Friday, May 27, 2011

Networking, Dementia, Australia and a Breakthrough...

Networking Evening
I just want to say a big thank you to everyone who came along last night and took part in this session. I really enjoyed the very animated conversation and am keen to take some of the ideas we discussed forward. For those of you who didn't attend the ares we really got to grips with were focused on the relationship between artists who work in the broad field of Arts/Health and colleagues in the Arts Therapy field. An outcome of this discussion will be to form a small group who'll pull together a statement that best encapsulates this relationship allowing for synergy and difference, but crucially, offering dialogue and mutuality.

We had some very passionate and interesting discussions around dementia and the arts and I'm sure all who came along last night would want to give a huge thanks to Zoe Keenan who shared her personal experiences around caring for her mum and her creative response to this experience. On the basis of this exciting work and suggestions form the group, we are going to explore some very interesting work in the region. I very much look forward to our next meeting and thanks again for everyone in making this such an enjoyable and inspirational evening.

Australia Calling
I am thrilled to be speaking at this conference. If you want to know more about it, or hear from Arts for Health Australia’s inspirational leader, please come along and meet Margret Meagher at the Head to Head here at MMU on June 30th (full details over the next two weeks). My paper this year at the Canberra conference will explore the relationship between Design, the Arts and Health with a specific focus on how the last days of our lives are often far removed than what we’d hope they might be like.

“The Aboriginal Memorial 1987-88, Ramingining Artists, National Gallery of Australia, Canberra, photographer credit John Gollings
3rd Annual International Arts and Health Conference:
The Art of Good Health and Wellbeing
14 - 18 November 2011
National Gallery of Australia, Canberra, ACT

The Art of Good Health and Wellbeing, 3rd Annual International Arts and Health Conference, will present best practice and innovative arts and health programs, effective health promotion and prevention campaigns, methods of project evaluation and scientific research. The 2011 Conference will continue to have a special focus on mental health and creative ageing, including programs for people with dementia and their carers; as well as workplace wellbeing programs; arts and health programs for Aboriginal communities; the built environment, design and health; medical education and medical humanities. 

Breakthrough: Art in Mental Health
Damian Hebron and Mike Farrer will both be speaking at Breakthrough’s third ARTS in Health Event:
‘Where to Next…?’
Location : NHS North West, 3 Piccadilly Place, Manchester
Date: 10th of June, 2011. 9:30-3pm

Towards a National Forum for Arts and Health Many of you will know that I sit on a group that has been looking at the notion of a National Forum for Arts and Health, following the collapse of the NNAH in 2007. I’ve been working with colleagues around the country to explore ways forward, and the linked report has been made by the external consultants Globe to help inform this direction. I would be grateful for any thoughts on this linked document, which I will feed into the forum at our next meeting.
If you would like me to email a copy of the SUMMARY REPORT, please email me directly.

Thursday, May 26, 2011

Food Reward: a Dominant Factor in Obesity, Part IV

What is Food Reward?

After reading comments on my recent posts, I realized I need to do a better job of defining the term "food reward".  I'm going to take a moment to do that here.  Reward is a psychology term with a specific definition: "a process that reinforces behavior" (1).  Rewarding food is not the same thing as food that tastes good, although they often occur together. 

Read more »

Tuesday, May 24, 2011

Healthy Skeptic Podcast

Chris Kresser has just posted our recent interview/discussion on his blog The Healthy Skeptic.  You can listen to it on Chris's blog here.  The discussion mostly centered around body fat and food reward.  I also answered a few reader questions.  Here are some highlights:
  • How does the food reward system work? Why did it evolve?
  • Why do certain flavors we don’t initially like become appealing over time?
  • How does industrially processed food affect the food reward system?
  • What’s the most effective diet used to make rats obese in a research setting? What does this tell us about human diet and weight regulation?
  • Do we know why highly rewarding food increases the set point in some people but not in others?
  • How does the food reward theory explain the effectiveness of popular fat loss diets?
  • Does the food reward theory tell us anything about why traditional cultures are generally lean?
  • What does cooking temperature have to do with health?
  • Reader question: How does one lose fat?
  • Reader question: What do I (Stephan) eat?
  • Reader question: Why do many people gain fat with age, especially postmenopausal women?
The podcast is a sneak preview of some of the things I'll be discussing in the near future.  Enjoy!

Sunday, May 22, 2011

Fast Food, Weight Gain and Insulin Resistance

CarbSane just posted an interesting new study that fits in nicely with what we're discussing here.  It's part of the US Coronary Artery Risk Development in Young Adults (CARDIA) study, which is a long-term observational study that is publishing many interesting findings.  The new study is titled "Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis" (1).  The results speak for themselves, loud and clear (I've edited some numbers out of the quote for clarity):
Read more »

Thursday, May 19, 2011

Job opportunities, and an Opera

Fables – A Film Opera
VENUE: Zion Arts Centre, Hulme (screening and live theatrical event)
DATE & TIME: 30th June, 7-8pm

Step into a magical world of legend and folklore with Streetwise Opera’s Fables - A Film Opera, a group of four short films interspersed with live performance and theatre, created by some of the UK's leading composers and filmmakers working with 125 Streetwise performers who have experienced homelessness. Composers Mira Calix, Emily Hall, Orlando Gough and Paul Sartin/Andy Mellon, and filmmakers GaĆ«lle Denis, Tom Marshall, Flat-e and Iain Finlay have created short films based on traditional fables ranging from the classic The Boy Who Cried Wolf to Shinishi Hoshi's contemporary tale, Hey! Come on Out!
This special event at Zion Arts Centre is part of the fringe Not Part of Festival, and involves a screening of the films, around which there will be live performance and theatre created by director Emma Bernard and led by a sizzling folk musicians. They will be joined by Streetwise Opera’s award-winning singers from the Booth Centre in Manchester, the ICC in Nottingham and narrator Neil Allen. The evening will include some rousing opera, folk, hidden performers and uplifting audience participation.

More details HERE.

Arts and Health Practitioners required for exciting dementia project in Merseyside  

Wednesday, May 18, 2011

Food Reward: a Dominant Factor in Obesity, Part III

Low-Fat Diets

In 2000, the International Journal of Obesity published a nice review article of low-fat diet trials.  It included data from 16 controlled trials lasting from 2-12 months and enrolling 1,910 participants (1).  What sets this review apart is it only covered studies that did not include instructions to restrict calorie intake (ad libitum diets).  On average, low-fat dieters reduced their fat intake from 37.7 to 27.5 percent of calories.  Here's what they found:
Read more »

Tuesday, May 17, 2011

Clarifications About Carbohydrate and Insulin

My statements about carbohydrate and insulin in the previous post seem to have kicked up some dust!  Some people are even suggesting I've gone low-fat!  I'm going to take this opportunity to be more specific about my positions.

I do not think that post-meal insulin spikes contribute to obesity, and they may even oppose it. Elevated fasting insulin is a separate issue-- that's a marker of insulin resistance.  It's important not to confuse the two.  Does insulin resistance contribute to obesity?  I don't know, but it's hypothetically possible since insulin acts like leptin's kid brother in some ways.  As far as I can tell, starch per se and post-meal insulin spikes do not lead to insulin resistance.
Read more »

Friday, May 13, 2011

Healthy Skeptic Podcast and Reader Questions

Chris Kresser, Danny Roddy and I just finished recording the podcast that will be released on May 24th.  It went really well, and we think you'll find it informative and maybe even practical!

Unfortunately, we only got around to answering three of the questions I had selected:
  1. How does one lose fat?
  2. What do I (Stephan) eat?
  3. Why do many people gain fat with age, especially postmenopausal women?
I feel guilty about that, so I'm going to answer three more right now.

Read more »

Wednesday, May 11, 2011

m a n i f e s t o update and much, much more...

Head to Head
In my last blog posting, I told you a little about the free event on June 30th that will see a host of international figures from the arts/health world, sharing some of their practice and engaging in conversation. I’ve been overwhelmed by the response and it looks like it will be fully booked well ahead of the event. I have to reiterate that I can’t guarantee anyone a place yet, but thanks for the emails. I will confirm places/agenda/venue/times at the beginning of June.

Towards a National Forum for Arts and Health
Many of you will know that I sit on a group that has been looking at the notion of a National Forum for Arts and Health, following the collapse of the NNAH in 2007. I’ve been working with colleagues around the country to explore ways forward, and the linked report has been made by the external consultants Globe to help inform this direction. I would be grateful for any thoughts on this linked document, which I will feed into the forum at our next meeting.

Networking evening
I’m discussing with a number of network members, the possibility of the next session here at MMU on the evening of 26th May, being an opportunity to share ongoing work, frustration, needs and ideas. The simple idea being that a small number of artists/health practitioners get in touch with me if they’re interested and on the evening, they can share what it is they’d like to discuss…then we can pitch in with constructive criticism and support. This could be really helpful to all of us and I’m pleased to say that the artist Zoe Keenan is happy to share some of her work around dementia and young people who find themselves in the position of being a carer. Zoe has produced some really exciting work around this and would be happy to share it and get feedback.

Anyway, if you’re interested in sharing something, or if you just want to attend, please email me at
(Venue details will be emailed next week)

M A N I F E S T O update
Since the first session last September, just under 400 people around the region have contributed to the emerging m a n i f e s t o and over May and June we’ll be holding the last sessions of the first stage of conversations. In June, I’ll be working with colleagues from all over the North West and others from as far as Durham, Yorkshire, Australia, South Africa, Ireland and the USA, who’ll all be feeding into the discussion. The final event of 2011 will be at MMU in September…then, we go public! Don’t forget, we’ll be getting some high-profile input into the m a n i f e s t o from the art, media, health sectors too, but the core of this work is about our shared vision. On the 9th May I facilitated an event in Cumbria that was over-subscribed. As usual, if you wanted to contribute but weren’t able to attend, please get in touch via email. And for the 3 people who left comments in my ‘composting thoughts bag’ in Cumbria, a particularly big THANK YOU. Your comments will feed into the mix and I really liked the illustrations too.

Sunday, May 8, 2011

Ask Me a Question

On May 13th, I'll be recording a podcast with Chris Kresser of The Healthy Skeptic. Chris interviewed me about a year ago, and I thought it went well. Chris is a good host and asks interesting questions.

This time around, we're going to do things a bit differently. I'll start with a little overview of my current thoughts on obesity, then we'll answer reader questions. The show is going to be mostly about obesity and related matters, but I may answer a couple of questions that aren't related to obesity if they're especially interesting. There are two ways to leave questions: either in the comments section of this post, or the comments section of Chris's post. The show will air on May 24th.
Read more »

Friday, May 6, 2011

Food Reward: a Dominant Factor in Obesity, Part II

How to Make a Rat Obese

Rodents are an important model organism for the study of human obesity. To study obesity in rodents, you have to make them fat first. There are many ways to do this, from genetic mutations, to brain lesions, to various diets. However, the most rapid and effective way to make a normal (non-mutant, non-lesioned) rodent obese is the "cafeteria diet." The cafeteria diet first appeared in the medical literature in 1976 (1), and was quickly adopted by other investigators. Here's a description from a recent paper (2):

In this model, animals are allowed free access to standard chow and water while concurrently offered highly palatable, energy dense, unhealthy human foods ad libitum.
In other words, they're given an unlimited amount of human junk food in addition to their whole food-based "standard chow." In this particular paper, the junk foods included Froot Loops, Cocoa Puffs, peanut butter cookies, Reese's Pieces, Hostess Blueberry MiniMuffins, Cheez-its, nacho cheese Doritos, hot dogs, cheese, wedding cake, pork rinds, pepperoni slices and other industrial delicacies. Rats exposed to this food almost completely ignored their healthier, more nutritious and less palatable chow, instead gorging on junk food and rapidly attaining an obese state.

Investigators have known for decades that the cafeteria diet is a highly effective way of producing obesity in rodents, but what was interesting about this particular study from my perspective is that it compared the cafeteria diet to three other commonly used rodent diets: 1) standard, unpurified chow; 2) a purified/refined high-fat diet; 3) a purified/refined low-fat diet designed as a comparator for the high-fat diet. All three of these diets were given as homogeneous pellets, and the textures range from hard and fibrous (chow) to soft and oily like cookie dough (high-fat). The low-fat diet contains a lot of sugar, the high-fat diet contains a modest amount of sugar, and the chow diet contains virtually none. The particular high-fat diet in this paper (Research Diets D12451, 45% fat, which is high for a rat) is commonly used to produce obesity in rats, although it's not always very effective. The 60% fat version is more effective.

Consistent with previous findings, rats on every diet consumed the same number of calories over time... except the cafeteria diet-fed rats, which ate 30% more than any of the other groups. Rats on every diet gained fat compared to the unpurified chow group, but the cafeteria diet group gained much more than any of the others. There was no difference in fat gain between the purified high-fat and low-fat diets.

So in this paper, they compared two refined diets with vastly different carb:fat ratios and different sugar contents, and yet neither equaled the cafeteria diet in its ability to increase food intake and cause fat gain. The fat, starch and sugar content of the cafeteria diet was not able to fully explain its effect on fat gain. However, each diets' ability to cause fat gain correlated with its respective food reward qualities. Refined diets high in fat or sugar caused fat gain in rats relative to unpurified chow, but were surpassed by a diet containing a combination of fat, sugar, starch, salt, free glutamate (umami), interesting textures and pleasant and invariant aromas.

Although the cafeteria diet is the most effective at causing obesity in rodents, it's not commonly used because it's a lot more work than feeding pellets, and it introduces a lot of variability into experiments because each rat eats a different combination of foods.

How to Make an Obese H
uman Lean

In 1965, the Annals of the New York Academy of Sciences published a very unusual paper (3). Here is the stated goal of the investigators:
The study of food intake in man is fraught with difficulties which result from the enormously complex nature of human eating behavior. In man, in contrast to lower animals, the eating process involves an intricate mixture of physiologic, psychologic, cultural and esthetic considerations. People eat not only to assuage hunger, but because of the enjoyment of the meal ceremony, the pleasures of the palate and often to gratify unconscious needs that are hard to identify. Because of inherent difficulties in studying human food intake in the usual setting, we have attempted to develop a system that would minimize the variables involved and thereby improve the chances of obtaining more reliable and reproducible data.
Here's a photo of their "system":
It's a machine that dispenses bland liquid food through a straw, at the push of a button. They don't give any information on the composition of the liquid diet, beyond remarking that "carbohydrate supplied 50 per cent of the calories, protein 20 per cent and fat 30 per cent. the formula contained vitamins and minerals in amount adequate for daily maintenance."

Volunteers were given access to the machine and allowed to consume as much of the liquid diet as they wanted, but no other food. Since they were in a hospital setting, the investigators could be confident that the volunteers ate nothing else.

The first thing they report is what happened when they fed two lean people using the machine, for 16 or 9 days. Both of them maintained their typical calorie intake (~3,075 and ~4,430 kcal per day) and maintained a very stable weight during this period.

Next, the investigators did the same experiment using two "grossly obese" volunteers. Again, they were asked to "obtain food from the machine whenever hungry." Over the course of the first 18 days, the first (male) volunteer consumed a meager 275 calories per day. The second (female) volunteer consumed a ridiculously low 144 calories per day over the course of 12 days, losing 23 pounds. Without showing data, the investigators remarked that an additional three obese volunteers "showed a similar inhibition of calorie intake when fed by machine."

The first volunteer continued eating bland food from the machine for a total of 70 days, losing approximately 70 pounds. After that, he was sent home with the formula and instructed to drink 400 calories of it per day, which he did for an additional 185 days, after which his total weight loss was 200 lbs. The investigators remarked that "during all this time weight was steadily lost and the patient never complained of hunger or gastrointestinal discomfort." This is truly a starvation-level calorie intake, and to eat it continually for 255 days without hunger suggests that something rather interesting was happening in this man's body.

This machine-feeding regimen was nearly as close as one can get to a diet with no rewarding properties whatsoever. Although it contained carbohydrate and fat, it did not contain any flavor or texture to associate them with, and thus the reward value of the diet was minimized. As one would expect if food reward influences the body fat setpoint, lean volunteers maintained starting weight and a normal calorie intake, while their obese counterparts rapidly lost a massive amount of fat and reduced calorie intake dramatically without hunger. This suggests that obesity is not entirely due to a "broken" metabolism (although that may still contribute), but also at least in part to a heightened sensitivity to food reward in susceptible people. This also implies that obesity may not be a disorder, but rather a normal response to the prevailing dietary environment in affluent nations.

A second study by Dr. Michel Cabanac in 1976 confirmed that reducing food reward (by feeding bland food) lowers the fat mass setpoint in humans, using a clever method that I won't discuss for the sake of brevity (4). I learned about both of these studies through the writing of Dr. Seth Roberts, author of The Shangri-La Diet. I'd also like to thank Dr. Stephen Benoit, a researcher in the food reward field, for talking through these ideas with me to make sure I wasn't misinterpreting them.

I'd like to briefly remark that there's an anatomical basis for the idea of two-way communication between brain regions that determine reward and those that control body fatness. It's well known that the latter influence the former (think about your drive to obtain food after you've just eaten a big meal vs. after you've skipped a meal), but there are also connections from the former to the latter via a brain region called the lateral hypothalamus. The point is that it's anatomically plausible that food reward determines in part the amount of body fat a person carries.

Some people may be inclined to think "well, if food tastes bad, you eat less of it; so what!" Although that may be true to some extent, I don't think it can explain the fact that bland diets affect the calorie intake of lean and obese people differently. To me, that implies that highly rewarding food increases the body fat setpoint in susceptible people, and that food with few rewarding properties allows them to return to a leaner state.

In the next few posts, I'll describe how food reward explains the effectiveness of many popular fat loss diets, I'll describe how this hypothesis fits in with the diets and health of non-industrial cultures, and I'll outline new dietary strategies for preventing and treating obesity and certain forms of metabolic dysfunction.

Tuesday, May 3, 2011

Arts and Health: Head to Head

On Thursday 30th June Arts for Health at MMU in collaboration with the Centre for Medical Humanities; Pioneer Projects and Open Art, will be hosting a once in a lifetime head-to-head, with some key international figures from the Arts and Health field.

These include, amongst others Executive Director of Arts and Health Australia, Margret Meagher; Murdoch University's Dr Peter Wright; Executive Director of DADAADavid Doyle, Durban University of Technolgy's Professor Kate Wells and the Centre for Medical Humanities', Mike White.

This event will offer participants the chance to hear about some global exemplars in arts and community health and research, and take part in a discussion and networking session.

This event is free and places are going to be limited. It is likely that it will take place between 3:00 and 6:00.

Tim Maley Exhibition DADAA
To register your interest (which does not guarantee a place), simply email with your name and subject line reading HEAD TO HEAD. Although priority will be given to North West Arts and Health Network members, this session will have a number of places open to colleagues from further afield.

Confirmation of a place will be provided in early June, as will fine details of the event including agenda, time and venue.