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Erik Hemmingsson – Food Pharmacy

Erik Hemmingsson

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Onward and Upward with the Diet Debate Now, Please?

As a researcher, it is not uncommon to receive comments when a new study is published in the likes of: “But didn’t we already know this?”. An example, this happened last autumn when a survey I was involved in was published, which showed that Swedes fitness has worsened over the last 20 or so years.

We have most certainly had a lot to say on the matter of our increasingly sophisticated lifestyle which creates a challenge to stay in form, but we have not had any good scientific documentation on the matter. And because we live in an evidence and information society, we are quite dependent on proof of what we believe we know.

Evidence requirements are, of course, both good and bad. As far as the work on improving human health is concerned, research is absolutely necessary, that part is obvious. But research also takes a very long time to perform, it is rarely as perfect as we would like, and it often has difficulty reaching out to the public.

In addition, the lack of solid evidence easily becomes an excuse for not doing anything, for example when it comes to food. It is easy to see how authorities and other decision-making bodies have postponed measures to help people improve their food intake with regard to a lack of research situation. We have also had dietary debates that have not always been constructive, such as with carbohydrates and fats and what causes obesity and type-2 diabetes.

At the same time, we have seen an enormous influx of processed and ultra-processed junk food, such as soft drinks, sweets and chips. These are products that are extremely nutrient-poor, but are packed with refined carbohydrates, fats, salt, additives, and other things that our body absolutely does not need. At the same time, we miss opportunities to consume nutritious food, which our body is absolutely dependent on.

It goes without saying that if we eat junk food, we can expect health consequences later. But I still like to argue that an important piece of the puzzle was recently added with the publication of a study that convincingly showed that the ultra-processed junk food leads to excessive calorie intake and obesity (Hall et al., Cell Metabolism, May 16). Earlier this year, research also showed that individuals who eat a lot of junk food have shorter lives. At the same time, we are more or less surrounded by the lure of junk food. This is obviously not how it should be.

What if we moved the discussions towards being more all encompassing and talked more about what’s happening in terms of the quality of what we eat, instead of getting stuck in old discussions about fat and carbohydrates, and how the processed junk food affects our health? Not only does this matter for out immediate, it’s equally important that we are building a healthy future, and a sustainable society. I think we owe it to our children, and to all future generations.

For those of you who want to read more in depth on the matter:

Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 May 16.

Kim H, Hu EA, Rebholz CM. Ultra-processed food intake and mortality in the

USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Public Health Nutr. 2019 Feb 21:1-9.

Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, Mendonça RD, de la Fuente-Arrillaga C, Gómez-Donoso C, Bes-Rastrollo M. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019 May 29;365:l1949.

Erik Hemmingsson is an obesity researcher at GIH in Stockholm. The views in the chronicle are the writer’s own.



Erik Hemmingsson

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How Much Responsibility Do We Own for Our Body’s Weight?

In regards to our weight, how much of it is really reliant on mind over matter? If you ask the public, especially those who never have to think about their weight, most would probably answer 100% or possibly just below. As for overweight individuals, 81% say their weight is 100% their responsibility, according to a recent study by a major congress on obesity in Glasgow. The corresponding figure for healthcare professionals was 30%, that’s quite a big difference in perceptions. From that it’s not very hard to conclude that many overweight people place the blame on themselves, a story I have heard many times over during my work as an obesity researcher.

But how much responsibility of what we weight rest on our own shoulders exactly? There is no exact answer to that question, but my opinion is that it is a much smaller proportion than most people think. It is now clear that the old model for explaining what we weigh (calories in and calories out), only works in the short term. Yes, we can get rid of extra pounds in the short term, mainly by reducing food intake, but what happens in the long term? Almost everyone goes up again, and many get stuck in a more or less destructive lifestyle, where dieting and weight become a more or less constant element in their life.

Nowadays, we understand quite a lot about why it is so difficult to maintain a weight loss over the long term, and this has to do with our physiology. Your body has its own intrinsic intelligence, which has nothing to do with your willpower. Imagine: most of us eat about 1,000,000 calories a year, and yet most of us are fairly weight-stable. This is hardly a coincidence. Other examples of how our physiology is regulated by the body is our fluid levels and PH value. Even our blood – for example, if you donate half a liter of blood, the body, on its own, will recreate exactly the amount of blood that has disappeared.

Fat is our body’s energy reserve, and of course it is closely monitored, among various places, the hypothalamus. Many different hormones are involved, such as leptin, our primary hormone for us to feel satiated, and is heavily involved in weight control, i.e., how big our energy reserves are. If you lose weight, the fat cells are partially emptied of their contents, and they will signal to the brain, via the hormone leptin, that it is time to replenish: you do not get the same satiation sensation anymore when you eat. Even the energy consumption goes down after a weight loss, all in order for you to replenish the fat cells on their valuable content. There are many indications that many individuals with obesity have a blockage of leptin at the cellular level, and therefore do not receive the same saturation as normal weight.

So everything about willful control of weight is at best only partially true. This does not mean that we should be less vigilant about what we eat, on the contrary, however to keep hopping on the scale and counting calories is really no optimal strategy. Personally, I do not wish to live my life with constant anxiety when the plan is not followed.

It is far better to learn to understand their body and how it works, and to focus on healthy habits, such as nutritious foods, regular exercise, good sleep, and less stress. It brings you extremely good health effects, regardless of your size, both in the short and long term.

For those of you who want to read more:

Cedernaes J, Schiöth HB, Benedict C. Determinants of shortened, disrupted, and mistimed sleep and associated metabolic health consequences in healthy humans. Diabetes. 2015, 64(4):1073-80.

Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obes Rev. 2014, 15(9):769-79.

Rosenbaum M, Leibel RL. 20 years of leptin: role of leptin in energy homeostasis in humans. J Endocrinol. 2014, 223(1):T83-96.

Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr,

Blair SN. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999, 27;282(16):1547-53.

Erik Hemmingsson is an obesity researcher at GIH in Stockholm. The views in the chronicle are the writer’s own.