Posts Tagged ‘Obesity’

What Katarina Borer Found: Good News for Maintainers?

In Weight-Loss Maintenance on July 8, 2011 at 12:52 pm

Before I say another word, my conscience tells me to add a BIG trigger caution here.  If you are a size acceptance proponent and are feeling the least bit susceptible to the call of the weight-loss diet fairy, skip today’s post.  If you’re feeling brave, however, I’d love your response as well as that of my maintainer friends.

In my last post I explained Katarina Borer’s methodology for comparing the effects of food intake and exercise on appetite and on certain endocrine secretions.  Dr. Barry Braun describes it as “a multicondition crossover design to cleverly disentangle the relationships between energy imbalance, exercise, energy intake, putatative energy-regulating hormones and perceived appetite.”  Yup.   That’s what it was.  Now, let’s see whether I can explain in plain English what happened and what was correlated and what was not.

In her first study, Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track changes in energy Availability, Dr. Borer found:  

  1. Human appetite is influenced by the passage of food through the mouth and gastrointestinal tract.  When food went through the mouth, it triggered GIP, a gut peptide that is activated and serves as a marker for GI activity but seemingly has no affecting qualities of its own.  This peptide rose and fell in concert with participants’ reported appetites. 
  2. Participants’ appetites responded to the size of meals that came in through the mouth, but were insensitive to calorie replacements (or saline placebos) that came through an IV.  Moreover, exercise did not increase appetite, but marginally suppressed it.  This led her to state that “between-meal increases in circulating nutrient load and exercise energy expenditure are not under homeostatic feedback control.”
  3. Ghrelin, leptin and insulin respond in slightly different ways to changes in energy availability, but had no influence on participants’ appetites.  Whoa.  Interesting, yes?  Dr. Borer thought so too.

The graph array that interested me most, as a maintainer, however, was Figure 2 (in the second study it was reposted as Figure 4).  I was surprised, in fact, that it was not included as a “finding” in the Discussion section.

It looks fuzzy in my preview, but I was able to click on it to get a blown-up view that was very clear.  Column 4 describes the trial day Read the rest of this entry »


Katarina Borer: My First Impressions of her Recent Work

In Weight-Loss Maintenance on June 30, 2011 at 3:04 pm

It’s taking time, but I am working my way through a study, an article and a commentary surrounding some recent work by Dr. Katarina Borer and colleagues on endocrine, appetite and exercise.  

I believe I mentioned that Dr. Borer contacted me in response to my Open Letter to Weight Management Scientists.  I may have also mentioned that she said my postings were, ahem, interesting and remarkably well informed for a person who is not actively engaged in research. I am digging deep to find my inner objective scientist who would not be moved by such flattery.

I am working my way through these pieces simultaneously because they are based on the same trials, but they present two sets of conclusions.  The first set may be found in the study itself, entitled Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track Changes in Energy Availability and was published in July 2009 in The Journal of Clinical Endocrinology and Metabolism.  To give credit where due, her co-scientists are Elizabeth Wuorinen, Kimberly Ku and Charles Burant, not that those names are meaningful to me.  Actually, very few of the names in this line of research are meaningful to me . . . yet. 

The way I read a study or article is to turn first to the footnotes to get an idea of the bricks that form the foundation for the work or thought at hand.  I screen through the lens of my own evaluation system to determine what biases are present.  Mostly, in the past, I have read studies that are solely obesity focused, and, whether they admit to it or not, most scientists in this area come with one or more biases.  Some feel that obesity is a medical and social ill that must be reversed or cured, and their research is colored by that view – it may prevent them from seeing certain options.  Some of these scientists have accepted support from commercial interests – diet companies, foundations associated with pharmaceutical companies, and the like, and that makes their work horribly suspect.  Others who publish in this realm are testing the “Health at Every Size” paradigm, or, more accurately, are Hell bent on proving the efficacy of that model, and that limits their view.  In any event, I often can see a study or article’s self-imposed limitations in its footnotes.  Certain names pop up together over and over, and they indicate a point of view.

I don’t have a grasp of such biases and limitations in the world of endocrine and exercise.  In this world, obesity and weight loss are sometimes the focus, but often just confounding factors. With the exception of Cummings et. al., who produced a Ghrelin study that I happened upon by accident, I recognized no one.  I am, therefore, trusting that these are all sterling people, and none is a “scientist for sale.”  Feel free to correct me if I’m wrong. Read the rest of this entry »

Beginning to Weigh in on the Linda Bacon/Lucy Aphramor Paper

In Weight-Loss Maintenance on February 28, 2011 at 2:34 pm

The great thing about procrastination in blogville?  If you wait long enough other people do big chunks of your work for you.  I have, for some time now, wanted to post my impressions of the Linda Bacon/ Lucy Aphramor treatise, from January 24th of this year, Weight Science:  Evaluating the Evidence for a Paradigm Shift.  The shift they speak of, of course, is away from a weight-loss centered medical model to one of Health at Every Size, or HAES (trademark pending).  It is a densely referenced essay, with only eleven pages of narrative followed by 178 footnotes filling nine pages of their own.  Those footnotes deserve fair inspection and at least some random verification to make sure the authors are interpreting properly (a daunting task), and that has held me up some.  However, to critique such a treatise as this, it is only fair to start with a summary, and I thank others for coming through for me, brilliantly.

From the size acceptance community we have a lovely essay from Living 400lbs, and we have Big Fat Blog’s earlier quickie post on the topic. 

Since we can expect the size acceptance community to embrace a paper promoting HAES (which is rooted first in size acceptance), I found it more heartening to see that Canada’s preeminent obesity expert, Dr. Arya Sharma, not only posted a thoughtful summary of his own, but he ended by saying he is keeping an open mind on the topic.  This from a man whose bread and butter entails (where he deems appropriate and judicious) recommending bariatric surgery for his patients.  Unsurprisingly, he has a much rosier impression of the evidence-based benefits of bariatric surgery than Bacon and Aphramor or others from the size acceptance community who publish in journals.  (To my lay eyes, this debate is stuck in a state of limbo, these-scientists-say-X/but-these-others-say-Y.  And few scientists are creating studies that cover a significant time period, which should be required if they are to break the tie by the weight of their evidence, credentials or the consensus of their colleagues.)   Read the rest of this entry »

Thoughts on Science, Optimism and Bias

In Weight-Loss Maintenance on January 7, 2011 at 12:46 pm

Happy New Year!  Hope you all had lovely holidays.  It’s good to be back at the blog, and back on the internet, for that matter.  (Long story involving words like #!%^&$!#!!, and a whole lotta bad Karma directed at AT&T.)

Between holiday adventures and internet mayhem, I managed to slip in a post about one of my weight maintenance peccadilloes – my ability to measure fluid in ounces using my gulp mechanism.  I must admit that when I get that personal, I do feel a bit self-conscious and self-indulgent, but I think it’s instructive – for me, mostly, but also for others who participate in the fray.  We broke into a lovely discussion about the admirable pursuit of goals, and when that pursuit crosses an invisible line and becomes something less noble.  I don’t think we reached any conclusions, but I came away recommitted to the idea that I should NEVER suggest, “if I can do this anyone can.”  Even if it’s true that anyone CAN do what I do, maybe not everyone should.  One person’s pursuit of a goal may be, in all likelihood, another person’s gateway to disorder.

Somehow, in the comments, RNegade was possessed to share a couple of science-related links.  (Whew!)  My favorite was this New Yorker article by Jonah Lehrer on the “Decline Effect” that happens to our sense of scientific certainty.   This “Decline Effect” is part of a larger problem with bias in science that misshapes our understanding of a variety of social and medical issues.  I put the phrase in quotes, because, as Lehrer notes, “This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology. In the field of medicine, the phenomenon seems extremely widespread . . .”   

As I understand it, the “Decline Effect” happens when the scientific method, and all its noble precepts, leads a scientist (or team) to discover a statistically significant anomaly, Read the rest of this entry »

Not so Fast, FDA!

In Weight-Loss Maintenance on December 8, 2010 at 9:55 am

The buzz now, in size acceptance spheres and elsewhere, is the FDA’s presumed lowering of the BMI threshold for bariatric surgery involving laparoscopic bands. There is discussion among weight loss maintainers and maintainer aspirants at Lynn’s Weigh.   It’s interesting (but not surprising to readers here) that Lynn and many of her commenters are as uncomfortable with this presumed decision as the people discussing this issue at size acceptance sites, such as Fierce Freethinking Fatties and Big Fat Blog. I tried to enter the fray at BFB, and just made a mess on the comments page with my lengthy URLs, So I will give my thoughts (and links) here.

First, let’s clear something up.  It’s not a done deal.  The FDA rarely bucks a panel’s recommendation, but it can, and it hasn’t made a final decision yet.   It’s as though a motion has been made, and lacking discussion, it will pass in a few months’ time.  Maybe we need to enter the discussion.

In short, I think the FDA is being pushed too quickly, and with inadequate and premature evidence.  If it proceeds, then it does so on the recommendation of its Gastroenterology and Urology Devices Advisory Panel. While I’m sure these are fine people, it can be argued that the interests of bariatric surgery are well represented and consumer concerns may be, er, less so.

The panel of 14 includes general surgeons and other medical experts, as well it should, since it is charged with making recommendations on a variety of surgical devices for GI and urology procedures. But more specifically, at least five of the panelists are bariatric surgery True Believers:

  • Jon C. Gould, Chief of Minimally Invasive and Bariatric Surgery, University of Wisconsin
  • Thomas H. Inge, Director of Cincinatti’s Surgical Weight Loss Program for Teens since 2004 and has performed over 135 minimally invasive weight loss procedures for adolescents during that time  Read the rest of this entry »

On Science and Ethics

In Weight-Loss Maintenance on December 1, 2010 at 11:59 am

Note to casual readers – if you aren’t reading the comments, you are missing the best of this blog – the commenters are superb.  Now, in response to a brilliant observation on my last post from Debby, I found a worthy observation falling from my own fingertips:   

“My mission statement, as a blogger, and I probably ought to post it somewhere, is “tell a truth; advance compassion.” I can do that, since I’m not a scientist — I just observe them.  A scientist’s mission statement can only be “tell a truth; advance more research.” When they unwittingly adopt an agenda, such as “advance weight control for all,” then they betray their mission as scientists.”

Other people, say, public policy makers, rely on scientists to provide unbiased information so that they may make decisions about what to advance.  Biased information, by definition, is incomplete, and that will compromise decisions.  

I recently ran across an interesting scientific overview of ethics as they might apply to public policy and obesity.  Forgive the grammatical eccentricities.  I think it’s been translated from Dutch.

The scientists looked at various ethical frameworks that public policy makers might use to frame decision making with regard to obesity.  As I was reading, however, I couldn’t help but notice that the overview itself has been affected by bias.  I was stopped short at the background section, for example, where they give three sample ethical questions that public policy makers might ask when creating policy: 

“Is a campaign that stresses the importance of a healthy weight acceptable when it stigmatizes overweight persons? At what point does encouraging physical activity in the workplace become too intrusive in the personal life sphere? Is policy to inform people about health risks of obesity ethically sound when it does not reach people from ethnic minorities?”  Read the rest of this entry »