Monday, November 12, 2012

Current Reseach and Outline

Disembodiment Outline:

I: Introduction


II: The Obesity Problem
A: Classifying the Problem

i: A Disease?
a: Yes
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-“It is generally accepted that a disease must have at least two of the following three features: (1) recognized etiologic agents, (2) identifiable signs and symptoms, and (3) consistent anatomical alterations. Obesity meets all three criteria”
-The etiological agents include: metabolic, physiologic, genetic, social, behavioral, and cultural factors
-some identifiable signs and symptoms include: an excess accumulation of fat tissue as well as increased risk of breathing problems, high blood glucose, and abnormal cholesterol levels
-anatomic alterations include a high percentage of body fat
 
b: No
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-“obesity-associated disorders are not necessarily caused by increased body weight”
-“a particular disease or treatment for disease may actually promote obesity
-hazardous weight loss practices and repeated loss and regain of weight is a major contributor to obesity-related diseases
-“not all obese people are unhealthy…calling obesity a medical problem reduces individual responsibility for maintaining a healthy weight”
-“when obesity is considered a disease it implies that individuals have no control over what is happening to their weight and health”
-“The American Medical Association (AMA) continues to recognize obesity as a major public health threat that requires great attention; however, it does not classify obesity as a disease”
ii: An Epidemic?
a: Yes
- Mary Gavin and the editors of TeensHealth.org (Health: Opposing Viewpoints p69-76)
- “Being overweight is not only a matter of appearance but also a matter for health”
-BMI is used to determine the relationship between the body fat content and health concerns
-Many diseases arise from being obese such as: Blount's disease [deforms bones in lower body from excess weight during developmental periods], Arthritis, Slipped capital femoral epiphyses (SCFE) [Painful hip problem that needs immediate attention and surgery], Asthma, Sleep apnea [when a person may stop breathing during sleep], High blood pressure, High cholesterol, Gallstones [hardened bile in gallbladder], Fatty liver [when fat accumulates in the liver], Pseudotumor cerebri [severe headaches caused by obesity in teens and adults], Polycystic ovary syndrome (PCOS) [elevated testosterone levels in bloodstream causing abnormal menstrual cycles], Insulin resistance and diabetes, and depression.
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-more diseases: hypertention, and endometrium, breast, prostate, kidney, and colon cancers
-Increased risk of death of baby and mother, high-weight infants, and birth defects in obese pregnant women
-limits mobility and decreases physical activity
-“Epidemiologists define an epidemic as the occurrence in a specified area of an illness or other health-related events in excess of what would normally be expected. Disease and epidemics occur as a result of the interaction of three factors: agent, host, and environment. Agents (too much food) cause the disease (extra body fat), hosts are genetically susceptible, and environmental conditions (easy access to high-calorie foods and reduced need to be active) permit host exposure to the agent”

b: No
- Patrick Basham (Health: Opposing Viewpoints p77-82)
-There is no obesity epidemic, politicians and the diet industry have manipulated statistics
-CDC claimed nearly 400,000 obesity related deaths in 2004, later research revealed the number at being only 25,814
-Are the obesity epidemic claims and prevention movements adding to the obesity problem?
-There is no childhood obesity epidemic and from 2004-2005 there was a decline in childhood obesity rates
-Programs designed to treat problem, more often than not, exacerbate it rather than help it
- “When the [US] government decided that obesity was 'a critical health problem in this country that causes millions of American to suffer unnecessary health problems and to die prematurely,' your right to decide what, where, and how much to eat disappeared”
-A little exaggerated claim
-obesity hasn't been empirically proven as the cause of the various afflictions it has been linked to

iii: A Different Type Of Epidemic
-Even though the mortality rates of obesity were over exaggerated and that some statistical claims were disproved, over half the population in the US is still overweight or obese and the problem is growing beyond the borders of the United States.

a. Discrimination and its Consequences
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-discrimination: obese people “endure widespread stigma and discrimination in social, academic, and job situations”
-obese individuals viewed as less competent and lacking in self-discipline
-harassment and rejection by peers at school
-fear of weight bias in medical settings and from medical professionals
-these stigmas and biases “can lead to a number of psychological problems that add to physical difficulties”
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”Weight-based stigmatization, or 'weight bias,' occurs in many domains of daily living and poses significant and debilitating consequences for emotional well-being, social functioning, and physical health”
-obese people seen as lazy, lacking in self-discipline, lacking in willpower, impulsive, incompetent, unmotivated, non-compliant, and sloppy
-Employment Weight-bias:
inequities in hiring, wages, promotions, job termination, and negative attitudes from co-workers
“overweight job applicants and employees are evaluated more negatively and have more negative emloyment outcomes compared to non-overweight applicants, even with identical qualifications, education, and credential”
fewer hiring recommendations, lower qualification/suitability ratings, lower salary assignments, more disciplinary decisions, worse placement decisions, and more negative personality ratings
obese men face as much as 3% wage penalties and women u to 6%
weight discrimination reports: overweight adults 12 times more likely, obese adults 37 times more likely, severely obese adults 100 times more likely
-Health Care Settings:
seen as non-compliant, unsuccessful, unintelligent, and dishonest
“physicians report lower respect for their obese patients”
some physicians believe obesity “can be prevented by self-control, that it is a non-compliance which explains their failure to lose weight (rather than limitations of existing treatment approaches), and that obesity is caused by emotional problems”
“providers spend less time in appointments with obese patients, engage in less discussion with obese patients, assign more negative symptoms to obese patients, provide less health education with obese patients, and intervene less with obese patients”
in a survey of 2,400 obese patients 69% reported weight stigma from a doctor and 52% reported that it happened on multiple occasions
doctors are the second most common source of weight bias
-Educational Settings:
“lower educational attainment and achievement among obese students compared to thinner peers”
“weight-based teasing is significantly associated with poorer school performance”
obese students are ascribed various stereotypes, less likely to have friends, excluded in peer activities, and are socially isolated
weight stigmatization from educators take the form that “obese students are untidy, less likely to succeed, more emotional, and more likely to have family problems than thinner persons”
-Interpersonal Relationships:
“weight descriptors such as 'obese,' 'overweight,' or 'fat' primed negative stereotypes about the target and less desire by respondents to date the target”
overweight women are ranked as “the least desirable sexual partner when compared to partners with various disabilities”
family members are the most frequent source of weight stigma, in a study of 2,400 people 72% reported negative stigmas from families which included “weight-based teasing, name calling, and inappropriate, pejorative comments” from mothers (53%), fathers (44%), sisters (37%), brothers (36%), sons (20%), and daughters (18%)
in the study of 2,400 patients 60% of participants reported negative weight stigmas from friends
-Media Biases:
“overweight characters are often depicted in stereotypical roles, as the target of humor and ridicule, engaging in unhealthy eating behaviors, and rarely engaging in positive romantic and social relationships”
“In children's cartoons, socially desirable traits are ascribed to thin characters, and undesirable traits are associated with overweight characters, who are often portrayed as being unattractive, unintelligent, unhappy, eating junk food, and engaging in physical aggression”
“exposure to these negative messages in the media may reinforce bias among youth”
the news coverage of “individual causes and solutions significantly outnumber other societal and environmental contributors to obesity” and as a result “the focus on personal responsibility overshadows other important causes of the obesity epidemic, and easily leads to blame of obese individuals and public perceptions that obesity is simply a matter of personal willpower”
“The emphasis on individual-level causes and solutions for obesity may also contribute to the plethora of news stories emerging which have reported that obese people are partially to blame for rising fuel prices, global warming, and causing weight gain in their friend, among other adverse outcomes”
-Emotional Consequences:
overweight youths who are discriminated against are two to three times more likely to engage in suicidal thoughts and behaviors

 b: Functioning Impairment
-Neil Mehta and Virginia Chang (The Oxford Handbook of The Social Science of Obesity p502-516)
-Class II/III obesity (BMI >34.9) was the only BMI category associated with significant and positive attributable mortality
-Over half of American adults are over weight or class I obese
-Although some health-related risk factors among the overweight and mildly obese could be declining, there is evidence of a parallel increase in disability among the obese
-Julie Guthman (Weighing In: Obesity, Food Justice, and the Limits of Capitalism)
- Even though obesity isn't an established cause of the risk factors associated with it, obesity still causes impaired functioning and makes one susceptible to certain diseases.
- “The use of risk factors makes it particularly difficult to pinpoint where the pathology lies. That gives space to the possibility that obesity is a weak proxy for some underlying pathology”
-From 1980-2008 trends in overweight children
-ages 2-5: 5.0%- 10.4%
-ages 6-11: 6.5%-19.6%
-ages 12-19: 5.0%-19.1%
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”obese youth displayed significantly lower health-related quality of life on multiple areas, including physical health, psychosocial health, emotional and social well-being, and school functioning”

c: Economic Consequences
John Cawley (The Oxford Handbook of The Social Science of Obesity p120-137)
-Obesity cost can be classified as being direct or indirect
-Direct costs (2008): Health care costs
-obesity-related illnesses: $147 billion
-Medicare: $19.7 billion
-Medicaid: $8 billion
-inpatient costs: $237.6 million
-childhood obesity: $14.1 billion
-10% of all medical spending in US
-Indirect costs:vLabor market consequences
-Obesity-related job absenteeism: $4.3 billion
-$506 per obese person drop rate in productivity
Eric Finkelstein and Hae Yang (The Oxford Handbook of The Social Science of Obesity p495-501)
-people with BMI levels of 30 and over have 17-24% more physician visits that normal weight individuals
-48% more inpatient days per year
-36% higher medical costs
-77% increase in prescription drug spending
-morbidly obese people (BMI> 34.9) spend $1,680 more annually that obese patients
-$175 per year of taxpayer dollars go towards obesity-related medical expenditures and programs
-Medicare spends 34% more money on obese patients than normal weight patients
Susan Averett (The Oxford Handbook of The Social Science of Obesity p531-552)
- “If obesity results in poor health, that may translate into an increased absenteeism and lower productivity”
-Morbidly obese women are118% more likely to miss work, Obese women 61%, overweight women 32%
 
B: What Are the Causes?
i: Overeating
Julie Guthman (Weighing In: Obesity, Food Justice, and the Limits of Capitalism)
-energy balance model: people eat more calories than they burn
-no empirical evidence that people have been increasing their calorie intake
-Americans have been eating processed food, high in simple carbohydrates and lots of fats for most of the 20th century, and obesity rates have only spike towards the end of the 20th century to present times
At its most superficial level, overeating is the cause of obesity; however, we can ask “What is the cause of over-eating?” and we begin to see a much more complex problem involving many factors.
Kristina Elfhag et. Al (Family links of eating behavior in normal weight and overweight children p491-500)
-Three aspects of eating behaviors:
1)Restrained- “conscious determination and efforts to restrict food intake and calories in order to control body weight”
2)Emotional- “an inclination to eat in response to negative emotions”
3)External- “eating in response to external food cues appealing to the senses” e.g visual characteristics, portion sizes, and varieties of food
-”External and emotional eating are considered more disruptive than restrained eating as they are associated with a tendency to overeating and higher body weight”

ii: Emotional and Psychological Issues
a: Depression and Obesity
Ellen Grandberg (The Oxford Handbook of The Social Science of Obesity p329-349)
-the relation between obesity and depression is a moderate one “whose size and intensity likely fluctuates between individuals and groups and across individual biographies and community histories”
-research focused on adolescents “generally identify positive associations between body weight and depression are stronger for girls than boys”
- Caucasian females “are especially concerned about weight and consequently uniquely vulnerable to experiencing depression as a result of obesity”
-”Studies assessing the prospective relationship between depression and subsequent obesity have also produced results suggesting that both a diagnosis of major depressive disorder or reports of elevated depressive symptoms predict an increased risk of obesity across time”
-”depression during childhood and adolescence is associated wih higher BMI and elevated risk of obesity by early to mid-adulthood”
-evidence suggests that “weight is associated with depression across time and that depression may be an early warning indicator of obesity risk”
 
b: Mood, Attitude, and Eating Behaviors
Almut Zeecl et. al. (Emotion and Eating in Binge Eating Disorder and Obesity)
-”negative mood often precedes binge eating episodes”
-”binge eating is seen as the result of an escape from unpleasant states, especially from 'the awareness of the self's shortcomings, creating negative affect such as anxiety and depression' – and represents a maladaptive way of coping”
-”different emotions may increase or decrease eating in the same person (e.g.: boredom increases and sadness decreases appetite)”
-”anger/frustration, anxiety, sadness/depression accounted for 95% of the antecedent moods preceding a binge”
-negative emotions related with interaction with others seem to be relevant in emotional-eating patterns
-”anger is experienced as especially threatening and possibly damaging to relationships, resulting in its suppression or regulation through eating”
-”eating is used as a strategy to regulate or escape negative emotions”
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”It may be that experiences of stigma lead to psychological distress, which in turn increases vulnerability of binge-eating patterns, or that individuals who internalize negative weight-based stigma are more vulnerable to binge-eating patterns”

iii: Genetics and Family Influences
a: Genetic Influences
Julie Guthman (Weighing In: Obesity, Food Justice, and the Limits of Capitalism)
-”since fat people have fat dogs and cats, the increase in obesity can't be because of genetics”
-”The glacial pace of evolutionary change simply does not square with an abrupt rise in obesity since 1980”
-Certain extreme cases of obesity have been related to genetic mutations that affect leptin distribution in the body. “Bodies without leptin 'think' they are in a state of starvation and thus will eat more”.
-less than 5% of obese people are considered to have this gene mutation
-genetic abnormalities result from various environmental toxins and chemicals in many pharmaceuticals that effects the endocrine system.
-leptin resistances results in leptin not being able to suppress appetite
-insufficient adiponectin results in high resistances to insulin resulting in higher obesity and diabetes levels
-endocrine-disrupting chemicals, EDCs,have been associated with “developmental changes (precocious puberty), reproductive disorders (low sperm count, infertility), behavioral disorders such as attention deficit hyperactive disorder (ADHD), and various cancers (breast, testicular, vaginal, prostrate)”.
Colin Waine (Obesity and Weight Management in Primary Care)
-”Children of families where one or both parents are obese are certainly at increased risk of becoming obese themselves”
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
- Only about ten children in the world have a severe leptin deficiency
-”most obese people already have high levels of leptin in their bloodstream” and that “injecting more of the hormone simply has no effect”
-”sleep deprivation enhances the release of peptides [called ghrelin] that produce hunger”
-”Genes themselves do not make a person obese or thin. They merely determine which individuals are susceptible to weight gain in response to environmental factors”
-the 'thrifty gene' hypothesis: “The same genes that made it easier for our ancestors to survive occasional lack of food are now being challenged by environments in which food is always plentiful”
-genes may influence a number of things such as: poor regulation of appetite, a tendency to overeat, a more sedentary lifestyle, reduced ability to use fats as fuel
-”Family history reflects the genetic background and environmental exposures shared by close relatives” and can help determine one's susceptibility of obesity-related disorders
-the genetic tendency of obesity is both metabolic and behavioral
-“Even when people have a genetic tendency to gain weight, overeating and inactivity are the main causes of obesity. The gene pool has not changed, but eating habits have”
 
b: Family Influences
Kristina Elfhag et. Al (Family links of eating behavior in normal weight and overweight children p491-500)
-”Eating disorders in mothers have been associated with more problematic feeding of their infant offspring(1), as well as eating problems for their children at various ages(2-7)”
-”children's food intake mainly reflects the food intake of their parents”
-”Overweight parents had a lower level of education than normal weight parents”
-parents influence restrained and emotional eating behaviors
-”eating behaviors that will eventually contribute to healthy and unhealthy food habits are formed in childhood”
-”One major source for forming eating behaviors are the eating behaviors the children observe and adopt from their parents through modelling”
-External eating behaviors “was most shared between parents and their children and to the greatest extent for overweight children”
-”The effect sizes in the family links were moderate for external eating and somewhat lower for emotional and restrained eating”

iv: Society and Environmental Influences
a: Economic Status

b: Peers and Attractiveness
Almut Zeecl et. al. (Emotion and Eating in Binge Eating Disorder and Obesity)
-”negative and stressful emotions in relationships with others might be a trigger as well as a maintaining factor for binge eating behavior”
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”weight bias increases risk for unhealthy eating behaviors, avoidance of physical activity, and poorer outcomes in weight loss treatment”
-”overweight youth who are teased about their weight are more likely to engage in binge-eating and unhealthy weight control behaviors compared to overweight peers who are not teased”
-Adults who report weight-based stigmas “engage in more frequent binge-eating behaviors, are more likely to be diagnosed with binge eating disorder, and are more likely to have maladaptive eating patterns and eating disorder symptoms”
-”Stigma-induced psychological stress may also lead to maladaptive coping strategies that reinforce unhealthy eating behaviors”
-”in a sample of over 2,400 overweight and obese women, 79% reported that they coped with weight stigma on multiple occasions by eating more food, and 75% reported coping by refusing to diet”
-”Among overweight youth, weight-based teasing has been linked to lower levels of physical activity, negative attitudes about sports, and less participation in physical activity”
-”Among adults, recent research shows that adults who report experiences of weight stigma are more likely to avoid exercise, and have less motivation for exercise”
-stigmas are a significant barrier in efforts to address epidemics because stigmas undermine public health
-”There are widespread societal perceptions that obese individuals are at fault for their excess weight, and thus deserving of blame, which often reinforces stigmatization”

c:Marketing, Media, and Capitalism/Industrialism
Franco Sassi (Obesity and the Economics of Prevention: Fit not Fat)
- “The mass production of food has changed both the quality and availability of food over time, with major effects on food prices and convenience of consumption from technological innovation. Falling relative prices of food contributed to up to 40% of the increase in BMI over the period 1976 to 1994 in the United States”. (p121)
-”agricultural policies... may have raised the relative prices of healthy foods, such as fruits and vegetables, and lowered the relative price of less healthy foods, such as fats and sugars”
-convenience of fast food restaurants and the increased sophistication of marketing ads continue to contribute to the growing epidemic
-Increased stationary job demands, town planning, and traffic regulations play a significant part of the growing inactivity in the US leading to higher obesity rates.
Kristina Elfhag et. Al (Family links of eating behavior in normal weight and overweight children p491-500)
-”The overall social and cultural environment, including advertisements that display and encourage the consumption of food and snacks, also constitute a source of influence. The highly palatable foods advertised may promote external eating, whereas the slim body ideal in the Western culture contributes to restrained eating”
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-“The current situation in the United States encourages energy consumption and discourages energy expenditure to the point that people who could have maintained a healthy weight in past decades find it too difficult to do so today”
-Because of today’s marketing “Americans have easy access to a wide variety of good-tasting, inexpensive, calorie-rich foods”
Elizabeth Vandewater and Ellen Wartella (The Oxford Handbook of the Social Science of Obesity p350-366)
Brian Wansink (The Oxford Handbook of the Social Science of Obesity p385-414)
James Sallis et. al. (The Oxford Handbook of the Social Science of Obesity p433-451)
Darius Lakdawalla and Yuhui Zheng (The Oxford Handbook of the Social Science of Obesity p463-479)
 
C: What Are the Current Solutions?
 i: How Are Solutions Picked?
a: Cost-effectiveness
Larissa Roux (The Oxford Handbook of the Social Science of Obesity p832-847)
Franco Sassi (Obesity and the Economics of Prevention: Fit not Fat)
b: Population vs. Individual
Franco Sassi (Obesity and the Economics of Prevention: Fit not Fat)

ii: What Are the Most Prevalent Solutions?
a: Dieting
b: Government Policies
c: Medical Procedures
d: Education
Ron Goetzel et. al. (The Oxford Handbook of the Social Science of Obesity p683-712)
Tamara Brown (The Oxford Handbook of the Social Science of Obesity p665-682)

iii: Are These Solutions Effective?
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”weight stigmatization was related to greater caloric intake, higher program attrition, lower energy expenditure, less exercise, and less weight loss among treatment-seeking overweight and obese adults who participated in a behavioral weight loss program”
-”national approaches to obesity primarily address individual behavior and nutrition education, reinforcing notions of personal responsibility as the primary cause of obesity”
-”prevention and intervention efforts often ignore weight stigma and its consequences for obese children and adults, and federal and state legislative initiatives related to obesity have largely avoided the broader societal and environmental conditions that have created obesity in the first place”
Sahara Byrne and Jeff Niederdeppe (The Oxford Handbook of the Social Science of Obesity p752-770)
 
D: Why Are the Solutions Not Working?
i: Is There Something We're Overlooking?
a: Treating the results of obesity rather than its causes

ii: Disembodiment and Obesity
a: The causes of obesity overlap with the causes of disembodiment
Julie Guthman (Weighing In: Obesity, Food Justice, and the Limits of Capitalism)
-”Rather than viewing the biological body as either a blank slate for social forces to inscribe or a preset genetic inscription, it is critical to think about the body as a site where the biological and the social constantly remake each other”
Almut Zeecl et. al. (Emotion and Eating in Binge Eating Disorder and Obesity)
-”Feeling 'satisfied' led to some protection from a desire to eat”
Judith Stern and Alexandra Kazaks (Contemporary World Issues: Obesity)
-in calling obesity a disease people “will inevitably have excuses for not taking ownership for their lifestyle habits”
 
III: The Disembodiment Problem
A: Why Is Disembodiment A Bad Thing?
i: Inability to think for ourselves
a: Blaming
b: Creativelessness
ii: “Mind Over Matter”
iii: The Importance of the Body
v: Body-Awareness in Relation to Obesity and other health issues
a: Emotional awareness
b: Habitual Awareness
c: Self/Other Awareness
d: Internal Physical Awareness
e: Energetic Awareness
B: What Is Causing Our Disembodiment
i: Society
a: Capitalism
b: Education
c: Family Values
ii: Religion
a: Jeudo-Christianity
b: Hinduism
c: Buddhism
d: Daoism
iii: Modernization
a: Science
b: Media
c: Luxury
C: Benefits of Embodiment
i: Creativity
ii: Movement and Exercise
iii: Higher Self-Esteem
iv: Positive Social Relationships
v: Behavioral Regulation
vi: Comfort
vii: Increased Attention
D: Is Anything Being Done To Increase and Promote Body Awareness?
i: In Education?
ii: In Society?
iii: In Religion?
 
IV: A Solution
A: Reforming Education
i: Why Education?
a: Developing Children
Kristina Elfhag et. Al (Family links of eating behavior in normal weight and overweight children p491-500)
-”Children are likely to adopt their parents' eating behavior during their own development, in addition to being influenced by their school environment, peers and cultural environment”
 
b: Social Indoctrination
c: Creative Development
B: What Would Be Done?
i: Reforming PE/Health class
a: Why PE/Health?
- Lack of Participation
- Not Mentally Stimulating
- Reinforces social ‘clicks’
Rebecca Puhl (The Oxford Handbook of The Social Science of Obesity p553-571)
-”It may be that avoidance of physical activities and physical education classes is likely due to the amount of weight-based teasing that overweight students experience in these settings”
 
ii: What would be Changed?
a: Changing PE/Health into a Somatic Awareness class
-Easy Cost-Effective Solution
 
C: Why A Somatics Class?
i: What Is Somatics?
a: Mind/Body integration and awareness
b: Approaches to Holistic Bodyways
ii: How is Somatics Better than our Current PE/Health Class?
a: Theory vs. Practice
b: Creative approaches to Exercise
c: A More Holist Approach to Health and Wellness
d: Focuses on Individuals in relation to the Group
e: Initiates Full Creative Participation
f: Beneficial to Expressive Behaviors and Attitudes
g: Increases Body Awareness and Self-Exploration

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