LWDI Alum Spotlight: Kim lands a position at the National Diabetes & Obesity Research Institute!

Kim has landed a position with the National Diabetes & Obesity Research Institute on their team of amazing Dietitians!

LWDI’s unique affiliation with NDORI allowed Kim to intern on-site with their team. We are beyond proud of her for being offered this valuable and important position to help lead the charge in Diabetes & Obesity prevention and treatment.

Please join us in congratulating Kim on her accomplishment!

Obesity and Mental Illness: Can one lead to the other?

By: Cassidy Shumway, LWDI Intern 

It is commonly understood that obesity and mental health are correlated to each other. In fact, it  is almost hard to acknowledge one of these topics without eventually addressing the other. We  know that there is some sort of connection, the question that remains is: what is it

In order to set the stage for the rest of this post, consider these two questions:

• Can obesity lead to developing a mental disorder? 

• Can a mental illness increase a person’s risk for developing obesity? 

Let’s start at the beginning: 

It is no secret that obesity is increasing not only within the United States, but worldwide as well.  According to the Center for Disease Control and Prevention (CDC), data from a National Health  and Nutritional Examination Survey found that in the United States between the years of 2017- 2018, the prevalence of obesity in adults was 42.4% which is more than a third of the population (1).  

CDC: Estimates for adults aged 20 and over were age adjusted by the direct method to the 2000  U.S. Census population using the age groups 20–39, 40–59, and 60 and over (1). 

This is a public health concern because: 

1. Obesity raises the risk for most chronic conditions 

2. Obesity can lead to poor mental health

3. Obesity can increase your risk for mortality (2).  

What is obesity? 

Obesity is a complex, multifactorial disease that is typically defined as excess body weight for  height. Body Mass Index (BMI) is the most widely used criteria for determining obesity and is  classified by a BMI of 30 kg/m2 or greater (2).  

Mental Health 

In addition, not only is obesity rapidly increasing, but mental health illnesses  as well. According to the American Psychiatric Association, one in five U.S. adults live with a mental illness which is roughly 51.5 million people.  A mental illness is a health condition that results in changes to an  individual’s emotions, thinking, or behavior and they are often associated with distress and result in an individual having difficulty functioning normally in  social, work, or family situations (3).  

Common mental illnesses include: 

• Depression 

• Anxiety 

• Bipolar disorder 

• Eating disorders 

• Personality disorders 

• Psychotic disorders 

• PTSD disorders. 

Nearly one in five U.S. adults experience some form of mental illness.

Individuals who are obese have an increased risk of developing some sort of neuropsychiatric  disorder such as depression and anxiety and individuals that have neuropsychiatric conditions  may exhibit features that can lead to the development of obesity (4).  

Let’s dig in and look into those questions from the beginning a little further: 

Can obesity lead to developing a mental disorder? Short answer: Possibly 

Individuals who are obese have a higher chance of developing some sort of  neuropsychiatric disorder such as depression and anxiety than non-obese people.  Unfortunately, because of high social expectations, beauty standards, and media, an individual with obesity can negatively influence a person’s self-image with a self depreciating perception. Ultimately, this can make an individual vulnerable lead to  depressive symptoms.  

Research Says: 

• A systematic review in 2017 was conducted which indicated that depressed adolescents  had a 70% higher risk for being obese and another study showed that older women with  obesity had a 38% increased risk for developing depression (5). 

• In 2019, a study was conducted to understand obesity in college aged women. This study  found that: 

o Obese women had significantly lower body image, self-esteem, and high  depressive symptoms than non-obese women. 

o The obese women who reported depressive symptoms reporting more eating  problems, and poorer body image (6).  

• A meta-analysis conducted in 2018 ultimately showed that individuals with central  obesity had a 38% increase of having depression than non-obese individuals (7).  

Within society, it has been established that there are many negative weight-related issues  prevalent in society today including (6): 

Because of this, individuals might look for ways to restrict their diets in an effort to lose weight.  Ultimately, that behavior has the potential to exacerbate depression and put obese individuals at  an increased risk for developing a mood disorder (7).  

Can a mental illness increase a person’s risk for developing obesity? Short answer: Possibly 

For the most part, it is common knowledge that obesity can increase an individual’s chance of  developing mental health disorders and maybe it is common knowledge because we are all aware  of the weight bias, discrimination, and stigmatization that exists in society as a whole, within the  media, but is also apparent on a normal basis in our day to day lives (4). How often do we think  about how mental illness can increase a person’s risk for developing obesity? 

Research Says: 

• Depressive symptoms can lead to an unhealthy lifestyle including being sedentary and  poor eating habits. 

o In college students, it was found that depressive symptoms lead to the  consumptions of sweets, cookies, snacks, and fast food. 

• Food preferences may change during states of stress of depression. 

• High carbohydrate food can temporarily life a person’s mood. 

o Leads to the consumption of pleasant tasting foods (usually those that are high in  fat and sugar) which activate the brains opioid system. 

o Carbohydrate consumption may increase serotonin production in the brain. • Mood disorders can cause sleep abnormalities and sleep impairment is associated with an  increase in the hormone ghrelin (hunger hormone) and decreases the hormone leptin  (inhibits hunger). 

• A high fat diet that can come from having depressive symptoms can potentially lead to  hypothalamic inflammation in the brain which ultimately compromises the regulation of  satiety and can promote weight gain.  

• Antidepressants and mood stabilizers that are prescribed in the treatment of mental health  disorders have been found to be associated with weight gain (4).  

Conclusion: 

Within the past couple of decades, studies are being conducted and evidence is being  accumulated that shows that there is an association between mental health disorders and obesity.  However, more specific studies are needed as there still a lot of unknowns and unanswered  questions. However, the evidence and literature that is currently available is significant and may be impactful by leading efforts towards further research and to the development of better  therapeutic strategies for these conditions. 

RESOURCES 

1. Products – Data Briefs – Number 360 – February 2020. Centers for Disease Control and  Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm. Published  February27, 2020. Accessed November 25, 2020.  

2. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmaco Economics.2015;33(7):673-689.  

3. What Is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness.  Accessed November 25, 2020.  

4. Martins LB, Monteze NM, Calarge C, Ferreira AV, Teiziera AL. Pathways linking obesity  to neuropsychiatric disorders. Nutrition. 2019;66: 16-21.  

5. Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3): 182-190. 

6. Sarigiani PA, Olsavsky AL, Camarena PM, Sullivan SM. Obesity and depressive symptoms  in college women: analysis of body image experiences and comparison to non-obese  women. International Journal of Adolescence and Youth. 2019;25(1): 765-779. 7. Mulugeta A, Zhou A, Power C, Hypponen E. Obesity and depressive symptoms in mid-life:  a population-based cohort study. BMC Psychiatry. 2018;18: 1-10.

The Effects of Weight Loss in Adolescents Diagnosed with Obesity and Type 2 Diabetes

By Maria Arana, LWDI Intern

Adolescence is one of life’s most challenging transitions. This stage of life is filled with new emotions, changes, relationships, and unforgettable lessons. As if these struggles were not challenging enough, dealing with obesity and type 2 diabetes can add to the stress. A diagnosis of this magnitude can be overwhelming and scary all at once. Despite this rollercoaster ride of emotions, the most important thing to keep in mind is that individuals still have some control over their health. Understanding obesity and type 2 diabetes is a step in the right direction. 

The Link Between Obesity and Type 2 Diabetes 

Numerous journals, such as the Diabetes Care journal, demonstrate that obesity and excess weight are significant contributors to developing insulin resistance. [1] Obesity also plays a role in cognitive and social problems in adolescents. These problems can often lead to discrimination, low self-esteem, depression, dissatisfaction with body image, and many other psychosocial issues. [2] Despite these consequences, obesity statistics continue to rise in this age group. Data shows that 5% of US adolescents were obese in the year 1980. [3] By the year 2012, 21% of US adolescents were obese. [3] These numbers have more than tripled in the past three decades!

Genetics, race, and family history play a significant role in developing type 2 diabetes. However, environmental factors such as obesity most often trigger the onset of this preventable disease. [3] The American Diabetes Association states that “the earlier an individual develops type 2 diabetes, the higher their lifetime risk of diabetes complications such as heart disease, vascular disease, vision loss, and amputation will be.” [4] 

What Goes on Inside the Body with Type 2 Diabetes? 

Type 2 diabetes is a chronic condition that affects how the body regulates blood glucose (sugar). [1] After eating a meal, the body turns the food into glucose, which travels in the blood system until insulin is released. Insulin, a hormone made by the pancreas, works like a key and allows glucose to enter the cells to be used as energy. [1] However, with type 2 diabetes, the body either does not produce enough insulin or becomes resistant. [1] When this happens, blood glucose can become too high.

Lifestyle Modifications

Making lifestyle modifications is a very personal decision, and it may not be the easiest thing to do. It is recommended that adolescents with obesity and type 2 diabetes aim to achieve a 7-10% decrease in excess weight. [1] However, family members must help with this process by engaging all members in making new lifestyle changes. [1] It can also be helpful to speak to a physician before making these changes. Working with a registered dietitian can help clear up any misconceptions about nutrition and help make individualized meal plans that will properly nourish the body.  

Get Daily Exercise 

A sedentary lifestyle can lead to weight gain. Therefore, the 2015-2020 Dietary Guidelines for Americans recommend that youth ages 6-17 get at least 60 minutes of physical activity daily. [5] Incorporating a mixture of aerobics, muscle-strengthening, and bone-strengthening exercises are recommended. [5] In addition to weight improvements, regular physical activity decreases the risk of coronary heart disease, stroke, high blood pressure, depression, type 2 diabetes, and much more. [5]

Community centers often offer exciting and inexpensive exercise classes, such as dance and yoga, to the community. These classes can be a great way to get involved, meet new people, and a creative way to get moving! 

Use the Diabetes Plate Method

Large food portions often lead to excessive consumption of calories. With time this may lead to a significant increase in weight. The Diabetes Plate Method is a great guide to help individuals choose healthy foods and be mindful about portion sizes. [6] This guide works well for many because it eliminates the need to count, calculate, or measure food. [6] According to the American Diabetes Association, this method starts with using a reasonably sized plate—a plate that is 9 inches across works perfectly. [6] 

First, fill half the plate with nonstarchy vegetables such as: 

  • Broccoli 
  • Carrots
  •  Mushrooms 
  • Leafy greens
  •  Zucchini 
  • Cucumbers

Second, fill one-quarter of the plate with lean protein foods such as: 

  • Chicken 
  • Fish
  • Eggs
  • Lean pork
  • Lean beef 
  • Cheese 
  • Tofu 
  • Any plant-based meat substitutes
What is the Diabetes Plate Method?
American Diabetes Association 6 

Finally, fill one-quarter of the plate with a carbohydrate food choice such as:

  • Grains (brown rice, quinoa)
  • Starchy vegetables (potatoes, peas, corn)
  • Beans 
  • Fruit
  • Yogurt 
  • Milk 

Carbohydrate food choices are limited to one-quarter because they have the most significant impact on blood glucose levels. [6] For beverages, choose those that do not contain calories or added sugars, such as water, unsweetened tea, or any other calorie-free beverage.  

The Importance of Diabetes Self-Management Education

Youth diagnosed with type 2 diabetes have a greater risk of accelerated diabetes-related complications. Type 2 diabetes diagnosed at a younger age is also associated with a greater risk of cardiovascular morbidity and mortality. [7] Therefore, diabetes self-management education is vital to successfully teach adolescents how to control and measure blood sugar levels, reduce mortality risks, and learn more about lifestyle modifications. [7] It is important to understand that diabetes self-management education will require periodic reassessment, especially as an adolescent grows, develops, and has a greater need for independent self-care skills. [7]

The Positive Effects of Weight Loss in Adolescents 

Studies show that lifestyle interventions, such as physical activity, improves insulin sensitivity independently from weight loss. [8, 9] Dietary patterns also contribute to overall health. For example, it is known that weight loss is promoted when dietary patterns are rich in whole grains and fiber. [8] Many of these high fiber foods come from fruits and vegetables. In some instances, pharmacologic interventions may be necessary for some individuals. Therefore, it is crucial to speak with a physician and a registered dietitian about these options.  In essence, whether adolescents are newly diagnosed or have been living with type 2 diabetes for a while,  they have control to redirect their lives and make the most out of those years of youth! 

References 

1. Arslanian S, Bacha F, Grey M, Marcus M, White N, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care. 2018;41(12):2648-2668. doi:10.2337/dci18-0052

2. Mazloomy-Mahmoodabad SS, Navabi ZS, Ahmadi A, Askarishahi M. The effect of educational intervention on weight loss in adolescents with overweight and obesity: Application of the theory of planned behavior. ARYA Atheroscler. 2017;13(4):176-183.

3. Rao PV. Type 2 diabetes in children: Clinical aspects and risk factors. Indian J Endocrinol Metab. 2015;19(Suppl 1):S47-S50. doi:10.4103/2230-8210.155401

4. Galuska D, Gunn J, O’Connor A, Petersen R. Addressing Childhood Obesity for Type 2 Diabetes Prevention: Challenges and Opportunities. 2018;31(4):330-334. doi: https://doi.org/10.2337/ds18-0017

5. Healthy Eating Patterns: Dietary Principles – 2015-2020 Dietary Guidelines | health.gov. Health.gov. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-1/healthy-eating-patterns/#callout-physicalactivity. Published 2020. Accessed December 7, 2020.

6. Intechnic h. What is the Diabetes Plate Method?. Diabetes Food Hub. https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html#:~:text=The%20Diabetes%20Plate%20Method%20is,you%20need%20is%20a%20plate!. Published 2020. Accessed December 7, 2020.

7. Care.diabetesjournals.org. https://care.diabetesjournals.org/content/43/Supplement_1/S163.full-text.pdf. Published 2020. Accessed December 15, 2020.

8. Tagi V, Giannini C, Chiarelli F. Insulin Resistance in Children. Pediatric Endocrinology. 2019. doi:https://doi.org/10.3389/fendo.2019.00342

9. Mahan L, Raymond J. Krause’s Food & The Nutrition Care Process. Pages 586-617 

Intern Spotlight: Jessica interning with Hy-Vee

I am currently interning at Hy-Vee, which is a Midwest grocery store. I previously worked at Hy-Vee for four years as an assistant manager. My preceptors are dietitians that work for corporate. Some of the big projects I will be working on include hosting cooking classes via Zoom, 3 seminars for Drake University via Zoom, and writing up to 10 articles for the Hy-Vee magazine Seasons. I have also been tasked with setting up a way to be able to go virtual with the elderly population. Hy-Vee is working towards staying as virtual as possible from here on out, but this poses an issue with the older population. It is my task to find a way to make it easier for them to be able to access the Hy-Vee dietitians for their one-on-one sessions. This rotation is unique as I will not be working 40-hour weeks for a month, but rather working with them from January until May on whatever projects they deem fit for me to work on. I am loving my time at Hy-Vee and cannot wait to see what else I get to accomplish!

-Jessica Wilming, LWDI Intern

Obesity and Gut Health

By: Alexis Villaret, LWDI Intern

Ahhh… the holidays festivities have finally ceased. Family gatherings may have not inspired the finest eating moments. Usually, temptations are reserved for an occasional birthday or anniversary but with the consecutive holidays indulgences of eggnog, cookies, cakes, holiday roasts and alcohol are hardly avoidable. We are all aware by now of the guilt felt eating one too many of grandma’s cookies and of course the impact on the waistline. It makes sense right…too many cookies equals extra calories and extra fluff in the midsection. That is no secret. Now that January is here the daunting task of shedding that “winter coat” ensues. The Peloton bike that has served as a clothes rack gets dusted off, the gym membership is renewed and we begin the arduous task of losing the same ole L-B’s we gain every year. However it never has occurred to us that our gut bacteria may be playing a less obvious role. We are all probably familiar with gut bacteria and its significant role in our immune system. However an emerging body of research is exploding that suggests a correlation between obesity and gut microbes exists. 

ROLES OF BACTERIA IN THE GUT 

Understanding the roles in the community of bacteria lining our gastrointestinal tract also known as the microbiota may aid in understanding the mechanisms responsible in weight gain. The microbiota is the ecosystem of bacteria that pertains to the gastrointestinal tract. 

Specifically, the five species of bugs that occupy the gut are called Bacte-roidetes, Firmicutes, Actinobacteria, Proteobacteria, and Verru-comicrobiai. Bacteroidetes and Firmicutes are the most dominate and contribute to the majority of microbiota. Collectively only 10% of the remaining microbes contributes to the overall microbiota population(7). 

These bacteria are vital for good health as they produce B vitamins and vitamin K(3) while assisting in nutrient absorption and storage(4). These microbes also aid in degrading fiber for energy, which simultaneously fuels growth of beneficial bacteria to prevent overgrowth of pathogeneic bacteria. The most well known role of bacteria in the gut is support of a healthy immune system (3).

THE GUT OBESITY CONNECTION

The connection between gut bacteria and obesity is not completely understood. However several animal studies are providing clues. The gut bacteria profiles actually vary in lean and obese animal models and potentially human. Therefore the type of bacteria matters! Specifically within the microbiota, Bacteroidetes and Firmicutes are responsible for breaking down dietary carbohydrates and utilizing them for energy(10).Therefore when there is a disruption in this delicate balance of gut bugs, a condition called dysbiosis, energy production is inhibited leading to weight gain. Other animal studies have revealed depleted Bacteroidetes populations combined with increases of Firmicutes populations were present in obese mice compared to mice of a healthy weight(4). So what does a spiked eggnog over the holidays have to do with all of this? Those indulgences may have also contributed to dysbiosis or a change in your bacteria profile. Animal studies suggest high fat animal based foods coupled with sugar actually increases Firmicutes species while beneficial bacteroidetes are depleted reducing energy production from food (2). 

An additional study of obese mice demonstrated how two different diet patterns (High Fat and High Carbohydrate) common during the holiday season impact gut bacteria. A HFD (High Fat Diet) decreased gut diversity, which lead to dysbiosis. A high fat diet will 

naturally lack adequate fiber (also known as prebiotics) a fuel source for beneficial bacteria including Bacteroidetes. Bacteroidetes have a positive association with adiposity(5). This infers a reduction in good bacteria translates to decreased utilization of food for energy production and subsequently an increased likelihood of energy stored as fat. 

The HCD (High Carbohydrate-Sucrose Diet) was more problematic than the HFD since it promoted the growth of obesogenic related bacteria Acinetobacter,Blautia, and Dorea(7). 

These are all animal studies and this data may not be extrapolated to humans. However a compelling human trial also linked lack of gut diversity and chronic weight gain which was sustained over 10 years (10). 

What we can extract from this emerging data is a prebiotic rich diet is necessary to support growth of beneficial Bacteroides that are associated with lower body fat percentage. Also when Bacteroides are flourishing it does not allow for fat promoting bacteria to survive through displacement. Furthermore prebiotics or resistant starches provide an acidic environment in the gut created through fermentation. Beneficial gut bacteria actually feeds on prebiotics and this may inhibit the growth of pathogenic bacteria and dysbiosis (9).

COMMON PREBIOTIC FOODS 

Vegetables 

artichokes 

asparagus 

beets 

brussel sprouts 

broccoli 

cabbage 

fennel 

garlic 

leeks 

okra 

onions 

peas 

shallots 

Fruits 

apples 

pears 

peaches 

mango 

watermelon 

dried fruit

MYPLATE

In conjunction with prebiotics, a well balanced diet represented by a model such as MyPlate is essential in promoting gut diversity (11). 

MOVING FORWARD 

It may not be a coincidence that high fat, high sugar holiday food that is representative of the Standard American diet is contributing to weight gain, especially post holiday weight gain. It potentially may be an insight into one of the several mechanisms contributing to the nations and worlds for that matter obesity rates. While this research is still in its infancy it serves as one more reason Americans need to ditch SAD (Standard American Diet) and adopt GLAD (Gut Loving American Diet) to potentially thwart weight gain. So yes, dry January is in full effect and do not let that gym membership expire just yet. However, please do focus on including more fiber rich plant sources and do not settle for SAD, get a GLAD. 

REFERENCES

1.Aoun A, Darwish F, Hamod N. The influence of the gut microbiome on obesity in adults and the role of probiotics, prebiotics, and synbiotics for weight loss. Prev Nutr Food Sci. 2020;25(2):113-123 

2. Carmody RN, Gerber GK, Luevano JM Jr, et al Diet dominates host genotype in shaping the murine gut microbiota. Cell Host Microbe. 2015;17(1):72-84.   

3.Davis CD. The gut microbiome and its role in obesity. Nutr Today. 2016;51(4):167-174. 

4. Gentile CL, Weir TL. The gut microbiota at the intersection of diet and human health. Science. 2018;362(6416):776-780. 

5. Gomes AC, Hoffmann C, Mota JF. The human gut microbiota: Metabolism and perspective in obesity. Gut Microbes. Published online 2018:1-18.   

6. John GK, Mullin GE. The gut microbiome and obesity. Curr Oncol Rep. 2016;18(7):45. 

7.Kong C, Gao R, Yan X, Huang L, Qin H. Probiotics improve gut microbiota dysbiosis in obese mice fed a high-fat or high-sucrose diet. Nutrition. 2019;60:175-184. 

8. Lv Y, Qin X, Jia H, Chen S, Sun W, Wang X. The association between gut microbiota composition and BMI in Chinese male college students, as analysed by next-generation sequencing. Br J Nutr. 2019;122(9):986-995.   

9.Mahan LK, Raymond JL. Krause’s Food & the Nutrition Care Process. 14th ed. Saunders; 2016. 

10.Menni C, Jackson MA, Pallister T, Steves CJ, Spector TD, Valdes AM. Gut microbiom diversity and high-fibre intake are related to lower long-term weight gain. Int J Obes (Lond). 2017;41(7):1099-1105. 

11.MyPlate. Myplate.gov. Accessed January 22, 2021.https://www.myplate.gov/   

12.Zhang Y-J, Li S, Gan R-Y, Zhou T, Xu D-P, Li H-B. Impacts of gut bacteria on human health and diseases. Int J Mol Sci. 2015;16(4):7493-7519.t