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.
Pregnancy in women after undergoing bariatric surgery are by no means uncommon. There is even some evidence from case series to suggest that babies born to mothers, who have undergone surgery may be less likely to become obese or experience the cardiometabolic complications of obesity.
This risk needs to be balanced against potential risks the known adverse effects of gastric bypass surgery on the metabolism of iron, vitamin B12, and folate,
Now a paper by Karl Johansson and colleagues, published in the New England Journal of Medicine, suggests that this may well be the case.
The researchers identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented.
They found that pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25) and a lower incidence of large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33).
These potentially beneficial outcomes for the infant were counterbalanced by a two-fold increase in the likelihood of having a small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20) and a somewhat shorter gestation (mean difference -4.5 days)
Also, the risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39).
No differences were found in the frequency of congenital malformations.
Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality.
Thus, the authors conclude that,
“…a history of bariatric surgery was associated with reduced risks of gestational diabetes and large-for-gestational-age infants.”
Nevertheless, they do recommend increased surveillance during pregnancy and the neonatal period, as bariatric surgery may also be associated with small-for-gestational-age infants, a shorter length of gestation, and potentially an increased risk of stillbirth or neonatal death.
For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd.
To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here.
To register – click here.
In 2011, The Lancet dedicated a special issue to the topic of obesity – the general gist being that obesity is a world wide problem which will not be reversed without government leadership and will require a systems approach across multiple sectors. The Lancet also noted that current assumptions about the speed and sustainability of weight loss are wrong.
This week, The Lancet again dedicates itself to this topic with ten articles that explore both the prevention and management of obesity.
According to Christina Roberto, Assistant Professor of Social and Behavioural Sciences and Nutrition at the Harvard T H Chan School of Public Health and a key figure behind this new Lancet Series, “There has been limited and patchy progress on tackling obesity globally”.
Or, as Sabine Kleinert and Richard Horton, note in their accompanying commentary, “While some developed countries have seen an apparent slowing of the rise in obesity prevalence since 2006, no country has reported significant decreases for three decades.”
As Kleinert and Horton correctly point out, a huge part of this lack of progress may well be attributable to the increasingly polarised false and unhelpful dichotomies that divide both the experts and the public debate, thereby offering policy makers a perfect excuse for inaction.
These dichotomies include: individual blame versus an obesogenic society; obesity as a disease versus sequelae of unrestrained gluttony; obesity as a disability versus the new normal; lack of physical activity as a cause versus overconsumption of unhealthy food and beverages; prevention versus treatment; overnutrition versus undernutrition.
I have yet read to read all the articles in this series and will likely be discussing what I find in the coming posts but from what I can tell based on a first glance at the summaries, there appears to be much rehashing of appeals to governments to better control and police the food environments with some acknowledgement that healthcare systems may need to step up to the plate and do their job of providing treatments to people who already have the problem.
As much as I commend the authors and The Lancet for this monumental effort, I would be surprised if this new call to action delivers results that are any more compelling that those that followed the 2011 series.
I can only hope I am wrong.
Anyone interested in the issue of obesity and cardiovascular disease may want to get a copy of the latest edition of the Canadian Journal of Cardiology, which includes a number of review articles and opinion pieces on a wide range of issues related to obesity and cardiovascular disease.
Here is the table of contents:
Lim SP, Arasaratnam P, Chow BJ, Beanlands RS, Hessian RC: Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease.
Garcia-Labbé D, Ruka E, Bertrand OF, Voisine P, Costerousse O, Poirier P. Obesity and Coronary Artery Disease: Evaluation and Treatment.
Lovren F, Teoh H, Verma S. Obesity and Atherosclerosis: Mechanistic Insights.
Sankaralingam S, Kim RB, Padwal RS. The Impact of Obesity on the Pharmacology of Medications Used for Cardiovascular Risk Factor Control.
Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to Choose and Use Bariatric Surgery in 2015.
Poirier P, McCrindle BW, Leiter LA. Obesity-it must not remain the neglected risk factor in cardiology.
Lang JJ, McNeil J, Tremblay MS, Saunders TJ. Sit less, stand more: A randomized point-of-decision prompt intervention to reduce sedentary time.