OBESITY: A MATTER OF MIND, BODY AND BEHAVIOUR

Transcription

1 OBESITY: A MATTER OF MIND, BODY AND BEHAVIOUR Dr Clare Llewellyn, Associate Professor of Obesity, Dept of Behavioural Science & Health, UCL MQ Research Fellow

2 OVERVIEW What is obesity and how many people are affected? Why is obesity relevant to mental health? What causes obesity? How can we reduce obesity-related mental health problems?

3 WHAT IS OBESITY? AccumulaUon of fat stores to extent health compromised Body mass index: weight/height 2 Obesity: BMI >30 Severe obesity: BMI >40

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25 PREVALENCE OF OBESITY AMONG ADULTS Health Survey for England % of men have obesity (up from 14% in 1993) 30% of women have obesity (up from 17% in 1993)

26 PREVALENCE OF OBESITY AMONG CHILDREN Around one in ten children in RecepOon has obesity (4-5 years) Around one in five children in Year 6 has obesity (10-11 years) 26

27 OBESITY RISK BEGINS IN EARLY LIFE Rapid weight gain from 0-2 years increases risk of later obesity by 3.66 Umes (meta-analysis 45/46 studies) ~90% of 3-year-olds with obesity are affected by overweight/ obesity in late adolescence (>50,000) Once developed, it is difficult to reverse Zheng et al (2017). Obes Rev; 19:321-32; Woo Baidal et al (2016). Am J Prev Med; 50:761-79; Geserick et al. (2018). NEJM; 379:

28 ANNUAL PROBABILITY OF A MAN WITH SEVERE OBESITY ACHIEVING A HEALTHY WEIGHT (n=278,982) 1 in 1290 Fildes, Charlton, Rudisill, Li=lejohns, Prevost, Guildford. (2015). Am J Pub Health; 105:e54-9

29 OVERVIEW What is obesity and how many people are affected? Why is obesity relevant to mental health? What causes obesity? How can we reduce obesity-related mental health problems?

30 OBESITY CO-OCCURS WITH MANY MENTAL HEALTH DISORDERS Depressive disorders AgenUonal disorders Obesity Anxiety disorders EaUng disorders

31 OBESITY CO-OCCURS WITH MANY MENTAL HEALTH DISORDERS Obesity=55% increased risk of depression Depressive disorders Depression=58% increased risk of obesity AgenUonal disorders Obesity Anxiety disorders 30% of adults with binge-eaung disorder had obesity as a child EaUng disorders Binge-eaUng disorder = 3-6x increased risk of obesity Weight loss intervenuons reduce eaung disorder symptoms

32 MENTAL HEALTH DISORDERS ARE VERY COMMON AMONG ADULTS WITH SEVERE OBESITY PaUents awaiung bariatric surgery 2/3 have a psychiatric diagnosis, most commonly major depression Up to 47% have binge-eaung disorder Most would swap severe obesity for healthy weight with a major handicap (deaf/blind/ one leg amputated) Adami et al (1995). Int J Eat Disord 17: 45 50; Sarwer et al (2004). Obes Surg; 14: ; Rand & MacGregor (1991). Int J Obes; 15:577-9

33 GaYneau & Dent. (2011). Obesity and mental health. NaYonal Obesity Observatory. OBESITY AND MENTAL HEALTH DISORDERS PERCEPTION Social: e.g. sugma; poverty Biological: e.g. disease, sleep; meds, stress Psychological: e.g. low self-esteem/self-efficacy Behavioural: e.g. diet, acuvity; emouonal-eaung

34 WEIGHT STIGMA NegaUve altudes towards and beliefs about others because of their weight Stereotypes: lacking in will-power, lazy, glugonous, unagracuve, unintelligent, socially inept, lacking in selfesteem, undisciplined Experienced across a range of selngs Health professionals: doctors, nurses, psychologists, dieucians, paediatricians Employers; educators; media; courtroom, friends, family WHO. (2015). Weight bias and obesity sygma: considerayons for the WHO European Region

35 WEIGHT STIGMA IS HIGHLY PREVALENT 45% of BriUsh employers are less inclined to recruit an applicant with obesity Crossland Employment Solicitors (2015). Employers a]tude to obese candidates

36 WEIGHT STIGMA IS HIGHLY PREVALENT 45% of BriUsh employers are less inclined to recruit an applicant with obesity Crossland Employment Solicitors (2015). Employers a]tude to obese candidates APPG On Obesity (2018). The current landscape of obesity services: a report from the APPG on Obesity

37 WEIGHT STIGMA IS HIGHLY PREVALENT 45% of BriUsh employers are less inclined to recruit an applicant with obesity Crossland Employment Solicitors (2015). Employers a]tude to obese candidates APPG On Obesity (2018). The current landscape of obesity services: a report from the APPG on Obesity

38 WEIGHT STIGMA IS HIGHLY PREVALENT 45% of BriUsh employers are less inclined to recruit an applicant with obesity Crossland Employment Solicitors (2015). Employers a]tude to obese candidates APPG On Obesity (2018). The current landscape of obesity services: a report from the APPG on Obesity

39 WEIGHT STIGMA IS HIGHLY PREVALENT 45% of BriUsh employers are less inclined to recruit an applicant with obesity Crossland Employment Solicitors (2015). Employers a]tude to obese candidates APPG On Obesity (2018). The current landscape of obesity services: a report from the APPG on Obesity

40 EXPERIENCE OF WEIGHT STIGMA LINKED WITH POOR MENTAL AND PHYSICAL HEALTH Bullying Poor body image Low self-esteem Loneliness Suicidal thoughts and acts Depression & anxiety Disordered eaung Avoidance of physical acuvity Stress-induced pathophysiology Avoidance of medical care Poorer quality of healthcare WHO. (2015). Weight bias and obesity sygma: considerayons for the WHO European Region

41 WEIGHT STIGMA RESULTS FROM AN OVERSIMPLIFICATION OF THE CAUSES OF OBESITY Weight is enurely within an individual s control It is about behaviour & willpower The soluuon is simple and easy: eat less, move more The blame and responsibility lies with the individual WHO. (2015). Weight bias and obesity sygma: considerayons for the WHO European Region

42 WEIGHT STIGMA RESULTS FROM AN OVERSIMPLIFICATION OF THE CAUSES OF OBESITY Weight 80% of is BriUsh enurely people within an individual s >90% of >300 control policymakers believe individuals with worldwide believe personal obesity It is about are responsible behaviour for & willpower it mouvauon is a strong/very strong influence on obesity The soluuon is simple and easy: eat less, move more The blame and responsibility lies with the individual (BriUsh Social Altudes Survey, 2015) (Obesity percepuon & policy, mulu-country review and survey of policymakers, 2015) WHO. (2015). Weight bias and obesity sygma: considerayons for the WHO European Region

43 OVERVIEW What is obesity and how many people are affected? Why is obesity relevant to mental health? What causes obesity? How can we reduce obesity-related mental health problems?

44 THE CAUSES OF OBESITY Foresight. (2007). Tackling ObesiYes: Future Choices Project Report. Government Office for Science

45 THE SUDDEN INCREASE IN OBESITY COINCIDED WITH MAJOR CHANGES TO THE FOOD ENVIRONMENT US NaOonal Health and ExaminaOon Surveys Rodgers A, Woodward A, Swinburn B, Dietz WH. (2018). Lancet Public Health e162-3

46 THE OBESOGENIC ENVIRONMENT Food environment Availability Cost PorUon sizes High energy density (kcal/g) Food adverusing AcOvity environment High cost of acuvity Labour saving devices Sedentary travel Enjoyable sedentary pasumes High ambient temperatures

47 CHILDHOOD OBESITY BY DEPRIVATION LEVEL

48 POOREST FAMILIES NEED TO SPEND 74% OF EXPENDABLE INCOME TO MEET DIETARY GUIDELNES Food FoundaYon (2017). Affordability of the UK s Eatwell Guide.

49 THERE ARE MORE FAST FOOD OUTLETS IN MORE DEPRIVED AREAS

50 GENETIC FACTORS EXPLAIN 50-90% OF INDIVIDUAL DIFFERENCES IN BMI IdenOcal twin pairs Non-idenOcal twin pairs From: Borjeson (1976) Acta Paediatr Scand: 65; Reviews: Elks et al (2012) Front Endocrinol:3;29; Silventoinen et al (2010) Int J Obes:34;29-40

51 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% GENETIC INFLUENCE ON BMI DEPENDS ON ENVIRONMENTAL EXPOSURE Obesogenic High Risk home environment Low Healthy Risk home environment Nonshared environmental influence Shared environmental influence GeneUc influence Schremph, van Jaarsveld, Fisher, Herle, Smith, Fildes, Llewellyn (2018) JAMA Pediatr; 172:

52 BEHAVIOURAL SUSCEPTIBILITY THEORY: GENES INFLUENCE OBESITY PARTLY VIA APPETITE Llewellyn & Wardle (2015) Physiol Beh: 152;

53 BEHAVIOURAL SUSCEPTIBILITY THEORY: GENES INFLUENCE OBESITY PARTLY VIA APPETITE Food Responsiveness SaOety SensiOvity I m full Llewellyn & Wardle (2015) Physiol Beh: 152;

54 BEHAVIOURAL SUSCEPTIBILITY THEORY: GENES INFLUENCE OBESITY PARTLY VIA APPETITE u Large individual differences in appeute from birth u AppeUte is a fairly stable trait & tracks over the life course u AppeUte predicts variauon in early weight gain u AppeUte has strong geneuc influence: heritability 50-90% u AppeUte mediates part of the associauon between measured geneuc risk of obesity and BMI Llewellyn & Wardle (2015) Physiol Beh: 152;

55 SUMMARY OF THE CAUSES OF OBESITY Obesity is not a lifestyle choice It develops from a complex interacuon between geneuc suscepubility and exposure to an obesogenic environment Some people find it much harder to eat healthily due to geneuc predisposiuon and psychosocial factors This is likely to be compounded for those who are also living with a mental health disorder

56 OVERVIEW What is obesity and how many people are affected? Why is obesity relevant to mental health? What causes it? How can we reduce obesity-related mental health problems?

57 HOW TO REDUCE OBESITY-RELATED MENTAL HEALTH PROBLEMS Reduce obesity sugma Greater educauon about the causes of obesity Specifically protect people with obesity under UK discriminauon law, alongside other protected characterisucs covered by Equality Act PosiUve images & person 1 st language (esp media): World Obesity FederaUon UCL Obesity Policy Research Unit work on language Improve care of pauents with MH problems and obesity HCPs should be aware of co-morbidity & obesity sugma Incorporate support for health behaviours into convenuonal MH treatment Incorporate MH monitoring and support into obesity treatment Advance research into link between obesity & MH MH researchers measure weight status & perceived sugma More cross-disciplinary research: MQ-funded work into EDs and obesity

58 BEHAVIOURAL SUSCEPTIBILITY THEORY: DO OBESITY & EATING DISORDERS SHARE AETIOLOGY Do obesity genes influence eaung disorders via appeute? Does the early home food environment modify geneuc suscepubility to eaung disorders? CollaboraUon: 4 cohorts; 3 countries; n=18,000

59 ACKNOWLEDGEMENTS Prof Jane Wardle, UCL Prof Robert Plomin, KCL Prof Susan Jebb, Dr Stephanie Schrempw, Oxford UCL Dr Abi Fisher, UCL Dr Susan Carnell, Johns Hopkins Dr Laura Johnson, Bristol Dr Maciej Trzaskowski, Queensland David Boniface, UCL Dr Ellen van Jaarsveld Nijmegen Dr Moritz Herle, UCL Andrea Smith, UCL Dr Ali Fildes Leeds; UCL Dr Hayley Syrad, UCL