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Canadian Obesity Network’s Toronto Chapter Takes Off

CON-Toronto Chapter Executive

CON-Toronto Chapter Executive

As regular readers may know, the Canadian Obesity Network is currently promoting the creation of local chapters across Canada. This is part of the Network’s strategy to continue growing and engaging researchers, health professionals, and others with an interest in obesity prevention and management to network and break down silos.

Following the very successful launch of local Obesity Network chapters in Calgary and Hamilton, last night saw the inaugural meeting of the Toronto Chapter (CON-YYZ), which got together to appoint their new executive and to exchange ideas on local activities that this chapter can pursue in the future.

I had the opportunity of joining in for part of this meeting via Skype and was delighted to see the diversity of attendees and their enthusiasm – certainly a promise of great things to come.

For anyone interested in learning more about how to start your own local CON chapter, more information is available here.

I look forward to seeing a number of new Obesity Network chapters created across Canada, as we continue to seek better ways to fight weight-bias, discrimination and find better ways to prevent and manage obesity.

@DrSharma
Edmonton, AB

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Does Exposure Of Women To Larger Men Make Them Appear More Attractive?

sharma-obesity-strongmanBeauty is in the eye of the beholder – but how is this eye influenced by cultural norms and familiarity?

This interesting question was the topic of an intriguing study by Eric Robinson and Paul Christiansen from the University of Liverpool, published in the International Journal of Obesity who examined whether women’s preferences for larger men can be influenced by prior exposure.

The researchers conducted a series of four studies. Studies 1 and 2 looked at how exposure to men with obesity vs. normal weight had on female attraction toward a man with overweight. The findings of these two study showed that exposure to obesity can alter visual perceptions of what normal body weights were resulting  in greater attraction toward an overweight man.

Study 3 found that women who are regularly exposed to males of heavier body weights reported a greater attraction toward overweight men.

Study 4 showed that after exposure to  images of men with overweight or obesity, females in an online dating study were more likely to choose to date an overweight man than a man of normal weight (Study 4).

Thus the researchers conclude that even brief exposure to men with obesity can increases female attraction toward overweight men and may affect mate choice.

However, as the researchers note, the findings are limited to single women rating caucasian males – whether exposure to women with overweight has a similar effect on male preferences remains to be studied.

Perhaps the results of this study can lead to the following dating advice – if you’re a big man, surrounding yourself with people of your size may just make you seem more attractive.

@DrSharma
Edmonton, AB

 

 

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How Do We Protect Our Kids From Being Judged For Their Weight?

sharma-obesity-pima-indian-kidsIf the lively response to last week’s post on the question of whether or not Sarah Hoffman is qualified to serve as Alberta’s health minister based on how people judge her size teaches us anything, it sure makes eviden the simple-minded thinking about obesity that is so pervasive in our society (thanks to all my bold readers, who stepped in to share their stories).

The problem, however, is not just that adults get judged by the general public (who may be forgiven for their ignorance) – the problem goes much deeper.

Thus, a study by Kenney and colleagues from the Harvard School of Public Health, published in the International Journal of Obesity, shows that worse educational outcomes for children living with obesity may be simply due to how teachers perceive them, rather than their objective performance.

The study includes 3362 children participating in the Early Childhood Longitudinal Study—Kindergarten Cohort (ECLS-K), who were studied longitudinally from fifth to eighth grade.

While an increase in BMI z-scores (a measure of childhood weight gain) from 5th to 8th grade showed no association to actual academic ability in standardized test scores, teacher’s perceived kids with higher BMI z-scores as to be poorer at math and in reading.

Interestingly, it was not just the teachers who rated heaver kids as poorer students, the larger students rated themselves as being less capable than they actually were – perhaps a reflection of how their teachers’ attitude towards them was reflected in their self-worth.
Here is how the researchers put it rather bluntly,

“From 5th to 8th grade, increase in BMI z-score was significantly associated with worsening teacher perceptions of academic ability for both boys and girls, regardless of objectively measured ability (standardized test scores).”

The implications of this finding are self-evident.

If teachers, who should know better, misjudge academic ability based on kids body weights (despite the lack of difference in objective tests), which in turn leads the kids to have less confidence in their own abilities, it is easy to see how this may well set them off on a trajectory leading to lower academic performance and thus a less bright start – a self-fulfilling prophecy, if I ever saw one.

Even if we do not care about adults being judged or discriminated against because of their size (and we should), the fact that our kids are also being judged by their teachers, who should know better, must set off all kinds of alarm bells.

Have you experienced weight-bias or discrimination in educational settings? I’d love to hear your story.

@DrSharma
Edmonton, AB

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Obesity Is Not Smoking – Period!

Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

The recent appointment of the Hon. Sarah Hoffman (NDP) to the post of Health Minister in Alberta has (as expected) prompted a wide range of remarks regarding her suitability for the job – not because of her qualifications as an administrator (these are uncontested) – but her size!

In a slurry of comments ranging from misguided misogynistic remarks (sadly, including by members of the former government) to outright personal insults, the social media frenzy around this topic is anything but unexpected.

The general story line is that someone living with obesity, who is thus obviously “unhealthy”, is not qualified be a health minister.

Indeed, one letter writer in the Edmonton Journal likens putting someone living with obesity in this position, to appointing a health minister who smokes – a fatal (but common) misconception of what obesity actually is.

For one, smoking is a behaviour – living with obesity is not!

When you inhale the smoke of a cigarette you are doing something (a behaviour) – when you gain (or lose) weight, it is something your body does (whether you want it to or not).

This distinction is fundamental: when I stop smoking, I become a non-smoker – end of story!

When I try to lose weight, my body will do everything it possibly can to resist losing weight. My appetite will increase, my metabolic rate will slow down, my body temperature will decrease, my thyroid function will decrease, my sense of taste and smell will increase, as will my risk-taking behaviour and my susceptibilty to stress. All of these changes (often referred to as the “starvation response”) will work day-and-night to “sabotage” my efforts and in 95% of people who set out to lose weight, these mechanism will eventually win out – even years after starting on their diet.

Every person I know who has ever lost a considerable amount of weight and is keeping it off, describes this as a daily on-going struggle. They are well aware that even the slightest interruption to their routine, an illness, an injury, a new medication, even just relationship issues or financial stressors and – boom – their weight is back, whether they like it or not.

This is why the WHO, the FDA, the AMA and a growing number of health organisations around the world are now calling obesity a chronic disease, because sadly, we have yet to find a cure for this condition.

Despite what celebrity pundits and the weight-loss industry may want you to believe, there are no easy solutions and try as they may, most people with excess weight will have to fight hard simply not to get any heavier.

So for one, even if Sarah Hoffman wanted to lose a few pounds, the chances that she will keep them off on her own in the long term are slim (unless of course she happens to belong to the lucky 5%). If she is looking for medical treatment, even surgery, I wish her good luck trying to access those services here in Alberta – welcome to the waiting list!

The other assumption underlying the criticism of Minister Hoffman, is the notion that obesity is a direct reflection of someone’s health behaviours – i.e. eating too much junkfood or not exercising.

Believe me that I have seen many patients in my clinic, who rarely (if ever) touch junk food, who spend hours in the gym, and still weigh in at 350 lbs or more. There is (and has been for a long time) enough scientific evidence to support the fact that people vary remarkably in their susceptibility to weight gain (and weight loss). The amount of weight gained by eating exactly the same amount of excess calories can vary as much as 5-fold between individuals.

So for all we know, Sarah Hoffman (like most people living with excess weight) is already well-informed and concerned about her diet and I’d hardly be surprised if, despite her busy schedule, she does manage to squeeze in as much physical activity into her daily routine as she possibly can.

But, irrespective of all of the above, there are simply so many different causes of weight gain (from genetics, to mental health, to sleep deprivation, to stress, to eating norms and culture, adverse childhood experiences, to medications – even perhaps the bugs that happen to live in your gut), that judging someone about their health knowledge or behaviours by looking at their size is truly laughable.

Indeed, who better to have as a health minister, than someone living with a chronic disease?

Would anyone seriously object to Sarah Hoffman’s appointment as Health Minister, were she living with diabetes, chronic kidney failure, coronary artery disease, HIV/AIDS, depression or for that matter cancer (even lung cancer)?

The only real difference between obesity and any of the above conditions is that obesity is visible for anyone to see (and apparently fair game for anyone to comment on).

Whether or not Sarah Hoffman turns out to be a capable and competent health minister remains to be seen – I am certain that neither her success nor failure will have anything to do with her size.

Perhaps it will take a Health Minister living with obesity, to finally create a health system, where people living with obesity are treated with compassion and respect and, most importantly, can find the help and treatments that they need.

@DrSharma
Edmonton, AB

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Will Dieting Make You Fatter? Only If You Are Skinny!

Professor Abdul Dulloo, University of Fribourg, Switzerland

Professor Abdul Dulloo, University of Fribourg, Switzerland

At the recent European Congress on Obesity, I had the occasion for a long chat with my friend and colleague Abdul Dulloo, from Friburg in Switzerland, who has worked extensively on the issue of weight regain.

I asked him how much evidence there is to support the common notion that losing weight makes you fatter – something many dieters claim to have experienced.

Indeed, both in animals and humans, weight loss, as a rule, is followed by a more rapid regain of body fat than lean body mass (i.e. preferential catch-up fat) than of lean body mass, as a result of which body composition post-weight regain results in a greater proportion of fat mass than before. But does this increased “fatness” persist over time?

This is where Dulloo made me aware of a recent paper he published in Obesity Reviews that examines this question.

What his analysis of prospective studies on this issue revealed is that paradoxically, people within a the normal weight range appear much more prone to weight gain over time with dieting than people who already have overweight or obesity.

Indeed as he points out,

“…it is dieting to lose weight in people who are in the healthy normal range of body weight, rather than in those who are overweight or obese, that most strongly and consistently predict future weight gain.”

The reasons for this rather unexpected finding are unclear and some have argued that repeated dieting to lose weight in normalweight people may represents unsuccessful attempts to counter genetic and familial predispositions to obesity – these people are genetically prone to weight gain, which is why they are dieting in the first place. Thus, rather than a causal relationship, the association between dieting and subsequent weight gain is just what would have happened to them anyway.

Others have argued that the metabolic effects resulting from the psychological “fear of fatness” (which prompts dieting) per se may increase the risk for weight gain hence a contributing factor to the obesity epidemic.

However, as Dulloo and colleagues discuss at length, based on their reanalysis of a wide range of human studies of weight loss and refeeding on body composition data on fat mass and fat-free mass (FFM) losses and regains, there is increasing support for the biological plausibility that dieting predisposes lean individuals (rather than those with overweight or obesity) to regaining more body fat than what had been lost (i.e. fat overshooting).

Overall the findings suggest that perhaps the reason why lean people regain fat faster is because their feedback signals in response to the depletion of both fat mass (i.e. adipostats) and fat-free mass (i.e. proteinstats), through the modulation of energy intake and adaptive thermogenesis, are more effective than in individuals with overweight or obesity, thus resulting in a faster rate of fat recovery relative to recovery of lean tissue (i.e. preferential catch-up fat).

In fact, it appears that lean people overshoot in terms of weight gain because the state of hyperphagia (in response to weight loss) appears to persist well beyond complete recovery of fat mass and interestingly until fat free mass is fully recovered (which may take months during which time fat gain continues).

Thus, it appears that in lean individuals “fat overshooting” following a diet is a prerequisite to allow complete recovery of fat-free mass (in obese individuals this may be less of an issue as recovery of fat-free mass is stimulated simply by the need to carry around a greater body weight).

Thus, it is easy to understand why repeated dieting and weight cycling would increase the risks for trajectories from leanness to fatness particularly in people who have a normal weight to begin with.

These findings have important public health implications and for promoting a “fear of fat”.

As Dulloo notes,

“Given the increasing prevalence of dieting in normal-weight female and male among young adults, adolescents and even children who perceive themselves as too fat (due to media, family and societal pressures), together with the high prevalence of dieting for optimizing performance among athletes in weight-sensitive sports, the notion that dieting and weight cycling may be predisposing a substantial proportion of the population to weight gain and obesity deserves greater scientific scrutiny.”

Indeed, I wonder how much of the obesity epidemic is directly attributable to normal weight people trying to lose weight for no good reason other than to look better.

@DrSharma
Edmonton, AB

ResearchBlogging.orgDulloo AG, Jacquet J, Montani JP, & Schutz Y (2015). How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16 Suppl 1, 25-35 PMID: 25614201

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