Orbital frontal cortex (OFC)

FDA-approved “Gastric Pacemaker” – What do the studies say?

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

For many years, gastric electrical stimulation (GES) has been under investigation as a treatment for obesity and overeating, but until last week, it has only been experimental. After 12 years, the FDA finally approved EnteroMedics device for treatment of obesity, making it the first “gastric pacemaker” to be approved for obesity treatment.

About the size of a pacemaker and implanted into the person’s abdomen, the EnteroMedics’ Maestro™ device is intended to offer potential weight loss for those struggling with obesity. Called VBLOC™ for vagal blocking therapy, its electrode touches the vagus nerve at a point between the esophagus and the stomach, and it works by intermittently down-regulating or blocking input from the stomach’s vagal nerve to part of the brain linked to appetite in people who have issues with obesity and metabolism.

Historically, the independent research of such devices has not been earth shattering. Both SBU (’04) and Buchwald (’02) felt that the results were not conclusive and that EGS did not provide satisfactory results. This discouraged them from carrying on with the study (Salvi ’09).

In a 2009 study, Shikora et al compared implantable gastric stimulation therapy to a standard diet and therapy regimen. Within their group of obese subjects, the team evaluated differences in weight loss and found that the control group lost 11.7% and the IGS group also lost 17.6% of excess body weight. The difference in results between the two groups was less than a high recommendation of the treatment.

In a more recent study, after 12 months with the EnteroMedics device, those with the device fitted lost an average of 24 per cent of their excess weight, while those in the control group without the device fitted lost only 16 per cent. The device produced an overall difference in total body weight of only 3% over the sham device, which did nothing (Ikamuddin’14). Therefore, though there was certainly clinically significant weight loss with this device, the procedure fell short of being as effective as the researchers had hoped.

Repeated evidenced-based failures to support the “stomach fullness theory” suggest seeking alternative signals to relay cessation of eating. This adds credibility to the idea that the primary feedback may be dictated by satisfaction rather than fullness. This suggests placing more emphasis on hedonic (pleasure) messages in research and potential therapy.

While this FDA approval may show some promise, who will it work for, what will it work with?

There are still several important under-researched questions to consider coming out of the trials to date:

  • How useful is it to rely solely on stomach hunger and fullness to create eating cessation? (Ikamuddin’14)
  • How will gastric stimulation stack up in more comprehensive comparisons to other treatments – such as diet, behavioral therapy, exercise? (Ikamuddin ’14; Dixon ’11).
  • We should be looking at response systems other than fullness, such as hedonic (pleasure) messages, for which treatment would be entirely different, less invasive, and possibly more long-lasting.
  • Cross-study between the medical mechanisms of obesity and the psychological/behavioral components is needed for optimum diagnoses – that is, which patients will benefit from which treatments – surgical, pharmaceutical, psychotherapeutic, and implant – or treatment combinations.


Buchwald H and Buchwald JN Evolution of operative procedures for the management of morbid obesity 1950-2000 Obes Surg (2002) 12: 705 – 717.

Salvi PF et al Gastric pacing to treat morbid obesity: Two years’ experience in four patients Ann Ital Chir (2009) 80: 25 – 28.

Shikora SA et al Implantable gastric stimulation for the treatment of clinically severe obesity: Results of the SHAPE trial Surg Obes Relat Dis (2009) 5: 31 – 37.

Swedish Council on Technology Assessment in Healthcare (SBU)n Gastric pacing (gastric electrical stimulation) for the treatment of obesity — early assessment briefs (Alert) Stockholm, Sweden: SBU (2004).

Yao S et al Retrograde gastric pacing reduces food intake and delays gastric emptying in humans: A potential therapy for obesity? Dig Dis Sci (2005) 50: 1569 – 1575.

Dixon JB et al Surgical approaches to the treatment of obesity Nature Reviews Gastroenterology and Hepatology (2011) : 429 – 437.

Ikamuddin S et al Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial JAMA (2014) 312: 915 – 922 [VBLOC-DM2 ENABLE Trial].


Why stress can make you fatter around the middle

Written by Dr. Ralph E. Carson on . Posted in Blog, Etc, From the Desk of Dr. Carson

As we have been seeing, those struggling with obesity are beset by many vicious cycles of fat begets fat. This self-fueling problem explains why only a slow, steady approach, accompanied by lifestyle changes that carry through the long haul, is the best solution. Another way that fat begets fat occurs in the area of belly fat. Studies paint an interesting picture on the nature of belly fat – its composition, and how it responds to stress, alcohol, fried foods, and processed foods, and how it increases. These studies shed light on why certain behaviors add to belly fat.

There are two different types of fat stores, the fat that forms a layer beneath the skin (called subcutaneous adipose tissue – SCAT), and fat that forms an apron around the belly, visceral belly fat. Within the body, and as a response to what you do on the outside (eat, exercise, undergo stress), these two types of fats act in very different ways. Subcutaneous fat can be exercised away much more easily than belly fat. This visceral belly fat receives more blood flow and is more responsive to cortisol than the subcutaneous fat deposited around the waist (beneath the skin).

The abdominal fat cell environment contains more nerves, more inflammatory and immune cells, has more testosterone (androgen) receptors, and produces a greater percentage of large fat cells (as opposed to greater numbers). It’s a lively, responsive cauldron of activity. As a consequence, intra-abdominal fat cells are more metabolically active, absorb and store more dietary fatty acids from circulation, and are less inclined to release fat during dieting (Ibrahim ’10).

The absorptive nature of belly fat is quite significant because these absorptive properties make belly fat more responsive to cortisol – the stress hormone. Stress increases the enzyme (11beta-HSD-1) that regulates cortisol in the belly.

What this means to the dieter, the average person watching his or her waist, is that when you add stress to excess belly fat, you get a chain reaction in which the 11beta-HSD-1 enzyme speeds up the conversion of inactive cortisone to active cortisol. And enough studies have shown that the over-expression of 11beta-HSD-1 in belly fat tissue results in a host of problems, not the least of which is more fat. The problems include an amazing fourfold cortisol receptor increase (greater sensitivity to cortisol), insulin resistance (glucose intolerance or the inability to utilize sugar appropriately) and central obesity (Kannisto ’04; Anderson ’02; Morris ’05).

Since the enzyme activity is higher in belly fat than subcutaneous fat, it explains how stress significantly increases girth (Tomlinson ’02).

It’s important to know what behaviors tend towards the creation of belly fat. And not just from the perspective of a waist watcher. We’ve also seen studies that connect belly fat to learning, memory, and decision-making.

For more (graphic view):


Andrews RC et al Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance The Journal of Clinical Endocrinology (2002) 87: 5587 – 5593.

Ibrahim MM Subcutaneous and visceral adipose tissue: Structural and functional differences Obesity Reviews (2010) 11: 11 – 18.

Johnstone AM et al Influence of short-term dietary weight loss on cortisol secretion and metabolism in obese men Eur J Endocrinol (2004) 150: 185 – 194.

Kannisto K et al Overexpression of 11 beta-hydroxysteroid dehydrogenase-1 in adipose tissue is associated with acquired obesity and features of insulin resistance: studies in young adult monozygotic twins J Clin Encocrinol Metab (2004) 89: 4414 – 1421.

Morris KL and MB Zemel ,25-dihydroxyvitamin D3 modulation of adipocyte glucocorticoid function Obesity Research (2005) 13: 670 – 677.

Tomlinson JW and PM Stewart The functional consequences of 11-beta hydroxysteroid dehydrogenase expression in adipose tissue Hormone and Metabolism Research (2002) 34: 746 – 751.

White PC et al 11 beta hydroxysteroid dehydrogenase and its role in syndrome of apparent mineralcocoricoid excess Pediatri Res (1997) 41: 25 – 29.

Diet is not the solution!

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

48 clinical trials attest; diet is not the solution.

For the umpteenth time, researchers have published proof that no matter what diet a person chooses (Paleo, Wheat Belly, Atkins, Weight Watchers, Jenny Craig, NutraSystem, etc.), the chances for success are the same. Whether the plan focuses on low fat or low carbohydrate, the study, involving 48 clinical trials and 7000 patients, resulted in an average weight loss of 18 pounds over 6 months. From one diet program to another, the differences were minimal. Basically, the difference between Jenny Craig, Atkins, NutraSystem, and you name it, was not enough to matter. Among scientists, the study was confirming, leading scientists to conclude that there is nothing magical about cutting carbohydrates or fat or adding protein.

These findings are not particularly new, but with every new fad diet that bursts on the scene, there’s an implicit challenge to the conclusion. The more interesting and persistent question is why test subjects in the reviewed studies had begun to gain weight back by the one-year mark – to wit, in all 48 trials, the participants started gaining weight back by one year. This caused the authors of the study to call out the true challenge for diet research: the need to understand how people can maintain their initial weight losses.

A total mind-body-spirit solution

A total mind-body-spirit solution

The authors reached an obvious conclusion, that the best dietary plan is one you can live with for a long time (i.e. the rest of your life).

The long view should be considered when comparing ways to lose weight and gain health. Considering the long view means choosing an approach that gives you the fewest challenges. And though the medical community often focuses on shedding pounds as a goal-oriented metric for improving health among the the obese, the root of the problem is rarely found in weight loss and weight control. FitRx focuses on health and well-being rather than the number of pounds. We consider the gold standard for longevity is an approach that offers encouragement and insight on attuned eating, healthy choices, image empowerment, physical wellness, joyful movement, mindfulness, and stress reduction.


Johnston BC et al Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis JAMA (2014) 312: 923 – 933.
Van Horn L et al Diet by any other name is still about energy JAMA (2014) 312: 900 -901.

Am I hungry or just not full?

Pleasure Overrides “Fullness”

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Hedonics trump homeostasis

There is a belief that tuning into physical and mental “fullness” signals, when eating, will decrease the likelihood of mindless over-consumption. However, “research is continually finding that regardless of how full a person may feel, the body is hard wired to chemically reward itself by overeating” when faced with highly palatable foods (*Monteleone ’12).  Two gut compounds are credited with causing us to indulge in goodies well beyond the point of caloric need. One of these is a stomach hormone called ghrelin, which helps regulate the motivation and drive to eat as well as the capacity to experience reward or pleasure.

The other is the endocannabinoid 2-AG (2-arachidonoylglycerol) which is involved also with appetite and drive to eat. When a person wants a particular kind of food, these chemicals team up to override the sense of fullness. In other words, we are programmed to stuff ourselves for a rainy day. In one study, individuals originally planned to eat significantly more of their favorite food, than they planned to eat of a bland or unappetizing selection, despite the feeling of being satiated. When participants ate their favorite food, their blood levels of ghrelin increased significantly and stayed high for as much as two hours post-ingestion. (*Monteleone ’12)


“The plasma levels of ghrelin and 2-AG increased during hedonic eating, with the favorite foods, but not with non-hedonic eating,” Science Daily said of Monteleone’s work.

After eating an unappetizing nutritionally equivalent item, the ghrelin levels went progressively down. Levels of the compound 2-AG decreased after eating both the favorite and the unappetizing food. However, exposure to and consumption of a favorite food allowed 2-AG levels to remain higher for up to two hours compared to the non-favorite food.

Many treatments for obesity attempt to curb eating by recreating the feeling of fullness, either mechanically or surgically. But the work of Monteleone and Mozes suggests that in dealing with binge eating behavior, a focus on the hedonic (pleasure-center driven) response will be more efficacious than a focus on “fullness.” (Monteleone ’12; Mozes ’12)

At FitRx, we use the technique of “attuned eating,” which approaches the problem from the angle of meal satisfaction rather than fullness. The distinction between these two hypotheses is important when looking at treatment facilities because they result in different treatment approaches.

Next time: Highly palatable foods trigger continuation of eating whether or not one is full or recently finished a meal.


*Monteleone P et al Mozes A Why You Overeat Even When You’re Full: Small study explores how body reacts when aroused by tempting treats HealthDay: A Pilot Study Journal of Clinical Endocrinology and Metabolism (2012) 97(6):E917-24.

Mozes A Why You Overeat Even When You’re Full: Small study explores how body reacts when aroused by tempting treats HealthDay (May 3, 2012).

obesity begets obesity

Obesity Begets Obesity

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Caught in a Vicious Cycle

People who struggle with size have high levels of leptin, the “satiety hormone.” But at the same time, they are leptin resistant. When functioning correctly, leptin will promote production of the appetite suppressant α-MSH after a meal. This is how the average person knows they are full and stops eating. In those struggling with obesity, there’s an abundance of leptin, which originates from large fat cells. And yet it has been found, counterintuitively, that this over-abundance of leptin does not produce an abundance of the α-MSH needed to increase metabolism and lower appetite. Essentially, these obese individuals lack a proper leptin response after a meal. There is no suppression of food-seeking behavior and no increase in TSH, which increases metabolism and therefore spurs caloric burning.

In a sense, there are so many leptin signals the brain shuts down to them. But for the more accurate picture of this disruption of healthy processing, we begin by looking at PC2, an enzyme necessary for making POMC, which eventually converts into α-MSH (to increase metabolism and lower hunger). The leptin overload in people of size stresses the POMC’s nucleic endoplasmic reticulum serving as the assembly line for making PC2. By mishandling PC2, the POMC protein leaves the POMC nucleus unfolded (useless and needing to be discarded) and impairs α-MSH production. Some people of size are 53% lower in PC2 and have 50% less α-MSH.

Vicious cycle of obesity

Vicious cycle of obesity

Any way you look at it, the normal feedback system is impaired in people of size, and it disrupts the body’s mechanism for maintaining one’s natural weight. What this means for obesity programs: Leptin should work to keep us at our natural weight. With leptin resistance that often occurs in people of size, the leptin is unable to tell the brain to eat less and burn more calories. As a result, the buildup of excess leptin stresses the manufacturing of the messenger that tells u, s to eat less and produces one that is useless. There is then no message to tell us to stop eating and/or increase activity. The result is that excess fat continues to accumulate as a consequence of gaining weight. To put it simply: “obesity begets obesity.”

At some point a simple solution to the leptin issue was sought in TUDCA (Tauroursodeoxycholic Acid), a chemical that eliminates ER stress and increases α-MSH in obese mice, but not normal mice. However, TUDCA is not readily applicable in treating excess fat in people of size. So while the leptin issue can be addressed, the most workable solution to date is programmatic and diet-related as opposed to organ or site-specific and treatable with a pill or procedure.

A total dietary program would include things like cutting out the fructose, the processed foods, the refined and simple starches, and adding things like oily fish, whole grains, etc. Once again, the evidence supports a whole-system or global approach to obesity. It also suggests the need to address complex dietary interactions, rather than narrowing in on simplistic solutions such as “portion control” or “calorie control.”

Next Week: Pleasure Overrides Fullness; Hedonics Trump Homeostasis


Cakir I et al Obesity induces hypothalamic endoplasmic reticulum stress and impairs proopiomelanocortin (POMC) post-translational processing J Biol Chem (2013) 288: 17675 – 17688.

How Diet & Hygiene Alter Gut Microbiota, Influence Our Health

The “Healthy Choice” Food Plan

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Retrain the brain to stop craving food

As humans, we do not start out loving French fries, potato chips and Oreos and hating whole wheat pasta, raw vegetables, and grilled salmon. It took years of consuming highly palatable recipes (high fat, high sugar, and high salt) to establish these unhealthy brain circuits. The good news is, the brain is mutable, and you can retrain it to stop craving calorically dense, unhealthy impulse foods. The even better news is that you can do this in a matter of months. By making healthy choices, even the brain with years of bad food training can be rewired in six months. In fact, studies report seeing some changes in as early as 2 weeks.

In a Tufts University study, scientists imaged (fMRI) obese individuals’ brains at the beginning of the study and again six months later. While the subjects observed pictures of healthy and unhealthy foods, the researchers noted activity in the reward centers of their brains. On initial screening, the reward center sparked activity only after highly palatable foods were viewed. This was true for all participants. In the ensuing months, the group was divided in half, with the control group eating whatever it wanted and the Healthy Food Choice group working with brain retraining.

Six months later, brain images of the group in the Healthy Food Choice program demonstrated activity in the reward center when they saw healthy, low calorie foods. The brain circuitry had changed. Conversely, that same area now also showed decreased sensitivity to unhealthy, high caloric foods.

This is excellent news for those who, due to long-standing habits of sugar or fat consumption, may feel daunted by the idea of retraining their food choices.

The Tufts study showed a clear delineation all around between those who received the Healthy Choice retraining and those who didn’t. Over the six-month period, people on the Healthy Choice plan lost 14 pounds, and those who continued to eat solely what they desired gained 5 pounds.

This study lays the groundwork for comprehensive programs in the treatment of obesity (such as the FitRx program) that include brain retraining along with exercise and the other components. Healthy Choice brain retraining could turn out to be simpler and more long-lasting than many of today’s popular, but desperate, measures.

For example, the healthy choice group outperforms those on restrictive diets because deprivation sets the restricted individuals up to feel hungry and miss eating their favorite foods. Unconsciously, the fat-sugar-salt-trained brain tells the individual not to continue restriction. Eventually, the individual gives in to these messages and returns to old ways.

Another drastic measure, gastric bypass surgery, generally decreases the amount of enjoyment the person derives from food. While this invasive procedure works, it works by a sort of forced deprivation. Taking away food enjoyment becomes pretty hard to justify when you can make healthier food more appealing through brain retraining, leave intact the individual’s ability to savor food, and avoid an invasive (and costly) procedure all at the same time.

Next week: Caught in a Vicious Cycle: Obesity Begets Obesity


Deckersbach T et al Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention Nutr Diabetes (2013) 4:e129.


Fit for Duty: Healthy Habits for First Responders

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

It has been said that being a fire fighter is not a job; but a way of life that invokes passion and dedication. The requirements involved are highly demanding, hazardous and risk filled. This “Call to Duty” unfortunately takes its toll on the body, mind and soul. Therefore, it is critical that one commit themselves to a lifestyle of healthy practices so as to avoid becoming a statistic of the fire service (Selndelbach ’14)

Sudden cardiac deaths:

  • Account for the largest proportion of on duty deaths (48%) amongst fire fighters annually (Eastlake ’13)
  • The strenuous duties of a fire fighter interact with a pre-existing risk profile (Kale ’09)

…..78% of firefighters know at least one fellow firefighter who has suffered a heart attack (Jerrard ’13)

Factors that contribute to unhealthy practices in the life of a fire fighter:

  • Shift work
  • Overexertion (Serra ’12)
  • Chaotic work environment (Smith ’12)
  • Irregular work hours
  • Unhealthy eating patterns; Less than 10 % have a healthy diet (Elliot ’07)
  • Sleep deprivation
  • No time or facilities to participate in moderate to high intensity non-work related activity
  • Exposure to a soup of chemical agents: smoke, toxic fumes and dangerous products of combustion that predispose one to cancer (Smith ’11; Serra ‘12)
  • Encountering high temperatures and noise levels (Serra ’12)

…..Each year, approximately 80,000 firefighters are injured and about 100 firefighters lose their lives in the line of duty (Smith ’11)

Body Composition Concerns: Disease Producing “Belly Fat”

  • More than 70% of US firefighters are overweight or obese (Haddock ’11)
  • Firefighters have the third highest prevalence of obesity among 41 male occupational groups in the United States (Choi ’11)
  • Excess fat is positively associated with frequency of:
  • 75% have prehypertension or hypertension (Tsismenakis ’09; NSCA ‘11)
  • Greater incidence of heart attacks and strokes (Beach ’14)
  • Abnormal blood lipid profile (cholesterol; LDL; triglycerides) (NSCA ’11)
  • Absenteeism in the workplace (Haddock ’11)
  • Less able to perform essential job duties (Beach ’14)
  • Increased risk of job related disability and musculoskeletal injuries (Jahnke ‘13a,b; (Mayer ’12)
  • Reduced muscular strength and increased back pain (NSCA ’1; Mayer ’12)

…..Yet surveys conclude that most firefighters underestimate the risk of added pounds and doctors often do not address the problem or offer a viable and long lasting solution such that the trend continues to worsen (Bauer ’12; Wilkinson ’14)

Sleep deprivation and excess daytime fatigue often cause: (Mehrdad ’13; Haddock ’13)

  • Depression (Carey ’11)
  • High injury rates (Elliot ’07)
  • Musculoskeletal pain (Lim ’14)
  • Accidents (Elliot ’07)

Firefighters experience both occupational and emotional stress (Gomes ’13)

  • Exposure to human suffering, injury and death (Serra ’12)
  • Self-blame (Meyer ’12)
  • Inadequate sleep
  • Financial challenges
  • Relationship problems

Few outlets are available to seek support and to learn coping skills (Meyer ’12)

  • Fire fighters consider themselves “stronger” than the problem and are unable to conduct “self-rescue” (Meroney ’13)
  • Fire fighters rarely speak out and ask for help
  • Details of their shift are not shared with family members

The high cost of Stress (McDowell ’13):

  • High risk factor for cardiovascular disease and other health problems (National Fallen Firefighters Foundation (NFFF); McDowell ’13)
  • Physical aches and pains
  • Sleep Deprivation
  • Obesity, inactivity, and poor eating habits
  • Depression or anxiety
  • Post Traumatic Stress Disorder
  • Suicidal thoughts and feelings (McDowell ’13)
  • Substance abuse including smoking
  • Marriage and Family problems
  • Anger issues

“The Solution”

FitRx (A prescription for finding inner transformation) is an intensive outpatient program with an individualized holistic approach that addresses wellness from a medical, therapeutic, nutritional and physical wellness perspective


  • Complete Medical assessment
  • Improved metabolic health profile (Cholesterol, high blood pressure, reduction of inflammation, blood sugar control)
  • Smoking cessation guidance
  • Sleep interventions for insomnia
  • Improved body composition and reduction of disease-producing abdominal fat
  • Access to physical therapy support


  • Therapeutic interventions to address trauma, relationship issues, depression, anxiety, anger, etc.
  • Psychotherapy that focuses on the underlying causes and treatment of binge eating, compulsive overeating, and night eating syndrome
  • Stress management
  • Interpersonal skills
  • Mindfulness and relaxation techniques

Nutritional Guidelines and Meal Plans:

  • Emphasis on fitting a food plan into one’s lifestyle that includes convenient, economical, and healthy choices
  • Revealing that healthy doesn’t have to mean that it’s not great-tasting food
  • Recommendations for fire station meals away from home as well as suggestions for family cuisine
  • Healthy, convenient and alternative snacks to maintain vitality and alertness and replenish energy stores
  • Learning to be “satisfied” without battling cravings and hunger by practicing attuned and mindful eating
  • Avoiding gimmicky, extreme or difficult to follow plans that will not lead to permanent habits and good health
  • Sound nutritional advice that dispels nutritional  myths and educates one to make healthy choices

Physical Wellness: Create your own wellness plan

  • Comprehensive assessments upon admission and discharge
  • Cardiovascular fitness, aerobic fitness and endurance training
  • Anaerobic capacity; muscular strength and core muscle endurance
  • Flexibility and yoga
  • Fitness on a budget while off duty:  Activities that fit into daily routine
  • Job specific functional exercises
  • Safe & applicable programs that can be done by all (rookies; 20 year veterans; individuals of size; and those rehabilitating from injury)

Maintenance and Follow-up:

  • A strong alumnae support system
  • Tracking devices to collect hard data that enhance accountability and long term success


Click here for References


Will the American government ever accept that weight is not the issue and obesity is not the problem?

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Experts doubt that obesity among preschoolers has fallen as much as the CDC reports based on a paucity of supporting evidence and few signs of behavioral change…

The CDC claims that there is a significant decline (43%) in preschooler (ages 2-5) obesity (Ogden, C et al JAMA February 2014). This data is based on the National Health and Nutrition Examination Survey or NHANES study which has been conducted annually since the 1960s and involves in-person interviews and physical exams. You need to have a healthy degree of skepticism about the validity of this finding.  The 2011-2012 version of the survey included 9,120 people; 871 of them were 2 to 5 years old. This would be considered a small survey size to make such a bold national claim because of the statistical limitations and potential for marked fluctuations. Such a change is at best fleeting in that rates have bounced around over the last decade

Anti-obesity campaigners credited everything from changes to the federal nutrition program for low-income women and children to the elimination of trans-fats from fast food, more physical activity in child-care programs and declining consumption of sugary drinks. First Lady Michelle Obama and others seized on the finding as a sign that efforts to combat the national obesity epidemic were paying off. The programs that have been implemented, from changing what’s in vending machines to the Let’s Move program (exercise initiative championed by Michelle Obama), target school-age children more than preschoolers.

This plunge may be a statistical fluke since other studies have not shown a comparable decline

A study of preschoolers in the federal WIC (Women, Infants and Children) program, which provides food vouchers, nutrition classes and counseling to low-income families, found virtually no change in obesity rates. The WIC study included more than 200,000 children while the CDC research looked at only a small population of 2 – 5 year olds. A larger set of data would most certainly be significantly more valuable.

Researchers found that the prevalence of obesity among 3 and 4 year olds in California’s Los Angeles County worsened from 2003 – 2011. Obesity rose from 17% to 20.4% (CDC’s Morbidity and Mortality Weekly Report 2013). There was a drop of 4% (19.5% – 15.5%) in the New York WIC study, though much less than a 43% drop CDC reported nationally. CDC’s Morbidity and Mortality Weekly Report 2013). An earlier CDC study of data collected at public health clinics, reported in JAMA in December 2012, found that the prevalence of obesity among 27.2 million children 2-to-4-year olds in low-income families fell (< 1%) to 14.9 percent in 2010 from 15.2 percent in 2003.

For obesity rates to drop, young children would have to eat differently, become more active, and sleep better. It turns out that research shows few signs of these changes among 2 – 5 year olds. In 2010 Whaley and her colleagues examined the effectiveness of WIC classes and counseling to encourage healthy eating and activities for women and children in the program. Television watching and consumption of sweet or salty snacks actually rose, while fruit and vegetable consumption fell – changes that could lead to weight gain. One positive was a rise in physical activity.

These statistical arguments emphasize decades of futility on behalf of the CDC, USDA and other government agencies that are determined to get under control the wrong enemy…WEIGHT. The problem may be part and parcel of the American Government expending too much energy, time and tax dollars on the ‘weights’ of preschool and young children by emphasizing statistical analysis of weight change and promoting the media hype that fuels a nation of dieters and creates a general obsession with being thin. There needs to be an acceptance of size diversity, emphasis on health, and incorporating lifestyle activity combined with appropriate measurements that support these initiatives rather than focusing on the weight on the scale. Habit changes should take the form of personal responsibility, mindful behaviors, stress reduction and reducing negative bias regarding size to counter the food industries’ infinite supplying our nation with an abundance of highly palatable foods designed to trigger overconsumption. If we cannot expect our country to limit the use of proven mind altering drugs such as marijuana, alcohol, tobacco and caffeine; do we honestly believe that there will ever be a successful campaign to remove pleasurable food choices from society? Not even in the Fairy Tale of Cinderella could they remove all the spinning wheels.

  1. CDC’s Morbidity and Mortality Weekly Report 2013
  2. (Ogden, C et al JAMA February 2014)
  3. Whaley, S (Public Health Enterprises Foundation) WIC Study

Ogden Journal of the American Medical Association 2014 focused on more than 9,000 adults and children in 2011-2012 and compared them to five previous obesity analyses dating back to 2003-04 We found overall that there was no change in youth or adults More older women are obese, but very young children seem to be slimming down Prevalence of obesity in children that age dipped from 14 percent in 2003-2004 to about 8 percent in 2011-2012 obesity prevalence ticked up in women 60 and older, from less than 32 percent in 2003-2004 to more than 38 percent in 2011-2012. Overall, more than two-thirds of adults are either overweight or obese, and more than 6 percent are extremely obese. There hasn’t been a big impact on prevalence in the last eight years, but at least there’s a leveling off.



Sitting Can Be Detrimental to Your Health and it is not offset by Exercise!

Written by Dr. Ralph E. Carson on . Posted in Blog, From the Desk of Dr. Carson

Modern man sits more than he sleeps. Studies report that most individuals spend an average of 9.5 hours sitting and 7.7 hours sleeping (Healy ’07; Owen ’09). And 5.5 of those sitting hours are spent watching television (Nielson ‘10). Being sedentary (sitting for extended periods of time) can be detrimental to your health.

Being extremely sedentary makes the blood flow sluggishly, produces swollen ankles, shuts off electrical activity to the legs, and ultimately deteriorates cells. When you are sitting for extended periods of time the enzymes that break down fat are reduced by 90%, muscles utilize less fat, you burn less than one calorie per minute and fat rapidly accumulates. Sitting reduces metabolism which eventually contributes to obesity and significantly causes fat accumulation around the heart. Resting on your derriere can lead to poor posture and disability resulting in even greater inactivity. Being sedentary disrupts metabolic function producing resistance to insulin culminating in diabetes as well as increasing blood pressure, triglycerides and bad cholesterol (LDL) leading to cardiovascular disease. All of this sitting around can ultimately result in premature death.

Regardless of how much time you spend in moderate exercise, it does not counterbalance the harmful consequences of prolonged sitting. Leisure-time physical activity or daily bouts of “super-exercising” alone may not be a sufficient public health approach to prevent obesity. It’s a bit like smoking. Smoking is bad for you even if you get lots of exercise

We need to take walking breaks every hour, stand while talking on the phone, perform chair exercises at our desk, and take several trips to the rest room on long flights. Regularly standing up from a seated position was in fact found to be more effective than walking (Verikos ‘11). Interrupt watching TV with 10 minute sparks to rake leaves, garden, sweep, play with your children, run in place, or climb stairs. Utilize a motion sensor (accelerometer) to track activity and be mindful of the frequency with which you interrupt prolonged inactivity. A consistent body of emerging research suggests it is entirely possible that sitting is its own risk factor. So don’t just sit there, MOVE!

ReferencesBauman A et al Leisure-time physical activity alone may not be a sufficient public health approach to prevent obesity—a focus on China Obes Rev (2008) 9: 119 – 126
Dunlop D et al Sedentary Time in U.S. Older Adults Associated With Disability in Activities of Daily Living Independent of Physical Activity J Physical Activity and Health (February 5, 2014)
Ekblom-Bak E et al The importance of non-exercise physical activity for cardiovascular health and longevity Br J Sports Med (Sept 13, 2013)
Healy GN et al Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose Diabetes Care (2007) 30:1384–9
Larsen BA et al Associations of Physical Activity and Sedentary Behavior with Regional Fat Deposition Med Sci Sp Ex (2014) 46: 520 – 528
Nielsen Company Three Screen Report: Television, Internet and Mobile Usage in the US Vol 8 1st Quarter (2010)
Owen N et al Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med(2009) 43: 81 – 83
Seguin R et al Sedentary Behavior and Mortality in Older Women American Journal of Preventive Medicine(2014) 46: 122- 135
van der Ploeg HP et al Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults Archives of Internal Medicine (2012) 172:494-500
Veerman JL et al Television viewing time and reduced life expectancy: a life table analysis British J Sports Med(2012) 46: 927-930Vernikos J Sitting Kills, Moving Heals Quill Driver Books (2011)

Smart Snacking: Small portions and wait 15 minutes

Written by Leah Miranda on . Posted in Blog, From the Desk of Dr. Carson

In addressing cravings, there is often a controversy whether one should resist and abstain from snacking on tasty foods or to honor and satisfy the urge. Brian Wansink provides some interesting insight on this dilemma.

Individuals were presented either large or small portions of tasty snacks. The large portion consisted of 100 grams of chocolate chips, 200 grams of apple pie and 80 grams of potato chips totaling 1370 calories. The smaller portion consisted of 10 grams of chocolate chips, 40 grams of apple pie and 10 grams of potato chips totaling 195 calories. The participants were given as much time as needed to consume the snacks. Individuals were asked to rate hunger and cravings before the food was presented and 15 minutes after the taste test ended.

Individuals with access to smaller amounts had similar feelings of satisfaction as those exposed to larger amounts as both reported significantly less cravings. However, those presented larger portions had a mean intake of 103 (77%) more calories. This suggest that smaller portions can lead to a decline in hunger and desire and would help people limit food intake. Eating a smaller portion of palatable snack foods satisfies you just as much as a large portion. A small amount satisfies and does not magnify hunger and craving tendencies.

The message is to take a few bites, wait 15 minutes and your head and stomach will remember you had a tasty snack. This study does not address the emotional state of the participants nor their history of binge eating. It does provide some insight as to how a more flexible and permissive approach to satisfying cravings may eventually be implemented.

Reference: Van Kleef , Shimizu M and Wansink B Just a bite: Considerably smaller snack  portions satisfy delayed hunger and craving Food Quality and Preference(2013) 27: 96-100