Losing weight isn’t easy. Dieters who regularly restrict food are often heavier than non-dieters. Exercise can be unpleasant, particularly for anyone who hasn’t done it in a while. Perhaps worst of all, people struggling with obesity often report “fat shaming” by doctors or other health care professionals. Studies have shown that “fat shaming” isn’t just damaging to the recipient. It’s ineffective. Now a program that focuses as much on emotion as eating has delivered some surprising results. It turns out if your broken heart is causing anxiety or depression, then your feelings really can do actual harm to the organ. Here’s what they learned.
Higher Weight; Higher Risk
People are getting heavier. Airplanes, as one example, have had to modify their passenger loads because individuals weigh more than they did just a few years ago. According to the Centers for Disease Control and Prevention, more than 40% of adults in the U.S. are obese. This number has risen by over 10% in the past two decades. Having a body mass index (BMI) over 30 increases a person’s chances of dying from heart disease or stroke. It even increases your risk for a bad outcome if you’re infected with COVID-19. Nearly three out of four adults in the U.S. are overweight. Across the planet, the World Health Organization notes that more people are dying from diseases related to obesity than they are from malnutrition.
Unfortunately, modern life holds much of the blame. Cheaper, calorie-dense foods have combined with a sedentary lifestyle where most people spend very little energy to get their meals or do their jobs. When we decide to go on a diet, our own bodies soon conspire against us. That’s because when we lose weight, the endocrine system reacts as if we’re starving to death, flooding our systems with hormones that make us hungrier while delaying any feeling of fullness that usually accompanies consumption. That’s why even the best-intentioned dieters often wind up heavier than when they started.
For nearly a decade, the Croi Heart and Stroke Centre, in Galway, Ireland, has adopted an approach that–while it may not be unique–is certainly unusual. Overseen by the center’s cardiac and weight management dietitian, Aisling Harris, the program works to overcome the many obstacles overweight people face. Since its adoption in 2013, over 1,100 participants were never told what not to eat. They weren’t expected to adhere to a rigid program nor were they required to count calories. As Harris recently explained during an online scientific congress of the European Society of Cardiology (ESC), “Many participants have tried diets with strict rules and have fears about foods they can’t eat. Our program has no diet or meal plan, and no foods are excluded. Each person sets their own goals, which are reviewed weekly, and our approach is non-judgmental, which builds rapport and gains trust.”
Called CLANN for Changing Lifestyle with Activity and Nutrition, the ten-week program accepted referrals from a nearby specialist bariatric service at Galway University Hospital. Many who joined were already battling anxiety and/or depression. Some had limited social interactions. That’s why the 2.5-hour weekly sessions were so significant. As Harris explained at the online conference, “For some people, coming to a group like this might be the only social contact that they’ve had in the week or that they’ve had in years. People share experiences and support their peers.”
The CLANN Difference
Each enrollee began by having their baseline levels for fitness, blood pressure, fitness, and other health markers measured. Their mental health was also tracked, using the standard Hospital Anxiety and Depression Scale which ranges from 0 for normal to 21 for severe. Much of the work done by the community-based program is devoted to improving participants’ mental health––which is frequently worse for people struggling with their weight. In this program, for example, nearly one third had an anxiety score higher than 11. One out of five had an equally elevated depression score.
Once the baseline data was recorded, each person attended weekly 2.5-hour sessions which included time for setting goals followed by a one-hour, physiotherapist-led exercise class. Each session ended with classroom-type discussions on topics like healthy eating, portion sizes, and emotional versus physical hunger. Participants were also taught coping strategies including meditation and other mindfulness techniques. Outfitted with activity trackers and food diaries, they were encouraged to record their meals but weren’t discouraged from eating anything.
According to the Body Mass Index (BMI), participants were classified with a BMI of 40 or higher –– often called Class 3 or “severe” obesity. Over one-quarter suffered from type 2 diabetes; nearly one-third had a history of depression. For the last week of the program, participants met with a nurse, a dietitian, and a physiotherapist who examined the results before referring them back to the hospital.
Although they weren’t restricted in their food choices, those who completed the program lost an average of five pounds. More than one out of four shed at least three percent of their starting weight. The number of participants hitting their recommended physical activity levels increased by nearly one-third. Their hearts clearly benefited as cholesterol and blood pressure improved. The majority of the diabetics also hit their recommended blood sugar target.
For those curious about the link between emotions and heart health, it’s worth noting that one-third of those with a reading above 11 for anxiety at the start of the program dropped below that number at the conclusion. More than half of those with high depression scores enjoyed a similar reduction. To Harris and the others who ran the program, it’s a clear sign that supportive, encouraging environments do more to help heart health than aggressive dieting or judgmental physicians.
Written by John Bankston
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