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Presented  at  the  25th  US  Psychiatric  and  Mental  Health  Congress    Conference  and  Exhibi@on  2012  

November  8-­‐11,  2012  San  Diego  Conven@on  Center,  San  Diego,  CA  

 

The obesity status in the United States is arguably the most pertinent issue in public health. Defined by a body mass index(BMI, weight in kilograms divided by height in meters squared) of over 30, 35.7 percent of U.S adults and 16.9 percent of children and adolescents were obese in 2009-2010.1 Obesity is such a deleterious problem because it reduces the quality of life for the affected individuals not only through poor movement quality, but also through an agonistic effect of causing hypertension, cardiovascular disease, type 2 diabetes, some cancers, stroke, and others2. Exercise, in all forms, is a key component to combating the obesity and its associated negative affects on health.

Introduc@on  

Prevalence  and  Morbidity  of  Obesity  

Narcissism, defined as “self-love, interest, often excessive interest, in one’s own appearance, comfort, importance, abilities, etc.”, has never been a socially acceptable trait. However, with the unfortunate spike in obesity and obesity-related health issues that exhaust the health care system by billions of dollars11 and diminish the quality of lives of our citizens, the imminent changes in public health we seek need to be accompanied by attitude changes to cement societal change. What if narcissism, a seemingly incompatible trait with optimal physiological function, can facilitate people’s quest to better health? Just as with any personality trait, there is a spectrum of various degrees of narcissism. At the extreme level, self-love can become a destructive personal behavior to the point of obsession and self-absorption, which is clinically diagnosed as narcissistic personality disorder12. Besides the obvious obsession with oneself that defines narcissism, narcissists are more likely to exhibit disagreeable behaviors, be academically disengaged, and use crude language13. However, more moderate doses of this trait, including a sense of pride in one’s appearance and extrovert tending behavior14, instilled into the general population, would behoove the nation as a whole in its quest to alleviate the obesity epidemic. Figures: The development of public interest in physique development, and its potential association with narcissism, was greatly influenced by Hollywood, such as with Steve Reeves and Sylvester Stallone in Hercules Unchained and the Rambo series, respectively.

Bodybuilders and other fervid weight lifters, actually hold a key to unlock these necessary public health changes: narcissism, through diligent, seemingly excessive, weight training and diet management are essential keys to weight management. In fact, being “excessively” interested in one’s appearance is one of the best ways to prevent obesity in this country because it places the responsibility to change and in pride in one’s appearance back to the individual. This is not to suggest that this is the only form of activity that will facilitate the decrease in obesity. All forms of rigorous exercise can facilitate better health,. However, exercise serves an even more important role of preventing fat regain, particularly visceral fat (associated with metabolic syndrome), after it is lost15. Weight training fulfills this role of exercise in a unique way, in that the results it delivers are the most physically noticeable. In addition, an hour of vigorous weight lifting for a 200 pound individual burns 455 Calories, an hour of very brisk walking burns 455 Calories, and high impact aerobics burns 65416. However, studies have shown that typical hypertrophy routines, i.e. using heavy resistance for a significant duration, induce the greatest effect on excess post exercise oxygen consumption(EPOC), which leads to more calories being burned after exercise has commenced17. This deviation in resting physiology attempts to replenish energy reserves, re-oxygenate blood, restore hormonal balance, and return to normal ventilation and heart rate18.

Narcissism  

Nutrition, another lifestyle facet that bodybuilders have striven to perfect since the dawn of the sport, is the second key determinant of a healthy weight. Vince Gironda, arguably one of the most influential bodybuilding minds to date, was famous for saying that bodybuilding is 85 percent nutrition and could not be ignored for physique improvement.19 Imposed physical stress through exercise can illicit positive physiological changes if properly fueled by ample nutrients, which is why bodybuilders value nutrition so heavily. Bodybuilders optimize their diets through supplementation, prodigious water consumption, carbohydrate cycling based on activity level, and overall Calorie counting based on the period in their overall contest preparation.20 For example, diets are altered based on whether the athlete wants to bulk (gain muscle while minimizing fat gain) or cut (lose fat while maintaining muscle mass), and sodium and water intake are heavily monitored in the final week of contest preparation to optimize appearance on stage.21 Ostensibly, the case here is not that everyone should acquire bodybuilding eating tactics and style, as that is even stressful for those competing in the sport. Nonetheless, it is evident from this summary of basic bodybuilding nutrition dogma that bodybuilders plan their dietary patterns extensively Figures: Vince Gironda (left), Arnold Schwarzenegger (middle), and Bernarr MacFadden (right)

Thus, we can take certain aspects of bodybuilding and apply them to public health improvement. In fact, bodybuilding used to be a method to pursue optimal health before the advent of massive steroid usage that has plagued the sport. A prime example is physical culture, a movement pioneered by Bernarr MacFadden. With his no nonsense attitude towards physical perfection, epitomized by his famous saying, “weakness is a crime,” and heading his magazines/newsletters with “Weakness is a Crime! Don’t be a Criminal”22, MacFadden actually embodied mild narcissism, considering disease and lack of physical condition a weakness and encouraging followers to embark on quests to attain physical conditioning. This is not in anyway blaming the individuals, which could have negative consequences in changing lifestyle habits23 .

Bodybuilding  Con@nued     Conclusions  

Narcissism is not undesirable quality, when graded appropriately, in a time where most feel comfortable being overweight because 2/3 of the US adult population is overweight/obese. Would it not be better to have 2/3 of the US adult population be narcissistic bodybuilders who care about their hypertrophy inducing regimens? When viewed from that perspective, it is evident that narcissism is simply a relative quality. Some are narcissistic and care deeply about their physical appearance and health, and thus outside the norm. This faulty thinking needs to be reverse. In other words, we need more people to be narcissistic through excessive concern about their health and appearances and single out the more moderates, thus making extreme diet and exercise ironically more normal. “Excessive” concern with outside appearance will reciprocally lead to higher concern of what goes inside the body and consequently improve health. More people need this attitude, and the only way to instill necessary attitude is by targeting individuals. We can tackle the “negative” social connotation of narcissism after obesity, and its offspring diabetes and heart disease, is reduced to more tolerable numbers. References  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics. 2012. 2. Centers for Disease Control and Prevention. National health and nutrition examination survey 2003–2006. Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed September 1, 2012 3. Id.(1) 4. Centers for Disease Control and Prevention. Adult obesity facts. Available at: http://www.cdc.gov/obesity/data/adult.html. Accessed September 1, 2012. 5. Id. 6. Id. 7. National Diabetes Information Clearinghouse. National diabetes statistics, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx. Accessed on October 19, 2012. 8. Id. 9. Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. 2002;25(2):358-363.

10. Dall TM, Zhang Y, Chen YJ, Quick WW, Yang WG, Fogli J. The economic burden of diabetes. Health Aff (Millwood). 2010;29(2):297-303.

11. Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010;3:285-95.

12. Mayo Clinic. (2011, November 4). Narcissistic personality disorder. Available at http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652. Accessed on August 25, 2012. 13. Holtzman NS, Vazire S, Mehl MR. Sounds like a narcissist: behavioral manifestations of narcissism in everyday life. J Res Pers. 2010;44(4):478-484. 14. Id. 15. Hunter GR, Brock DW, Byrne NM, Chandler-laney PC, Del corral P, Gower BA. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring). 2010;18(4):690-5. 16. Mayo Clinic. Exercise for weight loss: calories burned in 1 hour. Available at: http://www.mayoclinic.com/health/exercise/SM00109. Accessed on October 20, 2012. 17. Schuenke MD, Mikat RP, Mcbride JM. Effect of an acute period of resistance exercise on excess post-exercise oxygen consumption: implications for body mass management. Eur J Appl Physiol. 2002;86(5):411-7. 18. Id. 19. Gironda V, Kennedy R. Unleashing the Wild Physique, Ultimate Bodybuilding for Men and Women. Sterling Pub Co Inc; 1984:79. 20. Vinturis, Sorin. Nutrition for bodybuilding competition preparation. Body Building Science Journal. Vol. 1. Nov. 2, 2009 21. Id. 22. Wood C. Bernarr MacFadden: A Study in Success. Kessinger Publishing, LLC;2003;93. 23. Adler NE, Stewart J. Reducing obesity: motivating action while not blaming the victim. Milbank Q. 2009;87(1):49-70. 24. http://www.cdc.gov/obesity/data/adult.html(figure)           

Contact  Informa@on  

Robert A. Bitonte, MD, MA, JD, LL.M.- rbitonte@aol.com Donald J. DeSanto, II, MS1- ddesanto@neomed.edu

In 2009 and 2010, there were nine and twelve states, respectively, with obesity rates over 30 percent, but in 2000, no states had an obesity rate over 30 percent4. The lowest prevalence of obesity in the country is in Colorado, at 21 percent, but this means that no state has met the national standard set by Healthy People 2010 of 15 percent obese5. Furthermore, medical costs have skyrocketed due to the increase in obesity through its related health issues, costing third party payors $1,429 more each for obese persons compared to those of normal weight, and overall medical costs related to obesity were estimated at $147 billion in 20086. Though these statistics come from obesity diagnoses based off BMI, which does not take into account body composition and thus misplaces some muscled individuals, the numbers are still staggering and should trigger concern because most of the overweight/obese population are not athletes--this would be a public health boon-- and are at risk for the aforementioned myriad of health problems. Thus, it is no surprise that prevalence of diabetes mellitus (type 2, which accounts for 90 to 95 percent of cases), a major cause of heart disease, stroke, and leading cause of kidney failure 7, have risen sharply along with obesity. Diabetes affects around 8.3 percent of the American population along with8, and 80 percent of type 2 diabetes is associated with obesity9. Not only does diabetes lead to deadlier diseases that wreak havoc on the public health outlook of the future, but also it is by far responsible for most of the increased health care costs associated with obesity, costing the US $174 billion in 200710.

Physical  Culture  Origins  Bodybuilding  Demonstrates  Mild  Narcissism  

Robert  A.  Bitonte,  M.D,  M.A.,  J.D.,  LL.M.  ;  Donald  J.  DeSanto,  II,  MS1  UC  Irvine  Medical  Center,  Orange,  CA  :  Northeast  Ohio  Medical  University,  Rootstown,  Ohio  

Narcissism:  A  Novel  Concept  to  Integrate  into  Obesity  Preven.on  Efforts    

   

1.  UC  Irvine  Medical  Center,  Orange,  CA  ;  2.  Northeast  Ohio  Medical  University,  Rootstown,  OH  

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