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Active Video Games Do Not Promote Negative Energy Balance

sharma-obesity-videogame-pacmanThe dream of many teenagers (and parents?) is the notion that active video gaming can help manage weight by burning off those extra calories.

Unfortunately, judging by a randomised-controlled trial by Aidon Gribbon and colleagues from the University of Ottawa, published in the American Journal of Clinical Nutrition, this remains but a dream.

For this study, 26 male adolescents were randomised to three 1-hour sessions of rest, seated video game and an active video game. This was each followed by an ad libitum lunch. The researchers also asked the subjects to complete dietary records for another 3 days

Energy expenditure was measured by using portable indirect calorimetry throughout each experimental condition, and an accelerometer was used to assess the subsequent 3-d period.

Although energy expenditure (as measured by indirect calorimetry) was significantly higher during the active game, there was no significant differences in energy balance at 24hrs or 3 days after the end of the game (no surprise here).

Thus, while the researchers did not see any change in appetite or food intake after the active game, they also found no difference in energy balance after 24 hrs.

Thus, the energy expended during the game was apparently fully compensated for, suggesting that active gaming may have a rather modest (if any) effect on energy balance.

As to exactly how this compensation happens – the researchers attribute this to the:

“compensatory adaptation in spontaneous physical activity occurs subsequent to playing Kinect, resulting in no significant differences in net energy expenditure over the course of 24 h. This compensation in PAEE after engaging in AVGs is consistent with results from exercise trials that showed that individuals tend to compensate for physical activity interventions by decreasing subsequent spontaneous physical activity levels”

On a positive note, the authors also did not see an expected increase in caloric intake after the games.

Whether or not active video gaming over time may lead to different effects remains to be seen.

@DrSharma
Edmonton, AB

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Exercise Reduces Cravings For Sugar?

sharma-obesity-exercise2I have long postulated that the benefits of exercise in weight management have little to do with burning calories. Rather, I am pretty sure that when people lose weight with exercise, they do so because of the impact that exercise may have on their food intake (I call it exercising to ruin your appetite!).

Thus, I am happy to acknowledge my affirmation bias in paosting about the recent study by Larissa Ledochowski and colleagues from the University of Innsbruck, Austria, published in PLOS One on the outcome of a randomised controlled trial of brisk walking on cravings for sugary snacks.

The study was conducted in 47 overweight volunteers who reported habitually consuming a fair share of sugary snacks. Following 3 days of “chocolate abstinence” subjects were randomised (using a within-subject design) to a 15-min brisk walk or passive control.

On each occasion, subjects were then stressed using the Stroop color–word interference task after which they reported their urges for sugary snacks using the State Food Craving Questionnaire [FCQ-S] adapted for sugary snacks.

Compared to the control situation, brisk walking resulted in a significant and relevant reduction in the urge for sugary snacks and attenuated the increase in sugar-cravings under trigger conditions (stress).

Although the authors are careful about not over-interpreting their findings from this acute study (that did not actually measure sugary-snack intake), they do make the following speculation regarding clinical relevance,

“This study adds to the increasing evidence that physical activity can somehow help to regulate the urge to consume snack food. It may be easy for overweight people to fit in short bouts of low-moderate intensity physical activity, instead of being sedentary, to elevate affective activation and valence and reduce high energy food cravings which may be triggered by stress and the presence of snack foods.”

While I am certain that more intense exercise may well trigger a hunger response, it appears that even a short bout of brisk walking may help dispel those cravings for sugary snacks (let me know if you have experienced this).

@DrSharma
Edmonton, AB

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Weight Gain With Methadone Treatment For Opioid Addiction

scaleWeight gain is not an uncommon phenomenon with addiction treatment. This has been reported both in smokers and in those with alcohol addiction.

Now a study by Jennifer Fenn and colleagues from the University of Vermont report significant weight gain with methadone treatment for opioid addiction in a paper published in the Journal of Substance Abuse Treatment.

The retrospective chart review included 96 patients enrolled in an outpatient methadone clinic for ≥ 6 months.

Overall mean BMIs increased by about 3 units (from 27.2 to 30.1), which corresponds roughly to an 18 lb or 10% increase in body weight.

Interestingly, the weight gain was predominantly seen in women, who gained about 28 lbs or 17.5% body weight compared to men, who only increased their weight by about 12 lbs or 6.4%.

As the study did not have access to food records, one can only speculate as to the causes. While better nutrition may well play a role, one could also speculate that there may be some addiction transfer from opioids to calorie-dense foods.

Whatever the cause, clinicians should probably be aware of this potential impact of methadone treatment on body weight, as prevention of excess weight gain may be easier than treating obesity once it is established.

@DrSharma
Edmonton, AB

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Using Foods To Cope Promotes Weight Gain

sharma-obesity-chocolateUsing food as a coping strategy is not uncommon.

Now, Mary Boggiano and colleagues from the University of Birmingham, Alabama, in a paper published in Appetite, report that using tasty foods as a coping strategy is associated with weight gain.

The study administered the Palatable Eating Motives Scale (PEMS), which assesses eating for coping motives (e.g., to forget about problems, reduce negative feelings), to 192 college students, who were reexamined after two years (with a few measures in between).

Not too surprisingly, PEMS scores predict changes in BMI over two years.

On a positive note, however, the researchers found that PEMS scores (i.e. using food for coping) can change over time and a reduction in PEMS scores was also associated with a lesser weight gain. In overweight subjects, a reduction in PEMS scores was even associated with modest weight loss.

Thus, the authors suggest that interventions aimed specifically at reducing palatable food intake for coping reasons, should help prevent obesity if this motive-type is identified prior to significant weight gain.

@DrSharma
Edmonton, AB

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Can Dietary Emulsifiers Promote Obesity?

2013 Super Chefs Nat'l Obesity Summit 0001Emulsifiers are amongst the most commonly used food additives to improve the texture and palatability of foods ranging from margarine and mayonnaise to ice cream and baked goods.

Now a study by Benoit Chassaing and colleagues published in NATURE, suggests that dietary emulsifiers may promote weight gain and the metabolic syndrome by altering the composition of intestinal microbes.

The researchers hypothesized that emulsifiers may increase bacterial translocation across intestinal mucosa, thereby promoting local and systemic inflammation as well as affecting the composition of gut bacteria.

Their study in mice show that relatively low concentrations of two commonly used emulsifiers (carboxymethylcellulose and polysorbate-80) can induce low-grade systemic inflammation, weight gain and features of the metabolic syndrome, as well as promote intestinal inflammation in mice susceptible to inflammatory bowel disease.

Importantly, they used germ-free mice and faecal transplants to show that these changes can be induced simply by transferring the gut microbes from emulsifier-treated animals to controls.

As the authors note,

“These results support the emerging concept that perturbed host-microbiota interactions resulting in low-grade inflammation can promote adiposity and its associated metabolic effects. Moreover, they suggest that the broad use of emulsifying agents might be contributing to an increased societal incidence of obesity/metabolic syndrome and other chronic inflammatory diseases.”

While these findings (if replicated in humans) certainly point to the industrial use of food emulsifiers as a potential cause of the global increase in obesity and inflammatory bowel disease, given that these compounds are present in virtually all processed foods, they may well be difficult to avoid.

Guess it’s back to home cooking with raw ingredients.

@DrSharma
Edmonton, AB

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