Dear Parents/Grandparents: Your Toddler Does Not Need a Screen for Christmas

The end of civilization as we know it. (The iPotty. Source)

Christmas is upon us.  If you are a parent/grandparent/relative, you are likely scrambling for that last minute item that your child will love.  One thing I urge you to avoid: screens, and toys that incorporate screens.  Your toddler does not need a huggable iphone case, or a learning tablet, or (does this need to be said?!) an iPotty.

The Woogie (Source)

The research is absolutely clear: the more time that kids spend in front of screens, the worse their physical and mental health (a full review of the evidence is available here, and concluded that excess screen time was associated with excess body fat, reduced fitness, worse grades, and worse behaviour).
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3 tricks for preventing holiday weight gain

holiday dinnerAlthough only 1 in 10 individuals will gain 5 lbs or more during the holidays, most of us will put on some weight that tends to stay with us during the course of the following year. Thus, to help you avoid becoming that 1 in 10 who puts on more weight than average during the next couple of weeks, here’s a list of 3 easy tricks to curb overindulging.

1. Drink 1-2 glasses of water prior to all big meals
A study published online in the journal Obesity randomized overweight/obese older men and women to either a hypocaloric diet alone or a hypocaloric diet plus increased water consumption for a duration of 12 weeks. The hypocaloric diet consisted of 1200 calories for the women and 1500 calories for the men. Those in the diet + increased water group were required to consume 500 ml of water (2 cups) 30 minutes prior to each of the 3 large daily meals (breakfast, lunch, dinner).

While participants in both groups lost a significant amount of weight (5-8kg) in response to the diet, those who also consumed more water before their meals lost an additional 2 kg in comparison to the diet only group.

The greater weight loss in the group consuming pre-meal water was likely the result of smaller caloric intake during each meal (~40 calories less per meal).

Drinking more water will also have the added bonus of forcing you to take bathroom breaks, thereby increasing your level of physical activity.

2. Don’t skip breakfast
Research has shown that breakfast skippers have an overall poor diet quality and make lousy food choices throughout the day compared with breakfast consumers. Not surprisingly, breakfast skipping is strongly associated with an increased likelihood of weight gain. Given the plentiful availability of poor dietary options during the holidays, you can protect yourself against temptation by starting the day off right and eating breakfast.

While simply having breakfast is great, what you have for breakfast can make a big difference. Ideally, your breakfast should have plenty of fiber, plenty of protein, and not skimp on the calories. See here for more info.

3. Serve healthy snacks in large bowls and the unhealthy ones in small bowls

This little trick should result in a greater consumption of healthy snacks and a limited consumption of unhealthy ones, not only helping you, but those you have over to your place during the holidays.

A wonderfully simple study found that when snacks are offered in a large bowl, people take 53% more food (146 extra calories) and eat 56% (142 calories) more than when offered the same amount of food but in a smaller bowl (roughly half the size of large bowl).

Happy holidays!

Peter

References:

Tin, S., Ho, S., Mak, K., Wan, K., & Lam, T. (2011). Breakfast skipping and change in body mass index in young children International Journal of Obesity DOI:10.1038/ijo.2011.58

Wansink, B. (2005). Super Bowls: Serving Bowl Size and Food Consumption JAMA: The Journal of the American Medical Association, 293 (14), 1727-1728 DOI: 10.1001/jama.293.14.1727

Dennis, E., Dengo, A., Comber, D., Flack, K., Savla, J., Davy, K., & Davy, B. (2009). Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle-aged and Older Adults Obesity DOI:10.1038/oby.2009.235

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The truth about holiday weight gain

Today I’d like to revisit an issue which is becoming a bit of a holiday tradition here at Obesity Panacea. How much weight do people gain over the holidays?  

If you ask many people, they will say that the average person gains somewhere around 10 lbs, which is a pretty substantial amount (over a 10 year period, that would mean people were gaining roughly 100 lbs from the holiday season alone!).  This idea has taken root in the public imagination – see the above poster that was posted in a prominent Canadian gym chain in previous holiday seasons.

When I first heard about the above poster a few questions immediately jumped to mind:

  1. Where does this information come from? Who is the “average” person they are speaking of? Aged 18-80? Does it include kids? Seniors? Different ethnicities?
  2. If the average person gains 7-10 pounds, that means that some people are gaining much more. Is that even physically possible over a 1 or 2 week period (the definition of ‘holiday season’ varies pretty widely from person to person)? Canada has a population of roughly 33 million – if we gained an average of 9 lbs over the holidays, as a nation we are about to put on 297 million lbs this year alone!  In the USA, it would mean a collective holiday weight gain of roughly 3 billion lbs!!

This 7-10 lb weight gain statistic seems a bit strange, so I decided to look it up. Fortunately, I came across an excellent article from the New England Journal of Medicine which examines this very issue.
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Category: News, Obesity Research, Peer Reviewed Research | 8 Comments

In defense of Santa’s weight

santa“Santa’s behaviour and public image are at odds with contemporary accepted public health messages,” argues a British Medical Journal editorial written by Dr. Scrooge and colleagues. Given Santa’s tremendous popularity, particularly among children, the authors of the editorial argue the public should become aware of some of the less-than-ideal lifestyle practices advocated by jolly St. Nick.

The first issue they raise in support of their argument is the pervasive use of Santa Claus to advertise basically everything during the holidays, especially unhealthy food choices such as Coca-Cola products (fair enough). Apparently, it was the Coca-Cola company in the 1930s that developed the contemporary image of Santa Claus that we all recognize today, including his obesity.

And just how obese is Santa?

According to NORAD, Santa Claus weighs in at 260 lbs and has a height of 5’7, putting him at a BMI of 40.7 kg/m2. Then again, we know BMI isn’t all that useful anyway.

The authors worry that Santa’s image “promotes a message that obesity is synonymous with cheerfulness and joviality.”

The past US surgeon general is quoted as saying: “It is really important that the people kids look up to as role models are in good shape, eating well and getting exercise. It is absolutely critical.”

To make matters worse, an article by ABC news also suggests that Santa Claus impersonators have been putting on the pounds over the years, potentially helping normalize excess body sizes:

“In 1996, the biggest outfit sold at Santasuits.com was 2X, and sales of oversized suits accounted for just 12 percent of business. Today, the company offers a 4X, and plus-sized outfits are a third of their business. An original 1948 pattern owned by Western Staff Services Company in California has expanded inch by inch until it now accommodates a St. Nick who exceeds 300 pounds and a 50-inch beltline.”

Personally, here’s where I stand: at a time when discrimination against obese individuals is already rampant, and the large majority of the population is overweight or obese – it may not be a bad idea to have a public character who remains in good spirits despite his expanded waistline.

In fact, as we’ve pointed out numerous times before, the connection between body weight and health isn’t as clear cut as some think.  For instance, one can be obese, and yet be metabolically healthy. What seems to set healthy obese from unhealthy obese individuals apart comes down to limited visceral (intra-abdominal) fat accumulation, an earlier onset of obesity (<20 years) and high levels of physical activity. While we can’t speculate on the time of Santa’s obesity onset or his body composition (it could be mainly innocuous subcutaneous fat that he’s carrying around), we do know that he’s quite fit and athletic. I mean, what other 260 lb elderly man can climb up and down chimneys all night? He’s clearly physically active, nicely personifying the fat and fit phenotype.

To be fair, Santa’s diet may require a bit of an adjustment: ending the whole “milk and cookies” routine is probably a good idea for the health of Santa, or whoever dresses up as one. Santa could also benefit from a standing sleigh to reduce the time he spends sitting and cut his risk of deep vein thrombosis (I’m looking at you Mall Santa!), or park the sleigh a few houses away to increase his number of steps.

What do you think? Does Santa encourage impressionable minds to pack on the pounds, or does he represent one of the few positive cultural representations of obesity?

Peter

Reference: Grills, N., & Halyday, B. (2009). Santa Claus: a public health pariah? BMJ, 339 (dec16 1) DOI: 10.1136/bmj.b526

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Time to combine physical activity, sedentary behaviour and sleep guidelines into one holistic guideline?

Sitting is bad for you.  Exercise is good for you.  Sleep is too.

At present, we have 3 separate guidelines targeting these 3 separate behaviours.  However, when combined these behaviours make up the full 24 hour period, so it seems a bit strange to separate them out into separate and distinct constructs, especially since they all interact and influence each other (e.g. more screen time means less sleep, more activity means more sleep, more sleep means more activity, etc).  As a result, Canada is in the process of creating guidelines which integrate sleep, activity, and sedentary behaviour to give more holistic and less fractured advice to the public/policymakers/physicians/etc.

I’ve spent the past 3 days at a meeting learning about the development of these new guidelines, and I think they are a very interesting and relevant idea.  Drs JP Chaput, Val Carson, Casey Gray and Mark Tremblay (full disclosure: friends and colleagues all) have recently released a commentary outlining the rationale for these new guidelines, which has been published in the International Journal of Environmental Research and Public Health. The article has an open access license, so I have included it in full below.  It’s only a couple typed pages long, and worth the read.

I’m interested to hear what people think of this idea, as I think it represents a very different approach to thinking about activity/inactivity than has been employed in the past.

Travis

1. Introduction

Human movement has been a necessity for survival throughout evolution. However, sitting has become the new norm in today’s environment despite the fact that we have not genetically adapted to this sedentary lifestyle (1). It is now common to refer to physical activity as having “health benefits”, even though the active state is the normal biological condition for metabolic processes (2,3). Lack of human movement should rather be perceived as “abnormal” and associated with numerous health risks (4,5).

Physical inactivity and childhood obesity represent pervasive, and arguably the greatest, health challenges to our children today (6,7). There is no easy solution to these serious public health threats and they need to be addressed by a range of strategies to maximize success. One of the strategies is to find ways to increase overall physical activity of children. However, health research has mainly focused on the impact of moderate-to-vigorous physical activity (MVPA), or even high-intensity physical activity, on various health outcomes. Although this approach has resulted in important contributions to the field, emerging evidence indicates that a broader, more inclusive and more integrated approach to understanding and promoting human movement is required to better address the current public health crisis of physical inactivity and childhood obesity.

There is no doubt that MVPA provides many important health benefits. However, MVPA only accounts for a small proportion (<5%) of the 24 hour day, even among active children and youth. In contrast, sleep (~40%), sedentary behavior (~40%) and LPA (~15%) make up approximately 95% of the day (Figure 1). Ignoring other components of the movement continuum while focusing efforts on MVPA limits our understanding of how habitual movement behaviors interact to impact children’s health. Indeed, recent efforts to address the single-minded focus on MVPA have led to a proliferation of sedentary behavior research and to the creation of the world’s first sedentary behavior guidelines for children and youth (8-10).

There is accumulating evidence that excessive sedentary behavior, particularly screen-based sedentary behavior (e.g. television viewing), has unfavorable effects on various health indicators, independent of MVPA (8,9). Likewise, short sleep duration is associated with many adverse health outcomes including obesity, type 2 diabetes, depression, suicidal ideation, and poor academic performance (11-14). This issue is of particular concern since a decrease in sleep duration has been observed over the past decades in children and adolescents (15,16). Finally, a growing body of evidence indicates that spending more waking hours in LPA compared to sedentary pursuits can provide health benefits (17-19). Reallocating sedentary time to LPA (e.g. TV watching to active play) is of substantial public health interest given that it is not feasible to participate in MVPA during all waking hours. Breaking up sedentary time with LPA is a more achievable and viable goal for increasing movement (i.e. number of steps per day) and acquiring associated health benefits than focusing solely on MVPA. However, current physical activity guidelines only focus on MVPA (and recently sedentary behavior) and do not take into consideration other important movement/non-movement behaviors that occur throughout the day. This issue is important because having one “unhealthy” movement behavior can moderate the health benefits of another. For example, the health benefits of MVPA can be mitigated if children have poor sleep habits and/or engage in excessive sedentary behavior (20). Conversely, increased physical activity could well decrease the detrimental effects of insufficient sleep and/or extended periods of sitting in some individuals (21,22).

Figure 1. Estimated distribution of movement behaviors over the 24 hour period.

2. Is there a need for 24 hour movement behavior guidelines?


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Category: News, Obesity Research, Peer Reviewed Research, Physical Activity, Sedentary Behaviour | 1 Comment

Drinking coffee during pregnancy associated with obesity in offspring

pregnant coffeeIn 1992, David Barker suggested that many chronic diseases are the result of physiological processes initiated between our conception and our birth. The key feature of this model is that intrauterine environmental exposures and events affect fetal development, and may increase the risk of specific diseases in adult life.

For instance, you may have heard of the thrifty phenotype hypothesis. The thinking goes as follows: poor nutritional conditions in utero initiate metabolic adjustments to prepare the unborn fetus for survival in an environment in short supply of nutrients. However, when such a fetus is then born to an environment of plentiful supply of nutrients, this maladaptation increases their susceptibility to disease. In other words, any factor which reduces fetal growth tends to be associated with a number of chronic conditions later in life, such as coronary heart disease, stroke, diabetes, and hypertension.

Caffeine is one the most widely consumed substances in the world. For instance, over three-quarters of pregnant women in the US report consuming caffeine. Prior studies have suggested that caffeine intake by pregnant women can result in an increased risk of miscarriage, fetal death and impaired neurological development. More recently, human studies have shown that in utero caffeine exposure is associated with increased risk of abnormal fetal growth including small-for-gestational-age. Small-for-gestational-age has been associated with higher risk of obesity and metabolic syndrome after birth.

This indirect link between maternal caffeine intake and offspring obesity prompted Li and colleagues to assess the relationship in a prospective study of 829 pregnant women with 15 years follow-up of their offspring. Maternal caffeine intake was prospectively assessed during pregnancy while outcome measures, such as offspring BMI were retrieved from medical charts of the children. The analyses controlled for a number of potential confounders, including maternal prepregnancy BMI, race/ethnicity, diabetes, smoking during pregnancy, and absence of breastfeeding, among many others.

What did the authors find?

After controlling for a laundry list of factors, offspring of mothers who consumed caffeine during pregnancy had an 87% higher chance of being obese as children by comparison to offspring of mothers with no pregnancy caffeine consumption. Moreover, there was a dose–response relationship between pregnancy caffeine intake and offspring obesity, such that maternal pregnancy caffeine consumption in excess of 150mg/day was associated with more than twice the risk of childhood obesity, by contrast to no pregnancy caffeine intake. Finally, the observed association between maternal caffeine intake and obesity risk in offspring was not source specific: coffee, soda, tea and other sources of caffeine were all associated with an increased risk of childhood obesity.

What’s the explanation?

First off, it’s important to establish that caffeine can penetrate the placental barrier and enter the fetal circulation. Secondly, fetal in utero exposure to caffeine is prolonged due to slow clearance in pregnant women and a low rate of metabolism by the fetus. The authors propose a number of potential physiological mechanisms by which caffeine may negatively influence cell development – for example, decreased placental blood flow. However, the exact mechanism underlying this association remains to be elucidated.

In the meantime, women may want to add coffee and tea to smoking and drinking alcohol on their list of things to avoid during pregnancy.

Peter

Reference:
D-K Li, J R Ferber and R Odouli. Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study. International Journal of Obesity. 2014. Online ahead of print.

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