Tuesday, October 14, 2014

Electronic Versus Pen And Paper Monitoring Of Food Intake

diet journalSelf-monitoring is one of the few proven strategies for long-term weight management (which is why all programs worth their weight use it).

But does it really matter how you self-monitor and are electronic forms more accurate than simply using pen and paper?

This issue was examined by Melinda Hutchesson and colleagues from the University of South Wales, Australia, in a paper published in the Journal of the Academy of Nutrition and Dietetics.

The researchers examined the acceptability and accuracy of three different 7-day food record methods (online accessed via computer, online accessed via smartphone, and paper-based) in 18 young normal-weight women.

Actual energy expenditure was measured using indirect calorimetry and physical activity levels derived from accelerometers.

All three methods revealed roughly the same amount of daily caloric intake, falling short by about 500 kcal of the actual measured expenditure.

Nevertheless, around 90% of the participants preferred an electronic method to the paper based method.

Thus, the author argue that,

“Because online food records completed on either computer or smartphone were as accurate as paper-based records but more acceptable to young women, they should be considered when self-monitoring of intake is recommended to young women.”

As far as I am concerned, you can use whatever method you want as long as you use some form of self-monitoring. After all, it is the act of self-monitoring that counts – as with diets, this only works when you actually do it.

@DrSharma
Edmonton, AB

ResearchBlogging.orgHutchesson MJ, Rollo ME, Callister R, & Collins CE (2014). Self-Monitoring of Dietary Intake by Young Women: Online Food Records Completed on Computer or Smartphone Are as Accurate as Paper-Based Food Records but More Acceptable. Journal of the Academy of Nutrition and Dietetics PMID: 25262244

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Wednesday, October 8, 2014

Can Education Offset The Genetic Risk For Obesity?

sharma-obesity-dna_molecule9Obesity is a highly heritable condition with considerable penetrance, especially in our obesogenic enviroment.

However, as I have pointed out before, having a genetic predisposition for obesity (like having a genetic predisposition for other diseases such as diabetes or high blood pressure) does not mean your fate is chiseled in stone. Lifestyle changes can significantly reduce the risk, but those with a stronger genetic predisposition will have to work a lot harder at not gaining weight than those who are naturally slender.

That said, a new study by Liu and colleagues from Harvard University, published in Social Science & Medicine, shows that better education may offset a substantial proportion of the genetic risk for obesity and/or diabetes.

The researchers created genetic risk scores for obesity and diabetes based on single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs) in over 8000 participants in the Health and Retirement Study.

Linear regression models with years of schooling indicate that the effect of genetic risk on both HbA1c and BMI was smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders.

As one may expect, estimates from the quantile regression models consistently indicated stronger associations for years of schooling and genetic risk scores at the higher end of the outcome distribution, where individuals are at actual risk for diabetes and obesity.

In other words, the greater the genetic risk for diabetes or obesity, the greater the positive impact of finishing high-school or college.

In contrast, having less than a high-school education augmented the genetic risk for these conditions.

From these findings the authors conclude that,

“Our findings provide some support for the social trigger model, which speculates that the social environment can attenuate or exacerbate inherent genetic risks. Furthermore, it suggests social stratification may shape how genetic vulnerability is expressed. Social hierarchies based on socioeconomic status determine the health status of individuals. According to fundamental cause theory, policies and interventions must address social factors directly to have a population-level impact on disease risk . Our results show how education, a fundamental cause of health and disease, can serve as a valuable resource that offsets even innate biological risk. Education increases an individual’s ability to adapt, modify, and use surrounding resources. As such, polices that reduce disparities in education may help offset underlying genetic risk.”

This study strongly supports my view that one cannot (and should not) ignore genetic risk when studying the effect of environmental or behavioural factors in populations or individuals. Indeed, the greatest benefit of these interventions clearly appear to be found in those with the highest genetic risk.

@DrSharma
Ottawa, ON

ResearchBlogging.orgLiu SY, Walter S, Marden J, Rehkopf DH, Kubzansky LD, Nguyen T, & Glymour MM (2014). Genetic vulnerability to diabetes and obesity: Does education offset the risk? Social science & medicine (1982) PMID: 25245452

 

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Tuesday, October 7, 2014

The Freshmen 15 Are Neither 15 Nor Limited to Freshmen

sharma-obesity-black-studentsAccording to popular belief, the first year of college can be associated with a 15 pound weight gain – often referred to as “the freshman 15″.

Now, a study by Micheal Fedewa and colleagues from the University of Georgia, look at the weight trajectory in college studies in a paper published in the American Journal of Preventive Medicine.

Their systematic review and meta-analysis includes 49 studies evaluating the effect of the first year of college (and beyond) on the dependent body weight and or %body fat.

While the researchers found a statistically significant change in body weight among students, the average weight gain was a rather modest 1.6 kg during a typical 4-year college career. Interestingly, this finding is similar to previous estimates suggesting average increases ranging from 1.1. to 2.1 kg in the first year of college.

Thus, the actual average weight gain comes nowhere close to the notorious “15″.

Also, the authors found that most of the weight gain is progressive and continues throughout college – there is little evidence that most of the weight gained (if any) happens in the first year.

Thus, despite individual anecdotal experiences of weight gain, that may sometimes approach or even exceed 15 lbs, there is little scientific basis or reason for concern about the freshman 15.

Or, as the authors put it,

These results suggest that the “Freshman 15” may not pose a significant risk to students’ health, but unhealthy behaviors throughout college may lead to unfavorable changes in body weight, as weight change does not appear to stabilize as previously reported.

Perhaps it is time to put this idea to rest and move on to study issues that may be more important than this.

@DrSharma
Guelph, ON

ResearchBlogging.orgFedewa MV, Das BM, Evans EM, & Dishman RK (2014). Change in Weight and Adiposity in College Students: A Systematic Review and Meta-Analysis. American journal of preventive medicine PMID: 25241201

 

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Tuesday, September 30, 2014

Practical Guide To Obesity Prevention in Schools in Developing Countries

Practical Guide To Obesity Prevention in School-Aged ChildrenObesity in school-age children is not just a problem in the affluent West – this issue if of growing importance in countries where one may not quite expect this to be an issue like South Asia or Africa.

Now, researchers from the University of Montreal and McGill University have released a comprehensive practical guide to developing and implementing obesity prevention programs for school-aged children and adolescents in developing countries.

As the authors discuss,

“What is most challenging in low and middle-income countries is the urgency of preventing obesity while also tackling the problem of malnutrition. Again, the school setting is likely the most appropriate to address the dual burden of malnutrition, but interventions are needed at different stages of the lifecycle, beginning with girls, in order to break the intergenerational cycle of malnutrition and its impact on vulnerability to obesity and other chronic diseases.”

This guide is a product of TRANSNUT (for nutrition transition), a WHO Collaborating Centre comprised of 10 researchers from the Department of Nutrition and other units of the University of Montréal.

In the words of the authors,

“This manual is designed to provide a hands-on guide for health and nutrition professionals to plan, implement and evaluate obesity prevention programmes for school-age children and adolescents in developing countries, particularly in the school setting. Several practical tools are suggested, including for the assessment of obesity and of its proximal determinants, that is, eating and physical activity patterns. Models and conceptual frameworks are discussed because action has to be grounded in sound theory. We provide a 5-step guide to planning healthy nutrition promotion and obesity prevention interventions, which we adapted from the PRECEDE-PROCEED of Green. The steps consist of community and individual assessments, identification of targets for change(community, family, individual level), choice of objectives, design of programme methods, and procedures for theevaluation. In order to foster effective programmes to promote healthy nutrition and lifestyle among school-agechildren and adolescents, we discuss theoretical models of behaviours change that may be appropriate (Health Belief Model, Theory of Planned Behaviour, Social Cognitive Theory, Stages of Change, Transtheoretical Model).”

This document should provide an interesting read to anyone interested in the prevention of childhood obesity in developing countries or elsewhere.

A copy of this guide can be downloaded here

@DrSharma
Charlottetown, PEI

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Tuesday, September 23, 2014

5th Conference on Childhood and Adolescent Obesity, Winnipeg, Sept 23-26, 2014

The next couple of days, I will be attending the 5th Conference on Childhood and Adolescent Obesity in Winnipeg.

For a previous post on this conference and a copy of the program, click here.

For tickets to the Dr. Sharma Show in Winnipeg on September 24th, click here.

@DrSharma
Winnipeg, MB

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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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