OBESITY AND ANOREXIA: two sides of the same coin?

Gistaplus had the privilege to read a paper delivered on “Prevention of Obesity and Eating Disorders” at the SASA Roadshow on “Nutrition in NCD Prevention” (NCD = Non-communicable Diseases).

Suna Kassier, a lecturer and Post Graduate Academic Coordinator at the Department of Dietetics and Human Nutrition, at the university of KwaZulu-Natal, has a great deal of experience in this field. She believes that obesity and eating disorders are two ends of a linked spectrum of disordered eating, which makes a lot of sense and we decided to share the Common factors;

Obesity and eating disorders share the following risk factors:

1) Dieting

Both conditions are linked to dieting: overweight and obese individuals try every diet available and use every pill and potion they can purchase to lose weight, while anorexics starve themselves into skeletal ill-health, and bulimics and binge-eaters gorge and purge until their eating patterns are completely disturbed.

2) Media-driven

The urge to achieve slender to skeletal figures (weight-loss regimens, anorexia, purging in bulimia) or bulging muscles (bigorexia) is fuelled by the hype and unrealistic expectations created in the media.

 We cannot all look like models strutting the catwalk, or Mr Universe with a six-pack and muscles that resemble blown up balloons, but the problem is that so many people nowadays want to look like these role models.

3) Distorted body image or dissatisfaction

Both the overweight and the anorexic have distorted body images in both extremes of the weight-spectrum. In a survey conducted a number of years ago, the majority of South Africans suffering from overweight or obesity were “satisfied with their body image” or felt that “being thin was linked to illnesses like Aids, and therefore not desirable”.

Dissatisfaction with one’s body image is personified by thin people looking into their mirrors and seeing someone who is fat. Patients suffering from Body Dysmorphic Disorder (BDD) have extreme body image dissatisfaction, which can lead to disastrous behaviour and even suicide.

4) Weight-related teasing

It is an unfortunate phenomenon that human beings, like animals, tend to pick on individuals who deviate from the norm. Fat people are endlessly bullied, insulted, teased and denigrated by their peers. Nowadays even airlines and employers discriminate against passengers and employees who are obese. (Fatness can get you fired!) Conversely very thin people, particularly young men, who are not necessarily suffering from anorexia, are teased and bullied until they turn to body building and supplements to build up their abs and muscles – so that they can fit into our body-shape-obsessed society.

From one extreme to another

Because of the overlap and the many similarities between obesity and eating disorders, it is vital for therapists treating both ends of the weight-spectrum to realise that these disorders are not distinct and are actually mirror images of each other.

Obesity/anorexia/bulimia/orthorexia/bigorexia/etc are all eating disorders and can even occur simultaneously in one person. Far too often, someone who once was anorexic is “cured” and switches to another condition such as binge eating disorder. Obese people who have shed amazing amounts of fat, can also switch to anorexia or bulimia because they are terrified of gaining weight again.

It is important that dieticians, doctors and psychologists treating obese patients and/or people with eating disorders, should keep this relationship in mind and concentrate on identifying factors that can be modified and critical periods when an intervention could save the patient from one or the other condition.

Vital intervention periods

Kassier identified the following periods throughout life which are critical moments when interventions can prevent an individual from developing future obesity or eating disorders:

a) The prenatal period

The prenatal period – as researchers pay attention to the period before and immediately after conception, as well as pregnancy, they have come to realise that if the foetus is over-fed during the intrauterine period, the child will be prone to obesity in later life.

b) Foetal overnutrition

The prime factor driving foetal overnutrition is maternal obesity. In other words, modern populations are caught up in a never-ending vicious cycle where obese mothers overfeed their babies in the womb and then give birth to children who will in turn become obese and/or suffer from disordered eating. The value of ensuring that mothers are not obese or overweight before falling pregnant is becoming more and more evident. Excessive food intake particularly of foods with a low nutrient density and high energy content during pregnancy is just as detrimental to the future of our species as maternal starvation.

c) The adiposity rebound

The phenomenon of the “adiposity rebound” where normal children lose weight to reach their lowest weight by the age of 5 to 6 years and then gradually start to regain weight as they grow older, has been identified as a critical factor in future obesity.

Researchers have determined that if infants experience the adiposity rebound at an earlier age (e.g. 3 years), they will be more inclined to become obese in later life. This pattern of accelerated growth which leads to a very rapid decrease in body weight may be due to infants growing taller at an earlier age due to the high-protein, low-fat diets of modern infants. Mother’s milk, in contrast, is a high-fat, low-protein food, which pinpoints how important breastfeeding is to ensure normal growth in infancy, a normal adiposity rebound and less chance of developing obesity at a later stage.

d) Undernutrition in early life

Millions of infants throughout the world suffer from

malnutrition due to poverty and a lack of breastfeeding. Rolland-Cachera and co-workers (2006) suggest that early nutrient deprivation may programme children to develop a thrifty metabolism that will make them vulnerable to obesity in adolescence and adulthood.

These new insights into the many different factors that fuel obesity and eating disorders can be used to shed light on the obesity epidemic in South Africa where so many pregnant women are either over- or undernourished and so many children are not breastfed and are stunted or grow too rapidly at an early age causing them to have an early adiposity rebound. Interventions to address these diet-related problems are urgently required, if we are to win the war against eating disorders of all kinds.

References:

- Rolland-Cachera MF et al. (2006). Early adiposity rebound: causes and consequences for obesity in children and adults. International Journal of Obesity (Lond), Supplement 4:S11-17.

- Kassier S (2015). Prevention of Obesity & Eating Disorders. Paper presented at the SASA Nutrition in NCD Prevention Roadshow, Pretoria, on 12 February 2015.

- Health24

IF NOT BEER, WHATS CAUSING THE BIG FAT ROUND TOMMIES

No sooner had I written the words “beer belly” in my article on the use of waist circumference (WC) as a measure of body fatness, beer producers started vociferously defending their noble brews – with one going as far as sending me an article entitled “Revealed: Beer is not linked to ‘Beer Belly’!” If this is true, then where on earth do all those large tummies come from?

Background

I pointed out that waist circumference is a useful tool because it identifies what type of obesity a patient suffers from. We differentiate between two kinds of obesity that tend to form in the lower half of the body, namely android or “apple-shaped” obesity as opposed to gynic or “pear-shaped” obesity.

Android fat distribution is associated with fat deposits in the abdomen. Android fat distribution is associated with a greater risk of ill health than pear-shaped fat distribution. Research has shown that people with android obesity are more vulnerable to lifestyle-associated illnesses, such as heart disease, diabetes, hypertension, stroke, raised blood fats, arthritis, gout, and metabolic syndrome.

If not beer, then what?

The unfortunate name “beer belly” has become part and parcel of our parlance. To counter this negative image, South African Breweries (SAB) released their article in which they quote one of my colleagues, who quite correctly stated, “While beer would indeed contribute to a person’s kilojoule intake, it is often a small part of the equation.”

No one food or beverage is totally to blame for the high levels of obesity in Africa, and there are many high-energy foods and drinks, popular with consumers, that could be the culprits.

The role of alcohol and other beverages

Just like fat, which contributes 37 kJ per gram to our energy intake, alcohol of any kind contributes 29 kJ per gram and is thus the second highest energy item in the African diet when compared gram for gram.

However, it is not just the energy content per gram that is important. The volume of items such as drinks which we consume also makes a difference when it comes to energy intake.

Beer has a lower energy content than spirits, but is consumed in larger quantities at a sitting.

Spirits:

For example, the current edition of the SA Food Tables, lists the energy content of spirits (brandy, whisky, cane, vodka, rum (alcohol content of 43% v/v or 36% w/w) as 1044 kJ per 100 ml.

However, people who have a tot of spirits which in metric terms is 25 ml, will consume 1044 x 1/4 = 261 kJ, while a double metric tot of 50 ml will provide them with 522 kJ of energy.

Beer:

According to the current SA Food Tables, beer with an average alcohol content of 4,6% v/v or 3,6% w/w, provides 172 kJ of energy per 100 ml and stout with its higher alcohol content of 6.1% v/v or 4,7% w/w has 242 kJ/100 ml.

“So we were correct!” I hear the beer brewers say with satisfaction. “Beer, even stout, has a much lower alcohol and energy content that spirits and can’t be held responsible for those large tummies!”

Volumes consumed:

But who drinks only 100 ml of beer at a sitting? Beer is sold in various containers in South Africa, but the most common volumes are cans of 330 ml or bottles of 750 ml.

A 330 ml can of standard beer provides 330 x 172/100 = 568 kJ, which is the same as a daily double tot of whisky, cane, vodka or rum. And a 750 ml bottle of standard beer provides 750 x 172/100 = 1,290 kJ, which equals 5 tots of spirits.

So let’s say you are a prudent beer drinker and have only one 330 ml can of beer a day, this will add 568 x 7 = 3,976 kJ per week to your energy intake. And if you're less careful and drink one 750 ml bottle of beer a day, you will add 1,290 x 7 = 9030 kJ to your weekly energy intake.

In other words, even prudent beer drinkers who have only one can or one bottle of beer a day, 7 days a week, will increase their energy intake by around 4,000 kJ to 9,000 kJ per week, which can add up over time to cause fat deposition in the body.

Summary

We need to keep in mind that 

(1) the energy content per gram, 

(2) the energy content per 100 ml, and

 (3) the volume of alcoholic drinks we consume all play a role in our energy consumption and level of fat deposition.

Fat deposits

Where you deposit these extra kilojoules is probably determined by your genetic makeup, age and gender. Large stomachs tend to run in families, so genetics may be important. Age is also involved, although nowadays there is an alarming tendency for young people to develop what used to be called a “corporation” (i.e. a large stomach).

Then there are the gender-related fat depots – in women extra energy is usually deposited in fat depots in the breasts, hips and buttocks, particularly in younger women – later, after

menopause, abdominal fat deposits also increase in women.

In men, fat is usually deposited in the abdomen and the neck, which is often called a “buffalo hump”. (Apologies to the producers of buffalo meat!)

Conclusion

Any item of food or drink consumed in excess provides us with more energy than we need and can be deposited as fat. Beer is certainly not the only contributor to abdominal fat with all its health risks, but all alcohol, even when consumed in very moderate quantities, does add to your energy intake and may cause fat deposition, which in younger women will probably produce “pear-shaped adiposity” and in men and older women turn into “apple-shaped adiposity”.

It may be wise to keep this in mind when you sit down to watch the Cricket World Cup on TV!

References:

- Anderson, S (2015). Revealed: Beer is not linked to ‘Beer Belly’. FPD (2001). Certificate Course in the Management of Obesity. Foundation for Professional Development, 13-14 Sept 2001, Centurion.

- Kaslow JE (2015) Body impedance Measurement.

- Mahan K L et al (2012). Krause’s Food & the Nutrition Care Process. Elsevier Publishers, USA.

- Wolmarans P et al (2010). Condensed Food Composition Tables for SA. Medical Research Council, Parow Valley, Cape Town.

Food myths you should stop believing in

By: Kelly Abrahams (Health24)

Lagos - Much of what we believe about healthy eating is nothing more than hearsay. And, with all the diet and nutrition information out there, it’s not always clear how to distinguish fact from fiction.

With the help of Kim Hofmann, Jordana Ventzke and Elienne Horwitz, three registered dieticians from Cape Town, we dispel some of the most common food myths – some of which could be sabotaging your health.

Myth 1: Eggs are harmful to your health

Eggs contain a significant amount of cholesterol (about 211mg per large egg) and were regarded as unhealthy for many years. But while they may be high in cholesterol, their effect on our cholesterol levels is limited.

Studies have shown that foods high in cholesterol don’t seem to affect our blood-cholesterol levels; instead, foods containing saturated and trans fats are the ones that seem to have the most significant impact. What’s more, the body compensates for increased cholesterol levels from food by producing less cholesterol.

It’s therefore safe to say that eggs are an acceptable and healthy food choice. You can safely eat one or two eggs several times a week (one a day or two every second day) – it will help keep you full and thereby help you to keep your weight in check.

Whole eggs are also among the most nutritious foods in the world, containing high-quality protein and healthy fats. They also contain high levels of lutein and zeaxanthine – two antioxidants that protect the eyes. In addition, they’re packed with choline, an important nutrient utilised by the brain.

Myth 2: Carbohydrates make you fat

Cutting carbohydrates in an effort to lose weight is currently all the rage. While eating less starchy foods is one way of reducing your overall kilojoule intake, you don’t have to limit all carbohydrates to lose weight. Carbohydrates are after all a great source of energy.

Dieticians and health authorities worldwide agree that we should add complex carbohydrates, e.g. whole grains, legumes, fruits and vegetables, to our meals. Cutting these foods out of your diet means you’ll be missing out on a healthy supply of fibre, minerals, vitamins and antioxidants. In fact, cutting out a food group can be detrimental to your health as you risk missing out on vital nutrients, notes Dr Magda Robinson in Eat Carbohydrates: Get Thin (And Healthy).

Foods that consist primarily of refined carbohydrates, e.g. white bread, cake, sweets, cookies and sugar-sweetened desserts and drinks (including alcoholic drinks), are usually high in kilojoules, but low in nutrients. These “empty” kilojoules could contribute to weight gain: the foods don’t keep you full and satisfied for long and, as a result, you may consume more kilojoules than you need. To control your weight, it’s best to avoid refined carbohydrates and to have good, fibre-rich carbohydrates with some protein (e.g. an egg) or a healthy fat (e.g. peanut butter). This will keep those cravings in check.

Keep in mind, however, that no single food is truly fattening: overindulging in any of the three macronutrients – fat, protein or carbohydrates – can lead to weight gain. So, watch those portion sizes – even if you’re eating complex carbohydrates!

Myth 3: As long as it’s healthy, you can eat as much as you want

Many of us tend to forget that most healthy foods still contribute a significant number of kilojoules to the diet. For example, olive oil, avocados and nuts are wonderfully good for us – after all, they’re rich in healthy fats, vitamins, minerals and antioxidants – but they’re also high in kilojoules. If consumed in excess, they can lead to weight gain.

The same goes for most other foods, including the complex carbohydrates mentioned above and healthy protein foods such as fish, chicken, lean meat and eggs. Remember: choosing healthy foods is just the first step; the second important step is to keep an eye on your portion sizes.

Myth 4: Fruit is bad for you because it contains too much sugar

It’s true, fruit is high in sugar, but this doesn’t mean it isn’t good for you.

Firstly, the sugar in fruit is fructose – a simple sugar that occurs naturally in plant foods. What makes fructose different from table sugar (glucose plus fructose) is that fructose breaks down in the liver, which means it doesn’t lead to a spike in insulin levels. Secondly, fruit is high in fibre, which slows down the digestive process, keeping you fuller and more satisfied.

Fruit also differs from sugary sweets and table sugar in that it’s an excellent source of vitamins, minerals and antioxidants – all of which help to keep you healthy. Eating fruit is also a great way to satisfy a sweet tooth.

But this doesn’t mean you should overindulge in fruit. If you eat more than 2-3 servings of fresh fruit per day (i.e. what’s recommended), you could be setting yourself up for weight gain.

Myth 5: Frozen vegetables are not as healthy as fresh vegetables

Frozen vegetables are just as nutritious – if not more nutrient-dense – than fresh vegetables. This is because they’re picked and packaged at their peak, when they’ve just been harvested – the point at which nutrient levels are at their highest. They’re then frozen almost immediately, locking in all that wholesome goodness. Fresh produce, on the other hand, loses some of its nutrients during the journey from farm to fork.

Frozen vegetables are also incredibly convenient, allowing you to have vegetables in your fridge at all times. Nevertheless, whether you opt for frozen or fresh veggies, it’s best to not overcook the vegetables as this can further lower nutrient levels.

Myth 6: Potatoes are unhealthy

Think “potatoes”, and the first thing that, for most people, springs to mind is greasy, deep-fried fries or creamy mash with butter and cheese. The result is that potatoes are often associated with weight gain, diabetes and a myriad of other health woes.

But, contrary to popular belief, potatoes are actually a perfectly healthy food choice. When prepared the correct way (baked and not fried or drenched in oil or butter), they’re a good source of fibre, potassium and vitamin C.

Note, however, that potatoes do have a high glycaemic index (GI), which means that they cause a significant spike in blood glucose and insulin levels. For this reason, they should be eaten with a bit of lean meat or fibre-rich vegetables – both of which will lower the GI of the meal.

And do eat your potatoes with their skins – a source of fibre and nutrients.

Myth 7: Kilojoules eaten at night are more fattening

Kilojoules are kilojoules (and calories are calories), whether eaten at night or during the day. If your total food intake is too high, you’ll gain weight, regardless of the time of day you eat. However, if you eat too little during the day, the tendency is to eat too much at night, leading to weight gain.

The key here is to manage your meals throughout the day. Eat breakfast, lunch and dinner (with a healthy snack or two in between), and make sure you’re eating a balance of low-GI carbohydrates(e.g. legumes, whole-wheat bread, brown rice), lean protein (e.g. fish, chicken, lean meat, eggs), healthy fats, dairy, fruit and vegetables. The bottom line? You don’t have to skimp on dinner – just watch those portion sizes and don’t overindulge.

Myth 8: When eating out, it’s best to order salad

It may sound like the healthiest option on the menu, but sometimes salads contain as many or more kilojoules than a hamburger. They may be laced with high-fat ingredients such as croutons, bacon and cheese, and often come with very kilojoule-dense dressings.

Choose wisely when eating out. Check the ingredients before you order, and make sure the salad you order contains lots of fresh vegetables, a lean protein source (e.g. eggs or chicken) and only one or two healthy fats (e.g. avocado or olives).

Myth 9: Certain foods can burn fat and make you lose weight faster than others

People often believe that foods like grapefruit, celery or cabbage soup will help them shed weight quickly.

Yes, these are healthy food choices, which you could definitely incorporate into your daily diet, but they don’t contain magic ingredients that burn fat and help you lose weight overnight. Studies have shown that some of these foods temporarily boost metabolic rates, but the lift isn’t enough to offset consuming too many kilojoules. The path to weight loss, experts say, comes in the form of a balanced diet filled with nutrient-rich foods, cutting back on the number of kilojoules you eat by managing your portion sizes, and being more active. There are NO quick fixes.

Myth 10: Health bars are better than a bar of chocolate

It’s a “health” bar, so it must be healthy, right? As much as we like to think cereal, protein, energy and yoghurt bars are healthy, this isn’t always the case. In fact, many of these products contain just as many kilojoules as a bar of chocolate.

While they may include more nutrients, they’re also often loaded with high-kilojoule ingredients such as high-fructose corn syrup, sugar, honey and fat.

If you’re grabbing a snack on the run, go for bars with a short ingredient list. Make sure they include lots of nuts, seeds, dried fruit, protein and/or fibre, and very little sugar, salt and saturated fat. Steer clear of anything that contains trans fats.

If all else fails, make your own granola bars. This way, you have control over what goes into them.

References:

- IDEA Health & Fitness Association. 2006. The Professionals’ Guide to Diet, Nutrition and Healthy Eating

- Marber, I., & Corr, L. (2014). Eat Your Way To Lower Cholesterol: Recipes to reduce cholesterol by up to 20% in Under 3 Months. Hachette UK.

- Robinson, M. 2013. Eat Carbohydrates: Get Thin (And Healthy). Lulu. com