New obesity medication now available in Canada

saxendaThe very first Obesity Panacea post was written back in November 2008. The topic of that post was the removal from the European market of an obesity medication that had been previously heralded as a potential panacea (but was never approved in US or Canada). That drug was rimonabant (Acomplia), an appetite suppressant that works by blocking the CB-1 receptors of the endocannabinoid system – the same system which induces the “munchies” in response to smoking cannabis. Rimonabant not only suppressed appetite, but was associated with anxiety and depressive mood disorders – the same side-effects which initially prompted the US FDA to refuse approval of rimonabant back in 2007.

Two years later, another appetite-suppressing medication, sibutramine (Accomplia) was also withdrawn from the Canadian and US market due to increased risk of cardiovascular events and strokes.

Thus, over the past five years there was only a single obesity medication available to obese patients in Canada – orlistat (Xenical®). This agent reduces the absorption of ingested fat by about 30%. The 30% that doesn’t get absorbed ends up in the stool, which, as you’d expect, can result in some rather challenging gastrointestinal side effects (e.g. oily discharge).

All of that changed yesterday (Feb. 26), when Health Canada approved a new obesity medication. This new medication, liraglutide 3.0mg (Saxenda®), which is administered via a daily subcutaneous injection has actually been available in Canada but at a lower dose and marketed under a different name (up to 1.8mg, Victoza®) for the treatment of type-2 diabetes. Saxenda is approved for weight loss in addition to diet and exercise for patients with a BMI ≥30kg/m2 or a BMI≥27kg/m2 plus at least one weight-related illness (i.e. hypertension, dyslipidemia, or diabetes). This drug has been studied in a number of large clinical trials which suggest that patients experience an average reduction of 6.3-8.0 kg over and above that achieved with placebo (fake injection) at 1 year of therapy. This of course isn’t the most exciting magnitude of weight reduction, but keep in mind that most experts recommend that obese individuals only aim at 5-10% weight loss to reap health benefits.

More importantly, as we’ve highlighted ad nauseam, positive health behaviours – including a healthy diet and increase physical activity have a tremendous impact on your health regardless of your weight status. And these behaviours form the basis of ANY obesity therapy.

Nevertheless, obese Canadians who only had one option for a medication to help them lose weight (and have oily flatulence), now have another option.

Of course, obese folks in the US have many more pharmacological options – including two combination therapies (Qsymia® and Contrave®) – that remain unavailable in Canada or Europe.


Category: News | 2 Comments

The Fatter we Get, the Less We Seem to Notice

obesity ratesA significant number of overweight and obese individuals believe their body weight to be appropriate or normal and are satisfied with their body size. Misperception of overweight status is most common among the poor vs wealthy, African Americans vs white Americans, and men vs women. The unfortunate consequence is that overweight individuals who perceive themselves to be of normal weight are less likely to want to lose weight in contrast to overweight individuals with accurate perceptions. Such individuals are also more likely to smoke, have a poor diet, and be physically inactive.

An interesting hypothesis tested by Burke and colleagues in an Obesity journal article is that misperception of overweight status can actually increase over time in response to the secular increase in the average BMI of the US population. In other words, due to a possible anchoring effect, the more overweight the people around you become, the more one’s sense of “normal” weight is raised upwards, and thus the less likely you are to consider yourself overweight, even though you actually may be. Indeed, given that most individuals you interact with on a regular basis are likely to be overweight or obese, it becomes tough to define what someone with a normal weight looks like.

To answer the question at hand, the authors compared two representative cohorts of the United States population (NHANES) – one surveyed in the early 90’s and the other surveyed in the early 2000’s. Stated simply, they divided each cohort by gender and weight status (BMI) and compared the general perceptions of the individual’s weight.

What did they find?

Just as the researchers predicted, overweight individuals today are less likely to classify themselves as “overweight” in contrast to overweight individuals surveyed over a decade ago. For example, the proportion of overweight women who perceive their weight o be “about right” increased from 14% to 21%, and that among overweight men from 41 to 46%. This latter point also well illustrates the gender bias of weight misclassification.

Interestingly it was among individuals aged 20-25 that the greatest shift towards inaccurate weight classification occurred – overweight individuals in this age group were most likely to see themselves as “normal” weight.

Additionally, independent of the effect of time, this study confirmed a number of factors influencing one’s ability to accurately gauge their own weight status: those who are educated are more likely to self-classify as overweight than those who are not, those with higher incomes are more likely to feel overweight than those with the lowest incomes, married people are more likely to feel overweight than never-married people, and members of minority groups are less likely than whites to consider themselves overweight.

So there you have it – as a population, we are all getting fatter. Making matters worse, the fatter we all get, the less we seem to notice and the less likely we are to do anything about our bulging waistlines.


Burke, Heiland, Nadler. From “overweight” to “about right”: evidence of a generational shift in body weight norms. Obesity. 2010;18(6):1226-34.

Category: News | 1 Comment

Grade 1 class using standing desks

Very cool story out of Saskatchewan this week, with a grade 1 classroom that has converted to standing desks.  Unfortunately I can’t embed the full interview, although it can be seen here. A short video from CBC is included below, which shows children using the desks.

Some highlights from the CTV article:

In September, Justin Sauer raised the height of all the desks in his classroom at Delisle Elementary School, in Delisle, Sask.

He was motivated by research that shows sitting too much can lead to health problems in adults and children.


Since propping up all of the desks using metal extensions, most of Sauer’s students are opting to stand.

He’s already noticed some changes.

“(Parents) told me their kids were sleeping better, had better postures,” he says.

On top of that, several appear to be paying more attention in class.

“I can say definitively that five or six kids have really benefited,” he says.

Sauer hopes that his students aren’t the only ones who learn this lesson. He thinks fellow teachers should take note too.

They do note in the video that kids don’t have to stand – they have the option to sit or stand (as we all should).  In the coming weeks I’ll have a Q&A with teacher Adam Aldred, who has converted his high school classroom to standing workstations as well.

Hat tip to my wife Daun and our friend Heather for telling me about the story.


Category: Sedentary Behaviour | 1 Comment

Participants Needed For Online Survey on Weight Stigma

Norah MacMillan at York University is doing a research project on the topic “Social Media Use on Weight Stigma and Eating Attitudes”.

She is looking for participants between the ages of 18-40 years to complete the survey.

It is a short survey (~78 questions) and should take about 10-15 minutes to complete.

If you are in that age group, please consider checking out her survey.  And if you have a study of your own that is in need of participants, feel free to let me know.



Category: News | 2 Comments

Want people to stand? Just give them the option

Today’s post comes from PhD Candidate Justin Lang, describing a cool intervention study that he just had published in Preventive Medicine.  Along with Jessica McNeil, Mark Tremblay and myself, Justin found that an incredibly simple intervention resulted in a considerable increase in the number of people standing at an academic conference.

For media requests or further information on the study, please contact Justin directly at jlang (at) cheo (dot) on (dot) ca.  The full text of the study is available for free at the Preventive Medicine website (here) until March 27, 2015.


In recent years there has been an accumulation of evidence indicating that sedentary behaviors (i.e., sitting) are associated with negative health outcomes, such as cardiovascular disease, diabetes, and premature mortality. In light of this evidence, researchers are trying to develop creative interventions to reduce sedentary behaviors – one of which being point-of-decision prompts (PODP). PODPs are used to inform individuals about the health benefits associated with a specific behavior. For instance, PODP are used in the workplace to remind people to stand throughout the day; they are also used to encourage individuals to use the stairs rather than the elevator.

We were interested in testing PODPs as an intervention to encourage standing during the Global Summit on the Physical Activity of Children and Youth conference (Toronto, Ontario, May 2015). Conferences are an excellent venue for sedentary behavior research as they typically involve periods of uninterrupted sitting, especially during oral presentation. Thus, the purpose of our study was to determine if a PODP would influence the proportion of attendees standing during oral presentations.

What did we do?

We selected 12 of 16 oral presentation sessions that took place during the conference. Each presentation session included 4 different, 15 minute, oral presentations on various topics related to physical activity. We then randomly assigned 6 presentation sessions to the intervention group and the remaining 6 presentation sessions to the control group.

During the intervention group sessions we asked the facilitators to read the prompt (see below) at the beginning (before the first presenter) and middle (after the second presenter) of the session.

Prolonged sitting is associated with increased health risks. We encourage you to reduce and/or interrupt your sedentary time while attending the Global Summit on the Physical Activity of Children. Please feel free to stand during this presentation session.

Facilitators for the control group sessions were asked not to address sitting and/or standing, and to not mention the existence of the study.

During all 12 sessions, researchers counted the number of participants at the beginning (first 10 min), middle (30-40 min), and end (50-60 min) of the session. Each count consisted of (a) the number of individuals in the room and (b) the number of standing individuals at any time during the count period.

What did we find?

The results of this study indicated that individuals were significantly more likely to stand during presentation sessions that included the PODP (see Figure 1).  Roughly 60% more participants stood during the sessions with the PODP, when compared to the control group.

Lang et al., 2015 (Source)

Lang et al., 2015 (Source)

Take-home messages:

Our study suggests that frequent prompts and/or permission to stand results in a great proportion of people choosing to do so. This is an exciting finding because it supports the versatility of PODPs. Prompts represent an equitable population health intervention. In other words, they have the potential to influence a large group of individuals equally. In addition, PODPs have little to no cost associated with their implementation.

About the author:

Justin Lang

Justin Lang is a PhD candidate in the Population Health program at the University of Ottawa and holds a research assistantship with the Healthy Active Living and Obesity Research Group at CHEO. His PhD research focus is on the geographic variation of physical fitness in children and it’s relationship with childhood obesity. Justin also holds a Mitacs internship which provides him with the opportunity to further explore physical fitness in the Ottawa community.


Lang, J. J., McNeil, J., Tremblay, M. S., & Saunders, T. J. (2015). Sit less, stand more: A randomized point-of-decision prompt intervention to reduce sedentary time. Preventive Medicine.  Available here.


Category: Peer Reviewed Research, Sedentary Behaviour | Tagged | Comments Off on Want people to stand? Just give them the option

When you lose weight, where does the fat ACTUALLY go?

Fat lossThe answer to this question may surprise you.

In fact, according to a recent British Medical Journal article discussing this issue, few health professionals, including doctors, dieticians, and personal trainers know the correct answer.

First, let’s back up for a minute.

When you consume calories beyond what your body needs, you will end up storing that extra energy in the form of triglycerides (glycerol backbone plus 3 free fatty acids) within fat droplets of individual fat cells, or adipocytes. Importantly, whatever the macronutrient composition of your diet (carbohydrate vs. protein vs. fat), when “calories in” exceed “calories out”, the end result is more triglycerides stored in your fat cells. (Before the  carbohydrates or protein you ingested end up filling up a fat cell in the form of triglyceride, they undergo a chemical conversion.) In other words, you could plump up your fat cells by eating only salad (it would take a lot of salad, of course).
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Category: News, Obesity Research, Peer Reviewed Research | 11 Comments