OK, I am not actually on Oprah (yet?) - rather, this post is only about comments I was asked to make about Oprah’s “catastrophic” weight regain by Judith Timson, who interviewed me for her column, which appeared in yesterday’s Globe and Mail.

To read what Judith (and I) had to say - click here

Last week, Yoni blogged about the same topic - for his take on Oprah - click here 

I think Oprah has made the same mistake that most people make - they think there somehow must be a “cure”.

Unfortunately, there isn’t - there are only treatments - when you stop the treatment, the weight comes back - ALWAYS!

End of Story!

AMS
Edmonton, Alberta

BEST HEALTH BLOG FINALIST: The second round of voting is on - please vote AGAIN for your favourite health blog by clicking here

Last week I blogged about the recent Supreme Court ruling mandating that airlines accommodate oversized passengers.

This ruling was picked up by international media, especially in the US, where in light of their own obesity epidemic, this ruling attracted substantial attention.

In fact, I was interviewed by MSNBC for my take on this, especially with regard to the question how airlines should determine who would qualify for an extra seat and who would not.

My simple solution, as reported by MSNBC was as follows:

“You can’t bring it down to a BMI. People’s body shapes are different.” Instead, the chair of obesity research at the University of Alberta suggests a solution inspired by the baggage sizers already in place at many airports. Instead, Sharma would like airlines to place an airplane seat in the terminal — “somewhere that offers travelers a bit of privacy.” Then, if it’s not obvious that a traveler won’t fit in one seat, they can sit in the sample seat. “If they don’t fit in the seat, then they’re too big and they’ll need to have that extra seat. At no cost. It’s not rocket science.”

Obviously, other “experts” had other suggestions including bringing in doctors’ notes or simply increasing the seat sizes for everybody. For a full report on this story click here.

If readers of this blog have any other suggestions - I’d love to hear them.

AMS
Edmonton, Alberta

Earlier this week, the Globe and Mail reported on Dr. Sean Wharton’s clinic that provides a wide range of bariatric assessments and treatments within the Ontario public health system.

Yesterday, in a follow up to this report, one of Sean’s patients and I answered e-mail questions in an online forum hosted by the Globe and Mail.

As expected, the questions revolved around the usual issues:

1) How can I get to my goal weight? - quick answer: set realistic goals!

2) Why do I regain weight every time I go off my diet? - quick answer: the only way to keep the weight off is to continue on your “diet” forever.

3) How can I get past my weight loss plateau? - quick answer: by eating even less and moving even more - not that I recommend that - perhaps your plateau is as good as this is going to get.

4) Do I have food addiction? - quick answer: no, but you may have binge eating disorder.

5) How come I am still gaining weight, when I eat virtually nothing? - quick answer: either you are underestimating your caloric intake (hidden calories) or you have an unbelievably slow metabolism.

Obviously, the full answers are much more complicated - no wonder they are difficult to understand (and believe?).

What the forum shows? That there are very real people out there with very real weight issues. Too bad that evidence-based bariatric treatments are not readily available.

AMS
Vancouver, BC

Dr. Geoff Ball, University of Alberta

What do these adolescent kids and their parents expect of an obesity program? What are the barriers they face in terms of improving their lifestyles? What issues are relevant at the level of the family, peers, the health care system, and a policy and program level?

These are questions addressed by Nicholas Holt and colleagues from the University of Alberta, in a study just out in Qualitative Health Research. For this study led by Geoff Ball (picture), data were collected via 41 interviews with parents and children from the wait-list of the pediatric weight-management clinic and analyzed using grounded theory methodology.

While the study provides numerous insights into the familial and other circumstances faced by these families, I believe the following quotes from the paper speak for themselves:

On parental overprotection:

“Ever since [our daughter] was little, being the first grand daughter in the family . . . everybody watched her like a hawk. We were so afraid, like all of us, not just [my wife] and I . . . but it was the whole extended family . . .because she [daughter] was the first . . . we were so afraid that she’d get hurt . . . it’s probably that we have sheltered her a bit too much . . . [from physical activity].”

or

“I have been extremely overprotective [of my son] . . . like [I tell him], ‘Don’t go out in the cold.’ I don’t want him outside. We haven’t encouraged him that way [to be physically active].”

(not exactly a helpful recommendation in a city like Edmonton, where Winter lasts 5 months a year.)

On family meals:

“My husband has just changed jobs; he’s on shift work. So, sitting down together at 5 o’clock doesn’t happen at our house anymore . . . I go sit at the counter top and he’ll sit in front of the TV and eat and I’ll sit in front of the other [TV] and eat.”

On the importance of TVs in general:

“I think we have like five TVs in our house and four of them are just . . . well two of them are movie player ones. OK, there’s one in my brother’s room and it’s one that’s a DVD and movie player, but that’s all. And then the one in my dad’s room you can, it’s watching satellite from downstairs. And then there’s one downstairs and it’s a big screen TV and it’s just a satellite. And then we have two TVs in our toy room. And one of them is supposed to be for “GameCube” and the other one is supposed to be for “PlayStation.” But for some reason both of them are hooked up to one TV. And then we have a computer . . . well, we have two computers . . . a laptop and a computer.”

On how not watching TV cripples social life:

“[My daughter’s schoolmates] all get together and talk about . . . oh there’s One Tree Hill, Gilmore Girls, um Grey’s Anatomy . . . and they almost have one everynight that they could look at. . . . I don’t know about cutting back [TV time] much more . . . I don’t know. That would be hard . . . she’d still be able to talk about some of the shows . . . it wouldn’t cripple [her social life] . . . well [it might].”

On medical care:

“Usually the medical community, you know, they do the thyroid test and those type of things and then very little else happens, and then so it’s rested on [our] shoulders.”

Anyone interested in pediatric and adolescent obesity needs to read this fascinating study on what actually happens in families challenged by obesity and the obstacles they face in trying to change behaviour.

I can only agree with the authors, who conclude: “It is fundamentally important for program planners and health care providers, the individuals who are charged with developing and providing the best service possible, to be mindful of the personal experiences of overweight children and their families who seek weight management care.”

As with adults, overeating and “undermoving” are symptoms of underlying familial, cultural, societal and environmental challenges faced by kids, adolescents and their families. Simply telling them to “eat less and move more” is about as effective as telling them to “have a great day”.

AMS
Edmonton, Alberta

Last week, I blogged about the results of a study showing an association between vital exhaustion and weight gain.

This blog posting prompted Sharon Kirkey (award-winning health journalist and diligent reader of my blog) to explore this issue further by actually talking to the researchers themselves. Her article appeared yesterday via the Canwest News Service and contains far more details than I bothered to report in my blog.

For e.g. Sharon lists the actual questions Bryant and colleagues used to explore the presence of vital exhaustion. I found them most interesting so I list them below:

- Do you often feel tired?

- Do you wake up repeatedly during the night?

- Do you have the feeling that you have not been accomplishing much lately?

- Do you believe that you have come to a ‘dead end’?

- Do you lately feel more listless than before?

- Do little things irritate you more than they used to?

- Does it take more time to grasp a difficult problem than it did a year ago?

- Do you have increasing difficulty in concentrating on a single subject for long?

While to me none of these questions seem particularly specific and are likely to get a “yes” response from a lot of people (hey, even I have to say “yes” to some), I guess when you have to say “yes” to most or all of them, you are probably not hopping around like the Energizer Bunny or scrambling to follow diet plans.

Sharon quotes me as saying:

“Nobody is claiming all of obesity is exhaustion, but if people are clearly eating more than they need the question is not (just) how to get them to stop, but why, exactly, are they doing that. Maybe you’re losing your job. Or you’re overworked. Or it’s some private issue that needs to be addressed. You don’t fix obesity by giving people a copy of Canada’s food guide. You have to try to understand what it is that’s contributing to the weight gain.”

Exactly! Obesity is a symptom of overeating, which in turn is a symptom of something else that’s going on: it can be that you simply lack the knowledge about healthy nutrition or caloric content of foods, but it can also be a symptom of emotional (e.g. depression, vital exhaustion) or biological (e.g. MC-4 receptor defect) issue, medications (e.g. clozapine) or any number of other reasons I can think of.

Always remember: overeating (and/or sedentariness) is not a diagnosis - overeating (and/or sedentariness) is a symptom!

AMS
Edmonton, Alberta