Clinical Assessment: Skin Problems
Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network. This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest. SKIN PROBLEMS Obesity is associated with a number of dermatoses. It affects cutaneous sensation, temperature regulation, foot shape, and vasculature. Acanthosis nigricans is the most common dermatological manifestation of obesity and it appears as velvety, light brown-to-black markings usually on the neck, under the arms, or in the groin. Skin tags are more commonly associated with diabetes than with obesity, but may be an early clue to the presence of hyperinsulinemia. Obesity increases the incidence of cutaneous infections such as candidiasis, intertrigo, candida folliculitis, furunculosis, erythrasma, tinea cruris, and folliculitis. Less common infections include cellulitis, necrotizing fasciitis, and gas gangrene. Leg ulcerations, lymphedema, plantar hyperkeratosis, and striae are all more common with obesity. Contrary to popular belief, cellulite is not related to obesity. It is part of normal female physiology and is present to some extent in over 95% of all adult women. © Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved. The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network. Members of the Canadian Obesity Network can download Best Weight for free. Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network) If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.
Save Your Carbs For Dinner?
Diurnal changes in hormones and metabolism are well known and how these can be influenced by timing and sequencing of external stimuli (e.g. eating, exercise, sleep, etc.) has always been of considerable interest. A study by Sigal Sofer and colleagues from the Hebrew University of Jerusalem, Israel, published in OBESITY, suggests that eating most of your carbs at dinner may have beneficial effects on hormonal patterns, metabolism, and lead to more weight loss than eating a similarly calorie-restricted diet with carbs spread out throughout the day. The rationale for the study as stated by the researchers is that: “…consumption of carbohydrates mostly in the evening would modify the typical diurnal pattern of leptin secretion as observed in Muslim populations during Ramadan. The experimental diet induced a single daily insulin secretion in the evening, thus it was predicted that the diet would lead to higher relative concentrations of leptin starting 6–8 h later i.e., in the morning and throughout the day. This may lead to enhanced satiety during daylight hours and improve dietary adherence.” In addition, “Studies have shown that there is a negative correlation between insulin and adiponectin levels. Since the experimental diet used in this study reduces insulin secretion during the day, it was also hypothesized that adiponectin concentrations would increase throughout the day improving insulin resistance, diminishing symptoms of the metabolic syndrome and lowering inflammatory markers.” A total of 78 male subjects (policemen) with a BMI greater than 30 were randomized to 6 months of 1,300–1,500 kcal/day diets, with either the carbs served mostly at dinner (test) or throughout the day (control). Subjects eating their carbs in the evenings lost more weight (11.6 vs. 9.06 kg) and had lower hunger scores as well as greater improvements in fasting glucose, average daily insulin concentrations, and insulin-resistance. There were also greater improvements in lipid profiles, CRP, and other relevant markers in the intervention group. While leptin levels dropped in both groups (not surprising given the weight loss), the leptin decrease was less in the late-carb-eaters than in the control group, and adiponectin levels increased significantly only in the intervention group. The authors suggest that these hormonal changes may perhaps explain the improved metabolic control and lower hunger scores in this group. However, the authors are also careful to point out that: “Further research is required to confirm and clarify the mechanisms by which this relatively simple diet approach enhances satiety,… Read More »
Health Risks of Gaining Weight in Adulthood Similar to Risks of Persistent Childhood Obesity
One of the major concerns around the childhood obesity epidemic is that early onset obesity may be associated with greater health risks when these kids grow into obese adults compared to individuals who only become obese as adults. This hypothesis was recently tested in a study Markus Juonala (Finland) and colleagues in a study published last month in the New England Journal of Medicine. The researchers examined data from four prospective cohort studies that measured childhood and adult BMI with a mean length of follow-up was 23 years. Data were compared between four groups: Group 1: nonobese kids who grew into nonobese adults(n=4742) Group 2: obese kids who grew into nonobese adults (n=274) Group 3: obese kids who grew into obese adults (n=500) Group 4: nonobese kids who grew into obese adults (n=812) All analyses were adjusted for age, sex, height, length of follow-up, and their respective cohorts. The not so good new is that when childhood obesity persists into adulthood (Group 3), the risk is markedly higher than in Group 1 (never obese) – unfortunately, this is what happens to most of obese kids as 82% of them grew into obese adults. The good news, however, is that there was absolutely no difference in the cardiovascular risk factors (diabetes, hypertension, dyslipidemia, or intima-media thickess) between Group 1 (never obese) and Group 2 (only obese as kids but not as adults) – this suggests that any increased risk associated with being an obese kid can be virtually completely reversed if they manage to grow into nonobese adults. Unfortunately, the health risks associated with adult-onset obesity (Group 4) were exactly as bad as with childhood-onset obesity. In other words, even if you managed to get through childhood with normal weight – gaining weight as an adult put you at the same risk as if you’d been obese all your life. These findings certainly provide important nuances to the discussions about where obesity prevention and treatment resources should be focussed. Obviously, if you can prevent or treat childhood obesity, thereby reducing the number of obese adults, you would substantially lower risk. But this may be easier said than done, as so far, we are not exactly sure that ‘successful’ obesity treatment in childhood actually prevents adult obesity (we certainly hope it does but no one has yet shown this to be the case). In fact, in this study, two out of three… Read More »
The Double Pyramid or Why What You Eat Affects My Health (and Everyone Else’s)
Long-time readers will recall previous posts on the environmental impact of food production and how closely the societal root causes of the obesity epidemic may be linked to global warming (in more ways than one would think). I now came across a most interesting and remarkably comprehensive and insightful analysis of the true environmental impact of our food environment. This document, released by the Barilla Centre for Food and Nutrition (yes, the pasta folks are involved in this), answers important questions on just how different the carbon footprint of preparing pasta depends on how much water you use to cook 500 g of pasta (assuming a ± 20% pasta/water variable ratio and 10 min cooking time). Such, ‘light-hearted’ trivia aside, the report actually provides some amazing insights into the ‘field-to-fork’ impact of food production and how it relates to everything from environmental impact to economies of scale. The centre piece of the report is The Double Food-Environmental Pyramid, where one pyramid represents the traditional food recommendations and the other once (upside down) represents the environmental impact of those foods. As it turns out (not surprisingly perhaps), in general, the more recommended foods tend to have a lower impact on the environment that the foods recommended for a lower consumption. Thus, the double pyramid exemplifies how the food pyramid actually meets two important goals -maintains people’s health and protects the environment. In other words, eating ‘healthy’ is not just good for you but also for the planet (this is somehow reminiscent of ‘passive smoking’ because suddenly what YOU eat affects MY environment and, therefore, MY health). Rather than fascinate you with an incredible amount of highly interesting trivia in this report, I suggest you download the original document here for a most interesting Holiday read. Buon appetito! AMS Edmonton, Alberta p.s. Hat tip to Annette Anderwald for pointing me to this publication!
Canadian Obesity Network Welcomes Craving Change
This week, the Canadian Obesity Network welcomed a new parter – Craving Change, a small Canadian ‘start up’ that has become an almost overnight success with providers and patients. The founders describe it on their website as follows: “Created by dietitian Wendy Shah and clinical psychologist Dr. Colleen Cannon, Craving Change™ provides a missing piece to the puzzle of helping people change their eating habits. Craving Change™ translates behaviour modification and cognitive-behavioural theory into appealing and practical strategies that a variety of professionals can use with groups or individuals.“ What the program really does, is break down the cognitive-behavioural-theory (CBT) approach to dealing with emotional ‘overeating’ into a stepped-program that can be administered by health professionals (e.g. dieticians, nurses, etc.) with minimal prior expertise or training in psychology. “Craving Change does not provide dietary advice, nor is it psychotherapy – rather, Craving Change focuses on the “why” of eating – it is designed to help patients who struggle with what they eat, when they eat, and how much they eat.” As Colleen, herself a clinical psychologist is quick to point out, Craving Change does not attempt to replace psychologists or diminish their importance in an obesity program. However, it does address the reality that many health professionals called upon to manage obesity, do not have ready access to psychologists that will see their patients (indeed there are simply not enough psychologists around to help everyone who would require their help). “If you have limited access to psychosocial resources, the stepped care approach of the Craving Change™ workshop can be invaluable for reaching more clients. Self-awareness of eating triggers can be achieved in a group setting using Craving Change™ workshop activities. Clients can then be encouraged to try a variety of strategies, based on behaviour modification and cognitive-behavioural theory, to improve their eating behaviours. Craving Change™ also helps clients learn skills that promote long-term adherence to new behaviours.“ So, far Wendy and Colleen have trained over a 1000 health professionals to administer their program – their ‘clients’ include Alberta Health Services and a growing number of providers across Canada. Wendy and Colleen are also long-time members and enthusiastic supporters of the Canadian Obesity Network and have generously agreed to donate a proportion of their ongoing proceeds to sustain the Network. I am sure several of my readers will either have delivered or attended Craving Change sessions, here in Alberta or elsewhere… Read More »
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