OBESITY PANACEA

Travis' Note: As Peter mentioned in his post earlier this week, things have been very busy for us lately!  Peter is finishing up his PhD thesis, and I am completing the final assignments for my PhD coursework, among other lab projects that we are both involved with.  In addition to PhD-related work, we have some very exciting developments regarding the future of Obesity Panacea, which we will share with you as soon as possible (hopefully next week).  In the meantime, please enjoy this post from the Obesity Panacea archives, and have a great weekend!




DISHMAN, R., DEJOY, D., WILSON, M., & VANDENBERG, R. (2009). Move to ImproveA Randomized Workplace Trial to Increase Physical Activity American Journal of Preventive Medicine, 36 (2), 133-141 DOI: 10.1016/j.amepre.2008.09.038
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That's right - its like a 2 for 1 combo: you can slim your hips, thighs, and abdomen while simultaneously getting larger breasts.

Last time we discussed liposuction, or the surgical removal of subcutaneous (under the skin) fat, we looked at a study that suggested the loss of fat in this manner does not result in the metabolic benefits one gets when losing that same amount of fat tissue via dieting and exercise. Thus in that post, I argued that liposuction does not make you healthy.

While liposuction may not make you healthy, particularly if you are a female, it may increase your breast size. This is a little known fact that is emerging from a number of small studies.

Interestingly, it has been reported that approximately 30-50% of women undergoing liposuction of subcutaneous fat from the hips, thighs, or abdomen present with a paradoxical enlargement of breast size of at least one bra cup.

For example, in an analysis of women who had undergone liposuction at a single center, 25 of the 73 women assessed (34%) experienced an increase in breast size. Two factors which are correlated with a greater likelihood of breast enlargement post liposuction include the removal of a large quantity of fat and liposuction from the hip/thigh and abdominal region.

These findings suggest that liposuction induces a compensatory recovery of body fat that occurs through enlargement of non-removed fat mass, rather than regrowth of removed fat. Lucky for those who want slimmer thighs and bigger breasts but who can only afford surgery for one!

Note: Apologies for the brief post today - my time is almost exclusively being dedicated to finishing up my PhD thesis. In fact, much of the above text is a cut-and-paste from my thesis literature review.

Back to the thesis I go....

Peter Janiszewski

Yun, P., Bruck, M., Felsenfeld, L., & Katz, B. (2003). Breast Enlargement Observed After Power Liposuction: A Retrospective Review Dermatologic Surgery, 29 (2), 165-167 DOI: 10.1046/j.1524-4725.2003.29041.x
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[Travis' Note: Peter and I are both on tight deadlines for school work today, so for today's post we have chosen to re-post an article which was originally published on April 16 of last year.  We will return to fresh content next week.  Have a great weekend!]



It is often suggested that breakfast consumption is key facet of a healthful diet, especially when attempting to lose weight. However, while breakfast may be ‘the most important meal of the day’ the composition of that breakfast must not be overlooked.

Particularly, diets high in fiber are known to be associated with better control of body weight as well as glucose homeostasis. For example, a prior meta-analysis suggests that consumption of greater than 14 g/d of dietary fiber for over 2 d is associated with a 10% decrease in energy intake.

On an even shorter time scale, other studies have shown that eating a breakfast high in fiber, versus a breakfast low in fiber but with the same number of calories, is associated with greater suppression of appetite and food intake during the lunch meal.

A new study published ahead of print in the American Journal of Clinical Nutrition adds further support for the contention that consuming a high fiber breakfast aids in the control of energy balance.

In this study, 32 men and women were randomly assigned to have an EQUAL VOLUME (60g) of either a high fiber breakfast cereal (26 g fiber, 120 kcal) or a low fiber cereal (1 g fiber, 217 kcal). Subsequently their pre-lunch appetite as well as the food consumed during lunch (ad libidum) were monitored (some 3 hours post breakfast).

The study found that while the pre-lunch hunger and the caloric intake during the lunch did not differ between treatments, the cumulative caloric intake (breakfast + lunch) was significantly lower in the group eating the high-fiber cereal by about 100kcal, largely on account of the more satiating effect of the high-fiber cereal (greater fullness for less calories).

So it may be time to trade the Fruit Loops for some oatmeal for your daily breakfast – you may also save some money while you’re at it.

For about 2 years, I have been having a bowl of oatmeal for breakfast, along with some fruit. At first the transition from uber-sweet boxed cereals may be rough – adding some raisins or fresh berries or grapes to the oatmeal eased my transition.

What did you have for breakfast today?

Peter

Hamedani, A., Akhavan, T., Samra, R., & Anderson, G. (2009). Reduced energy intake at breakfast is not compensated for at lunch if a high-insoluble-fiber cereal replaces a low-fiber cereal American Journal of Clinical Nutrition, 89 (5), 1343-1349 DOI: 10.3945/ajcn.2008.26827
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So I agree completely with Yoni's conclusion that we need to keep food advertising away from children (In fact, TV watching in adolescence is associated with poor diet in early adulthood, so maybe we should ban food adverts altogether...).  This makes sense for a whole lot of reasons.  But, if we prevent children from being exposed to food advertising, will the relationship between television watching and health risk completely disappear?  Probably not.

Sedentary time (which includes TV time) is linked with all manner of health problems - from abdominal obesity to reduced insulin sensitivity, and even mortality.  And as we have discussed in the past, these relationships are usually found to be independent of physical activity.  In other words, no matter how much time you spend engaging in physical activity, the more time you spend sitting, the greater your health risk. 

One mechanism that is likely to link TV time (and overall sedentary time) with increased health risk is the relationship between TV viewing and junkfood ads that we discussed above.  Research also suggests that eating while watching TV may result in greater food intake than eating when not watching TV, which is likely another important mechanism linking TV time with health risk.  But these mechanisms focus on the relationship between screen time and increased body weight, and do little to explain the strong association of sedentary time with numerous metabolic risk factors independent of body weight.  For example, Sardinha and colleagues report that the more time that children spend being sedentary, the greater their risk of insulin resistance, even after control for both total and abdominal fat mass. So, how can sedentary time influence health risk independent of adiposity?

It turns out that engaging in sedentary behaviours like TV watching results in rapid and dramatic changes in skeletal muscle.  For example, in rat models, it has been shown that just 1 day of complete rest results in dramatic reductions in muscle triglyceride uptake, as well as reductions in HDL cholesterol (the good cholesterol).  And in healthy human subjects, just 5 days of bed rest has been shown to result in increased plasma triglycerides and LDL cholesterol, as well as increased insulin resistance - all very bad things.  And these weren't small changes - triglyceride levels increased by 35%, and insulin resistance by 50%!

These negative changes are likely related to reductions in the activity of lipoprotein lipase, an enzyme which allows muscle to uptake fat, thereby reducing the amount of fat circulating in the blood (it also strongly influences cholesterol levels - the details can be found here).  Animal research has shown that lipoprotein lipase activity is reduced dramatically after just six hours of sedentary behaviour - not unlike a work day for many individuals. Sedentary behaviour may also reduce glucose transporter protein content in the muscle, making it more difficult for glucose to be taken into the muscle, and resulting in higher blood sugar levels.  What is most interesting though, is that these mechanisms have little or nothing to do with the accumulation of body fat.  This means that both lean and obese individuals (and even those with otherwise active lifestyles), are at increased health risk when they spend excessive amounts of time sitting down.

What's the take-home message? 

Although it's impact on food intake is very important, TV watching (like all forms of sedentary behaviour) is also likely to result in rapid changes in skeletal muscle function, causing dramatic increases in metabolic risk, even for lean or otherwise physically active individuals.  The good news?  Animal research suggests that simply walking at a leisurely pace may be enough to rapidly return these metabolic risk factors to normal levels. 

So, let's work to prevent children from bring exposed to food advertisements, but let's also focus on reducing all forms of sedentary behaviour. 

Travis Saunders 

Zimmerman, F., & Bell, J. (2009). Associations of Television Content Type and Obesity in Children American Journal of Public Health, 100 (2), 334-340 DOI: 10.2105/AJPH.2008.155119
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Since our first post in November of 2008, Peter and I have made over 270 posts here on Obesity Panacea. We're always looking for ways to improve the blog, and we realized that that would be much easier if we knew more about our readers.  We have our regular commenters and have had interesting discussions with many of you via Twitter, but we don't always know why people specifically visit our site, or what type of content they are looking for.

So, here's your chance to improve the Obesity Panacea experience.  We'd like you to leave a comment, or send an email, or a tweet, letting us know who you are, what brings you here, and what you like and dislike about our site.  Would you like to see more interviews, or more practical tips like Peter's recent series on gym etiquette?  More product reviews?  Anything you'd like to see less of?

Any comments or suggestions will go a long way in helping us to make Obesity Panacea a more useful resource for our readers.  We want this site to be a conversation, and the more we know our readers, the easier that will be.  And if you don't feel comfortable leaving your name, remember that people can (and often do) comment anonymously.  We are looking forward to hearing form you!

Have a great weekend, and enjoy the Olympic Opening Ceremonies tonight!!!

Travis Saunders
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For anyone who has spent any time around a gym or even around fervent gym goers, you have probably heard the adage that chocolate milk is the ideal drink of choice post exercise to aid in recovery. In fact, dairy companies have put out commercials advertising the purported athletic benefits of drinking chocolate milk post exercise. I must admit that I personally love a 500ml carton of chocolate milk after my workouts. But is there any evidence to support all the hype?


Now, before I go any further, I want to warn our readers that the evidence I am about to discuss may not pertain to many people who do a leisurely 20 minute jog as their workout. If your goal is weight loss, rather than recovery from intense exercise and thus improved performance on subsequent exercise bouts, then drinking 500ml of chocolate milk (330 kcals) may not be appropriate. Indeed, some obesity experts liken chocolate milk to a liquid chocolate bar – as in, something that should be seen as a treat and thus consumed in minute quantities.

Endurance exercise performance (cycling, running for long distances) depends highly on the amount of glycogen (stored sugar) in the muscle, and intense endurance exercise can quickly deplete these muscle glycogen stores. Thus, it is important to replenish these stores between bouts of exercise to ensure good performance in the subsequent session. However, there is an important window of time after an exercise session during which your body will replenish your glycogen stores – within 30-60 mins post exercise. If you wait over 2 hours to eat or drink something rich in carbohydrate, your levels of muscle glycogen may be half of that if you had the same meal within 30-60 mins of exercise. As this has stuck with me ever since my undergraduate course on sports nutrition, I try my best to time my workouts so that they occur directly before a meal.

With regards to the composition of what you ingest post intense endurance exercise, it is currently recommended that 50-75g of carbohydrates along with some protein (in quantity of 1/4 to 1/2 the grams of carbohydrates, or approximately 15-30g) are ingested soon after intense exercise. Interestingly, one 500 ml serving of 1% chocolate milk includes 55g of carbohydrates and 16g of protein – thus seemingly being designed ideally for post-exercise recovery.

While research directly testing the ability of chocolate milk to help with exercise recovery is a bit scant, I found one good example. In this study, published back in 2006, Karp and colleagues tested 9 trained cyclists by having them perform an interval workout followed by 4 h of recovery, and a subsequent endurance trial to exhaustion at 70% intensity, on three separate days. On each of the 3 days, the subjects received a different drink – a fluid replacement drink (basically water with 30g of carbs - Gatorade) , a specially designed post-exercise carbohydrate replacement drink (~70 g of carbs, 18g of protein, and 1.5 g of fat), and chocolate milk (70g carbs, 18g protein, and 5.0 g of fat) . In contrast to consumption of the fluid replacement drink (basically Gatorade), the ingestion of either chocolate milk or the carbohydrate replacement drink resulted in 50% increase in endurance performance in the test to exhaustion. Thus, it turns out that chocolate milk is better than Gatorade and just as good as specially designed exercise recovery concoctions for helping athletes recover from intense exercise and improve subsequent performance. Keep in mind that chocolate milk is also cheaper than special exercise recovery drinks.

Again, I must emphasize that unless you are exercising strenuously for extended periods of time, and you could care less about your time to exhaustion on your next exercise bout, or if you are exercising for weight loss purposes, chocolate milk may not be the ideal choice. In this situation, as your carbohydrate stores are less likely to be depleted, a nice glass of water will suffice.


Peter

Karp JR, Johnston JD, Tecklenburg S, Mickleborough TD, Fly AD, & Stager JM (2006). Chocolate milk as a post-exercise recovery aid. International journal of sport nutrition and exercise metabolism, 16 (1), 78-91 PMID: 16676705
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Last Friday, Peter wrote a post about Wii-related injuries which generated some interesting discussion.  Essentially, some readers felt that we were being too hard on the Wii, with one commenter going so far as to suggest that the post was "anti-Wii" (hard to dispute, given that the post was focused on Wii-related injuries!).  Although we've mentioned the Wii in passing on Obesity Panacea before, we've never had a full discussion of the pros and cons, and I thought that this would be an excellent opportunity to do so. So - should we really consider the Nintendo Wii as a form of physical activity?

People who feel that the Wii is a good source of physical activity often point out that it raises your heart rate and/or body temperature.  I have played the Wii several times, and Peter has a Wii himself, so I don't think either of us would try to dispute those two facts - when you play the Wii intensely, you can work up a sweat very quickly.  This is also backed up by empirical research.  For example,in a paper in the British Journal of Sports Medicine, Graves and colleagues report that teenagers expend nearly twice as many calories when playing Wii tennis or Wii boxing as they do when sitting passively.

So we can all agree - playing the Wii is better than sitting quietly - but this is not necessarily a ringing endorsement.  Keep in mind, the same could be said about jumping jacks, running on the spot, or even walking.  In fact, in another paper in the journal Pediatrics, Graf and colleagues report that Wii boxing burns roughly the same number of calories as walking on a treadmill at a moderate pace of 5.7 kilometers (3.5 miles) per hour.  Not exactly an intense workout!  And in their paper in the British Journal of Sports Medicine, Graves and colleagues point out that Wii bowling, Wii tennis, and Wii boxing all burn roughly half as many calories as performing those same sports in the real world.  Further, the authors report that if the teenagers in this study were to replace sedentary videogames with the Wii, they would have increased their weekly physical activity by just 2%!  Certainly not a panacea for the childhood inactivity epidemic!

And this is why the Wii is such a controversial topic for those of us working in the field of physical activity.  Yes, it can get your heart pumping, but is that all that really matters?  An editorial in Pediatrics points out that only a few exergaming activities can even be considered as moderate physical activity, and no clinical trial has assessed the impact of exergaming on child health. Certainly we can come up with other creative and engaging ways of increasing physical activity (including turning off the television!) that have the potential to build a life-long love for physical activity, rather than a love for video games.

In fact, this is the real concern for many of us - we fear that exergames like the Wii are far more likely to get kids interested in video games than in physical activity.  Keep in mind that screen time in children is a strong predictor of all sorts of negative outcomes, from obesity to the metabolic syndrome.  Is it worth giving children one more reason to sit in front of a TV, just because it might involve some physical activity?

Now this post is likely to come off as very anti-Wii, but I realize that the Wii is just a tool.  In many situations - including physiotherapy, or improving balance or motor skills in the elderly or those with physical or mental disabilities - I feel that the Wii could prove to be incredibly useful.  And as one commenter pointed out Friday, the Wii can be used to get a great workout when heading to the gym is not an option.  This is very similar to the way that I use my bike trainer, and the Wii makes perfect sense to me in that context.  But as a means of increasing physical activity in inactive children, I feel that the Wii is unlikely to create any tangible benefit, and may even cause real harm by replacing more vigorous forms of physical activity.  Evidence from clinical trials could certainly make me change my tune, but I am a firm skeptic in their absence.

So that's what I think about the Wii - what about you?  Is it worth exposing children to video games just so they can exercise at an intensity akin to walking?  Or is any increase in physical activity an important increase?  Should we place Wii's in our schools and rec centers to attract inactive children, or should we stick with more traditional forms of physical activity (which may or may not engage the most at-risk kids)?  It's a complicated issue, and one that I know is being dealt with by many schools and recreation organizations.  This is going to be an increasingly important issue in the coming years, and I would love to hear what you think!

Travis Saunders

Graves, L., Stratton, G., Ridgers, N., & Cable, N. (2007). Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study BMJ, 335 (7633), 1282-1284 DOI: 10.1136/bmj.39415.632951.80

Daley, A. (2009). Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? PEDIATRICS, 124 (2), 763-771 DOI: 10.1542/peds.2008-2357
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The whole world of exergaming (using video games as a means to get exercise) really came to the forefront when the Nintendo Wii first came out, complete with remotes that you actually had to move in space rather than just pushing a button or two. In time they also added a balance board as part of the Wii Fit game series which involved your whole body and not just your hands. More recently, EA sports created a new series of active games for the Nintendo Wii (Wii Active) which uses a legstrap for one of the controllers to involve the lower body in place of the balance board. As someone who has purchased the Wii Active game I can say that you can get an alright workout on those days when there is a blizzard outdoors. But, thus far, exergaming (from my experience) in no way compares to the intensity as well as the caloric expenditure of more traditional exercise (only so much you can do while jogging in one spot).


An interesting development in the world of exergaming, as discussed in a recent publication in the New England Journal of Medicine is that of injuries sustained by vigorous exergaming. Most of us can remember the sore thumbs we used to get while playing Mario Bros on the original Nintendo console in the early 90’s. In fact, there was a clinical term adopted for the thumb injuries kids were sustaining on account of Nintendo – “Nintendinitis”. As the brief article suggests, “Wiiitis” is also becoming a common problem.

What’s more, due to the more dynamic nature of Nintendo Wii playing, more serious injuries can also be experienced. For example, one 14-yr old girl in the UK sustained a fracture in her foot as she fell off of the Wii balance board during game play, requiring the subsequent use of crutches.

In another example, a 55-yr old woman swung her Wii remote so vigorously that she ended up falling chest first into the corner of her couch, breaking a rib and puncturing a lung in the process. After surgery, she recovered – though likely will not be playing Wii Tennis with nearly as much vigor as before.

And finally, there is also a case report of an 8-yr old girl being hit in the head with a Wii remote which was being swung around by her older brother in the midst of some fierce Wii action. This one seems the least surprising to me, as on the few occasions I’ve played Wii with a group of 4 people – it can get pretty dangerous. Make sure you have a LARGE living room!

Have a great weekend and try not to hurt yourself or those around you while exergaming. Instead, just go for a nice walk outside.

Peter Janiszewski


Eley, K. (2010). A Wii Fracture New England Journal of Medicine, 362 (5), 473-474 DOI: 10.1056/NEJMc0909544
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Shields, M, Tremblay, MS, Laviolette, M, Craig, CL, Janssen, I, & Connor Gorber, S (2010). Fitness of Canadian adults: Results from the 2007-2009 Canadian
Health Measures Survey Health Reports, 21 (1), 1-15
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In the past 2 posts in the series on proper gym etiquette we’ve covered what you should wear at the gym and what personality you should avoid adopting while there. Thanks to all for all the great comments on those 2 posts – it is a whole lot more fun for us when our readers join the conversation (Hint: please continue to do so!)

In the last post in the gym etiquette series, I will wrap up some loose ends, and cover some basic guidelines you can follow next time you head over to your local fitness establishment.

1. Clean up after yourself: This is pretty straightforward. Whether you are done with a cardio machine or any piece of equipment and you left behind a serious pool of sweat, please wipe it down with the towels and alcohol spray that is available at all gyms (I hope, at least). There is nothing more gross and frustrating than getting to your exercise machine of choice to find it covered in someone else’s juicy efforts.

2. Share equipment: When the gym becomes very busy, as mine has been of recent, it becomes difficult to get your routine completed given the traffic. If you are using a bench, and are combining with other exercises performed all over the gym or are taking long breaks between each set, allow others to work in on the equipment with you. These days most of my exercises are done “working in” on equipment someone is already using. If you see someone hogging a piece of equipment that you need to use, just approach politely and ask: “Do you mind if I work in with you?”

3. Safety First! Because many people (mostly guys) feel the need to compete with others at the gym, safety is very often overlooked. While I sometimes think injury to the person acting inappropriately may be a good lesson, it is particularly scary when the actions of one buffoon put others in danger. Here are some basics:

- Always put collars on barbells to avoid weight plates from falling off onto your or someone else’s toes

- I can’t emphasize this enough: don’t pick up more weight than you can handle!

- When running on a treadmill, ensure you can handle the speed you just set, and also avoid looking all around you if your balance is questionable (treadmill wipeouts are dangerous and VERY embarrassing)

- If lifting heavier loads, particularly when doing exercises such as squats, bench press, shoulder press, etc. (any exercise where you can get trapped under your weights or when these are lifted over your head) always ask someone experienced for a spot. When someone spots your exercise, their purpose is to assist you with lifting of the load on the very last repetition (or 2) of that exercise when you are struggling to do it on your own. If you need serious help doing a single repetition of that exercise, it is unwise to go for more as this puts you and your spotter in danger. (I once had to spot a moron on the bench press who could not perform even half a repetition of the exercise without my help, yet continued to do 6 repetitions – with me having to lift close to 100% of the load. I refused to spot this individual on subsequent exercises – don’t become the person no one will spot for fear of injuring themselves.

4. Come clean/leave sweaty: There is nothing wrong with leaving the gym covered in sweat, maybe even smelling a bit rich. In fact, I commend those who actually work their butts off at the gym over those who fall asleep on the recumbent bikes reading novels. Nevertheless, just because you will eventually end up sweaty and gross you should make an effort to arrive clean and wearing fresh clothing. Unshowered bodies develop a foul smell MUCH quicker than showered ones, and re-wearing previously worn gym clothes is never a good idea (unless of course, you want all the equipment in your vicinity to be evacuated so that you get exclusive use). In a previous gym I used to work out at, there was one gentleman who came everyday wearing the same sweat-stained white t-shirt and grey track pants, who would fill the entire space with the scent of a dead carcass within minutes of arrival. After enough complaints from other gym members (I can attest it was almost unbearable), the staff had to ask the fellow to wash himself and wear clean clothes to come back.

As this  is all the venting that I need to do for the time being, this completes our series on proper gym etiquette. Thank you for letting me get years of frustration off my chest – I feel much better (I never imagined how therapeutic blogging could be). For further discussion on proper gym etiquette from a female perspective, please check out the excellent post by our friend ERV over at scienceblogs.com. Also, as always if you have any thoughts or personal experiences you'd like to share please leave a note in the comments section below.

Peter Janiszewski
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