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Does Exercise Improve Fatty Liver Disease?

>> Thursday, July 28, 2016

Nonalcoholic fatty liver disease is a potential consequence of carrying excess body weight, and is essentially caused by extra fat being stored in the liver. It is the third most common cause of liver cirrhosis, and affects up to 30% of the world’s population. 

Weight loss has been clearly established as the first line treatment for NAFLD, and we know that most successful weight loss strategies focus most attention on reducing calorie intake, with exercise playing only a minor part.  However, we know that exercise can have many cardiometabolic benefits even if a person doesn’t lose weight because of it, so it would be interesting to know if exercise itself could improve NAFLD.

A study was recently published in JAMA Internal Medicine which addresses this question.  In the study, 220 participants with NAFLD were randomly assigned to moderate exercise (brisk walking for 30 mins, 5 days per week) for a year, vigorous exercise for 6 months followed by moderate exercise for 6 months, or no additional exercise for a year.

They found that moderate and vigorous exercise were equally effective to reduce fat content in the liver, and that most (but not all) of the effect was mediated by weight loss. 

So, while actual reduction in weight remains the key factor in improving fatty liver, exercise may play some role even if the exercise itself doesn’t shed a whole bunch of pounds.  And it is good news that moderate activity is just as good as intense activity, as moderate exercise regimens like walking are more likely to be adhered to in the long run.

Follow me on twitter! @drsuepedersen © 2016


The Pokémon Go Revolution - What Public Policy Couldn't Do

>> Thursday, July 21, 2016

We've all seen it: Pokémon Go users are everywhere!  Since it's launch earlier this month, we have seen people everywhere, more enraptured by their smart phones than ever before, playing the game with a joyous enthusiasm.

The engagement in Pokémon Go is paying off in physical activity.  Tracking devices such as Jawbone have seen a major increase in physical activity since the game was launched:

We have never seen any public policy or population based strategy have such an incredible effect on physical activity.  I had a patient in my office this week (who had just found a Pokémon under my examination table) tell me that the game had caused her family's 15 minute walk to turn into a 45 minute adventure where the family enjoyed extra fun time together, and a whole lot more exercise! These stories are abundant on social media.  So cool!

I felt like a massive LED light went on in my brain when I heard about this game - of course!  What a great way to motivate activity, by blending a fun smartphone game with real life exercise.  While this particular game may be a fad, I'm sure that other games are now in hot pursuit to develop the next ones.  I hope that this is the beginning of what may be one of the most successful (and hopefully sustainable) population level 'interventions' to motivate physical activity.

A note to be careful when using this or other games - there have been reports of people falling off of cliffs and standing in freeways playing the game, or playing the game in sensitive places like graveyards - do be careful and mindful when you are enjoying your Pokémon Go adventures.

Follow me on twitter! @drsuepedersen © 2016


Obesity Eradicated!!

>> Thursday, July 14, 2016

I opened my inbox at 5 o’clock in the morning as I prepared to take my fist sip of coffee the other day, and my sleepy eyes fell upon a medical journal article that started like this:

While a major driver of chronic disease burden at the
turn of the century, obesity has been largely eradicated.
With the majority of pregnant women maintaining
healthy weight gain and good nutrition, children are
starting life with better epigenetic risk. A societal reinvestment
in health has resulted in the majority of
Canadian children and adults having more than double
the minimum recommended amount of physical
activity and advanced skills in household management
at school leaving. A holistic understanding of
the root causes of obesity has resulted in better access
to effective mental health and family supports to promote
health. The majority of households have the
skills and resources to access and prepare high quality

Say what?!  Now I was certain I was still actually in bed and dreaming… or perhaps catapulted to an alternate universe?  So I took a big swig of coffee and kept reading….

The result, more Canadians are healthier,
disability burden has plummeted and the proportion
of the population living with severe obesity continues
to decline. Canada’s dream of universal healthcare
remains alive and well.

Ok now I was good and confused.  The last time I checked (like, yesterday), obesity was still highly prevalent, and we were FAR from achieving any of these goals. 

Then, I settled on the citation at the bottom of the page:

Current Obesity Reports, 2041

Finally, I understood (with the caffeine now having reached my brain, plus a little adrenaline) that this was a futuristic spoof (and hope) of sorts, designed by authors Denise Cambell-Scherer and Arya Sharma, to get our attention to highlight the importance of having primary care in Canada fully engaged in obesity care and prevention, if we are to have any hope of achieving these goals in the future.

The article goes on to discuss that obesity prevention needs a lifecycle approach, starting in the womb and continuing throughout life. Primary care (ie, family doctors) are in the best position to address this lifelong process that needs to reach out to the population as a whole.  However, still less than 50% of family physicians discuss obesity during routine health examinations, with reasons cited being lack of time, resources, and training as to how to approach this often sensitive topic.

So how can family doctors be supported in the management of obesity? The 5As of Obesity have been developed by the Canadian Obesity Network to provide a straightforward way to approach the topic of obesity.  Teams of allied health care professionals need to be available and supported by the health care system to manage obesity (similarly to the diabetes world, where care is shared amongst doctors, nurses, dietitians, pharmacists, diabetes educators, and pshcyologists).  As the article notes, 7.4 hours of health provider time would be required to deliver all of the current recommended screening and prevention maneuvers (eg nutrition, activity, alcohol etc) – and clearly it is not reasonable for each doctor to see only one patient per day.

Developing these teams is not a small task.  As we learn how to best educate health care professionals and figure out how to build teams into well functioning units that can help people with their weight struggles, resources to do this are still scarce and eclipsed by the enormity of the problem.  Empowering patients with useful and evidence-based educational resources is crucial as well – and often hard to find amongst all the garbage diet info that plagues the internet.  (I try to do my part by writing this blog for the last 8 years!)

At the Canadian Obesity Network, we are doing everything we can to reach these goals, but the entire health care profession and society as a whole needs to be fully on board if we are going to be successful in achieving these goals.  

Wouldn’t it be wonderful if this article from year 2041 became a reality?

Follow me on twitter! @drsuepedersen © 2016


(In)Accuracy of Your Wrist Technology for Estimating Calorie Burn

>> Thursday, July 7, 2016

There are many different kinds of wrist technology out there - Garmin, FitBit, and Jawbone UP just to name a few.   In response to concerns that these devices may not be accurate to measure energy burn, researchers have now conducted a study to test how accurate they are.

The study, published in JAMA Internal Medicine, examined several brands of wearable energy tracking technology, and compared them to gold standard research methods of measuring energy burn, including both a standardized day (indirect calorimetry using metabolic chamber) and fifteen free living days (doubly labeled water method).  Brands studied included the Garmin VivoFit, Jawbone UP24, and FitBit Flex.

They found that these wearable devices were overall quite inaccurate, with inaccuracies ranging as high as 590 calories per day. !  Most of the inaccuracies were underestimates of caloric needs, while some overestimated needs.

So does this mean that these devices are totally useless?  No.  They can be great motivation for keeping track of daily activity and steps taken per day (pedometer) - though there are inaccuracies here as well.  But I do see a lot of people with weight struggles feeling frustrated that they seem to be burning way more calories (according to their device) than the food they are eating, yet they are not losing weight.   Overall, the biggest benefit of these devices is probably motivation to move, and keeping us engaged in mindful eating (ie we think more about what we are eating if we are keeping track of it).

Follow me on twitter! @drsuepedersen © 2016


Chicken and Bean Tostadas

>> Friday, July 1, 2016

Happy July Long Weekend!  Here's hoping that your days are filled with fun, family, friends, great weather, and outdoor activities.  Here's an easy, tasty, and healthy crowd pleaser that can easily be thrown together as a light meal, without having to spend much time cooking and missing out on all the fun!  I haven't changed the recipe much from the original.  Serve with a big summer salad to make a delicious, filling, and healthy meal!  Note that this recipe is not low on salt (salsa is especially salty - consider making your own as a lower salt alternative!).


  • 2 cups shredded chicken (breast from a rotisserie chicken works well)
  • 1 cup salsa
  • 1 can pinto beans, rinsed and drained
  • 10 corn tortillas
  • 2 cups shredded Mexican cheese blend


  • shredded lettuce
  • chopped tomato
  • chopped green onion
  • chopped cilantro
  • 10 tsp reduced fat sour cream
  • hot sauce


  1. Preheat oven to 375 degrees. Spray 2 baking sheets with nonstick spray and spread corn tortillas on baking sheets. Set aside.
  2. In a large bowl, combine chicken, salsa and beans.
  3. Top each tortilla with chicken and bean mixture, then add cheese on top. Bake in 375 degree oven for 12-14 minutes until tortillas are crisp and cheese is melted.
  4. Serve immediately and with toppings of choice!

Makes 10 Tostadas.  Per Tostada (approximate): 

Calories: 217
Fat: 8.3g
Carbs: 19g
Protein: 17g

MMmmmmm.... Enjoy!

Follow me on twitter! @drsuepedersen © 2016



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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