Mind Body Seminar: November 1982

OBESITY & HEALTH

A new view of human obesity is emerging. Recent research suggests that we have overestimated the medical risks of moderate obesity while underestimating the social and psychological effects of being fat. Further, we are beginning to understand the complex interplay between differences in body metabolism, brain regulation, dietary intake, and activity in determining body weight. This symposium will present a state-of-the-art review of current thinking about obesity in an attempt to foster more sensible, effective, and humane approaches to weight management.

FACULTY

Robert Baron, M.D., is Clinical Instructor in Medicine, University of California, San Francisco where he is also Associate Director of the Screening and Acute Care Clinic. He has a master of science degree in nutrition and serves as a member of the Nutrition Consultation Service, Moffitt Hospital, UCSF.

William Bennett, M.D., is Associate Editor of the Harvard Medical School Health Letter and has worked for a number of years as a science and medical writer. His latest book The Dieter’s Dilemma reviews the emerging evidence on set-point theory in the regulation of body fatness.

George A. Bray, M.D., is Professor of Medicine, University of Southern California; and Chief, Division of Diabetes and Clinical Nutrition, Los Angeles County General Hospital. The main focus of his research has been in obesity about which he has published numerous scientific papers and two books, The Obese Patient and Obesity.

Stacey FitzSimmons, M.P.H., is completing a doctorate in Epidemiology at the University of California, Berkeley. Her research interests include management of hypertension screening and intervention programs in the worksite as well as behavioral factors in cardiovascular disease such as stress, coping, and social support.

Margaret Mackenzie, Ph.D., R.N., is former Assistant Professor and Director of the Medical Anthropology Program, University of California, Berkeley; and is now conducting research with the Alcohol Research Group, School of Public Health, University of California, Berkeley. She has done extensive cross-cultural study of obesity and is author of the forthcoming book Fear of Fatness: The Pursuit of Self-Control and Distrust of Pleasure.

PROGRAM

FRIDAY, NOVEMBER 5 MORNING

FEAR OF FATNESS: PSYCHOSOCIAL ASPECTS OF OBESITY
Margaret Mackenzie, Ph.D., R.N.
Obesity is more than a medical matter; it involves moral and social dimensions. Concern about body weight may be symbolic for dealing with issues of self-control, self-discipline and self-worth. Cross-cultural and epidemiological research suggests that the adverse effects of moderate obesity derive more from cultural prejudices than medical consequences.

HOW BAD IS FAT?
Stacey FitzSimmons, M.P.H.
Obesity can be defined in many ways: physiologically, statistically, operationally and socially. Each definition presents a different perspective on the prevalence and health consequences of increased body weight. A critical reevaluation of the evidence suggests the health hazards of moderate obesity may have been over-estimated.

THE ENIGMA OF OBESITY
George A. Bray, M.D.
Recent research reveals a growing understanding of the pathophysiology of how one gets fat. This understanding can then be applied to designing various treatment strategies to adjust energy balance and body weight.

AFTERNOON

SET-POINT REGULATION OF FATNESS
William Bennett, M.D.
Body fatness is not easily controlled by dieting, behavior modification or medications. Set-point theory offers a plausible explanation of how the organism works to maintain a constant amount of fat. Research on current approaches to alter body set-point will be presented.

POPULAR DIETS: AN ASSESSMENT
Robert Baron, M.D.
Health professionals are often asked questions about the latest popular diets. The office assessment of the nutritional value and health risks of various popular diets will be discussed including vegetarianism, Pritikin, macrobiotics, Scarsdale, Last Chance, Cambridge, Beverly Hills, and the latest diets.

NUTRITION & HEALTH

Nutrition has been a neglected part of health care. Fortunately, there is now a growing public and professional interest in the relationship between food and health. A distinguished faculty of researchers, clinicians and educators will present a responsible, up-to-date review of major controversies in nutrition with an emphasis on practical clinical applications.

FACULTY

Barbara Abrams-Root, M.P.H., R.D., is Lecturer and Clinical Nutritionist with the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco and a doctoral candidate in Public Health Nutrition at the University of California, Berkeley. She was a Research Nutritionist with the Food Additives Project, an FDA study that investigated the relationship between artificial colors and behavioral disturbances in children.

Stephen B. Hulley, M.D., M.P.H., is Adjunct Associate Professor in the Department of Epidemiology and International Health and the Institute for Health Policy Studies at the University of California, San Francisco. He is a Principal Investigator in the Multiple Risk Factor Intervention Trial (MRFIT) and in the Systolic Hypertension in the Elderly Project. His research and teaching have been in the field of coronary heart disease epidemiology.

Michael F. Jacobson, Ph.D., is Executive Director of the Center for Science in the Public Interest in Washington, D.C. and Editor ofNutrition Action. He is active in governmental policy-making and public education in nutrition and author of Nutrition Scorecard and Eater’s Digest: The Consumer’s Factbook of Food Additives.

Marshall Joseph, M.D., is a resident in Psychiatry at the Langley Porter Psychiatric Institute, University of California, San Francisco. He has recently completed a fellowship in psychopharmacology investigating the neuroendocrine correlates of behavioral states and the effects of opiates, nicotine and caffeine.

Marion Nestle, Ph.D., is Associate Dean, School of Medicine, University of California, San Francisco and Lecturer in the Departments of Medicine and Biochemistry. She directs the UCSF Nutrition Curriculum Development Project and teaches nutrition to medical and other health professions students and practitioners.

Judith R. Turnlund, Ph.D., R.D., is Research Nutritionist and Project Leader of the Nutrients Research Unit, USDA, Western Regional Research Center. Her research interests in human nutrition include trace element availability and utilization, nutrition and aging, and nutrition in developing countries.

Diane W. Wara, M.D., is Associate Professor of Pediatrics, University of California, San Francisco. Her primary interests are in pediatric immunodeficiency and rheumatological disorders and the role of thymic humoral factors in the immune response.

David Watts, M.D., is Associate Professor of Medicine, University of California, San Francisco, specializing in gastroenterology. He is the host of the KQED radio program “Here’s to Your Health” and the television program “Health Notes.” He is also editor of the Lange publication, Modern Gastroenterology.

SYMPOSIUM CHAIRPERSON David S. Sobel, M.D., M.P.H., is Chief of Preventive Medicine, Kaiser-Permanente Medical Center, San Jose and Lecturer in the Department of Epidemiology and International Health, University of California, San Francisco. He also serves as Medical Director of The Institute for the Study of Human Knowledge.

PROGRAM

SATURDAY, NOVEMBER 6 MORNING

INTRODUCTION
David S. Sobel, M.D.

HUMAN NUTRITION
Marion Nestle, Ph.D.
Research in nutritional science has increased our understanding of human nutritional requirements, yet considerable confusion exists in popular dietary advice, A unifying hypothesis for optimal diet is emerging that embodies the best available dietary recommendations and goals.

NUTRITION AND THE PREVENTION OF HEART DISEASE
Stephen B. Hulley, M.D, M.P.H.
The role of nutritional factors in the development of coronary heart disease will be explored, with particular attention to population studies relating dietary fats and serum cholesterol to heart disease. The scientific and political controversies surrounding nutritional guidelines for public health and preventive medicine will be discussed, arriving at practical guidelines for providing clinical advice to individual patients.

AFTERNOON

NUTRITIONAL ASSESSMENT
Marion Nestle, Ph.D.
Although many methods exist for evaluating the nutritional status of an individual, no single biochemical or physical measurement adequately determines nutritional health. The use of simple diet history to estimate adequate nutrient intake will be demonstrated.

VITAMIN SUPPLEMENTS
Marion Nestle, Ph.D
While vitamins are clearly essential to human health, considerable controversy surrounds the use of vitamin supplements to promote optimal health, The safety and efficacy of vitamin supplements will be critically reviewed using vitamin C as a case study.

TRACE MINERALS: HOW MUCH IS ENOUGH?
Judith R. Turnlund, Ph.D., R.D.
Many factors must be considered when determining optimal intake of essential trace elements. Deficiency can result when the dietary intake is inadequate or when the mineral is poorly absorbed. Further, high intake of one mineral may inhibit absorption of others. Trace elements can be toxic in excess and in some cases the margin of safety between adequate and toxic levels is small.

SUNDAY, NOVEMBER 7 MORNING

NUTRITION AND THE IMMUNE RESPONSE
Diane W. Wara, M.D.
One hundred million children in the world suffer from malnutrition. Nearly 50% of deaths in children under five occur as a result of infections in malnourished children. Nutritionally induced defects in the immune response can be prevented and reversed thereby decreasing susceptibility to infections.

DIETARY FIBER AND HEALTH
David Watts, M.D.
Dietary fibers are a diverse group of complex substances that cannot be completely digested in the human digestive tract. The current scientific evidence of the role of dietary fiber in such diseases as diverticulosis, colon cancer, irritable bowel syndrome, and diabetes will be reviewed.

AFTERNOON

FOOD FOR THOUGHT
Marshall Joseph, M.D.
Recent research demonstrates that certain dietary substances can affect brain chemistry and behavior. The criteria for evaluating such effects will be illustrated by discussing the influence of tryptophan as an hypnotic and antidepressant and the possible effect of choline and lecithin on memory and mood.

FOOD SAFETY: THE CHEMICAL FEAST
Barbara Abrams-Root, M.P.H., R.D.
During the last century thousands of new chemicals have found their way into our food raising serious concerns as to the acute and long-term health effects of these natural and synthetic chemicals. Aflatoxin, pesticide residues, lead and PCBs in breastmilk will be used as examples. In addition, some tentative guidelines for reducing exposure and enhancing food safety will be offered.

THE PUBLIC DIET AND THE POLITICS OF FOOD
Michael F. Jacobson, Ph.D.
The changing role of government and industry in addressing contemporary nutrition problems will be presented. Government policy on such issues as federal food programs, food labeling and food content (salt, fat, sugar) will be critically reviewed. In the absence of effective government initiatives, continued progress in the public diet will require grassroots activism and voluntary action by the food industry.