Family Weight & Wellness Clinic and Medi-Spa

02/25/2022

Is Breakfast Important? A Dietitian's Honest Opinion

The age-old debate of the most important meal of the day still stands and remains one of the most controversial health quarrels. In a generally black and white world, it is common nature to seek surefire answers. However, when it comes to nutrition, rarely does an indisputable answer exist.

Although that first meal is often regarded as the most important of the day in American culture, is breakfast so important and why or why not? A dietitian provides insight into the most burning questions about the infamous meal that breaks an overnight fast.

The History of Breakfast
Historically speaking, breakfast used to be the most condemned meal of the day, signifying gluttony and unnecessity. Breakfast did not bask in glory until the middle of the 18th century and recipes were not even included in cookbooks until the 19th century.

Historians purport that John Harvey Kellogg changed the nutritional breakfast landscape with the invention of his sugar-laden cereal. They also suggest that marketing ploys popularized the meal which eventually spurred much controversy among the scientific community.

Interestingly, in earlier centuries breakfast did not have much importance ascribed to it and specific foods were not labeled as "breakfast foods". In fact, people often consumed leftover dinner if they participated in an early breaking of the fast.

However, during the industrial revolution, people began blaming hearty breakfasts of eggs and meat on indigestion and low work output at the workplace. As a result, religious health gurus essentially invented cereal and marketed it as a lighter, healthier breakfast option that led to more efficiency and productivity at work.

Once vitamins were discovered and fortified into cereals, these refined wheat products became a convenient food for workers to eat and mothers to provide for their children. But this is all despite a lack of actual scientific evidence to back its importance.

Then, in the early 1990s, studies began examining breakfast and its impact on health markers such as weight loss. The problem was, and still is, that there are so many definitions of breakfast, the studies are largely observational and not randomized. This makes it difficult to control for confounding variables such as exercise, smoking, and other lifestyle habits. Thus, two highly heated camps still exist: a group that asserts breakfast kickstarts metabolism and another that swears by fasting, sometimes into the early afternoon hours.

So, to summarize, a combination of fear of indigestion and low work performance, religious moralization, and advertising paved the notion of breakfast as the most important meal of the day. Not science.

Nonetheless, based on the available scientific literature, the only consensus among researchers is that what someone chooses to eat to break their fast is more important than when they choose to consume it. Rather than asking, "What time should I eat breakfast," a better question is "What should I eat to break my fast?"

Asking this second question then provides a clearer-cut answer to the question of whether breakfast is so important. In short, the answer becomes a resounding yes. But not because eating a meal between the hours of 5:00 a.m. to 9:00 a.m. is vital. Rather, it is important because this first meal sets the tone for bodily functions for the rest of the day.

02/25/2022

Fat vs Muscle vs Water Weight: What Scale Fluctuations Actually Mean

Up and down... Up and down... The scale can seem like an ongoing rollercoaster ride, especially toying with emotions when trying to lose weight.

If wondering how the number on the scale shifts so quickly, this article fully clarifies how and why the scale can shift so seemingly rapidly. (Even within and throughout a single day!)

So instead of worrying about pesky pound changes, understand how fat, water, and muscle weight affect the number on the scale and the difference between fat loss versus weight loss. Never fret again!

The Difference Between Fat Versus Muscle
Weight can be a tricky concept to dissect, hence the reason people still say that muscle weighs more than fat. In reality, one pound of muscle weighs the exact same as one pound of fat - they both "weigh" a pound! However, muscle is denser than fat, which exerts differences in physique and appearance.

Think of it this way: whereas weight is the mass or heaviness of an object, density refers to how much space an object assumes. Meaning, two objects can weigh the exact same but take up vastly different amounts of space. For example, a pound of steel consumes much less space than a pound of feathers. Steel is monumentally denser than feathers!

A more practical example, a pound of fat is bulky, feathery, and around the size of a small melon. A pound of muscle is solid, compact, and around the size of a small tangerine. Thus, two people who weigh the same but have different body compositions (i.e. one has more fat and one has more muscle) can look completely different and endure or not endure different health problems.

In general, a higher body fat percentage appears as a soft, less toned physique whereas a higher percentage of muscle appears as a firm, toned physique.

Furthermore, a higher percentage of fat is correlated with poor health outcomes but higher percentages of muscle mass tend to boost metabolism so one burns more calories at rest. This is important because someone with a poor muscle-to-fat ratio exhibiting a low weight is at higher risk for obesity-related complications and conditions than someone with higher body weight but a better muscle-to-fat ratio. This perfectly transitions into the BMI conundrum.

How Does BMI Relate to Weight?

Body mass index (BMI) is determined by dividing a person's weight (in kilograms) by the square of height (in meters) and is considered a measure of body size. However, it’s often criticized as an inaccurate portrayal because it does not account for the specificity of tissue, meaning it does not distinguish between fat and muscle mass.

To revisit the example from above, this means that two people who are the same height and weigh the same but have different tissue composition may be deemed at equal risk for chronic conditions. However, the person with more muscle mass has much less risk in reality.

How Do These Concepts Affect the Scale?

Many people know the all too disheartening feeling of stepping on the scale after beginning a new fitness regimen and seeing a higher number than baseline. How can this happen one might think through frustration and boiling tears.

Well, to reiterate, muscle and fat technically weigh the same. Thus, if someone loses a pound of fat but gains two pounds of muscle, weight will rise on the scale.

However, before the last 10 years or so, the scale could not differentiate between fat and muscle mass. This has left many people feeling defeated when they actually made tremendous progress. It is important to recognize that body composition or the differentiation between skeletal tissue is a much better predictor of overall health than the weight reflected on a scale.

Moreover, weight aside, one should be able to visually see a difference in appearance because muscle consumes less space and appears smaller and more sculpted than fat. Nowadays, there are scales that can differentiate between fat and muscle mass, although they can have a large margin of error and thus, should be used with caution.

The most accurate ways to measure the difference in tissue is to get a DEXA scan or utilize a bioelectrical impedance analysis (BIA). The former is the gold standard and the latter is much more accessible and cost-effective.

In summary, before fretting about increasing scale weight, consider the differences between fat versus muscle tissue plus the following points.

02/25/2022

Complete List of Sugars & Which to Use

It is obvious added sugar is found in desserts, sweets, and sweetened beverages. However, added sugars can be found in many unsuspecting foods.

According to University of California San Francisco, an astounding 74 percent of packaged foods in grocery stores can have added sugar! On top of this, there are many names for sugar on labels and ingredient lists that make looking for sugar in foods confusing.

Most American adults recognize the health concerns of too much sugar in the diet. In fact, according to a survey from statista, 67 percent of Americans are trying to cut back on sugar.

While many Americans are trying to cut back on sugar, it can be tricky to catch all the different types and names of sugar on food labels. Read on for clarification of different forms of sugar, how they are used and how they can impact health.

The Health Risks of Too Much Added Sugar
While sweet treats can be enjoyed on occasion, too much added sugar in the diet can harm health. In fact, eating too much can increase the risk of countless chronic diseases, including heart disease and type 2 diabetes.

On the flip side, giving up refined sugar can change your health for the better! Despite the initial "withdrawal" symptoms, those who limit sugar intake are more apt to lose and maintain a healthy weight, think more clearly, sport healthier skin, and beyond.

To counter such risks and gain some major health benefits, the American Heart Association (AHA) suggests limiting added sugars to less than 24 grams of sugar (6 teaspoons) per day for women. Men are encouraged to consume less than 36 grams of sugar (9 teaspoons) per day.

Whether dieting or trying to eat healthier, identifying and understanding the various forms of sugar can help you make informed decisions.

Conclusion: What Is the Healthiest Sugar?
When it comes down to deciphering the healthiest type of sugar, the typical consensus is this: Sugar is sugar no matter what the form.

Despite differences in flavor, appearance, and texture, one teaspoon of any type of sugar generally offers 16 calories. Some sugar sources may provide trace amounts of other nutrients, but the impact on blood sugar is the same.

No one type of sugar can be eaten without concern of excess, even artificial sugars. While artificial sugars will not raise blood sugar and have none to very low calories, some research suggests caution for their use.

For that reason, all sugars, even natural ones, should be consumed in moderation with AHA recommendations. With the average American consuming a high intake of sugar, it is important to recognize the different types of sugar and the names it can hide under.

Just because a food label does not have "sugar" in the ingredient list does not mean a food is low in sugar. Unusual names sugar can fall under dextrose, sucrose, syrups, or sugar alcohols ending in "ol".

12/01/2021

Can you really banish junk food cravings?

Couple eating junk foodOne of the most difficult challenges on your journey to reach your ideal weight is learning how to deal with cravings.

Cravings can appear out of nowhere for a variety of reasons. They can be tied to a specific nutritional deficiency, caused by stress, or brought on as your body’s attempt to deal with emotional needs.

But no matter what their cause, cravings can make it difficult for you to stay on-track with your nutritional goals.

The best way to proactively deal with cravings is to make sure that your diet provides you with all of the nutrients you need — you can do that by sticking to lean proteins, fresh live foods, and foods rich in Omega-3s. But you can also deal with cravings that aren’t tied to real nutritional needs by using guided visualization.

In this guided visualization from Jon Gabriel, you’ll learn a powerful technique for training your brain to dismiss junk cravings — and instead focus on vibrant, healthy, beautiful foods.

Practice this technique every morning and as needed in order to create lasting change in your relationship to your cravings, and to food itself!

11/30/2021

Semaglutide Approved in Canada: It’s Time to Change the Game

by Ian Patton, PhD, Director of Advocacy and Public Engagement, Obesity Canada

After a long anticipated wait, the day has come where Health Canada has approved a new treatment option for the management of obesity in the form of the medication semaglutide 2.4mg (marketed as Wegovy). This medication has been dubbed a “game changer” in the world of obesity management because of the impressive data suggesting significantly improved outcomes compared to other options. This is an important step in providing a diverse and effective toolbox of options to address this complex chronic disease.

To date, our toolbox has been limited. Bariatric surgery has been the most effective treatment for obesity, but no treatment is universal and surgery is not the right choice for many individuals. Further, bariatric surgery is severely under-utilized. We have unacceptably long wait times that vary greatly across the country, in many cases waits are measured in years. No one should have to wait multiple years to have treatment for a chronic disease. The end result is disease progression, worse health outcomes and delays in achieving better health.

Dr. Arya Sharma, OC’s former scientific director, regularly brought this point up in presentations, and would highlight that in all other chronic diseases you can think of that treatment gap can be addressed with other treatments like medications. Medications are scalable and something that could be helpful to a lot of people. With what we know about the role of the brain and biology in obesity, there is hope that effective treatments that address these factors can significantly improve outcomes for individuals living with obesity. While the medications that are currently approved for obesity management are safe and effective, the effectiveness is generally somewhat less than that seen with bariatric surgery.

What has caused the launch of semaglutide 2.4 mg to be deemed a “game changer” is that the data suggests that the effectiveness of this medication is getting close to the effectiveness seen with bariatric surgery. As someone living with obesity, it is exciting and hopeful that as we learn more about this disease, more options become available so more people can manage their disease.

However, the approval of this game-changer only highlights the need to change the game itself. Yes, a new tool is available and it shows a great deal of promise, however, availability and accessibility are two very different things. In Canada, accessibility of evidence-based effective obesity treatments is abysmal. Beyond the wait times for bariatric surgery, individuals living with obesity, generally do not have access to health professionals with training in obesity management, support for things like mental health, cognitive behavioural therapy, nutrition and activity are also very limited. When it comes to obesity medications, very few Canadians have coverage through either public or private drug plans.

This lack of coverage and accessibility of effective treatments is rooted in not recognizing obesity as a chronic disease and rather incorrectly labeling it a “lifestyle” condition or in other words, something you have done to yourself making you not worthy of treatment.

So while our tool box is getting bigger and more effective, we have not seen significant changes in who is able to open that tool box.

Now is the time to start making some noise and asking questions. Ask your health professionals about obesity and obesity management. Use this infographic and direct them to our Clinical Practice Guidelines. Ask your benefits provider why they are not covering obesity treatments in the same manner they do for other chronic diseases. Ask your employer why obesity treatments are not included in your benefit plans on the same level as other chronic diseases. You can find some templates of letters you can use here. Ask your local, provincial and federal policy makers to recognize obesity as a chronic disease and to implement policy that supports accessibility to evidence-based care by signing on to this campaign.

Changing the game starts with having the conversations, and the more these conversations are happening, the easier it will be to make the changes needed.

11/25/2021

Why are we seeing an Increase in Gastroesophageal Reflux Disease?

The number of cases of GERD has been on the rise among younger populations, and this likely is due to an increase in obesity across populations.

Gastroesophageal Reflux Disease (GERD) has traditionally been associated with middle-aged or older patients. However, the number of cases has been on the rise among younger age groups — 30 through 39 years — and this likely is due to an increase in obesity across populations.1

Many people experience occasional gastroesophageal reflux which occurs when the content of their stomach leaks back into their esophagus. It is typically experienced after a meal and the discomfort may be greater when lying down or bending over. People with obesity, particularly those with visceral fat, can be at increased risk because excess abdominal fat creates additional pressure on the stomach, which makes acid leakage or backflow more likely. Hiatal hernias, asthma and esophageal adenocarcinoma are also strongly linked to GERD in people with obesity.

Non-Pharmaceutical Treatment Options for GERD
There are many non-pharmaceutical options that can help reduce symptoms of GERD. Patients can be advised to:

Avoid certain foods: Citrus, tomatoes, spices, caffeine and fatty foods contribute to acid reflux. Awareness of foods that trigger acid reflux can reduce symptoms, as can limiting alcohol and smoking.
Avoid lying flat: GERD patients should avoid lying down for three hours after a meal to avoid heartburn and other symptoms. Sleeping with the head of the bed raised four to six inches also can help.
Try relaxation techniques: Practicing meditation can relax muscles, and incorporating periods of deep breathing daily can strengthen the diaphragm.
Eat smaller meals: Having five or six small meals throughout the day allows time for the stomach to empty, which reduces pressure on the esophagus.
Chew non-mint-flavored gum: Chewing increases saliva and absorbs acid in the mouth so that it does not get to the esophagus. However, mint-flavors should be avoided because it might have a reverse effect.
Weight Loss Can Reduce or Eliminate Reduce Gastroesophageal Reflux
Antacids may help with occasional acid reflux, but GERD is better treated with moderate dietary and lifestyle changes or the use of medication. Structured weight loss programs, such as New Direction, include dietary modifications, increased activity and behavioral change that can completely resolve GERD symptoms for overweight and obese patients.2 Additionally, weight loss of between five and 10 percent has been found to have a significant impact on reducing GERD scores for women.

Both occasional acid reflux and GERD can be well-managed by patients. Informing them about the symptoms and how to relieve them via weight management can reduce symptoms, and also can help them distinguish between heartburn and a possible heart attack.

Sources:

The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger?
Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial

11/25/2021

I wrote this prompt thinking we’d pick ONE must have running gear item, but it’s so hard to choose. I made a list of things I use or wear every time I run and decided it’s an 11 way tie for first place.

Re-adjusting my shirt/shorts/other while running makes me uncomfortable, causes me to stop, can lead to chafing and overall just makes for a frustrating run. Wearing the right gear is key to a good run. So, each of these items is a MUST HAVE because an alternative would cause some problem or distraction while running.

Best Running Gear 2021
Running Shoes – I currently rotate between a few different pairs. Quality running shoes are super important to help prevent fatigue and injuries. Be sure to check your shoes periodically for wear and tear.
Sports bra (high impact with adjustable straps) – Even though I don’t have a large chest I HATE any boob-bounce situation. I only wear certain sports bras to run and they must have adjustable straps. I have lower impact sports bras for strength training days.
Aftershokz wireless bone-conducting headphones – This is the newest must have item in my running gear, but since I got a pair of wireless open-ear headphones I can’t imagine running without them. Obsessed.
Running Shorts (sweat wicking, long shorts) – Chafing sucks. The right running gear for your body and activity can help. I swear by long-ish tight shorts made from sweat wicking materials.
Sweat wicking shirts and tanks – My favorite running top is a long sleeve, form fitting shirt by Athleta. It has piping around the bottom so it won’t ride up (sometimes my running belt pulls up my shirt, but NOT with this top).
Visor (Run Eat Repeat visors have a big brim that I LOVE) – I need a visor while I run so much I’ve worn it during night runs! I love a wide brim visor to help keep the sun off my face and to help prevent sweat in my eyes.
Sunglasses (lightweight, small-ish frames that fit under my visor) – I have to have sunglasses to run, even when it’s not sunny out (in that case I wear yellow lenses). I think my eyes can be sensitive to light and smog so it helps to protect them.
Running belt to hold my phone and keys – I always run with a belt for my phone, keys, chapstick and if I’m doing a long run fuel. I prefer a wide infinity type type belt that doesn’t bounce or move. I usually forget I’m wearing it.
Phone for podcasts/audiobooks/music – I always run with my phone and am usually listening to a podcast or book, but have been mixing in more music recently.
Running GPS Watch (I currently wear a not fancy Polar watch) – I don’t watch my pace super close right now (because I’m still slow compared to before 2020), but in the past would use my watch to check my pace on easy runs and at the start of races to make sure I wasn’t going out too fast (*fast for me and I didn’t want to burn out). Now I use it for intervals, overall distance and speed sessions.
Running Socks (I love no show, thin-ish socks) – Preventing blisters and chafing is so important. Once you have a blister or chafing somewhere you often keep irritating the area as you continue to run. The best way to stop blisters is to try and prevent them by wearing quality running socks.

11/21/2021

International Coalition Spotlight: 5As Team Program (5AsT)

Today’s blog post is brought to you by Dr. Denise Campbell-Scherer and Melanie Heatherington. Dr. Campbell-Scherer, a Professor of Family Medicine and Associate Dean of the Physician Learning Program and Office of Lifelong Learning at the University of Alberta, and the lead investigator for the 5AsT Program. Melanie Heatherington is an Education Specialist with the Physician Learning Program and Research Coordinator for the 5AsT Program.



The 5As Team (5AsT) program of research aims to improve health through revolutionizing the prevention and management of obesity and related comorbidities in primary care. The team consists of interdisciplinary researchers, healthcare professionals, educators, and patient advocates who are dedicated to conducting methodologically rigorous, patient-centred, community engaged, mixed methods research in primary care. The 5AsT program focuses on pragmatic solutions to problems that occur in real-world practice. The team respects and seeks input from clinicians and people living with obesity.



The 5As Team Intervention project

Funded by an Alberta Innovates CRIO grant, the 5As Team (5AsT) partnered with the Edmonton Southside Primary Care Network to co-create a project to understand why frontline interdisciplinary team members were not conducting clinical obesity care despite being trained to do so. We worked together with frontline healthcare providers to understand what they wanted to learn to help them advance their skills; they identified 42 topics. We then used this information to develop an intervention with the aim of changing provider behaviour in order to improve obesity prevention and management in practice. The intervention was effective in addressing provider-identified gaps and lead to increased confidence in conducting obesity assessments and interdisciplinary work. Integration new knowledge required that providers change their own mental models of their practice and increased success was achieved when the entire team developed a new way of working together to integrate their different roles to support patients and each other.



5AsT tools to support collaborative conversations

Funded by CIHR this project focused on the improvement of 4 existing tools developed by the 5As Team research program. The tools aim to anchor our collaborative clinical approach. To understand how well the tools responded to the users’ needs, we developed three co-design workshops. We used personas, role playing, dialogue prompters, and prototypes to foster collaboration and communication between patients, health professionals and researchers. The first workshop helped to identify patients’ needs and expectations about the tools. It also helped develop performance specifications and a first prototype. Ten patients and ten healthcare providers participated in the other two design workshops to tailor the tools. We started an iterative design process to improve the design of the four tools. Information design principles were applied to enhance the effectiveness of the tools. The toolkit is available for download from our website: http://www.obesitycanada.ca/5as-team



5AsT – MD

A labour of love, the 5AsT-MD Course project reacted to the Lancet’s call in 2015 to improve training for healthcare providers in obesity prevention and management. 5AsT-MD is a comprehensive educational program that was developed, piloted, and refined for use with medical residents. The course combines didactic lectures, experiential learning, and clinical practice to provide learners with knowledge of the complexity and pathophysiology of obesity as well as an overview of therapeutic approaches, tools and resources to help them better care for their patient’s living with obesity. Evaluation of the 5AsT-MD pilot project shows increases of residents’ understanding of the complexity and chronicity of obesity, and improved confidence with their weight management practice. The course has now been implemented with residents in family medicine, pediatrics, psychiatry and internal medicine at the University of Alberta and under the direction of Dr. Sonja Wicklum, has been implemented within the family medicine residency program at the University of Calgary as well.



5AsT – Lifelong Learning

In partnership with the Office of Lifelong Learning the 5AsT-MD course has also been offered to practicing physicians, and interdisciplinary care providers as Continuing Professional Development. The workshop takes the learners outside of the classroom and engages them in activities to foster reflection about obesity discourse, to question assumptions, and promote understanding of what it is like to live with obesity. The workshop emphasizes experiential learning and incorporates didactic lectures. Learners have the opportunity to wear a bariatric suit, simulating the encumbrance of a larger body. In addition, learners explore a therapeutic approach that transforms clinical into collaborative deliberation about improving health within the specific life context of the individual patient, and practice the approach with tools that guide the conversation. To date we have trained over 400 learners, including physicians, residents, dietitians, nurses, pharmacists, and psychologists. We are now in the process of creating a virtual training course for obesity prevention and management that we will be launching soon.



Addressing clinical and social determinants of health to advance obesity and diabetes prevention and management in vulnerable newcomer ethnocultural communities

Funded by NOVAD, a collaborative grant between the University Hospital Foundation, the Alberta Government and Novo-Nordisk, this project extends the work to people who often fall outside the formal primary care system. Developing contextually appropriate interventions for people living with obesity and type 2 diabetes in vulnerable ethnocultural newcomer communities is a highly complex problem. To develop an intervention, we need to understand this problem more deeply. Our project seeks to understand care gaps through a mixed-methods approach that integrates population-level data about these communities with the perspectives of people with obesity and diabetes and interdisciplinary primary healthcare providers. Our coalition links community health workers, primary care providers, newcomer patients with obesity and diabetes, public health professionals, policy makers, and researchers to build the foundation for sustainable solutions to improve obesity/diabetes care for vulnerable populations.



Using NAPCReN data we have intergrated clinical and material/social deprivation data and analyze patterns of obesity, diabetes, and related comorbidities in newcomers to establish our baseline data. We will work with our stakeholders to co-design strategies with stakeholders to make the data clinically actionable for primary health care teams, community health workers, and policy makers.



We are in the process of conducting environmental audits and integrating this data with qualitative data on community perceptions to demonstrate gaps in care on a population level and inform design of personalized, actionable interventions.



The Multicultural Health Brokers (MCHBs) is an innovative Edmonton cooperative of community health workers committed to improving health equity by bridging cultural and social distance between newcomers, healthcare, social, and community services and systems. The Edmonton Southside Primary Care Network (ESPCN) is the largest Edmonton Zone PCN and aims to increase connectivity with the ‘health neighbourhood’ – community resources, including community health workers, to support needs of people with deficits in key determinants of health.



For further information, please visit our webpage at: http://www.obesitycanada.ca/5as-team



Or contact us directly:

Melanie Heatherington

mnoakes@ualberta.ca

News International Coalition Spotlight: 5As Team Program (5AsT) Byadmin November 21, 2021 Today’s blog post is brought to you by Dr. Denise Campbell-Scherer and Melanie Heatherington. Dr. Campbell-Scherer, a Professor of Family Medicine and Associate Dean of the Physician Learning Program and Offi...