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The Perfect Push Up Exercise Gimmick Although push-ups are the most rudimentary exercise in existence, multiple companies have produced ridiculous gimmicks to help you do the Perfect Push-up!

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Self-assessment of obesity in children is influenced by body weight of their classmates

Monday, June 29, 2009 Author: Travis Saunders 6 Responses
 Photo by Dave_mcmt

A very interesting article came out this past week in the journal Obesity.  Dr H Shelton Brown III and colleagues at the University of Texas School of Public Health examined how a child's assessment of their own body size (e.g. lean, overweight, or obese) is influenced by the body size of their classmates.  Subjects consisted of male and female students in grades 4, 8 and 11.  All students had their height and body weight measured, which were used to calculate their body mass index (BMI).  This objective measure of obesity was then compared to the students' response on a questionnaire, which asked:

“Compared to other students in your grade who are as tall as you, do you think you weigh “The right amount,” “Too much” or “Too little(or not enough)”?

They found that for children in grades 4 and 8 (but not those in grade 11), a higher average BMI in their classmates was associated with a significant under-estimation of their own body weight.  In other words, if an obese student was surrounded by overweight and obese classmates, they were more likely to estimate that they weighed the "right amount", rather than "too much". 

It is interesting, and not terribly surprsing, that students assess themselves based on their peer group, rather than a scientific abstraction like BMI.  I'm a distance runner, and many times I have heard people say that after being around other runners for several years, they start to think of a runner's body as the norm, even though it obviously is not (it's not surprising that disordered eating is quite high among distance runners).

This study is especially interesting in light of past research showing that obesity and other health behaviors like smoking tend to spread through social networks, which I blogged about here in one of my first posts last November.  Could it be that individuals are less likely to address their own obesity if it is the norm for their peer group?  Some have even suggested that targeting social networks, rather than individuals, may be the most effective way to prevent and treat obesity at the societal level.  In fact, Dr Brown and colleagues suggest that interventions that focus on the school, rather than the individual, may be the best way to promote healthy body weights in children, and I think that it is a very reasonable suggestion (even though the Comments section on many of our posts suggest that many still feel obesity is about "personal choice", and nothing more).

This study adds to the growing body of evidence that obesity, as well as our perception of obesity, are influenced by those around us.  If we want to see healthy behaviors in our society (and in our youth) as a whole, targeting individuals one at a time is probably not the most effective way to go about it.  Interventions that target the school (or even better, the community) are the only way we are going to gain any ground against the current childhood obesity epidemic.


Related Posts:

1.  Food addiction - fact or fiction?
2.  Eating with friends - a cause of weight gain?
3.  Want to avoid weight gain? Stay single!

Brown, H., Evans, A., Mirchandani, G., Kelder, S., & Hoelscher, D. (2009). Observable Weight Distributions and Children's Individual Weight Assessment Obesity DOI: 10.1038/oby.2009.168

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Hoodia for weight loss - where's the evidence?

Friday, June 26, 2009 Author: Travis Saunders 1 Response
Photo by Amrum.
If you have passed through the weight-loss aisle at any pharmacy over the past few months, you will probably have seen several products claiming to contain Hoodia gordonii, more commonly known as Hoodia. This is particularly so given the empty shelf space created by the recent recall of all Hydroxycut weight-loss supplements (discussed here). Hoodia is a type of succulent (a type of plant that looks like a cactus, but is in fact completely different) which is said to have been used by the San Bushmen of the Kalahari desert to ward off hunger and thirst. Hoodia first came to prominence when the South African government suggested that extracts from the Hoodia plant caused a decrease in appetite and body weight in animals. Since then, a Hoodia diet pill has been under development by Phytopharm, a pharmaceutical company based in the United Kingdom. However, while the "official" Hoodia pill from Phytopharm remains to this day under development, countless other Hoodia products have hit the shelves as supplements claiming to reduce appetite and body weight.

Despite the ample hoodia based products currently availabe for sale, you may be surprised to find out that the clinical evidence supporting the use of Hoodia is practically non-existent.

On their website, Phytopharm reports on an in-house (and unpublished) study where Hoodia was found to significantly reduce both caloric intake and body weight over a period of two weeks in a group of overweight individuals. Although I could not find any further details about the magnitude of weight loss on the Phytopharm website, a review article in Obesity Management by Drs George Bray and Donna Ryan reports that the weight loss observed in the Hoodia group was a relatively modest 0.98 kg over the two week period. Unfortunately that is the only additional detail provided by Drs Bray and Ryan, and it remains unclear what dosage of Hoodia was provided to the subjects, or if the weight loss in the Hoodia group was significantly different from that in the control group.

Believe it or not, that's about the only clinical evidence supporting the use of Hoodia whatsoever, and the details haven't even been published in a peer reviewed journal!

There is one other study reporting that Hoodia injected directly into animal brains reduces food intake by 40-60% over a 24 hour period, but that's obviously not very relevant to the present discussion - as far as I know, none of the Hoodia products commercially available involve injection into the brain.

Given the lack of research, it's not surprising that on their website, the Mayo Clinic says that "There is no conclusive evidence that hoodia is an effective appetite suppressant or that it contributes to significant, long-term weight loss."

In addition to the complete lack of published clinical research on Hoodia, there are also serious questions about the quality of many products claiming to contain Hoodia. Hoodia is a rare plant, and Phytopharm has an exclusive deal with the South African government for most of it. It's not surprising then, that it's been reported that about 60% of products claiming to contain Hoodia may contain no Hoodia at all.

So let's recap.

1) There is no conclusive evidence suggesting that Hoodia produces long-term weight loss in humans. Phytopharm might eventually come out with a peer-reviewed study on the subject, but their former partner Pfizer got out of the Hoodia game in 2003, and it's been 8 years since their original (unpublished) clinical trial was completed.

2) Even if Hoodia is effective in promoting weight loss, there's still a 60% chance that the products that are currently available won't contain any Hoodia anyway.

The folklore about Hoodia being used by the San Bushmen is intriguing, but does not provide direct evidence of its efficacy in producting any appetite-suppressing or weight loss effects. At the moment, there's no conclusive evidence suggesting that any Hoodia product will help you lose weight, or keep it off. Thus, as with most commonly touted 'solutions' for excess weight, until peer-reviewed evidence supports Hoodia for weight-loss, you're better off saving your money.

For further reading on Hoodia, check out the discussion on WebMD here.


Related Posts

Bray, G., & Ryan, D. (2006). Supplements Used in Weight Management Obesity Management, 2 (5), 186-189 DOI: 10.1089/obe.2006.2.186

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Eating with friends – a cause of weight gain?

Wednesday, June 24, 2009 Author: Peter Janiszewski, PhD 6 Responses

I’m sure we all remember dealing with peer-pressure during our youth – most of the stuff making headlines focused on smoking, alcohol consumption, and sexual activity. If your friends started smoking it is reasoned there is a pretty good chance you would also try your hand at it. This type of thinking paved way for our worried parents to warn us against associating with certain friends, as they were “a bad influence.”

It turns out that peer-pressure may also account for the amount of food consumed by kids.

In a previous post, we had discussed a landmark study which described how obesity seems to spread via social networks – that is, having obese friends increases your chances of also becoming obese. In that study it was left unclear how exactly this happened, but it was hypothesized that similar dietary and physical activity patterns were involved.

A new study published ahead of print in the American Journal of Clinical Nutrition examines the effect of presence of a friend versus an unfamiliar peer on the amount of food consumed by youth.

In the study, the investigators set up a room full of games and toys, as well as individual bowls of snacks for each child (carrots, grapes, chips, cookies). Twenty three overweight and 42 normal weight youth (aged 9-15 years) were allowed to play and eat with either a friend of their choice (of the same sex) or an unfamiliar peer for a duration of 45 mins. After the 45 minute period of play/eating, the amount of food consumed by each child was assessed.

Here is what the authors found:

1. In the company of a close friend, youth consumed significantly more calories during the 45 minute session than in the company of an unfamiliar peer. Specifically, when playing with a friend, a total of 500 kcals were consumed, in contrast to the 300 kcals consumed in the presence of an unfamiliar play partner.

2. Regardless of friendship status, overweight youth ate more food when in the presence of another overweight youth than in the presence of a normal weight youth.

3. Lastly, the effects of familiarity (friend vs. unfamiliar peer) and weight status of the play partner (overweight vs. normal weight) on the caloric intake of a youth are additive – such that an overweight child in the company of his/her overweight friend ate the most food during the testing session, in comparison to all other conditions.

Why does this occur?

The authors speculate that either friends act as “permission givers” and facilitate an increased caloric intake, or alternatively that strangers thwart caloric intake by making the child self-conscious among making a good impression on the unfamiliar peer.

Every time I come across such a study, pointing to yet another potential cause of caloric imbalance, I come to realize how the notion of "eating less and moving more" is painfully myopic.


Salvy, S., Howard, M., Read, M., & Mele, E. (2009). The presence of friends increases food intake in youth American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2009.27658

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Monday, June 22, 2009 Author: Travis Saunders 1 Response
Our posts over the pasts few weeks have all been pretty serious, so I thought that our first official post of summer 2009 should be a bit lighter.  And for this occasion, I have decided to share the latest fitness craze - Catflexing. The idea is this - take any type of resistance exercise, and substitute your cat for the dumbbell.  It's that simple.  For some examples, please see the videos below (email subscribers should click the title of this post to see the videos on the blog itself). My personal favourite is the "hip rotation" video, although I'm not sure how the cat adds to the exercise in any way. 

Now these exercises are obviously a bit goofy, but the fact remains that the best workout is the one that you enjoy, no matter how ridiculous it may seem to others.  For more cat workout ideas, please visit

As an unrelated aside, Dr Yoni Freedhoff is leading a campaign to see nutritional information included along with recipes in the Ottawa Citizen, the daily newspaper of the National Capital (not to be confused with La Capitale Nationale, but that's a whole other issue).  The campaign is picking up steam (he was on CBC radio this morning), and for more information, or to find out how you can get involved, visit his Weighty Matters blog here.


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The SMART device for weight loss: jaw wiring for the 21st century?

Friday, June 19, 2009 Author: Peter Janiszewski, PhD 1 Response

For some time, jaw wiring, which severely limits ingestion of solid food whilst allowing for somewhat normal ability to speak, was touted as the panacea for obesity. The procedure was performed by orthodontists, and predictably led to weight loss in many obese individuals (not being able to eat will do that to you). Unfortunately, as soon as the ‘wiring’ was removed, the large majority of patients gain all their weight back – probably not surprising given that no actual counseling on proper dietary patterns, or physical activity were ever prescribed along with the 'wires'.

While jaw wiring seems to have gone out of fashion, a new gadget is entering the market which works in a similar way. The SMART (Sensor Monitored Alimentary Restriction Therapy) device is manufactured by Scientific Intake of Atlanta, US. While the full name of the device sure sounds impressive – don’t be fooled – it is nothing more than a tricked out retainer.

According to the Scientific Intake website, the SMART device does the following:

- It makes you take smaller bites, slowing food intake.
- It requires more chewing of food before swallowing.
- It makes “gulping” of food difficult.
- By slowing the eating process, it permits more appreciation (savoring) of the taste, smell, and texture of food.
- By slowing food intake, it permits triggering of your body’s physiological satiety response when you have eaten less food.

The whole notion behind the product is that if you make eating more difficult and laboured people are less likely to overeat. In fact, it is true that some satiety signals lag behind such that if you eat too fast, you may over-consume before your body signals that you have eaten more than is necessary. For this reason, masticating your food slowly has been often recommended to increase the sensation of fullness at an earlier caloric intake. This method has come to be called Fletcherizing, after a health guru of the past (Horace Fletcher) who recommended that each piece of food much be chewed 100 times - a tad extreme.

Indeed, some recent research suggests that slower eating may reduce energy intake among men, but oddly enough, not women.

So rather than learning to eat food at an appropriate pace, or employing dietary strategies to keep intense hunger at bay (i.e. having a protein-rich snack 15 minutes before having a big meal to ‘spoil your appetite’), you can now insert an awkward piece of plastic in your mouth and do your best not to swallow it along with the food you are consuming.

Now, I must commend Scientific Intake for actually providing some research on which this device is based – this is not often done by other companies peddling weight-loss gimmicks. While the website lists a bunch of supporting ‘studies’, many of these are just poster presentations at conferences (not exactly peer-reviewed literature). However, there was one study conducted on a retainer-type device at the prestigious Pennington Biomedical Research Center which was actually published in the journal Obesity Research.

In short, the study showed that compared to a control day (no retainer), individuals wearing the retainer device consumed approximately 500kcals less.

However, there are some caveats to this study:

1. Only two days were assessed: Day 1) no retainer, Day 2) retainer. Thus, we have no idea what happens in the longer term – maybe people become better at eating more and faster once they become accommodated to the awkward sensation of eating with a retainer.

2. As an extension of point #1, there is no peer-reviewed evidence to suggest that this device will result in significant weight loss. My guess is that when people get really hungry – which they will, being in a constant caloric deficit, they will likely dispense with the device and binge.

3. The participants were MADE to wear the device during all meals. This is very different from having the option to do so in a real life setting. A study of this type – an effectiveness study – where subjects are given the device and allowed to go about their normal routine is required before it can be said whether it will actually work for the majority of people.

4. The duration of the meal intake was not measured – sort of a key variable given the thinking behind the device.

5. As clearly stated by the authors of the study,

Further controlled research, e.g., a clinical trial, will be required to empirically determine the long-term efficacy of the DDS System. Until such studies are performed, the findings of this study should be viewed as a preliminary "proof of concept" investigation.”

6. And most importantly, the study was funded by Scientific Intake – the makers of the SMART device. While this does not guarantee a biased study, it surely points in that direction.

If you were reading carefully, you may have noticed that in the above quote, the authors refer to the “DDS system” and not the SMART device. From what I can gather, the DDS system was the original version of what is now the SMART device – only difference is that the SMART device now has an electronic component which allows you to track how many times you used it on a given day – pretty useless, but it allows for the excessively verbose name (Sensor Monitored Alimentary Restriction Therapy).

Also, you should note that despite the company being based originally out of the US, sales of the SMART device are only available in Canada. Their website states:

“SMART has been designated as a non-significant risk device by the U.S. FDA. It is considered investigational and not commercially available in the United States”


According to friend and director of the Wharton Medical Clinic, Dr. Sean Wharton, these devices go for about $500 each. In fact, Dr. Wharton has apparently been approached a few times by reps from Scientific Intake in an effort to get him and likely many other physicians across Canada in the obesity field to prescribe the fancy retainers to their patients.

I have my reservations about any proposed treatment for obesity, that does nothing but make eating a bit less comfortable. Nevertheless, I await the results of a long-term, randomized effectiveness trial of obese individuals prescribed the SMART device to make a final judgment.

Until then, I recommend you save your money.

As a side note, Dr. Yoni Freedhoff of Weighty Matters blog has previously discussed a very similar gimmick called the Diet Guard – basically a cheap version of Invisaligns, which do not straighten your teeth, but make eating uncomfortable.

Have a great weekend,


Walden, H., Martin, C., Ortego, L., Ryan, D., & Williamson, D. (2004). A New Dental Approach for Reducing Food Intake** Obesity, 12 (11), 1773-1780 DOI: 10.1038/oby.2004.220

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Food addiction - fact or fiction

Wednesday, June 17, 2009 Author: Travis Saunders 11 Responses
Photo by Marina Komolova

One topic that never fails to generate a lively discussion is the relationship between obesity and personal responsibility.  For example, in response to a post on psychological exams for bariatric surgery patients, one anonymous reader commented that:

I don't have a gym membership. I'm not even all that active. I live in a bad neighbourhood and i'm floating right around the Canadian poverty line. I'm not obese. When I see a little extra belly building over the winter, I watch how much I eat and try to expend a few extra calories in the comfort of the tiny living room. By blaming any other extraneous factors other than caloric-imbalance, we take away the inherent power from individuals to take charge of their own weight.

While it is convenient to villify obese individuals for their perceived lack of self-control, the evidence suggests that the situation is not so simple.  This topic is explored in depth in this week's special issue of the International Journal of Obesity (IJO) titled "Obesity in a Modern World: When Pleasure Meets Homeostasis".

In a review article in this supplemental issue of IJO, Dr A Dagher of McGill Univesity examines the parallels between drug abuse and food "addiction", and discusses the implications for the current obesity epidemic.The crux of the issue is this; appetite is controlled by two separate systems. The homeostatic system, which is related to energy needs, and the hedonic system, which is focused on palatability and perceived rewards.  If you eat a sandwhich because you are hungry, that is the homeostatic system at work.  If you eat a sandwhich because you had a craving for a Fluffernutter sandwhich, even though you weren't hungry, that's the hedonic system.  

I'm not sure how I feel about food addiction as a disease just yet, (Dr Dagher seems to have reservations about the term as well), but I have to admit there are some interesting similarities between drug-abuse and chronic over-eating.  Both appetite and drug cravings are triggered by reward-associated stimuli - think of smokers who crave a cigarette when they see others lighting up, or the incredible allure of frying bacon.  Further, both food and all drugs of abuse affect the secretion of dopamine, and blockade of dopamine receptors abolishes the cravings for both. Finally, both drug abuse and chronic over-eating are more common in individuals with a heightened drive for reward, otherwise known as impulsivity.  These individuals require more stimuli (be it food, drugs, or adrenaline) to achieve a given level of pleasure or reward.  This last point, as well as possible links between obesity and Attention Deficit Hyperactivity Disorder, is examined in depth in an article by Dr C Davis from the University of Toronto in the same issue of IJO.

Whether or not food addiction is an actual disease seems beside the point to me.  It seems clear that food intake is influenced by hedonic stimuli.  We happen to live in an environment which is completely saturated with these same hedonic stimuli, which target us, and our children, on an almost continual basis.  Think of the ubiquitous ads for McDonald's and Coca-Cola - these are exactly the types of hedonic stimuli which have been shown to increase food intake.  So is it any surprise then that we have an obesity epidemic, as millions of people are constantly being tempted to eat more than they need to?  This very quickly leads to questions of free will and free markets and other thorny issues, but it becomes quite clear that advertising that promotes food intake is not in our societal best interest.  Should we ban food advertising just like we banned cigarette advertising?  I won't go that far... yet.  However, it's becoming increasingly clear that like drug abuse, obesity is not always as simple as sheer will power.

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Related Posts:

1.  Psychological exams for obesity surgery. 
2.  High fructose corn syrup is ruining everything.
3.  Misguided ad campaigns.

Dagher, A. (2009). The neurobiology of appetite: hunger as addiction International Journal of Obesity, 33 DOI: 10.1038/ijo.2009.69

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Want to avoid weight gain? Stay single!

Tuesday, June 16, 2009 Author: Peter Janiszewski, PhD 4 Responses

There are certain changes during life that can have a significant impact on your lifestyle. All are likely aware of the “Frosh 15”: the notion that most undergraduates gain about 15lbs in the first year of university. While I fell considerably short of that prediction during my undergraduate days, when I first came to Queen’s and lived in the graduate residence (and thus ate at the residence cafeteria, which I might add was significantly lower in food quality that that of my undergrad alma mater) I managed to gain at least 5lbs.

Apparently, according to a recent study which is available ahead of print at the journal Obesity there is another lifestyle change which can have a significant impact on your lifestyle. As the title of the article reads, “Entry into romantic partnership is associated with obesity.”

Although marital status is often tied to improved health, greater longevity and lower prevalence of unhealthy behaviours, such as smoking, being in a romantic partnership is also a recipe for weight gain.

First it is important to note that BMI status has long been shown to be highly correlated between spouses. It is hypothesized this correlation is due to the following:

1) Assortative mating – likelihood of individuals to select romantic partners who are similar to them in behaviour as well as appearance. This explains why Brad Pitt is with Angelina Jolie and why Danny DeVito is with Rhea Perlman.

2) Shared household environment – live in the same place and thus the same environmental cues which cause one partner to be inactive and eat unhealthy influence the other.

However, this recent study specifically looks at the likelihood of gaining weight or becoming obese when people enter into relationships and co-habitate.

In one of the analyses, the authors report that over a 6 year follow up of over 11 000 individuals transitioning from being single or just dating to being married doubled the risk of becoming obese over those who did not marry.

In another analysis, the authors also found that “cohabiting and married couples had less healthy profiles for obesity, physical activity, and screen time than dating romantic pairs.” In particular, living together for more than 2 years seemed to up the risk of most unhealthy and obesigenic behaviours.

So what is it about being in a stable and long-term romantic relationship that seems to make us fatter? One theory suggest that there is a general decline in the desire to maintain body weight or general appearance for the purposes of attracting a mate.

So what’s the solution to the apparently inevitable weight gain? Stay single!

On a more serious note, we had previously discussed a paper which reported that obesity (or at least the behaviours that lead to it) are transmitted via social networks – marriage being one of the strongest social ties we can develop. On the other hand, such thinking also suggests that healthy behaviours can also be transmitted from partner to partner.

So if you’d like to be in a relationship and yet avoid the impending weight-gain, maintain a healthy lifestyle and you and your partner will live happily and healthily ever after.


The, N., & Gordon-Larsen, P. (2009). Entry Into Romantic Partnership Is Associated With Obesity Obesity DOI: 10.1038/oby.2009.97

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Nutritionists and Personal Trainers - What's in a name?

Friday, June 12, 2009 Author: Travis Saunders 10 Responses
Photo by ericmcgregor

As obesity, physical activity, and proper nutrition have become increasingly important topics within our society, we are seeing more and more people claim to be "experts" in these respective fields. For example, the news clip I posted Wednesday regarding chocolate and weight loss, included an interview with a "nutritionist". Now that sounds pretty official - he must have some sort of training in order to be called a nutritionist, right? Wrong.

Anyone, and I do mean anyone, can call themselves a nutritionist. For example, "I, Travis Saunders, am a nutritionist". I just did it. I could put that on my business card or resume, and have no fear of ever being sanctioned, because the term can be used by anyone, regardless of education, knowledge, or experience. The title is completely meaningless, and please point that out to anyone who claims to be one. Now if I were to claim that I were a physician, a lawyer, or physiotherapist, there would be serious repercussions. Not so with nutritionist. The term personal trainer is exactly the same - it can be used by absolutely anyone, and just because someone calls themselves a trainer does not mean that they have any training or skills whatsoever.

Why do I bring this up? One of the main reasons that Peter and I started this blog was because we saw so many people promoting training programs and weight loss gimmicks that are misleading, or even dangerous. These people often hide behind terms like personal trainer or nutritionist, which sound official, but really mean absolutely nothing. I get very frustrated when I hear some of the things that personal trainers tell their clients - things that at best are funny and misguided, and at worst can be dangerous and turn people off of physical activity forever. Most major fitness chains require that their trainers have Can-Fit-Pro certification, which requires a whopping 2 days of training. If you have ever taken a CPR weekend course, think about how little you know about life-saving. That is the same amount of training that most personal trainers have. This problem is not trivial - there is much more to personal training than simply showing someone how to lift weights. You need to understand metabolism, common injuries, illnesses, drugs, and how these things should dealt with in an exercise setting. Those aren't things that you can properly address in a 2 day course. It's a similar story with most nutritionists who, in contrast to Registered Dietitians, may have no special training whatsoever. 

Luckily, things are starting to move in the right direction. The Canadian Society for Exercise Physiology offers two certifications - Certified Personal Trainer (CPT) which requires a minimum of 2 years of post-secondary education in Kinesiology, and Certified Exercise Physiologist (CEP) which requires a minimum of a Bachelor of Science in Kinesiology, as well as requiring experience and core competencies in several areas.  In the United States, the American College of Sports Medicine offers similar designations known as Exercise Specialist and Registered Certified Exercise Physiologist. These terms are regulated, meaning that you can only call yourself a CPT or CEP if you have the required skills and education, and have passed a qualifying exam, just like any other professional designation (and in contrast to Can-Fit-Pro, which requires no training other than their own 2 day course). These terms are also being increasingly recognized, and many hospitals and clinics will only hire trainers that have a CPT or CEP.

These new certifications are great for several reasons. First of all, if you are being trained by a CPT or CEP, your trainer is much more likely to have the skills and knowledge necessary to train you safely and effectively. Just as importantly, these new designations make a Kinesiology degree far more valuable than it was just a few years ago. What's the point of doing a 4 year degree, when you can call yourself a personal trainer while you're still in high school? Now that these certifications are being required for an increasing number of jobs within the fitness and health industry, suddenly the Kinesiology degree is far more valuable, because it actually prepares you for a professional certification (just like a physiotherapy or occupational therapy degree prepares you for those professional certifications).

So, if you decide that you want the help of a personal trainer as you become more physically active, ask about your trainer's certifications. If they don't have a CPT or CEP, there is no guarantee that they have the knowledge or skills required to train you safely and effectively. There are enough obstacles to a proper fitness program, your personal trainer shouldn't be one of them.  For a list of Certified Personal Trainers and Certified Exercise Physiologists in your area, contact the Canadian Society for Exercise Physiology

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Have a great weekend,

Travis (Certified Exercise Physiologist)

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Xocai and The Chocolate Weight Loss Diet - Where's the Evidence?

Wednesday, June 10, 2009 Author: Travis Saunders 3 Responses

If you spend any time following the "super" foods that are currently promoted on websites and daytime talk shows, you will certainly have heard about the "miracles" of dark chocolate, one of the super-est of all the super foods. If the Super Foods were the Super Friends, chocolate would probably be Batman (second only to Super Man, a role currently filled by Acai Berry).

Unlike most other super foods like Acai Berry whose proponents just make things up, there is some legitimate research suggesting that dark chocolate has a modest impact on blood pressure and other cardiovascular risk factors, although the research is far from conclusive at this point. For example, one recent article in the American Journal of Clinical Nutrition reports that an acute dose of dark chocolate results in a modest decrease in systolic blood pressure in overweight, normotensive adults. However, another paper published two months earlier in the same journal reports that daily consumption of dark chocolate over a 6-week period in elderly adults had no impact on blood pressure or other markers of cardiovascular disease risk. So right now it's not really clear how (or if) chocolate influences health.

The biggest problem with this area of research is that almost all studies reporting a benefit of chocolate are associated with the chocolate industry. In fact, a 2008 review in the British Journal of Nutrition reports that of 28 papers examining the effects of chocolate intake on health risk, 20 were somehow affiliated with the chocolate industry, while others were supported by the American Cocoa Research Institute, a chocolate lobby group. The fact that a study is associated with industry doesn't automatically mean that it is poorly done, but it does make it more likely that they will find a favourable result. For example, a systematic review in the British Medical Journal found that studies which were funded by the pharmaceutical industry were 405% more likely to report a favourable finding than studies funded by non-industry sources.

The British Journal of Nutrition review (which itself was written by an author from the Nestle´ Research Center) goes on to suggest that:

"Most previous short-term studies have given a single ‘dose’ of chocolate, which is probably more
than one person would normally consume"

So let's recap so far:

1. Chocolate may have modest effects on markers of health risk
2. Most of these studies were funded by the chocolate industry
3. Most of these studies have used a dose larger than people would normally consume

All of this brings me to the Chocolate Weight Loss Diet, a diet which allows you to lose weight while enjoying as much chocolate as you like - or at least that's what the creators of the diet claim on their website. How does it work? According to the Chocolate Weight Loss Diet website, "... of all the properties that exist in raw cacao, one is a powerful appetite suppressant". Unfortunately that claim is completely unsupported by the research. In fact, I cannot find a single study supporting the use of cacao as an appetite suppressant.

The website goes on to claim that cacao "...provides the appropriate amount of vitamins and minerals the body needs, thus decreasing the urges for added "fuel"". First of all, vitamins and minerals are not "fuel". Nor does the body crave "fuel" based on vitamin and mineral intake. And finally, if you are truly concerned that you are not getting enough vitamins and minerals, a diet high in fresh, unrefined foods is almost certainly going to be more effective than eating chocolate.

Of course this lack of evidence hasn't stopped legitimate news organizations from promoting chocolate as a potential weight loss tool. Case in point is the following Canadian news piece which suggests that cacao may be associated with weight loss, without providing any evidence whatsoever to back up the claim (our email subscribers will have to visit our site by clicking on the title of the post to see the clip). Of note, the chocolate product which is highlighted in this clip (Xocai) combines cacao with Acai Berry, the hottest and most misleading weight loss gimmick on the market today (and one which has been thoroughly debunked here on Obesity Panacea).

So, what's the take home message? Chocolate may be associated with some health benefits, but the research isn't clear at this point. What is clear is that there is no evidence that chocolate promotes weight loss, and the potential benefits resulting from chocolate intake pale in comparison to those seen following even a single bout of exercise. So if you're looking for a short-term reduction in health risk, eschew the chocolate for a 30 minute walk.

A big hat tip to Dr Yoni Freedhoff of Weighty Matters for the suggestion of today's topic, as well as the link to the Youtube video. To receive evaluations of other weight loss gimmicks products, as well as the latest obesity news and research via email, please enter your email address into the "Subscribe via email" box in the upper right hand corner of this page.


Related Posts:

1. Acai Berry Scam Exposed: We Called It!
2. Slender Shaper: Another Weight Loss Gimmick?
3. HCG for Fat Loss
Cooper, K., Donovan, J., Waterhouse, A., & Williamson, G. (2007). Cocoa and health: a decade of research British Journal of Nutrition, 99 (01) DOI: 10.1017/S0007114507795296

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Slender Shaper debuts on the Shopping Channel

Monday, June 08, 2009 Author: Peter Janiszewski, PhD 3 Responses

Those who have been following our blog since its inception may recall my rant on the ridiculousness that is the Slender Shaper System back in November of last year. In addition to being the very first post on this blog in which Travis and I evaluate a health and fitness gimmick, the Slender Shaper discussion has actually become our most viewed page (for a long time, if you Googled ‘Slender Shaper’ we were the second link listed, just below the website of the manufacturer of Slender Shaper, Interwood). I’d like to think that we may have ‘saved’ at least a few individuals from wasting their money on this gimmick.

Late last week I stumbled across a program on the Shopping Channel – “Let’s Get Fit Hour” hosted by Orlena Cain, with special guest – health and fitness ‘expert’, Jeannie Daniels. And imagine my joy when I saw these esteemed experts peddling the revolutionary technology of the Slender Shaper System. While the original infomercial for the Slender Shaper was absolutely moronic (as I thoroughly discussed here), I dare say that the Shopping Channel’s rendition might just be the absolute pinnacle of absurdity.

Let’s start with the obvious – the product is absolutely useless, and there exists NO legitimate evidence to support its use in producing anything more than a rash. (To answer a number of questions posed via email regarding my original criticism of the Slender Shaper: No, I have not personally tried the Slender Shaper to test if it actually works. Nor have I jumped off my balcony to test whether gravity exists.)

More interesting than the product itself was the exchange between the show’s host and the Shopping Channel’s resident fitness expert, Jeannie Daniels. As I explained to Travis during an excited phone conversation: “The woman (Jeannie Daniels) opened her mouth and a whole bunch of crazy came out!”

Let us examine some of the wonderfully erroneous advice and claims provided by the obviously aloof Shopping Channel personalities.

So, you may have wondered if any peer-reviewed evidence exists to support the use of the Slender Shaper in fat loss, or muscle toning, or really any function.

According to Jeannie Daniels, plentiful research conducted by “exercise SCIENTOLOGISTS” supports the use of the Slender Shaper. Apparently, Tom Cruise and fellow followers of failed science fiction writer, L. Ron Hubbard are performing some serious scientific studies – who knew!?

I was also curious about the possible chaffing of skin induced by a vibrating belt on your skin.

Not to worry, assure us the Shopping channel experts. “If it’s red (the skin) – it’s ok!” The rash you are likely to develop from the friction of the vibrating belt is apparently a sign that it is working! It just means that the blood is being “pulled” into the area. Jeannie Daniels tells us that when using the Slender Shaper you will “feel a lot of warmth!” You will also feel a lot of warmth while rubbing your knees on the carpet – as in, rug burn. The science of FRICTION!

Also, if you are currently participating in an effective form of exercise, such as jogging, but are unable to do so on any given day – there is an easy and equivalent substitute: you guessed it - the Slender Shaper! Indeed, just plug in the Slender Shaper for “5-10 minutes” and that is “equivalent to jogging for 30 or 60 minutes!” Imagine that – lying on the couch for 5-10 minutes whilst getting a rash from the Slender Shaper is the equivalent to jogging for 60 minutes. There are no words to accurately describe how completely absurd and erroneous this assertion is.

I bet you didn’t know the following:

“When you do squats, you only work your squats.” Well put, Jeannie Daniels, certified personal trainer and fitness expert.

The funniest part of the whole debacle was the attempt by the show host to buffer some of the ‘crazy’ that came out of Jeannie’s mouth. It was like watching “The Office” – painfully awkward and yet hilarious.

Keep up the great work Shopping Channel!


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Equmen 'Core Precision Undershirt' for men: abdominal obesity to a six-pack in mere seconds!

Friday, June 05, 2009 Author: Peter Janiszewski, PhD 3 Responses

No longer will men stand by idly while their female counterparts benefit from the slimming effects of Spandex, LuluLemon pants, and Kymaro’s body shaper. Hitting Holt Renfrew store shelves this week in select locations across Canada (Vancouver, Toronto and Montreal) is a line of ‘slimming’ and ‘shaping’ undergarments for men from Australian company Equmen.

The main page of the Equmen website states the following:

“Equmen high-performance men’s compression clothing is designed to immediately improve how men look and feel, street to sport, work to weekend. Equmen compression undershirts and underwear are engineered with seamless athletic technology and physiotherapist techniques for ergonomic results. Equmen Helix-Mapping Technology focuses on core body machanics – optimizing support, improving posture stability and slimming at the same time. This makes Equmen compression clothing ideal for any man, whether he wants to slim his body under a suit, reduce back pain, or improve performance in a sporting activity.”

Damn, that is impressive! Imagine a simple tank-top that is an all-in-one solution for abdominal obesity, chronic back pain, and lack of athletic ability!

Much like Kymaro’s Body Shaper for women, I have no issue with clothing that helps people look more svelte and thus feel less conscious about their physique, especially when being self-conscious of one’s body may be a barrier to becoming more active. However, elastic clothing that is 3 sizes too small is not a solution to excess adiposity, and despite making you look leaner will not make you any healthier.

Nor will it make you an exceptional basketball player.

Unfortunately, in a number of places on the Equmen website being overweight and sedentary but wearing a slimming garment is equated to actually being active and lean.

For example, one of the celebrity promotions of the products comes courtesy of Les Ferdinand, former England soccer player:

“This is a pretty miraculous product. Although I am not as fit as I once was, this garment makes me feel like I have been back training, without all the sweat!”

Key distinction: Les has not been training, and any sweating he may be doing these days might be caused by wearing undergarments that fail to fit him.

According to Equmen, their undershirt (pictured below) gives ‘a better fit and more tailored look by gently pulling the shoulders back while compressing the core and self-adjusting to your unique body shape.’

Additionally, their underwear comes complete with “Butt lifting technology” and an “Anti-Muffin Top elastic” – I swear, I am not making this up.

In fact, the design of both the man-girdles (shirts) and crotch-crushers (pants) is all based on revolutionary ‘science’!

For example, by wearing Equmen’s wondershirt “blood circulation is improved, which gives you a healthier colour, while comfort is improved via body temperature control. Finally, there is a clear slimming effect as the shirt optimizes the body in all the right places. As a result of these benefits, you will project an overall energy that exudes confidence.”

While the science sure sounds dazzling, how comfortable are these things to wear?

As they have only been available in Canada for less than a week, and more importantly, because they cost about $100 a piece, I cannot personally attest to the relative (dis)comfort of Equmen’s undergarments.

However, a number of reports by journalists in the UK (where the products have been on sale for much longer) give a good indication of what you can expect.

For example, John Waters of the UK Sunday Times describes his first experience with the Equmen shirt as follows:

“I manage to plunge myself into its flapping mouth. Several moments of flailing, grunting and yelping, and I’m in. Actually, no, not quite. Wrinkles of fabric are twisting up my arms, there are air pockets of fabric below my armpits and I’m trying not to fart. Which isn’t surprising, for where’s my stomach meant to go? My breathing is rapid and short, like a hunted creature’s. I’ve pulled on a size large, but according to the Equmen fitting table, I could equally have gone for a medium, my actual size, to “maximise results”. What, total asphyxiation?”

He further eloquently explains how he feels when wearing said garment: “like a marble-filled condom swinging from a rope.”

After also trying on the slimming undershirt, Vincent Graff of UK’s Daily Mail states:

“…Lyrca isn’t just figurehugging, it’s figure crushing. It’s all very well talking about how my vest ‘augments what should stand out and diminishes what shouldn’t’. But, unfortunately there’s a human being inside who is quite attracted to the idea of breathing.”

But wait, there may be something to be gained from Equmen’s Core Precision Undershirts – the exercise of putting them on, as explained by Graff:

“…fighting my way into the tight-fitting top, seemingly made for a nine-year old was the most strenuous workout I have ever endured for months, and that could well have burnt away a couple of pounds.”

Equmen undershirts can be purchased for $90-110 by visiting the website. Once there you can also learn about the fascinating “Helix-Mapping Body Response Technology” and see pictures of a bunch of lean and fit guys unnecessarily wearing slimming undershirts.

And finally, didn't Seinfeld beat Equmen to this idea over a decade ago - anyone remember "The Bro" or "The Manssiere"?

To receive the latest obesity news and research by email, enter your address in the "Subscribe via email" box in the upper right-hand corner of this post.


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Canadian Kids Still Don't Make the Grade

Wednesday, June 03, 2009 Author: Travis Saunders 0 Responses

Each year, Active Healthy Kids Canada produces a report card evaluating the physical activity levels in Canadian youth. Not surprisingly, we have a history of underachieving. In fact, this is the third straight year that Youth Physical Activity Levels have received a grade of "F". However, in contrast to previous years, this year's report card shows signs for hope. For instance, research suggests that 13% of the youth population is now physically active, in comparison to 9% in 2006. That still leaves 87% who are not getting adequate amounts of physical activity, but at least the trend is moving in the right direction (leave it to us Canadians to look at the glass as 13% full rather than 87% empty) .

In addition to an overall grade for physical activity levels, the report card also examines a number of other measures related to physical activity. Highlights of this year's report card were the areas of Sport and Recreation Infrastructure and Community Programming, which received marks of B and B+ respectively. In contrast, two areas of personal interest, Active Transportation (Grade = D) and Screen Time (Grade = F) are both areas that could use a lot of improvement. For example, even though 2/3 of kids live within walking distance of their school, only 1/3 have ever done so. Even worse, 90% of Canadian youth accumulate more than 2 hours of screen time each day. That is a lot of screen time!

As you can surmise from the cover of this year's report card (above photo), a specific focus of this year's report card was the link between physical activity and academic performance. Quoting from the press release:

"The Report Card notes that by improving memory, concentration and attention span, physical activity positively impacts children’s achievement in math, reading, grades, perceptual skill and overall academic readiness. Physical activity has also been shown to increase a child’s self-confidence, self-esteem, self-image and connection to school."

The report card is evidence based, and contains a staggering amount of information on the physical activity levels of Canadian youth. For people interested in this area, it is a must read. The report card is available in a (very) long form, which will likely appeal to the research minded among us, as well as a short form which summarizes things very nicely for the rest of us. For more information on the Active Healthy Kids report card, including power point slides and previous reports, please click here.


UPDATE: To ask Dr Tremblay your own physical activity related questions through the CBC website, click here.

Related Posts

1. Ten simple ways to become more physically active.
2. Public transit users get more physical activity.
3. Can sitting too much kill you?

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Big breasts; a hazard for type 2 diabetes?

Monday, June 01, 2009 Author: Peter Janiszewski, PhD 2 Responses

While it may sound like a ridiculous headline from The National Enquirer, a study published in 2008, actually found that all else being equal – women with larger breasts had an increased risk of type-2 diabetes.

The use of various anthropometric (human body) measurements to help predict disease risk is nothing new. As most are aware, body mass index is widely used to help physicians classify risk associated with excess weight. Also, as I reported in a 2007 study in the journal Diabetes Care, waist circumference (a measure of abdominal obesity) is another important measure of health risk, which gives information regarding your chance of developing type-2 diabetes beyond that explained by body mass index (Read more about this here). However, the notion that big breasts may predict risk of type 2 diabetes independent of other measures of obesity, is novel, and largely unexpected.

In the study, published in the Canadian Medical Association Journal, Ray and colleagues assessed the prospective risk of developing type-2 diabetes according to bra cup size among a sample of over 92 000 women participating in the Nurses’ Health Study II.

The average age of the women at the start of the study was 38 years. During the 10 year follow up, a total of 1844 women developed type 2 diabetes.

After taking into consideration numerous established risk factors such as physical activity, smoking, diet, family history of diabetes, body mass index and waist circumference, among others, it was shown that in a graded fashion, the bigger the bra cup size – the greater the risk of developing diabetes. Specifically, in comparison to women with an A cup, women with a B, C, and D or greater bra cup had a 32, 71, and 58% greater risk of developing diabetes, respectively.

Despite the interesting observation, a number of limitations are inherent to this study.

First, what I did not mention above, is the fact that breast size was not directly measured. Instead, the women (aged 38 years) were asked to recall what bra size they wore when they were at 20 years of age. Given that self-report of current anthropometric characteristics is fraught with significant error and influenced by social desirability, the assessment of bra cup size via self-report is an obvious limitation.

Additionally, while it is assumed that breast size of tissue volume is the outcome of direct relevance, bra cup size (even when measured directly) may be a poor estimate of breast volume given that an estimated 50% of women do not wear the correct bra cup for their breast size.

Despite these shortcomings, the results are quite interesting.

Unfortunately, as is often the case, when the popular media started reporting on this study back in February of 2008, I remember seeing many comments to the effect of: “I had been thinking about breast reduction before, but now that I know I can not only relieve back pain, but also reduce my risk of diabetes, I am definitely going through with the procedure.”

There is absolutely no evidence to suggest that surgically reducing your breast size will lead to health improvement. In fact, to date, only this one single study (with its inherent limitations) shows any association between cup size and diabetes risk.

Until this finding is further explored and supported by additional studies, if you look like Dolly Parton or Pam Anderson, there is no need to fret about your risk of diabetes. More important are factors such as family history and current lifestyle.

More on this topic to follow in the future.


Related Posts:

Ray, J., Mohllajee, A., van Dam, R., & Michels, K. (2007). Breast size and risk of type 2 diabetes mellitus Canadian Medical Association Journal, 178 (3), 289-295 DOI: 10.1503/cmaj.071086

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About Us

We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. Our research focuses on the relationships between obesity, physical activity, and health risk. This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Enjoy.


The opinions expressed here belong only to Peter and Travis and do not reflect the views of any organization. Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.

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