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.
Skinny Legs a Risk for Cardiovascular Disease and Death [The Chicken Leg Syndrome]
by Peter Janiszewski, MSc, PhD Candidate Peter is a PhD candidate in the School of Kinesiology and Health Studies at Queen's University. For more health and fitness news, visit his website at obesitypanacea.com
IN PRIOR POSTS, I have described the results of countless research, including my own studies which suggest that independent of how much you weigh — the location of that excess storage is a key determinant of your health risk. Indeed, over the last couple of years I have published 2 separate studies which show that regardless of your weight, having a big belly (being apple shaped) can increase your risk of type-2 diabetes (men and women) as well as erectile dysfunction among men (see all pertinent studies discussed in this post below).
Additionally, it has also been known that for a given size of your belly — the smaller your hips or thighs, the greater your risk of a number of diseases. indeed, along with Drs. Jen Kuk and Bob Ross, i had previously shown in another study that for a given amount of belly fat, having more fat in the buttocks, hips, and thighs was actually associated with a healthier metabolic profile among both men and women.
All this evidence is often simplistically summed up as the difference between apple (android) or pear-shaped (gynoid) obesity, with the latter being largely benign.
A very recent study published in the British Medical Journal has investigated the influence of thigh circumference on prospective risk of cardiovascular disease and death, and the results are making quite a few headlines.
In the study, Heitmann and Frederiksen assessed longitudinal (over time) data on 1436 men and 1380 women looking for occurrence of cardiovascular disease and mortality.
Over the approximately 10 years of follow-up, 257 men and 155 women died while 263 men and 140 women developed cardiovascular disease.
The authors found that for a given body mass index (BMI) or waist circumference, men and women with smaller thighs had an increased risk of dying and of developing cardiovascular disease compared to those with larger thighs. However, there was a threshold for this effect, such that only people with thigh circumferences below approximately 60cm were at increased risk of dying. people with thigh circumferences higher than 60cm didn't seem to get any additional benefit from having bigger thighs.
The explanation for why smaller thighs may predispose someone to a risk of cardiovascular disease or mortality is still up in the air. The two schools of thought suggest the problem lies in either not enough muscle mass or too little fat mass in the lower body. Indeed, as i briefly mentioned above, all else being equal, those with less lower body fat tend to be less healthy than those with more.
However, there is another plausible explanation for these findings, which the authors did not at all explore. a couple of years ago, Dr. Jen Kuk and i were interested in seeing what exactly a large hip or thigh circumference was predicting in reference to someone's body composition, when other measures such as their BMI or waist circumference are also considered. In a study we published in the American Journal of Clinical Nutrition, we showed that while a large hip or thigh predicts more lower body fat mass and muscle mass, it was also a predictor of less visceral fat — the fat inside your belly, that has been shown repeatedly to be the strongest predictor of health risk.
In other words, our results suggest that the risk of disease and death associated with a small thigh circumference in the recent study, can be explained by increased storage of the dangerous visceral fat. It would seem that if the body can't store your excess calories in the legs (where the health risk is minimal) it stores it in more dangerous depots, such as inside your belly, where the excess fat is more likely to cause trouble.
While i could literally go on for hours on this topic, i should quit my rambling there — it is dangerous when you get someone who works in an area of interest (body composition, in this case) to discuss their research — it may never end ...
ACCORDING TO a United Kingdom study of thousands of civil servants, middle-aged males who smoke, have high blood pressure, and high cholesterol levels are more likely to die ten years earlier than their healthier male counterparts. It gets worse when more risk factors are added!
The study, performed at Oxford University, looked at 19,000 male civil servants in the United Kingdom who were from 40 to 49 years of age. They were studied at two points in their lives, thirty-eight years apart. The study began between 1967 and 1970.
Within the study, the researchers measured such things as the men's weight, height, blood pressure, lung capacity and function, and cholesterol and blood glucose levels. The participants also completed a questionnaire about their medical, smoking, marital, and employment history.
The data found that 42% of the men were smokers, while 39% had high blood pressure and 51% had high cholesterol.
Written up in the British Medical Journal, the results of the study showed that middle-aged men with these three health risk factors — smoking, high blood pressure, and high cholesterol levels — were more likely to live ten (10) years less, after the age of 50 years, than middle aged men without these three risk factors.
The difference got worse when the researchers expanded the risk factors and included obesity, diabetes, employment, and other such health risk factors. When all risk factors were included, it was found that middle aged men with the highest number of risk factors (5% of the participants) and those with the least number of risk factors (5% of the participants), had a fifteen-year difference in expected lifetimes.
That is, it was found that the highest-risk men lived, on average, fifteen (15) years less then the lowest-risk men.
Dr. Robert Clarke, (Clinical Trial Service Unit and Epidemiological Studies Unit, at Oxford University), led the study. He stated, “We've shown that men at age 50 who smoke, have high blood pressure and high cholesterol levels can expect to survive to 74 years of age, while those who have none of these risk factors can expect to live until 83.” [BBC News: “Unhealthy men 'may lose 10 years”]
Dr. Clarke added, “It is precisely this kind of very prolonged follow-up study that is necessary to get these results - that modest differences in heart risk factors can accurately predict significant differences in life expectancy.” [BBC News]
He also stated, “The results give people another way of looking at heart disease risk factors that can be understood more readily.” [BBC News] Dr. Clarke concluded, “If you stop smoking or take measures to deal with high blood pressure or body weight, it will translate into increased life expectancy.” [BBC News]
In addition, the article in the British Medical Journal concludes, “Despite substantial changes in these risk factors over time, baseline differences in risk factors [in middle-aged men] were associated with 10 to 15 year shorter life expectancy from age 50.”
IF YOU HAVE ANY DOUBT as to the veracity of the fun factor in helping people adopt healthy behaviours — look no further than the Stockholm video below which showcases the most innovative method for getting people to adopt a simple behavior like taking the stairs. [A hat tip to our friends, Peter and Travis at Obesity Panacea.]
Note: DDB Stockholm and Volkswagen are opening up The Fun Theory, as they've named their lighthearted, imaginative campaign, to the whole world — offering $4,333 (2,500 British pounds) for the best idea to be number four in this series. Details and the other two videos are at www.thefuntheory.com.
THERE'S AN ODD QUESTION, but if new research holds true the answer may be yes. In a study currently in press (meaning accepted but not yet published) by Roberto and colleagues, 303 subjects were studied with 3 different dinner menu situations.
The first menu was a standard fast casual style menu with no calories posted.
The second menu was the same food/layout but with calories posted beside each item.
The third menu was the same food/layout with calories beside but with a line at the top that explained that 2,000 calories was how many the average person needed each day.
The results were fascinating.
Without calorie labeled the average consumer ordered 2,189 calories, with calories that went down to 1,862 calories and with the 2,000 calorie anchor statement, 1860.
So? That doesn't sound fascinating. Calories posted lowered calories. Um, not exactly. It lowered ordered calories.
Next the researchers looked as consumed calories (by subtracting food left on the plates). Without calories labeled the average consumer ate 1,459 calories, with calories that went down to 1,335 and with the 2,000 calorie anchor statement, 1,256.
Ok, that's pretty neat but fascinating?
Here's the really cool part. Researchers then contacted these folks the next day and using dietary recall (yes, it's inaccurate but still useful to see trends) they explored what these folks ate after dinner.
Folks who had menus without calories ate an additional 179 calories, folks with calories labeled ate an additional 294 calories, and those with the anchor statement in addition to calories ate 177 more.
Putting it all together (calories eaten at dinner and then later at home), folks without labeled menu calories ate a total of 1,630 calories, folks with calories labeled ate a total of 1,625 calories and those with the 2,000 calorie anchor statement ate a total of 1,380 calories.
What this research suggests is that if consumers are not made aware of how many calories they burn each day posting calories on menus may lead them to feel they can consume more at home because they chose a "lower" calorie choice when they were out.
Certainly suggests that any menuboard calorie initiative needs to include an educational component. Maybe it's not a huge surprise. Trying to navigate calories without context would be like trying to manage your money travelling without knowing the currency exchange.
Fascinating!
(Interesting sidebar. The American federal labeling bill that's currently being considered does include a 2,000 calorie anchor statement in its requirements. Great comment at the conference by Diane Finegood who pointed out that for many women 2,000 calories daily would in fact cause significant weight gain.).
All this evidence is often simplistically summed up as the difference between apple (android) or pear-shaped (gynoid) obesity, with the latter being largely benign.
The data found that 42% of the men were smokers, while 39% had high blood pressure and 51% had high cholesterol.
Dr. Clarke added, “It is precisely this kind of very prolonged follow-up study that is necessary to get these results - that modest differences in heart risk factors can accurately predict significant differences in life expectancy.” [BBC News]
What this research suggests is that if consumers are not made aware of how many calories they burn each day posting calories on menus may lead them to feel they can consume more at home because they chose a "lower" calorie choice when they were out.
