Category: Wellness

Right now, as you read this, you’re burning calories. From breathing to thinking to the subtle movements of your eyes across the screen — everything your body does takes energy. Of course, it’s not much. An hour of reading or watching something on a screen burns fewer than 50 calories. But it does add up. And at a time when most of us are more sedentary than ever, every little bit counts.

I’ve talked before about finding the right combination of approaches to lose weight or treat obesity, and I’d like to add something else to the mix: doing nothing. Or close to nothing. “Nonexercise activity thermogenesis,” or NEAT, refers to the body’s continuous expenditure of energy. Think of it like the gas used when your car is idling. Scientists are increasingly aware of the value of NEAT in weight loss, not as a standalone focus but rather as a way to extend your regimen into downtime.

The idea is simple: try to find opportunities to add movement to otherwise sedentary activities in order to increase NEAT. The differences can be surprising. Here are just a few very simple ways to put it to work.

Inconvenience yourself

We take countless shortcuts in our lives. Microwaves, elevators, dishwashers – making things easier is just part of human nature. But there are major benefits to doing things the old-fashioned way. Beyond the obvious advantages of taking the stairs whenever possible, something as simple as baking dinner instead of microwaving it can massively raise the relative caloric expenditure of the activity. Not to mention make for tastier meals. Scientists have shown that choosing to take the slightly more challenging approach to a task can add up to a higher level of NEAT over time.

Start by standing

If you’d like to help burn calories while binge-ing your show du jour, you can. Just stand up. Anything you normally do sitting down can become a tool in your weight loss regimen this way. It’s one of the reasons why standing desks have become so popular in offices. With a slight shift in verticality comes a major jump in NEAT, and seeing how long you can go without sitting down will also make your move to the couch that much more satisfying.

Take a moment to move

If you’ve ever been self-conscious about fidgeting, don’t be. Believe it or not, studies show that tapping fingers and feet can actually add calorie-burning movement to sedentary activities. But don’t stop there. Pacing and stretching take that NEAT even further. While your family may not appreciate you circling the room on movie night, walking around while performing otherwise stationary tasks is one of the most reliable ways to increase thermogenesis. Research indicates that something as simple as stepping in place during TV commercials not only made a significant contribution to daily steps, but also reduced overall TV time among participants of one recent study.

Find NEATer hobbies

You’ve probably picked up on the theme by now: If it involves movement, it burns calories. Playing an instrument, watering the garden, or singing in a choir – these are the kinds of downtime activities with good potential for NEAT. Every note played or flower planted is another micro-step toward your goals.

Nonexercise activity thermogenesis is never a replacement for true exercise. But it is a valuable reminder that every activity has potential to contribute to your fitness priorities. At the end of the day, being mindful and proactive about our bodies can have remarkable benefits over time. It’s about more than just pushing yourself hard for an hour each day, but rather sustained, gradual choices to be just a little more active. And as COVID keeps us indoors for at least a little while longer, there has never been a better time for this kind of mindfulness.

How the “maintainers” keep their progress

‘Tis the season for ambitious goals. With 2021 (thankfully) here, many of us are setting out on new fitness journeys. But how do we turn an ambitious beginning into sustained improvement?

Losing weight is hard enough — but maintaining that loss is always harder. Fatigue sets in, life gets in the way of carefully laid plans and before too long many people find themselves back at where they started on January 1st. But not everyone.

To identify what works best over the long term, doctors turned to the people most successful at sustaining weight loss: the “maintainers.” What’s working for those who can lose 30 pounds, then keep it off for more than a year? It turns out that it’s not about restriction, but addition.

Scientists recently confirmed an idea that doctors have had for quite a while: restrictive diets may help a great deal in the short-term, but for long-term results, the maintainers rely on Physical Activity Energy Expenditure (PAEE). This refers to active exercise, not just the Total Daily Energy Expenditure (TDEE) we experience in our day-to-day lives. In other words, the attribute shared by most maintainers is that they’re making a concerted effort to exercise every day. The study, which used isotopes in specially prepared water to track the energy expenditure of its participants, made exercise the clear star when it comes to sustaining change. Seems like a no-brainer, but there are a few nuances worth discussing.

As many of us discover every holiday season, restrictive diets don’t always line up with our real lives. Changing our eating habits may need that serious behavioral switch at first, but it’s important that we can eventually transition back toward enjoying the foods we love. We can — but only if we introduce exercise to match. The maintainers weren’t consuming less calories than the other groups of the study. They were just far more active: in some cases nearly twice as much as the others.

The research showed that not only do maintainers walk farther each day than the less-successful members of the study with obesity, they walked farther than people of a normal body weight. On average, the maintainer group walked the equivalent of 12,000 steps each day, as opposed to the normal body-weight participants’ 9,000 steps. To me, this shows a major commitment to physical activity.

So how do we apply this to our own lives? Well, let’s look at that resolution. If you’re utterly miserable by March, you probably won’t still be at it in December. So rather than trying to commit to a rigorous exercise regimen, try experimenting. Give a new activity a shot. If you don’t enjoy it, try something else. Once you find something you do enjoy, it will be far easier to keep it going through 2021 and beyond — even if it’s not the most calorie-burning activity possible. It’s about finding that path to those 3,000 “extra steps” each day. Talk with your doctor about the kinds of activities you love, then work with them to develop a dietary plan that fits. 

Soon lots of us will be entering the new year with new gadgets and new regimens to help support our health and fitness goals. Smart watches, trackers, apps — there’s a host of products designed to help people live healthier. But do they work?

Well, I’m not going to endorse any specific gizmo here. But the fundamental idea they’re based on is strong: when we’re more aware of our goals, our progress, and the effort we’ve made every day, we’re more likely to achieve our priorities. This doesn’t just come from my own experience – there’s solid science behind it. For example, recent research has shown that when we keep track of our diets in a structured, consistent way, weight loss is made easier.

In a study published last year, scientists tracked the weight loss journeys of 142 participants. Every week, they joined an online session led by a dietician (this was before COVID introduced many of us to the world of teleconferencing, of course), and in between sessions they were asked to log everything they ate. Some kept detailed notes. Others spent large chunks of time on the tracker. But those who lost the most weight (over 10% of their starting number) were the people who logged most frequently. Researchers noticed the major improvements coming at a twice-daily log. But those who updated it three or four times a day found even more success.

Repetition creates habits. And new habits create sustained change. Along the way, it becomes easier. The frequent loggers spent about 23 minutes each day tracking their diets at the beginning of the study. Six months later, it was down to just 14. They had made it a seamless part of their routine.

I think this research is impactful for another reason: it shows the benefits of telemedicine. The participants had regular access to expert support from the convenience of their homes. It removed a barrier to care that prevents many people from sustaining their progress. In my book, anything that makes forming positive habits easier is an invaluable tool. Combined with effective monitoring tools, whether they’re focused on diet or exercise, telemedicine can be a powerful tool in your weight loss journey.

So as we unwrap our new gadgets and sign up for new apps, remember that they aren’t going to be a solution on their own. It’s how actively and regularly we use them that will make the difference. Of course, some people feel they’re already too glued to their devices and may be reluctant to add another to the mix. But if we can check our social media feeds every few minutes, we can spare some time to record something as important to our health as our diets.

In medicine, there are few silver bullets. It’s rare for any illness to have just one cure or one treatment. Usually it’s a tailored blend of therapies, medication and behavioural changes that add up to a solution that works for the patient’s unique needs. For example, chemotherapy and surgery for cancer patients, or dietary adjustments and insulin for people living with diabetes. Obesity is no different.

In my last article, I talked about the impact that our circadian rhythm can have on weight loss and appetite. Of course, changing when you eat is not going to achieve your goals on its own. For that, we need to change our behaviour — sometimes intensely.

Intensive Behavioural Therapy (IBT) is how doctors refer to “high-intensity” lifestyle changes like diet, exercise, and psychological therapy. In other words, a concerted regimen supported by doctors with the goal of losing weight. Through in-person counselling, physical therapy, clear goals and a strategy to meet them, IBT has been proven to be one of the two most reliable ways to achieve a 5-10% reduction in body weight. And it seems to work best when combined with the other one.

There are several medications approved for treating chronic weight management that can be relied on to achieve a 5% reduction in body weight. Each has their own benefits and side effects that must be managed by the patient and their doctor. Recently, scientists have shown that some medications can be paired with IBT for an even more effective treatment. Patients who underwent the therapy while taking a liraglutide drug called Saxenda achieved nearly double the weight loss of those who only underwent IBT. The single-approach patients lost an average of 6.1% of their weight, while the combined-approach patients lost 11.5%. That’s a serious improvement.

This study serves as good reminder to anyone frustrated with their own progress: just because one approach doesn’t seem to be working doesn’t mean it isn’t working at all. It may just need the right complement. In fact, the study even added a third layer: some patients also went on a strictly controlled diet of nutrient shakes and salad. While the addition didn’t dramatically change the results for this group, in the end they did lose the most weight.

There will always be another tool, however minor, that can help you reach your goals. But it’s never going to be a silver bullet on its own. So start small and keep layering. Set achievable goals to find a regimen that balances ambition with sustainability.

What’s critical is that you don’t simply add medications or diets at random. Don’t take risks: talk with your doctor about moderate additions that can bring out the best effects of the others. It may take a while to discover the formula that works best for you, but it’s worth it in the end.

It’s no secret that COVID-19 is hitting our older neighbours hardest. We’ve seen how devastating the pandemic has been to long-term care homes and retirement communities. The reasons are relatively clear: elderly people have a wide range of increased risk factors that put them in danger of hospitalization or worse. From pre-existing conditions to compromised immune systems, those over 50 are most vulnerable.

But what about younger people who experience the worst cases of COVID? As scientists look for common threads connecting younger patients who end up at the hospital, a recent study may have found one. Weight.

The data shows that patients below the age of 50 hospitalized for COVID-19 have a mean (or average) Body Mass Index (BMI) of 43.1, while those above 50 have a BMI of 30.1. That’s a big difference. Not only is the gap considerable, but the mean BMI of hospitalized COVID patients actually goes down as they get older. This isn’t the case for other illnesses. So it does look like obesity is one of the key variables that can make the difference between a relatively smooth recovery and a potentially fatal hospitalization.

Earlier this year I wrote about how obesity — and specifically the inflammation it causes — can make COVID worse. Now it seems as though that insight has been reinforced. Of course, there’s much more research that needs to be done on the subject. This new study doesn’t necessarily show why a high BMI can make the disease more dangerous. They do speculate that sleep apnea may be related to certain respiratory complications. It’s a condition quite common in people struggling with obesity.

To me the study points to a simple but critical takeaway: obese patients may be as vulnerable as elderly ones. So if you or someone you love is living with obesity, it’s vital that they take precautions, no matter their age. In other words, treat yourself as though you are high risk, because you very well may be. Wear a mask. Wash your hands regularly. Limit physical interactions to a minimum outside your immediate family.  

But people living with obesity can do more to protect themselves and their families. The same fundamentals that can help them live healthier and happier can be considered part of their pandemic safety regimen. Eating fresh fruits and veggies, taking time to stay physically active — lifestyle changes made now may make a difference if you or your loved one ends up in the hospital.

The pandemic may be with us for some time to come, so it’s never too late to make positive changes. Every step towards better health is another safeguard against the worst effects of the virus.

Imagine if people were ashamed to have cancer. And that the stigma was so great it could actually affect the outcome of surgery to remove their tumor. It may seem shocking, but that’s exactly what a recent study has shown for patients struggling with obesity.

Bariatric surgeries can represent hope when all other options have failed. And like any operation, they have major impacts on the body that require diligent preparation and follow-up. A study published in the journal Obesity found that a significant number of people who undergo bariatric surgeries experience high levels of anxiety, depression, and internalized shame about their illness — and that these psychological issues can seriously affect their post-operation success.

The study revealed that poor mental health in bariatric surgery patients can lead to higher risk of post-operative issues like weight gain, substance abuse and even self-harm. In other words, external biases and societal stigma surrounding obesity not only affect patients’ mental health, they can prevent them from getting better.

But the study also provides hope: active self-compassion can help reduce the risk.

Self-compassion is exactly what it sounds like: making a focused effort to be kind to yourself. For obese patients, it needs to be a priority. That means giving yourself credit for your success and forgiving yourself for perceived failures. Self-compassion is an actionable skill that can be developed and reinforced. Patients — even those not struggling with low self-esteem, shame or anxiety — can easily add it to their regimen. Now it seems as though techniques designed for our mental health can make the difference in our physical healing process.

 Shame and internalized biases about weight are difficult enough without being reinforced by your doctor and other caregivers. That’s why it’s crucial for medical professionals to fight stigma and bias in their care. There have always been good reasons for this — providing patients with a safe, supportive space as one example — but this study shows it has real, clinical impacts on patient health.

This study makes clear something I believe quite passionately: the medical profession urgently needs to de-stigmatize obesity and begin treating it like we would any other medical condition. That begins with helping patients reduce their own feelings of shame or internal stigma, teaching them that the road to recovery begins with self-love.  

If you or someone you care about are considering bariatric surgeries, please take time for the mental health care you deserve, both in the lead up to the procedure and as you recover. In fact, why not make self-compassion part of your regular routine?

The roadmap of our lives is first laid out by our genes. Before environment, experiences and choices shape us, they define many of the parameters in which we’ll grow. Some can be unexpected: for instance, the tendency to sneeze in direct sunlight is an inherited trait, as is the ability to differentiate musical notes through “perfect pitch.” Long before we mapped the human genome in 2003, we looked to family history to understand the risks of inherited illnesses. In the nearly two decades since that remarkable accomplishment, our genes continue to reveal new insights. But can they influence the way we diet and control weight gain? A recent study indicates they might.

Nutrigenomics is the emerging science of tailoring our diets to best fit our genes. Still a young discipline, it’s grounded in the theory that by understanding our genetic makeup, we can make choices customized to our unique needs and proclivities. This can be as complex as adjusting vitamin intake to reflect the way your body processes them, or as simple as recognizing allergies and intolerances to avoid certain foods. Practitioners of nutrigenomics begin with a deep understanding of the patient’s genes, then create a uniquely tailored diet to reflect them. Until now, however, there has been little comprehensive research into its effects.

In an article reported in The Obesity Society’s research journal Obesity, a team from The University of Western Ontario has established for the first time that nutrigenomics can have a measurable impact on weight loss, especially in the short and medium-term.

By comparing the results from two groups: one who underwent the “gold-standard” of today’s weight-loss regimens — clinically supervised dieting, exercise and other lifestyle changes — versus one who underwent the same regimen plus a nutrigenomic intervention, it was revealed that the second group’s results were considerably better after three and six months. By twelve months, the two groups’ results were similar, but the study shows that in cases where relatively rapid weight loss is required, such as in the lead up to a medical procedure, nutrigenomics can be a valuable introduction.

What can this tell us about the future of obesity treatment? Although it’s still early days, the study does show that there are still many factors beyond diet and exercise that influence how we control our weight. A better understanding of genetic differences can empower doctors to prescribe more relevant treatments or identify the reasons why certain approaches may or may not work

In the end, it’s all about listening to our bodies in new ways and using what we hear to make better decisions. There has never been a one-size-fits-all approach to tackling obesity, but studies like this one show us that we can continue to be more precise, relevant and effective in the ways we customize treatment. And as in-depth genetic testing becomes more available to patients and doctors, I’m excited to see how it can benefit how we work to improve outcomes for those struggling with weight loss. 

Another day, another shocking statistic. When dramatic data is commonplace, we can be forgiven for letting them slip past our radar. One particularly alarming stat you may have missed last month came from The Journal of Behavioral Nutrition and Physical Activity: only 2.7% of Canadian children and teens are getting the recommended hour of physical activity each day. Alarming as it might be, it’s probably not much of a surprise to parents currently at home with young ones.

As physical activity goes down, screen time goes up. Any parent can tell you that the “less than two hours” previously recommended by the American Academy of Pediatrics has gone out the window. Trying to fight it is a losing battle. After all, it’s how they learn, how they stay connected with friends, and how they’re spending a summer unlike any other in their lives.

Lockdowns have been especially tough for children struggling with obesity. Fitness regimens and support systems critical to progress were totally disrupted by the virus. But it’s especially important that this disruption doesn’t push back hard-won progress. And screen time might be the key to this.

Virtual classes, fitness apps, even video games can help obese children introduce physical activity into their quarantine regimen. But it takes support from the people around them. Physicians agree that active goal setting and involvement and education from family members can be the secret ingredient that makes digital fitness work. When families play and learn together, it’s far more likely to stick.

But beyond the digital tools that can help children stay active, it’s also critical for those with obesity and their families to stay connected with the doctors and other care providers on their journey to better health. It’s not simply about getting those hours of physical activity: mental health support, clear goals, monitoring progress – tackling obesity effectively requires a coordinated effort. This is where Telehealth options become critical.

Meeting with physical and mental health professionals regularly can be key to ensuring that COVID-19 doesn’t derail your child’s care plan. Set up a consistent schedule and stick to it. Check-ins can be an opportunity for kids to share questions, anxieties, and successes with someone outside of their family and friends. It creates a system of accountability that shifts some of the weight off parents’ already overburdened shoulders. And it’s a way to help return to a feeling of normalcy: a reminder that the priorities they had before life changed are still important.

The lockdown has been the perfect testing ground for Telehealth technologies. Doctors are learning how to use video-calling platforms like Zoom more effectively, and we’re complementing them with remote collaboration tools that let patients track progress, share data, and keep their support systems in the loop.

I encourage you to reach out to your family doctor to learn about the Telehealth options offered, and how they can support your child’s obesity treatment. Let’s keep the progress moving.

It’s Men’s Health Week in Canada, so here’s another for the men out there — and the people with men in their lives they care about.

It’s no secret the differences between the sexes is more than skin deep, and few medical conditions reveal this quite like obesity. In my last article, I talked about some of the unique health challenges men face from the condition. But there was an elephant in the room that I didn’t mention. And more so than low testosterone, more so than prostate issues, more so than erectile dysfunction, this ought to be the greatest motivation to change our lifestyles.

Obesity can be nearly three times as deadly for men than for women. In fact, the only thing more likely to contribute to a premature death is smoking. But most Canadian men aren’t smokers, while 67 percent of us are overweight or obese.

For men of normal weight, the risk of dying before age 70 is roughly 19 percent. For women, it’s 11 percent. A difference, sure, but not an extreme one. However, in obese men that risk jumps up to 30 percent, but only 15 percent for obese women. That’s an 11 percent increase as opposed to a 4 percent increase. Quite a gap.

Why such a big difference? While it’s not yet crystal clear, it’s likely a combination of many things. The increased risk of poor outcomes from prostate cancer I’ve mentioned previously is just one example. Combine that with dramatically increased risks from diabetes and heart failure (57 percent and 79 percent greater in men, respectively), and you begin to recognize how obesity adds fuel to not just one fire, but many. As health issues begin to arise, they’re often caught later for men — after all, we’re 24 percent less likely than women to have visited a doctor within the past year.

None of this is good news, I know. But Oxford professor Richard Peto helps us look at it from another, more positive, perspective: “If you could lose about 10 percent of your weight, a woman would knock 10 percent off the risk of dying before she was 70, and for a man it would knock about 20 percent off.” That’s a pretty good trade in my book. Ten percent is an admirable goal, but even five percent will begin to make an impact.

The first step is starting a tough conversation with your doctor. We need to be honest with one another about the challenges we face, whether with obesity or any of the other issues we experience. And as the conversation continues, we need to be supportive — not just of each other but of ourselves. We need to break the stigma that surrounds obesity by sharing our experiences and hearing how others are facing it. As we begin making changes to our diet and our lifestyles, we need to celebrate them, no matter how small they may be.

Just like the current pandemic, this is a shared, global challenge. But after the pandemic is over, obesity will remain deadly. Let’s face it together.

We may be celebrating Men’s Health Week in June, but the issues men face as a result of obesity are a year-round struggle. And our health can suffer in a few unique ways you might not know about.

Prostate Problems

As our waistlines get bigger, so do our prostates. This condition, known as benign prostate hyperplasia or BPH, sometimes requires surgery to correct. And when combined with obesity, the likelihood is far higher that you’ll need it. Obesity can also lead to decreased levels of prostate-specific antigens. Measuring the amount of these proteins in the bloodstream is one of the key ways that we can detect prostate cancer early. Obese men have more blood in their bodies, so these antigens are diluted and any drop in the level becomes harder to recognize. When you combine that with the fact that obesity can raise your risk of prostate cancer by as much as 34% — and the fact that obese men often delay seeking medical help (sometimes for reasons I discuss in another article) — you get a deadly cocktail with one underlying ingredient.

Lower Testosterone

When we’re younger, most men produce a ton of this hormone — it helps shape our bodies, our voices and even our bones. But as we age, it begins to decrease at a rate of about 1% a year – unless you’re suffering from obesity. Studies have shown that for each one-point increase in our Body Mass Index (BMI), we lose 2% of our testosterone. Not only that, but our waistlines are actually one of the strongest indicators of our testosterone levels. Research tells us that 1 in 7 obese men could be candidates for testosterone replacement therapies. Compare that to nearly 1 in 30 for the non-obese.

Erectile Dysfunction (ED)

Despite what many believe, ED isn’t usually caused by lower testosterone levels. But it certainly is linked to obesity. Even just being overweight can increase our chances of developing the condition by 90%. And for men struggling with obesity, that risk can more than double. But at the same time, losing weight has been shown to be an effective response. An Italian study indicated that diet and exercise could be five times more effective than simply treating the condition with medicine.

As always, I want to remind men of the silver lining here: we can deal with a whole host of issues through a simple two-pronged approach: healthier eating and more active living. This month is the perfect time to begin. It’s also an opportunity to support the men in your life as they try to make these changes. Encourage each other to start small, keep working towards a goal and keep sight of the bigger health picture.