Although exercise is certainly overrated when it comes to losing weight, I have often blogged about the many benefits of being physically active.

A paper just published online in Diabetes Research and Clinical Practice by Lorian Taylor and several of my colleagues here at the University of Alberta, we explored the relationship between physical activity and health-related quality of life in individuals with prediabetes.

Based on a completed mailed-in questionnaire in 232 individuals with prediabetes residing in Northern Alberta, individuals with prediabetes who reported being physically active (i.e., achieving >600METmin per week; 38% of responders) reported significantly better physical and mental health. than those not achieving this recommended level of physical activity.

The study raises two important issues:

1) Why were over 60% of the individuals with prediabetes not meeting physical activity goals, especially when physical activity has been shown to significantly delay the onset of diabetes?

2) Is the association between less physical activity and poorer mental and physical health truly causal or are the poorer mental and physical health perhaps the very reasons for not being active?

This is certainly an area that deserves further study.

AMS
Toronto, ON

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Taylor LM, Spence JC, Raine K, Plotnikoff RC, Vallance JK, & Sharma AM (2010). Physical activity and health-related quality of life in individuals with prediabetes. Diabetes research and clinical practice PMID: 20727611

A few weeks ago, I read Lori Lansens’ bestselling book “the wife’s tale“.

The book tells the story of Mary Gooch, a 43 year-old woman with severe obesity, who lives her life in defensive, deflective blame, segregating herself in the small farming town of Leaford, Ontario.

When her husband dissapears on the eve of their 25th wedding anniversary, Mary abandons her comfortable position to take the next flight to look for him in California. Soon after arriving she loses her wallet and passport, which further complicates her situation.

With the help of some unlikely friendships that she makes along the way, Mary undertakes a journey of self discovery resulting in an amazing transformation. The deeply insightful story touchingly depicts the heart-wrenching daily reality of someone living with severe disabling obesity.

In an opening sequence, Mary describes how, as a nine year old, she heard her doctor whisper the word “obese” to her mother. Never having heard the word before, little Mary imagined that she was under the power of an “obeast”, a creature that had taken over her body and was manifesting itself in her starving gut.

As Lori Lansens, who hails from Chatham, Ontario, a rural community near the border to Detroit, notes in her self-penned author profile,

“I drove the curving roads of the Santa Monica Mountains thinking of the thousands of conversations I’ve had with women about loneliness, self acceptance, marriage, husbands, body image, food, denial, betrayal and more recently, encroaching middle-age. I thought about what it means to be a stranger, and how one can be transformed by circumstance, and as I found my own tribe of friends and settled into the new rhythm of a different life, the story of Mary Gooch unfolded.”

Although her biography makes no mention of any weight issues that Lansens herself may have experienced, she tells the story of many patients that I see in my clinic everyday.

Anyone who still believes that we will solve the obesity epidemic by simply telling people to eat less and move more should take the time to read this book - but my guess is that if you believe that the solution to obesity is as simple as eating less, then you may have little interest in a book which reveals uncomfortable layers of complexity to a problem for which there are no easy solutions.

If any of my readers have read “The Wife’s Tale”, I’d love to hear from you.

AMS
Edmonton, Alberta

“The doctor wrote down “morbid obesity” in my chart. I was mortified. I looked it up. It meant I was going to die from being fat. I was 12.”

This is perhaps the most moving paragraph in Obese From the Heart, a book that everyone struggling with excess weight should read – more importantly, a book that every obesity researcher, health professional and decision maker should read.

Written by Sara L. Stein, a psychiatrist who has struggled with severe obesity all her life, the book provides profound insights into everything that I see in my own practice every day.

In just over 100 pages, divided into chapters that are often not more than a couple of pages long, Stein touches on all of the important human issues that are so often the underlying causes of uncontrolled overeating and excess weight.

From her own seminal experience as a three year old, with clear memories of the ecstatic experience of one day biting into a chocolate chip cookie, which triggered off a life long addiction, Stein writes about how emotions can profoundly influence ingestive behaviour.

With regard to food addiction, Stein notes:

“Food addiction is unique among addictions in four ways: Food is unavoidable; Food is essential for life; Food is socially acceptable, everywhere; Food can actually elevate your status if it’s good. …food is the only addicting substance where abstinence is both impossible and unacceptable.
…it’s everyone noticing that you are not eating. Especially the cook.
So begins the brutal cycle of trying to control your additcion while still using. DIEting…”

Other chapters deal with stress, depression, anxiety, anger, trauma, and grief. Regarding the later, she notes,

“I can trace my weight gains to anticipating grief, experiencing grief, and reliving grief”.

Her account of growing up as a “morbidly obese” child, teenager, and young woman are both insightful and heart wrenching.

Based on her extensive experience as a bariatric psychiatrist, she discusses the role of bariatric surgery, the problem of anti-fat bias and discrimination (especially amongst health professionals and the media), the important role of sex (or lack of it), and the self-destructive “people pleaser” attitude that reinforces the cycle of nourishing (and respecting?) everyone else but yourself.

Most importantly, Stein shares how she herself found balance – the struggle continues but, down 75 lbs from her highest weight, she has never found it easier to manage her weight since identifying her emotional eating patterns and accepting herself as a wonderful divine being. (“all of us are human with souls, and wants, and emotions, and families and friends”).

While I do not agree with everything Stein writes, such as her views on the role of nutritional supplements (for which evidence is anecdotal at best) or detoxification (whatever that means), the book is nevertheless full of important advice both for health professionals as well as anone struggling with excess weight.

Thank you Sara for sending me a copy of your book – it will definitely be recommended reading for my staff and colleagues – even my patients!

AMS
Edmonton, Alberta

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Yesterday, I blogged about the finding that increased body fat appears to precede lower activity levels and not the other way round (which is probably why attempts to increase physical activity in kids has so far not done much in terms of obesity prevention).

Almost on cue, the latest issue of the Canadian Medical Association Journal (CMAJ) publishes a study by McMaster University’s John Cairney and colleagues, suggesting that kids with developmental coordination problem (perhaps unfairly described as “clumsiness”) may be particularly prone to weight gain.

The study builds on previous reports that kids with developmental coordination disorder were found to be less likely to participate in physical activities.

The researchers studied 2278 (95.8%) of 2378 fourth grade kids (ages 9 to 10) from 75 schools in southwestern Ontario, Canada. Children were followed up over two years, from the spring of 2005 to the spring of 2007.

Not only did the 111 children (46 boys and 65 girls) who had possible developmental coordination disorder have a higher mean BMI and waist circumference at baseline than the other kids, but these differences persisted or increased slightly over time.

In fact, kids with with possible developmental coordination disorder were four times more likely to become obese over the course of the study.

While this study is of course strongly suggestive of less physical activity being a risk factor for childhood obesity, it should be noted that the researchers did not directly measure activity levels. There was also no report of their energy intake or their mental health status (e.g. cognitive ability, depression, attention deficit disorder, etc.), which may significantly affect ingestive behaviours.

There was also no mention of low birth weight, which may be associated both with developmental coordination disorder and excess post-partum weight gain.

Finally, as the authors themselves are careful to note, obese kids have been noted to be less coordinated - so again, it is not clear if the sequence here is “clumsiness -> inactivity -> obesity” or “obesity -> inactivity -> clumsiness” or even “obesity -> clumsiness -> inactivity”.

As always, solving ‘chicken or egg’ questions from cross-sectional or even longitudinal data remains challenging. This is exactly why we need more intervention studies.

AMS
Edmonton, Alberta

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While the phenomenon of depression during and following pregnancy in women is widely appreciated (and often associated with weight gain and/or antenatal weight retention), the effect of pregnancy on mood of fathers is less appreciated.

A recent study by James Paulson and Sharnail Bazemore from the Virginia Medical School, Norfolk, VA, just published in the Journal of the American Medical Association, throws new light on this interesting issue.

The researchers performed a meta-analysis of 43 studies that documented depression in fathers between the first trimester and the first postpartum year involving 28 004 participant.

Although there was substantial heterogeneity between the rates of paternal depression between studies, the average rate of paternal depression in the antenatal period (during pregnancy) was abour 10% but increased to about 25% during the 3 to 6-month postpartum period (after birth).

While paternal depression was more likely in the presence of maternal depression, this was by no means a strong predictor of paternal mood disorder.

These findings have important implications.

Not only is it important to also be wary of mood disorders in expecting and new fathers (especially if the mother has mood problems), but these mood disorders in fathers may need to be addressed.

This is of particular importance given the emerging evidence that paternal depression may have substantial emotional, behavioural and developmental effects on the infant.

Furthermore, it may well be that paternal peripartum depression could contribute to weight gain in dads.

Thus, prevention, screening and interventions for depression should likely be focussed on the couple rather than on the individual parent.

AMS
Oslo, Norway

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Paulson JF, & Bazemore SD (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA : the journal of the American Medical Association, 303 (19), 1961-9 PMID: 20483973