The New York Times - USA (2020-07-28)

(Antfer) #1

D10 Y THE NEW YORK TIMES, TUESDAY, JULY 28, 2020


APPEARANCES, AS I’Msure you know, can be
deceiving. In one all-too-common example,
adolescents and young adults with dis-
ordered eating habits or outright eating dis-
orders often go unrecognized by parents
and physicians because their appearance
defies common beliefs: they don’t look like
they have an eating problem.
One such belief is that people with ano-
rexia always look scrawny and malnour-
ished when in fact they may be of normal
weight or even overweight, according to re-
cent research at the University of Califor-
nia, San Francisco.
The researchers, led by Dr. Jason M. Na-
gata, a specialist in adolescent medicine at
the university’s Benioff Children’s Hospital,
found in a national survey that distorted
eating behaviors occur in young people ir-
respective of their weight, gender, race, eth-
nicity or sexual orientation. And it’s not just
about losing weight.
The survey revealed that among young
adults ages 18 to 24, 22 percent of males and
5 percent of females were striving to gain
weight or build muscle by relying on eating
habits that may appear to be healthy but
that the researchers categorized as risky.
These practices include overconsuming
protein and avoiding fats and carbohy-
drates. The use of poorly tested dietary sup-
plements and anabolic steroids was also
common among those surveyed.
The Covid-19 pandemic has likely exacer-
bated the problem for many teenagers
whose daily routines have been disrupted
and who now find themselves at home all
day with lots of food being hoarded in
kitchens and pantries, Dr. Nagata said in an
interview. “We’re seeing more patients and
referrals for eating disorders and their com-
plications,” he said.
Without a proper diagnosis and interven-
tion, young people with distorted eating be-
haviors can jeopardize their growth and
long-term health and may even create a
substance abuse problem. The findings sug-
gest that abnormal behavior with regard to
food and exercise is often overlooked, mis-
understood, ignored or perhaps viewed as a
passing phase of adolescence.
This is especially true among teenage
boys. One-third of the high school boys sur-
veyed said they were trying to gain weight
and bulk up, and many were using risky
methods to achieve their goals, Dr. Nagata
told me. Sixty percent of the girls surveyed
said they were trying to lose weight. Some


consumed unbalanced diets that can jeop-
ardize their growth and long-term health;
others resorted to induced vomiting or
abused laxatives, diuretics, diet pills or en-
gaged in other hazardous behaviors like
fasting or excessive exercise. Over all, dis-
torted eating was more than twice as com-
mon among females than males. It was also
reported more often among those who de-
scribed themselves as Asian/Pacific Island-
ers, gay, lesbian or bisexual.
The survey was conducted among a na-
tional sample of 14,891 young adults who
were followed for seven years, starting at
an average age of 15. The goal was to see if
the youngsters’ perceptions and habits sur-
rounding food and exercise could serve as
warning signs of behaviors that could injure
them physically and emotionally.
Among the boys in the study, those most
at risk worried that their bodies were puny
— too small, too skinny or insufficiently
muscular, prompting them to consume un-
balanced diets, exercise obsessively and
take supplements or steroids that are a haz-
ard to their health. When overly fixated on
building their bodies, they can become so-
cially withdrawn and depressed and de-
velop a disorder called muscle dysmorphia
that can lead to heart failure, resulting from

insufficient calories and overexertion.
A missed diagnosis is likely when a young
person’s relatives or doctors have precon-
ceived notions about how someone with an
eating disorder looks or behaves. For exam-
ple, Dr. Nagata said, a teenage girl or young
woman who is anorexic can fall under the
medical radar because her weight is normal
or even overweight.
Although diagnosis of an eating disorder
like anorexia or bulimia was twice as com-
mon among the young adults whose weight
was normal or underweight, the fact that
these disorders also exist in heavier young
adults is often overlooked, Dr. Nagata said.
“Almost half of those with anorexia ner-
vosa are at or above normal weight,” he
said. “Young people with atypical anorexia
have the same body image distortions and
severe psychological distress as those with
regular anorexia. They’re at high medical
risk and just as likely to be hospitalized for
complications caused by their distorted eat-
ing behaviors.”
Dr. Nagata’s colleague and co-author of
the study, Dr. Kirsten Bibbins-Domingo, an
internist at the university, said in an inter-
view: “Physicians who care for young
adults should think about patterns of eating
that are harmful, and not just among very

thin women. Young adults with abnormal
eating habits too often fall between the
cracks because physicians think of them as
healthy. However, abnormal eating pat-
terns are not uncommon in adolescence and
young adulthood, and that’s when patterns
of behavior related to later health and dis-
ease are established and solidified.”
The problem of disordered eating behav-
iors among teens and young adults is often
encouraged or compounded by participa-
tion in certain competitive sports and other
activities that overemphasize a particular
body weight and physique. Among these
are gymnastics, wrestling, dance, figure
skating, weight lifting and bodybuilding.
Social media, with its heavy focus on ap-
pearance, is also a contributing factor. “If
youngsters are obsessed with an idealized
body image, their thinking and behavior be-
come disordered and can take over their
lives,” Dr. Nagata said. “The detrimental ef-
fects can be subtle. Prior to the pandemic,
they may have rejected going out with
friends so they could spend more time in the
gym. It’s a warning sign when they with-
draw from normal activities and become
preoccupied with their appearance.”
Unhealthy weight control methods can
predispose people to eating disorders and
actually lead to weight gain, not loss. I
struggled with weight gain in my early 20s
and, having failed to control my weight any
other way, I eventually resorted to fasting
all day until supper. But once I started eat-
ing, I couldn’t stop and ended up gaining
even more weight. I had developed a binge-
eating disorder that resolved only when I
stopped trying to diet and returned to eat-
ing three wholesome meals a day, including
one small snack so I didn’t feel deprived.
Dr. Bibbins-Domingo wants doctors to be
proactive in asking about eating and exer-
cise habits when treating adolescents and
young adults. “They should have a conver-
sation about what these young people are
eating, when they’re eating and how they’re
eating, and be able to give advice about
healthy eating patterns.
“Without making a value judgment about
body size, they can open the door to a dis-
cussion about eating and exercise habits,”
Dr. Bibbins-Domingo suggested. “The phy-
sician might ask, ‘What did you eat yester-
day, and where, and what do you think
about the choices you made?’ or ‘Do you
want to address weight issues?’ ”
The pandemic may offer one silver lining,
Dr. Nagata said. “With more families eating
meals together, it’s easier for parents to
monitor what their kids are eating.” Having
family meals together is one of the basic
tenets of therapy for eating disorders, he
said.

With Eating Disorders, Look Beneath the Surface


Distorted behaviors occur in


the young regardless of gender,


race, weight or other factors.


GRACIA LAM

‘Almost half of those
with anorexia nervosa
are at or above normal
weight.’
DR. JASON M. NAGATA
BENIOFF CHILDREN’S HOSPITAL

PERSONAL HEALTH JANE E. BRODY

We l l


IN AN INTERESTINGnew study of over-
weight adults, those who donned a
weighted garment for three weeks dropped
pounds, without consciously changing their
diets, moving more or otherwise altering
their lives.
The study, which grew out of research
with rodents, suggests that our bodies are
capable of judging how much we should
weigh and, if we abruptly rise above that
level, nudging us into dropping pounds. But
the findings also raise questions about why,
then, so many of us pack on uncontested
pounds during adulthood, and whether as-
pects of our modern lifestyle, such as long
hours of sitting, might contribute.
Anyone who has shed pounds and then
grimly watched them return has experi-
enced the pull of homeostasis. A well-estab-
lished biological concept, homeostasis
refers, in essence, to our bodies’ stubborn
desire to keep things the way they have
been. If a physiological process worked be-
fore, the body typically tries to reset to it
when something within our bodies changes.
In practice, homeostasis means that if, for
instance, we manage to trim some body fat,
various homeostatic mechanisms in our
brains and cells recognize the loss and start
sending out messages that increase hunger
or prompt us to move less until, inexorably,
that original weight creeps back on.
But for some reason, the opposite homeo-
static reaction rarely occurs. If we over-
shoot our original weight or, in the course of
normal modern living, pack on some
pounds, our innate weight management
mechanisms rarely kick in, alert our bodies,
and rid us of those added pounds. Instead,
the homeostatic system seems almost to
shrug and accept that extra body mass as
the new normal.
There are many theories about why extra
pounds are so intractable, and the full
mechanisms are still mysterious. But a few
years ago, researchers at the University of
Gothenburg in Sweden started to wonder
about sitting. Being sedentary for multiple
hours a day is associated with heightened
risks for weight gain and obesity, in part be-
cause sitting burns few calories.
But the Swedish researchers wondered if
immobility perhaps also fools bodies into
thinking they weigh less than they do, since
chairs support a portion of someone’s
weight. To study the issue, they first under-
took extensive experiments a few years ago
with overweight rodents. The scientists im-
planted lead pellets into the animals, in-

stantly rendering them heavier.
Within two weeks, most of the animals
had dropped enough body fat that their
weight, including the pellets, was about the
same as it had been a month before. After
the pellets were removed, the animals re-
gained the lost weight. Their homeostatic
weight management had worked.
But when the researchers performed the
same experiment on animals bred to have
few bone cells of a specialized type that
senses outside pressure on the skeleton,
they lost little weight after pellet implanta-
tion. Their bodies’ sense of how much they
weighed appeared to have been thrown off.
The researchers speculated that, nor-
mally, the animals’ bone cells would have
provided what they called a “gravitostat,”
using the body’s pressure against the earth
to sense its weight and send messages to
the brain about whether that weight had
grown or declined. Without those bone cells
at work, the rodents did not realize how
heavy they had become.
People are not rodents, though. So, for the
new study, which was published recently in
EClinical Medicine, the same scientists re-
cruited 69 overweight adults and, in lieu of
lead pellets, asked them to wear weighted
vests. Some of these vests added 11 percent
to a person’s body weight; the others added
about 1 percent and served as a control. The
volunteers were asked to wear the vests
throughout the day but not otherwise
change their diets or lives.
After three weeks, the men and women
wearing the heavier vests had dropped
about three pounds of fat, on average, which
was less than the weight of their vests but

substantially greater than among the other
group, whose weight loss was negligible.
Some of this successful loss likely was a re-
sult of the fact that people in the heavier
vests carried more mass now, the scientists
believe, meaning they burned more calories
whenever they moved.
But the results also intimate that, like the
animals in the earlier experiments, humans
may contain a gravitostat, said John-Olov
Jansson, a professor at the University of
Gothenburg who oversaw the new study. If
so, our bodies and bones rely on the relative
dent we make against the ground to know if
our mass has changed and if, for the sake of
homeostasis, we should gain or drop a bit.
In that case, the broad implication is that
we may need to stand and move in order for
our gravitostat to function correctly, Dr.
Jansson said. When you sit, “you confuse”
the cellular sensors into thinking you are
lighter than you are, he said.
The idea of an internal gravitostat is still
speculative, though, he said. The re-
searchers did not look at volunteers’ bone
cells in this study. They also did not com-
pare their diets and sitting time, although
they hope to in future experiments. Plus,
the study was short-term and has practical
limitations. Weighted vests are cumber-
some and unattractive, and some of the vol-
unteers complained of back pain and other
aches while wearing them.
But the researchers expect that wearing
a weighted vest is not necessary to goose
someone’s gravitostat into action, Dr. Jans-
son said. If they are right, getting out of your
chair could be a first step toward helping
your body recalibrate your waistline.

PHYS ED GRETCHEN REYNOLDS

Add Weight to Drop Pounds?


A study found that test


subjects who wore weighted
garments had lost fat.

ISTOCK

Meditation may be
linked to a lower risk
for cardiovascular
disease, a new study
suggests.
Researchers used data from a
national survey conducted annu-
ally by the Centers for Disease
Control and Prevention, identify-
ing all patients with high choles-
terol, hypertension, diabetes,
stroke and coronary artery dis-
ease and any who reported that
they meditated. Of 61,267 people
in the survey, there were 5,851
who meditated. The study is in
the American Journal of Cardiolo-
gy.
After controlling for age, sex,
body mass index, marital status,
smoking, sleep duration and
depression, they found that medi-
tating was associated with a 35
percent lower risk of high choles-


terol, a 14 percent lower risk of
high blood pressure, a 30 percent
lower risk of diabetes, a 24 per-
cent lower risk of stroke and a 49
percent lower risk of coronary
artery disease.
The lead author, Dr. Chayakrit
Krittanawong of the Baylor Col-
lege of Medicine, said the reduc-
tion in stress that meditation can
provide could at least partially
explain the result. But he cau-
tioned that the study is observa-
tional and that clinical trials
would be needed to determine the
mechanism that explains the
association.
He added that the study did not
distinguish between the many
different kinds of meditation.
Still, he said, “I believe that any
kind of meditation would have
benefits for cardiovascular dis-
ease risk reduction.”

MIND AND BODY


Meditation and Heart Health


Overweight and obese
children may show
signs of cardiovascu-
lar disease risk even

before age 11, Australian re-
searchers report.
For a study published in Pedi-
atrics, scientists measured body


mass index in 1,811 children
every two years between ages 2
and 11 and calculated their meta-
bolic syndrome risk scores. For
this study, the score calculated


risk for cardiovascular disease
based on the presence of four
factors: high blood pressure,
high blood sugar levels (insulin
resistance), high triglyceride


levels and low levels of HDL
(“good cholesterol”).
They found that B.M.I. was
relatively stable over time in


most children. Higher B.M.I. was
associated with higher metabolic
risk scores, and the association
became stronger with age.


Higher B.M.I. in 2- and 3-year-
olds predicted higher metabolic
risk scores at age 11 to 12.
By age 6 to 7, obesity was also
associated with thickened arteri-
al walls and greater arterial
stiffness, which can be precur-
sors of vascular disease.
“Children who are obese in
childhood track into obese ado-
lescents and adults,” said the
lead author, Kate Lycett, a child
health researcher at the Mur-
doch Children’s Research Insti-
tute in Melbourne, Australia. “As
a parent, it’s really difficult, but
turning it around early in life
would prevent later cardiovascu-
lar disease.
“We’ve made very successful
efforts to control heart disease,”
she continued, “but when you
have children who are obese
throughout life, we’re really at
risk that a lot of that good work
can be undone.”

CHILDREN


High B.M.I. in Toddlers


In Brief NICHOLAS BAKALAR

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