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Musings of an obesity medicine doc and certifiably cynical realist
[This is an updated and edited version of a post originally published in February 2011. I'm updating it as the original post referred simply to a poster presentation but yesterday the full article was published ahead of print in the Journal of Clinical Endocrinology and Metabolism]Talk about setting people up for long term struggle.The term metabolic adaptation is given to the phenomenon whereby when a person loses a certain percentage of weight, their metabolisms slow by greater amou........ Read more »
Darcy L. Johannsen, Nicolas D. Knuth, Robert Huizenga, Jennifer C. Rood, Eric Ravussin, & Kevin D. Hall. (2012) Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass. The Journal of Clinical Endocrinology and Metabolism. info:/10.1210/jc.2012-1444
Das SK, Roberts SB, McCrory MA, Hsu LK, Shikora SA, Kehayias JJ, Dallal GE, & Saltzman E. (2003) Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. The American journal of clinical nutrition, 78(1), 22-30. PMID: 12816767
A waste of a perfectly good gym?Last week saw a press release from Konami bragging about the involvement of the American Diabetic Association in bringing their exergame Dance, Dance, Revolution to schools across the United States.Demonstrating what I would call a questionable understanding of energy balance, the ADA's Director of Youth Markets Mary Baumann was quoted in the release as stating, "We look forward to the impact the new classroom edition can offer schools to help keep children in the........ Read more »
Lanningham-Foster, L., Jensen, T., Foster, R., Redmond, A., Walker, B., Heinz, D., & Levine, J. (2006) Energy Expenditure of Sedentary Screen Time Compared With Active Screen Time for Children. PEDIATRICS, 118(6). DOI: 10.1542/peds.2006-1087
I don't envy the food industry spin doctors their jobs, as at least some of them must realize how ridiculous their arguments are to folks who take the time to critically appraise them.Take for instance Justin Sherwood. Mr. Sherwood is the President of the Canadian Beverage Association and just this week he was tasked with defending sugar as a contributor to obesity, diabetes and heart disease.Let's review Mr. Sherwood's letter, but seen through the lens of Kelly Brownell and Kenneth Warner's Bi........ Read more »
Kelly D. Brownell, & Kenneth E. Warner. (2009) Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?. The Milbank Quarterly, 87(1), 259-294. DOI: 19298423
That's the conclusion drawn by a recent meta-analysis of the impact of after school sports on pediatric obesity and diet.Weight wise, despite what between the lines reading of the paper suggests the authors wanted to find, they were unable to conclude that after school sports had a beneficial impact on weight status. While there were some studies that suggested benefit, there were many others that did not, leading the authors to ultimately state, "there is not sufficient evidence to conclu........ Read more »
Nelson TF, Stovitz SD, Thomas M, LaVoi NM, Bauer KW, & Neumark-Sztainer D. (2011) Do youth sports prevent pediatric obesity? A systematic review and commentary. Current sports medicine reports, 10(6), 360-70. PMID: 22071397
File this under "How could this possibly have been published", along with, "Really. Really?".From the University of Tennessee comes a paper that quantifies the calories burned by adults who while watching an hour of television, were instructed to stand up and step in place during commercial breaks.The results? Apparently you can take around 2,000 steps during an hour of television if you just get up and step on the spot during commercials.My favourite part though has to be the researchers' con........ Read more »
STEEVES, J., THOMPSON, D., & BASSETT, D. (2012) Energy Cost of Stepping in Place while Watching Television Commercials. Medicine , 44(2), 330-335. DOI: 10.1249/MSS.0b013e31822d797e
Ugh.So without spending too much time on this, here's the thing, that paper that purported daily diet soft drink consumption was associated with several vascular risk factors including strokes? It's useless, and moreover, it's a glaring failure of peer review.Why?Because the authors didn't even attempt to control for dietary quality, and moreover, the dietary recall data itself was obviously inherently flawed.First the control issue. As I'm sure you're aware, what we eat has a tremendous impac........ Read more »
Gardener, H., Rundek, T., Markert, M., Wright, C., Elkind, M., & Sacco, R. (2012) Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study. Journal of General Internal Medicine. DOI: 10.1007/s11606-011-1968-2
If you like your data clean, pretty and predictable, you probably don't want to read the rest of this post.Researchers from my hometown here in Ottawa recently published a study ahead of print in the journal Obesity. The paper, Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City looked at a number of different built environment variables and their impacts upon the probability of both leisure time physical activity and overweight an........ Read more »
Prince, S., Kristjansson, E., Russell, K., Billette, J., Sawada, M., Ali, A., Tremblay, M., & Prud'homme, D. (2012) Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City. Obesity. DOI: 10.1038/oby.2011.392
While this wasn't a randomized or blinded trial, the results were striking.442 case-matched patients were followed for 6 post-operative years. Half received a gastric bypass, and half a gastric band. While early minor complications were higher in the gastric bypass group (triple the rate seen in banding), major complications were similar. Aside from that, it's all bypass with the bypassed patients enjoying quicker losses, larger maximal losses and significantly better maintenance of losses.How........ Read more »
Romy, S., Donadini, A., Giusti, V., & Suter, M. (2012) Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity: A Case-Matched Study of 442 Patients. Archives of Surgery. DOI: 10.1001/archsurg.2011.1708
"Fat Children Eat Less Than Their Thinner Peers". That's the tweet Linda Bacon from HAES fame sent out to her followers at 9:55am yesterday morning.
It certainly fits the HAES narrative that the world's completely backwards in regard to anything and everything weight related.
Sadly it also continues Linda's confusing practice of tweeting bad data.
Linda's HAES platform, whether you agree or disagree with it, rests on the shoulders of her critical analysis of the medical literature on obesit........ Read more »
Magarey, A., Watson, J., Golley, R., Burrows, T., Sutherland, R., McNaughton, S., Denney-Wilson, E., Campbell, K., & Collins, C. (2011) Assessing dietary intake in children and adolescents: Considerations and recommendations for obesity research. International Journal of Pediatric Obesity, 6(1), 2-11. DOI: 10.3109/17477161003728469
That was the question that leaped to mind after looking at one of the appendices of the recent Edmonton Obesity Staging System paper in the CMAJ.
Looking at the graphic up above (if you click it, it'll get larger), it would appear that the earlier NHANES III cohort (1988-1994) included a significantly higher percentage of so-called, "fit and fat" folks, as compared with the later NHANES 1999-2004 cohort.
In the later cohort, the percentage of the study population with an EOSS score of zero (me........ Read more »
Padwal, R., Pajewski, N., Allison, D., & Sharma, A. (2011) Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. Canadian Medical Association Journal. DOI: 10.1503/cmaj.110387
Janssen, I., Shields, M., Craig, C., & Tremblay, M. (2011) Changes in the Obesity Phenotype Within Canadian Children and Adults, 1981 to 2007–2009. Obesity. DOI: 10.1038/oby.2011.122
Jennifer L. Kuk, Chris I. Ardern, Timothy S. Church, Arya M. Sharma, Raj Padwal, Xuemei Sui, & Steven Blair. (2011) Edmonton Obesity Staging System: association with weight history and mortality risk. Appl. Physiol. Nutr. Metab., 570-576. info:/10.1139/H11-058
I heard about it when Linda Bacon from HAES tweeted a link to a press release about it multiple times, calling it "Myth Busting". Knowing that Linda knows how to critically appraise a journal article, I figured it'd be worth reading the actual study.
I was wrong.
The study looked at one solitary day's 24hr. dietary recall collected from 11,182 children between the ages of 2-18 years of age, and then compared candy intake to overweight and obesity status in those same children.
Now d........ Read more »
E. O'Neil, C., L. Fulgoni Iii, V., & A. Nicklas, T. (2011) Association of candy consumption with body weight measures, other health risk factors for cardiovascular disease, and diet quality in US children and adolescents: NHANES 1999–2004. Food . DOI: 10.3402/fnr.v55i0.5794
But also don't hide them too!
What am I talking about?
A recent study out of Volumetrics' Barbara Rolls' lab that found incorporating pureed vegetables into 3-5 year olds' bread, pasta sauce, and chicken noodle casserole reduced energy intake in kids by 12%! And don't worry, Dr. Rolls has shown these same type of effects over and over again in adults.
That's not an insignificant, or unexpected reduction - decreasing the energy density of food by adding in piles of pureed vegetables means if........ Read more »
Spill, M., Birch, L., Roe, L., & Rolls, B. (2011) Hiding vegetables to reduce energy density: an effective strategy to increase children's vegetable intake and reduce energy intake. American Journal of Clinical Nutrition. DOI: 10.3945/ajcn.111.015206
Let me start things off by telling you that I do believe exercise to be extremely helpful in long term weight management. I'll also tell you that I'm a huge fan of the National Weight Control Registry. For those of you who aren't familiar with the Registry, Registrants are folks who are supremely good at maintaining their weight-losses. In fact, the average Registrant has lost 67lbs and kept it off for 5.5 years!There's a great deal of variety in the Registry. Different types of dietary appr........ Read more »
Catenacci VA, Grunwald GK, Ingebrigtsen JP, Jakicic JM, McDermott MD, Phelan S, Wing RR, Hill JO, & Wyatt HR. (2011) Physical activity patterns using accelerometry in the national weight control registry. Obesity (Silver Spring, Md.), 19(6), 1163-70. PMID: 21030947
There's got to be a better way than peer review, because if papers like this one can make it through, the system is broken.The paper's entitled, Dairy attenuates oxidation and inflammatory stress in metabolic syndrome, and it's written by Renee Stancliffe, Teresa Thorpe and Michael Zemel.The paper's aim was to study the impact of dairy on oxidative and inflammatory biomarkers in individuals with metabolic syndrome, following 12 weeks of being randomized to different levels of dietary dairy. The........ Read more »
Stancliffe RA, Thorpe T, & Zemel MB. (2011) Dairy attentuates oxidative and inflammatory stress in metabolic syndrome. The American journal of clinical nutrition. PMID: 21715516
Have you caught the amazing, shocking, unbelievable news that type 2 diabetes can be managed through weight loss and lifestyle change?I sure did.Um, I first caught it in medical school nearly 20 years ago and see it virtually daily in my office. I'm guessing if you've got type 2 diabetes, you caught that news from your doctor. In fact I'd be shocked to learn if there were a single type 2 diabetic on the planet who wasn't told at diagnosis that weight loss and/or lifestyle change could reverse t........ Read more »
Lim, E., Hollingsworth, K., Aribisala, B., Chen, M., Mathers, J., & Taylor, R. (2011) Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. DOI: 10.1007/s00125-011-2204-7
It's been a bad few weeks for obesity related press releases.The first was that press release from CIHI, where its headline and first paragraph served here in Canada, to lead journalists to declare that all that's necessary to combat obesity are 15 minutes of exercise a day, and a diet rich in fruits and vegetables (and consequently anyone who's obese is lazy and eats Ding Dongs for supper).Now there's this one.It came from the University of North Carolina at Chapel Hill, and it was released in ........ Read more »
Sampey, B., Vanhoose, A., Winfield, H., Freemerman, A., Muehlbauer, M., Fueger, P., Newgard, C., & Makowski, L. (2011) Cafeteria Diet Is a Robust Model of Human Metabolic Syndrome With Liver and Adipose Inflammation: Comparison to High-Fat Diet. Obesity, 19(6), 1109-1117. DOI: 10.1038/oby.2011.18
Right off the top let me say I'm not well versed enough in statistics to know who's right.On one side of the fence are the findings of Christakis and Fowler, famously published in the New England Journal of Medicine that posited obesity is socially contagious. Non-statistically, their paper didn't sit right with me, but as far as stats go, I'm no maven.On the other side of the fence is a new paper published by Russel Lyons who posits that Christakis' and Fowler's work is a great example of stat........ Read more »
Lyons, R. (2011) The Spread of Evidence-Poor Medicine via Flawed Social-Network Analysis. Statistics, Politics, and Policy, 2(1). DOI: 10.2202/2151-7509.1024
That was one of the cases put forth by Dr. Bob Ross during our Forks vs. Feet debate.He had discussed an as of then unpublished study that concluded that due to changes in occupation-based physical activity, we were all on average burning 100 fewer calories per workday, and that those no longer burned calories have caused us to become obese.Well, the paper was just published and I had a gander.Now I do think there are weaknesses to the analysis, in that this study of theoretical energy expenditu........ Read more »
Church, T., Thomas, D., Tudor-Locke, C., Katzmarzyk, P., Earnest, C., Rodarte, R., Martin, C., Blair, S., & Bouchard, C. (2011) Trends over 5 Decades in U.S. Occupation-Related Physical Activity and Their Associations with Obesity. PLoS ONE, 6(5). DOI: 10.1371/journal.pone.0019657
Wilkin, T., Mallam, K., Metcalf, B., Jeffery, A., & Voss, L. (2006) Variation in physical activity lies with the child, not his environment: evidence for an ‘activitystat’ in young children (EarlyBird 16). International Journal of Obesity, 30(7), 1050-1055. DOI: 10.1038/sj.ijo.0803331
Luke, A., Dugas, L., Ebersole, K., Durazo-Arvizu, R., Cao, G., Schoeller, D., Adeyemo, A., Brieger, W., & Cooper, R. (2008) Energy expenditure does not predict weight change in either Nigerian or African American women. American Journal of Clinical Nutrition, 89(1), 169-176. DOI: 10.3945/ajcn.2008.26630
Lara R Dugas, Regina Harders, Sarah Merrill, Kara Ebersole, David A Shoham, Elaine C Rush, Felix K Assah, Terrence Forrester, Ramon A Durazo-Arvizu, & Amy Luke. (2011) Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies. The American Journal of Clinical Nutrition, 93(2), 427-441. info:/10.3945/ajcn.110.007278
Westerterp, K., & Speakman, J. (2008) Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. International Journal of Obesity, 32(8), 1256-1263. DOI: 10.1038/ijo.2008.74
Swinburn, B., Sacks, G., & Ravussin, E. (2009) Increased food energy supply is more than sufficient to explain the US epidemic of obesity. American Journal of Clinical Nutrition, 90(6), 1453-1456. DOI: 10.3945/ajcn.2009.28595
Very interesting study just came out ahead of print in the American Journal of Clinical Nutrition.In it, researchers studied the impact of over-feeding on stool based calorie loss.Basic principle is that we're not perfectly efficient creatures when it comes to extracting calories from our food. Further, mouse experiments have suggested that their guts' microbial flora and fauna causally impacted their weights. To start exploring this in humans, here researchers studied whether or not changing ........ Read more »
Jumpertz R, Le DS, Turnbaugh PJ, Trinidad C, Bogardus C, Gordon JI, & Krakoff J. (2011) Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans. The American journal of clinical nutrition. PMID: 21543530
You may have read or heard about a research paper that came out a few weeks ago in JAMA. The study followed 3,681 Europeans and looked for relationships between sodium excretion (the gold standard means of determining sodium intake), and cardiovascular disease and death.The study's findings were in contrast with what most would have expected. Though higher sodium excretion did in fact correlate with higher blood pressures, surprisingly, it also correlated with decreased mortality.So what's goi........ Read more »
Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E.... (2011) Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA : the journal of the American Medical Association, 305(17), 1777-85. PMID: 21540421
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