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Who Benefits Most From Bariatric Surgery?

>> Saturday, March 31, 2012

At this week's ISORAM Boot Camp hosted jointly by the Canadian Obesity Network, University of Alberta, and University of Leipzig (Germany), one of the main topics of discussion was bariatric surgery.  While I was only able to attend a fraction of the week long meeting due to my clinic schedule, I had the great pleasure of hearing several great sessions, including the final lecture provided by Dr Arya Sharma.

Dr Sharma, as always, gave a very thought provoking talk, highlighting several points, ranging from the '4 M's' of obesity assessment and management for clinicians to consider, to the '5 A's' of obesity counseling.  When we overeat, he urged us to consider: are we eating in response to hunger (called 'homeostatic hyperphagia' in medicalese), or for the purpose of reward (aka 'hedonic hyperphagia')?

Another of the many topics Dr Sharma explored was the discussion of what type of patient benefits most from bariatric surgery.  He reviewed the 2012 update from the landmark Swedish Obese Subjects (SOS) study for us, which examined the long term effect of obesity surgery on heart attacks and strokes, compared to control patients who did not have obesity surgery.  While the study did show a lower rate of cardiovascular events and cardiovascular deaths in the group that had obesity surgery, it took nearly two decades of study for this difference to emerge.  As the SOS study participants were obese but otherwise quite healthy, this suggests that body mass index (BMI) alone may not be an appropriate criterion to decide who is the most appropriate candidate for obesity surgery.  As has been suggested by many studies since the SOS study began, it may be more prudent to select patients based on whether they have complications of their excess body weight (eg diabetes, severe hypertension, etc), as there may be greater health benefits to be had for these individuals.

Interestingly, the SOS study also found that it didn't matter how high the patient's starting weight was, nor did it matter how much weight the patient lost by having obesity surgery - the reduction in risk was the same.  Again, this suggests that body weight or BMI alone is probably not the best way to decide who stands to benefit most from bariatric surgery - an assessment based on the presence or absence of complications of excess body weight (ie the EOSS staging system) may be far more appropriate.

Congratulations to the CON on another hugely successful meeting!

Dr Sue Pedersen © 2012

Follow me on Twitter for daily tips! @drsuepedersen 


The Science Behind Comfort Foods and the Stomach Brain Connection

>> Saturday, March 24, 2012

Have you ever wondered why you might feel the urge to reach for a chocolate bar or a bowl of ice cream after receiving some bad news?   Or why that baked mac n' cheese really does fit the bill of a 'comfort food'?  The effect on mood that we often feel after eating these foods is not a figment of our imaginations - it is a physiologic reality that high fat foods affect our emotions, and it turns out that it goes farther than the enjoyable taste, smell, or texture of these foods.  In fact, a recent study provides some interesting evidence to suggest that a direct message from the stomach to the brain in response to a fatty meal may play a role in this fascinating phenomenon.

A rather ingenious study (in my opinion) published by Van Oudenhove and colleagues in the Journal of Clinical Investigation infused a solution of either fats or salt water directly into the stomachs of 12 healthy, non obese volunteers (thereby bypassing any satisfaction or pleasure derived from the taste, smell, or texture sensations of a fatty meal).  Along with these infusions, they induced feelings of either sadness or neutral emotion, using pictures and music, and asked them to rate their mood. 

The researchers found that hunger scores were higher during the sad emotion than during the neutral emotion (supporting that a down mood promotes hunger).  While they did not find that the fat infusion decreased hunger compared to the salt water infusion, they did find that the difference in hunger ratings between the sad and neutral conditions was less during the fat infusions than it was during the salt water infusions, suggesting that the fat infusion has an effect to take the edge off of, or lessen the blow of, the effect of sadness on hunger.

They also found that while there was no difference in sadness ratings in the fat infusion versus the salt water infusion, the difference in sadness ratings between the sad and neutral conditions was less during the fat infusions than during the salt water infusion.  Again, this suggests that fat has an effect to moderate sadness such that it feels like less of a roller coaster ride.  

The researchers also looked at parts of the brain involved in sadness using functional MRI, and found that the fat infusions had an attenuating (lessening) effect on the activity of some of these areas of the brain in response to induction of sadness, compared to the salt water infusions.

Putting these findings together, it suggests that there may be a direct signal from the stomach to the brain  after taking in a fatty meal, which may lessen the feeling of hunger that sadness induces, and may lessen the swing between neutral mood and sadness.  What this message is, exactly, is unknown, but it is likely that gut hormones are involved in this fascinating response.

These findings beg the question:  Is the effect of a fatty meal on mood, or mood swings, or perception of sadness, different in people who struggle with their weight, compared to normal weight individuals?  Do people with obesity have less mood modulation after consuming a similar amount of fatty food than nonobese individuals, thereby resulting in the need to eat a larger fatty meal in order to feel better or more emotionally stable?  Or, do individuals with obesity have more mood improvement or stability with eating a fatty meal, thereby providing a greater emotional reward and causing that individual to be more inclined to seek out high fat meals in the future (eg in the case of food addiction)?

Very, very interesting, and most deserving of further research.

Dr Sue Pedersen © 2012

Follow me on Twitter for daily tips! @drsuepedersen


Canadian Diabetes Association St Paddy's Day Road Race!

>> Friday, March 23, 2012

Here's a little something to make you giggle.  We had great fun last weekend on a St Patrick's Day Road Race, in support of the Canadian Diabetes Association.  A reporter from the Calgary Sun thought our outfits were humorous enough to warrant publishing a few photos of our antics.... somehow I thought I looked a little smoother clicking my heels in the air!

It was wonderful being outside, getting some exercise, and doing it for a great cause!

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


Food Addiction - The Giraffe In The Room

>> Saturday, March 17, 2012

In a recent issue of the Canadian Medical Association Journal, I came across an interesting editorial, speaking out against the stigma that medical professionals often display against patients who are addicted to substances, namely, smoking, alcohol, and drugs.  My immediate question was: what about food addiction???

This editorial came in the wake of a study which investigated the negative opinions of hospital staff regarding inpatients who are actively smoking.  The editorial went on to try to break these discriminatory tendencies, explaining that substance addiction is often not a choice, but a byproduct of a genetically ingrained predisposition towards altered perception of want, need, and reward, in the context of a toxic environment or situation that may have led to poor choices.

While I applaud the editorial for this discussion, where, oh where, was the discussion of food and obesity in all of this??  Not only is there a clear stigma amongst health care professionals (proven by studies) as well as the general public against obesity; not only do many people who struggle with their weight suffer some of the exact same genetic and ingrained addictive type brain responses to food as those addicted to other drugs; but, (and perhaps making food addictions the most challenging of them all), food is a substance that the addicted person cannot just cut off and avoid.

Somehow, the person struggling with food addiction must figure out how to break the habit, while continuing to ingest the 'offending' substance every day for the rest of their lives.

Just like people addicted to other substances, the health care profession and society in general needs to be far more sensitive to the issues faced by people who struggle with their weight.  We must blow the stigma to pieces, and help people address their weight struggles with an empathetic hand and a warm heart.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen


Is Global Warming Contributing to Obesity?

>> Friday, March 9, 2012

In parallel with the rising obesity rates around the world over the last decades, so too have we seen an environmental trend of global warming.  I never stopped to consider that the two might be related - until now.

A thought provoking paper just published by my Danish colleagues suggests that there may be a link between increasing atmospheric carbon dioxide levels (as observed with global warming) and obesity.  Breathing in air containing higher carbon dioxide (CO2) level causes the pH of the blood to decrease ever so slightly.   The brain is exquisitely sensitive to these small changes, and the activity of neural cells that are involved in appetite regulation are affected.  In addition, these decreases in pH may affect neurons that regulate wakefulness, resulting in less sleep, which is a known risk factor for obesity.

Therefore, they hypothesize that these small pH changes in our blood seen with higher CO2 concentrations in the air could lead to an increase in appetite as well as energy storage, and could therefore be one of the many contributors to the high rates of obesity that we currently see.

My colleagues went on to test this theory in a small study of six participants, and found that study participants consumed 6.1% more calories when exposed to higher CO2 concentrations in the air, compared to ambient air.  It is noted that this difference was not significant in the study, but a study of a larger size is now needed to see if there is a real difference here.

The obesity endemic, therefore, may be one more important item to add to the list of reasons to put a stop to global warming.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 


Travel Tips for Eating Well!

>> Saturday, March 3, 2012

On a recent trip to visit my cousin Melissa, who was studying in Hong Kong, she was very interested to note how I approached healthy eating while we were on the go in this amazing city.  She suggested that I share my tips and tricks with my readers!

First of all, let me tell you that I absolutely LOVE to travel.  Although I love nature and am definitely an outdoors enthusiast, the main attraction in travel for me is the cultural learning that comes with visiting a new country.   I love learning about people, and I always find that I come home with a better understanding of the dynamic melting pot that we live in.  Food, of course, is intricately tied in to any cultural experience: this includes the unique textures, spices, food types, and of course, the cultural contexts within which eating occurs.    Events with huge and varied amounts of food are often highlights of any trip, and it is often feels like a 'requirement' to eat in order to avoid being impolite.

So how can we survive, and enjoy, these experiences, without packing on extra pounds?  Here are a few suggestions:

1.  Take Small Portions.  This is probably the most important one of them all.  Having just a taste, rather than a full plate, enables you to enjoy the taste sensation without excess calories.

2.  Don't feel obliged to taste everything.  If you are escorted to a table with ten different mouthwatering dishes to take from, consider tasting just 3 or 4 of them.  If you are in a new country for a number of days, chances are that you will have ample opportunity to taste the other dishes on a different day.

3.  Survive the Buffet:  All inclusive resorts can be a lot of fun, but a real challenge as well.   Again, take only 3 or 4 different selections per meal, and trust that some permutation of the other dishes will be available the next day, and the next, and the next....  Portion control is key as well.  Consider the dessert display to be a treat twice in the week, rather than at every meal.  Avoid the ultra high calorie drink mixes, or make them a special treat (daquiris, pina coladas, etc).

4.  Throw it Out: While traveling in a developing country where some people go underfed, it can be especially hard to consider throwing out a portion of food when the serving provided was too large.  Do everything you can to avoid this by asking for smaller servings, but if this is impossible and the food is already there in front of you, remember that eating the extra is not actually bringing any benefit to those who are underfed.

And most of all.... ENJOY!!!

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 



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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