How we diagnose and define obesity is set to change – here’s why, and what it means for treatment
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.
Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.
But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.
As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.
What’s wrong with BMI?
The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.
Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.
People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.
Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.
But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.
On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.
BMI is therefore an imperfect tool to help us diagnose obesity.
What is the new definition?
The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.
The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.
We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.
1. Clinical obesity
A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).
There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:
- breathlessness caused by the effect of obesity on the lungs
- obesity-induced heart failure
- raised blood pressure
- fatty liver disease
- abnormalities in bones and joints that limit movement in children.
2. Pre-clinical obesity
A person with pre-clinical obesity has high levels of body fat that are not causing any illness.
People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.
However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.
What does this mean for obesity treatment?
Clinical obesity is a disease requiring access to effective health care.
For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.
Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:
- support for behaviour change around diet, physical activity, sleep and screen use
- obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
- metabolic bariatric surgery to treat obesity or reduce weight-related health complications.
Should pre-clinical obesity be treated?
For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.
This may require health counselling, including support for health behaviour change, and monitoring over time.
Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.
Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.
What happens next?
These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.
Once adopted, training health professionals and health service managers, and educating the general public, will be vital.
Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.
People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.
Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Capsaicin For Weight Loss And Against Inflammation
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Capsaicin’s Hot Benefits
Capsaicin, the compound in hot peppers that makes them spicy, is a chemical irritant and a neurotoxin. However, humans being humans, we decided to eat them for fun.
In contrast to many other ways in which humans recreationally enjoy things that are objectively poisonous, consuming capsaicin (in moderation) is considered to have health benefits, such as aiding weight loss (by boosting metabolism) and reducing inflammation.
Let’s see what the science says…
First: is it safe?
Capsaicin is classified as “Generally Recognized As Safe”. That said, the same mechanism that causes them to boost metabolism, does increase blood pressure:
Mechanisms underlying the hypertensive response induced by capsaicin
If you are in good cardiovascular health, this increase should be slight and not pose any threat, unless for example you enter a chili-eating contest when not acclimated to such:
Capsaicin and arterial hypertensive crisis
As ever, if unsure, do check with your doctor first, especially if you are taking any blood pressure medications, or otherwise have known blood pressure issues.
Does it really boost metabolism?
It certainly does; it works by increasing oxygen consumption and raising body temperature, both of which mean more calories will be burned for the same amount of work:
Dietary capsaicin and its anti-obesity potency: from mechanism to clinical implications
This means, of course, that chili peppers enjoy the status of being functionally a “negative calorie” food, and a top-tier one at that:
Chili pepper as a body weight-loss food
Here’s a good quality study that showed a statistically significant* fat loss improvement over placebo:
*To put it in numbers, the benefit was:
- 5.91 percentage points lower body fat percentage than placebo
- 6.68 percentage points greater change in body fat mass than placebo
See also: Difference between percentages and percentage points
For those who prefer big reviews than single studies, we’ve got you covered:
Does it really reduce inflammation?
Counterintuitive as it may seem, yes. By means of reducing oxidative stress. Given that things that reduce oxidative stress tend to reduce inflammation, and in turn tend to reduce assorted disease risks (from diabetes to cancer to Alzheimer’s), this probably has more knock-on benefits too, but we don’t have room to explore all of those today.
Fresh peppers are best for this, but dried peppers (such as when purchased as a ground spice in the supermarket, or when purchased as a capsule-based supplement) still have a very respectable anti-inflammatory effect:
- Capsaicinoids, Polyphenols and Antioxidant Activities of Capsicum annuum: Comparative Study of the Effect of Ripening Stage and Cooking Methods
- A Review on the Effect of Drying on Antioxidant Potential of Fruits and Vegetables
How much should we take?
It’s recommended to start at a low dose and gradually increase it, but 2–6mg of capsaicin per day is the standard range used in studies.
If you’re getting this from peppers, then for example cayenne pepper (a good source of capsaicin) contains around 2.5mg of capsaicin per 1 gram of cayenne.
In the case of capsules, if for example you don’t like eating hot pepper, this will usually mean taking 2–6 capsules per day, depending on dosage.
Make sure to take it with plenty of water!
Where can we get it?
Fresh peppers or ground spice from your local grocery store is fine. Your local health food store probably sells the supplements, too.
If you’d like to buy it online, here is an example product on Amazon.
Note: options on Amazon were more limited than usual, so this product is not vegan, and probably not halal or kosher, as the capsule contains an unspecified gelatin.
Share This Post
-
Change Your Brain, Change Your Life – by Dr. Daniel G. Amen
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
To what extent can we change our brains, and to what extent are we stuck with what we have?
Dr. Amen tells us that being mindful of both ends of this is critical:
- Neuroplasticity means we can, indeed, change our brains
- We do, however, have fundamental “brain types” based on our neurochemistry and physical brain structure
He argues for the use of brain imaging technology to learn more about the latter… In order to better go about doing what we can with the former.
The book looks at how these different brain types can lead to situations where what works as a treatment for one person can often not work for another. It’s also prescriptive, about what sorts of treatments (and lifestyle adjustments) are more likely to do better for each.
Where the book excels is in giving ideas and pointers for exploration… Things to take to one’s doctor, and—for example—request certain tests, and then what to do with those.
Where the book is a little light is on including hard science in the explanations. The hard science is referred to, but is considered beyond the scope of the book, or perhaps beyond the interest of the reader. That’s unfortunate, as we’d have liked to have seen more of it, rather than taking claims at face value without evidence.
Bottom line: this is distinctly “pop science” in presentation, but can give a lot of great ideas for learning more about our own brains and brain health… And then optimizing such.
Click here to check out “Change Your Brain; Change Your Life” on Amazon today!
Share This Post
-
How Much Can Hypnotherapy Really Do?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Sit Back, Relax, And…
In Tuesday’s newsletter, we asked you for your opinions of hypnotherapy, and got the above-depicted, below-described, set of responses:
- About 58% said “It is a good, evidenced-based practice that can help alleviate many conditions”
- Exactly 25% said “It is a scam and sham and/or wishful thinking at best, and should be avoided by all”
- About 13% said “It works only for those who are particularly suggestible—but it does work for them”
- One (1) person said “It is useful only for brain-centric conditions e.g. addictions, anxiety, phobias, etc”
So what does the science say?
Hypnotherapy is all in the patient’s head: True or False?
True! But guess which part of your body controls much of the rest of it.
So while hypnotherapy may be “all in the head”, its effects are not.
Since placebo effect, nocebo effect, and psychosomatic effect in general are well-documented, it’s quite safe to say at the very least that hypnotherapy thus “may be useful”.
Which prompts the question…
Hypnotherapy is just placebo: True or False?
False, probably. At the very least, if it’s placebo, it’s an unusually effective placebo.
And yes, even though testing against placebo is considered a good method of doing randomized controlled trials, some placebos are definitely better than others. If a placebo starts giving results much better than other placebos, is it still a placebo? Possibly a philosophical question whose answer may be rooted in semantics, but happily we do have a more useful answer…
Here’s an interesting paper which: a) begins its abstract with the strong, unequivocal statement “Hypnosis has proven clinical utility”, and b) goes on to examine the changes in neural activity during hypnosis:
Brain Activity and Functional Connectivity Associated with Hypnosis
It works only for the very suggestible: True or False?
False, broadly. As with any medical and/or therapeutic procedure, a patient’s expectations can affect the treatment outcome.
And, especially worthy of note, a patient’s level of engagement will vastly affect it treatment that has patient involvement. So for example, if a doctor prescribes a patient pills, which the patient does not think will work, so the patient takes them intermittently, because they’re slow to get the prescription refilled, etc, then surprise, the pills won’t get as good results (since they’re often not being taken).
How this plays out in hypnotherapy: because hypnotherapy is a guided process, part of its efficacy relies on the patient following instructions. If the hypnotherapist guides the patient’s mind, and internally the patient is just going “nope nope nope, what a lot of rubbish” then of course it will not work, just like if you ask for directions in the street and then ignore them, you won’t get to where you want to be.
For those who didn’t click on the above link by the way, you might want to go back and have a look at it, because it included groups of individuals with “high/low hypnotizability” per several ways of scoring such.
It works only for brain-centric things, e.g. addictions, anxieties, phobias, etc: True or False?
False—but it is better at those. Here for example is the UK’s Royal College of Psychiatrists’ information page, and if you go to “What conditions can hypnotherapy help to treat”, you’ll see two broad categories; the first is almost entirely brain-stuff; the second is more varied, and includes pain relief of various kinds, burn care, cancer treatment side effects, and even menopause symptoms. Finally, warts and other various skin conditions get their own (positive) mention, per “this is possible through the positive effects hypnosis has on the immune system”:
RCPsych | Hypnosis And Hypnotherapy
Wondering how much psychosomatic effect can do?
You might like this previous article; it’s not about hypnotherapy, but it is about the difference the mind can make on physical markers of aging:
Aging, Counterclockwise: When Age Is A Flexible Number
Take care!
Share This Post
Related Posts
-
The Little-Known Truth…
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Myth-Buster, Myth-Buster, Bust Us A Myth (or three!)
Let’s can this myth for good
People think of “canned foods” as meaning “processed foods” and therefore bad. But the reality is it’s all dependent on what’s in the can (check the ingredients!). And as for nutrients?
Many canned fruits and vegetables contain more nutrients than fresh ones! This is because the way they’ve been stored preserves them better. For example:
- Canned tomatoes contain more bioavailable lycopene than fresh
- Canned spinach contains more bioavailable carotene than fresh
- Canned corn contains more bioavailable lutein than fresh
- The list goes on, but you get the idea!
Don’t Want To Take Our Word For It? Read The Scientific Paper Here!
Gaslight, Gymkeep, Girl-loss?
Many women and girls avoid doing weight-training as part of their exercise—or use only the smallest weights—to avoid “bulking up” and “looking like a man”.
Many men, meanwhile, wish it were that easy to bulk up!
The reality is that nobody, unless you have very rare genes, packs on a lot of muscle by accident. Even with the genes for it, it won’t happen unless you’re also eating for it!
Resistance-based strength training (such as lifting weights), is a great way for most people to look after an important part of their long-term health: bone density!
You can’t have strong muscles on weak bones, so strengthening the muscles cues the body to strengthen the bones. In short, your strength-training at age 45 or 55 (or earlier) could be what helps you avoid a broken hip at 65 or 75.
We’re Not Kidding, It Really Is That Important (Read The Study Here)!
Something doesn’t smell right about this
There’s been a big backlash against anti-perspirants and deodorants. The popular argument is that the aluminium in them causes cancer.
This led to many people buying “deodo-rocks”, crystal rocks that can be run under water and then rubbed on the armpits to deodorize “naturally”. But, those crystal rocks are actually alum crystals (guess what they contain…).
The belief that deodorants cause cancer came from studies done by applying deodorant to cells (like the canine kidney cells in this study) in petri dishes. So, assuming you don’t cut out your kidney and then spray it directly with the deodorant, the jury is still out!
A more recent systematic review sorted out quite clearly the ways in which aluminium was, or was not, harmful, and said:
❝Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of Alzheimer’s Disease or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic.❞
Critical Reviews in Toxicology
…but also says that you should avoid eating aluminium while pregnant or breastfeeding. We hope you can resist the urge.
See The Summary For Yourself Here!
(actually the whole article is there, but we know you value condensed knowledge, so: the abstract at the top will probably tell you all you want to know!)
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Beat Cancer Kitchen – by Chris Wark & Micah Wark
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
When we eat, many things can increase our cancer risk. Some we might remember to avoid, like ultra-processed foods and red meat. Others might be more neutral when it comes to cancer, neither good nor bad.
But! Some foods also have cancer-fighting properties. Which means reducing cancer risk, and/or having an anti-proliferative effect (i.e., shrinks or at least slows growth of tumors), in the event of already having cancer.
That’s what Chris & Micah Wark are offering here; a cookbook built around anti-cancer foods—after the former beat his own cancer with the help of the latter. He had surgery, but skipped chemo, preferring to look to nutrition to keep cancer-free. Now 18 years later, and so far, so good.
The dietary advice here is entirely consistent with what we’d offer at 10almonds; it’s plant-based, and high in anti-cancer phytonutrients.
The recipes themselves (of which there are about 70-ish) are as delicious and simple as the title suggests, and/but you might want to know:
- On the one hand, many recipes are things like sauces, condiments, or dressings, which in a recipe book can sometimes feel like underdelivering on the promise of recipes when we expect full meals
- On the other hand, those things if you just purchase them ready-made are usually the things with the most ultra-processed products, thus, having anticancer homemade versions instead here can actually make a very big difference
- On the third hand, there areplenty of starters/mains/desserts too!
Bottom line: if you’re looking for an anti-cancer cookbook, this is a very good one whose ingredients aren’t obscure (which can otherwise be a problem for some books of this kind)
Click here to check out Beat Cancer Kitchen, and take good care of yourself and your loved ones!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Bromelain vs Inflammation & Much More
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Let’s Get Fruity
Bromelain is an enzyme* found in pineapple (and only in pineapple), that has many very healthful properties, some of them unique to bromelain.
*actually a combination of enzymes, but most often referred to collectively in the singular. But when you do see it referred to as “they”, that’s what that means.
What does it do?
It does a lot of things, for starters:
❝Various in vivo and in vitro studies have shown that they are anti-edematous, anti-inflammatory, anti-cancerous, anti-thrombotic, fibrinolytic, and facilitate the death of apoptotic cells. The pharmacological properties of bromelain are, in part, related to its arachidonate cascade modulation, inhibition of platelet aggregation, such as interference with malignant cell growth; anti-inflammatory action; fibrinolytic activity; skin debridement properties, and reduction of the severe effects of SARS-Cov-2❞
Some quick notes:
- “facilitate the death of apoptotic cells” may sound alarming, but it’s actually good; those cells need to be killed quickly; see for example: Fisetin: The Anti-Aging Assassin
- If you’re wondering what arachidonate cascade modulation means, that’s the modulation of the cascade reaction of arachidonic acid, which plays a part in providing energy for body functions, and has a role in cell structure formation, and is the precursor of assorted inflammatory mediators and cell-signalling chemicals.
- Its skin debridement properties (getting rid of dead skin) are most clearly seen when using bromelain topically (one can literally just make a pineapple poultice), but do occur from ingestion also (because of what it can do from the inside).
- As for being anti-thrombotic and fibrinolytic, let’s touch on that before we get to the main item, its anti-inflammatory properties.
If you want to read more of the above before moving on, though, here’s the full text:
Anti-thrombotic and fibrinolytic
While it does have anti-thrombotic effects, largely by its fibrinolytic action (i.e., it dissolves the fibrin mesh holding clots together), it can have a paradoxically beneficial effect on wound healing, too:
For more specifically on its wound-healing benefits:
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Anti-inflammatory
Bromelain is perhaps most well-known for its anti-inflammatory powers, which are so diverse that it can be a challenge to pin them all down, as it has many mechanisms of action, and there’s a large heterogeneity of studies because it’s often studied in the context of specific diseases. But, for example:
❝Bromelain reduced IL-1β, IL-6 and TNF-α secretion when immune cells were already stimulated in an overproduction condition by proinflammatory cytokines, generating a modulation in the inflammatory response through prostaglandins reduction and activation of cascade reactions that trigger neutrophils and macrophages, in addition to accelerating the healing process❞
~ Dr. Taline Alves Nobre et al.
Read in full:
Bromelain as a natural anti-inflammatory drug: a systematic review
Or if you want a more specific example, here’s how it stacks up against arthritis:
❝The results demonstrated the chondroprotective effects of bromelain on cartilage degradation and the downregulation of inflammatory cytokine (tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8) expression in TNF-α–induced synovial fibroblasts by suppressing NF-κB and MAPK signaling❞
~ Dr. Perephan Pothacharoen et al.
Read in full:
More?
Yes more! You’ll remember from the first paper we quoted today, that it has a long laundry list of benefits. However, there’s only so much we can cover in one edition, so that’s it for today
Is it safe?
It is generally recognized as safe. However, its blood-thinning effect means it should be avoided if you’re already on blood-thinners, have some sort of bleeding disorder, or are about to have a surgery.
Additionally, if you have a pineapple allergy, this one may not be for you.
Aside from that, anything can have drug interactions, so do check with your doctor/pharmacist to be sure (with the pharmacist usually being the more knowledgeable of the two, when it comes to drug interactions).
Want to try some?
You can just eat pineapples, but if you don’t enjoy that and/or wouldn’t want it every day, bromelain is available in supplement form too.
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
