Category: Wellness

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:

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. 

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.

 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.

The elderly are bearing the brunt of the worst of COVID-19, but children are hurting too. More than 2 million children in the U.S. have tested positive for coronavirus although rates of death and hospitalizations in those under 16 are very low — 0.01% and 0.8%, respectively. Still the long-term effects of the pandemic are expected to have an impact on kids, especially when it comes to obesity.

COVID-19 has kept kids out of school and cooped up indoors during the pandemic. The result? They are moving less, sleeping more, increasingly hooked on their phones and tablets and, in some cases, eating less healthily. Studies show that regular school attendance helps reduce obesity in children since it gives them a regular structure to their day, as well as access to physical education classes and healthy school lunches. 

Not being able to walk or bike to school, to access playgrounds and participate in sports teams and physical education during the pandemic puts kids at risk of obesity. A survey from Dalhousie University’s Healthy Population Institute found that less than 3% of kids were getting the recommended amount of exercise (60 minutes of moderate to vigorous physical activity a day) for kids aged 5 to 17. 

It’s not just a lack of exercise that’s having a negative effect on kids. A lack of sufficient shut-eye can also be a problem. The pandemic has created havoc with our usual routines but it’s important to have some kind of structure around bedtime.Children ages 5 to 13 should be getting 9 to 11 hours of sleep a night and those ages 14-17 need 8-10 hours.

Another factor that affects the health of kids is the increased amount of time they are spending in front of their screens during the pandemic. Pediatric organizations recommend no more than two hours a day of recreational screen time for children over 2. (If you are finding it difficult to put limits on how much time your children are spending on their devices, know that you aren’t alone).

In addition to the lack of access to healthy school lunches, many families have been negatively financially impacted by the pandemic, and this can result in the kind of food insecurity that leads to the consumption of inexpensive and unhealthy meals. Many families also made fewer grocery shopping trips and increasingly relied on non-perishable foods. Evidence suggests that having multiple convenience stores in a child’s neighbourhood can also have a negative impact on their weight, especially because they are more likely to go to these stores during extended school closures. 

So what can families do to protect their children from the obesity-related risk of COVID-19? Here are a few things to consider;

•Get creative when it comes to movement: Consider activities such as physically-distanced football, shooting hoops together as a family or solo activities such as juggling.

•Keep the idea of balance in mind. Is your child eating healthy, getting some form of exercise every day, doing schoolwork and keeping in touch with friends and family. If the answer is yes, a bit of extra screen time right now likely isn’t a problem.

•Maintain a routine: Try to make sure kids still have some structure — for example, getting up, eating and going to bed around the same time every day.

•Consider that having a family pet, particularly a dog, can help kids cope better during stressful times such as COVID-19. The health benefits of having a pet are well documented, from providing a reason to get out and walk every day to reducing anxiety.

•Manage your own anxiety and consider reducing the consumption of alarming news, especially on TV and radio, when children might overhear upsetting information.

•Reach out for help if you need it. Whether it’s support from family and friends or professional care from a therapist or health care provider, it’s important to recognize your limits and know when to seek assistance with life’s challenges.

As the pandemic wears on, one thing is clear: parental awareness and support can go a long way to keeping children healthy during COVID-19.

Plenty of Canadians have put on pandemic pounds during COVID-19. In fact, according to a study from Dalhousie University, of the 42 per cent who say they’ve gained weight, four in ten report an increase of six to 10 pounds. 

This isn’t good news, especially for midlifers who already struggle with added pounds as they age. Many of them believe that a sluggish metabolism is what’s to blame for their thickening middle. A new report, pooling data from more than 40 studies involving 6,400 participants and published in Science magazine, offers new insights into how our metabolism functions as we get older. 

The report found that metabolism, the process our body uses to convert food to energy, is quite stable throughout adulthood and middle age and doesn’t actually start declining until about age 60.

This might come as a surprise to anyone who has gained weight after age 40, thinking it was due to a slowing metabolism. 

But this isn’t the case. Weight gain can be the result of a myriad of factors, ranging from a change in lifestyle, diet, exercise levels, hormones, a medical condition and even the social determinants of health, such as access to quality health care and economic stability. 

People want to know if there’s anything they can do to increase their metabolism later in life. Some even seek out faddish products, such as caffeine and ephedrine, which are marketed as “metabolism-boosting,” but are not backed by evidence-based research to have any real impact. 

The truth is, metabolism is hard to adjust. The rate at which we change the energy we burn from food is often genetically programmed. It may not be fair, but some people are simply born with a faster metabolism than others.

The factors that control weight gain are tried and true: regular exercise, calorie control, engaging in resistance training, increasing your water and fibre intake, reducing stress, cutting back on sugar and getting plenty of rest. 

If you are concerned about your weight gain, don’t blame your metabolism, which is something over which you have little control. Instead, try to understand why you are adding pounds and figure out a way to create a sustainable weight loss plan that works for you over the long-term. Physicians trained in obesity medicine can help you get to the root of the reasons for the weight gain and determine the lifestyle changes will help you feel and look your best.  

Patients who are battling obesity know that exercise is key to losing weight, but they often aren’t sure whether they should focus on aerobic or muscle strengthening workouts. A new study on resistance exercise and body fat sheds some light on the issue, revealing that lifting weights now will help keep you lighter later.

A new study of 12,000 midlife participants found that those who regularly engage in any kind of muscle-strengthening exercise are far less likely to become obese (regardless of whether they also work out aerobically) than their counterparts who don’t do any weight training at all.

The researchers found that those who did weight training a few times a week for a weekly total of one to two hours were 20-30 percent less likely to become obese in the future. 

There’s no doubt about it. If you want to whittle down your waistline, weights are your friend. They not only help you lose weight, but offer a host of other benefits, from building and maintaining muscle mass, to keeping your bones healthy and boosting metabolism and mood.  

But how do you get started with a weight training regimen if you’ve never used weights before? Especially if you are self-conscious about going to the gym because you are overweight or obese?

Here are a few tips to consider:

•Meet with your health care provider first to determine how best to reach your weight loss goals with weight training and determine if there are any limitations or modifications that may apply to you.

•Investing in some nice workout wear isn’t a necessity but it could make you feel better about exercising. There are plenty of retailers that carry plus-size activewear.

•Start lifting weights at home using free weights, which are inexpensive and versatile. If you want to step it up a notch, a weight bench and a barbell can provide a greater variety of workout options. 

•Follow workout routines online to stay motivated. Here’s a series that offers plus-size positive beginner workouts by an instructor who is on a mission to lose 100 pounds herself. 

•Hiring a personal trainer (in person or online) even for just one session, can be especially effective in helping you learn simple weight bearing exercises and techniques to guide you in creating a routine. 

•Finally, don’t give up on going to the gym. Doing so on a regular basis will help you achieve great results. Gyms have a wide variety of weights that will work all your muscle groups and often offer a sense of community that motivates you to keep coming back.

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. 

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. 

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). 

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: 

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. 

There’s no question about it: We live in a fat-phobic society. Negative weight-related attitudes include believing that obese people are lazy, lacking in willpower and generally unhealthy. Their excess weight is thought to be their own fault.

How common is weight discrimination? A study published by the Obesity Action Coalition found it increased by 66% over a 10-year period from 1995-2005, making it more prevalent than discrimination based on ethnicity, sexual orientation and physical disability. Among women, weight discrimination was even more common than racial discrimination. And almost 60 percent of the study participants reported at least one experience of employment-based discrimination, such as not being hired for a job.

Obesity is highly stigmatized in all kinds of settings—from the workplace to the schoolyard—and, yes, even in the doctor’s office.

Weight bias remains socially acceptable in our culture. But when it occurs in the healthcare setting it can have dire consequences. For example, sometimes serious health issues are blamed solely on weight and physicians can inadvertently ignore other possible causes. 

We know there is a connection between obesity and certain conditions, such as diabetes and cardiovascular disease, but it’s important to remember that not everyone who is overweight or obese is, in fact, unhealthy. A 2015 study published in the Journal of Clinical Investigation found that as many as 50% of obese adults are “metabolically normal,” with a low risk of these health complications.

Weight is just one of many factors that affect health. Excess weight should not be treated as a flawed personality trait and healthcare professionals need to remember that obesity is a complex condition involving one’s genes, the environment, stress, overall health and personal choices. Bringing up the subject of weight at each and every patient visit can cause shame, which can undermine weight loss efforts and even lead to weight gain. Weight bias can also exacerbate health issues such as disordered eating and avoiding preventive care, 

A 2016 paper published in The Journal of Nurse Practitioners revealed these alarming statistics:

Obesity can affect one’s health status, but it’s not necessarily the most important factor to consider when it comes to good overall health. Regardless of their weight, everyone has the right to benefit from compassionate quality care from their healthcare providers and never feel judged or shamed.