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Time To Act On Obesity!

>> Saturday, July 25, 2015

Unfortunately, there continues to be a powerful stigma against obesity in our society.  This stigma prevails not only amongst the general public, but also amongst health care professionals.  People with obesity are far too often assumed to be lazy overeaters who simply choose not to live a healthy lifestyle.


In addition to referring you to my previous blog posts speaking out against obesity stigma (see here and here and here and here for starters), this week I am sharing an awesome youtube video called 'Time To Act On Obesity'.  It's a great 5 minute primer on obesity, to get a start on understanding some of the many complex aspects that underlie this medical condition.    We at the Canadian Obesity Network (Calgary Chapter) are so taken by the title that it has become the namesake for our exciting upcoming event in November geared towards annihilating this obesity stigma, addressing weight bias and discrimination, and preventing and treating obesity in childhood.  Stay tuned!

Thanks so much to my dear friend and colleague Dr Shahebina Walji, and my friend Krista for the heads' up on this super youtube video.

Follow me on twitter! @drsuepedersen © 2015


Gluten Free Cauliflower Pizza Crust

>> Sunday, July 19, 2015

While pizza is a favorite food around the world, it unfortunately usually comes with a mega dose of calories.  A thick crust, piled high with fatty meats and oozing with cheese all contribute to the final count.   In addition to choosing healthier meats (eg chicken breast) and enjoying a thinner layer of cheese, have you ever considered switching up the crust altogether?  Here's a great recipe for a gluten free pizza crust that is not made with flour, but with cauli'flour' instead!

There are lots of cauliflower crust recipes online - this one is derived from, but I switched up the cheeses and upped the spice content for better flavor.  One slice of this pizza crust has only 67 calories - compare this to a standard pizza crust slice which comes in around 180 calories!


  • 1/2 head of cauliflower, coarsely chopped
  • 1/4 cup parmesan cheese (from a block of parmesan), shredded
  • 1/4 cup part skim mozza cheese, shredded
  • 1 tsp dried basil
  • 1 tsp dried oregano
  • 2 tsp chopped garlic
  • 1 egg
  • salt and pepper to taste


1.  Pulse cauliflower in a food processor until all cauliflower is shredded.

2.  Place a steamer insert into a saucepan and fill with water to just below the bottom of the steamer.  Bring water to a boil.  Add cauli, cover, and steam until tender (around 15 mins).  Put cauliflower into a bowl and refrigerate, stirring occasionally, until cooled (about 15 mins).

3.  Preheat oven to 450F (230C), and line a baking sheet with parchment paper.

4. Add remaining ingredients to the cauliflower and stir until blended.  Pour the mixture onto the baking sheet and form into shape of a pizza crust.

5.  Bake until lightly browned (about 15 mins).

Makes 6 servings.


  • calories: 67
  • fat: 3.6g
  • carb: 3g
  • protein: 5.8g

Thanks to Leah for the recipe idea!

Follow me on twitter! @drsuepedersen © 2015


Fatty Liver - A Dangerous Complication of Obesity

>> Sunday, July 12, 2015

Amongst the long list of medical complications of obesity, one very common complication that is not considered often enough is fatty liver.

Non alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide.  It is divided into:
  • fatty liver (fat deposition) only
  • fatty liver with inflammation (steatohepatitis)
  • fatty liver with inflammation and scarring (fibrosis), which in the most severe cases is called liver cirrhosis 

A recent review by Mary Rinella in the Journal of the American Medical Association (JAMA) reports some sobering statistics on this problem:

  • non alcoholic fatty liver disease (NAFLD) affects 30% of the American population - in other words, between 75 million to 100 million Americans likely have this disease
  • liver cirrhosis is the third most common cause of death in patients with NAFLD
  • 66% of patients age 50 or older with diabetes or obesity are thought to have advanced fibrosis (scarring) of the liver

The diagnosis of NAFLD presents a number of challenges.  Liver enzyme tests (ALT and AST) are normal in 30-60% of patients with fatty liver plus inflammation (steatohepatitis) on liver biopsy, so we clearly cannot rely on these blood tests to make the diagnosis.  Ultrasound can catch many cases of fatty liver, but can miss the milder ones.  MRI is the best non invasive test to detect fat in the liver, but is unfortunately expensive and in limited supply.  

To look for scarring (fibrosis) in the liver, a special kind of test called a Fibroscan (vibration-controlled transient elastography) can be done in a liver specialist's office and is fairly accurate.  MRI elastography may be more reliable, but again is costly and not widely available.  

The best test to look for fatty liver, inflammation, and scarring is a liver biopsy - but of course, this is not without risk.  

In terms of treatment, the only good therapy we are currently aware of is weight loss.   A weight loss of 10% has been shown to decrease liver inflammation.  It also appears that a lower carbohydrate diet is important.  Vitamin E has been shown to have some benefit, but may be associated with a higher risk of prostate cancer and hemorrhagic (bleeding type) stroke.  A number of medications have been looked at (including pentoxyfylline, obeticholic acid, and pioglitazone), but none have been found to be sufficiently effective, and/or have too high of a side effect risk profile. 

It is important for health care providers to consider fatty liver as a possible medical condition in any patient with obesity.  As for treatments, we have a long way to go, but the importance of healthy lifestyle changes seems more important than ever.

Follow me on twitter! @drsuepedersen © 2015


New Obesity Medication - Liraglutide On The SCALE

>> Sunday, July 5, 2015

Liraglutide, a medication that we currently use to treat type 2 diabetes, will soon become available in Canada as a treatment for obesity.  Hot off the presses, the biggest clinical trial to study liraglutide as an obesity treatment has just been published this week in the New England Journal of Medicine.

This SCALE obesity trial enrolled just over 3700 participants, and evaluated the effect of liraglutide 3.0mg vs placebo on body weight, with both groups receiving counselling on lifestyle modification.  To participate in the study, patients had to have a BMI of at least 30, or a BMI of 27 plus high blood pressure or high cholesterol (treated or untreated).  After a year, patients on liraglutide lost 8.4kg of body weight, compared to 2.8kg in the placebo group.

We generally consider a weight loss of 5% to be clinically important, in that a 5% loss of body weight has been shown to be associated with a decreased risk of developing many complications of obesity.  In the SCALE trial, 63% of patients lost at least 5% body weight, compared with 27% in the placebo group.

While patients with type 2 diabetes were not included in this study, patients with prediabetes were included, and were equal between groups receiving medication vs placebo at the start of the study.  After a year on liraglutide, 70% of patients who had prediabetes at the start of the study had normal blood sugar levels; after a year on placebo, only a third of patients with prediabetes at the start of the study had normal blood sugar levels.

In terms of side effects, the most common side effect in the liraglutide group was gastrointestinal side effects (such as nausea or vomiting); 94% of these symptoms were mild to moderate in nature.  Gallbladder related side effects were also more common on liraglutide. Pancreatitis occurred in 0.4% of patients on liraglutide vs less than 0.1% of patients on placebo; the majority of these cases were related to gallstone disease.

Liraglutide will become available as an obesity treatment in Canada later this summer, and is already available in USA.  As the first obesity medication approved by Health Canada in 19 years, it will provide a useful tool in our toolbox to treat obesity, in addition to permanent lifestyle changes.  Our next challenge is now to convince payors (both provincial and private insurance companies) of the need to truly consider obesity as a chronic disease, and accordingly provide financial coverage for obesity medications.

Disclaimer: I was involved in the research trials of liraglutide as an obesity treatment.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of type 2 diabetes.

Follow me on twitter! @drsuepedersen © 2015



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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