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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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The Health And Social Benefits Of Risky Play

sharma-obesity-active-kidsThe recent report card on physical activity released by Participaction strongly recommends (unsupervised) free play as a means to increase physical activity in kids.

But free play has far greater benefits on children’s development than just physical fitness, especially when there is an element of risk involved.

That is the conclusion of a paper by Marianna Brussoni and colleagues, published in the International Journal of Environmental Research and Public Health.

For their paper, risky play was defined as play that involves an element of danger, including the possibility of physical injury.  Such types of play include play at height, speed, near dangerous elements (e.g., water, fire), with dangerous tools, rough and tumble play (e.g., play fighting), and where there is the potential for disappearing or getting lost.

This systematic review of 21 relevant research studies shows that risky outdoor play not only improves physical health (despite the inherent risk of injuries and even death), but also social health and behaviours, risk for injuries, and reduced aggression.

Specifically, studies have shown improvements in risk detection and competence, increased self-esteem and decreased conflict sensitivity and conflict resolution, better developed motor skills, enhanced social behaviour, greater independence, improved risk management strategies, and the ability to negotiate decisions about substance use, relationships and sexual behaviour during adolescence.

Obviously, risky behaviour is risky – according to the researchers,

“In Canada, approximately 2,500 children age 14 and under are hospitalized annually as a result of playground falls (play at height)—81% are for fractures.”

Nevertheless, weighing all of the available evidence, the researchers came to the following conclusions:

“Although these findings are based on ‘very low’ to ‘moderate’ quality evidence, the evidence suggests overall positive effects of risky outdoor play on a variety of health indicators and behaviours in children aged 3-12 years. Specifically, play where children can disappear/get lost and risky play supportive environments were positively associated with physical activity and social health, and negatively associated with sedentary behaviour.

Play at height was not related to fracture frequency and severity. Engaging in rough and tumble play did not increase aggression, and was associated with increased social competence for boys and popular children, however results were mixed for other children.

There was also an indication that risky play supportive environments promoted increased play time, social interactions, creativity and resilience.

These positive results reflect the importance supporting children’s risky outdoor play opportunities as a means of promoting children’s health and active lifestyles.”

Clearly, these finding go against the popular policies that focus on harm reduction and making kids’ play environments as safe as possible.

Perhaps these policies are doing more harm than good – as always, you never know where the unintended consequences of well-meant public policies rear their ugly head.

@DrSharma
Edmonton, AB

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The Biggest Risk Is Keeping Kids Indoors

Participaction report card 2015This week, Participaction released the 2015 report card on activity in Canadian kids (a yearly exercise formerly undertaken by Healthy Active Kids), and its message is simple – send your kids outside to play!

This is how Participaction defines the protection paradox:

“We may be so focused on trying to intervene in our children’s lifestyles to make sure they’re healthy, safe and happy, that we are having the opposite effect….We overprotect kids to keep them safe, but keeping them close and keeping them indoors may set them up to be less resilient and more likely to develop chronic diseases in the long run.”

And it works best when you send the kids out alone – here is what research shows:

  • Grade 5 and 6 students who are often or always allowed to go out and explore unsupervised get 20% more heart- pumping activity than those who are always supervised.
  • 3- to 5-year-old kids are less likely to be active on playgrounds that are designed to be “safer,” because many kids equate less challenging with boring.
  • Children and youth are less likely to engage in higher levels of physical activity if a parent or supervising adult is present.

Safe is boring – who would have guessed?

And here’s even more research to support this idea:

  • Kids with ready access to unsupervised outdoor play have better-developed motor skills, social behaviour, independence and conflict resolution skills.
  • Adventure playgrounds and loose parts playgrounds, which support some exposure to “risky” elements, lead to an increase in physical activity and decrease in sedentary behaviours.

Simply stated:

“We need to consider the possibility that rules and regulations designed to prevent injuries and reduce perceived liability consequences have become excessive, to the extent that they actually limit rather than promote children’s physical activity and health. Adults need to get out of the way and let kids play.”

The full report card can be downloaded here.

Time to set your kids free!

@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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