Secrets To Success - Keeping Weight Off

Have you ever wondered what the secret to success might be, for people who have lost weight and have been able to keep it off?

While the answer to this question will be different for each individual, the American National Weight Control Registry was established in 1994 to try to identify behaviors associated with long term weight loss success.   It is the largest prospective observational study of weight maintenance out there, and includes individuals who have maintained a weight loss of at least 30 lbs for at least 1 year.

Some interesting facts about NWCR members:

• 80% are women, 20% men
• average age is 45-50 years
• 45% lost weight on their own, and 55% with a program

Here are the winning patterns of NWCR members:

• 98% modify their food intake in some permanent way: portion control, low fat diet
• 90% exercise at least 1 hour per day, burning at least 400 calories per session
• 78% eat breakfast every day
• 75% weigh themselves once a week
• 62% watch less than 10 hours of TV per week
• average daily calorie intake for women = 1306 cal
• average daily calorie intake for men = 1685 cal

While the causes and contributors to excess weight, and the challenges in maintaining weight loss are different from person to person, it would be worthwhile to consider these permanent habits to improve the likelihood of long term weight management success!

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www.drsue.ca © 2015 

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Keeping Kids Active This Father's Day - And All Year!

In the fight against childhood obesity, it's important to promote an active lifestyle for kids.  Studies show that family based interventions work best to prevent and treat childhood obesity.  Recently, I participated in a fantastic family-oriented triathlon weekend, where kids raced one day and adults the next.  What a great way to get kids interested and enthusiastic in not one but three sports - and adults got to be great role models at the same time!

So this Father's Day weekend, grab your kids and embrace a fun, family-oriented activity - and keep the theme going all year long!

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www.drsue.ca © 2015

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What Determines Our Daily Energy Burn?

Whether we gain, lose, or maintain weight depends on the balance between calories in, which is what we eat and drink, and calories out, which is the energy that we burn.

So, what exactly determines the calories out side of the equation? 

Our daily calorie burn, also called energy expenditure, is divided into several components: 

1.  Resting Metabolic Rate (RMR)

The RMR is the energy that we use while at, well, rest!  This includes the energy it takes to run our daily functions like breathing, heart pumping, and brain function, and all of the functions of maintenance and repair that go on inside all of our cells on a 24/7 basis.  Believe it or not, this comprises 50-80% of our total daily calorie usage.

The RMR varies greatly from one person to the next, due to differences in lean body mass, age, gender, and genetics.  The RMR is also determined by thyroid hormone levels and the baseline activity of each person's sympathetic nervous system, which produces a baseline level of adrenaline and a tendency towards usage of body fat as an energy source (called lipid oxidation).

2.  Spontaneous Activity

Spontaneous activity refers to everything that we do to move around in a day, from daily living activities to purposeful exercise.  Although one might think this is the biggest part of our daily calorie usage,  it accounts for only 10-25% of our total calorie burn in most people.  

The calorie burn from spontaneous activity varies a lot from person to person, with the biggest variance between individuals actually being due to all of the spontaneous activity excluding purposeful exercise, hence the name non exercise activity thermogenesis or NEAT.  NEAT includes everything from the calories burned during work activities, transport from place to place (eg walking vs driving), and even the amount we fidget!  Interestingly, our tendency for fidgeting behaviors seems to be largely genetically determined.  So, a person who is less inclined to be 'fidgety' will burn less calories in NEAT than a person who is more inclined to be fidgety.    People who have a higher sympathetic nervous system drive tend to have higher NEAT as well. 

The calorie burn from spontaneous activity also depends on body weight, as it requires more calories to carry a higher body weight through life's daily activities.  

3.  Thermic Effect of Food

The thermic effect of food refers to the calories it requires to actually digest the food that we eat, and comprised about 10% of our daily calorie burn.  This can vary somewhat, depending on the types of food eaten (protein requires more calories to digest than carbs or fat), and by sympathetic nervous system activity.  However, the jury is still out as to whether differences in the thermic effect of food plays a role in obesity or not.  

So, a few tips to take away in terms of weight management: 

• With weight loss, the daily calorie burn in resting metabolism and spontaneous activity actually decreases, because there is less weight to maintain and carry around in a day. (Think of a 20 lb weight loss like taking off a 20lb backpack - less weight to carry around means lower calorie burn).  Our metabolism actually slows when we lose weight as well, further decreasing the calories that we need to eat.  So, the 'calories in' side of the equation needs to be scaled back as a person is losing weight, to stay in tune with the decreased calories burned with weight loss. 
• Think about being NEAT!  In other words, try to put more movement in your day.  Rather than being still after dinner, go for a walk instead.  Take the stairs instead of the elevator.  Look for a further parking spot instead of a closer one. 
• Use an exercise program to burn calories, but also to gain muscle mass (as a higher muscle mass increases your RMR). 

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015

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ENDO 2015: Performance Enhancing Drugs

Late yesterday at the Endocrine Society's ENDO 2015 conference, I attended a fascinating session about performance enhancing drugs given by Dr Shalender Bhasin.  

When we think about performance enhancing drugs (PEDs), we tend to associate their use with elite athletes who are using them to get an edge to win a game or a race (with the cycling scandals being an example).  While this certainly does occur, the far more common abuse of PEDs is actually amongst recreational weight lifters, who use PEDs to improve their aesthetic appearance (ie to looked as cut and ripped as possible).  Those that use PEDs for muscle appearance may be at an even higher risk of adverse health effects than the elite athlete, because recreational body builders are more inclined to use these drugs for many years continuously, whereas elite competitive athletes tend to use them more intermittently, usually limited to a few years, and usually supervised by sports med physicians.  (That being said, let's be clear: any use of PEDs can be very dangerous, 'monitored' or not.)

The use of PEDs by men with the goal of enhancing their aesthetic appearance sheds light on an important issue that doesn't get enough attention: namely, that it is not only women, but also men, that are at risk of body image disorders in our current society.  While women may feel a social pressure to emulate the wafer thinness of some celebrities or models, men may also feel pressure to emulate their Hollywood counterparts, to be more chiseled and buff than may be obtainable under normal physiologic circumstances.  A term called Muscular Dysmorphic Syndrome has been coined to describe the condition where an individual (usually a man) is preoccupied with muscularity and leanness, causing dissatisfaction with the person's own body size and shape to the point where it results in impaired function in occupation and social life. 

Muscular Dysmorphic Syndrome with resultant abuse of performance enhancing drugs (PEDs) can be difficult to detect.  This group of individuals typically do not come to doctors for help, and if they do, may not admit that they are using PEDs.  This is a grave concern, because there are multiple (including some life threatening) risks of PED use, with the particular list of risks depending upon the drug or drugs being used.  (PEDs can vary from testosterone derivatives, to growth factors, to hormone modulators, to diuretics, to Beta-2 agonists, to peptides, to stimulants - or any combination of the above).  

As Dr Bhasin eloquently pointed out, the best diagnostic tool that we as health care professionals have to diagnose both Muscular Dysmorphic Syndrome and resultant PED abuse is a good conversation - ie, to proactively ask our patient about it if suspected; and, the ability to have an empathetic, compassionate discussion with our patient about it.

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www.drsue.ca © 2015

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Do iWant the iWatch?

Big news in the technology world - the Apple Watch was unveiled for the first time, and it's expected to arrive on shelves in 2015.  Of the multitude of fascinating features, one aspect that is getting a lot of attention is the iWatch's ability to track physical activity and provide integrated fitness/activity apps to help guide your progress.   You may find yourself asking - is this something that iWant? that iNeed? Will iBenefit?? Can iTrust it??

While there are many fitness apps out there, here's what catches my attention: the iWatch can measure your heart rate, and your total body movements (via an accelerometer).  It also uses the GPS and wifi in your iPhone to track how far you've moved.  There's a little circular icon that fills up each day as you move - even letting you know how many minutes you have stood during the day.

Pretty nifty that you can now track your activity, heart rate, and personal info all together in one internet-linked system.  I also really like the encouraging nature of the movement icons filling up, with Apple's stated goal to be 'Sit less, move more, and get some exercise by completing each ring each day.'

There are rumblings as well that the iWatch will someday be able to check blood sugar without poking the skin.   (Currently, the closest a diabetic can get to this is with a continuous glucose monitor, which still requires that a sensor is worn under the skin, and it has to be calibrated against the standard finger-poke twice a day.  There is also a brand new technology just approved in Europe early this month, whereby a small round sensor is placed on the skin with a small filament that is inserted just under the skin; a reader is scanned over the sensor to get a glucose result. More on this on drsue.ca soon - stay tuned.)      As testing blood sugars can be painful and frustrating for my diabetic patients, this news not only got me sitting up, but also spiked my own heart rate to well over 100.

With real time, painless monitoring of these parameters, I get carried away into a dream land where patients could be monitored in second-to-second real time with internet data transmission to their family members, caregivers, or health care professionals anywhere in the world... do I dare to dream?? (editorial note: there are a number of established glucose monitor companies working on this for blood glucose monitoring, in various stages of development)

Before we get carried away, though, we need a lot of questions answered.  How have they validated their technology?  How accurate is their accelerometer? How accurate is the heart rate monitor?  Can the heart rate monitor pick up irregularities and notify the patient or caregiver?  If they are going to incorporate a blood glucose monitor, how will this be tested and validated for precision and accuracy?  I suspect these details and information will become available as the iWatch unfolds into the marketplace, but if we as people, patients, and health care professionals are going to trust the data, we need to know that the studies have been done to prove that it is worthy of our trust.

Definitely exciting, though - my eyes will be focussed on these interesting developments in health technology.

Thanks to Glenn for the heads' up, and to Anita Dobson for her input.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2014

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Downsize Fitness Comes to Canada!

The first of an American chain of stigma-free, welcoming gyms exclusively for people who struggle with their weight has arrived in Canada.  Rather than focusing on cardio burn, Downsize Fitness focuses on functional fitness - helping people learn exercises to gain strength and mobility for daily activities like getting to and from work, standing up from the floor, keeping up with kids - whatever each individual needs to help them lead their best life.

There are a variety of levels of exercise programs to help people address their individual needs, and a strong sense of community that helps to support members in their journey to improve their fitness.

As discussed in the Canadian Medical Association Journal, one of the barriers to exercise cited by people who struggle with their weight is a fear of being stigmatized at traditional gyms, so it's great to see facilities that will help to take down this particular obstacle in the weight struggle.

I'm looking forward to seeing more of these and similar facilities pop up around the country!

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014

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Landmark Study Shows Physical Activity Decreases Heart Attack Risk

We have all heard before that physical activity is important for overall health.  Believe it or not, it is now for the first time that we have solid evidence to prove that being more active in daily life decreases the risk of cardiovascular events (eg heart attacks) in particular.

The study, recently published in Lancet, assessed pedometer data (recording # steps per day) in over 9,000 people with prediabetes from 40 countries around the world.  They examined how many steps per day each person took at the beginning of the study and again at 1 year, and then followed them up for an additional 6 years.  They found that:

• people who were more active at baseline (start of the study) had a lower risk of cardiovascular events
• people who became more active over the course of a year had a lower risk of cardiovascular events at 6 years
• for every 2,000 steps/day increase in activity over a year (about one mile or 1.6 km), there was an 8% decrease in cardiovascular events!

Prior to this study, the studies suggesting that being more active decreases the risk of cardiovascular events have been based on less rigorous data and study design.  Also, previous studies have generally been based on self reported data (ie the person in the study gauges how active they are), whereas this study objectively measured number of steps per day with pedometers.  For these reasons, this study is considered a landmark trial in that it has shown us, very objectively and in a high quality study design, that being active really does decrease heart risk in a group of high risk individuals.

See if you can find ways to take more steps in your day!

Follow me on twitter: @drsuepedersen

www.drsue.ca © 2014

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