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Decreasing Food Variety May Help Control How Much You Eat

>> Sunday, July 31, 2011

We all know it to be true: by day 2 or 3 of eating the same leftovers, most of us are good and tired of that meal and ready to enjoy something new.  Most of us look for different things to eat each day, to enjoy a constantly changing taste sensation.  Perhaps we should not be too quick to switch up our meals, as research suggests that eating in a more repetitive pattern may be beneficial in controlling our food intake.

A recent study tested the difference in food intake patterns in a group of women served macaroni and cheese every day for 5 days, versus once a week for 5 weeks.  They found that the women who received the meal once a week ate about the same amount each week, whereas those who received it every day had a gradual decline in the number of calories they consumed.  These results were consistent for subgroups of both obese and non obese women.

Thus, it appears that eating in a more repetitive fashion may be beneficial for prevention of weight gain and as a weight loss strategy as well.  As discussed in an accompanying editorial to the article, public health policy planners and school lunch menu planners should take this information into careful consideration - a plethora of variety on the menu may not be a virtue.

Of course, eating the same meals every day would be detrimental if there is not enough variety, as a varied food intake is crucial in ensuring that we obtain all of our necessary vitamins and minerals.  Consider a strategy such as this: If you were planning to make seven different dinner meals in a week and you were planning to repeat this menu each week for a month, consider instead eating the same meal for four days in a row, then switching to the next one (you may need to re-cook the same meal to ensure your food is fresh).  This would also simplify the grocery shopping!

I'm interested to hear what my readers think!

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Why We Hit a Weight Plateau (and then Regain)

>> Sunday, July 24, 2011

It's a common occurrence: After weeks of following a successful diet plan, with weight coming off surely and steadily, the rate of decline in the numbers on the scale starts to almost imperceptibly slow...slow.... and stop.  Welcome to the weight plateau, and the frustrations that come with it.  Even worse, the weight plateau is most often followed by a tipping of the scales in the opposite direction, and the ultimate frustration as the pounds begin to add up again.  Let's take a look at why this weight plateau happens, why weight regain most often ensues, and what we can do about it!

The short answer and hard truth of the matter is that our bodies and brains are evolutionarily wired to allow us to collect energy, and to restore energy (in the form of fat) if energy stores are depleted (as in the case of weight loss).

As nicely reviewed by Paul MacLean and colleagues, here are some of the mechanisms that may be involved (and this is not an exhaustive list!):

  •  Leptin levels drop proportionally more than fat mass.  Leptin is a hormone secreted by fat tissue, whose primary effect is to tell our brains that we feel full (it is therefore a 'satiety' hormone).  Because leptin is made by fat, we could expect that leptin levels drop as fat mass declines, which is true; however, the leptin levels drop lower than expected, leaving us feeling even hungrier, and giving us more drive to eat and regain weight. 
  • There is a small drop in adrenaline levels and thyroid hormone levels with weight loss, which results in a lowering of metabolic rate and 24 hour calorie burn.  
  • There may be a reduced biological drive to be physically active, following weight loss. 
  • When we lose weight, we inevitably lose some lean body mass (muscle tissue) along with the fat. This can be minimized by increasing physical activity, but some muscle will be lost nonetheless.  People who lose proportionally more lean body mass with weight loss will have a lower 24h calorie expenditure, making it easier to hit a weight plateau. 
  • Our brains do not appear to reset our appetites to account for the lower energy needs with a lower body weight.  Instead, our brains are wired to try to bring us back to the weight we were previously.  The sensitivity of our brains to hunger signals appears to be increased, and sensitivity to fullness hormones decreased, following weight loss. 
  • There may be genetically ingrained processes in the muscle, liver, and fat tissue of people who have previously been obese, that work in favor of promoting weight regain, that are not present in individuals who have never been overweight (as they have never had this genetic tendency).
  • Animal studies and some human studies suggest that weight loss results in an increase in the number of fat cells, which drives weight regain.
  • A different type of bacteria inhabit the intestines of obese individuals compared to lean individuals, and these bacteria may have a different influence on our metabolism.  It is not yet well understood what happens with these bacteria after weight loss, but it is thought that they may play a role in promoting weight regain as well. 
Taken together, the sum of the evidence to date suggests that that there are many factors (many of them being genetically determined) that permissively allow us to gain weight in our toxic, sedentary, easy food access environment.  Once an individual has become overweight or obese and loses weight, changes occur in their physiology which try to prevent weight from coming off, and actually promote weight regain. 

These mechanisms evolved over millions of years, while the human species was fighting to survive periods of famine interspersed with periods of feast.  The trouble with the current day situation in most countries around the world, is that there is a continual feast.  Food surrounds us at every turn, and often these are foods that are poorly satiating with high caloric content to boot!

So, what can we do about this?  Well, the first step is to understand why the plateau and weight regain often happen, as this can help to decrease some of the frustration associated with it (knowledge is power!).  The good news and next step is, that these elements that promote weight regain are not insurmountable, and can often be counteracted with constant attention towards:
  • eating a more satiating (higher protein, lower carbohydrate) diet; 
  • making a conscious effort to be active in daily life; and 
  • programming and planning regular dedicated exercise. 
Remember to speak with your doctor about what is right and safe for you, before making any changes. Also remember to view any lifestyle changes as permanent; there should be no such thing as a temporary 'diet'.

Hopefully we will also move forward in our development of medications that may be helpful to maintain weight loss and prevent weight regain.

And, of course, it goes without say that on an individual and population level, prevention of obesity in the first place is a Number One priority.

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Berry Sorbet Lemon Cups

>> Saturday, July 16, 2011

Here is a fantastically healthy dessert recipe that is aesthetically pleasing, low calorie, and diabetic friendly! I've seen different variations of this on many websites; I think it tastes wonderful with blueberries, blackberries, or raspberries. You decide which is best!


  • 6 lemons
  • 2 cups frozen blueberries or blackberries (or both!)
  • 1/2 cup Danone Silhouette 0-Plus berry flavored yogurt
  • 1 1/2 tsp lemon juice
  • 1 packet of Splenda sweetener

Cut a slice from the stem end of each lemon about 1/5 of the size of the entire lemon. Cut a sliver of peel from the opposite end so the lemon has a base to stand on. Carefully scoop out the flesh from inside the lemons, keeping the peel intact. Put the shells in a resealable freezer bag and freeze for at least 3 hours.

Just before serving, put the frozen berries directly into a food processor, and pulse until finely chopped. Add the yogurt, lemon juice, and Splenda, and process until smooth.

Spoon the sorbet into the lemon shells and serve immediately!

Makes 6 servings. Per serving: only 40 calories, and 9g of carbohydrate!

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


The Trials and Tribulations of Urban Transport

>> Saturday, July 9, 2011

In last week's post, I blogged about the sad state of some rural Canadian roads - the shoulders being too narrow and covered in rumble strips, with no option for a cyclist to safely enjoy a day on the road.  This week, allow me to rant about the problems that plague urban North America, making it difficult, and sometimes impossible, to get around on our own steam!

For the first time since I started working at my current clinic location (and that's a year and a half!), I decided to brave the roads and cycle to work one day last week.  I live 5km from my office, so it would seem on the surface that it would actually be very convenient to cycle there.  Well, let me tell you... I am not sure how many lives I'm going to get, but I think I used up about a dozen of them during that 10 km round-trip adventure.  Although Calgary is known as a city with one of the best cycling path systems in Canada, this system is only useful for daily transport if you are so lucky to both live and work somewhere along its length.  Most of us are not so geographically lucky to have both work and home on the system, so we're exposed to the elements of regular traffic if we want to ride.

 Obstacles/health hazards encountered on my adventure to and from work included:
  • no cycling lanes 
  • drivers who did not show any interest in yielding to, or even minding, the cyclist; 
  • sidewalks did not have graded curbs on the corners (making these areas highly inaccessible to people in wheelchairs, never mind bikes)
  • many through roads were blocked off by industrial companies with fences around their properties, necessitating back tracking and finding curcuitous routes
  • random hubcaps, broken glass
  • the same train track had to be crossed three times before reaching my destination

So for me, some big changes would have to be made before I would consider riding my bike to work again.  Our new mayor has made it a priority to improve cycling access and safety, so let's see what happens.  Contrast this with the year I spent working at the University of Copenhagen, where the society is so geared towards bike travel that it actually dissuades one from wanting a car.  Coincidentally, I lived the exact same distance from work in Denmark that I do here in Calgary (5km), and when I calculated the calorie burn over a year of cycling to work - it equated to 18 pounds of body fat!  This focus on self powered transport is one contributor to the lower obesity rates seen in Denmark (11%, compared to 25% in Canada, and 34% in USA).

This week's biggest hats off goes to the people of the Netherlands, who are turning to cycle powered school buses to help their children stay active and safe (pictured above)!  I love it.  It appears that the company that makes these buses, De Caferacer, also makes these buses for adults (if there are any Dutch speakers out there who can help me out with the website, please feel free to comment on this post - my Danish is not saving me here!).

For those of us back in North America - we'd sure love to incorporate these self powered buses as transport, but the reality is that our entire society will require an infrastructural overhaul before that would even be possible.  Fair enough to say that our climate is not as permissive of this form of travel, but for half the year, it would still be a blessing!

Thanks to my friend Brian at for the heads' up on the great photo!

Dr Sue © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Ready to RUMBLE??

>> Saturday, July 2, 2011

North America suffers some of the highest rates of overweight in the world, with 66% of American adults and 59% of Canadian adults affected. Although the list of contributing factors is long and complex, there is no doubt that an infrastructure and attitude that promotes sedentary living is clearly a major issue.

I took the above photo at last year's meeting of the American Diabetes Association in Orlando, FL, USA. This is one of the largest gatherings of health care providers interested in the treatment and prevention of diabetes on earth, and yet, when offered the option, the escalator was usually preferred to the stairs. Part of the problem here was the construction of the conference centre: while an escalator is certainly important for accessibility for people unable to take the stairs, are two sets side by side really necessary?

For people who try to engage in more healthy leisure activity, golf has really taken off as a popular activity. Golf can provide fantastic exercise; within the space of an afternoon, several kilometres can be walked and enjoyed with friends or colleagues. Sadly, many golf courses now don't allow patrons to walk the course, insisting that they use a buggy so that more players can be moved through! While golf courses were previously built to walk, many are now developed with the goal of maximizing real estate property on the course, which results in an enormous golf course which may not even be practical to walk.

The tipping point which stimulated me to write this blog on this particular week was a recent experience I had on the rural highways in Southern Alberta. I was out for a fantastic ride on my road bike on a fairly quiet highway, with beautiful views and great weather to accompany me on my journey. The shoulder was narrow, but I felt comfortable.... until I came upon a long stretch of rumble strips that had been planted in the middle of it! Unfortunately, there was no cycle path alongside for cyclists to move to; the choices were to brave the traffic, or turn around. This is in stark contrast to many other countries around the world, where there is a priority on accessible and safe self-powered transport, which not only helps to keep people active, but also saves on CO2 emissions and keeps road traffic more manageable. I certainly understand the need to alert drivers with rumble strips if they get distracted and are edging towards the side of the road, but this should not be at the sacrifice of others who are trying to enjoy the road under their own steam.

As North Americans, it is upon each of us to work exceptionally hard to find ways to stay active in our environment. Maybe it's time to rumble with policy makers to make our infrastructure more conducive to physical activity.

Dr Sue Pedersen © 2011



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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