Small steps

Sometimes it just takes that first small step. Then another, and another. Soon you will find you have progressed quite a distance.

I have been thinking and reading a lot about the obesity dilemma facing the US and considering what is appropriate and necessary to push it backwards. I have talked about thinking big, acting big and eating big and I am sure that is part of the problem, so is the general lack of exercise, particularly with the kids. But also I think we have simply started accepting the fact that we are overweight and not really getting too upset about it. So what if we get Type II diabetes, we have a number of new drugs that work effectively in reducing blood sugar. So our blood pressure is elevated, we have new drugs for that as well. Cholesterol? New drugs. We think in terms of short term health solutions instead of long term health modification. Diet and the associated weight seem to be pushed into the background.

A recent study showed how if we were overweight, our friends and family would be as well. It’s not genetics necessarily; it seems to be primarily perception. What we see we emulate. If our friends are overweight, and we want to be close to them, we gain weight. If we are overweight, our friends and family will think of it as acceptable and move in that direction as well.

A study, titled Obesity is Socially Contagious was published in the July 26, 2007 issue of the New England Journal of Medicine, and suggests that obesity is "socially contagious," as it can spread among individuals in close social circles. The author’s likely explanation is that a person's idea of what is an appropriate body size is affected by the size of his or her friends. This new study finds that when the scale reads "obese" for one individual, the odds that their friends will become obese increase by more than 50 percent. Conversely, the researchers found that thinness is also contagious.

"Social effects, I think, are much stronger than people before realized," said co-author James Fowler, a social-networks expert at the University of California-San Diego. "There's been an intensive effort to find genes that are responsible for obesity and physical processes that are responsible for obesity, and what our paper suggests is that you really should spend time looking at the social side of life as well."

It has been demonstrated in research that peers influence each other's health behaviors. The data for this study was part of the Framingham Heart Study, an ongoing cardiovascular study. The health data was collected between 1971 and 2003 from more than 12,000 adults who participated in the Framingham study. Participants provided contact information for close friends, many of whom were also study participants, resulting in a total of over 38,000 social and family ties.

The most interesting results noted were when the researchers found that if a participant's friend became obese over the course of the study, the chances that the participant also became obese increased by 57 percent. Among mutual friends (both individuals indicate the other is a "friend"), the chances nearly tripled. So it is with friends. Among siblings, if one becomes obese the likelihood of their sister or brother becoming obese increases by 40 percent. Among spouses there is a 37 percent increased risk.

Gender also affected the degree of "obesity contagion." In same-sex friendships, individuals had a 71 percent increased risk of obesity if a friend became obese. If a guy's brother is obese, he's 44 percent more likely to also become obese. Among sisters, the risk was 67 percent.

This phenomenon was apparently was not based upon the potential that fat people hung out with fat people. A direct and causal relationship was determined. If a person had a close friend who was obese they tended to be affected by that person’s obesity. An interesting piece of the puzzle is that if you considered yourself a friend of someone, you were influenced by their weight. Conversely if that person did not consider you a friend, they were not affected by your weight. That is interesting.

So what does all this mean regarding weight gain, weight loss and the relationship to WLS? I feel that the closeness we feel for another can influence how we perceive them physically as well as socially. It can influence whether we discuss weight with them or just accept what and who we are. I feel that it goes to the question of talking to each other honestly about weight issues. Not being judgmental, not being critical, and certainly not making the issue a point of humor. We do not degrade our friends. We want to do what we can to help them look critically at what they are and the implications on their health. I am trying to create a forum where we can talk honestly about these issues. Sometimes it seems almost insurmountable, and sometimes you move a bit forward. Sometimes it just takes that first small step. Then another, and another. Soon you will find you have progressed quite a distance.