Attaining a healthy weight is often billed as an individual pursuit, with television commercials eagerly encouraging customers to take hold of their habits. But for all the calorie-counting and exercise schedules you can give a person, their struggle with weight doesn’t occur in isolation. Family members and friends can negatively influence your diet, whether it’s meals at home or dining out, and your activity levels – encouraging a night at the bar instead of an hour on the treadmill.
But those external influences can also be harnessed for good, as a front page article by Julie Deardorff in the Chicago Tribune showed yesterday. Deardorff focused on the Maudsley Approach, a family-based treatment for anorexia and bulimia that involves the parents or other relatives in encouraging the patient to eat. That strategy is a shift from the traditional treatment for eating disorders, which usually involves a one-on-one inpatient program designed to convince the patient to regain healthy eating habits. But the Maudsley Approach, designed in part by University of Chicago psychiatrist Daniel Le Grange, has evidence on its side: trials, such as this one, that showed better outcomes with family-based treatment compared to traditional psychotherapy.
I spoke to Le Grange about the Maudsley Approach and other research trends for our Dr. FAQ video series in March; here’s the video that most directly focuses on family-based treatment.
While family appears to be a useful tool for positively changing the diet of someone with an eating disorder, there is also a dark side to the familial influence on food habits. Study after study has found that obesity runs in families, through an as-yet-undetermined interaction of genetics and environmental factors. Even in families where one member undergoes a surgical procedure for their obesity such as gastric bypass, the ripple effects through their family remain.
That was the conclusion of a paper last year by a team of researchers from across Chicago’s academic medical centers, including Jean Bao of the Pritzker School of Medicine and authors from UIC and Northwestern. A survey of bariatric surgery patients found that their children and grandchildren were far more likely to be obese than natural averages; in the case of 2-to-5-year-olds, the obesity rate was 4 times higher. Biologically-related children were more likely to share their parent’s obesity than non-related children (presumably stepchildren or adoptees), which suggested a genetic influence, but the authors cautioned that nature and nurture could not be conclusively separated by such a small study.
However, the author’s conclusion about these “aggregations” of obesity within families was guardedly optimistic. A successful bariatric surgery, as our surgeon Vivek Prachand explained in another Dr. FAQ segment, is about more than just the procedure, as a patient’s success also depends on shifting to a healthier lifestyle. Bao and colleagues suggest that doctors should be aware of the elevated obesity risk for the children of those seeking bariatric surgery, and use the procedure as an opportunity for family-wide interventions, rather than just direct counseling of the patient. Not only will the children benefit from improved diet and exercise, but the patient themselves will be more likely to experience the full benefits of the surgery without relapsing due to the unhealthy habits still surrounding them.
Indeed, an earlier study had found that children born to women after bariatric surgery were on average less obese than children born before the surgery – suggesting that environment can outweigh genes in this scenario. Obesity may not be an infectious disease, but it seems to be culturally transmissable; if maintaining a healthy weight is anywhere near as contagious, it’d be a valuable tool for doctors. For whether the goal is weight loss or weight gain, family matters.
Bao, J., Desai, V., Christoffel, K., Smith-Ray, P., & Nagle, A. (2009). Prevalence of Obesity Among Children and/or Grandchildren of Adult Bariatric Surgery Patients Obesity Surgery, 19 (7), 833-839 DOI: 10.1007/s11695-009-9835-5