Sunday, November 23, 2014

Obesity Weekend Roundup, November 21, 2014

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

@DrSharma
Edmonton, AB

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Friday, November 21, 2014

Obesity Myth: Exercise is the Best Way to Lose Weight

sharma-obesity-exercise2Here is what we had to say about the role of exercise in weight management in our recent article published in Canadian Family Physician:

There is now a consistent body of evidence showing that exercise alone, despite a range of health benefits associated with regular exercise, results in rather modest weight loss (less than 2 kg on average).

One of the explanations is that exercise is often accompanied by an increase in sedentary activities and appetite and a decrease in dietary restraint that counteract the increased energy expenditure of exercise.

However, increased exercise has been shown to reduce visceral adiposity (even with minimal changes in body weight).

Individuals who include regular exercise and active living as part of a weight-loss program are more likely to improve their overall health and keep the weight off.22 This latter finding might be attributable to the effect of regular exercise on caloric intake rather than on caloric expenditure per se.

Exercise alone generally promotes modest weight loss; however, individuals who exercise regularly might improve their overall health independent of weight loss and are more likely to keep their weight off.

@DrSharma
Wellington, NZ

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Thursday, November 20, 2014

Obesity Myth: Losing Weight Is Always Beneficial For Your Health

sharma-obesity-scale2Another common misconception about obesity discusses in our recent paper in Canadian Family Medicine, is the notion that anyone with excess weight stands to benefit from losing weight.

The benefits of weight loss, however are far from as established as most of us may think:

“The strong biological response to weight loss (even the recommended 5% to 10% of baseline weight) involves comprehensive, persistent, and redundant adaptations in energy homeostasis that underlie the high recidivism rate of obesity treatment.

The multiple systems regulating energy stores and opposing the maintenance of a reduced body weight illustrate that fat stores are actively defended.

Among the adverse effects of weight loss, it is well known that body fat loss increases the drive to eat, reduces energy expenditure to a greater extent than predicted, and increases the tendency toward hypoglycemia.

Weight loss is also related to psychological stress, increased risk of depressive symptoms, and increased levels of persistent organic pollutants that promote hormone disruption and metabolic complications, all of which are adaptations that substantially increase the risk of weight regain.

In addition, there is considerable concern about the negative effect of “failed” weight-loss attempts on self-esteem, body image, and mental health.

Thus, clinicians should document and consider the powerful biological counter-regulatory responses and potential undesired effects of weight loss to maximize the success of their interventions. Obesity is a chronic condition and its management requires realistic and sustainable treatment strategies.

Successful obesity management requires identifying and addressing the obesity drivers as well as the barriers to and potential complications of weight management. Family physicians should discuss the possible adverse effects of weight loss with their patients and actively look for these effects in patients trying to lose weight.”

@DrSharma
Wellington, NZ

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Wednesday, November 19, 2014

Obesity Myth: Dieting Is The Best Way To Control Your Weight

sharma-obesity-fat-dietingHere is what we had to say about the third common misconception in our paper published in Canadian Family Medicine:

Approximately two-thirds of people who lose weight will regain it within 1 year, and almost all of them will regain it within 5 years.

Although dieting (ie, caloric restriction) to lose weight is a difficult task, the maintenance of lost weight requires the patient to deploy even greater efforts.

Rather than a simple lack of willpower, the relapse of most individuals to their previous weight after otherwise successful weight loss is largely driven by the coordinated actions of metabolic, neuroendocrine, autonomic, and behavioural changes that oppose the maintenance of reduced body weight.

The few individuals successful at maintaining weight loss (at least 13.6 kg for at least 1 year) generally have common behaviour and strategies that include consuming low-energy, low-fat diets; engaging in high levels of physical activity; consistent self-monitoring of body weight and food intake; eating breakfast regularly; and demonstrating a high level of dietary restraint.

It is highly unlikely that some of this behaviour can be emulated by most of the population with excess weight.

There is also concern that unhealthy weight control methods (eg, fasting, meal skipping, laxatives, diuretics, stimulants) might ultimately lead to a larger weight regain and pose a risk to both mental and physical health.

Thus, although sustained weight loss with diet alone can be possible for some individuals, agreeing on realistic weight-loss expectations and sustainable behavioural changes is critical to avoid disappointment and nonadherence.

Weight regain (relapse) should not be framed as failure but as an expected consequence of dealing with a chronic and complex condition like obesity.

@DrSharma
Wellington, NZ

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Tuesday, November 18, 2014

Obesity Myth: Obese Individuals Are Less Active

sharma-obesity-active-livingThe second most common misconception about obesity, addressed in our article in Canadian Family Physician, is the idea that people living with overweight are any less active than people with “normal” weight:

“It is very common to hear that obese people are lazy and should get off the couch. This discriminatory bias against those with excess weight is not only widespread among the lay public but also among health professionals, even those in regular contact with patients with obesity.

Yet, the most recent data from the Canadian Health Measures Survey, a study of a nationally representative sample that used accelerometers to measure physical activity, suggest otherwise.

Based on objective measures, only 7% of Canadian children and youth8 and 15% of Canadian adults9 meet physical activity guidelines. When split by body mass index categories, obese girls average 11 159 steps per day, while normal-weight girls average 10 224 steps per day. Obese boys average fewer steps (10 256 steps per day) than their normal-weight counterparts (12 584 steps per day), but they have a larger body to carry. Translating this physical activity level into calories expended (kcal per day) would likely show that obese boys actually burn more calories on a daily basis.

Similar findings are observed for Canadian adults. Overall, the message is that there is a physical inactivity crisis in Canada—most people do not meet the recommended amount of physical activity required each day for health benefits—and every Canadian, regardless of body size, would benefit from an increase in physical activity and a decrease in sitting time.

Rather than focusing on burning calories, interventions should aim at reducing sedentary activities and increasing physical activities to improve overall health and general well-being.”

@DrSharma
Auckland, NZ

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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