In the past, I have generally analyzed major health problems in the United States by comparing our outcomes to other countries. Take diabetes, for example. There are many reasons why an individual in the U.S. might be at greater risk of developing diabetes than someone in Japan. It may relate to factors such as food regulations, having routine exercise built into you day, genetics, food servings, access to affordable health care, or even public school lunches. There are many sociological and societal factors at play that influence an individual. However, what I perhaps did not realize was how many different physiological and psychological factors are at play just in our own bodies that may be producing these outcomes. It is not simply that we eat too much sugar and get sick. Rather, our bodies are highly complex, and each dietary or emotional or other event causes downstream consequences that we may not even be aware of. In addition, although we are often able to adapt or compensate for unhealthy steps along the way, these adaptations in and of themselves may reconfigure our body’s response and lead to long-term, irreversible consequences.
On the surface, if we just look at diabetes, we have a pretty good understanding of how it works, as outlined by Sapolsky (2004). In juvenile (Type I) diabetes, an individual’s ability to secrete insulin is severely compromised. As a result, they are unable to process glucose correctly, their cells begin to starve, and eventually leads their organs to malfunction. In addition, the glucose and fatty acid that has been left in the bloodstream clogs blood vessels in various parts of the body, further causing organ failure. Thus, Type I diabetes must be managed with insulin injections. In adult (Type II) diabetes, an individual’s cells actually fail to respond to insulin. When individuals are overweight and have a fat surplus, their fat cells are full and cannot take up as much glucose when prompted by insulin. As a result, the pancreas produces more insulin, their cells become less responsive to insulin, and the cycle continues. Subsequent exhaustion of insulin-secreting cells can lead an individual to then develop Type I diabetes.
On the surface, diabetes may seem easy enough to prevent (at least Type II diabetes)—don’t overburden your fat cells! Unfortunately, simply avoiding that pumpkin pie at the end of your Thanksgiving meal may not protect you. As it turns out, simply being stressed (e.g., preparing that entire Thanksgiving meal for your extended family) decreases how much energy we use after we eat and increases our insulin production, both potentially contributing to the downward spiral of diabetes (Kiecolt-Glaser et al., 2015). To counteract this stress, we may dig into some post-meal chips once everyone has left. Indeed, as many all-nighter college students might be able to attest, stress increases consumption of such comfort foods, just filling up those fat cells even more (Finch & Tomiyama, 2014). If you then begin to reflect on the political conversation from your (2016) Thanksgiving meal and enter a depressive state, you may also experience higher postmeal cortisol release, leading to triglyceride (fat) accumulation (Kiecolt-Glaser et al., 2015). All that fat accumulation and you didn’t even get to enjoy that pumpkin pie!
When we talk about weight management in the U.S., it is often in the form of concrete input and output of food and exercise. I ate three cookies for breakfast. I burned 300 calories at the gym. Then I ate a piece of pizza but maybe the negative calories from my celery stick balances it out? But in reality, the factors that determine our weight and general health are so much more complex. And understanding what each of the factors is is just the first step. Once we identify an influential factor, we must develop interventions to help change an individual’s course and prevent negative outcomes. One area of study that has been identified as particularly in need of study is affect in the context of health decision making (Magnan, Shorey, & Brady, 2017). While economic theory may give us a precise cost-benefit analysis for how we should make important decisions that impact our health, the reality is that issues related to our health (and food!) are inevitably affect-laden. Precisely measuring how affect contributes to health-related decisions we make has the potential not only help identify new and reliable predictors, but also to design more effective interventions to prevent individuals from succumbing to a multitude of deadly diseases.
Finch, L. E., & Tomiyama, A. J. (2014). Stress-induced eating dampens physiological and behavioral stress responses.
Kiecolt-Glaser, J. K., Habash, D. L., Fagundes, C. P., Andridge, R., Peng, J., Malarkey, W. B., & Belury, M. A. (2015). Daily stressors, past depression, and metabolic responses to high-fat meals: A novel path to obesity. Biological psychiatry, 77(7), 653-660.
Magnan RE, Shorey Fennell BR, Brady JM. Health decision making and behavior: The role of affect-laden constructs. Soc Personal Psychol Compass. 2017;11:e12333. https://doi.org/10.1111/spc3.12333
Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.