Toxicity of the adipose tissue and human thinking.
Article Type: Editorial
Subject: Adipose tissues (Physiological aspects)
Obesity (Psychological aspects)
Obesity (Physiological aspects)
Brain (Physiological aspects)
Author: Christodoulou, Irene
Pub Date: 07/01/2010
Publication: Name: Archives: The International Journal of Medicine Publisher: Renaissance Medical Publishing Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Renaissance Medical Publishing ISSN: 1791-4000
Issue: Date: July-Sept, 2010 Source Volume: 3 Source Issue: 3
Accession Number: 264481485
Full Text: When an organ becomes toxic for our body? When an organ becomes too large (hypertrophy, hyperplasia) and produces large quantities of hormones or other products, then we may have toxic results. Like the toxic goiter, for example, in thyroid diseases. The role of adipose tissue as an endocrine gland has been studied in depth by many medical specialties. When the adipose tissue becomes toxic due to its large size one main alteration is produced in thinking; thinking may be dependent in hormonal changes and may alter dramatically in obesity. Obesity has many times been connected to an addiction for eating. Addictions have been confirmed as serious and difficult or impossible to treat neurological conditions, with massive influence in the intelligence and emotional status of the patients. Obesity has not been treated as a genuine neurological problem, but classically as a metabolic disease. Of course, the psychological aspects of obesity have been studied in depth, and the cognitive methods for obesity treatment have been presented in detail in research studies, but the intelligence problem has not been considered a neurological consequence so far. The concept of toxicity in the human thinking caused by the overdeveloped adipose tissue should be considered. The vicious circle that makes obese people to eat without control or adds more stress to the stress eaters are toxic phenomena, which resemble to toxicity (impulse for eating, inability to resist and think more wisely when the impulse comes).

Toxic results of the Adipose Tissue in Obese

a) Toxic Result 1--Food motivation in obese

Martin et al (1) showed that brain function associated with food motivation differs in obese and healthy weight adults and may have implications for understanding brain mechanisms contributing to overeating and obesity, and variability in response to diet interventions. Food motivation, which has been found to be higher in obese compared to healthy weight individuals. Martin et al used functional magnetic resonance imaging to examine changes in the hemodynamic response in obese and healthy weight adults while they viewed food and nonfood images in premeal and postmeal states. During the premeal condition, obese participants showed increased activation, compared to healthy weight participants, in anterior cingulate cortex and medial prefrontal cortex. Moreover, in the obese group, self-report measures of disinhibition were negatively correlated with premeal anterior cingulated cortex activations and self-report measures of hunger were positively correlated with premeal medial prefrontal cortex activations. During the post-meal condition, obese participants also showed greater activation than healthy weight participants in the medial prefrontal cortex.

b) Toxic Result 2--Depression, anxiety and schizophrenia in obese

According to Rivenes AC et al, (2) abdominal fat distribution (as measured by waist to hip ratio) appears to be the key mediator in the relationship between obesity and depression; the authors support the hypothesis that obesity and depression link via metabolic disturbances involving the hypothalamic-pituitary adrenocortical axis.

Dr Rivenes et al examined the relationship between depression, anxiety, and two different measures of obesity in a large community-based sample. The HUNT-2 study was used to conduct a cross-sectional study of 65,648 adults between 20 and 89 years of age. During a clinical examination, trained nurses took various anthropometric measurements allowing participants' body mass index (BMI) and waist-hip ratio (WHR) to be calculated. Anxiety and depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale. Information regarding physical activity, level of social support, and medical comorbidity was also obtained. According to the results, elevated WHR was associated with increased prevalence of both anxiety and depression. After adjustment for BMI, physical activity, social isolation, and somatic diseases, WHR remained independently associated with depression in both males and females and with anxiety among males. Obesity, as defined by BMI, was associated with depression; however, this association was strongly attenuated by WHR. There was a negative association between BMI and anxiety in both genders. Levels of obesity are higher in those with schizophrenia and depression. (3)

c) Toxic Result 3--Compulsive overeating behavior as an addiction disorder; is overeating a neurological symptom?

Davis C and Carter JC (4) correlated compulsive overeating and addiction disorders. They supported that compulsive overeating has compelling similarities to conventional drug addiction. Their concept is based on the comparable clinical features, the biological mechanisms they have in common, and on evidence that the two disorders have a shared diathesis. In making the argument for overeating as an addictive behaviour, it is clearly not appropriate to include all cases of excessive food consumption in this taxon. The authors did not claim that obesity and addiction are one and the same. However, it was proposed that Binge Eating Disorder is a phenotype particularly well-suited to such a conceptualization, and that sound clinical and scientific evidence exists to support this viewpoint. Also the authors have provided some recommendations for treatment modifications that recognize the similarities between treating drug dependence and compulsive overeating.

d) Toxic Result 4--Stress-eating and emotional pleasure by eating

Dallman MF (5) supported the hypothesis that the stress and emotional brain networks foster eating behaviors that can lead to obesity. The neural networks underlying the complex interactions among stressors, body, brain and food intake are now better understood. Stressors, by activating a neural stress-response network, bias cognition toward increased emotional activity and degraded executive function. This causes formed habits to be used rather than a cognitive appraisal of responses. Stress also induces secretion of glucocorticoids, which increases motivation for food, and insulin, which promotes food intake and obesity. Pleasurable feeding then reduces activity in the stress-response network, reinforcing the feeding habit. These effects of stressors emphasize the importance of teaching mental reappraisal techniques to restore responses from habitual to thoughtful, thus battling stress-induced obesity.

e) Toxic Result 5- Neuropsychological performance in extremely obese

Boeka AG and Lokken KL (6) examined neuropsychological performance in a clinical sample of extremely obese patients. While it is known that individuals with specific obesity-related medical conditions perform poorly on neuropsychological tasks, recent evidence suggests that cognitive dysfunction in obese individuals may occur independently of medical comorbidities. Sixty eight individuals seeking surgical treatment of obesity were administered cognitive tests as part of a standard pre-surgical evaluation. Results indicated significant differences in performances of extremely obese individuals on tests of executive functioning (planning, problem solving, mental flexibility) in comparison to normative data. Lokken KL et al (7) tested the cognitive performance of morbidly obese adolescents seeking bariatric surgery. The patients exhibited deficits in many cognitive domains, including impairment in attention and executive functions (e.g, mental flexibility, disinhibition) compared with the normative data. The results provided evidence for specific cognitive deficits in extremely obese adolescents and highlighted a need to determine whether early weight loss interventions, such as bariatric surgery, for obese adolescents could potentially prevent or reverse cognitive deficits and/or reduce the risk of future adverse neurocognitive outcome. Huizinga et al (8) showed that low numeracy skills are associated with higher BMI. (Numeracy skills are used in healthy weight management to monitor caloric intake).

f) Toxic Result 6- Low reward dependence

Either low reward dependence is a personality characteristic of obese or it is induced by the toxicity of the adipose tissue. De Panfilis C et al (9) correlated personality and attrition from behavioral weight-loss treatment for obesity. Some personality features, as measured by the Temperament and Character Inventory, have recently been found to be related to successful weight outcome after both behavioral and surgical therapies for obesity. The 67.4% completed the 6-month program, while the 32.6% dropped out. Treatment attrition was predicted only by low reward dependence and the presence of mental disorders. The authors concluded that personality features denoting difficulty relying on others' support (low reward dependence) are associated with treatment noncompletion in obese patients attending a behavioral weight-loss program.

g) Toxic Result 7- The toxic impact of the adipose tissue on intelligence

* Syndromes with obesity and declined intelligence (Rett syndrome, Prader-Willi syndrome).

* School performance of overweight children has been found to be inferior to normal weight children. Psychosocial factors, such as weight-based teasing, have been proposed as having a possible mediating role, although they remain largely unexplored. Gale CR et al (10) examined the relationship between locus of control at age 10 years and self-reported health outcomes (overweight, obesity, psychological distress, health, and hypertension) and health behaviors (smoking and physical activity) at age 30, controlling for sex, childhood IQ, educational attainment, earnings, and socioeconomic position. The participants were members of the 1970 British Cohort Study, a national birth cohort. At age 10, 11, 563 children took tests to measure locus of control and IQ. At age 30, 7551 men and women (65%) were interviewed about their health and completed a questionnaire about psychiatric morbidity. The results showed that men and women with a more internal locus of control score in childhood had a reduced risk of obesity, overweight, fair or poor self-rated health, and psychological distress. Associations between childhood IQ and risk of obesity and overweight were weakened by adjustment for internal locus of control. As they concluded in their study, having a stronger sense of control over one's own life in childhood seems to be a protective factor for some aspects of health in adult life. Sense of control provides predictive power beyond contemporaneously assessed IQ and may partially mediate the association between higher IQ in childhood and later risk of obesity and overweight.

* Adipose tissue changes in degree and intensity over the lifespan, and has been shown to influence brain development in relationship to early and late measures of cognitive function, intelligence, and disorders of cognition such as dementia. Gustafson (11) has correlated BMI and dementia. A lower BMI is associated with prevalent dementia, potentially due to underlying brain pathologies and correspondingly greater rates of BMI or weight decline observed during the years immediately preceding clinical dementia onset. However, high BMI during midlife or at least approximately 5-10 years preceding clinical dementia onset may increase risk.

REFERENCES

(1.) Martin LE, Holsen LM, Chambers RJ, Bruce AS, Brooks WM, Zarcone JR, Butler MG, Savage CR. Neural mechanisms associated with food motivation in obese and healthy weight adults.Obesity (Silver Spring). 2010;18(2):254-60.

(2.) Rivenes AC, Harvey SB, Mykletun A.The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res. 2009;66(4):269-75.

(3.) Allison DB, Newcomer JW, Dunn AL, Blumenthal JA, Fabricatore AN, Daumit GL, Cope MB, Riley WT, Vreeland B,Hibbeln JR, Alpert JE.Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med. 2009;36(4):341-50.

(4.) Davis C, Carter JC. Compulsive overeating as an addiction disorder. A review of theory and evidence. Appetite. 2009;53(1):1-8.

(5.) Dallman MF.Stress-induced obesity and the emotional nervous system. Trends Endocrinol Metab. 2010;21(3):159-65.

(6.) Boeka AG, Lokken KL.Neuropsychological performance of a clinical sample of extremely obese individuals. Arch Clin Neuropsychol. 2008;23(4):467-74.

(7.) Lokken KL, Boeka AG, Austin HM, Gunstad J, Harmon CM.Evidence of executive dysfunction in extremely obese adolescents: a pilot study. Surg Obes RelatDis. 2009;5(5):547-52.

(8.) Huizinga MM, Beech BM, Cavanaugh KL, Elasy TA, Rothman RL.Low numeracy skills are associated with higher BMI. Obesity (Silver Spring). 2008;16(8):1966-8.

(9.) De Panfilis C, Torre M, Cero S, Salvatore P, Dall'Aglio E, Marchesi C, Cabrino C, Aprile S, Maggini C.Personality and attrition from behavioral weight-loss treatment for obesity. Gen Hosp Psychiatry. 2008;30(6):515-20.

(10.) Gale CR, Batty GD, Deary IJ.Locus of control at age 10 years and health outcomes and behaviors at age 30 years: the 1970 British Cohort Study.Psychosom Med. 2008;70(4):397-403.

(11.) Gustafson D.A life course of adiposity and dementia.Eur J Pharmacol. 2008;585(1):163-75.

Irene Christodoulou

Editor in Chief
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.