CHAPTER 10

WEIGHTED ISSUES

The number of obese children in the United States between the ages of six and eleven has more than tripled over the past three decades.1 Almost 30 percent of all children under the age of nineteen in the United States qualify as overweight, with an additional 13 percent reaching the rate of obesity. That rate goes up to 71 percent overweight for adult males and 62 percent for adult females, with obesity rates reaching well over 30 percent for both, making us one of the fattest nations in the world. In 2018, the American Diabetes Association (ADA) estimated the total costs of Type 2 diabetes, a preventable disease, to the American public rose to $327 billion in 2017 from $245 billion in 2012, a 26 percent rise in only five years.2 We’re spending hundreds of billions more than that to treat cardiovascular disease, obesity and the many types of cancer that have been linked to weight-related inflammation.

The reality is that we don’t even know that we’re overweight. As a recent US Department of Health and Human Services national household survey report demonstrates, the data suggests we’re significantly off track. Even though some of us claim to know what is necessary to control our weight, the fact is that there is a lack of follow-through, knowledge or ability.

“Americans’ knowledge and good intentions are not reflected in behavior,” the DHHS states. “Compared to adults’ own self-perceptions of their weight, their body mass index scores (derived from self-reported height and weight) show that adults are actually heavier than they believe themselves to be. At the same time, of those self-reported being overweight, at least seven in ten adults in all age groups are currently trying to lose weight.”3

Many researchers believe that an increase in fast foods, processed foods, engineered foods, artificial preservatives and food additives have set the stage for the prevalence of these diseases. Many of us believe that we can prevent diabetes and related weight diseases by simply making better choices.

That may not be the case at all.

We may actually trace our path to obesity back to something else entirely, related not only to our policy choices but also to that low-level trauma that we’re repeatedly experiencing.

Our children's lunches: A pathway to obesity

In 1946, the National School Lunch Program (NSLP) was created to ensure that children consumed nutritious food and to eradicate childhood hunger.4 The NSLP provided funding for each state to establish, maintain, operate and expand not only lunch programs but also nutritional education programs for children and their families. The federal government had determined, having witnessed the effects of hunger and malnutrition in adults and children across the population during the Great Depression, that there was a direct relationship between malnutrition and the capacity of children to develop, learn and become contributing members of society. That government understood the link between the health of our children and the future success of our country.

But let’s be clear, this program wasn’t just about feeding children.

The NSLP was linked to federal policies after the end of the Second World War that managed surpluses created as a result of changes to supply and demand when the war ended. The government was storing the surplus of farm commodities it purchased through the Farm Bill in order to stabilize prices, and the public demanded release of this food to feed the majority of the population that was hungry and malnourished due to the economic situation. The government determined that stored surplus farm commodities were to be utilized for food first by the armed forces and institutional settings, and then by schools, thereby setting the stage for the NSLP to be operated under the auspices of the US Department of Agriculture.

By the mid-2000s, the NSLP was widely criticized. The food at offer was carb-heavy, fat-laden and laced with sugar in order to feed children at the lowest possible cost. Even worse, the program was targeted at children who come from families with limited household incomes that depended on the NSLP for nutrition, thereby setting up these children for disease and a lack of ability to succeed.5

In the best interest of Americans in 2010, Congress enacted the Healthy, Hunger-Free Kids Act (HHFKA), which called for a revision of school-nutrition standards to align with the 2010 Dietary Guidelines for Americans by increasing quantities of fruits, vegetables and whole grains; establishing calorie ranges and limiting the amount of trans fats and sodium that these children ingest. The HHFKA prevented the sale of food that did not fit into the guidelines and made recommendations to remove vending machines and other temptations from school properties. Today, and several iterations of the program later, the NSLP provides low-cost or free lunches to more than 31 million students at 92 percent of US public and private schools.6

With these changes, it was assumed that the food provided by the NSLP would meet required standards and that the overall health of Americans would improve.

That didn’t happen.

What we know is that the vast majority of schools that already participated in the NSLP still sell food that is not associated with the program. Even though there is a mandate to restrict the use of junk food, half of the schools in the program are likely to be utilizing vending machine sales, with schools with the lowest poverty concentration the most likely to do so. Competitive foods, such as vending machine and a-la-carte offerings, are generally poor-quality foods that students like and will purchase, which means that the possibility of enforcing the rules and converting these offerings to nutritional foods is not being addressed.

This is a business issue, and it’s also a policy issue. As field researchers Dr. Jennifer Woo Baidal and Dr. Elsie Taveras from Harvard School of Public Health’s department of nutrition explain, only a few years after its inception, HHFKA is at risk of being undermined by schools where administrators want to benefit from deals with Big Food.

“Some school officials, food-industry advocates and the School Nutrition Association (SNA, a professional organization that represents school-lunch programs and whose members include food manufacturers) have raised concerns about increased food waste, decreased school-lunch participation, difficulties in meeting whole-grain and sodium goals and potential for increased operating costs,” Woo Baidal and Taveras explain. “In response, the House of Representatives included waivers for school-lunch nutrition standards in its fiscal-year 2015 Agriculture Appropriations Bill. The provision would allow schools with a six-month net loss of revenue to opt out of providing the healthier meals outlined by the HHFKA.”

These decisions impact the poorest and most vulnerable children in our country. As these children age, they require additional health care due to an increase in all kinds of illnesses, including obesity, diabetes and cardiovascular disease. All of these diseases are related to one thing: inflammation.

Inflammation and the endocannabinoid system

Dr. Nick DiPatrizio is a neuroscientist based at the University of California at Riverside. His state-of-the-art lab uses analytical, genetic, surgical, biochemical, molecular, pharmacological and behavioral models to test how and why we eat too much of the wrong things for our bodies.

“It’s been feast or famine up until only very recently in human history,” DiPatrizio explains. “It’s always been evolutionarily advantageous for animals, including humans, to consume high-energy nutrients. The problem is that, in our modern cultures and Western societies, we consume high-fat, high-sugar diets. Our drive to consume these high-energy foods for survival have become maladaptive and dysregulated, and this leads to diet-induced obesity, Type 2 diabetes, metabolic disease, as well as a whole other host of other disorders.”

Understanding how the endocannabinoid system fits into the equation offers a way for us to control our food intake. DiPatrizio calls the endocannabinoid system a safety net, because it’s heavily involved in controlling our attraction to high-energy foods.

“In the gut, during and after a meal, we release what are called peptides from our small intestines, and these basically stop us from eating more. Peptides tell us that we’re full. We’ve recently found that endocannabinoid receptors, which line the inside and the outside of the intestines, can produce these peptides.”

The connection between endocannabinoid receptors and our eating patterns is complex and still unfolding, but as DiPatrizio explains it, it’s critical to understanding why so many Americans are overweight. His experiments have shown that when people are provided with a higher-fat diet, for example, this creates a preference for high-energy foods. In modern environments where food is plentiful, however, this can lead to an excess of signals in the brain that lead to compulsive eating and promote obesity. The endocannabinoid system also controls movement of food throughout the intestines, which can either speed up or slow down our metabolism.

We know a lot about the way in which THC affects our appetite. Most people are aware of the phenomenon called the “munchies” that affects those who smoke marijuana, as DiPatrizio notes, which is why THC is so commonly used to combat nausea and lack of appetite associated with chemotherapy and other medical treatments. It wasn’t until recently that we began to understand how this phenomenon works and how it can actually inform weight loss as well as weight gain.

As far back as the nineteenth century, physicians mentioned the increased appetite that accompanied cannabis use.7 Later on, the effect of marijuana on food intake was studied by a military research group in Panama in 1933, where soldiers using cannabis were shown to eat much more than others and reported feeling hungry long after others were sated. Those taking part in these later studies showed a preference for sweet and savory foods and a tendency to eat long after their hunger waned.

DiPatrizio says that, in his lab, he’s shown that a rise in endocannabinoids doesn’t necessarily lead to long-term weight gain, however. When his subjects took CBD or THC consistently, they tended to be less overweight than those who took it once in a while. This is likely because, once a person’s endocannabinoid system is in order, it returns to that needed state of homeostasis. If you’re overweight or underweight, endocannabinoids can help you regulate your body so that you can find the right balance.

“The endocannabinoid system regulates mood, emotions, pain, appetite, you name it, it regulates it. Every organ is regulated by it,” DiPatrizio says. “Pick an organ system in the body, the endocannabinoid system is indeed present and there controlling its activity.”

Inflammation is one of the most important processes related to the endocannabinoid system control mechanisms. We hear a lot about the fact that inflammation is bad for us. What inflammation actually refers to is an excess of lymph production in the body; the more that our cells and tissues are in crisis, the more that our body works hard to flood itself with lymphatic fluid to provide a soft buffer at the cellular level. It literally creates a pillow effect over every part of your body that hurts.

Over time, this fluid causes what is called oxidative stress on the body, which means that our cells are under constant strain to function. Technically, therefore, when we are constantly affected by inflammation, this can lead to stress in our arteries and heart, autoimmune diseases, diabetes and cancer, as well as allergies and anaphylactic shock.8 Being overweight, sometimes, isn’t just a lack of willpower or the preponderance of fat in the body; sometimes it’s that our body is experiencing so much strain that it becomes filled with fluid at the cellular level. Inflammation is therefore increasingly recognized as an underlying factor in many chronic disorders.

“Inflammation comes from a cascade system that is designed to protect us,” Gaudino says. “Let’s take the example of banging your foot when you’re, say, playing a sport. Typically, your foot will swell up with fluid as a protection reaction to guard that part of the body from further injury or further attack. That makes sense. But when your body is under generalized strain, or when it gets triggered by something like an insect bite, then the entire body reacts. That’s why, typically, inflammation is not a localized thing, unless it’s a sports injury. If you have a disease, inflammation is system wide, and the entire body tends to respond.”

As Dr. Reggie Gaudino explains, what we do know about CBD and body regulation is that it can directly decrease inflammation, no matter the cause.

This excess of fluid is why inflammation leads to a lot of disease conditions, if the body can’t find homeostasis again. When we’re under constant emotional stress, the reality is that homeostasis is hard to achieve, notes Gaudino. For this reason, inflammation almost always results in a cascade reaction from which it’s almost impossible to recover. As Gaudino points out, however, this is where CBD can help. “It’s the endocannabinoid system’s job to maintain the balance of all the other systems and decrease inflammation. Both THC and CBD can treat inflammation very effectively. In fact, they actually probably have a higher efficacy for inflammation reduction than corticosteroids do.” Corticosteroids are hormonal drugs that stimulate the activation or deactivation of our metabolism. This can either speed up or slow down our body’s processes so that it’s easier to heal, but they come with massive side effects such as skin and eye damage, weight gain, depression and cardiovascular risk.

While we know for certain that our endocannabinoid receptors help us choose the food we eat and process the food in our bodies, as well as lessen inflammation throughout the body, scientists still have a lot of work to do. Even though this work is ongoing, what Gaudino and DiPatrizio suggest about the role of endocannabinoid receptors in finding our bodies’ highest level of efficacy rings true. We have the opportunity to regulate our systems so that they are not under constant attack.

“We’ve only just scratched the surface, I believe, over the past few decades,” DiPatrizio says, when it comes to the question of how we can directly create CBD protocols to help people who are overweight. “There are many wonderful open questions, of course, that we still have to address.”

Nonetheless, study findings have begun to answer these open questions. There have been years of chemical analysis research conducted which suggest that the endocannabinoid system has a role to play in telling the brain when and how to eat.9 It can also tell the body when and where to store fat, to convert sugars into fat and when we might need to become more active.10 Being able to control the endocannabinoid system could allow people to make better choices, control eating disorders and ensure that we have stronger and healthier metabolisms.

There has been a social shift taking place with respect to the way in which communities engage with food production and use, which is another question that we need to address.

Efforts such as the Healthy, Hunger-Free Kids Act of 2010, the USDA Nutrition Standards in NSLP, the 2013 Nutrition Standards for All Foods Sold and other federal legislation have been made in the recognition that the effects of school policies, advertising and industrial food production need to be balanced. There is a social drive to ensure that these changes take place and that there are tools available for those who are in a position to ensure compliance with the recommended policies. Schools can benefit from helping children and youth understand how food production and consumption works, so that they are better able to make their own decisions about their health.

The social context of food and nutrition is broader than simply that of personal choice and the influence of family and government policies, however. We need to address the challenges that the American population has faced over multiple generations when it comes to our eating habits and how these are connected to political and corporate choices. We have to shift the social determinants of health that affect vulnerable young people. Direct action is needed in coming to terms with the obesity epidemic that affects children around the country.

1. [Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C. , . . . & Abraham, J.P. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9945), 766–781.]

2. [American Diabetes Association. (2018). Cost of diabetes. Retrieved from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html]

3. [Department of Health and Human Services. (2018). Health & Diet Survey. Washington, DC: Author]

4. [Gunderson, G. (1971). The National School Lunch Program: Background and Development, United States Department of Agriculture. Retrieved from http://www.fns.usda.gov/cnd/lunch/AboutLunch/ProgramHistory.htm]

5. [Huang, J., & Barnidge, E. (2016). Low-income children’s participation in the national school lunch program and household food insufficiency. Social Science & Medicine, 150, 8–14.]

6. [Woo Baidal, J.A., & Taveras, E.M. (2014). Protecting progress against childhood obesity—the National School Lunch Program. New England Journal of Medicine, 371(20), 1862–1865.]

7. [Cota, D., Marsicano, G., Lutz, B., Vicennati, V., Stalla, G.K., Pasquali, R. & Pagotto, U. (2003). Endogenous cannabinoid system as a modulator of food intake. International Journal of Obesity, 27(3), 289.]

8. [Ketonen, J., Shi, J., Martonen, E. & Mervaala, E. (2010). Periadventitial adipose tissue promotes endothelial dysfunction via oxidative stress in diet-induced obese C57Bl/6 mice. Circulation Journal, 74(7), 1479–1487; Li, W., Wang, L., Huang, W., Skibba, M., Fang, Q., Xie, L. , . . . & Liang, G. (2015). Inhibition of ROS and inflammation by an imidazopyridine derivative X22 attenuate high fat diet-induced arterial injuries. Vascular Pharmacology, 72, 153–162.]

9. [Di Marzo, V., & Matias, I. (2005). Endocannabinoid control of food intake and energy balance. Nature Neuroscience, 8(5), 585.]

10. [Pagotto, U., Marsicano, G., Cota, D., Lutz, B. & Pasquali, R. (2005). The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocrine Reviews, 27(1), 73–100.]