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Physical Activity Alone Doesn't Prevent Weight Gain for Most Women

>> Saturday, August 27, 2011

I am often asked by my patients if it is possible to prevent weight gain by maintaining high activity levels, without giving special consideration towards food intake. An important study from the Journal of the American Medical Association tells us that physical activity is not enough to prevent weight gain for most women.

The study by I-M Lee and colleagues surveyed over 34,000 American women over a 16 year period, and asked them to report their weight and physical activity levels. They were classified into one of three levels of activity:
  • less than 150 minutes of moderate intensity exercise per week
  • 150-420 minutes of moderate intensity exercise per week
  • 420 or more minutes of moderate intensity exercise per week (at least 1 hour per day)
The study found that for women who were overweight, there was no difference in weight gain over time between each activity group. It did not seem to matter how much exercise overweight women engaged in; weight gain was the same regardless.

Interestingly, they found that physical activity was helpful to prevent weight gain in some women who were not overweight (ie, with a Body Mass Index of ≤ 25; you can calculate your own BMI here, in the right hand column). It is no cake walk, though (so to speak) - in order for normal weight women to prevent weight gain with exercise, they had to engage in at least one hour of exercise per day.

The take home messages, as I see them, are:

1. For most women, exercise alone is not enough to prevent weight gain. Weight management is more about watching what you eat, rather than how much you exercise.

2. Regardless of whether or not exercise will prevent further weight gain, it is still very important to exercise for its other health benefits!  Exercising for 150 minutes per week has been clearly shown to lower the risk of chronic diseases, so it remains of crucial importance to continue to exercise for the benefit of your overall health.  (Before engaging in, or stepping up, an exercise program, be sure to speak with your doctor to make sure you are making changes safely.)

3. For normal weight women, at least an hour a day of moderate activity is necessary for exercise alone to prevent weight gain over the long haul.

You can read about the Canadian Physical Activity guidelines here to find out how much exercise is recommended.   Check out Health Canada's website for further details, and some great ideas as to how you can work exercise into your daily life!

Dr. Sue © 2011


Alcohol Abuse Risk After Gastric Bypass Surgery

>> Saturday, August 20, 2011

Following gastric bypass surgery, there are many tribulations, but also many trials that a patient may encounter.  One of the challenges that has become apparent is the increased risk of alcohol abuse that has been observed in this population. 

There are several important aspects to consider regarding the risk of alcohol abuse after gastric bypass surgery:

1.  Food addiction looking for a new outlet.  For some people who struggle with their weight,  one of the central issues at hand is a true food addiction.  Research has shown us that some people truly feel an euphoria or a 'high' after eating, particularly from eating calorie laden, tasty foods.  This euphoria is caused in part by a high release of, or robust response to, opioids and other neurotransmitters in the brain, and parallels the response seen in people addicted to other substances.

After gastric bypass surgery, the capacity to eat is greatly diminished, and food preferences may change as well.  The euphoric sensation and response is often decreased or lost, such that many people find a significant decrease in the satisfaction they get from eating.  The hormone and neurotransmitter alterations that occur can result in something that can psychologically even feel like a drug withdrawal.   
Thus, without being able to satisfy their food addiction after surgery, some people turn to other forms of addiction and self-medication, and a common place to turn is unfortunately alcohol (or other drugs).

2.  Need for a coping mechanism.  Big changes happen in the life of an individual who's had gastric bypass surgery.  Many of these changes are for the better, no doubt, but there can be struggles as well.  Depression can ensue for a host of reasons, ranging from the loss of food as a coping mechanism, to negative feelings about the excess skin that becomes apparent after substantial weight loss, to changes in that person's relationship with their spouse or family (which are not always good changes).  Some may turn to alcohol or other substances as a way to cope with these changes.

3.  Alcohol absorbs faster.  Because alcohol reaches the small intestine faster after gastric bypass surgery, there is a high and swift peak in blood alcohol levels.  While this effect is uncomfortable for many patients, others may find it enjoyable, and may find them searching for more. 

The number one way to minimize the risk of alcohol abuse after gastric bypass surgery is knowledge and education about the potential risk, both on the part of the patient, as well as on the part of all of the health care providers that are involved in the pre and post operative care of the patient. 

Having a psychologist closely involved every step of the way is absolutely essential.  Any food addiction or tendency towards addictive behaviors must be assessed and managed prior to surgery.  The risks vs benefits of surgery must (as always) be carefully weighed; surgery may not be the best choice for patients with a true food addiction that has proven difficult to break. 

Patients must be followed and supported closely postoperatively, as they undergo often dramatic changes both physically and psychologically.   Multidisciplinary follow up must continue long term, often for a lifetime, to provide ongoing support and assistance.  In this way, any difficulties encoutered can be met swiftly with support and appropriate interventions, to help these individuals stay on the right track of a successful long term outcome and a healthy long term lifestyle!

Dr. Sue © 2011

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Does the weight of those you eat with influence your diet?

>> Saturday, August 13, 2011

An interesting study in the Journal of Consumer Research says yes - the way in which another person heaps (or doesn't heap) up their plate can affect the eating habits of those eating with them.

In this study from the University of British Columbia, a study participant (who did not know the intent of the study, and thought they were participating in a study of movie viewing) was paired up with a researcher who was thin on one visit, and disguised wearing a 'fat suit' on a second visit. Each pair was offered a snack of granola or M&Ms.

In the first round of study, the thin researcher went first, and took a big helping of the snack. Participants were found to heap their own plates in response, taking even more food than they did when they were in the room alone. When the researcher dressed up in a fat suit and took a large helping, the study volunteers took a smaller amount of food, though they still took more than when they were alone.

In the second round of study, the thin researcher took a tiny amount of food; the result was that study volunteers cut down on their own portions. When the obese researcher took only a little food, study participants indulged a little more.

So what is the psychology behind these findings?

1. When we see thin people taking large helpings, it may provide some (false) reassurance that it is OK to heap up too. The thinking is that if they can do it and stay thin, then it must be ok. What is not seen, however, is what that thin person is eating for the rest of the day, nor what they are doing for physical activity to burn off the excess calories.

2. When we see an obese person taking a large helping, an association is drawn between that person's obesity and their excess caloric intake, which may motivate others around them to scale back their own eating, so as not to gain weight with extra calories themselves.

3. When a thin person takes a small helping, an association is again drawn between that person's appropriate weight and appropriate intake, encouraging others to do the same. When the overweight person takes a small helping, however, the perception is that that person must be on a diet, and if someone around them is not on a diet themselves, the subconscious conclusion may be that it is OK to take a little more on their own plates.

The solution? Don't let other people's eating habits influence your own; remember that when you are meeting someone and eating together over a one hour lunch, that is only a snapshot, and not necessarily representative of what that person is doing or eating for the rest of the day. Stay true to your goals, and what you know you need to do in order to accomplish them!

Dr. Sue © 2011


Chatelaine Interview: The Latest News and Research in Obesity

>> Saturday, August 6, 2011

A few months ago, I was asked to provide an overview of the undertakings at this year's Canadian Obesity Summit in Montreal, by James Fell, fitness columnist, certified strength and conditioning specialist, and the man behind Body For Wife

The complete article can be found at this link.  Below are some excerpts regarding elements of the Summit that I felt were important to highlight.  As some very controversial issues were raised and discussed, I thought I would post these items, and I'd really like to survey my readers as to their thoughts on these issues!  Please feel free to post a comment by clicking on the envelope icon at the bottom of this post - this is how we can get a good dialogue going, and stimulate change in our society!

1. Genetics: “There are least 45 obesity-related genes that have been discovered and each one contributes 2-3kg to body weight. We don’t understand a lot about how they work; some create a different balance in hunger hormones and others cause fat storage. It’s not that some people are genetically fixed to be obese, but it can set the stage.”

Dr. Pedersen also mentioned how a woman who is obese while pregnant increases the prevalence of the child being obese through epigenetic changes that take place in utero.

2. Environment: “There was a lot at the conference about guiding Canadians to lead healthier lives. For example, should there be a junk food tax? Can we create programs to get Canadians to focus on weight loss and healthy eating and getting more exercise?”

3. Childhood obesity:Eight percent of Canadian adolescents are obese, so how do we create good family-based programs to help them lose weight? These have to be focused on the parents because if they lose weight, then the kids lose weight by default.”

Sue also had some interesting comments about adolescents and bariatic surgery. “Lap banding is favoured in kids [in extreme cases where it is deemed necessary] because it is the least invasive and is reversible. The Hospital for Sick Children in Toronto is the only place in Canada that is doing it right now. The decisions for bariatric surgery with children are very challenging.”

4. Adult obesity management: “There was a big focus on weight-loss surgery for people with Type 2 diabetes because the surgery can put it into remission. Having the surgery is done when the benefits of it outweigh the risks. Bariatric surgery can be the appropriate decision for a patient who has failed in all other attempts to lose weight.” Dr. Pedersen stated that such patients require psychological counseling as well, and that this is never a decision to be entered into lightly.

In regards to bariatric surgery, there is not enough funding so the wait list is about five years. Some provinces allow people to pay for it themselves, allowing lap banding for about $16-20 thousand for those who don’t want to wait.

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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