Obesity isn’t just harmful to the heart — it can also have a negative effect on the brain.

While we’ve long known about the link between obesity and conditions such as heart disease and diabetes, a growing body of research examining the connection between body fat and the brain’s grey matter reveals that some types of obesity can lead to a greater risk of dementia and stroke.  

For example, a new study  from researchers at the University of South Australia, reported in the Neurobiology of Aging, found that for every extra 3 kilograms of body weight in a person of average height, the amount of gray matter decreased by 0.3%. With the ongoing rise in obesity (globally nearly two million adults are overweight and 650 million have obesity, according to the World Health Organization) this poses big concerns for overall brain health among the obese. 

We know all too well that the obesity problem extends to children — it’s been on the rise over the past 50 years in the pediatric population. Nearly 40 million children younger than five years old and over 340 million young people aged 15–19 years are considered to be overweight or obese. In the U.S., the percentage of children and adolescents with obesity has more than tripled since the 1970s — the prevalence of obesity in those aged 12 to 19 is now 20 percent.

It’s not yet known how obesity affects cognitive functioning in young people — although a small study presented at the Radiographic Society of North America found that MRI scans have found signs of damage in the brains of teens with obesity. It’s thought that obesity may trigger inflammation throughout the body and the nervous system that may affect the brain. 

“Brain changes found in obese adolescents related to important regions responsible for control of appetite, emotions, and cognitive functions,” said Pamela Bertolazzi, the study co-author and a biomedical scientist and PhD student from the University of São Paulo in Brazil.

COVID-19 hasn’t helped. Teens are more sedentary than ever before and this poses a new set of challenges for clinicians trying to assist the pediatric population. 

The message to parents? These are the tried-and-true strategies when it comes to developing healthy eating and exercise habits in young people:  

  • Provide plenty of vegetables, fruits, and whole-grain products.
  • Include low-fat or non-fat milk or dairy products, including cheese and yogurt.
  • Choose lean meats, poultry, fish, lentils, and beans for protein.
  • Encourage your family to drink lots of water.
  • Limit sugary drinks.
  • Limit consumption of sugar and saturated fat.
  • Children ages 3 through 5 years should be active throughout the day. Children and adolescents ages 6 through 17 years should be physically active at least 60 minutes each day. 

Photo credit: Unsplash

How are kids coping through COVID-19? They aren’t so different from adults. They’re bored, they’re comfortable eating, they miss their friends, they’re binging on their digital devices and they’re experiencing higher rates of depression and anxiety.

Add to this the fact that the protracted disruption of in-person schooling means they are more sedate than ever, without the benefit of walking to school, engaging in gym class and extracurriculars and running around at recess. All these factors can contribute to pediatric weight gain that could have long-term impacts on children’s health, including increasing their risk for Type 2 diabetes mellitus and high blood pressure.

Good habits begin in childhood, which is why it’s important for parents to do what they can to help kids maintain a healthy weight and thus reduce the risk of obesity later in life.(The rate of childhood obesity has more than doubled in recent decades among preschool children, as well as those ages 12 to 19, and more than tripled among those ages 6 to 11.)

Example is the best teacher.  As such, helping kids lead healthy lifestyles begins with parents who lead by example. Kids emulate what they see — so by being a good role model and eating well, exercising regularly and building healthy habits into your own daily life, you are providing your child with a solid blueprint for incorporating healthy habits that will serve them well and in the future. One of the best things you can do is to try to have as many family meals together as possible. The Childhood Obesity Foundation reports that the more meals a family eats together at home, the more likely the children are to eat fruit, vegetables, whole grains and calcium-rich food and beverages. Children and youth who eat at home are also more likely to feel connected to their family. They do better in school and are half as likely to run into problems with substance abuse as teenagers.

Many parents worry about whether they should intervene if their child gains weight during the pandemic. It’s important not to put the focus on dieting, restricting foods and calorie counting. For one thing, research shows that childhood dieting can increase the risk of developing an eating disorder. And controlling what children eat can cause them to fixate more on the foods parents don’t want them to have. It helps to remember that some weight gain may have nothing to do with the pandemic since many children follow a growth pattern, especially around puberty, where they “round out” before they shoot up in height. 

Instead, focus on helping your child have good habits, and focus on developing them yourself —balanced meals and healthy snacks (limit high-fat, high-sugar snacks and sugary beverages such as pop and sports drinks), getting enough sleep (which will be improved if digital devices are moved out of the bedroom) and regular movement (the American Academy of Pediatrics suggests kids move 60 minutes a day, which can be done in movement breaks throughout the day).

While it can be challenging to fit in physical activity at home, parents can take the lead by engaging in regular walks or hikes with their kids, without invoking weight loss as the goal. The fresh air and movement can give them a serotonin mood boost in addition to physical exercise. There are lots of creative options to engage in on the homefront — from TikTok dance routines to yoga videos. Cycling, skipping rope, playing catch and shooting hoops all offer the opportunity for kids to connect with their kids and it’s good exercise for adults too.

It’s also very important to encourage your kids to take care of themselves emotionally, and take care of yours! — help them talk about their feelings about the pandemic, ask them how they are doing and allow them to speak freely, whether it’s their fears for the future or the fact that they miss hanging out with their friends. Support their creativity and hobbies, whether it’s playing a musical instrument or journalling or cooking. Get them professional help if they seem depressed. When kids feel good about themselves and their lives, they are more likely to be both physically and mentally healthy. 

In this way, they are a lot like adults.

Feature Photo by Vitolda Klein on Unsplash

Protect Yourself and Your Loved Ones This Season.

At Winterberry Family Medicine we invite and encourage you to book your flu shot and counselling appointment as early as possible. To make your appointment at our clinic instantly, please click here.

Below you’ll find important and trustworthy information about the flu and the flu shot from the Ontario Ministry of Health flu and flu shot news release.

TORONTO — To keep Ontarians healthy this flu season and prevent unnecessary visits to the hospital during the fourth wave of COVID-19, the Ontario government is launching one of the largest flu immunization campaigns in the province’s history, with the flu shot available to all Ontarians starting in November.

“Our government is prepared for flu season and is launching an even larger flu shot program this year to keep Ontarians healthy as we continue to respond to COVID-19,” said Christine Elliott, Deputy Premier and Minister of Health. “It is safe to receive the COVID-19 vaccine and the flu shot at the same time, so if you’re receiving your flu shot and still have yet to receive a first or second dose of the COVID-19 vaccine, now is the time.”

Last year, uptake of the flu vaccine by Ontarians was the highest in recent history. Building on this success, Ontario is investing over $89 million this year to purchase over 7.6 million flu vaccine doses, which is 1.4 million more doses than last year. This includes a total of 1.8 million doses specifically for seniors.

To protect the most vulnerable, Ontario’s initial supply of flu vaccine was prioritized for long-term care home residents and hospital patients beginning in September, and flu shots are now available for seniors and others most at risk for complications from the flu. Starting in November, the flu shot will be available for all Ontarians through doctor and nurse practitioner offices, participating pharmacies, and public health units. To further improve access and convenience to the flu shot and based on demand in recent years, pharmacies will receive approximately 40 per cent of the allocated doses, up from 36 per cent last year.

“The annual flu shot is the best defence against the flu this season,” said Dr. Kieran Moore, Chief Medical Officer of Health. “As we head into the fall and begin gathering indoors more often with family and friends, it is even more important to get your flu shot, in addition to following public health measures, to protect yourself and those around you.”

Each flu season, Ontario receives its supply of flu vaccine in multiple shipments from manufacturers over several months starting in mid- to late September based on the schedule negotiated between the federal government and manufacturers. Distribution and the ability for locations in Ontario to re-order additional supply of flu vaccine are based on the timing of shipments from manufacturers and the replenishment of the provincial supply. Ontarians are encouraged to be patient as it may take time for shipments to arrive to their local flu shot locations.

To help stop the spread this fall, Ontarians should continue to follow COVID-19 public health measures and advice in public settings, including wearing a face covering indoors, frequent handwashing, and maintaining physical distance from those outside their household.

Let’s face it: We live in a world where we are judged by our appearance. Women, especially, are constantly bombarded with unrealistic standards of “beauty” in the media, from magazine covers to TV ads and carefully curated Instagram images.

So, it’s not surprising that people who are obese suffer from a lower sense of self-worth determined by their weight status. A growing body of evidence is showing the toll that obesity can take on mental health. 

A new study in Human Molecular Genetics, using data from  a mental health questionnaire of 145,000 people, found that having a higher body mass index (BMI) increases the likelihood of depression. In fact, obesity and depression have a two-way connection—having obesity appears to cause depression and vice versa. There’s also the fact that many antidepressants list weight gain as a side effect.

This points to the threat of increasing rates of depression in people around the world. Obesity has nearly tripled since 1975, according to the World Health Population. More than 40% of adults with depression are obese, according to the Centers for Disease Control and Prevention, and depressed children often have a higher BMI than children who aren’t depressed. 

There isn’t just one cause for either depression or obesity. Both can be influenced by social and environmental determinants, such as childhood trauma, abuse, neglect, chronic stress and poverty. And both conditions are risk factors for other health issues, including diabetes, heart disease, chronic pain and sleep problems.

In terms of prevention strategies, here are 3 strategies to reduce your risk for both depression and obesity:

  1. Keep active

Regular exercise helps release mood enhancing endorphins and  keeps weight in check. However, most depressed people aren’t motivated to exercise. Taking small steps of even just 10 minutes a day can help kickstart a regular exercise routine. 

  1. Seek therapy

Talking to a professional can help address issues such as emotional eating, binge eating and food addictions. For those who are depressed, understanding the causes of their low mood and the available treatments can be helpful. It’s important to process the emotional issues that both obesity and depression can cause.

  1. Have a plan

 If you’ve been diagnosed with either obesity or depression, or both, your health care provider will have provided you with a treatment plan that might include medication, dietary changes, referral to a therapist or other suggestions to manage your condition(s). Doing your best to stick to this plan — and informing your health care provider when you run into difficulties — is your best chance to minimize side effects and complications and put yourself on a path to better health.

In science, the journey from a theory to a well-understood fact isn’t always straightforward. It often starts with a hunch – something scientists have noticed but just don’t fully understand yet. That hunch is tested from every angle, again and again. Sometimes for years, sometimes for centuries, until it becomes a model for what’s actually going on. 

For doctors who treat obesity, one of these ever-evolving theories is the “protein leverage hypothesis” or “protein leverage model.” Basically, it argues that appetite isn’t just determined by how much we eat, but by what we eat. We’re hard-wired for protein, and our body doesn’t want to turn that appetite off until it gets enough of it. In other words, when we eat less protein, we tend to eat more of everything else. 

This wasn’t a problem for most of human history. If we didn’t get enough protein, we made up for it with larger quantities of vegetables and grains. But since the 1970s, those protein substitutes have been steadily replaced with over-processed foods high in sugar, carbohydrates, and fats. Not only that, but protein is relatively expensive, while processed foods are not. So in developing areas, this issue can be compounded by poverty. 

To what extent protein leverage has contributed to the obesity epidemic is still unclear. There’s some evidence proving elements of the hypothesis, but nothing that conclusively shows it’s a leading cause. One of the reasons some scientists are skeptical is that the overall percentage of protein in our food supply has risen over the last century. So we’re eating more protein than ever, right?

Kind of. While the overall protein content in our diet has risen, the actual percentage of calories from protein has decreased by 1% due to the even greater rise in available carbohydrates and fats. Researcher Kevin D. Hall recently showed that the 1% decrease actually raises our overall calorie intake significantly. I won’t go into the math here, but his work seems to show that protein leverage may have contributed to as much as a third of the average adult weight gain over recent decades. Of course, it’s not the only contributor. Lifestyle and environment changes play their roles as well. 

What does protein leverage mean for the average person trying to lose weight? Well, it reinforces a fundamental idea: that we should be more mindful of the things we eat. By understanding the sources of our nutrition – especially protein – we may be able to control appetite more effectively. When developing a strategy with your doctor, make sure that healthy sources of protein take center stage. 

As we study the protein leverage model more closely, we’ll understand obesity better. But more importantly, we’ll be able to develop treatment plans that work with our bodies’ natural priorities. By listening to what our bodies tell us, the road to weight loss can be just a little bit easier.

Millions of people use step trackers as a way to meet their goal of walking 10,000 steps a day for better health and fitness.

But what’s so magic about this number? Is it actually based on science?

Turns out it isn’t. 

In fact, its origins date back to 1964 when a Japanese company marketed the world’s first pedometer, a device called a manpo-kei, which translates as “10,000-step metre.” Over the next half century that widely promoted step goal became seen as the ideal to strive for. 

Eventually, studies confirmed that people who engage in this number of daily steps do indeed have lower blood pressure, more stable glucose levels and happier moods. 

No wonder that number found its way onto the wrists of FitBit users around the world.

But now some research indicates that number may be too high. For example, a research study from Harvard Medical School examining the data on 17,000 older women who did 4,500 daily steps found they were about 40 percent less likely to have died than those who managed only 2,700 steps. 

Other research indicates that number may be too low. A small study of Scottish postal workers reported in the International Journal of Obesity found those who walked an average of 15,000 steps had a lower risk of heart disease, healthy cholesterol levels and trim waistlines.

Currently, the average number of steps for the U.S. adult population is between 4,000 and 5,000 steps a day. 

So what’s the ideal number of steps?

There’s nothing wrong with aiming for 10,000 steps a day but it may be a problematic goal for a number of reasons. First, it doesn’t take into account the intensity of exercise—there’s a big difference between sauntering and walking at a quick stride, for example. Slow steps aren’t going to get your heart pumping, which is essential for keeping fit. 

Speed walking or running in short bursts can offer more health benefits than walking for an extended time.

Also some fitness activities, such as yoga and weight training, can’t be quantified in steps. 

Finally, setting an arbitrary goal of a certain number of daily steps may cause some people to stop walking once they reach that threshold, even if they might benefit from more activity.

The fact is, there’s nothing magical about walking 10,000 steps a day. What’s most important is being regularly active. Your best bet when it comes to walking is to establish a baseline to determine how many steps you currently take and then continuously increase that by setting new goals that are ambitious but attainable.

And remember, every step really does count.

Why is it that some people seem to gain weight by just looking at a piece of cake, while others can pack away large meals without packing on the pounds?

It doesn’t seem fair, but the fact is leanness comes naturally to some. And now a comprehensive new study on the genetics of obesity reveals why this might be so. The researchers identified rare gene variants that protect some lucky carriers from gaining weight.

The researchers examined mutations within genes that were associated with a lower or higher body mass index (BMI), the most reliable measure of obesity. They found 16 genes tied to BMI, some of which are expressed in the hypothalamus, the area of the brain that regulates hunger and metabolism. Those who carried variants that inactivate one of these genes—GPR75—weighed an average of 5.3 kilograms less and had half the odds of being obese compared to those with working copies of the gene. The variants that inactivate this gene are thought to be quite rare with only one in 3,000 people carrying it.

One of the impacts of this finding is that the discovery of these rare variants could lead to new medication treatments for people struggling with obesity.

And that’s good news because obesity is an epidemic. In the U.S. more than 40 percent of the population is considered obese (in Canada it’s closer to 30 percent). 

At least 2.8 million people die every year from being overweight or clinically obese. Obesity increases the risk of developing type 2 diabetes, heart disease, some cancers, and even severe COVID-19. 

So is DNA destiny when it comes to gaining weight? There are many factors that determine a person’s chances of being obese, including diet, exercise and ill health. A healthy diet and regular exercise can offset a genetic predisposition but these people may have to work harder to maintain a normal weight.

Approximately 10 percent of a person’s obesity risk may be determined by their DNA, according to the authors of a 2019 study published in the journal Cell, which examined data from 2.1 million genetic variants to identify adults at risk of severe obesity.

The researchers found that a genetic predisposition to obesity begins to appear in early childhood and is often clearly evident by early adulthood — suggesting an opportunity for early intervention.

“We’ve known for a long time that some people are born with DNA predisposing them to obesity,” says one of the study authors, Dr. Amit V. Khera, a clinician and researcher at the Massachusetts General Hospital Center for Genomic Medicine. “Now, we can quantify those differences in a meaningful way, and potentially explore new routes for achieving better health.”

Fresh from my time at Obesity Week 2019, I came across a compelling op-ed in the Globe and Mail by Sasha High, medical director of the High Metabolic Clinic in Mississauga. Commenting on a recent fat-shaming Golden Globes segment by talk show host James Corden, Sasha passionately argues for a shift in our perception of people suffering from obesity in order to change how we approach its treatment and management. Despite the advances in obesity management and treatment, and its recognition as a disease, she claims its patients continue to suffer discrimation. This stigmatization redirects ‘blame’ onto patients, and creates a culture of discrimination that permeates every aspect of their lives, impacting not only their physical, but also mental health. 

In addition to the personal impact, these negative perceptions of obesity, known as weight or obesity bias, also have important ramifications for the diagnosis and management of obesity and its comorbidities. A recent study from Fruh et al. (2017) in the UK reported a significant prevalence of obesity bias amongst primary care physicians. More than 50% of physicians surveyed reported perceiving obese patients as “awkward, unattractive, ugly, and non-compliant” and having spent less time with these patients than thinner patients. 

Why are these figures important? As Sasha bluntly points out in her op-ed, fat-shaming should have no place in obesity treatment. Enacted stigma on the part of primary care physicians has critical ramifications for patients, and can reduce the quality and availability of patient-centred care. As physicians, it would be taboo to treat a patient with cancer or coronary disease with contempt; yet patients suffering from obesity often fail to receive the same consideration. The perpetuation of these negative stereotypes creates a hostile environment that can hamper diagnosis and treatment. Patients can recognize this negative bias against them, and the deterioration of the bond between patient and provider not only makes the patients less likely to seek out treatment, but also can decrease adherence to management recommendations, making treatment less effective and exacerbating the development of more severe comorbid diseases. 

Our society as a whole requires a profound change in the way we approach and inherently stigmatize weight. While this paradigm shift will require more collaborative action across multiple sectors of society, as physicians we can do our part by working to create a more supportive and understanding environment for our patients. Easy steps to combating obesity bias in our own practice and offices include: 

  • Use language and terminology that patients are comfortable with when discussing weight
  • Employ sensitive weighing procedures
  • Practice bias-free treatment approaches
  • Provide medical equipment (i.e. gowns, office chairs, etc) that can accomodate for larger sized persons

And the last, but perhaps the most important step we can implement in our practice? Recognize our own implicit bias. Self-awareness is the first step in change, and it is critical that we are conscious of our own attitudes and values in order to avoid alienating our patients and ensuring that we are providing the highest quality of care. 

Alarmed by the number you’re seeing on your bathroom scale? You aren’t alone. Almost half of all adults say they’ve been eating more during the pandemic.

The term “COVID-15” has gained popularity as a variation on the “Freshman 15” many students gain during their first year of university. But it turns out that number may actually be too low.

According to the American Psychological Association’s annual “Stress in America” report, 40% of Americans have gained unwanted weight during the pandemic, with the average gain being a whopping 29 pounds (50% of those who reported undesired weight gain said they had gained more than 15 pounds, and 10% said they had gained more than 50 pounds).

Is it any wonder many of us are tipping the scales? We’ve been stuck at home for well over a year, with few opportunities to socialize, our schedules are off, gyms are closed and cooking and baking are among the few activities keeping us occupied.

Consider that the hashtag #stressbaking has 53,000 posts on Instagram.

The pandemic has us worried, bored, lonely, sad and stressed—all factors that can make us turn to food for comfort.

Because these unsettling emotions can be difficult to deal with, it’s tempting to seek out things to make ourselves feel better. That might be an extra glass or two of wine at night, too many Netflix shows, excessive online shopping — or repeatedly staring into the fridge or pantry for something yummy to eat.

As we reported in our last post, children are also gaining extra weight during the pandemic, due to missing physical education classes thanks to school closures, a lack of after-school sports activities and even just playing outside with friends. Studies show screen time for kids has doubled during the pandemic. 

Even our pets are getting heavier. The Wall Street Journal reported that the largest chain of vet practices in the U.S. conducted a survey that revealed 42% of pet dogs and cats had gained weight during the pandemic. 

Extra pounds aren’t easy to lose—for adults, children or pets—and they are cause for concern since significant weight gain poses long-term health risks. Just adding an extra 11 pounds can put you at higher risk of developing coronary heart disease and Type 2 diabetes. An extra 25 pounds put you at higher risk of stroke. 

So what can you do to get a handle on pandemic weight gain? Here are a some tips to consider:

  1. Think before you eat: Ask yourself if you are actually hungry. Maybe you are just bored—or thirsty. 
  2. Keep a food diary: Write down what you eat and see if there’s a connection between food and mood
  3. Keep it on the regular: Schedule your mealtimes. 
  4. Avoid after-dinner snacking. Shut off the TV and go to bed earlier with a good book. 
  5. Healthy food choices begin in the grocery store: If you don’t bring junk food home you won’t have it on hand when you get a hankering for something unhealthy.
  6. Allow yourself an occasional “treat” so you don’t feel too deprived. Keep healthier snacks on hand, such as fresh fruit, veggies and low-fat dip, nuts and popcorn.
  7. Distract yourself with a stress-relieving activity, such as listening to your favourite tunes, connecting with a friend, going for a walk or stretching. 
  8. Don’t’ drink your calories: Nearly 25% of respondents in the Stress in America report said they are drinking more alcohol to cope with stress amid the pandemic.  
  9. Make mealtime a pleasant event: If you can, eat with someone in person (or by FaceTime or Zoom) rather than chowing down alone in front of the tube.
  10. Eat mindfully: Allow yourself to fully enjoy your food. Focus on what you are eating and eat slowly, being sure to savour every single bite.