Obesity Epidemic Hits India!

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

[RECENTLY], the Indian Ministry of Health and Family Welfare proposed new obesity guidelines, which reduce the BMI criteria for the diagnosis of overweight and obesity to 23 and 25 respectively.

Likewise, the abdominal circumference cutoffs for abdominal obesity have been reduced to 90 cm for men and less than 80 cm for women, i.e. 12 cm and 8 cm, respectively, lower than the cutoff for abdominal obesity in the West.

According to these guidelines, people with BMI of 25 and above will be considered for initiating drug therapy, eligibility for bariatric surgery requires a BMI of 32.5.

These lower cutoff levels are fully in line with the greater metabolic risk posed by excess weight in people of South Asian origin — currently already home to the largest number of patients with diabetes anywhere in the world. The current load of diabetes in India (41 million) is expected to increase by 170% in the next 20 years.

This new definition of obesity, means that currently 15% of the Indian population have obesity — not too far behind Canada, where the population prevalence of obesity is only 3% points higher. Remarkable statistics for a country, where a significant proportion of the population still performs hard manual labour and has modest access to nutritious foods.

According to my good friend and colleague Dr. Anoop Mishra, director and head, department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi and Noida, "The guidelines — with revised statistics — will benefit the additional 15-20 per cent (60-80 million) of the Indian population who can now be clinically termed obese under the revised measurement."

How India will cope with the treatment of obesity at a population level is unclear. Knowing that so far no society has succeeded in preventing or managing the obesity epidemic (e.g. it is hard to imagine how we will actually deliver obesity treatments to the 600,000 Albertans who need it), it will be interesting to see how a country like India, with its limited health care resources, will even begin to cope.

It is perhaps most timely that I have been invited to speak and chair sessions at the forthcoming 5th Asia-Oceania Obesity Conference to be held in Mumbai in February 2009 — I certainly look forward to some interesting discussions with my Indian colleagues.

N E W S  N U G G E T S  1

Shocker! Restaurant Food has More Calories! — Sure, common sense already told you so, but now here's proof.

In a recent issue of Review of Agricultural Economics James Binkley looked at, "Calorie and Gram Differences between Meals at Fast Food and Table Service Restaurants".

His non-shocking conclusions?

Calories and portions in restaurant meals are larger than at home ones and restaurants are as bad if not worse calorically than fast food. Breakfasts at table service restaurants typically had 261 more calories than home cooked and fast food 206 more. Lunches at table services restaurants typically had 183 more calories than home cooked and fast food 227 more. Dinners at table service restaurants typically had 219 more calories than home cooked and fast food 120 more.

Couple those conclusions with the facts that food dollars spent outside the home have increased from 33% in the early 70s to 54% today and that obesity rates have risen dramatically since the early 70s (doubling in adults and trebling in children) and you've got one clear cut puzzle piece.

Want simple eating out rules?

Keep celebratory meals out. Keep some social meals out (but look for other socializing options). Keep necessary business meals out. Lose all the convenience ones, the because it's easier than cooking ones.

Quite simply eat out the smallest amount you need to be happy.



For Kids Who Grew Up Long Ago, the Hula Hoop Comes Full Circle — Twirling a hula hoop isn't just kiddie business these days. Some adults are channeling their younger selves and gaining health benefits by hooping, rolling their hips and performing tricks they may not have attempted the first time around.

Marketed as aerobic exercise, hooping improves flexibility and works the abdominal muscles — and legs and arms for people who can spin a hoop around those limbs.

A little mental flexibility is also involved, says Baltimore hooping instructor Noelle Powers. During her hour-long classes, she tries to get exercisers to switch the direction of the hoop, which is more of a challenge to the brain than to the muscles. The exercise can also induce a meditative trance, Powers adds.

Classes usually involve stretching with the hoop and then performing various tricks and routines: walking while hooping, for example, or moving the hoop up the body from the waist, ending with a lassoing movement around a raised hand.

If exercisers can get over any traumatic memories of playground harassment, Powers says, hooping isn't that difficult. Custom hoops sold by instructors are larger and heavier than the traditional toy-store variety and more proportional to the size of an adult, so they revolve more slowly and don't take as much effort to sustain. Even with a potbelly, it's doable, Powers insists. "And it doesn't feel like exercise," she says. "It feels silly and childlike."

Supersizing Air Ambulances

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

IPREDICTED THAT THIS YEAR we will continue seeing concerns about
and services for individuals with extreme obesity. 

Perfectly on cue, the Government of New South Wales (Australia) announced that they have put out a tender for larger air ambulances that will allow transportation of patients weighing upto 260 Kg (up from the current 140 Kg). The larger planes will cost an additional $10 Mill per plane.

Given the importance of air ambulances for transporting patients from geographically dispersed remote parts of Canada to urban centres, I wonder how we are dealing with this issue in Canada. Given the high prevalence of obesity in rural communities, I would not be surprised if our air ambulances are faced with a very similar problem.

I assume that this is only the first of a whole series of news stories that we will be seeing from around the world regarding the need to "supersize" everything from public seating, hospital beds, commodes and doctors' scales to ambulances and amusement park rides.

I predict a good year for the "bariatric" industry.

N E W S  N U G G E T S  2

I'm walkin', yes, indeed! — When he was 21 years old Edward Payson Weston walked from Boston to Washington D.C. in 10 days. It was 1861 and the purpose of the trip was to settle a bet and see the inauguration of Abraham Lincoln. In 1867 he walked 1,326 miles from Portland, Maine to Chicago, Illinois in 26 days. In those days there were European hiking contests and dare I say it, Mr. Weston walked off with the trophy, purse, and title as the "world's best long distance walker". People paid to watch him walk. At age 68 he repeated his walk from Portland to Chicago, cutting 29 hours off his time. At 69 he walked from New York to San Francisco and back again in 181 days. He became known in America as the "Old Pedestrian" and was still walking and speaking on the benefits of walking well into his 80's. Admirers around the country formed Weston Walking Clubs. As I said yesterday he became America's most famous walker. You don't have to be famous or walk across the country to benefit from physical activity, but knowing what is possible may help doing what is practical. Learn more »

Carb addiction is making us fat (researchers) — Carb addiction is real, according to researchers who fear that by taking fat out of snacks, food producers are replacing it with more carbohydrates and making them even more addictive.

Addiction to high glycemic index foods — i.e. white bread, white bagels, white rice, breakfast cereals — plays a key role in why people are getting fatter, researchers from New Zealand say.

The glycemic index is a measure of how fast and by how much a food raises blood sugar and insulin levels. "GI may be the element of food that, like nicotine in cigarettes, predicts its addictive potential," researchers write in the journal, Medical Hypotheses.

But the focus is on getting fat out of food, which can increase carb content.

If their hypothesis is right, "these foods may be more reinforcing of overeating behaviour than those they have replaced," the researchers say.

In 2004, nearly seven million Canadian adults were overweight, and another 4.5 million were obese. Obesity among adults has nearly doubled since 1978, to 23 per cent in 2004. Despite a drum beat of bad news about the health risks, the numbers are rising.

"We always talk about people making poor choices and not sticking to their diets," says Dr. Arya Sharma, professor of medicine and chairman for cardiovascular obesity research and management at the University of Alberta.

Studies show palatable foods stimulate the same parts of the brain as cocaine and other drugs of abuse. When addicts stop using, they often transfer those addictions to food, Sharma says.

Researchers say people with addictive eating behaviours exhibit the classic features of addiction: They "use" more over time, they use to avoid unpleasant feelings, they eat more than they intend to, they fail in repeated attempts to cut down, and they overeat despite "negative consequences."

Dr. Simon Thornley, public health medicine registrar in Auckland, and his colleagues say the idea that rapidly digested carbs are addictive parallels nicotine dependency. A cigarette provides "the ultimate in fast delivery," with peak concentrations hitting the smoker's central nervous system within seconds of inhaling.

The same holds for refined, high-starch carbohydrates, the researchers say: A doughnut causes blood glucose levels to shoot up faster than eating low-glycemic carbs such as broccoli. People get a burst of energy, but soon after feel hungry again. And high-glycemic foods drive up the production of insulin, which tells the body to make and store fat. 

School children need less work, more play: U.S. study — All work and no play may be a hazard for some U.S. school children.

Researchers reported on Monday that a growing trend of curbing free time at school may lead to unruly classrooms and rob youngsters of needed exercise and an important chance to socialize.

A look at more than 10,000 children aged 8 and 9 found better classroom behavior among those who had at least a 15-minute break during the school day compared to those who did not, Dr. Romina Barros and colleagues at the Albert Einstein College of Medicine in New York reported.

The behavior assessments were general in nature and not made at any particular time of the school day, their report said.

"The available research suggests that recess may play an important role in the learning, social development, and health of children in elementary school," the research team said in a study published in Pediatrics, the journal of the American Academy of Pediatrics.

But today many children get less free time and fewer physical outlets at school "because many school districts responded to the No Child Left Behind Act of 2001 by reducing time committed to recess, the creative arts, and even physical education in an effort to focus on reading and mathematics," they added.

The researchers also found that children not getting recess were more likely to be black, from poor families and attending public schools in large cities.

"This raises concern in light of evidence that many children from disadvantaged backgrounds are not free to roam their neighborhoods or even their own yards unless they are accompanied by adults," the team said. "For many of these children, recess periods may be the only opportunity for them to practice their social skills with other children."

Barros told Reuters that previously published research indicates that poor children often are deprived of recess because "those schools are located in very violent neighborhoods, and there is the concern that children may get exposed to fights or gun shooting while in recess."

In addition, she said, such schools are often overcrowded, with space designated for recess or physical activity turned into classrooms.

The study also said the growing problem of childhood obesity needs to be addressed by more activity, especially at school where children spend so much of their day.

One earlier study found that free time has shrunk for U.S. children in and out of school since the 1970s, the report said. At the same time most elementary schools in Asia provide a 10-minute break after every 40 to 50 minutes of instruction, it added.

Older Women Who Are More Physically Fit Have Better Cognitive Function — New research by Marc Poulin, PhD, DPhil, finds that being physically fit helps the brain function at the top of its game. An Alberta Heritage Foundation for Medical Research Senior Scholar, Poulin finds that physical activity benefits blood flow in the brain, and, as a result, cognitive abilities. "Being sedentary is now considered a risk factor for stroke and dementia," says Poulin, a scientist in the Faculties of Medicine and Kinesiology at the University of Calgary. "This study proves for the first time that people who are fit have better blood flow to their brain. Our findings also show that better blood flow translates into improved cognition."

The study compares two groups of women whose average age was 65 years old. From a random sample of 42 women living in Calgary, the study observed women who took part in regular aerobic activity, and another group of women who were inactive. Poulin's team recorded and measured the women's cardiovascular health, resting brain blood flow and the reserve capacity of blood vessels in the brain, as well as cognitive functions. The team included scientists, doctors and graduate students, with MSc student Allison Brown taking a lead role.

The scientists found that compared to the inactive group, the active group had lower (10 per cent) resting and exercising arterial blood pressure, higher (5 per cent) vascular responses in the brain during submaximal exercise and when the levels of carbon dioxide in the blood were elevated, and higher (10 per cent) cognitive function scores.

One study participant, Calgarian Merceda Schmidt, 91 years old, walks about six kilometres per week to her volunteer schoolteaching and piano playing commitments. "It's just in my nature — the batteries I got when I was born. My legs want to go," says Schmidt. "I have to admit, I was nervous before the bike test. I could've done better if my shoe hadn't fallen off."

"The take home message from our research is that basic fitness ­ something as simple as getting out for a walk every day — is critical to staying mentally sharp and remaining healthy as we age," says Poulin, a member of the Department of Physiology & Biophysics, and the Hotchkiss Brain Institute.

Poulin's research is supported by AHFMR, the Heart and Stroke Foundation of Alberta, NWT & Nunavut, Canadian Institutes of Health Research, the Canada Foundation for Innovation, the Natural Sciences and Engineering Research Council of Canada, and the Strafford Foundation.

Are you eating North America's Least Healthy Breakfast Cereal?

 by Yoni Freedhoff, Weighty Matters
visit Weighty Matters website »

CAN'T SAY I'VE EVER HEARD OF IT. Quaker Instant Grits Butter Flavor received a score of just 6/100
from NuVal (formerly known as ONQI), my favourite food rating scale.

Coming in a close second last was a more familiar name — Cap'n Crunch Sweetened Corn & Oat Cereal with a 10/100.

So what's the healthiest cereal according to NuVal? Another unknown for me — Hodgson Mill Unprocessed Wheat Bran (Millers Bran) which received a perfect score of 100 with Red River cereal a close second at 93.

This is why I love NuVal — it's incredibly easy to use. It takes 30 nutrients and 5 nutritional concepts and gives them to 11 of the world's leading nutritional scientists who then crunch them down in a weighted algorithm that spits out a rating between 1 and 100.

Healthiest sugary cereal? Kashi Golean Crunch Protein & Fiber Cereal Honey Almond Flax with a score of 40.

Most surprisingly unhealthy cereal? Cheerios with a score of 34.

Brain-dead simple to use. 

Thanks NuVal!

N E W S  N U G G E T S  3

Fetal Alcohol Facts — Fetal Alcohol Spectrum Disorder is responsible for huge human and government costs. 

Lifetime cost: Estimated at $1.5 million per person with FASD  

Prevalence: One in 100 Canadians have some form of brain abnormality due to mothers who drank during pregnancy. Up to one in five Inuit and First Nations infants.  

How harmful is alcohol? To a fetus, worse than any other drug, including cocaine.  

Results of brain abnormalities: Everything from difficulty sleeping on a schedule to impulsive and hyperactive behaviour. Teens with low self-esteem due to social and learning gaps with their peers take dangerous dares and have sex to seek acceptance.  

School and work can be a struggle as they have difficulty paying attention, have poor organizational skills and have trouble completing tasks.

Other common diagnoses with FASD:

Attention deficit and hyperactivity disorder — 65 per cent 
Depression — 47 per cent 
Panic disorder — 21 per cent 

Even more negative effects: Post-traumatic stress disorder, obsessive-compulsive disorder, defiance and bipolar disorder, high incidence of substance use, all of which worsen the isolation, anger and problems with personal relationships associated with FASD.  

Trouble with the law and FASD: Estimated at 60 per cent.  

Sources: Statistics Canada, B.C. FAS Resource Society, B.C. Partners for Mental Health and Addiction Information, a group of non-profits funded by the province, the Canadian Journal of Clinical Pharmacology, Public Health Agency of Canada.

Belly up to the hearse, boys — Waist-hip ratio is now rated as an accurate predictor of death. A large European study has confirmed that simple measurements of the waist and hips may offer a better way of predicting obesity-related death than a standard, but more complicated, system of relating weight to height.

The standard body mass index, or BMI, method does not work very well for some people, such as the elderly or body builders, and researchers have begun building a case that it is better to look at waist circumference or the ratio of waist size to hip size.

Among people with comparable BMIs, having an extra two inches around the waist increased the annual risk of death by 17 per cent for men and 13 per cent for women, according to the team led by Dr. Tobias Pischon of the Institute of Human Nutrition Potsdam-Rehbruecke in Nuthetal, Germany.

When they calculated the waist-to-hip ratio by dividing a person's waist size, measured at the navel, by the biggest part of their hips, the Pischon group found that the risk of death increased by 34 per cent for men and 24 per cent for women every time that ratio increased by 0.1.

Hip circumference alone did not predict death any better than BMI, which is a person's weight in kilograms divided by the square of the height in metres, the researchers found.

They used data from the European Prospective Investigation into Cancer and Nutrition database, involving 359,387 people in nine countries.

Even among people of normal weight, men with the biggest bellies had more than twice the death rate of the slimmest. For women, the rate was 79 per cent higher if their weight was in the normal range, yet their bellies were big.

The findings, published in the New England Journal of Medicine, "underscore the importance of assessing the distribution of body fat even among persons of normal weight and challenge the use of cutoff points to define abdominal obesity, at least when they are used to predict the risk of death," the researchers wrote.

Earlier research had suggested that men should not have a waist-to-hip ratio above 0.95, and in women it should be no higher than 0.8.

New Cancer Report — A new report (http://www.dietandcancerreport.org/) [just released] by the World Cancer Research Fund and the American Institute for Cancer Research states that most cancers are preventable.

Poor diet, lack of exercise, obesity and smoking account for the vast majority of cancers; the role of genetic factors is by far overrated.

Indeed, the dramatic impact of obesity on cancer is now increasingly appreciated ­ one in three cancers may be caused by obesity (or as a result of lifestyle factors that promote obesity).

:: This is an excerpt from Arya Sharma's blog

Review 1 :: The World is Fat

 author: Barry Popkin

POPKIN ARGUES that sweetened beverages and processed foods are the primary culprits in our "ever-expanding" world in The World Is Fat: The Fads, Trends, Policies and Products That Are Fattening the Human Race. Add the decline in physical activity and a trend toward supersized meals and snacks away from home, and it becomes clear why our collective health has begun to suffer.

Popkin, Carla Smith Chamblee Distinguished Professor of nutrition in The University of North Carolina at Chapel Hill Gillings School of Global Public Health and director of the UNC Inter-Disciplinary Obesity Center, has studied economics and nutrition for three decades. His research spans six continents and includes wide-ranging, long-term studies of the effects of lifestyle change on body composition.

More people in the world are now overweight than malnourished — 600 to 700 million suffer from malnutrition, and 1.6 billion people are overweight. Those numbers differ markedly from 50 years ago, when 10 times more people (7 billion) were malnourished and fewer than one-tenth the current number (100 million) were overweight. Popkin's book claims that widespread obesity is less an effect of poor individual choices than the consequence of a high-technology, interconnected world in which governments and multinational corporations have unprecedented power to shape lives and behaviors.

"The global obesity epidemic affects all of us — families, communities and nations around the world," says Dr. Jeffrey D. Sachs, director of Columbia University's Earth Institute. "It's a weighty subject in every way, with dire consequences for well being, life expectancy, and economic productivity in the years ahead unless seriously confronted. The World is Fat is compelling reading on this complex and growing societal threat."

Review 2 :: In Defense of Food: An Eater's Manifesto

 author: Michael Pollan

BECAUSE MOST of what we're consuming today is not food, and how we're consuming it — in the car, in front of the TV, and increasingly alone — is not really eating. Instead of food, we're consuming "edible foodlike substances" — no longer the products of nature but of food science. Many of them come packaged with health claims that should be our first clue they are anything but healthy. In the so-called Western diet, food has been replaced by nutrients, and common sense by confusion. The result is what Michael Pollan calls the American paradox: The more we worry about nutrition, the less healthy we seem to become.

But if real food — the sort of food our great grandmothers would recognize as food — stands in need of defense, from whom does it need defending? From the food industry on one side and nutritional science on the other. Both stand to gain much from widespread confusion about what to eat, a question that for most of human history people have been able to answer without expert help. Yet the professionalization of eating has failed to make Americans healthier. Thirty years of official nutritional advice has only made us sicker and fatter while ruining countless numbers of meals.

Pollan proposes a new (and very old) answer to the question of what we should eat that comes down to seven simple but liberating words: Eat food. Not too much. Mostly plants. By urging us to once again eat food, he challenges the prevailing nutrient-by-nutrient approach — what he calls nutritionism — and proposes an alternative way of eating that is informed by the traditions and ecology of real, well-grown, unprocessed food. Our personal health, he argues, cannot be divorced from the health of the food chains of which we are part.

In Defense of Food shows us how, despite the daunting dietary landscape Americans confront in the modern supermarket, we can escape the Western diet and, by doing so, most of the chronic diseases that diet causes. We can relearn which foods are healthy, develop simple ways to moderate our appetites, and return eating to its proper context — out of the car and back to the table. Michael Pollan's bracing and eloquent manifesto shows us how we can start making thoughtful food choices that will enrich our lives, enlarge our sense of what it means to be healthy, and bring pleasure back to eating.

Pollan's last book, The Omnivore's Dilemma, launched a national conversation about the American way of eating; now In Defense of Food shows us how to change it, one meal at a time.

Read the introduction to In Defense of Food in .pdf format

Overweight but Underproductive: Report

OVERWEIGHT CANADIANS are more likely to miss work or be unproductive at the office, and they report higher job stress and less support from their co-workers and bosses.

That's according to a new Statistics Canada report that also shows increasing numbers of people falling into this category, with obesity rates in the Canadian workforce rising to 16 per cent in 2005 from 13 per cent a decade earlier. The rate is rising fastest among men, Statistics Canada says, and obesity is most common among older workers aged 55 to 64.

The trend may come from an environment that "encourages excessive eating and discourages physical activity and to increases in more sedentary jobs," the agency notes.

"Obesity really is a societal problem," said Dr. Arya M. Sharma, scientific director of the Canadian Obesity Network. "We've virtually eliminated physical activity from the workplace ... We have to make up the lost physical activity in our spare time."

Obese men under age 35 are almost four times more likely to miss work than those of normal weight, the agency found. However, "presenteeism" or reduced productivity on the job may be the bigger problem for overweight workers and their employers, it says.

"None of this is surprising," said Dr. Yoni Freedhoff, medical director at the Bariatric Medical Institute in Ottawa.

Bariatric medicine concerns the treatment of obesity and associated conditions.

"Weight contributes to a lot of morbidity," Freedhoff said, adding that illness and injury can cause absence from work, while co-morbid conditions such as sleep apnea result in lost productivity.

Overweight people are also likely to retire earlier, and to draw lower salaries while on the job, leading to lost tax revenue, Freedhoff said.

More obese workers also report high job stress and low support from those they work with than their thinner counterparts, Statistics Canada found, but it's difficult to unravel which came first.

The report says that while "higher job stress may precede obesity," being obese in the workplace may also lead to stress.

"There's increased bullying of obese people. They're less likely to be promoted. They're less likely to be hired in the first place," Sharma said.

Men aged 35 to 54 in the bottom half of the earnings ladder are less likely to be obese than those in the top quarter, but women aged 18 to 54 with low income are more likely to be obese than high earners.

While StatsCan suggests that this may be due to different "symbolic values of body size" for men and women, or to the fact that higher-earning men are more likely to dine out on rich foods, Freedhoff said that no one knows for sure why this relationship exists.

In Sharma's opinion, the trend towards obesity in the workplace is unlikely to improve. The economic downturn, he said, will create stress for both employed and unemployed people, leading to an increase in stress-related eating. People are also less likely to eat healthy food, he said, and will cut back expenditures, such as sports and gym fees.

The report also found that factors such as level of education, type of work and work hours affected the likelihood of obesity.

Marital status also plays a role, with never-married workers under age 35 less likely to be obese than their married colleagues, the report finds.

And many more Canadian workers are overweight than are willing to admit it. Based on self-reported height and weight, 59 per cent of working Canadian men were obese or overweight in 2005, but actual body measurements from the year before put that figure at 63 per cent.

For women, the contrast is even more stark: 39 per cent of employed women aged 18 to 64 were considered overweight or obese, but measurements from 2004 show that 50 per cent actually fell into that category. The "stigma" surrounding obesity may motivate people to lowball their weight, Statistics Canada says — especially for women.

Dr. Yoni Freedhoff: Obesity expert and medical director of the Bariatric Medical Institute in Ottawa, Dr. Freedhoff is one of Canada's most outspoken nutrition watchdogs and appears regularly in national media to advocate for healthier living.

Dr. Arya Sharma: Widely recognized as one of Canada's leading obesity experts, Dr. Sharma was recently appointed Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta in Edmonton, Canada. Dr. Sharma passionately believes in educating the public on this chronic disease.

Speakwell has obtained permission from both of these Doctors to reproduce some of their material in our WELL Newsletter. Please visit their sites.