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How Big is the Problem of Obesity in Canada?

>> Saturday, June 25, 2011

A few days ago, a report on Obesity in Canada was released by the Canadian Institute for Health Information and the Public Health Agency of Canada.  The sixty-two page document is a great read for geeks like me, and I'd encourage anyone who is interested in obesity treatment or research to have a read through the entire document (it's a free download).   In this blog, I have chosen some interesting facts and excerpts to share with you.  This is not meant to be a review of the key points of the article - more of a collection of 'did you know?' facts about obesity in our country.

1.  Twenty-five percent of adults in Canada are obese.  (Obesity is defined by a Body Mass Index of 30 or more; you can calculate your own BMI here, in the right hand column).

2.  In the last 30 years, rates of obesity have approximately doubled amongst most age groups, amongst both males and females.

3.  The variation in obesity rates across the country is huge, from a low of 5.3% in Richmond, BC, to a high of 35.9% in the Northern Athabasca region of Saskatchewan.  Urban centres tend to have lower obesity rates than rural areas, with Montreal, Toronto, and Vancouver all having obesity rates below the national average.

4.  The causes and contributors to obesity are numerous and complex (understatement of the century!)  - the report does go in to quite a lot of detail on this.  One interesting fact is that while a higher income (or socioeconomic status) is associated with lower rates of obesity for females, there is no relationship between income and obesity for men.

5.  The cost of obesity to the health care system is about $4.6 billion per year.

The final pages of the report are dedicated to a very important discussion of just how we can combat and prevent obesity in our country.  Potential interventions are categorized into individual person-level interventions, community based interventions, and public policy changes.  Numerous specific interventions are discussed and put forth as potential avenues that we could expand upon in our pursuit of a healthier Canada - now let's see if policy makers, politicians and health care providers take more aggressive action based on these suggestions.

Treatment and prevention are our biggest struggles in our understanding of obesity; as the review cogently notes: 'There is unlikely to be a single solution that will reverse the rising prevalence of obesity in Canada; rather, a comprehensive, multisectoral response may be needed.' 

Dr Sue © 2011

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Can Watching TV Kill You?

>> Saturday, June 18, 2011

That may sound a little melodramatic, but this is what recent research suggests, bluntly put: watching TV for more than 2 hours per day is linked with an increased risk of death.

TV watching is the number one sedentary activity of our time.  Sixty percent of American adults watch TV for more than two hours per day on average, with a slightly lower number of hours logged for our western european counterparts.  

Several studies have examined the association between TV watching and risk of diabetes, heart disease, or death.   The data from several of these studies was recently brought together in a meta analysis by Grøntved and colleagues in the Journal of the American Medical Association.  Upon evaluation of all prospective cohort studies in this area in the last four decades, they found that over 7-8 years of follow up, watching TV for two hours per day is associated with:
  • a 20% increased risk of getting type 2 diabetes; 
  • a 15% increased risk of cardiovascular disease; 
  • and a 13% increased risk of death.

Put another way, for every 2 hours of TV watched daily, the authors found that per 100,000 people, there would be 176 cases of type 2 diabetes and 104 deaths per year. For mortality (death) risk, they found the risk really started to accelerate above 3 hours per day of TV watching. 

It may not seem like rocket science that a sedentary activity like TV watching is associated with increased risk, but it turns out that the relationship is much more complex than that.  As blogged previously, as many as 25% of the day's calories are consumed in front of the tube, and TV watching results in a preference for calorie laden foods (advertising may be partly to blame here).  In addition, emotion, adrenaline, and/or stress generated from watching your favorite, riveting TV program, may result in increased hunger as well.

It is more clear than ever before: let's work to keep our tube time to a minimum and spend the time being active instead!

Dr Sue © 2011

Follow me on Twitter for daily tips! @drsuepedersen


USA Moves from Food Pyramid to MyPlate!

>> Saturday, June 11, 2011

Despite attempts to engender healthy eating strategies in North America with Canada's Food Guide and the USDA MyPyramid, obesity rates are higher than ever before.  On June 2nd, the United States introduced a revolution of sorts to their recommendations - they have thrown out their Food Pyramid and replaced it with a simple, effective strategy: a portion controlled plate!

USDA's MyPlate is the most recent piece in the evolution of America's dietary counseling history (a fascinating history, which you can read more about here).  On the MyPlate plan, Americans are asked to portion our meal on our plate into four categories: vegetables, fruit, proteins, and grains.  Aside the plate is a circle called 'Dairy', which is meant to represent a portion of dairy product with your meal, such as a glass of skim or 1% milk.

On the website, you can hover over and click on any part of the plate to read more about what each food group should entail.

Some of the guiding principles of the MyPlate system include:

  • vegetables and fruits should take up half of your plate
  • vegetables and fruit can be raw, cooked, frozen, or canned, but should not be in oil or with extra high calorie containing sauces
  • at least half of the grains eaten in a day should be whole grains
  • eat at least 8 ounces of cooked seafood per week (adults)
  • enjoy your food, but eat less
  • avoid oversized portions
  • drink water instead of sugary drinks

The MyPlate website contains an absolute wealth of information, including interactive links where you can look up caloric information of your favorite foods with MyFood-a-pedia, find out how much you should eat of each food group in order to achieve your personal goal of weight loss, weight maintenance, or weight gain; and even get help in creating a personalized meal plan!  I really encourage you to have a look around their website, as there are all kinds of fascinating nooks and crannies of extra reading, and lots of user-friendly downloadable one-page summaries of healthy eating hints that are designed to post right on your fridge.

I've long been a big believer in the power of portion control. In my own research, we've shown that a simple portion control tool is useful even to help insulin using type 2 diabetics lose weight - a group in whom it is particularly challenging to achieve weight loss, as insulin is a hormone that can directly lead to weight gain. 

I really take my hat off to the United States for taking this extremely user friendly and pragmatic approach to health eating in America.   Though there are some elements that I would change (for example, I would not recommend dried fruit as it is much more calorie dense than fresh fruit), overall, it is an excellent, practical approach that everyone can access (online or in paper form). While this plate approach is only a small step forward, and does not address the plethora of contributors to obesity in our society, our sedentary lifestyles, or the psychological contributors to obesity, in my opinion it is a great way to help people formulate their eating patterns into a healthier approach on a daily basis.

As it currently stands, the Canada Food Guide remains our only standardized tool to guide healthy eating in Canada.  We are in desperate need of a more practical approach, as the guide can be confusing to follow, can lead to weight gain amongst older adults, and offers no suggestions for modification for people who need to lose weight (making our Food Guide applicable to only a minority of the population, given that 59% of Canadian adults are overweight).  We need to move forward as a nation and follow the good example that the United States has set with the MyPlate program.

Dr. Sue © 2011

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Apartment Building Combats Obesity

>> Saturday, June 4, 2011

The sedentary nature of our society is a key contributor to the endemic of obesity that we face today.  In North America especially, every aspect of our daily life encourages a maximum time efficiency, minimum effort approach.  Cities are engineered for optimum motorized traffic flow with little to no regard for cyclists; many streets have sidewalks only on one side, if at all; elevators and escalators abound.  Hats off to a new apartment building in the Bronx that is designed to promote an active home lifestyle!

The Melody apartment complex, unveiled for the first time earlier this week and due to be inhabited this summer, is a 63 unit complex with several features designed to increase calorie burn.  The stairwell is a simple, yet important feature of this building.  Decorated with bright colors and inviting artwork, they have even installed speakers spouting funky jazz music (yes - dance your way home!).  The stairs are a central and prominent feature, whereas the single elevator is available, but much more subtly placed, and sans music.  

I take a moment to contrast this with my own condo complex: several elevators centrally placed, and it's not even possible to use the stairs to go upward upon entry into the building - the stairs are emergency exit only, with a one way door that locks from the outside. 

I pause for another moment as a recollection of a recent hotel stay flits through my mind: a lavishly decorated elevator with thickly cushioned walls to lean against, and a flat screen TV built into the wall to keep me rooted to the spot!  I looked for the stairs for a while, but I couldn't find them.

There is also a beautiful backyard with a collection of brightly colored exercise equipment for adults, and climbing equipment for children.  Having parent and child exercise facilities in one place makes it easier for all family members to get exercise simultaneously, and the central location facilitates the easy meeting of friends to get in a workout together - support and group activity promotes dedication to an ongoing exercise program.  For rainy days, there is also an indoor gym with big windows to allow lots of natural lighting and keep energy levels high.

Apartments in this complex are reasonably priced between about $105,000-220,000 USD, and is the first building to be designed in concert with suggestions from New York City's Active Design Guidelines, which provides a guide for developing buildings with exercise in mind.

While not every apartment complex will have the finances to support gym facilities, putting a few more dollars into the stairwell and placing it/them more centrally is surely affordable for any builder, particularly if costs are cut on the number or luxury of elevators installed.

Simple things with a big impact - now we're talking. 

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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