Gender Wars In Obesity

Obesity is a medical condition that now affects about 25% of the Canadian adult population, with the prevalence being slightly higher amongst men than women.  Interestingly, it is most often women that seek help to treat their obesity.  In fact, in clinical research trials of obesity, enrolment is usually constituted by about 80% women and 20% men - we would much prefer a 50/50 split so that we could study both genders equally well, but the reality is that women are more interested to participate in programs or studies that may help them to lose weight.   Why is this?

Though the reasons are likely multiple and complex, and also different from person to person, it seems that at least some of this difference may be thanks to societal views on obesity in women vs men.   I heard a poignant commentary from a colleague at a meeting recently.  He said:

Next time you are in the grocery store or gas station, have a look at the magazine rack.  When you go to the section that is most often read by women - fashion magazines, women's fitness, social news etc - what do you see?  Thin women, often models that are underweight, in skin tight clothing, strutting their stuff and painting the image of what a woman 'should' look like.  

Now, head to the outdoor and sporting section, which is the section that men most often enjoy.  These men are often larger, dressed in bulky clothing, looking large and strong... while many of these photos are very muscular, many are often carrying excess fat tissue as well. 


This societal dichotomy is doubly unfortunate, because it leaves women with an inappropriate impression of what they 'should' look like, while it could leave men thinking that it may be desirable to carry excess body weight.

I would love to hear from my readers if this resonates with you - feel free to post a message at the end of this blog post.

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www.drsue.ca © 2016

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JDRF Reaches Out To Fort McMurray Evacuees with Type 1 Diabetes

In the wake of the wildfires that have ravaged Fort McMurray, there have been many heartwarming stories of outreach and support to victims of this monumental natural disaster.

The JDRF (formerly known as the Juvenile Diabetes Research Foundation) is reaching out to Fort Mac victims living with type 1 diabetes to help ensure they have ongoing access to insulin, test strips and supplies.  Here is the media release directly from the JDRF:

Media Advisory

JDRF Canada Assisting Fort McMurray Individuals Living with Type 1 Diabetes

The North Central Alberta & Northwest Territories Chapter of JDRF Canada is coordinating with local type 1 diabetes (T1D) support groups to provide assistance for T1D families evacuated from Fort McMurray with their insulin related needs.

Families who were forced to evacuate may have limited access to insulin, test strips and other related supplies. Local social media groups for people living with T1D have been very active with families offering to share their supplies with families in need. “Many people are now in the Edmonton Area while others are in camps around Fort McMurray”, said Dorothy Ross, Regional Director for JDRF in Western Canada “We are compiling the lists of people that are in need with people who can share some of their supply, both in the Fort McMurray area and in other communities in the region.”

People who are either in need of or able to offer supplies can contact JDRF at1-855-428-0343 or local at 780-428-0343. For after hours support, please e-mail Edmonton@jdrf.ca. JDRF staff will coordinate resources with those in need.

About JDRF

JDRF is the leading global organization funding type 1 diabetes (T1D) research. JDRF’s goal is to progressively remove the impact of T1D from people’s lives until we achieve a world without T1D. JDRF collaborates with a wide spectrum of partners and is the only organization with the scientific resources, regulatory influence, and a working plan to better treat, prevent, and eventually cure T1D. As the largest charitable supporter of T1D research, JDRF is currently sponsoring $530 million in scientific research in 17 countries. For more information, please visit JDRF.ca.

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www.drsue.ca © 2016

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What The Biggest Loser Teaches Us About Metabolism After Weight Loss

Well, I never thought I would say this, but the show The Biggest Loser has been useful for something: it has taught us some important scientific lessons about just how much, and for how long, metabolism drops after weight loss.

(I say that the show is useless otherwise for a host of reasons: It portrays unsafe, dramatic means of weight loss that are not sustainable and gives many incorrect and inappropriate messages about obesity.  I could go on...)

Fourteen participants of The Biggest Loser agreed to have their metabolism measured before the weight loss program, at the end of the 30 week competition, and again 6 years later.

The study (which has been big in the news media in the last several days) was conducted at the National Institute of Health and published in the medical journal Obesity.  The baseline weight amongst these six men and eight women was 148.9kg, and they lost an average of 58kg at the end of the 30 week competition.   After 6 years, most participants regained a significant proportion of the weight lost during the show, with only one person not regaining any weight, and five people having returned to their baseline weight or above.

When they measured metabolism in these people before the competition and compared it to their metabolism 6 years later, they found that on average, their metabolism burned 499 fewer calories per day, compared to what would be expected for a person of that gender, age and body composition who had not previously lost weight.

Similar to an older study I previously blogged about, this teaches us that metabolism decreases markedly after weight loss, not only due to carrying around less weight, but also due to an additional, evolutionarily designed adaptation to defend our body weight. For The Biggest Loser contestants, this means that on average, they have to eat 500 calories less, every day, than they would if they weighed the same but had not come down from a higher weight in the past.  This metabolic adaptation goes on for at least six years after weight loss (based on this study) - and of course may well go on much longer, possibly indefinitely.

So how does a person handle this new lower metabolism after weight loss, to keep the weight off?  We can look to the American National Weight Control Registry to learn about habits that are associated with keeping weight off - the themes are lots of activity (at least an hour a day) and lots of self monitoring - read more on this here.

If you'd like to read more about The Biggest Loser study and the individual participants, the New York Times wrote an excellent article about it, including interviews with several participants - check it out here.

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www.drsue.ca © 2016

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World Health Day - Eyes On Diabetes

Today is the World Health Organization's World Health Day, and for the first time, the focus is on Diabetes and its global impact.

In Canada, it is estimated that 11 million Canadians are living with diabetes or prediabetes, with 20 Canadians being diagnosed with diabetes every hour.

As per the press release from the Canadian Diabetes Association:

Diabetes increases a person’s risk for many serious complications such as heart attack, stroke, kidney failure leading to dialysis, and blindness. Nevertheless, for many people it is possible to live a healthy, full life with diabetes.

“People with diabetes play a critical role in ensuring the best health outcomes with the disease. Working closely with their health-care team, they manage blood sugar levels, foot care, eye care, physical activity and healthy eating,” says Dr. Jan Hux, chief science officer at the Canadian Diabetes Association (CDA). “Self-management is the cornerstone of diabetes care and people affected by it need the knowledge and skills to properly manage diabetes.”

According to the CDA’s Report on Diabetes: Driving Change, access to diabetes education is vital for learning more about nutrition, physical activity, blood sugar monitoring, medication and ways to make even little changes that can lead to success.

Some tips to keep on top of your diabetes include: taking action to learn as much as possible and using diabetes programs and services when needed; setting your targets and goals to maintain optimal average (A1C) and daily blood sugar levels; performing self-checks for foot problems; and scheduling regular eye exams. For more information, visit diabetes.ca/takecharge. 

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www.drsue.ca © 2016

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Liraglutide Reduces Heart Disease In People with Type 2 Diabetes

BIG news in the diabetes world was released on Friday - for the first time, a medication in the class called GLP-1 receptor agonists, called liraglutide (trade name Victoza), has been shown to reduce cardiovascular events in people with type 2 diabetes.

The LEADER trial enrolled over 9000 people with type 2 diabetes, who were at high risk of cardiovascular disease, and randomized them to receive either Victoza vs placebo with usual standard of care.

They found that Victoza was better than placebo to reduce the combination of death from cardiovascular disease, non-fatal heart attack and non-fatal stroke. A reduction in all three of these components contributed to the benefit that was seen.   The numbers and details are not yet available - we'll have to wait until the American Diabetes Association meeting in June to find out more.

Here's why this is ground-breaking news: 

We have long been uncertain whether we are actually preventing cardiovascular disease by treating diabetes - we know that the higher sugars are, the higher the risk of heart disease, but it has been evasive to actually prove that lowering blood sugars prevents heart disease. The next question is whether some medications to treat type 2 diabetes could be better (or worse) than others to protect from heart disease.  LEADER has now shown us that treating type 2 diabetes with liraglutide does indeed protect patients from cardiovascular events.

Within the GLP1 receptor agonist group of medications, a study of lixisenatide (called the ELIXA study) showed that it did not increase the risk of cardiovascular events, but it didn't prevent them either.  Studies of the other GLP1 receptor agonists available are currently underway.

As far as other type 2 diabetes medications go, the only other medication that has clearly been shown to reduce cardiovascular disease is empagliflozin, which you can read more about here and here.  Metformin, which is the #1 treatment advised for type 2 diabetes worldwide, has some weak evidence that it prevents cardiovascular events as well.

We will be waiting in anticipation for more details from the LEADER trial in June!


Disclaimer: I have been involved in research trials of liraglutide.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of type 2 diabetes.

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www.drsue.ca © 2016

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What's The Beef On Processed and Red Meat?

BIG NEWS in the nutrition world this week - the World Health Organization's International Agency for Research on Cancer (IARC) has stated that processed meat causes colon cancer. 

The science:  IARC assessed more than 800 epidemiological (population based) studies to evaluate the link between red meat, processed meat, and cancer, giving the greatest weight to prospective cohort studies, and taking additional evidence from high quality population based case-control studies.  They made a point of focusing on data that included large sample sizes and controlled for possible confounding factors (these are other factors that could be responsible for the same result, for example smoking).   Their meta-analysis found:

1.  An 18% increased risk of colon cancer per 50g of daily processed meat consumption (with confidence that there was no confounding or other explanation for the results);

2.  A 17% increased risk of colon cancer per 100g of daily red meat consumption (with less confidence that there was no other explanation for the results)

3.  Positive associations between consumption of processed meat and stomach cancer;

4.  Positive associations between consumption of red meat and cancers of the pancreas and prostate.


Based on these results, they have classified processed meats as being carcinogenic (cancer causing), and red meat as 'probably carcinogenic' to humans. 

It seems that how meat is cooked or processed is relevant to this discussion.  Meat processing, such as curing or smoking, can result in the formation of cancer causing chemicals such as N-nitroso-compounds and polycyclic aromatic hydrocarbons (PAH).  Cooking meat can produce chemicals also suspected of causing cancer, including heterocyclic aromatic amines and PAH.  High temperature cooking (pan frying, BBQ, or grilling) produces the highest amounts of these chemicals.

While red meat does contain lots of good quality protein and important nutrients such as B vitamins, iron and zinc, these nutrients can be found in other, healthier food choices.

So, meat lovers: you're best off to limit your intake of processed meats and red meats; consider healthier alternative such as poultry or fish.

A scientific discussion of the evidence can be found in The Lancet Oncology, and you can read more about the IARC (if interested) here.

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www.drsue.ca © 2015 

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Canadian Medical Association Regonizes Obesity As A Chronic Diease

Finally, finally!  Canada has joined in with other nations to FINALLY recognize obesity as a chronic disease.

On October 9th, the Canadian Medical Association (CMA) officially declared obesity to be 'a chronic medical disease requiring enhanced research, treatment and prevention efforts'. 

As CMA president Cindy Forbes states:

"It is important for health care providers to recognize obesity as a disease so preventive measures can be put in place and patients can receive the appropriate treatment.  This move by the CMA speaks to the importance of addressing obesity and dealing with the stigma that is often associated with the condition."

I couldn't agree more.  There is an urgent need to shift society's thinking away from the idea that obesity is a lifestyle choice, and towards understanding the complex physiologic mechanisms that underlie this medical condition.

The CMA now joins other organizations, such as the American Medical Association and the World Health Organization, in recognizing obesity as a chronic medical condition.  With this important recognition, Canada has taken an important step towards supporting patients with obesity, and abolishing the obesity stigma that plagues not only our society, but also health care.

The way forward is now for improvements in access to important treatment options for patients with obesity - from nutritional counselling, to psychological support, to medications, to bariatric surgery.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2015 

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