eat Less Move More. And it’s not emotional.

It’s replacing Vitamin D, detecting Vitamin B12, A, Zinc, Iodine deficiencies, finding food allergies even when the lab tests are not sufficiently sensitive, treating pain and weakness with gentle movement therapy, jumping on that sleep disorder, correcting inflammation and insulin resistance, helping that sluggish thyroid, changing obesigenic medications to those with a more neutral weight profile. And yes, sometimes it’s sending us to behavioral health, but not nearly as often as you think.

You can treat obesity by understanding the many pathways and reactions that have been altered in response to excess inflammatory adipose and its causes. And one by one, correcting them. Just like you learned in medical school. Imagine that.

And I’m here to tell you, if  you do that, your patients will lose weight. And feel better. And love you forever.

Announcing the opening of Stein Wellness Centers in May 2011, dedicated to comprehensive and integrative treatment of obesity. In person and distance.

Offering free consultation to any medical professional.

See one, do one, teach one.

Sara Stein, M.D.

Stein Wellness Centers (opening May 2011)

800 680-3451

http://SteinWellness.com (under construction)

info@SteinWellness.com

A Matter of Size: The Deserving of Obesity

(An obese psychiatrist analyzes an obese comedy, A Matter of Size, the heartwarming story of four obese Israeli men and one woman who decide to quit dieting and become Sumo wrestlers)

They had me from the opening scene. The obese little boy gingerly lifting his foot, hoping the scale will drop down a bit at the school weigh-in. Thirty years later, morbidly obese, single and living with his mother, taking off his watch at the diet club weigh-in wishing that an ounce will matter.

The loving, interfering, nagging, long-suffering, conflicted mother. Why are you eating that, she asks him as he unloads the refrigerator in the night. He argues until she begrudgingly gives in, if you want there’s rice to go with it.

The brand new pants in the used-to-be right size that fit like sausage casing.

The diet club. The misguided skinny diet director who thinks tough love and sarcasm will make fat people lose weight. That’s because we haven’t had enough bullying in our lives.

The looks, the nasty comments, the derisiveness, defensiveness, the loneliness, the rejection.

They had me back in my childhood, in my adulthood, in pain and embarrassment and agony. I felt so badly for the people in the movie. I felt so badly for me. Obesity is the heart of loneliness.

And then everything changed. These weren’t fat suffering people. These were resilient, strong, courageous people. People who took lemons and made lemonade. They fell down time and time again, and picked themselves up from the insults and the sneers and the disdain. Just in order to have a life and love and happiness. Out of obesity came sumo.

Obese people kissing on the screen. Fat people in love. In tears and fears. With hopes and dreams. Imagine that.

A film that depicts obese people the way we are… simply human beings, divine creations, with perfections and imperfections that allow us to stand out as individuals, and combine into relationship and community.

A film that depicts our struggles the way they actually exist.

In all of my pounds and all of my years, believing I deserve a good life has been my biggest struggle. Losing those pounds one at a time did not increase my feeling of worth.

What changed my life was accepting those pounds. One at a time. And allowing those same pounds to leave – one at a time – because they no longer represented who I was inside. The essence of me was not how my body looked or acted or felt. The essence of me was how I loved and cared and created. The essence of me was not fat. It was life.

And for that reason alone, obese people

Deserve love in our relationships

Deserve success in our endeavors

Deserve respect for our efforts at making a life.

“My heart is not a muscle.” My soul is not obesity.

The lesson of sumo, and of comedy, is acceptance and deserving…and seeing the divine romance of it all.

Dr. Stein will be facilitating a community discussion on obesity following the screening of A Matter of Size at the Cedar-Lee Theatre in Cleveland, OH on October 9, 2010 beginning at 9 pm. Please join us!

STRESS EATING: RUNNING ON EMPTY

Stress is society’s greatest modern affliction. We have completely lost control of our workdays. A workday used to be dawn to dusk. It used to be from the time you arrived at your workplace until you went home. It used to be 5 days a week. Not anymore. We work constantly, 24 hours a day, 7 days a week. We work at our jobs, in our homes, at school, in traffic, at the grocery store. We work shopping on the Internet.

When we are resting, we are working: making lists, setting goals, reviewing today, and planning for tomorrow. We are not resting.

We continually increase our workload because work is addicting. We physically experience an increase in adrenalin, and energy and focus that expands our productivity. It’s a rewarding feeling to do a good job at something.

We add more work so we can feel even better. We start multi-tasking: the dishes, and the laundry, and the homework and the science project.

We add more forms of communication: television, radio, email, Internet, regular mail, newspapers, magazines, cell phones, voicemail, text messaging.More lives to keep track of, including people we don’t even know. Pretty soon, there is no time and we are multi-tasking every task, including some that should be enjoyable.

We read while we eat, we talk while we drive, we work on three things at once. Simple pleasures are eroded by a sense of urgency and the need for more adrenalin to keep us going. No time to say, “Hello”, “Goodbye”.

We work this hard because our society sets up overwork as a model of success. “Supermoms”, mandatory overtime, full-time students with full-time jobs.

One day I saw a 40-ish single mom who was working two jobs, going to school full-time and raising her children. She was exhausted, stressed, depressed, gaining weight and forgetting things.

“Why are you doing all of this”, I asked.

“For my kids, so I can get a better job.”

I looked at her without any humor, and replied, “If you live long enough”.

We are operating at a level of INTENSITY that causes DISEASE.

We have lost our ability to play, and live and love. We have lost our ability to experience emotion because we are so busy working. We have lost the ability to relax, and think and be alone with ourselves. We have lost the ability to feel content with our circumstances. We have forgotten how to look at the sky and wonder about the stars.

We have lost the ability to experience emotion when we are under severe chronic stress.

Hard at work and numbed out to everything and everybody.

When it’s time for me to relax and have fun, I often cannot. Unless I eat. Then I relax. The food pours out dopamine and GABA and serotonin and acetylcholine into my parched brain until I am positively serene. Am I relaxing because I’m healthy? Or am I relaxing because the food just drugged me into forgetting what I was doing.

For the five or ten minutes that you are stress-eating, your brain is transported to a lower-stress zone. You give your body, your brain, and everyone else in your life a break from the jagged energy you are projecting.

If you are eating all the time in response to stress, “all the time” is simply a reflection of HOW STRESSED YOU ARE!

Just in case you thought this was only about your own personal stress, there’s more. You can also absorb other people’s stress, particularly if they are close to you. Stressed people have a tendency to pour out their problems in rapid-fire succession, one after another, with great energy and emotion.

Relief from stress is about learning to say no: no to demands, no to internal goals, no to family expectations, no to overzealous work projects. Saying no does not mean quitting your job in a bad economy, nor does it mean walking away from a difficult supervisor and getting fired. Saying no means acknowledging your physical and emotional limits and respecting them.

Relief from stress is about recognizing your body’s signals. When you cannot sleep, and you cannot relax, and you cannot stop thinking about work, you are overworked.

The solution to stress and overwork lies in learning and practicing proper endings. To be able to say this is my workday and I am now off. This is my homework time and it is now over. The day’s work has ended and this is my sleep time. This is my stress, and this is yours and I cannot accept it. These are boundaries, yours, mine, and ours.

The solution for stress is to recognize that for your body, rest is as essential as exercise.

For your brain, quiet is as vital as thinking.

For your spirit, solitude is as healing as company.

The solution to stress is to accept your humanity and all its limitations.

excerpt from Obese From The Heart: A Fat Psychiatrist Discloses ©Sara L. Stein, M.D 2009 http://obesefromtheheart.com

NOOOOO!!! An Open Letter to Oprah on Obesity

NOOOOOO!!! That eardrum shattering scream you just heard was mine after I listened to Oprah Winfrey (I adore her) talk about her very public weight gain with emotional eating maven Geneen Roth. (Oprah on a Time She Forgot Her Loveliness, 5-11-2010)

I hear the thundering herd of hoof beats running for a book THAT IS NOT MEANT FOR OBESITY. And I hear the collective thud a month or two from now, of millions of copies tossed into the failed diet books collection. (Yes, we have those).

Don’t get me wrong – Geneen’s elegantly worded conversation on emotional eating is entirely appropriate for someone with 30 pounds to lose, or binge eating, or anorexia-bulimia. She even says that. Yet the audience was stocked full of morbidly obese people. Like me. And Oprah, God love her.

Certainly obese people have emotional eating that needs to be worked through for successful weight loss. But it is NOT the predominant driving force behind sustained obesity.

“I shamed my fat self”, Oprah said, “when I put myself on the cover of O and said how did I let this happen again”.

OPRAH! YOU DIDN’T LET IT HAPPEN! Anymore than you LET your bladder fill or LET your body go to sleep. This is your brain and body we’re talking about, not your soul.

Yo-yo dieting and weight regain are NOT the result of weak wills. THEY ARE THE RESULT OF AILING BODIES. And frantic brains trying to heal them.

Obesity is NOT a state of feeling badly about oneself – it is a MEDICAL CONDITION…with:

1) Chronic Inflammation, Pain and Exhaustion –  Addicted to sugar and caffeine? Maybe you’re an ENERGY addict! It takes additional energy in the form of calories to move your extra-large aching, swollen, inflammed self down the hall. The worse your end-stage illnesses of obesity are (such as sleep apnea, diabetes, arthritis, fibromyalgia, hypothyroid), the longer that hallway becomes. Even if the end-stage illnesses have not yet manifested, the inflammation of obesity is simmering inside you, and exhausting you.

2) Altered Metabolic Pathways – abnormal insulin, leptin, cortisol metabolism (and others) cause the obese person to hold on to weight, be hungry all the time, have higher blood sugar and insane food cravings. Your continuously elevated stress hormones have convinced your trillions of cells to HANG ON TO EVERY BIT OF FAT BECAUSE WE”RE IN A FAMINE!! Don’t you wish you could explain grocery stores to them?

3) Altered Brain Chemistry – Depressed and anxious brains screaming for serotonin and GABA and dopamine driving you possessed toward the chocolate counter. Searching for oxytocin love in all that comfort ice cream and macaroni and cheese. Driven by sleep deprivation, changes in genetic expression and medication effects. Responding to toxic food injury from junk food as addicting as crack cocaine in your brain. This is not emotional eating; this is your brain directing your chemistry ingredients.

4) Severe Vitamin and Mineral Deficiencies – such as (but not limited to) D, B12, A, iodine, fatty acids:

Vitamin D from the sun – a prehormone – manufactured by the cholesterol in your skin when exposed to that beautiful yellow orb in the sky. Vitamin D that gives us energy and happiness and relaxation and protects us from diabetes and heart disease and cancer and obesity. You don’t get credit if you stay indoors and look out the window, or if you live in Cleveland like I do and there isn’t any sun half the year, or if you’re African American and your skin acts like sunscreen. And you’re never going to be able to lose weight with Vitamin D deficiency until it is corrected.

Vitamin B12 from animal proteins (not vegan diets). Blocked from absorbing by all those prescription reflux medications. Vitamin B12 that gives us energy, memory, concentration, happy moods, relaxation.

Vitamin A from fruits and vegetables for our skin and eyes – night blindness, psoriasis, eczema – the 5th leading cause of blindness in the world – not found in junk food, you can be sure, but a good carrot or sweet potato might help.

Mineral and element deficiencies like Iodine – Iodine that keeps your thyroid running and your breast tissues healthy, essential for the production of every hormone. Added to salt in the early 1900’s so you wouldn’t get a thyroid goiter, but now you eat fancy non-iodized kosher salt and sea salt or no salt at all. Iodine that used to be in flour until the 1970’s when it was replaced by bromine (the stuff they gave soldiers in World War II to kill their sex drives!)  Makes you tired, in pain, obese, dull.

Essential fatty acid deficiency – I know you’re eating fish 3 times a day, right? Essential means brain function – attention deficit disorder, memory, mood. Essential means skin – eczema, rash, dryness. Essential means inflammation and immune function – cancer, heart disease, arthritis, dementia. My grandmother frying those smelts every week – she knew something!

5) Food sensitivities like 1) gluten from all that fake wheat processed stuff used to thicken, texturize and cheapen your food, 2) corn from the high fructose corn syrup that makes you gain MORE weight than the same caloric amount of sugar; 3) processed soy that slows your thyroid down because it’s no longer recognizable to your immune system. 60% of people with obesity have food sensitivities, aka allergies.

Now…does that sound like ‘”only eat when you’re hungry in a quiet room focused on food” is really going to make a difference?? Treating morbid obesity with emotional eating techniques is the same as treating cirrhosis of the liver with 12-step programs. The proverbial peeing in the ocean.

Here are some suggestions if you are obese.

Get your vitamin and mineral levels checked. Be careful of those who tell you what you should be eating. Pay attention to when you feel sick, what did you eat in the last 24 hours? The hell trinity of obesity is gluten, dairy and sugar. Purify your food and water sources. If you can’t pronounce it or picture it, don’t eat it. It’s making you fat, and that INCLUDES artificial sweeteners. Forget gourmet, aim for plain. Like grandma used to make. Whatever you’re doing now…do the opposite. Get out of the chair. Sleep more. Eat grapes. Watch less TV. Spend more quiet time. Work less. Work out less. Play more. Do nothing that causes physical or emotional pain. Take baths. Dance in a chair. And if you cannot do anything at all, at least get a little sun.

Try 70% dark chocolate EVERYDAY to fool your body about that famine delusion. The heavenly trinity that treats depression…exercise, Vitamin D and dark chocolate. Can you add one in?

There is hope and healing from obesity. One medical condition at a time. Give your emotional soul a rest.

Sara L. Stein, M.D., is a bariatric and integrative psychiatrist  who runs Obesity Clinic at Kaiser Permanente in Cleveland, and is the author of Obese From The Heart: A Fat Psychiatrist Discloses (2009). Learn more at http://obesefromtheheart.com

I Know I Am Obese; Where Do I Begin??

This is the question I am most often asked. My patients come dragging in reluctantly, sent to Obesity Clinic by the primary care doctor or their own frustration and failing health. They are certain they will be given a lecture and a diet or told to go have surgery. They are surprised when they leave my office with directions to eat chocolate, take these supplements, get some more rest, and stop working out so hard.

“WRONG” says the medical world and the diet industry and every magazine you read. Restrict your diet! Quit eating things you crave! Work out harder! No pain, no gain! YOU MUST SUFFER!!!

Puhleeze. As if obese people aren’t already suffering.  Apparently all those skinny trainers and nutritionists and doctors think we were having a great time during those lonely nights by the refrigerator or trying to run in gym class with our thighs chafing.

I have news for you if you are obese. You have suffered enough. You have struggled enough. It isn’t difficult to lose weight, it’s just different than what you have been told.

By the time a person has become obese, they have an ailing body, even if there are no visible end-stage diseases such as diabetes or hypertension. Pain, inflammation, changes in metabolism, nutritional deficiencies, altered brain chemistry. It’s not fun to be morbidly obese. It hurts physically and emotionally.

If you push a broken body (or a broken car) too hard, it breaks down further. To your body, exercising and nearly starving feels like incredible stress. So does divorce, bankruptcy, unemployment, problems with your kids, or working two jobs. Your brain doesn’t make a distinction between one bad stressor and another bad stressor. To your million-year old brain, bad stress means the famine is coming. (Remember that one? 7 lean years?) “OMG,” says your brain to each one of your body’s many trillion cells, ”We’re starving to death…HOLD ON TO OUR FAT!!! We need it!”

Ever see the program where the fat people stop losing weight as the workouts get harder, until they go home, relax and eat? It’s called stress relief.

Welcome to the No-Stress Zone. Here’s where you start, and this is the first of many blogs that will help.

You start by determining what very small change in your food you can make today that will not send your brain into a starvation frenzy. If you drink 5 sodas a day, can you drink 4 and one water? If you skip breakfast and binge every night, could you move a little food earlier in the day? My first change was drinking coffee instead of lattes. And if I really wanted a latte, I would have one.

Next, what movement can you do that WILL NOT HURT?? Can you stretch a little in your chair? Can you walk a little? I started out cycling my legs in the bathtub – it was the only place I didn’t have pain.

Finally, what joyful or relaxing moment can you treat yourself to today? When’s the last time you heard music you loved, or called someone you care about? Or took 10 minutes to read something beautiful?

And when you wake up tomorrow, do this again. A little further. A little longer. And again the next day, and the next.

That’s it.

That’s the secret to losing weight with obesity.

Small, easy, sequential changes that add up over time. And give your body and your mind a chance to heal with each small adjustment.  From my husband who lost over 100 lbs: “Tell them this is the first of many small changes they’ll make, and they’ll be surprised how easily they rack up.”

Now that didn’t hurt, did it?

Next Page »

maxx test 300 review . Essaydragons.com