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Canadian Obesity Summit Starts Tomorrow!

>> Tuesday, April 30, 2013

I'm very excited to be attending and presenting at the third Canadian Obesity Summit in Vancouver this week!  There's a fantastic array of workshops, symposia and poster presentations which provide diverse learning opportunities across the spectrum of obesity, from contributors to comorbidities and complications of obesity, to all aspects of treatments from lifestyle through to many topics about bariatric surgery.  I'll be speaking about the effect of newer type 2 diabetes treatments on body weight on May 2 - come and say hello if you're in the neighborhood!

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Longer Sleep (In Short Sleepers) Can Prevent Weight Gain

>> Monday, April 29, 2013

It is well known that both too little sleep, and too much sleep, are associated with obesity.  Reduced sleep in particular is a problem in modern society - I'm sure we can all attest to this!   The optimum amount of sleep is between 7-8 hours for adults.

A recent study led by my colleague Dr Chaput looked at people who habitually slept less than 6 hours per day, and divided them into two groups: those who increased their sleep to a healthier 7-8 hours per day, and those who kept their usual sleep habits.

At 6 years, they found that those who kept their short sleep patterns gained 2.4kg more fat mass than those who changed their habits to longer sleep.

So, for those of us who are certain that we can thrive on less than 6 hours of sleep - it may not be the best for our health in the long run.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


New Bariatric Surgery Guidelines are Out!

>> Monday, April 22, 2013

It's been an exciting few weeks - not only are the Canadian Diabetes Association 2013 guidelines out, but so too have the Clinical Practice Guidelines for Bariatric Surgery been updated!

These guidelines, published as a joint effort by the American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic & Bariatric Surgery, have some exciting new updates and features.

The guidelines address 7 key questions:

1.  Which patients should be offered bariatric surgery? 

2.  Whic bariatric surgical procedure should be offered? 

3.  How should potential candidates for bariatric surgery be managaed preoperatively? 

4.  What are the elements of medical clearance for bariatric surgery? 

5.  How can early postoperative care be optimized? 

6.  How can optimal follow-up of bariatric surgery be achieved? 

7.  What are the criteria for hospital admission after bariatric surgery?

A few headliners that caught my eye:

1.  Sleeve gastrectomy is no longer considered to be investigational; it is now considered to be a mainstream bariatric procedure. (though it has been 'unofficially' considered to be mainstream for some time already)

2.  Emerging data to suggest that bariatric surgery could be offered to patients with a BMI between 30-34.9 with diabetes or the metabolic syndrome, though the current evidence is limited by the small number of patients studied, and the lack of long term outcomes (so far).   See my previous comments on this issue here.

3.  There are excellent preoperative and postoperative checklists to help guide health care providers in terms of what needs to be asked about, checked for, and monitored.

The guidelines are a must-read for anyone involved in the care of bariatric patients.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Sex Drive, Fertility, and Bariatric Surgery

>> Thursday, April 18, 2013

It is a well known fact that obesity is a risk factor for female infertility, and that fertility is often seen to improve after obesity surgery.  While it has been generally thought that improvements in various hormones after surgery are the reason for the improvement in fertility, a recent study suggests that it is not just about the physiology, but also the psychology.

The study, by Dr Legro and colleagues, included 29 women having gastric bypass surgery.  They looked at ovulation rates before and up to 2 years after gastric bypass surgery, and they also looked at responses to a questionnaire designed to assess sexual function.

Interestingly, they found that despite half of these women reporting irregular periods before surgery, 90% were actually ovulating before surgery.  While they did see some improvements in the hormonal parameters of the menstrual cycle after surgery, what was most impressive was the marked improvement in the sexual function questionnaire scores, with the biggest improvements seen in sexual desire and arousal.

It's important to note is that the group in this study was comprised of women who were relatively healthy obese women, so the ovulation rate may have been unusually high in this group.  However, the Bottom Line of the study is that improvements in sex drive and enjoyment may be a major factor in the improvement in fertility seen after gastric bypass surgery.

The most important thing to point out is that pregnancy MUST be avoided for 1-2 years after bariatric surgery (exact recommendation varies by clinic and country), due to concerns for fetal undernutrition and poor fetal growth as well as potential nutritional deficiencies.  Furthermore, there are concerns that the birth control pill may not be absorbed properly after bariatric surgery, and therefore, the pill MUST NOT be relied on for contraception.    Therefore, be sure to speak to your doctor about these issues before surgery, such that appropriate plans can be made to avoid pregnancy until it's safe to proceed.

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Kale Adventures Continued.... Maple Citrus Salad!

>> Monday, April 15, 2013

I'm really getting into the kale phenomenon - it's tasty!  Here's a super easy kale salad recipe - thanks to Pamela Salzman for the inspiration - I toned the recipe down in terms of calories by cutting out some oil.   Many salad recipes out there have way more oil than actually needs to be included.


  • 6 cups of kale, cut into strips (see below) - about 2 bunches
  • 1/2 cup red cabbage, shredded
  • 2 Tablespoons fresh lemon juice
  • 2 Tablespoons fresh orange juice
  • 1/2 teaspoon fine sea salt
  • A few twists of black pepper
  • 2 teaspoons minced shallot
  • 2 teaspoons pure maple syrup 
  • 2 tablespoons olive oil


Strip the leaves from the tough stem, and throw away the stem. Cut the kale into strips, and add the shredded cabbage.  

Mix remaining ingredients together, and pour over the vegggies.  Toss and serve!

Makes 6 servings. 

PER SERVING: (approximate)

CARBS: 10g
FAT: 4.5g

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Canadian Diabetes Association 2013 Guidelines are Out!

>> Tuesday, April 9, 2013

Attention all diabetes health care providers and patients!  The
Canadian Diabetes Association 2013 Clinical Practice Guidelines are
now published and available online.

You can browse the executive summary here.

Helpful information for patients is available here.

Here is a summary of the key changes: (quoted from the CDA guidelines)

  • Diagnosis
    • Use of A1C for the diagnosis of diabetes (A1C ≥6.5%)
    • Use of A1C for the diagnosis of prediabetes (A1C 6.0% to 6.4%)
  • Organization of Care
    • New “Diabetes Patient Care Flow Sheet”
  • Glycemic Targets
    • Individualization of glycemic targets with the vast majority of people with diabetes continuing to target an A1C ≤7.0%
    • Better definition of scenarios in which one may consider a target of A1C ≤6.5% or less stringent target of A1C 7.1% to 8.5%
  • Self-monitoring of Blood Glucose (SMBG)
    • Recommendations for frequency of SMBG for those with type 2 diabetes not receiving insulin therapy
  • Nutrition Therapy
    • Continued emphasis on balanced, individualized nutritional therapy with the inclusion of alternative dietary patterns as options
  • Pharmacological Management of Type 2 Diabetes
    • Achieve target A1C within 3 to 6 months of the diagnosis of diabetes
    • New algorithm for the pharmacological management of type 2 diabetes with emphasis on individualization of agent choice
    • Metformin may be used at the time of diagnosis
    • A1C ≥8.5% at the time of diagnosis should receive immediate pharmacological therapy and consideration for use of ≥2 antihyperglycemic therapies and/or insulin
    • Inclusion of cost table for antihyperglycemic therapies
  • In-hospital Management
    • Targets preprandial blood glucose (BG) 5 to 8 mmol/L and random BG <10 for="" i="" ill="" majority="" mmol="" noncritically="" of="" patients="" the="">
    • BG 8 to 10 mmol/L for critically
    • BG 5 to 10 mmol/L in the perioperative period
  • Vascular Protection
    • New, simplified definitions of who should receive statins, angiotensin converting enzyme (ACE), angiotensin II receptor blocker (ARB), or aspirin
    • No need to assess for high risk as suggested in 2008
  • Chronic Kidney Disease
    • New definition of microalbuminuria of albumin-to-creatinine ratio (ACR) ≥2.0 for both men and women
    • New “Sick Day Management” document for acute illness
  • Diabetes Pregnancy
    • New criteria for the screening and diagnosis of gestational diabetes
  • Diabetes in the Elderly
    • New recommendation for glycemic targets among the frail elderly A1C ≤8.5%-fasting and preprandial BG of 5 to 12 mmol/L

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 188 Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2013;37(suppl. 1). S1-SXX.


New York Soda Size Ruling - Politics Win Over Sound Health Policy

>> Monday, April 8, 2013

In the midnight hour (literally), a restriction on sugary drink size that was about to go into effect in New York was struck down by a judge.  Health care providers across the continent heaved a sigh of disappointment and sadness, as this move was widely viewed as a leadership step in making some important societal changes to help manage the obesity endemic.

The New England Journal of Medicine published an excellent editorial discussing the decision.  I'd love to hear what you think about this - please submit your comments and ideas by clicking on the comments link at the bottom of this blog! (subscribers, you'll need to click on the title link of this email to go to my website to do this)

Dr Sue Pedersen © 2013 

Follow me on Twitter for daily tips! @drsuepedersen


Eating With Your Ears, Eyes, Mouth, and Hands

>> Thursday, April 4, 2013

Think the soundtrack they play at Starbucks is random?  Think again.

It's an interesting concept called multisensory dining, and it's gaining momentum as research to support it continues to grow.

The principle of multisensory dining is that the enjoyment of food is not just affected by how it tastes, looks, and feels, but can even be affected by the sounds you hear when you are eating, and the texture and color of the dishes it's served up in.

Some interesting research findings can be read about here - for example, higher pitches of sound may emphasize sweeter flavors in food, and lower sounds may emphasize bitterness.  As previously blogged, music can also affect how much food we consume at a meal.

Food may also taste different depending on what color of dish it's served in.  Color of plate can also affect how much we eat - having contrast between food color and plate color can help to keep portions under control (read more about this here).

The psychology behind eating patterns is fascinating, and there is still so much for us to learn!

Thanks to my friend Priti for the heads' up on this article.

Dr Sue Pedersen © 2013 

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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