Wednesday, June 25, 2014

Social Anxiety As A Deterrent To Physical Activity

sharma-obesity-distored-body-image1Social anxiety, defined as persistent fears of one or more social situations in which the person is exposed to others and expects to be scrutinized, has been reported in as many as one in ten individuals with overweight or obesity.

Now, a paper by Abbas Abdollahi and Mansor Abu Talib, published in Psychology, Health and Medicine, examines the relationship between social anxiety and sedentary behaviour in this population.

The researchers surveyed 207 overweight and obese students (measured heights and weights) using a number of validated instruments to assess social anxiety, sedentariness and body esteem.

As one might expect, social anxiety was associated with lower body esteem and higher sedentary behaviour.

The key mediator in this relationship was body dissatisfaction and poor body esteem.


“…obese individuals with poor body esteem are more likely to report social anxiety, because they are concerned about negative evaluation by others; therefore, obese individuals indicate avoidance behaviour, which, ultimately, leads to social anxiety.”

The implications of these findings are obvious,

“First, when assessing the social anxiety in individuals, it is important to account for the presence of sedentary behaviour in addition to other psychological risk factors. Second, reducing sedentary behaviour can alter the effect of social anxiety factors; this may be a significant factor to incorporate into social anxiety treatment programmes. Reducing social anxiety in individuals is a main part of any clinical intervention. Third, the findings of the current study suggest that health professionals should encourage obese individuals with social anxiety to reassure their value and abilities regardless of their weight or body shape, and assist them to recognize that everybody is unique and that differences between individuals are valuable.”

This will take more than simply telling people with overweight to be more active. It will certainly require targeted and professional help to overcome body dissatisfaction and low self esteem.

Or, even better, we need to do all we can to help people gain more confidence and be accepting about their own bodies in the first place.

Vancouver, BC

ResearchBlogging.orgAbdollahi A, & Talib MA (2014). Sedentary behaviour and social anxiety in obese individuals: the mediating role of body esteem. Psychology, health & medicine, 1-5 PMID: 24922119



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Monday, June 23, 2014

Does More Energy In And Out Make It Easier To Maintain Energy Balance?

sharma-obesity-caloric_balance_scaleFrom every thing we know about obesity, the simplistic model of energy-in-energy-out (or Eat-Less-Move-More) approach to managing weight has not led us to any meaningful advances in obesity management. The number of people who can successfully manage their weight by this approach in the long-term is so minuscule, that every “success story” is considered “newsworthy”.

Now, a provocative paper by Gregory Hand and Steven Blair, published in US Endocrinology, suggests that what matters for good health is the amount of energy flowing through the system rather than the state of energy balance.


“Recent findings suggest that a high energy flux, maintained by increasing energy expenditure, can improve an individual’s metabolic profile without changing weight.”

This, essentially, is a fancy way of saying, that simply moving more calories through your body by burning more calories (even if you instantly eat them back) benefits the organism irrespective of any impact this may have on body weight – or that exercise is good for you even if you do not lose weight.
Anyone familiar with Steven Blair’s work (fat and fit is better than skinny and unfit) – will recognize the theme – but couching it in a concept of energy flux is a novel and interesting spin to this idea.

Apart from providing a theoretical model for how exercise may benefit you even if you don’t lose any weight doing it, the model may also have implications for weight management.


“The significance of the model of energy regulation is twofold: First, the model suggests that energy balance, and maintaining a stable weight is more easily achieved at a high energy flux. Second, a high energy flux can be achieved by matching a high energy intake with equivalent high energy expenditure, or by increasing energy stores (gaining weight). Of note is that these two characteristics of the model suggest that the biological system was designed to maintain a high energy flux, and increasing energy stores is a quite viable mechanism to achieve this level of energetics. An extensive body of research indicates that multiple and redundant mechanisms regulate the ‘drive’ for energy intake. The high energy flux is attained by matching the intake with expenditure and/or a change in energy storage. Weight gain is consistent with high energy flux combined with low energy expenditure, and it follows that attempting to achieve energy balance at a low energy flux (sedentary behavior combined with food restriction) is not a long-term strategy for weight maintenance.”

The biological question that pops into my mind of course is as to how exactly the body would sense this “flux”. While it is easy to see how the body would sense energy stores (e.g. through hormonal signals such as leptin), it is not clear how the body would monitor flux (after all, to regulate something, it needs to be measured).

This is not something that the authors delve into, thus leaving a somewhat unsatisfying gap in what otherwise makes for an interesting hypothesis.

Toronto, ON

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Tuesday, June 3, 2014

Why Promoting Exercise May Make Us Fatter

sharma-obesity-exerciseDon’t get me wrong – I am all about physical activity – the more the better. If physical activity was a pill, I’d be all about putting it in the drinking water.

But here is the problem – a new study by Carolina Werle, Brian Wansink and Collin Payne, published in Marketing Letters, provides rather convincing evidence that simply calling physical activity “exercise” may actually increase food intake (which we know will often exceed any calories burnt during that activity).

The researchers present the results of three studies – two field experiments showing that when physical activity was perceived as fun (e.g., when it is labeled as a scenic walk rather than an exercise walk), people subsequently consume less dessert at mealtime and consume fewer hedonic snacks. Incidentally, the participants also reported enjoying the fun walk way more than the exercise walk, despite both walks covering exactly the same ground.

An interesting aspect of the post-walk ad libitum food intake was that the extra calories consumed by the exercise group was entirely attributable to increased servings of desserts and choice of sugary beverages – not by consumption of the main meal – clearly suggesting the “reward” nature of the compensatory response.

A third observational field study during a competitive race showed that the more fun people rated the race as being, the less likely they were to compensate with a hedonic snack afterwards.

Thus, the authors conclude that,

Engaging in a physical activity seems to trigger the search for reward when individuals perceive it as exercise but not when they perceive it as fun.

Long-distance runners have a variety of ways they can frame their experience in a race. If competitive, they can view their race as a serious effort to win a medal or achieve a personal best time. Alternatively, some other runners could view the race as a form of a workout or exercise, but still others could see it as a form of adventure or as a “fun run.” How they view their 30–60 min experience relates to what they chose to eat following the race.

The article concludes with the advice to the fitness industry to warn participants about compensatory overconsumption of snacks – to which I say, good luck with that. Most sports facilities that I know off actually rely on their in house snack bars for a rather substantial part of their revenue. I have also yet to see the activity event that is not routinely paired with some form of culinary reward for participants (and often even for those, who just stood around watching the event).

My advice to both health professionals and policy makers is to simply drop the “E-Word” from their vocabulary – but then again, what fun is that?

Edmonton, Alberta

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Tuesday, May 27, 2014

What’s Europe Doing About Obesity?

ECO2014 logoAs I head out to attend the 21st European Congress on Obesity in Sophia, Bulgaria, I came across this interactive site that allows interested readers to checkout obesity interventions across Europe.

The atlas of European projects and interventions for obesity prevention in adults is part of the SPOTLIGHT project which udertook a Europe-wide survey to provide an overview of projects and interventions to prevent adult obesity through improving diet and physical activity.

While the atlas may not include every single intervention that is currently happening, it does provide a sense of the scope and range of these activities.

For each project or intervention the atlas considers the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) aspects and presents these data where available.

I am sure I will have plenty more to report on based on what I hear at the conference.

Munich, Germany

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Thursday, May 22, 2014

Canada’s Bubble-Wrapped Kids Need More Free Play

sharma-obesity-active-healthy-kidsNo doubt Canadian parents think physical activity and sports is of utmost importance for their kids’ health – this is why, they have apparently sold them off to the multi-billion dollar sport and fitness industrial complex that has pretty much commercialized all aspects of physical activity.

This is why good ol’ get out doors and play (without your parents hand holding you, peering over your shoulder or tracking your whereabouts on GPS) is pretty much dead.

At least this is the gist of the latest Physical Activity Report Card presented by Active Healthy Kids Canada.

Here are some of the main findings:

Canadian parents look to structured activities and schools to get their kids moving:

- 82% of parents agree that the education system should place more importance on providing quality PE.

-  79% of parents contribute financially to their kids’ physical activities (through equipment, fees, etc.), but only 37% of parents often play actively with their children.

Organized sports and plenty of places and spaces for activity may never make up for lost (active) time:

- One study shows only 24% of kids got a full 60 minutes of moderate/ vigorous activity in one session of soccer, and only 2% got this at softball practice.

- Kids on hockey teams spend close to half of the time during practices in moderate/vigorous activity, but in an actual game they are sedentary nearly a third of the time.

So if you think you are doing your kids a favour by putting them in organiszed sporting activities, that break both your time and money budget, then think again.

Your kids may be way better off if you just kicked them outdoors (not to be seen again till the lights come on).

Barcelona, ES

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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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