P R O T I P S

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.

Weight Loss in a Pill!

Click here to watch this video and decide for yourself.

Want To Be More Physically Active? Quit Your Job!

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

ON NUMEROUS OCCASIONS Travis and I have written on the independent benefits of maintaining an active lifestyle (view my recent lecture on the topic) as well as the dangers of increased sedentary time, such as sitting.

A new study by McCrady and Levine published online in the journal Obesity investigated the role your job might have in making you sedentary.

In the study 11 men and 10 women were monitored for a duration of 10 consecutive days to assess physical activity (or inactivity) using a Physical Activity Monitoring System composed of four inclinometers and two triaxial accelerometers that are attached to the torso, thigh, and trunk using special clothing. This methodology allows the researchers not only to get an estimate of physical activity patterns but the postures taken and thus distinguish one form of inactivity from another (standing vs. sitting vs. lying down).

What did this study find?

During work days people sat for 110 minutes longer than on their leisure days (597 min/day vs. 484 min/day).
Conversely, work days were associated with 76 less min/day of standing and walking in contrast to leisure days.
Based on calculations, the authors approximated that during leisure days people expend an additional 59 calories through walking than on word days (586 vs 527 calories). This may not seem like a lot, but the lack of expending 300kcals every week can really add up over the year (15 600 kcals/year or ~5 lbs of fat/year).
Generally, people who were more active on their work days also tended to be more active during their leisure time. This is rather reasonable I can't sit still for more than about 30 minutes at a time, and it doesn't matter whether I am at work or home.
Lastly, the obese subjects and lean subjects in the study showed similar patterns of inactivity at work and activity during leisure with no differences between the groups.

So given that physical inactivity is a major cause of many chronic diseases, disability, and early mortality, what is one to do?

While quitting your job may not be a viable option, being cognizant enough to increase your normal amount of activity at work is likely a good idea. You can refer to our Top 10 Ways to Become Active for some ideas:

Take the stairs as often as possible.

This one is as simple as it sounds. If you have to go up two floors or less, opt for the stairs. Ditto if you have to go down three floors or less. If you have to go up or down a distance that is too great for you to walk at the moment, walk the first few flights, then take the elevator the rest of the way. Remember, every time you take the stairs instead of the elevator or escalator, you are making a decision that will positively affect your long term health.
Drink plenty of water.

This sounds odd, but it's a trick that I've been using for years. If you are constantly sipping water throughout the day, you are going to have to pee at least once an hour. Every time you have to pee, you have a guilt-free excuse to go for a 5-minute walk to the washroom and back! To crank it up a notch, use a washroom in another part of your building, which may give you an opportunity to use the stairs as well. It's easy to forget to take a 5-minute walk-break every hour, but it's impossible to forget to go pee.

Added bonus — staying well hydrated may also reduce feelings of hunger, and can often reduce chronic back pain. So this is really a win-win-win.
Park as far from the front door as possible.

Another simple but effective tactic. Whether you're at the mall, work, or school, parking the car at the edge of the parking lot forces you to walk just a little bit further than you are used to. It will only add a few seconds to your trip, but if you do it everyday it could add years to your life.

Added bonus — less chance of getting dinged by shopping carts and teenage drivers.
Clean your home regularly.

I've got to admit, this one was Peter's idea (as any of my former roomates can attest, cleaning is not my forte). Most people don't realize what a good workout cleaning can be, especially if you have a large home. Cleaning involves plenty of walking, lifting, and stretching - all of which are very good for your body. Washing dishes by hand can also be an easy way to burn a few extra calories, and to spend some time chatting with other members of your family (I spent many hours drying pots and pans for my Mom growing up).
Gardening and yardwork.

Yardwork is great because not only does it increase your physical activity, but it also gives you an excuse to be outside. Pulling weeds, mowing the lawn, trimming the hedge, and raking leaves are all very physically taxing and like cleaning, they use a range of muscle groups.
Disconnect your cable for the summer.

Time spent watching TV is an independent predictor of disease, especially for kids (for a great article on the topic by Ekelund and colleagues, click here). It's not surprising when you think about it - the only time that most kids aren't moving around is when they're sitting in front of the TV. Get rid of the cable, and suddenly you've got one less reason to spend your days sitting on the couch. If you're like me, after a few weeks without cable, you might start to wonder why you ever had it in the first place. And if, like me, you need to watch the NHL playoffs — walk to the local pub/sports bar with your friends on game night.

Buy a pedometer.

Pedometers are beeper-sized gadgets that count the number of steps that you take each day. They are a terrific way to measure the amount of physical activity you are getting each day, and can also serve as a great motivator to make the decision to walk whenever possible. Aim for at least 10,000 steps each day, but any increase is likely to bring health benefits, so don't feel bad if you can't get up to 10,000 right away. A high quality pedometer costs just $20, and are available online from Speakwell, a Canadian company based in British Columbia.
Use active transportation and public transit.

I have only been living in Ottawa for a week, but already I am in love with the bike paths. I have a beautiful 20 minute bike ride to work each day, and I can't imagine a better way to start the day. It takes about 4 minutes longer than driving (but is significantly cheaper since there's no parking fee to lock up my bike). Walking, roller blading, and biking are all great ways to get around, and they often take a lot less time than you'd expect.

If the trip is a little too far to hoof it, consider taking public transit. As researcher Ugo Lachapelle discussed in a recent interview here on Obesity Panacea, individuals who take public transit are more likely to meet physical activity recommendations than those who don't take public transit. This is because most transit trips involve at least some walking to and from stops. And remember that most major cities have bike racks for buses in the summer, and allow bikes on trains during off-peak hours.

Many workplaces offer free or discounted transit pass programs, so be sure to check if your employer has such a program.
Have ‘walk-meetings’.

In an ideal world, we would all have 45 minutes for a relaxed lunch. If you happen to enjoy this luxury, consider taking half your lunch break to go for a walk either alone or with someone else you work with. It will help wake you up for the afternoon, as well as giving you a chance to chat with your co-workers (you could even use it to kickstart that workplace romance you've been planning for so long).

If you don't have time to take a large walk break at lunch, consider having ‘walk-meetings’. Whenever you have to meet informally with co-workers, turn the meeting into a short walk. If it takes 5 minutes to discuss the project you are working on, that means you just got 5 extra minutes of physical activity! Peter and I used to frequently walk to the local grocery store on our lunch break, all the while discussing projects we were working on. It was a chance to get out of the lab, to talk about our work, and to get some physical activity all at the same time.
Go for a family walk after dinner.

This one was Peter's idea, but I have to admit that we did this almost every night when I was a kid in my family as well. My sister and I would hop on our bikes, my parents would walk behind us, and the four of us would go for a half hour trip around the neighborhood. It's another chance to spend some time together, get outside, and get some exercise all at the same time.

The M & Ms of Obesity Assessment

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

MOST TEXTBOOKS ON OBESITY will tell you that assessing someone for obesity should start with a careful exploration of weight history, eating habits and lifestyle.

I disagree!

For reasons that I will outline below, I believe that the proper assessment of patients presenting with excess weight should first focus on the four “M”s or the mnemonic “M”, “M”, “M”, & “M”.

As I presented [recently] in a talk on obesity assessment at the American Heart Association Meeting in Orlando, obesity is not only a remarkably heterogeneous condition resulting from a wide range of environmental, psychosocial and biomedical causes, successful weight management is also remarkably difficult and tenuous even in the most motivated and determined of patients.

The primary goal of assessment therefore should first strive to identify the possible causes and circumstances leading to excess weight gain, determine to what extent that excess weight is affecting health and systematically look for barriers that will make weight management difficult, if not impossible.

Each of the four “M”s explores a domain that is potentially relevant to all of the above questions.

The first “M” stands for “Mental Health”. Not only can common mental health problems often lead to weight gain (e.g. depression, addictions, attention deficit, abuse, PTSD, sleep disorders, emotional eating, etc.), but when present (as is often the case), they can make weight management most challenging. In addition, excess weight can directly affect mental health by promoting poor self-esteem, depression and social anxiety disorder. Thus, devising a weight management plan always requires a good understanding of a patient's mental health status, if only to determine that there are indeed no major mental health causes or consequences of weight gain nor significant mental health barriers that will make weight management difficult, if not impossible.

The second “M” is a reminder to look for the many “Mechanical” causes or complications of excess weight. These can present in the form of back pain or osteoarthritis, sleep apnea, reflux disease, urinary incontinence, and many other problems associated with excess weight. When present, these issues can not only promote or exacerbate weight gain but can also pose important barriers to weight management — clearly someone with plantar fasciitis is unlikely to walk the recommended 10,000 steps.

The third “M” should prompt us to look for the wide range of “Metabolic” complications of excess weight. These not only include diabetes, dyslipidemia or gout, but also hypertension (a problem of sodium metabolism), fatty liver and gall-bladder disease, polycystic ovary syndrome, and some forms of cancer. Often the presence of these conditions or the treatments we use to control them can contribute to further weight gain rather than help solve the problem.

The fourth “M” stands for “Money”, a not unimportant factor that can affect weight gain (healthy eating is expensive) or pose an important barrier to weight management (weight management costs time and money). Only after a complete understanding of the four “M”s can a clinician hope to fully appreciate the likely causes and consequences of obesity and the potential barriers to its treatment in a given patient.

Only after we have fully explored the four “M”s does it make sense to delve further into issues related to energy balance, i.e. ingestive behaviour, energy metabolism and physical activity in order to devise a sensible and effective management plan.

As I have argued before, simply assessing and describing a behaviour is not a diagnosis — understanding the root cause of that behaviour is.

Exercise Prevents Regain of Visceral Fat (But Not Body Weight)

by Travis Saunders, MSc, CEP
Travis is an obesity researcher, Certified Exercise Physiologist, public speaker, writer and distance runner. For more health and fitness news, visit 2his website at obesitypanacea.com

PETER AND I have often discussed the links between visceral fat and metabolic risk. Visceral fat is the fat which surrounds the internal organs, and is thought to mediate much of the risk between obesity and disease. For example, individuals with excess body weight tend to have more visceral fat, which is likely responsible for the relationship between body weight and numerous chronic diseases. However, as Peter discussed [recently], subcutaneous fat (the fat beneath the skin) does not seem to have these same negative associations with health. This means that regardless of body weight, individuals with excess visceral fat tend to be at increased health risk, while those with low amounts of visceral fat tend to be at low risk. This probably explains why up to 30% of obese individuals are metabolically healthy — these individuals are likely to have lots of subcutaneous fat, but not much visceral fat.

Given this link between visceral fat and chronic disease, it is interesting that exercise preferentially reduces visceral fat. In other words, even when exercise does not result in reductions in body weight, it still results in reductions in visceral fat (which is likely one reason that exercise results in dramatic health benefits even without a change in body weight). Perhaps just as importantly, a new study in the journal Obesity suggests that even small amounts of exercise can prevent the accumulation of visceral fat, even when total body weight is increasing.

In this new study, Dr Gary Hunter and colleagues at the University of Alabama followed a group of women for 1 year after completing an intervention which resulted in significant weight loss (~25 lbs). The authors divided the women into three groups — those that were to perform aerobic exercise twice a week, those that were to perform resistance exercise twice a week, and a control group which performed no exercise at all. As is often the case, body weight gradually increased following the intervention in all three groups. However, among the exercisers, body weight increased by much less than in the non-exercisers (~7.5 lbs vs ~13.5 lbs). What is even more interesting (and probably much more important from a health perspective), is that visceral fat levels increased by over 20% in the non-exercise group during the 1-year follow up, while there was no change in visceral fat levels in individuals who performed resistance or aerobic exercise.

I find these results to be very encouraging. Individuals in this study performed just 80 minutes of exercise per week, which is well below most recommendations, and frankly isn't much exercise at all. And yet, these individuals still prevented any increase in visceral fat. So while 80 minutes of exercise may not be enough to completely prevent weight gain (although it did dramatically reduce it), it might still be enough to prevent the accumulation of visceral fat, which is likely to also help prevent the accumulation of metabolic risk factors. These results are also a reminder that exercise can have dramatic effects on body composition and metabolic health, regardless of what is happening with your body weight. So whether your body weight is increasing, decreasing, or holding steady, if you are exercising regularly, you are likely reducing your visceral fat levels, as well as your health risk.

Want to Look Good for Spring?
This Won't Do It for You!

AFEW MONTHS BACK, Peter wrote a fantastic post on the Equmen Core Precision Undershirt, which is essentially a girdle for men. Somehow the ridiculousness of the shirt was only exceeded by its popularity on both sides of the Atlantic. Today we bring you an even more impressive product from the United Kingdom — pants which are reported to literally melt the fat off your legs!

The Scala Bio-Fir Anti-Cellulite Pants look like regular tights, but contain crystals which heat up on contact with the skin. Although somehow this heat remains undetectable to the wearer, the Daily Mail from the UK claims that this heat results in “[improved] circulation in the thighs, bottom and stomach, encouraging fat cells to ‘melt’ into a liquid” (emphasis added). That's right, heat that is so small that you can't feel it, yet is somehow powerful enough to melt your fat cells, while causing no damage whatsoever to muscle or other cells.

Now this might seem a little fantastical, but the Daily Mail includes a figure titled “Now for the science bit” which breaks it down for the skeptics.

Now I'm a bit embarrassed. You see, despite spending the past few years studying physiology, I had no idea that fat cells melted when exposed to undetectable heat/increased blood flow. I guess that means every time I go for a run, or a shower, or put on a pair of warm pants, my fat cells are melting into my bloodstream, where the fat is somehow excreted by my kidneys into my urine. Which explains all those fat droplets in your urine on a hot day.

But what if my skepticism is misplaced and these pants do cause fat cells to melt? Well, that could actually be very bad from a health perspective. Fat cells are meant to store fat, so they tend to do it pretty well and with minimum health risk, especially subcutaneous fat cells in the lower body. However, when these subcutaneous fat cells fill up, or when they somehow disappear (e.g. your pants cause them to melt) fat begins to overflow into the liver, heart, and skeletal muscle, causing all sorts of metabolic problems. This is exactly what happens to many individuals who receive Highly Active Anti-Retroviral Therapy for HIV — they lose fat cells in the arms and legs, causing increased visceral and liver fat accumulation and severe metabolic dysfunction. So if the magic crystals in these pants do somehow cause your fat cells to melt, that could actually be a pretty big health concern.

As far as I can tell, the pants are currently only being carried in the UK, where they are said to be selling like hot cakes. They are being sold by John Lewis for £30 (~$50 USD), although pairs are now popping up on eBay for anyone in North America who is eager to have some magic pants of their own. Personally, if you're looking to spend $50 on your health I'd suggest a pedometer or a terrific book on healthy eating like Food Matters, but that's just my opinion. And if for some reason you desperately want to have pants that cause your legs to heat up, I suggest a nice pair of snow pants, which have been keeping us Canadians warm for centuries.

Hat tip to reader Kate Tolley for bringing this product to our attention.

Ate between 8 and 8? Bad Move!

THAT SNACK AT MIDNIGHT — rather than at midday — could be what's destroying your diet, a researcher believes, based on his finding that when you eat has a stronger impact on your metabolism than what you eat.

“The cycle of feeding and fasting is extremely important,” Dr. Satchidananda Panda revealed recently. His research at the Salk Institute for Biological Studies in San Diego tested the theory that the circadian clock, or the roughly 24-hour cycle that each person's body follows, regulates metabolism. What he found was that mice on exactly the same number of calories reacted differently depending on whether they stuck to a strict feeding regime with periods of fasting or whether they ate small meals and snacks all the time.

“This changes how we think of rhythms,” said Panda. “It was thought that it is driven by the clock itself. Now we know it is driven by when you eat.”

Scientifically, the genes that encode the enzymes that break down sugars rise immediately after a meal, while genes that encode the enzymes that break down fat are at their highest during a fast.

So a clearly defined eating schedule “puts the enzymes of metabolism in shift work and optimizes burning of sugar and fat”.

What this means in theory, Panda said, is that a person would be better off not eating from, say, 8 p.m. until 8 a.m. than eating the same number of calories but not fasting for a stretch. In fact, Panda himself instituted his own nighttime fast during his study and lost weight, without changing the amount he ate.

He also tested his theory on recent flights to and from India after a flight attendant told him her secret: Eat very little during the flight and have a big meal when you arrive.

“With this new schedule, I've had very little jet lag. I might still wake up at 3 or 4 in the morning, but the lethargic conditions are gone.”

The research would also explain why shift workers have an increased risk of developing metabolic syndrome, a combination of medical disorders that increases the risk of developing cardiovascular diseases and diabetes, he said.

“It's not because they're shift workers, but because on their days off they change their eating patterns” and throw their liver clocks into crisis. The next step in the research, said Panda, is to extend the experiment on mice to see if extremely scheduled eating makes them live longer.

Earlier research by Panda found the conventional wisdom of a circadian rhythm entirely governed by the brain clock to be untrue: While exposure to bright light will reset the brain clock, it has no affect on the other organs' ‘clocks’, he said. The other organs responded to other stimuli, of which feeding time was a major factor, according to his latest study, released by the Salk Institute.

How Many Extra Calories Do You Need To Become Obese?

by » Dr. Arya Sharma

ONE OF THE MOST COMMON OBESITY MYTHS (propagated in countless publications and statements) is that it only takes a small daily caloric excess to put on vast amounts of weight over a lifetime. Thus, it is often said that eating as few as 20 extra calories a day, resulting in around 7000 extra calories per year, will add up to approximately one kilo annual weight gain, which, if continued over decades, can add up to tens of kilos of extra weight.

However, this calculation is far too simplistic, because as the body gains weight, its energy requirements also increase. As soon as the body's daily energy requirements increase by 20 calories, there is no longer any caloric excess and so weight gain stops. To continue gaining weight, you would need to now add another 20 extra calories which will in turn increase body weight till those too are just enough to meet increased demands, at which point you would need to add another 20 calories to keep gaining weight.

In other words to continue gaining weight, it is not enough to simply eat 20 extra calories per day and hope for the best—rather, the amount of extra calories has to keep increasing to sustain weight gain over time. This means that you would soon need to be eating 100s of extra calories per day more than you were eating before you started gaining weight just to maintain the same rate of weight gain.

This simple physiological truth is now once again explained by Martijn Katan and David Ludwig in a brief but enlightening article published in JAMA.

Using simple examples, Katan and Ludwig illustrate that for most people to move from a BMI of say 25 to a BMI of 35 actually requires 100s of extra calories per day (in the 300-500 cal range). Because of the natural growth and ever increasing caloric demands in children, the daily energy excess required for kids to become obese is even greater (in fact 500 to 1000 extra calories per day for young children).

Sadly, for exactly the same reasons that weight gain for a given caloric excess is self-“limiting”, so is weight loss for a given caloric deficit.

This means that a given reduction in caloric intake (let's say eating 500 calories less per day) will only result in weight loss for as long as it takes the body to decrease its daily caloric needs by that amount. Unfortunately, this generally occurs within a few weeks of starting your diet (as the body loses weight and hormonal changes kick in to reduce energy metabolism). This is when you stop losing weight, despite still eating 500 calories less than before. To start losing weight again, you would now need to reduce your calories even further, but even then weight loss would once again stop as the body adjusts to even fewer calories. (This is why people who have bariatric surgery, despite consuming far fewer calories than before, don't simply continue losing weight till they disappear).

Thus, in the same way that continued weight gain requires relatively large net daily increases in calories (albeit in progressive steps), so does continued weight loss require huge caloric deficits to be maintained over time. The commonly promoted myth that small changes in energy intake will eventually lead to large gains or losses in weight over time is simply wrong.

Indeed, it is exactly because gaining or losing large amounts of weight takes a considerable caloric excess or deficit that has to maintained over time, that weight management is so difficult.

If small changes could make huge differences, we would not have an obesity epidemic.