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Eat Breakfast - and Make It High Protein!

>> Saturday, May 28, 2011

We have long extolled the virtues of eating breakfast as an important weight loss and weight maintenance strategy: we often counsel patients to 'eat breakfast like a king, lunch like a prince, and dinner like a pauper'.  A recent study gives us more insight as to just how eating breakfast affects our brain activity and helps us control weight - especially if we load it up with a good dose of protein!

Heather Leidy and colleagues looked at the effects of breakfast eating in overweight, breakfast-skipping adolescent girls.  Ten girls were provided a normal protein (18g) and a high protein (50g) breakfast (each containing 490 calories) for a week each, and their appetite, feelings of fullness, and brain activation responses (using functional MRI scans) were compared to their baseline values in their usual breakfast-skipping habits.

The study found that the addition of breakfast resulted in significant reductions in brain activation responses to food stimuli several hours later, in areas of the brain that are associated with hunger, desire to eat, food motivation, and reward.  Decreased brain activation in these areas (including the hippocampus, amygdala, and others) were associated with lower appetite scores and higher sense of fullness as ranked by study participants.

In addition, the high protein breakfast led to even lower activation in some of these important food intake regulating areas of the brain, compared to the normal protein breakfast.

Therefore, this study shows that eating breakfast may help to regulate brain activity to control eating behaviours later in the day, especially if the breakfast is high in protein. 

So, get out your Egg Beaters, your no-salt-added cottage cheese, your skim milk, and your lean cuts of deli meat - there are lots of options to create a high protein, healthy start to your day!

(Please note that if you have any kidney problems, that you should speak with your doctor about how much protein in your diet is right for you, before making changes to the protein in your diet.)

Dr. Sue © 2011

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Video Blog - Managing the Munchies at Work!

>> Saturday, May 21, 2011

In this video blog, Dr Sue reviews simple tricks to help manage hunger during a long day at the office. Consider baking some chicken breasts on the weekend, which can then be taken to work each day and eaten in various healthy ways for lunch. Bring Ziploc bags packed with healthy greens and store them in the fridge at the office (celery and carrots can make it for a number of hours outside of the fridge)! 100 calorie packs of snacks are available in many varieties at the grocery store as well. Diet pop or sugar free candy is good to have on hand to fight off a craving for sweets!

Dr Sue Pedersen © 2011

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Are We Getting Our 10,000 Steps A Day?

>> Saturday, May 14, 2011

As part of living a healthy lifestyle, it's important to make a point of being active on a daily basis.   Though this used to come naturally to our ancestors, we have to make a purposeful point of moving these days, as our society is built to promote a sedentary lifestyle where we can get most of our daily tasks accomplished without moving much at all.   Thus, one piece of counseling that health care providers often give (including myself!) is to take 10,000 steps a day.  To confirm that I am practicing what I preach, I donned a pedometer a couple of weeks ago to check out my own daily steps.

I must admit to you that prior to this little self-experiment, I was confident that I was well over my requisite 10,000 steps.  I rush around all day long in a whirlwind of activity as many of you do as well - there was no doubt in my mind that I was making the cuts!

Well....was I wrong!

In a crazy day in my clinic, running literally up and down the halls all day, it turns out that I bag only 2,000 steps.  This was a disappointing realization! The first day I discovered this, I thought, no matter, I still have errands to run at the grocery store... those laps up and down the aisles will be sure to get me there.  Nope - just 600 steps more.  (I even took a couple of extra trips down the veggie aisle to buff this up a bit.)  A walk to the gym and back (from the parking lot) gets me another 1,200 steps... and then there's about another 500-1000 steps around the house between the start and end of the day.

My grand total for a typical, very busy day, ranges between 3,000-4,500 steps.  Not even half! 

This is why we all need to have a purposeful focus on activity on a daily basis.   Other than those lucky few of us who truly engage in physical exercise at the workplace (manual labor, or a self-propelled transport/delivery job such as newspaper delivery), we simply do not get enough exercise in our day. 

There are two ways to solve this dilemma:
1.  Focused physical activity (workouts at the gym, running, cycling, skiing, etc)
2. Modification of daily life to accomplish those 10,000 steps! 

The science behind the 10,000 steps is that walking this distance (about 8km or 5 miles) is equivalent to about a 500 calorie burn (though this amount will vary depending on how much you weigh).  If you have a 500 calorie deficit per day, this would result in one pound of weight loss per week - but remember that this has to be 500 calories above and beyond what you take in.  Also remember that if your weight is stable, you'd have to walk an additional 10,000 steps above and beyond what you already do, without eating anything extra, in order to lose weight at that rate.  Sound difficult? - It is!! This is why the studies show overall that exercise alone does not result in weight loss - unless it is accompanied by a calorie reduced diet.  However, exercise remains crucially important as it has many health benefits, and is very important for weight maintenance as well.

Modification of daily life to increase your daily steps can include any number of things:

  • park at the far end of the parking lot (it is interesting to observe people circling the lot at the gym to get the spot closest to the door!)
  • walk into the the store instead of using the drive-thru
  • go to the mall instead of shopping online
  • take the dog for a longer walk
  • get off the bus one or two stops earlier
  • and the list goes on!
Wearing a pedometer is a great way to monitor and motivate yourself - studies show that it is those of us who walk the least, who benefit the most from this wonderful little tool.

For me, I'll keep up my workouts at the gym to make sure I top my 10,000 steps worth of activity each day....and I'll take our dog for a few more trips around the block!

I'd love to hear about your experiences with your pedometer, and how you've modified your life to increase your steps!

Dr. Sue © 2011

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Should Adolescents Have Bariatric Surgery?

>> Saturday, May 7, 2011

Obesity is a serious problem amongst all age groups, and we are seeing obesity affect younger individuals in higher numbers.  It is estimated that 18% of American adolescents and 9% of Canadian adolescents are obese.   In adults, bariatric (weight loss) surgery is increasing recognized as an important treatment option for adults who suffer from severe or complicated obesity, in whom all other treatment options have been unsuccesful.  As such, the question is being raised as to whether adolescents with severe obesity should be considered for weight loss surgery.

This complex issue was discussed at the Canadian Obesity Summit last weekend in Montreal.  I had the pleasure of hearing several speakers from both the US and Canada, sharing their experiences on this issue.

Dr Evan Nadler, pediatric surgeon at the George Washington University School of Medicine & Health Sciences, discussed the various types of weight loss surgeries and the known data to date.   So far, preliminary evidence suggests that lap banding may be the most appropriate surgery to consider in this age group.  Early data suggests that the risks of gastric bypass surgery may be unacceptably high amongst teens, and there is little data regarding sleeve gastrectomy.  All three of these surgeries are being actively studied.

Dr Jill Hamilton, pediatric endocrinologist at the Hospital for Sick Children in Toronto presented the STOMP (SickKids Team Obesity Management Program), an innovative program which provides multidisciplinary support to adolescents with obesity, and for the appropriate candidate, bariatric surgery.  Five patients have been operated so far (with the first ones being done in October 2010), and this is the only pediatric Canadian site that is currently exploring this area.

Dr Beth Dettner, PhD and psychologist who works with the adolescents in the STOMP program, provided a poignant review of the psychological complexities of this population.  There are several challenges involved in selecting the appropriate teen for bariatric surgery: assessing for psychological conditions like depression, anxiety, and eating disorders, assessing family functioning and support for surgery, patients' and parents' understanding of the surgery and required diet and activity behaviours, the teen's coping skills, and their motivations for surgery are all key components.  

I found this to be an absolutely fascinating workshop, and I have a deep and renewed respect for the challenges that face adolescents with obesity, and their health care professionals as they work with these patients to find the most appropriate and successful treatment options.  Elements ranging from the high prevalence of binging and purging behaviours (as high as 30%), to the potential impact of gastric bypass surgery on accrual of peak bone mass, to the possibility of parental coercion to have the surgery, to the challenges of compliance with follow up, to specific motivations for desired weight loss (and the list goes on) all need special consideration in this population, and must be very carefully weighed against the potential weight, health, and psychosocial benefits that can result from successful bariatric surgery.

Dr. Sue © 2011

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I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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