Tag Archives: pharmaceutical industry

Why Do We Find it So Hard to Accept that Our Weight is Not as Within Our Control as We’d Like to Think?

bridget jones

Most of us have grown up in countries preoccupied with weight. We have grown up being told that it is down to us what size we end up at, that we have control over what weight we are, and that it’s about having willpower and making the “right” choices about what we put in our mouths. We’ve been told to count calories, exercise at the gym, resist cake, fill up on fruit and veggies, and even to curb hunger with glasses of water. We’ve been told to ignore hunger, wage war on our bodies, and to trust the information given to us by the media and the weightloss and dieting industry. Even our doctors have gotten on board with the “healthy is only for the slim” message, regardless of evidence to the contrary.

But recently, health at every size and weight set point theory are finally starting to become recognised as fact. Information about our bodies having varying, individual, healthy weights that the body will attempt to stay at regardless of what you eat is at last wedging itself into the media. Information about the fact that you can be fat and be healthy is now getting noticed, rather than being swept under the rug and buried by the pharmaceutical and weight loss industries that benefit hugely from the majority of the population trying to alter the way that their bodies look.

But even though this evidence is coming to light, people still seem to be having a hard time accepting it. By people, I mean healthcare officials and others who get to make the big decisions about what information is given as guidelines for health. By people, I also mean the public. Even though the evidence showing those who are in the “overweight” BMI category are living longer than any other BMI category (yes, including the “normal” category) was so overwhelming that it was published in the Journal of the American Medical Association, people are still trying to find reasons to why this could be other than it actually just being the obvious: that it’s healthy to be “overweight”, and that “overweight” is not overweight: that we have to accept this as reality, like we would with any other comprehensive scientific study. Even the medical community keep trying to bury their heads in the sand and subtly hide or erase the information that the (many) studies have given us.

Other studies show that you can be any shape, weight, or size, and be healthy (this becomes less likely with the very morbidly obese and the underweight, but that is not to say that there are not those in both categories that are healthy), and many, many studies show that food and weight is not as correlated as we have been told it is (for more information on weight set point theory go to “Weight Set Point Theory!” under my links section). In fact, it probably doesn’t play much of a part at all, unless you are starving yourself so that your body cannot maintain its weight because of the lack of energy, or you are stuffing yourself to the point of nausea every time you eat so your body cannot cope with the excess energy. The latter is not a common occurrence, except for those with binge eating disorder (which is far less common than you think it is, but that’s a conversation for another time), whereas, unfortunately, the former is – because of the influence the dieting and weight loss industry has had on us, and the prevalence of restrictive eating disorders. The body actually has it’s own system for regulating body weight when you are listening and responding to it properly, not ignoring hunger, and following cues from the body to eat whatever it wants, whenever it wants. If you are in touch with your body and can eat an amount comfortably within your day, then you’re not eating too much, and your body can regulate the energy it is being given so that you still maintain within your healthy weight range that is individual for your body.

So why, even with all the hard facts and evidence, it is so hard for us to accept that a) you can be fat and healthy and b) if you want to be healthy, you have to let your weight be what it is supposed to be naturally?

It’s something that I’ve had to think about, because this is a topic close to my heart and one that helped my recovery from atypical anorexia, and because I’ve come across people on the internet and in my life that have point blank refused to even look at the research showing them that the misinformation that has been drilled into us from our fatphobic, thin-obsessed diet culture isn’t actually reality. It’s frustrating, and it’s sad. I am lucky that most of my friends are at ease around food, and – even though they have their own insecurities about the way that they look – accept their bodies as they are. However, I have a few friends that include those who go on and off diets, desperate to find a way to feel better about their bodies, those who flit between diets and disordered behaviour whilst loathing the skin they live in, and those who battle eating disorders (and before I end up validating the myth that diet culture is a common cause of eating disorders, it’s not, but it sure as hell makes recovering all the more difficult). It’s these people that I feel so sad for, and all the billions of others that are at war with their bodies, that don’t know about – or can’t accept – the fact that their natural, healthy weight is not under their control. And I feel sad for all those who are naturally in the overweight or obese BMI ranges, whose natural, healthy weights are where there bodies are at, but are constantly shamed and abused for those bodies that they are in. And I feel sad for those who have spent their life yo-yo dieting, only to see their weight go up and up and not understand why (side note: it’s because your metabolism slows down during the diet because your body is being starved, and then it stores energy as fat when you go off the diet and so you subsequently gain weight, so you end up back on a diet again, and the cycle continues, rather than letting your body heal and settle back at its natural, healthy weight range). And I feel angry at those who remain wilfully ignorant and keep judging and condemning those who are overweight or obese.

culture

But back to the question: why is it that we find it so hard to accept that maybe body diversity is great, and that people can be healthy at any weight, shape, or size,  and that we can’t dictate what our weight is if we want to be healthy and happy?

The first, most obvious reason to me is that we have had misinformation drilled into us for so long. We have grown up being told fat is bad and that we are responsible for saying no to so many of the foods we want to eat, responsible for exercising frequently, and responsible for maintaining a slim body. To then hear such opposing information means that our world turns upside down. Food and weight are such integral parts of our culture and society that to have what we think we know turned on its head is disturbing. It’s confusing. It’s shocking. It means we have to rethink everything about that topic. For some people, that’s just too much, so they refuse to believe it: they reject the new knowledge outright. People don’t like change. It’s scary and it makes people feel uneasy and unstable. It also means that if you accept that we are being lied to, then it makes it hard to know what information to trust, and that makes life a hell of a lot harder.

For some people, making choices about food and maintaining a certain weight through those choices are a form of control. People generally like to be in control. And even though we associate food and control being two parts of an equation that results in an eating disorder, those without eating disorders often engage in what is called “disordered eating”, and that can most definitely include feelings of control. Disordered eating is not a mental illness, but it’s an unhealthy relationship with food (and most probably involves body image issues too). It’s also really, really common because of how obsessed our society has made us with food, and because our diet culture literally encourages it. To be someone who uses food and weight maintenance as a way of feeling in control, and then finding out that you don’t need to have that control and actually to not be controlling about food and weight is the best way to be healthy, is an anxiety-provoking experience. So they reject it.

People also don’t like to have laboured under false hope. Those who feel unsatisfied with their bodies (and who doesn’t after our bodies have been attacked and shamed and ridiculed by the media and the dieting and weight loss industry in order to get us to buy their products) and who have gone on to diet, don’t want to know that their efforts are in vain and that they will not maintain any weight loss, that they will probably end up gaining more weight than the weight they originally lost, and that their dieting and subsequent weight loss and weight fluctuations can actually create health issues including higher risk of developing diseases, and a higher mortality rate. People who feel unhappy in their bodies don’t want to hear that they actually can’t make those changes to their bodies, especially if they want to be healthy. They don’t want to know that they are stuck with the body that they have, even though it has been shown over and over that changing your body doesn’t make you any happier (and again, changing your body isn’t sustainable). To actually learn to accept your body as it is can – sadly – seem like a much bigger challenge than changing it.

In addition, there’s a darker reason why people don’t want to accept the changing of the tides where food and weight is concerned: people who make what are considered “healthy” choices about diet and exercise feel morally superior.

Untitled-1

from “How We Eat: Appetite, Culture, and the Psychology of Food” By Leon Rappoport

This makes me feel highly, highly uncomfortable, and it should make you feel the same. What people eat or don’t eat is not a reflection of who they are as a person. It doesn’t make someone a better person if they eat whole foods and abstain from any kind of “junk” food. It doesn’t make someone a worse person if they enjoy burgers and fries. Eating “healthy” doesn’t mean that they have more willpower than someone who chooses to eat “junk” foods. It doesn’t make anyone more superior than anyone else. It doesn’t mean that they are making better life choices. It doesn’t even mean that they are doing the best thing for their body and souls. It doesn’t mean anything except that they are making different choices to someone else. That’s it. That’s all it means. But somehow, it has become ingrained in us that we are morally superior if we make “healthier” choices. And yes, I chose to put that word in quotation marks because I don’t believe that you are necessarily healthier if you only eat “healthy” foods. I also believe that distinguishing “healthy” and “unhealthy” perpetuates a negative relationship with food because it then leads to “good” and “bad”, and there we are, back to morality, guilt, and shame again.

Accepting information that affects us in so many different ways is a really, really tough thing to do. Food and weight is inextricably linked with feelings of superiority and willpower, shame and guilt, with privilege, abuse, money, hatred, insecurity, laziness, greed, power, and sexuality – if not much more. To look at it all anew and recognise how much of it is wrong, and the devastating affect it has had on so many people takes time and patience. It also takes acceptance that those providing us with our health information don’t have our best interests at heart, and that can make some people feel embarrassed for having such blind faith in such a corrupt system.

So I get it. I get that it’s not something that people can just accept at a moment’s notice. But on the other hand you can’t bury your head in the sand and protest blindly against that which is proven fact, however much others try to muddy the water and cloud your judgement. Think for yourself. Educate yourself. Whatever conclusion you come to, make sure you’ve got the information and the knowledge. Don’t just blindly accept whatever you are told as the truth. That is all I ask, for your sake, and the sake of those affected by our obsession with food and thinness…for the sake of everyone. Take control by educating yourself, making the right choices for your physical and mental health, and taking steps towards making peace with your body, as it is.

Vyvanse and BED: Money-making in Disguise as Treatment?

vyvanse pic

Fairly recently, Vyvanse – a drug known for treating ADHD – was approved to treat binge eating disorder (BED). I was first made aware of this drug via a message sent to my blog from a woman living in the US who was angry about the effects this could potentially have on people who were prescribed it. I did a bit of reading up about it, but soon forgot about it. The topic came up again when a friend linked me to an article about the drug being used for treating BED, which I read, and my interest was piqued. I started thinking about the problems that would arise from it’s approval to treat BED that are both numerous and highly concerning.

In May 2013, the DSM-V was published, with BED being newly recognised as a psychiatric disorder. On the surface, this sounds great: sufferers of BED were finally being recognised and validated, but a further look into this and the subsequent approval of Vyvanse to treat it raises some serious questions.

In a society where almost two in five (37%) women and one in six (18%) men in the UK are dieting “most of the time”, and 108 million people are on diets in the US, a huge amount of us are restricting on a daily basis, and when we “fail”, we feel shame, guilt, hopeless, and anger at ourselves. And failing is inevitable, because diets do not work. Dieters often end up in a restriction/binge cycle, and mistake their dieting for normal behaviour, and so only take note of their binging and see this as a weakness rather than a normal biological response to starving the body. If the body has an energy deficit due to restriction, it will seek to restore balance by compensating later on. So with that in mind, we can now look at the criteria for BED:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

For me, this criteria is extremely problematic. This criteria is pretty vague, and in conjunction with a society that vehemently fears over-eating and weight gain, becomes a fit for a large proportion of people. Let’s take a look at it in more detail:
– “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances” – this is particularly non-specific, and in our society, many people have a distorted view on what is larger than most people, especially when so many are restricting. It is also normal for someone who has been restricting to experience eating more than normal, because of the body trying to restore itself to being energy-balanced.
– “a sense of lack of control over eating during the episode” – many people feel out of control when it comes to food because we are made to feel that out of control if we are not eating in some strict and regimented way. That feeling is even more accentuated when the drive to survive overcomes the person’s desire to diet, and the body makes up for lost energy by “binging”.
– Eating rapidly is also part of the drive to get energy in as fast as possible when it needs it.
– Eating until uncomfortably full is easy to do when the body requires more energy than the stomach has room. The desire for food is just another way for the body to communicate hunger, and people often do not recognise this as a type of physical hunger (the brain is part of our physical being as well).
– Eating alone when eating what someone considers more than normal, or when someone is experiencing reactive eating in response to restriction, is – unfortunately – normal because of the way our society has surrounded food in a thick layer of shame.
– And if you are dieting, or misinterpreting your eating as a “binge” (because I would argue that many people have a distorted view of what a binge actually is), this is likely to happen “at least once a week for three months”.

“With these diagnostic criteria [for BED], there is huge potential for a false positive. Do a lot of people struggle with binge-eating? Absolutely. Are all of these people actually ill? That is the major question around this diagnosis and the Vyvanse treatment,” said Lisa Cosgrove, a professor and clinical Psychologist at the University of Massachusetts, Boston.

So what we have here is a list of things that those with BED suffer from, but written in a way that it could easily fit someone misinterpreting their eating habits because they have distorted ideas of what binging is, or are not aware of the effects that dieting has on the body. This means that these people could go to the doctors, tick all the boxes, and receive a diagnosis. Our fatphobic society steeped in diet culture would have no problem with that. A quote from Ray Moyniham in  Motherboard talks about this:

“You have to be extremely sensitive to the fact that there are people who are really suffering severe and debilitating symptoms from a condition,” said Ray Moynihan, a senior research fellow at Bond University in Australia and the author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. “But when we put so much energy into medicalizing normality, it takes resources and attention and care away from people who are seriously ill.”

Now on to June 2014, where Shire wins the key patent ruling for the drug Vyvanse. The Telegraph writes:

Shire hopes to increase sales of the drug by broadening its uses into other patient groups, such as very young children and sufferers of the newly-recognised psychiatric problem binge-eating disorder (BED).
The drug maker told investors on Monday that it expected to make $300m from sales of Vyvanse to BED patients by 2020, following a successful clinical trial showing the drug helped control binge eating.

This raises a red flag for me: Shire will desperately want to make as much money as possible before its patent expires, and this means expanding its treatment to those with other illnesses other than ADHD. Shire had already thought of BED as an option, and already had that idea in the pipeline. Is the fact that BED was finally recognised and put into the DSM-V just when Shire needed a new illness to treat a convenient coincidence, or something more dubious?

In January 2015, Vyvanse was approved to treat BED. The fairly vague criteria for BED could mean that BED is over-diagnosed and over treated, with a drug that is an amphetamine. Hang on, what?

Amphetamines became extremely popular in the mid 1900s as a weightloss drug, before concerns about the dangerous side effects caused the FDA to ban amphetamines from diet ads.

The most serious risks include psychiatric problems and heart complications, including sudden death in people who have heart problems or heart defects, and stroke and heart attack in adults. Central nervous system stimulants, like Vyvanse, may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania, even in individuals without a prior history of psychotic illness. The most common side effects reported by people taking Vyvanse in the clinical trials included dry mouth, sleeplessness (insomnia), increased heart rate, jittery feelings, constipation, and anxiety. – take from here.

Vyvanse was approved for treating BED after only two 12-week studies.

“I tried (and failed) to persuade the DSM 5 group that BED was a premature and dangerous idea precisely because I feared it would be a backdoor excuse for drug companies to promote stimulant diet pills,” Dr. Frances Allen, a psychiatrist and frequent critic of the DSM-5, told Motherboard in an email. He has had particular concerns about the new criteria for diagnosing eating disorders. “The rushed approval of Vyvanse realizes my worst fears”

People actually suffering from BED are desperate to get rid of their mental illness, but therein lies the issue: BED is a mental illness. I have severe reservations about an appetite suppressant being used to combat an eating disorder that for a lot of people has roots in trauma, and other deep-seated emotional problems. The appetite of that person isn’t the issue: the drive to eat as a coping mechanism is. And not only are we going to be dealing with actual sufferers, but those misdiagnosed because of the ill-defined criteria, and those faking the illness to get a hold of Vyvanse, either because of its street value, or because of its use as a weightloss drug. Which brings me to the dangers of those with restrictive eating disorders reeling off the list of BED symptoms, and getting a prescription of Vyvanse to continue their downward spiral that only leads closer and closer to death. Because a binge eating disorder diagnosis relies on self-reported behaviour, it means that it is not difficult to fake, and consequently, it is not difficult to get a diagnosis. Pro-ana sites are already sharing their experiences with Vyvanse, and tips on how to get hold of the drug. The consequences of this could be catastrophic.

I received a message to my blog recently when the subject of Vyvanse came up:

I was recently diagnosed with BED and prescribed Vyvanse. My psychiatrist gave it to me because he said I was gaining too much weight. He gave it to me to use as a weightless pill. I don’t think that’s okay. In the past I have suffered from anorexia and bulimia. So of course, I accepted the pill. Hoping it would be easier to not eat at all. I think this may be a problem for a lot of people very soon.

This shows that already Vyvanse is being misused by doctors themselves, who are supposed to be people that we trust with our healthcare. But with the pharmaceutical industry being all about the money-making, it’s hardly surprising.

In my opinion, the inclusion of BED in the DSM-V, the vague diagnosis criteria, the subsequent research into using Vyvanse to treat BED, and the swift approval of that usage, are linked together. The pharmaceutical company have helped themselves to make more profit off both those with BED, and so many without it, with a drug that in my opinion will not successfully treat the disorder it has been approved for. And this drug is likely to have devastating consequences.