Professor 'thinks around the edges' of obesity problem

September 23, 2013

Research looks at complex interactions between human biology, culture

As an anthropology graduate student in the late 80s, Alexandra Brewis Slade carried out field projects in the Pacific Islands on women’s fertility and family planning. While Pacific Islanders at that time were among some of the most overweight populations on earth, she never heard obesity mentioned as a health problem even once. The islanders scolded her for being “too skinny” to attract a husband. Download Full Image

When she moved to expand a Samoan body image project at the University of Auckland in the early 90s, a colleague warned her that obesity was a marginal area for a social scientist to work in, a bit odd and freakish, and its explicit study was probably not the best career move.

Brewis Slade persisted, going on to study the cultural aspects of a high rate of school children’s obesity in rural Georgia and central Mexico, many of whom were at high risk for being obese. Now a widely-cited expert, she has been working on comparative studies of obesity, based on field research in a broad array of countries, such as Paraguay, New Zealand and Fiji.

The recipient of a Rockefeller Foundation pre-doctoral fellowship and an Andrew W. Mellon post-doctoral fellowship, she has published 55 papers and three books, including “Obesity: Cultural and Biocultural Perspectives” in 2011. She is director of ASU’s School of Human Evolution and Social Change and director of operations for the ASU-Mayo Obesity Solutions Initiative.

Brewis Slade notes that in a stunningly short time, obesity has gone from being considered an aberration in both popular culture and scientific circles to being perceived as a massive global threat. Unlike many global calamities such as climate change, no one seemed to notice the dramatic rise in obesity until it was well under way.

“Obesity is arguably one of the greatest public health challenges we face, infiltrating almost every aspect of our lives,” says Brewis Slade. “It shapes whether we get into college, the job offers and promotions we get, how much money we make, our access to health care, our romantic relationships. We are bombarded in the media with messages about the need to be slim and lose weight.

“We associate obesity with moral failure, with a lack of control, laziness and lack of ambition. The stigma of being obese is profound, and it causes tremendous emotional suffering. The social cost is just as important to address as the health cost.”

Cruel comments about weight are socially acceptable in many circles, and are a leading factor in childhood bullying, she says.

She also has found that globalization has spread the stigma associated with obesity from the western world to other parts of the world, including regions that previously viewed large body size in a neutral or positive light. Her research shows that negative media and public health messages about obesity are so powerful that they overshadow the positive support of family and friends in shaping how people feel about their large body size.

Her most recent work on obesity-related stigma particularly appears to have hit a cultural nerve. Her comment, “Of all the things we could be exporting to help people around the world, really negative body image and low self-esteem are not what we hope is going out with public health messaging,” was quote of the day in the New York Times and was mentioned on NBC’s “Saturday Night Live,” which she notes with good humor.

Her research team’s work on obesity also has focused on university students, based on research conducted at ASU.

They have confirmed that obesity is socially contagious and the risk of a woman’s obesity rises if her friends and family members are obese. Shared eating and exercising habits may have the strongest correlation. Currently, her team is working with a start-up company to design ways of using smart phones to connect friends and family to exercise together.

“There are lots of reasons why we gain weight and we know that telling people to ‘eat less and exercise more’ doesn’t work. We’re swimming upstream with that approach because people are working long hours, they don’t have time to exercise or make home-cooked meals. We have to look at what’s possible to change.

“Instead of blaming people for their condition, we need to step back and look at the structure of our cities, our neighborhoods, our schools and our campuses, that shape health at every level.”

She works with ASU students enrolled in research practicum classes to do research on the campus, such as surveys, focus groups and interviews with other students. Fat stigma is surprisingly high at ASU, she says; about 20 percent of students would rather be blind than obese. Her work with undergraduates has a view to designing more healthful campuses, from the perspective of people’s norms and behaviors related to weight, exercise and nutrition.

Brewis Slade’s research is ultimately concerned with the complex interactions between human biology and culture, looking at human health in the context of massive transformational processes, such as globalization and climate change. She enjoys working in diverse collaborative teams, a factor that led her to join ASU in 2006.

“ASU is a fantastic place for someone like me who thinks around the edges of problems,” she says. “I’m inspired and invigorated by the transdisciplinary environment at ASU. It’s an energetic, exciting place and I can’t think of anywhere else I’d rather be.”

She believes the partnership with Mayo makes it possible, for the first time, for a university to think of tackling the challenge of obesity on a global scale.

“What makes ASU able to attempt this is the comprehensive nature of our expertise, and the scale and scope of our collective research. We have people with talent and expertise that can be applied to almost any aspect of the complicated problem of obesity, from the built environment, to food choices, to genetics. ASU’s coverage is unmatched in the volume of different ways we can devise to tackle the problem.

“Partnering with Mayo gives us additional access to talent in the medical understanding and treatment of obesity. This provides us with a truly massive shared toolkit to address the complicated challenge of obesity.”

The School of Human Evolution and Social Change is an academic unit in ASU's College of Liberal Arts and Sciences.

Leader of 'inactivity studies' tackles obesity head on, from every angle

September 23, 2013

Co-workers wear their walking shoes if they’ve scheduled a meeting with Dr. James Levine, co-director of the Mayo Clinic/Arizona State University Obesity Solutions Initiative. He’s not known as the leader of the emerging field of “inactivity studies” for nothing.

Levine and his colleagues head out to the Secret Garden near his office at ASU’s West Hall to walk as they talk, pacing around the enclosed area. Levine often stands at his desk to have a phone conversation, or walks on his desk treadmill as he catches up on e-mail messages. As the inventor of the desk treadmill, he finds sitting for more than an hour anathema. Download Full Image

“Excessive sitting is a toxic activity,” says the energetic scientist who has devoted his career to obesity studies.

“Sedentary activity is a major health concern and there’s been a whole realization over the last five years that sitting for long periods of time is deleterious to health, far more than we ever realized.”

Americans sit more than ever before, at work, at school and even at play, and “it is literally killing us,” claims Levine. Our metabolism slows down, insulin effectiveness drops and cholesterol levels rise.

Having spent the last 25 years studying obesity from every angle at the Mayo Clinic in Rochester, Minn., Levine says activity levels are only a part of the picture, however. As an international nutrition expert who has advised the World Health Organization, the United Nations and the National Institute of Health, Levine has published more than 150 articles on building effective solutions to obesity for adults and children.

Obesity may be the top challenge to ill health in America, he says, accounting for more than half of U.S. dollars spent on health care, for lost work days, diabetes, high cholesterol, hypertension, depression, early cancer, cardiovascular disease, arthritic pain, obstructive sleep apnea and other ailments. It is a complex challenge.

“It’s not as simple as advising people to diet and exercise more, because we’ve been doing that for decades and that’s obviously not the answer,” he says. “There are multiple factors involved. Poverty, with low access to healthy food or regular exercise, is a major driver of obesity. Stress, loneliness, culture, genetics all have a role. Lack of sleep is a major driver in obesity, as is prior abuse history. There are a whole catalog of factors that are maybe even more important than diet and exercise.

“Finding the right solutions for individuals in their situation at that time that will work for them is what we’re trying to build here.”

The high octane researcher was intrigued to affiliate with ASU by the prospect of having access to a large research university that would channel its resources toward solving such a complex issue. Combining that with the expertise of Mayo Clinic seemed a natural fit.

“It blew me away, to find an academic institution that literally wanted to take a societal issue and solve it,” he says. “By joining forces with the world’s finest medical center in this endeavor, it’s like a dream team of how to impact obesity in America.

“At Mayo we have a group of physicians and scientists who are expert, skilled in the art of understanding health. Joining with ASU, having access to the scientists and mathematicians who work in complex adaptive systems, is obviously a perfect fit. We have a group of dynamic, innovative scientists and shared intellectualism to bring this to fruition. Could you think of a better combination than Mayo and ASU? If we ever had a chance to impact obesity in America, this has to be one of those opportunities.”

Levine’s sympathy for the patients he sees in his clinic is obvious. They have tried an average of 17 times unsuccessfully to lose weight, an effort he calls “heroic.” He describes their difficulties finding healthy food and a safe place to exercise, and their pain at being looked at negatively over and over. He says he would like to alleviate their suffering.

An entrepreneur at heart, the creative and engaging physician has developed activity monitors ranging from small personal devices to bike shorts with sensors mounted on the thighs and wires running to a fanny pack. Many offices at ASU now sport desk treadmills, and faculty and staff are often seen with monitors attached to their belts or pockets.

Levine hopes to attract young entrepreneurs to the Obesity Solutions Initiative and to offer corporations the chance to test their products and technologies for weight loss in an ethical and safe way.

Already a quarter of the ASU freshman class have been weighed and measured, and faculty researchers are bringing in grants to explore pieces of the solution puzzle. ASU is exploring a lease at the Downtown Phoenix campus for space for a nutrition kitchen, nursing clinic and a testing center.

Levine’s compassion and efforts extend to ending child slavery, a very personal work he began eight years ago when he interviewed child prostitutes on the streets of Mumbai while researching child labor with a UN contingent. The experience led him to write “The Blue Notebook,” a novel narrated by a young girl sold into the sex trade by her family.

His work has led him to projects in sub-Saharan Africa, Nairobi, Jamaica, China and India. He will continue his passionate advocacy against child prostitution during his work at ASU.

Levine came to Mayo Clinic and then ASU by way of the UK, where he attended the Royal Free Hospital School of Medicine in London, earning doctor of philosophy and doctor of medicine degrees. He did postgraduate internships at the Royal Free Hospital in medicine, at the Wellhouse Trust in surgery and at Mayo Graduate School of Medicine in internal medicine. He also was a fellow in endocrinology.

Levine will continue as a professor at Mayo Clinic, serving as a tenured professor in ASU’s School of the Science of Health Care Delivery in the College of Health Solutions. His appointment extends to the 
School of Life Sciences in the ASU College of Liberal Arts and Sciences, as well as the School of Biological and Health Engineering in the Ira A. Fulton Schools of Engineering.