EACH ISSUE OF THE WELL NEWSLETTER will feature one or more articles from health care professionals. Our contributing writers will be medical doctors, PhDs (or PhD students) and fitness trainers who will tackle issues that are important to your health and wellness.

What is Obesity?

 by Dr. Arya Sharma  
visit Dr. Sharma's website »

DON'T WORRY – I am not going to take off on a discussion about whether obesity is a disease or "simply" a risk factor. I am also not going to discuss again obesity definitions – anthropometric or otherwise.

Today's post is simply about an analogy that may help sharpen our clinical thinking around excess weight.

Think of someone who has an elevated plasma creatinine level (a marker of kidney failure) – the elevated creatine definitely tells us that there is something "wrong" with the kidneys, but that's about it. From the creatine level alone we can certainly tell that the kidneys are failing in their excretory function, but we cannot tell what is causing the kidneys to fail – is it a pre-renal, intra-renal or post-renal problem? We can probably list a 100 reasons why kidneys could fail and obviously the treatment (apart from some very general principles) will very much depend on the cause, i.e. the actual diagnosis.

In many ways, one can look at excess body fat simply as a sign or symptom of the fact that there is a something "wrong" with energy homeostasis. The excess body fat tells us nothing about what the problem is – sure, it's either excessive food intake or reduced energy expenditure – but that is like saying that the creatinine levels are elevated because the kidney is not excreting properly. I can think of a long list of reasons or factors that would contribute to excessive caloric intake or reduced energy expenditure: sociocultural factors, psychological factors, biomedical factors – figuring out what exactly is causing the energy imbalance is the real problem.

Only when we find what is causing the excessive intake will we have made a diagnosis of what is causing the problem – a few specific examples could include: poor meal planning, peer pressure, hedonic overeating, depression, obesogenic medications, binge eating disorder, defective satiety signaling, etc. The point is that till we know what is causing the overeating, we can't fix it, which means we will have little success in treating the weight problem and will be limited to a "symptomatic" approach – just eat less!

Similarly, when the problem appears to be lack of activity, again the question is what exactly is causing the problem. Obviously if the problem is lack of time our approach will hopefully be very different than if the problem is back pain or lack of motivation (a possible symptom of sleep apnea, exhaustion or depression). A "symptomatic" but useless approach would be to simply recommend 10,000 steps. No better than offering an ice-pack to someone with a fever.

Just as the term "kidney failure" only tells us that there is something "wrong" with the kidneys the term "obesity" only tells us that there is something "wrong" with energy homeostasis.

In itself, neither the term "kidney failure" nor "obesity" is a real diagnosis – they are only helpful if they prompt further investigation into what might have or is still causing the problem. Only when we find the cause will we be on our way to solving the problem.

Is Exercise Necessary for Weight Maintenance?

by Yoni Freedhoff, Weighty Matters
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Yes, but the much more important question really is why? Today a new paper » in the Archives of Internal Medicine again suggests that exercise is crucial for long term weight maintenance, but I think misses the boat on why.

The paper, written by one of the giants in exercise and its role in obesity treatment and prevention Dr. John Jakicic and colleagues, follows 201 women for 24 months randomizing them into one of 4 different exercise arms (having to do with intensity and duration) and giving all of them Calorie reduced diets.

They then subdivided the results into groups representing percentages of maintained weight loss at 24 months and analyzed scads of data.

Their results and conclusions?

The folks who maintained a weight loss of greater than 10% of their starting weights exercised more minutes per week than those who did not. The authors concluded that the magic number of weekly exercise minutes for weight maintenance therefore were 275 (an average then of 40 minutes daily or an hour 5 days a week).

The thing is, I don't think that's the whole story.

Looking more carefully at the data we can see that on a weekly basis the folks who exercised the most burned only 1,145 more Calories than the folks who exercised the least (illustrating that exercise really doesn't burn boatloads of Calories given that to burn those additional Calories those folks on average exercised 3.5 hours more a week). That's only an average of 163 Calories more burned daily – not much to write home about.

No, for me the story is elsewhere in the data.

Looking at those who exercised the most, on a daily basis they were consuming 444 Calories less than those exercising the least. Extrapolating that and those folks were eating 3,108 fewer Calories a week! That's almost a full pound of Calories less a week! They also had much better scores on an eating behaviour inventory meant to assess weight control eating behaviours.

Translation?

The folks who exercised the most, ate the least and controlled their eating the best and in fact the magnitude of their dietary interventions at 24 months were 3 fold higher in Caloric impact than their exercise interventions.

My conclusion?

Exercise works and is integral to most for weight maintenance, but not via its direct Calorie burning capacity (which is small), but rather through its remarkable ability to cultivate healthy attitudes about weight management and in so doing, support dietary restraint and thoughtfulness for the long run.

Therefore, to truly harness the power of exercise, we need to explore how exercise leads these folks to consume less Calories and stick to weight control-eating behaviours. If we can figure that out, perhaps we can create interventions that do not in fact necessitate seemingly other-worldly amounts of daily exercise.

The Diary of... You and Your Diet

 by Joseph Hall

IT WON'T BURN MANY CALORIES ON ITS OWN, but if you're looking to lose weight, the most important exercise you can do is to pick up a pen and write.

Dieters can increase their weight loss twofold by simply keeping a daily diary of what they eat, a large new U.S. study says.

"The more food records you keep, the more weight you lose," says psychologist Victor Stevens, senior investigator with the Kaiser Permanente Centre for Health Research in Portland, Ore. and a study co-author. "And the good news is that's a technique that anyone can use."

The study will be published in the August edition of the American Journal of Preventive Medicine. The 20-week study was part of a three-year research program that involved some 1,700 overweight people who were placed on fruit- and vegetable-rich diets.

It showed that people who kept no daily food records lost an average of four kilograms, while those who kept six or more per week lost an average of eight kilograms.

Stevens says a diary makes it plain to dieters where it would be easiest to cut out calories. "You would think people would know ... where the extra calories are coming from, but they don't," Stevens says.

"At the end of the day ... you say, 'Where did you eat too much?' and they don't know."

The diaries were simple tabulations of what you ate, the quantity, and the calories each item contained, Stevens says. "And you look at that list and say 'Well, wow, I can reduce the calories in my lunch, that would be easy.'

"Then they develop plans to deal with that. And that's a critical part of the process. You need a specific plan of action, rather than some vague notion that you'll just eat less."

And keeping track of food intake as the day goes on also allows dieters to see how well they are keeping to their plans, Stevens says.

Stevens also says dieters who attempt weight loss within a social network are also much more successful at dropping excess pounds.

The study found that each social session study dieters attended — where they would discuss their successes and failures — was worth 0.3 kilograms in extra weight loss.

"So one session doesn't make that much difference, but if you look at 10 sessions, that's three kilos."

Stevens says discussing plans and showing your diaries, and the failures they may contain, to others can actually guilt people into significantly greater weight loss.

It makes sense that keeping a record of what you consume could change your eating habits, says Diane Finegood, scientific director of The Institute of Nutrition, Metabolism and Diabetes at the Canadian Institutes of Health Research.

"A lot of what we do about eating is mindless," says Finegood. "If you keep a monitor on behaviour, then it's a lot easier to change that behaviour in quantifiable ways."

Stevens says exercise pales in importance to diary keeping, especially in the early stages of weight loss.

"Keeping track of what you eat is so much more important than exercise," he says.

He says the study's goal was to reduce calories by 500 a day, far easier to achieve through dieting than exercise. Stevens says exercise becomes more critical in maintaining weight loss once the initial pounds have been cast off.

The study was also conducted by researchers at Duke University and The University of Alabama.

Pregnancy weight gain: What to expect

 Reviewed by The BabyCenter Medical Advisory Board

How much weight should I gain during my pregnancy?

IT DEPENDS ON YOUR HEIGHT AND WEIGHT, or body mass index (BMI), before you conceived. If pre-pregnancy weight was in the healthy range for your height according to your healthcare provider (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 2 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby. If you were underweight for your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds. If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain no more than 15 pounds. If you're having twins you should gain about 35 to 45 pounds. If you fall into any of these four categories, talk to your healthcare provider about how much you should gain each month.

How will gaining so much weight affect my body?

SOME OF THE ACHES AND PAINS you'll feel during pregnancy are related to weight gain. Backache and feeling more awkward and clumsy (thanks to your changing center of gravity) are the most common problems. Many women complain of swollen legs and ankles (edema), but this is actually caused by the increased amount of blood and other fluid in your body, not by the extra pounds you're carrying.

FYI: Call your healthcare provider if you notice sudden swelling in your hands and face. It could signal a dangerous pregnancy-related condition called preeclampsia.

IF YOU'VE STRUGGLED with controlling your weight in the past, or even if you've never dieted in your life, you may have a hard time accepting that it's okay to gain weight now. It's normal to feel anxious and even depressed as the numbers on the scale edge up. Try to keep in mind, however, that the extra weight is important for a healthy pregnancy and that those extra pounds will eventually come off after you've had the baby. And it's important to pay more attention to how well you're eating than to how much you gain. "Tracking your weight gain weekly may help you feel more in control and give you a chance to make some adjustments in your eating before the total weight gain gets out of control," suggests Julie Redfern, R.D., L.D.N., senior nutritionist in the department of obstetrics and gynecology at Brigham & Women's Hospital in Boston. Cutting out junk food and exercising regularly (after first checking with your healthcare provider about what you can do safely) can make a positive difference in how you feel during pregnancy. Pregnant women should increase their daily intake by 300 calories per day. If weight gain is making you feel blue, you're not alone. Find out how other moms-to-be are coping with pregnancy pounds.






How will I get rid of all those extra pounds later?

FIRST OF ALL, FOLLOW A HEALTHY DIET while you're pregnant and have an exercise physiologist or your doctor or midwife help you set up an exercise program that's right for you. After pregnancy, suggests Redfern, "I'd recommend following a healthy diet similar to the one you ate while you were expecting and seeing a registered dietitian to help tailor a program for weight loss to you, especially if you're breastfeeding." Any or all of these efforts will help you lose the appropriate amount of weight at the right rate. Much of the weight you've been accumulating will be gone pretty soon after you give birth. Mothers usually lose one-half of their pregnancy weight gain in the first six weeks postpartum. The baby accounts for about 7.5 pounds (more or less), and the amniotic fluid, placenta, and extra body fluids and blood in your body add up to another 8 to 12 pounds. Also, your uterus and breasts have gotten bigger, adding up to 4 to 6 pounds. Remember, it took nine months to put on the weight, and it can take just as long or longer for all of it to come off.

Obesity: It's Not TV – It's TV Dinners

 by Dr. Arya Sharma  
visit Dr. Sharma's website »

PEOPLE WHO WATCH MORE TV tend to be heavier that people who don't. The question, however, is whether it is the lack of physical activity associated with TV watching or the snacking that often goes with it that accounts for the weight gain.

This question was recently addressed by Verity Cleland and colleagues from the Menzies Research Institute, Hobart, Tasmania, Australia, in a paper just out in the American Journal of Clinical Nutrition »

This study involved a cross-sectional analysis of data from 2001 Australian adults aged 26-36 y. Waist circumference (WC) was measured at study clinics, and TV viewing time, frequency of food and beverage consumption during TV viewing, leisure time physical activity, and demographic characteristics were self-reported. 

In both men and women, watching more than 3 hrs of TV per day was associated with a roughly two-fold higher risk of abdominal obesity compared to men or women watching an hour or less per day.

Interestingly, adjusting for leisure time physical activity did not change this relationship, whereas adjusting for food and beverage consumption during TV viewing did.

The authors conclude that the impact of TV viewing on weight is more likely due to the associated snacking than due to the sedentariness of sitting in front of the TV.

So if you do watch a lot of TV, watch out for those snacks and drinks. 

Remember, one of the best weight management tips has always been: do not eat in front of the TV!

Catnapping—It's Purrfect for You!

 by Ron Nye

IT'S NOT JUST FOR YOUR FELINE FRIENDS, kiddies, senators, the idle rich or other assorted lay-abouts anymore!

A short daytime snooze can alleviate poor performance resulting from long, stressful hours at work and the dubious contemporary fetish for non-stop multi-tasking.

I usually take a two hour nap from one to four.
:: Yogi Berra

"We're misguided in our lack of naps and, in this, our society is driven by economy and not biology. We've gotten rid of naps even though they're good for us ... but that idea is coming back." John Peever, 39, an assistant professor in University of Toronto's department of cell and systems biology, continues, "I close my door, lean back in my chair, put my feet up and for 20 minutes I'm out." He started the routine following a 2002 study by colleagues at Harvard University that demonstrated a short nap of just 45 minutes significantly reduced information overload.

I catnap now and then, but I think while I nap, so it's not a waste of time.
:: Martha Stewart

Peever mentions MetroNaps, a New York company on the 24th floor of the Empire State Building that offers 20 minutes in a sleep pod, a specially adapted chair, for $14. "Some companies are starting to realize the benefits to cognitive abilities and how we get those with naps." He notes that research last year at the University of Wisconsin demonstrates that sleep both aids memory and appears to weed out irrelevant details or background clutter, thus improving focus on what is important. "We know there's something fundamental that happens, and that a nap is just a part of full sleep. We've hypothesized that there's something about deep sleep that allows the cells in the brain to reorganize," Peever continues. "There's an intuitive part of it—if it feels good after you nap, then it's good for you."

Most cultures, even our own, include a quick daytime snooze. "We used to do it here in North America—it's part of the farming culture," Peever notes. "I grew up on a farm outside of Peterborough and everyone kind of had a nap after a big lunch. We all know about it—think about the picture of the person with their belt buckle undone after a meal, relaxing on the couch with their eyes closed," he says of a nap most often associated with Thanksgiving. "When we have time, we do it."

Without enough sleep, we all become tall two-year-olds.
:: Dirt Farmer Wisdom

The future of napping, given current sleeplessness, looks bright. "If you look at recent literature, there is a global phenomenon that people are getting less sleep than 50 years ago," Peever states. "Research shows that when you're behind the wheel, a night's sleep deprivation impairs you to the same level as being legally drunk. "Sleep deprivation is that severe. The sleep deprivation we face, we can mitigate or minimize with naps."

Nap not enough?

"I used to be a fantastic sleeper," Amanda Ross says. But then the 37-year-old had a baby. "Suddenly I couldn't fall asleep, and when I did, I usually woke up a few hours later." By the time she had her second child, Ross had what she thought was incurable insomnia. But as editor of HomeSpa Magazine », she knew there was help at hand. The latest trend in spas: Not just relaxing massages, but sleep therapy.

Life is something that happens when you can't get to sleep.
:: Fran Lebowitz

In fact, according to Susie Ellis, the president of Spa Finder, requests for sleep programs tripled last year. And spas are responding—some are offering flotation tanks to promote deep rest, while others have launched dedicated nap chambers. Then there are intensive workshops to help guests stop tossing and turning for good.

That's what Ross had in mind when she signed up for the Sweet Art of Sleep Seduction last year. Led by Robert de Stefano, the spa world's "sleep whisperer," the four-day session at Red Mountain Spa in Utah teaches participants how to get a good night's sleep—even after their vacations end.

How do people go to sleep?  I'm afraid I've lost the knack.
I might try busting myself smartly over the temple with the night-light.
:: Dorothy Parker

"I am now entirely cured," a well-rested Ross says. "When my head hits the pillow, i'm out immediately."

It's true, she adds, she also bought a "really, really good mattress." And she admits that, like most self-improvement programs, her workshop wouldn't have worked if she hadn't been committed.

But whether you are committed to a whole new approach to sleep or just want a luxe nap to recharge from a day spent hiking or sightseeing, spas are increasingly catering to sweet dreams. and experts predict that the trend will continue into the next decade.