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Category Archives: Weight Loss
The first of January inevitably brings on a list of common resolutions among your patients as well as yourself as a professional. Most of these are directed towards what we perceive as something that will lead to a healthier, if not happier life. With any luck it results in both.
A while back I wrote an article that explained how a popular weight loss program (Ideal Protein) worked. I still believe it to be the best we have available to safely lose weight, both in scientific background and in personal clinical results. It stands as our most popular blog to this day. Many key points however are often lost on the patient we help to lose weight and both the patient and the clinician MUST regularly remind themselves of these points. Failing to do so steers us and the patient gradually away from reality, and more towards a route that can often result in disappointment.
I have found these so vital to the understanding of the concept of weight that I have pinned them on the wall of my consultation room. In a time when our patients are bombarded daily with the best ways to lose weight and how to eat healthy and “clean”, I’m a big fan on grounding them with a few simple concepts:
- Weight is not a measure of health
- Suffering yourself down to a goal weight that you will suffer to remain at results in no quality of life
- Your weight is not as directly under your control as some will have you believe
- There are unhealthy thin people and healthy overweight people
- Extremist forms of eating that are difficult to maintain will result in a waste of your time and money
- If your excess weight is determined by your doctor to be detrimental to your health and quality of life, then an overall change in your lifestyle is required
- Typical exercise that 99% of us do, does not result in lost weight (It will help with blood glucose, lung capacity, joint mobility, cholesterol, mood, cardiovascular health, and make it more difficult to gain weight however)
- It is estimated that 80% of those that lose weight will gain it back
- Eating food is not only cultural, but it should also be enjoyable. Eating in moderation and doing your best to avoid added sugars and any trans fat is recommended.
- The weight you are at is not as simple as calories in vs calories out
- There are many ways to lose weight that are effective and safe. If you decide to lose weight, pick one that is sustainable for you and ask your healthcare professional for advice.
Graham MacKenzie Ph.C.
In 2015 I took four months to film a healthy grocery shopping tour with the help of a local filmmaker where I went through all areas of the grocery store to help people make healthy choices for themselves and their family. https://www.youtube.com/watch?v=cgEbpNL9PSg&t=1s
In the 40 minutes of video, the opening scene stresses the importance of cooking your own meals at home and knowing what to buy in order to do that.
This year I had the pleasure of attending a Diabetes Canada meeting in Sydney, N.S. It was a great morning of networking and meeting colleagues from all over Cape Breton. I asked one of the attendees at that meeting, Ann Marion Willis, a Registered Dietician who works with Atlantic Superstore if she was able to help out with an idea I had to do a cooking class for a small group. Out of that conversation I requested a location at the home economics room at Baddeck Academy with four stations to do a cooking class. They were gracious enough to allow us to use their facilities.
The plan is to have a parent or two bring their children in (from grade primary to grade 12) and show them how easy it is to make a meal that is healthy for them. Ann Marion has healthy recipes with nutrition information for all, a starter smoothie, a meal and dessert. She also demonstrated the preparation of the food. Space is tight but hopefully demand will drive further classes.
Studies that try to tie food intake with outcomes are notoriously plagued by problems that measure food consumption with questionnaires based on personal recall of consumption. Nevertheless there are studies that show the effect of how your food is prepared and what affect it has on your health. A 2007 study of 84 undergraduate students in Greece found that diet becomes less optimal when the student leaves home to live away, including eating out. Specifically, fresh fruits and vegetables and oily fish consumption dropped once they moved away from home.
The time taken to cook and cleanup after a meal has decreased by 50% in the last 40 years. While this number on its own isn’t very significant in determining anything, but it does reflect the availability of commercially prepared food, which is both quicker to prepare and cheaper because of its mass production. It stands to reason that both of these factors can lead to increased food consumption. In fact, countries that spend more time in food preparation correlate with a lower obesity rate. Again, there is no causality claimed here though.
In another study in the Journal of the American Dietetic Association (2006) that utilized food intake questionnaires in just under 1000 young adults, it was discovered that young adults that prepared food less claimed time restraints as a major determining factor. However in those that did report frequent food preparation did claim that they ate out much less often and were more likely to meet dietary objectives for healthy eating.
Learning to cook meals at home not just for yourself but your loved ones is one of the single most important things you can do to live a healthy life, when combined with physical activity. Teaching yourself and your children to prepare healthy meals at home controls much of what you consume and much of your overall health.
The month of March ushered in news of a new report entitled “Obesity in Canada”. Submitted by the Senate, this report was a 21 recommendation paper to try and constructively address the growing concern of why Canadians are following its Southern neighbors in growing rates of obesity in both children and adults. In fact there are is a doubling in obesity in adults since 1980 and children’s obesity rates in this country have tripled in that time. This report was a breath of fresh air from a government group that many today look at with question of why they are even there.
As a Pharmacy owner that discontinued sale of such products in September of 2014, this story caught my eye. Anything having something to do with sugary beverages is a hot topic with the media, as I abruptly found out that day a year and a half ago. Even a small pharmacy in the middle of nowhere can make the national and international news by making “such a bold and forward thinking move” (as it was described) as stopping the sale of everything from pop, juice, vitamin water, sports drinks and chocolate milk.
Any talk of manipulating the sale of a staple in the Canadian diet will bring about cries of a “Nanny State move”. So when news hit that one of the recommendations from the Senate’s report was a proposed tax on such drinks, the naysayers came out of the woodwork, and along with them, the defenders of the plan. One of the first to press against the idea was Jim Goetz, the president of the Canadian Beverage Association who attempted to educate us in a biased way with stories of how this has been tried in other parts of the world and didn’t work, had no effect on obesity and resulted in lost jobs and increased grocery expenditures. Mr. Goetz is a name I learned back when I stopped selling these beverages and saw an article in rebuttal to this type of move. When I read of crazy claims that increased calorie intake had nothing to do with obesity, it really opened my eyes to the war that goes on in this category.
Granted there is no shortage of stories where an increase in tax on a target food group seemed to be a dud with respect to changes in obesity, even when the calorie intake did seem to drop. Denmark, Mexico, the United States, Finland, France, Hungary all are examples of stories where a tax was implemented with results that vary depending on who tells the story. In fact during a recent CBC Radio interview on the Senate report I gave recently, I was pressed on the success (or lack of) in such programs. I was quite persistent though on the complete irrelevance of the obesity outcome but rather we should focus on the fact that we need to pay for the adverse health issues that arise from the obesity that we know these beverages cause.
When I cross from Dartmouth to Halifax on either bridge, I expect to pay a toll. It doesn’t really cause me to take the long way around through Bedford, I pay the toll and drive over the bridge. I do it because I realize the upkeep of the bridge has to happen somehow and if I don’t pay it through tolls, I’ll sure as heck going to end up paying it some other way. It just makes sense for users to pay for that. When I buy tires for my car, I pay a fee that is to be used for the recycling of that tire at its end of life. You just do it because something has to happen to that tire when you’re done with it and that costs money to do.
If you agree that extra calorie intake results in obesity, then what is it that drains the healthcare budget of a country so quick when its population becomes more obese? Children with obesity are more likely to suffer from type 2 diabetes, hypertension and asthma. Adults with obesity have a higher incidence of depression, anxiety, heart disease and diabetes and also are more likely to be absent from work, pursue lower income jobs and earn lower overall wages (and in doing so pay less tax). Last year in the U.S., health care costs as a result of obesity reached $300 billion annually. A simple consideration in mathematics will show how this cost could be somewhat offset by a sugary beverage tax. Even though there are many reasons a nation becomes overweight, sugary beverages are one of them and you can consider it a user fee with that tax.
Lots of other great ideas came from the report, like an overhaul of the Canada Food Guide – without involvement from the food industry and one of my favorite recommendations, stricter controls on advertising unhealthy food and drinks for kids. Well done Canadian Senate!
Graham MacKenzie Ph.C.
Baddeck, Nova Scotia
In response to my decision to remove sugary drinks from my pharmacy in September of 2014, there seem to be the odd lingering claim that “…targeting the sale of one particular category is not going to have a significant impact [on obesity]”, and that “information – not restriction – is key.”
While we agree with the point that obesity is a complex, multifactorial problem, it is completely baseless, in fact hovering on outright deception, that extra calorie intake does not increase your weight. In 2013, the journal PLOS Medicine published a systematic review of systematic reviews, which are the most comprehensive forms of evidence that we have. This review by Bes-Rastrollo and colleagues found that 83% of reviews not funded by the beverage industry a relationship between sugar-sweetened beverage consumption and weight gain. On the other hand, 83% of the reviews that were funded by the industry found insufficient evidence to support a positive association between sugar-sweetened beverage consumption and weight gain or obesity.
Also keep in mind metabolic disease which has also been shown to increase with consumption of these drinks and is one of the main reasons we pharmacists see our customers (high blood pressure, increased cholesterol, increased abdominal obesity, and insulin resistance). For example, a 2010 meta analysis in the Journal of Diabetes Care of over 300,000 subjects found that those that consumed the most sugary drinks, one or two per day (pop, juice, vitamin water, iced tea and energy drinks) had a 26% greater chance of developing type 2 diabetes than those that drank none or 1 serving per month. They concluded that weight gain and metabolic syndrome correlates positively with consumption of these drinks. The New England Journal of Medicine published a study in 2011 which followed over 120,000 people and concluded that one 12 ounce sugary beverage serving a day increased their weight more than those that did not consume this beverage. Finally, a 2012 study in Circulation followed 40,000 men and found a 20% higher chance of having a heart attack or dying from a heart attack when one can of sugary beverage per day was consumed compared to men that didn’t. This was verified by a second study.
Calorie consumption from all sugary beverages combined has continued to climb each decade, especially among children and teens. By coincidence, today, the World Health Organization is changing its recommendation for daily total consumption of sugar to 6-12 teaspoons daily. This would be exceeded by consuming even one can of soda. Finally, we are seeing revised recommendations on sugar that follows science. The new recommendation now recommends free sugars being as low as 5% of total calories, meaning a serving of orange juice is off limits – imagine, a recommendation that pushes you to eat the fruit instead of drinking the juice. Brilliant! There is now a separation of total sugars and free sugars. The total sugar concept meant you could gobble up your calories with juice and pop, but now it’s considered free sugar.
The withdrawal of sugary beverages from Stone’s Pharmasave in Baddeck was not meant to “ban” pop sales, and I certainly do not expect to see a drastic change in obesity levels in my town as a result of my decision. I made this decision to help educate my customers on the effects of sugary drinks. I therefore agree that education is an important component of healthy eating. However, in keeping with recommendations from world experts in obesity research (see the 2015 Lancet Obesity Series), I am also aiming to move beyond education by starting to create an environment in my store that is supportive of healthy food choices. As a pharmacist, I know I shouldn’t sell tobacco, no matter what the industry claims. I don’t feel I should sell sugary beverages, either.
If you are timid about wading into the weight loss realm, either as a practitioner or as a user, there may be many reasons for that. One of the biggest may not be cost, confidence or will power, it may be the stigma of either paying someone for your weight loss or charging someone for your weight loss. There is a permanent black eye we have permanently imposed on both. Clearly it is a lose/lose situation. Either you have gouged someone for something they could have clearly done on their own with simple diet and exercise, or you have been ripped off by a snake oil salesman looking for a quick buck by a vulnerable audience with low self esteem that have come to the conclusion that they are worthless and in need to be capitalized on.
Well first of all, to all of you lifelong healthy weights who have little idea of the psychological reasons for weight loss and weight gain, if the simple, “go away and eat right and exercise” bit worked we would all look the same with such a simple set of directions. I have worked as a pharmacist in the same community for 22 years and have seen many people residing at the same BMI for the entire time and would still be there were it not for my intervention. I would see a typical customer and fill the same oral type 2 diabetic medication along with their high blood pressure medication for the entire time. Is this what we expect of our pharmacists. Who commits the bigger crime here? A pharmacist who quietly collects a dispensing fee forever without actively trying to reduce a patient’s weight or a pharmacist who takes the bull by the horns and aggressively works towards lowering a patient’s weight with careful body composition monitoring and nutrient intake for a fee for 6-12 months? The former is often left alone when in fact they are enabling the patient. The latter is left open to criticism even though they make the patient the hero in their weight loss and reduce overall healthcare costs.
Granted there are a lot of unhealthy weight loss programs out there. Ask your health care professional which one is a fit for you.
Anyone who looks at an overweight person as someone who is too lazy to try the correct eating and exercise route is completely blind to psychology. Have you been watching the Montreal/Tampa Bay series lately? A sure finish in the series by Tampa Bay began to fall apart because of a too confident feeling for Tampa Bay combined with a desperation mentality by Montreal, which completely changed the series. You could have said to Tampa Bay, just win one more and play like you did last game. That didn’t happen though.
Mentality has a lot to do with results and weight is no exception. There is no shame in asking for help, or offering it. I have many people ask me for help with weight loss as long as we keep it just between us. Imagine – someone wanting to get healthy but not wanting anyone to know it! There is no shame in this, regardless of the experts and seemingly intelligent advisors that warn against any regimented weight loss program. Is the weight loss program ensuring they keep the weight off? Well only if it has and end date. In that case, the weight loss program loses control. Eating right and exercising has no end date.