OBESITY PANACEA

While Travis and I regularly strive to debunk various health myths on Obesity Panacea, it is always a pleasure when we get the opportunity to expose health misinformation to a wider audience, as made possible by popular media outlets. Not that long ago, Travis was interviewed by Alex Hutchinson of the Globe and Mail to clear up issues pertaining to obesity and mortality. Just last week, I had a great discussion with another Globe and Mail reporter, Hayley Mick, who was seeking to debunk the popular myth of the Freshman 15. The result of that discussion is a wonderful article by Hayley which appeared in print yesterday (you can read online here) in which she generously featured my opinions on the topic and even gave a shout-out to our blog.

Thanks again, Hayley!

It is a common held assertion that the average freshman will gain approximately 15lbs during the 2 semesters of 1st year university or college.

However, my experience and the results of numerous studies suggest that the phenomenon is purely myth, and a student who gains 15 lbs during their 1st year is clearly an exception rather than the rule.

The average university school year is approximately 30 weeks. Thus, to gain 15lbs over the 30 weeks of 2 semesters would require an additional 1750kcals per week – which is almost an extra days worth of calories added every week. That is some pretty serious overeating.

During my first year of university, I definitely did not experience a substantial increase in body weight. If anything, the initial stress of being away from home, the foreign environment, the increased academic workload, being forced to eat cafeteria food instead of my mother's delicious cooking - actually caused me to drop a few pounds. By second semester I was well adjusted, had figured out the 'healthier' eating options on campus, and had re-acquainted myself with regular exercise. When I went home for the summer, I had actually arrived in better shape (and approximately 5 pounds lighter) than when I first departed. In her article,

Hayley referred to me as an example of the “freshman minus 5”.

And what does the research suggest?

A study by Morrow and colleagues investigated the idea of a freshman 15, and was published in the journal Obesity back in 2006. This study has one of the largest samples to look at the phenomenon of freshman weight gain, and is the only one (to my knowledge) to assess body composition. In that study, 137 female freshmen at the University of Oklahoma were assessed for body weight and composition at the start of the school year and again at the end of the spring semester.

While the study did find a statistically significant increase in body weight from the start to the end of 1st year, the average weight gain was approximately 2lbs – a far cry from the commonly touted gain of 15 lbs. And of those 2 lbs, about 25% was due to an increase in muscle.

What’s also obvious when examining the results of this study is that about a quarter of the students actually lost weight during the 1st year, and many maintained their baseline weight.

So while I may be in the minority of those who lose weight in 1st year, it appears to be an experience shared by a quarter of first year students.

Additionally, the freshman 15 is more accurately the freshman 2 – but that doesn’t sound nearly as exciting or catchy.

Regardless of the magnitude of weight change, the transition from home to living on your own is a critical period for developing your own dietary and activity patterns, and thus educating 1st year students on proper nutrition and regular exercise is of utmost importance.

Given the appropriate education, first year students can not only resist weight-gain, they can actually improve on the lifestyle habits they had adopted from their parents over the past 17-18 years.

That is, if your parents didn’t have the best lifestyle habits, moving away from home may be an excellent chance to fix the dietary and physical activity patterns that were handed down to you from your folks.

Of course, I had some friends who did adopt a regular diet of beer, pizza, burgers and video games during university - these individuals fared less well with their weight and health - not to mention their academic performance. But this is far from the norm as often popularized by the freshmen 15 myth.

Debunking the myth that all freshmen gain weight may help remove the excuse to eat unhealthy and become sedentary - we often allow suggestion to affect our behaviour more than we'd like to think. If it is expected that most students will gain an average of 15lbs, the incoming students may feel that how their body will look in 8 months it is out of their control.

So all incoming students - don't buy into the hype and fear-mongering. You are more likely to be a freshman 0 than a freshman 15.

Have a great weekend.

Peter

It has often been recommended in popular weight-loss programs that overweight and obese individuals hoping to shed unwanted pounds should drink more water.

As is often the case, the evidence base behind this recommendation was rather scant. Fortunately, a new study published online in the journal Obesity suggests the recommendation may be quite sound.

In the study, Dennis and colleagues randomized overweight/obese older men and women to either a hypocaloric diet alone or a hypocaloric diet plus increased water consumption for a duration of 12 weeks.

The hypocaloric diet consisted of 1200 calories for the women and 1500 calories for the men. Those in the diet + increased water group were required to consume 500 ml of water (2 cups) 30 minutes prior to each of the 3 large daily meals (breakfast, lunch, dinner).

And what did they find?

While participants in both groups lost a significant amount of weight (5-8kg) in response to the diet, those who also consumed more water before their meals lost an additional 2 kg in comparison to the diet only group.

The greater weight loss in the group consuming pre-meal water could be the result of smaller caloric intake during each meal (~40 calories less per meal), as shown during the baseline laboratory test meals comparing no-water to water meal conditions in all the subjects.

While this is the first randomized trial to investigate the effect of increased water consumption on weight loss, the findings are in agreement with prior epidemiological studies showing that caloric intake in water drinkers is on average 200 calories less than among non water drinkers.

This study provides compelling evidence to encourage all those attempting to lose weight to increase their daily intake of water to help in their efforts. Specifically, one should consume approximately 2 cups of water, about half an hour prior to most meals.

As Travis has previously described, drinking more water will also have the added bonus of forcing you to take bathroom breaks, thereby increasing your level of physical activity.

Peter

In response to a recent letter sent on behalf of the Voice of Young Science Network (of which I am a member), the World Health Organization has stated that it does not support the use of homeopathy for treating HIV, TB, malaria, influenza and infant diarrhea.

In that original letter, young researchers and physicians representing the Voice of Young Science Network, outlined the following:

- Medics working with the most rural and impoverished people of the world already struggle to deliver the medical help that is needed. The promotion of homeopathy for serious diseases puts lives at risk.

- Lists some of the examples of recent and planned developments of homeopathic clinics offering treatment for these five conditions.

- Asks the WHO to make clear that homeopathy cannot prevent or treat these five conditions.

The responses from numerous WHO directors have strongly supported these concerns.

Here are a few examples:

Dr Mario Raviglione, Director, Stop TB Department, WHO: “Our evidence-based WHO TB treatment/management guidelines, as well as the International Standards of Tuberculosis Care (ISTC) do not recommend use of homeopathy.”

Dr Mukund Uplekar, TB Strategy and Health Systems, WHO: “WHO’s evidence-based guidelines on treatment of tuberculosis...have no place for homeopathic medicines.”

Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO: “We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children...Homeopathy does not focus on the treatment and prevention of dehydration - in total contradiction with the scientific basis and our recommendations for the management of diarrhoea.”

As was the hope shared by all in the network, this exercise has created quite the media buzz today being featured on BBC news, among other media outlets worldwide.

Despite the clear condemnation by the most powerful health organization in the world, homeopaths are trying their best to weather the storm.

From the BBC article:
Paula Ross, chief executive of the Society of Homeopaths, states that "this is just another poorly wrapped attempt to discredit homeopathy…”

Touché, Paula! I couldn’t have responded better myself to accusations of being a medical fraud by the World Health Organization. Well played!

For those readers not familiar with the basic tenets of homeopathy, you can click here to download a nice 2-page PDF summary provided by Sense About Science.

In essence, its basic (not to mention completely irrational) principles are the following:

(1) Like cures like: First, homeopaths choose a substance that causes the same symptoms as the disease they want to treat. For example, the runny nose and watery eyes of a cold can be recreated by inhaling onion fumes, so onion juice can form the basis of a homeopathic preparation.

(2) The smaller the dose the more potent the cure: The chosen substance is repeatedly diluted and shaken (also called succussed). This is supposed to reduce the substance’s potential to harm, and also make it more effective.

And what does the scientific literature suggest about Homeopathy’s efficacy to treat or cure certain conditions?

A large scale meta-analysis published in Lancet in 2005 by Shang and colleagues, compared the effects of 110 trials of homeopathic treatments with another 110 studies of traditional medicine matched for disorder treated and the outcome measured.

In the end, after controlling for the poor methodologies of many of the homeopathic studies, the authors concluded the following:

“…there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”

So there you have it, homeopathy’s basic principles are illogical, it is as effective as a placebo, and it is condemned by the World Health Organization for the treatment of many conditions.

If you are still unconvinced as to the flaws of homeopathic practice, then maybe this humorous and yet largely accurate video below may help (email subscribers must log onto Obesity Panacea to view teh video). (Credit for video to Yoni Freedhoff of Weighty Matters Blog ).

As an aside, this whole campaign against homeopathy in the treatment of serious diseases was started by the Sense About Science charity, an independent charitable trust promoting good science and evidence in public debates. It consists of young reserachers and physicians, like us, who can't stand for health myths and thus are on a mission to discredit anything which is not based on a strong evidence base. Check out their website to learn about some of their other pursuits.

Peter

 Photo by Steph & Adam 

If you haven’t heard about it yet, you are in the minority.

The news, blogosphere, academic associations, etc. have been abuzz (rather negatively) regarding a recent cover page story in Time magazine entitled, “Why Exercise Won’t Make You Thin.”

In the story, John Cloud selectively chooses to report singular studies, often incorrectly, misquotes experts, often showcasing his naive understanding of physiology, all in order to arrive at his apparently preconceived (and largely absurd) notion that not only will exercise not help you lose weight – it may actually make you fatter.

In the first page of the article, he asks the question: “Could exercise actually be keeping me from losing weight?”

Throughout the article, Cloud painfully describes with very apparent distaste his “grueling” 4 hours of weekly exercise in a manner that is reminiscent of many infomercials which also attempt to convince the viewer that exercise is too difficult and should be replaced by whatever product being peddled (see the Slender Shaper video for a great example of “painful situps”). The interesting thing about his confessions is that only approximately 90 minutes of his weekly exercise is actually composed of aerobic activity – the very activity you should be doing if your goal is to expend calories.

In contrast, how much exercise do major medical authorities suggest for weight-loss?
Answer: 60-90 minutes of aerobic-type activity on MOST DAYS OF THE WEEK!

Not on one day of the week, as the author is performing.

Throughout the article you get the impression that while he demonizes exercise as the cause of his apparent inability to shed pounds, the likely cause of his issues is his improper nutritional habits. For example, he admits to previously “self-medicating with lots of Italian desserts”. He also describes craving French fries or greasy bourritos after exercising – not sure how common that is…

It should come as no surprise that nutrition is extremely important when it comes to weight management. You can’t expend 300 calories on a jog, follow it up with a 500 kcal bourrito and expect to lose weight. Additionally, when attempting to create a negative energy balance to shed pounds – it is pragmatically easier to restrict food intake than to burn the same number of calories through exercise. Thus, calorie restriction and proper nutrition (taking into account meal frequency, macronutrient composition, etc.) is a critical component of a lifestyle based approach to dealing with excess weight.

However, to suggest that: “Exercise… isn’t necessarily helping us lose weight. It may even be making it harder” is simply incorrect and given the popularity of the publication in which this is written, largely irresponsible from a public health perspective.

Back in the early 1990’s, the popular notion was that exercise interventions are not as efficacious in reducing body weight or fat mass as are dietary ones. Unfortunately, these conclusions developed predominantly from a rather unfair comparison of studies: as an example, comparing weight loss of a dietary intervention reducing daily caloric intake by 700kcal versus an exercise intervention which increases energy expenditure by 300kcal per day. You can well guess who the winner was…

However, in a 2000 study from our lab publiched in the Annals of Internal Medicine, we directly compared the efficacy of diet versus exercise to reduce weight, fat mass, etc. in a group of men after controlling for the caloric deficit created (fair comparison). In that study, over the 3 month intervention, individuals lost about 7-8kg, regardless of the intervention (diet or exercise). Our lab then replicated this study in women and showed much the same results: when carefully controlling for the number of calories – diet and exercise produce the same degree of weight loss. Additionally, from these studies it is also apparent that exercise will result in meaningful weight loss – WHEN it is done in appropriate volume.

Of course, the obvious caveat here is that it is much easier to reduce caloric intake by 1000 kcal than to expend that much via physical activity. Thus, for practical reasons, diet is the cornerstone of weight management.

More important than any this is the following:

Regular physical activity is good for your health and reducing basically any disease outcome (diabetes, cardiovascular disease, cancer, erectile dysfunction, depression, anxiety, etc.) INDEPENDENT of its effect on body weight.

As I have written in published review papers, and have discussed previously on Obesity Panacea, the focus on weight as the primary outcome in lifestyle based obesity interventions is myopic and misguided – and this is really where the author of the TIME article fails. Individuals of all sizes, and ages, can vastly improve their health without a noticeable budge in their scale weight. Thus, true treatment benefit (on lipids, insulin sensitivity, BP, etc.) may be masked by an apparent resistance to weight-loss. This lack of weight change will likely be interpreted by the individual as a treatment failure causing them to discontinue the healthy behaviors.

Unfortunately, this is EXACTLY the conclusion Mr. Cloud comes to at the end of the article, and it is this conclusion that I believe to be the most damaging.

In the last sentence of the article, Cloud sums up by stating that “tomorrow I might skip the VersaClimber…” I truly hope others do not follow TIME’s misguided advice.

While there is much more that I could discuss in regards to this article, I should also point our readers to other sources of disagreement over the contents of the TIME article – some of them, from the very people who were misquoted in the article itself.

For example, the American College of Sports Medicine released a statement disagreeing with the conclusions reached by Cloud in the recent article.

In that statement, Dr. John Jakicic, states: “The statement ‘in general, for weight loss, exercise is pretty useless’ is not supported by the scientific evidence when there is adherence to a sufficient dose of physical activity in overweight and obese adults.”

“Again, it is clear in this regard that physical activity is one of the most important behavioral factors in enhancing weight loss maintenance and improving long-term weight loss outcomes,” Jakicic is also quoted as stating in the statement.

What’s worse, Dr. Tim Church, a colleague of both Travis and I, and someone whom I have gotten to know personally over the years, has come out and said that Mr. Cloud has actually misrepresented his professional opinions in the article. This is rather unfortunate for Mr. Cloud, as much of his thesis rests on the results of a recent study by Dr. Church and his erroneous extrapolations thereof.

I feel there is more backlash to come over the next little while (letters to the editor are a certainty) – I will keep you all updated.

I assure you that I will be writing a letter to TIME magazine scorning them on the rather biased and poorly researched article.

Don’t believe everything you read…


Peter

UPDATE: Click here to read my column on the TIME story published in the Kingston Whig Standard, Saturday August 22, 2009.

Back in April of this year, Jaimil Choudhry of New Hampshire was arrested for driving while intoxicated as assessed using roadside sobriety tests. For whatever reason, he refused to take the breathalyzer test.

Now, his defense lawyer is claiming that the tests used to assess Choudhry’s sobriety were inappropriate given that Choudhry is obese (BMI = 33.0 kg/m2) and thus the charge should be dropped. According to the lawyer, the test which has the alleged drunk driver walk toe-to-heel and then turn should not to be used by police officials on people who appear to be overweight or obese.

The police prosecutor, on the other hand, suggests that basing a drunk driving defense on BMI is a “stretch”.

While the case goes to trial this September, there may already be some precedent for such a case, as a man in Illinois has previously walked away from a similar charge using excess weight as a defense.

 Image by ingorrr.

1. Once people are exposed to sodium, they tend to crave more of it.

2. Our current environment exposes us to very large amounts of sodium.

3. Once people become "addicted" to sodium, they are likely to seek out ever increasing amounts, which will almost certainly mean an ever increasing caloric intake.

What weighs about 2 lbs, is shaped like a phallus, and is used exclusively by women?

Nope – not what you were thinking!

The product I just described is the Shake Weight – the new fitness product sweeping the nation! As described in the brief commercial which has now gone viral on YouTube for all the wrong reasons (see video below to understand exactly what I am alluding to), the Shake Weight is “the revolutionary new way to shape and tone arms ... designed specifically for women!”

Apparently, “in just 6 minutes a day you can get arms you’ll be proud to show off.”

If you have any weight to lose, somehow I doubt that using the Shake Weight for 6 minutes a day will lead to much improvement in body composition in any area of the body. To accomplish this, you need to expend some calories.

But wait, as the commercial plays, I start to think I may have missed something.

The Shake Weight is “based on a completely new workout technology called DYNAMIC INERTIA which ignites the muscles in your arms, shoulders and chest.”

Wow that sounds impressive! Dynamic inertia – that’s got to be good for you! (While I have no idea what this “new workout technology” actually entails, I get the impression it has something to do with vibration training – a topic previously debunked on our site.)

So what exactly is this advanced piece of exercise technology?

In essence, it’s a 2.5 lb dumbbell that you shake.

According to the sexy voiceover, “Scientific studies at a prestigious California university prove that the shake weight increases upper-body muscle activity by more than 300% in comparison to traditional weights.”

As we always try to do at Obesity Panacea, I attempted to find out more details about these studies from this mysterious university, but alas, the Shake Weight website was not working: “HTTP Error 404 - File or directory not found”. This is always a good sign.

However, I did uncover by reading some other (potentially unreliable) sources that the “prestigious” California university in question was actually DeVry.

Then comes the typical product endorsement…

Is this a glowing product endorsement by a physician, or researcher, or exercise physiologist?

Nope, instead the Shake Weight is endorsed by Lindsey Reese, “Professional Personal Trainer.”

You must have heard of Lindsey Reese! No? Ok, me neither.

Lindsey believes that the Shake Weight is the “fastest, easiest, and most effective way to get a beautiful, defined, and sexy upper body.”

ALERT: If this woman is your personal trainer, you should be VERY worried.

You can work your biceps, triceps, shoulders, and chest – all for $19.95! What a steal! (Keep in mind this only buys you ONE 2.5 lb dumbbell).

But wait – there’s more!

Included for the listed price, is a bonus revolutionary exercise DVD which will show you how to perform the most basic exercises ever (i.e. lunges) – but I bet you’ve never done lunges whilst holding a vibrating sex-toy above your head!

Remember – this is revolutionary exercise technology!

Dynamic Inertia!

Science!

(If you are baffled by the highly punctuated and ‘loud’ tone of today’s post, please click here to view a previously featured silly video which should clear things up).

We usually like to direct our readers to the source of the product, in the unlikely event they weren’t convinced by our analysis and were interested in purchasing the discussed product. Unfortunately, as the official Shake Weight website is out of order, you will just have to try eBay.

Enjoy the video.

UPDATE: check out the newly released Shake Weight for Men!

Peter




[Note: Thanks to dedicated Obesity Panacea follower and friend, Andrew for bringing this wonderful video to our attention.]