OBESITY PANACEA

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.

Travis

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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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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Peter


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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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 www.catworkout.com.

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.

Travis
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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.
















Interesting…








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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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:


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.

To have similar posts on the latest obesity news and research delivered directly to your inbox, enter your address in the Subscribe Via Email box in the upper right-hand corner of this post.

Travis

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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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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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. 

To receive similar posts on the latest fitness news and research via email, enter your address in the "Subscribe via email" box in the upper right hand corner of the blog.

Have a great weekend,


Travis (Certified Exercise Physiologist)
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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:


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.

Travis

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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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 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.

Travis

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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