Are We Digging Our Graves with a Spoon in America? A Psychiatrist Weighs In.

The etiology of obesity, in my opinion, has several distinct ones. Each has its own specific phenomenology which may require more in-depth blog-posts in the future. However, in this particular post, I want to provide you with an overview of some of my thoughts.

My opening comment is that I would like to suggest four (4) clinical etiologies as a frame of reference for my discussion. My hypothesis is basically birthed out of my experience as a physician in America.  Michelle Obama, among others, are now speaking out on this public health tragedy. America is digging its grave with a spoon. All hands need to be on deck and we can no longer afford to sit in oblivion and not start with the discussions to address this public health problem. Here are my thoughts for your consideration:

Possible Etiologies for Obesity in America:

1. Genetics

  • This is an area that has to be looked at very closely.  As with depression, obesity certainly runs in families. Although we have not isolated any particular gene for this disorder, any genogram will certainly offer you data that suggests the genetic relation to this disorder.  Most of us have probably observed this phenomena in our communities as well. It is also a known fact that most children develop many of their eating behaviors from their parents.

2. The Poverty-Derived “Clean Your Plate” Syndrome

  • Many adults who grew up in impoverished settings have always heard the very familiar saying of “clean your plate.” Many were also taught not to throw away food because someone in the home had worked very hard to pay for it. As a result, in our later years, we now gorge ourselves, even when full. This certainly leads to increased caloric intake and can lead to obesity and its sequela. Have you ever over-eaten and really couldn’t understand why?

3.  Emotional Eating (Depression)

  • I see numerous small and obese persons yearly who have this problem. People in America use food for comfort; when many people become anxious at work or home, they immediately run to get a highly glycemic snack, such as cookies, cakes, or potato chips. Pretty soon, this becomes a conditioned response: stress = food. This is a bad mix, and I encourage persons who experience bad relationships, stressful jobs, and tragic loss to seek out the proper mental health treatment. The old saying that one thing leads to another will certainly be the case if emotional eating is not dealt with at the onset.

4. Economics

  • This is a very important multi-factorial consideration for obesity.
  • Many people just can’t afford to buy healthy foods.
  • Many people will purchase pork and non-lean meats because they are cheaper.
  • Sometimes in impoverished communities, “Top Grade” products are not available for purchase.
  • Sometimes, because of budgets, people have to purchase cheaper meats, canned vegetables and day-old breads to make it through the month.
  • Unemployment is at an all-time high.
  • Jobs are not paying as much, so budgets have to be strategic in purchases.

This is just the beginning of my discussion. Do you see “obesity’ as a problem in your family, church or community? What do you think some of the etiologies are in your surroundings? Please share your comments on the blog…

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  • BCS

    I feel that some people early on have eating problems.This problem started in the early development of their adolescents. And as a result it has lead to a life of weight gain, insecurity and host of other things that comes with obesity. Do you think America will ever become a more healthy nation? How can we as a community or nation solve this problem? What do you think?

    • admin

      @BCS My concern is that with the current unemployment and economic crisis state of America, this may be a difficult task. I don’t think that anyone wants to die prematurely, but some may have no other choice. Are you a part of any community partnerships, or organizations with “obesity in adolescents” as one of their initiatives? If so, how is it going?

      • admin

        @JC Probably the most common disorder would be PTSD. The other mood and anxiety disorders as well may be culprits, too. You also have to be careful with the psychotic disorders, because many of the antipsychotic medications can cause weight gain.

  • JC

    What other mental disorders can be associated with obesity besides depression?

  • Essdie

    Dr.O, why are you getting all up in our dietary business?!:) More seriously, this is a vital issue for all Americans and it hits the Black community very hard. I think there are a few additional causal possibilities…

    a. Some people take the attitude that if they have been overweight since childhood, they are just supposed to stay that way.

    b. “My dad was a big man and his father before him and the weight looked good on ‘em.” is a way of addressing possible genetic dispostion for excessive weight. However, most of these claimants will not tell you that their parent probably died before the age of sixty.

    c. Many young parents use the bottle to quiet a crying baby. This establishes the notion of “comfort food” and it is a scapegoat for actually blaming those sweet, loving parents who created the current food addict.

    d. The other side of the poverty issue – instead of “Clean your plate”, is “Because I can!”. This is where people who were SO poor that they could not eat what they wanted when they wanted now feel a sense of entitlement to eat in excess as a way of “making up” for having to eat whatever was available back in the day.

    That’s my story and I’m sticking with it!

    • admin

      @Essdie. Not quite sure of the origin of some of your theories, but they are worth and honorable mention. I guess that I am not sure that a bottle is comfort food as it is usually a primary mode of feeding before a human can sit at the table. Not sure about that one. The genetic predispostion assertion, all I can say is that, it is what it is! The person should always seek medical attention to rule out true gland or hormonal diseases. The sense of entitlement hypothesis I am not sure that I can digest that one, either. I will however, chew on it for a few days.

  • brooklynkid1180

    Although I have never been obese, I have gained a lot of weight and managed to loose it over the years. I found that a lot of us are just uneducated to different foods and will not try better. I am sticking to that because……..

    Black people do not try new vegetables and fruits. I live in the south, and if it is not “greens”, they turn their lips up. You can eat salads and get all types of nourishment. There are so many nutrients. Potato dishes,….Soups.

    With natural food,…. Cook for goodness sake. We do not cook, we eat process and microwave. I bet if we took a poll of black women bet ages 18 to 24, we could not get 10 females that know how to bake a pan of bread, or make a cake from scratch. (That might stir up a response; males either.)

    Fast food is killing us. We have always called the burgers from fast food restaurants “kangaroo meat” because…..honestly does it share the same taste as the beef you make at home?

    I do realize that we have problems with economics, etc, etc,…….
    We have to consider the calorie intake, cholesterol, nourishment, etc. You can get some cheap cuts of meat and make a stew with vegetables, and bread for instance.
    Cut out soda, drink natural juice. Get apples, when you find a sale then buy grapes……… We don’t think about what we eat at all. Just that it is good…..We eat mac n cheese, collars, ribs, fried chicken….. and things of this nature too often.

    We will not walk, run or exercise. You have to move. Couch potatoes…..Move especially if you are as you described… depressed, or emotional about something. Stop yourself when you go for the bag of chips and just do something, some laundry, read or go visit someone or go to the mall….. Stop being a creature of habit…..For breakfast, have some juice and fruit. Some oatmeal,……cut back on the pork.

    These are all suggestions, that can help us…..Help ourselves instead of making up excuses. Black Americans were working in the previous decades and did not have time to get fat, obese, etc. There were no easy cleaners., vacuums, ……They washed by hand…..Worked in fields, factories, and the mill….. so our fore parents were burning off those calories from the food. But still suffered from high blood pressure, diabetes, etc.

    If we lower our intake of the bad things like sugar, salt and pork and increase vegetables we would be in such better shape.

    • admin

      @Brooklynkid 1180 I agree with your coimments. The people perish because of a lack of knowledge. The question for you is, how do we effectively get the word out?

  • Essdie

    Am I the only person who has seen a parent shove a bottle into the mouth of a crying baby “just to shut him up”, rather than hold the baby, check the diaper, or do anything else that requires some real effort? We all know that the bottle is the primary method of feeding an infant, but it is not always hunger that makes a baby cry. If a baby is crying out of lack of attention and you just shove a bottle in their mouth, then they will think that feeding is the solution to being upset as they grow older. My point is that some parents overfeed their young and that establishes a pattern for obesity in the future.

    It is true that there can be valid medical reasons for obesity, but there are usually valid medical solutions when that is the case. For the most part, many of us are just plain greedy.

    Entitlement manifests in many ways…overeating is just one of them. Some people who were poor grow up and spend excessivley on cars, clothes, homes, boats, and travel because they did not have access to such luxuries when they were young. Overeating can be another manifestation of this kind of thinking… that’s all I’m saying.

    • admin

      @Essdie I think that you are the only one that feels parental “over-feeding” is an etiology of obesity. The literature doesn’t support this hypothesis. Afterall, we are referencing infants and babies.

      @Essdie No I am almost sure that there is NO valid medical reason for obesity.

      @Essdie Are you maybe suggesting that over-indulging, as a result of feeling entitled, precludes some victims of obesity? This sounds great but I am not sure that your hypothesis will stand. However, I think that you may be on to something…

  • Essdie

    Are all those children on the “fat babies” shows on cable tv fake? If not, how did they get so fat? Are thyroid conditions not “medical”? I’m just asking for the last time.

    • admin

      @Essdie. I am not sure. However, as it relates to thyroid disease, hypothyroidism can indeed cause decreased metabolism and subsequently weight gain but hypothyroidism is a treatable disease.

  • http://www.cna-trainingclass.com/ [Blocked by CFC] cna training

    Wow this is a great resource.. I’m enjoying it.. good article

  • brooklynkid1180

    @Essdie. Have you seen what those moms feed their babies on the fat babies shows? Junior is 2 years old eating pancakes, half dozen of eggs, a slab of bacon……. Most 2 year olds eat some oatmeal and fruit, a piece of toast and eggs. They feed the babies like they are doing manual labor.

    You never see carrot sticks, and apple slices for snack. They are giving the kid french fries, soda, cakes……..Starting the child on the wrong track. The obese adult says…..”I weighed 180 lbs at 10 and now at 28, I weigh 300lbs. I say give Junior a piece of fruit, or celery stick….

    (The lady in the picture above, has a female eating a whole cake.) That is gluttony.

    People always joke on the fat kid too, so they carry alot of burden on their shoulders that they don’t have to if they were not so fat. People are cruel and the teasing starts all kinds of mental issues.
    The kids can’t find fashionable clothes; sit in tight places, run, touch their toes. It is not good for your self esteem if you are overweight. It is really sad for a parent to contribute or allow this to happen to their child. Those kids become creatures of habit, and it takes effort…… to help reverse their actions. – Call it an addiction if you want.

    Thyroid and other diseases come from over time abusing you body by over indulgence in food. Exercise and time spent with the child educating them on food choices will prevent them from craving grease, salt and sugar. So the risk of high blood pressure, diabetes, high cholesterol, etc. is lowered.

  • Lia

    For a couple of years I was doing the emotional eating. I had no idea what I was doing. I started getting up during the night to eat. I gained weight. Then I had to see a doctor to find out what were the problems causing illnesses. All kinds of physical problems took over to which I had to see different doctors. I had the right sense to start seeing a Christian counselor. She sent me to another doctor for depression. All of these things manifested from childhood issues. Once I started to address the issues the pull to eat started to subside.

    • admin

      @Lia I am so glad that you came forward for help. Psychiatrist, some of us aren’t all that bad. If you find one who is compassionate, like me, you’ve got a winner. Keep up the work in Psychotherapy.

  • [Blocked by CFC] Autism Symptoms

    Pretty nice post. I just stumbled upon your blog and wanted to say that I have really enjoyed browsing your blog posts. In any case I’ll be subscribing to your feed and I hope you write again soon!

    • AskDrO

      @Autism Symptoms I hope that we can link back. Thanks

  • Abby

    I subscribe to the idea of entitlement as one of the driving forces behind at least some morbid obesity, not just your standard 50 – 100 pounds overweight but the really big people like the woman in the picture. I’ve come to this conclusion through association and observation, although I admit that my sample population is not high.

    My ex was about 150 pounds overweight when we met. He was very fearful of dieting (afraid of hunger pangs) but interested in losing weight. I met his family – normal weight parents – morbidly obese older brother (about 600 pounds.) The family had no sense of how to eat and the boys used food for comfort. Mom cooked to show her love. Food = comfort + love.

    Over time I realized another dynamic – the idea that “I deserve.” I worked hard – I deserve a big piece of cake. Older brother said the same very openly as he sat in a chair wheezing because he could not breathe. I asked if they didn’t deserve a long and healthy life and both told me that their eating was not a health risk. Both have become very sick with their obesity contributing. My ex hasn’t worked in over 3 years and now has developed disk problems. He now lives with his feeder mom who provides all the food he thinks he deserves. His health is so bad that, at 36, he was denied health insurance. He literally said “I have to lay in bed don’t I deserve to have something good to eat.” When I suggested something low calorie he wrinkled his nose in disgust. That was the last time I tried to visit him.

    I’ve worked with two obese people and both had the trait of greed – not just for food, but for things like office supplies and other resources. Both at one point or another expressed the idea that they worked there and therefore were entitled to anything they wanted even to the point of hording supplies while others had to scrounge.

    I’m wondering if morbid obesity might not be a combination of the feeling that one deserves to eat the food you like in the quantities that you want maybe combined with almost a hording mentality. It seems that once people reach these levels of obesity it is very difficult for them to lose (even though they appear physically uncomfortable) and they tend to gain it back quickly. Personally I hover at 50 – 60 pounds overweight on a large frame, but don’t go higher because it is too uncomfortable. I like to eat too much to go much lower though, so I have some frame of reference for what drives obesity.

    • AskDrO

      @Abby, if we accept your theory, (which sounds great) why is there such a large sample of morbidly obese persons unemployed and living below the poverty level?

  • Abby

    I’m not sure what income has to do with it. People find a way to get food, look around Wal-Mart. Maybe I should add “have access to abundant quantities of food,” or “are enabled by family and friends.” I remember seeing an interview on Montel Williams with a Black man who was so obese that he could no longer get out of bed. Now, not only couldn’t he work, but he couldn’t possibly have cooked for himself. Another guest that appeared on the show was the man’s niece who stated that she loved talking to him so much that she would bring food and cook it for him. When asked what food she brought she said she would fry him up a couple of chickens and then talk with him while he ate it. If the support system for these people was removed they would lose weight. I’ve been out doing some searches and all the supersize people I can find all have a good support system.

    There is an active fetish community geared toward these “supersize” women they can make money and receive gifts by showing off their bodies. Donna Simpson who says she wants to be the world’s fattest woman has such a site: http://www.supersizedbombshells.com/Treasure/index.html There are comparable sites for “supersize” gay men as well called “chubs” and “superchubs.” There is a twist to some people’s brain that makes morbid obesity sexually desirable and validates the obese person’s remaining at that size or even growing.

    One thing I’ve found that obese people all seem to have in common is the inability to stop eating when they are full, and I include myself. Eating is comforting, reduces stress and is a form of entertainment. The real problem comes when the obese person chooses to ignore physical discomfort and continue over eating. The body can take only so much so they get sick and since many can’t work they are a strain on the health care system.

    You asked about family and my ex’s obesity, refusal to lose weight, poor health and the attitude he developed about his entitlement destroyed our family. His brother literally hit the floor with an obesity related illness and now has to diet or die. I live close to Wal-Mart so I shop there on occasion and a large percentage of people are somewhat to very over weight. I went to a “networking” party the other night with other professionals and was really the only over weight person there. I’m also employed as a profession at a large hospital and am one the few overweight people in my department and the entire hospital. I’d say from my minute research sample that education and income level very much affects how obese you are.

    • AskDrO

      @Abby It appears that you have made a rather simple phenomena sort of complicated. I thinks that their is a problem, but most of the culprit is in lifestyle and choices. Don’t you agree?

  • Abby

    Uh, I thought I was posting on the blog of a psychiatrist. That was about the last sort of statement I expected from someone who is a mental health care professional… If lifestyle choices were all there was to it, there would be no need for rehab clinics for drug addicts, or medical treatment to help them kick the habit. People could just give up smoking and drinking – if they made the right choice. You of all people must be aware of all of the mental twists and turns that drive addiction, denial, dependency, entitlement and so on. I find your reply simplistic and worrisome in a psychiatrist.

    • AskDrO

      @Abby great. I understand your thinking but it was a little clouded. My point, which I may not have made very clear, is that OBESITY cures will have to take on a more BIO-PSYCHO-SOCIAL understanding of the etiologies. Maybe I misunderstand your “entitlement concept.” This is where I had some difficulty in your first response.

About Dwight A. Owens, M.D.

As a practicing physician, Dr. Dwight A. Owens, has a respected voice in psychiatry that truly makes an impression. He keeps readers enthralled by refusing to shy away from controversial topics and pulling no punches. He also adds spice to the blog by commenting on the state of relationships at every stage, from the first encounter to the daily struggles in even the most satisfying marriages.

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