Colored Potato Chips Curb Snacking

I'm pretty sure that most of us have had that experience where we open a package of our favorite (insert: candy, chips, chocolate) for a little taste... and the next thing you know, it's gone!  In an effort to discover ways to help us curb our snacking habits, researchers have discovered that inserting the occasional red potato chip into a stack of regular chips helped to curb snack size by over 50%!

The study, just published in the journal Health Psychology, asked a group of American undergraduate students to eat chips from a tube while watching a movie.  Red chips were inserted at regular intervals (eg every 5th chip) in one group, with no red chips in the tubes of the other group.

They found that when red chips were inserted, the number of chips consumed was reduced by more than 50%.  Further, when participants were asked how much they ate, they were more accurate in their estimates when the red chips were inserted, compared to when there were no red chips inserted.  

So what does this teach us?  It seems that having a natural 'break' in a snack, in this case created by a different color, helps us to curb our portions.  This may be because the alternate color gives us pause to actually think about the fact that we are eating (ie avoiding Mindless Eating), or to think about how much we have eaten, or how much we should be eating.  It is also possible that the color gives us a subconscious cue to portion control.

Perhaps in the future, we will see a new wave of colored snack products on the shelves in response to this study.   In the meantime, think about what your favorite snacks are, and how you could adapt them to take advantage of these findings.  I'd be thrilled to hear your ideas!

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

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Liposuction Increases Bad Fat

While liposuction is a commonly performed cosmetic procedure, the long term health effects are not well understood. A recent study reveals that not only is there regain of fat after liposuction, but that fat regain is in the form of ‘bad fat’ – the fat that increases the risk of diabetes and heart disease.

The study evaluated 36 healthy, normal weight women, who underwent abdominal (tummy) liposuction at the University of Sao Paolo, Brazil.  Two months after surgery, participants were randomly allocated to two groups: one group was put into a 4 month exercise program, and the other group was not put onto an exercise program.

At 6 months after liposuction, while fat did not reaccumulate in the area of liposuction, the group that was not in the exercise program had a 10% increase in visceral fat – this is the fat that surrounds our organs, which, in excess, is the ‘bad fat’ that secretes hormones and inflammatory chemicals that increase our risk of getting diabetes and heart disease.  The ‘bad fat’ did not increase in the exercise group, suggesting that the physical activity was sufficient to keep the bad fat at bay.

So, what this study teaches us is that although the lipo-sucked areas do not reaccumulate fat, the body’s compensation mechanisms do kick in to reaccumulate fat in more dangerous places around the organs, thereby increasing the risk of health complications of excess fat.  While exercise kept the bad fat away in this study, it would be very interesting to see what happened to these women six months or a year after the study was complete – if they stopped exercising, did they regain bad fat too?  Yet another research study that needs to be done.  

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

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Breast Feeding and Obesity Risk Later in Childhood

There is a long list of established benefits of breast feeding, including benefits to baby's immune defenses, gastrointestinal function, nutrition, and psychological well being.  It is controversial as to whether breast feeding decreases the risk of obesity later in life, but the evidence is mounting, with another new study lending support to this claim.

The study by Cathal McCrory and colleagues examined data from nearly 8,000 Irish children and their families, to see if breast feeding vs formula feeding had an impact on the risk of obesity later in childhood.  They found that kids who had been breast feed for 3 to 6 months were 38% less likely to be obese at 9 years of age, compared with kids who were exclusively formula fed.  Those who were breast fed for 6 months or more had half the risk of obesity at age 9, compared with formula fed kids.

While the mechanism responsible for these findings is still up for debate, the study lends further credence to the mantra we already know: Breast is Best!

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

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Healthy Obesity - Is There Such A Thing?

In this era where obesity is so prevalent, the question has arisen as to whether everyone with obesity is at risk of developing complications of their excess weight, such as heart disease.  It turns out that all obesity is not equal, and that Healthy Obesity is a very real phenomenon.

A recent study that adds to our growing knowledge on this topic examined data from over 22,000 people in the United Kingdom, and compared the risk of developing cardiovascular disease, or death, in people who were obese vs not obese, according to whether they had other metabolic risk factors for cardiovascular disease or not (including high blood pressure, low levels of good cholesterol, diabetes, waist circumference, and a blood marker of inflammation called CRP).

Over an average of 7 years, the obese people who were metabolically healthy (with 0 or 1 of the above risk factors) were not at increased risk of cardiovascular disease, compared with metabolically healthy people who were not obese.  Amongst people who were metabolically unhealthy (with 2 or more of the above risk factors), body weight didn't make a difference in risk - it was the metabolic factors that mattered, not the body weight.   Amongst people with obesity, those who were metabolically unhealthy were at 72% increased risk of death compared to those who were metabolically healthy.

The bottom line here is that it is not body weight that is the primary determinant of health, but rather, it is the risk factors for disease that may or may not be present (or develop) in the person who carries excess body weight that are the key.  In this study, one quarter of the people who were obese were metabolically healthy, and were therefore not at increased risk.

Once again, we learn that it is not about 'curing' obesity.  Rather, it is about each individual achieving their Best Weight - a realistic weight goal (which is different for everyone) that optimizes metabolic health and overall wellbeing.

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

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Medications vs Bariatric Surgery for Treatment of Type 2 Diabetes

It has become clear that bariatric (obesity) surgery can result in substantial improvement, or even remission, of type 2 diabetes for some people.   Two new articles from the New England Journal of Medicine now add to our knowledge on this topic.

(For the non-scientists in the audience, feel free to skip down to 'So what does this mean?' below.)

One of these studies, by Mingrone and colleagues, looked at 60 patients randomized to receive either gastric bypass surgery, biliopancreatic diversion surgery (BPD), versus their usual diabetes care with medications, and examined how many people would be in remission from their diabetes 2 years later.  They found that 75% of the patients who had gastric bypass and 95% of the patients who had BPD were in remission, whereas none of the control group was in remission.  Interestingly, none of age, gender, baseline body mass index, nor duration of diabetes were predictive of remission.

The other study, by Schauer and colleagues, randomized 150 patients to receiving either gastric bypass surgery, sleeve gastrectomy, versus usual medical care of type 2 diabetes, with the goal being to see how many patients from each group could achieve very tight control of their diabetes (defined by A1C of 6% or less) at one year.  They found that more patients who had surgery achieved this goal (42% of gastric bypass patients and 37% in sleeve gastrectomy patients), compared with 12% of patients receiving medications alone.  At one year, the mean A1C in the medication group was 7.5%, compared to 6.4% in the gastric bypass group and 6.6% in the sleeve gastrectomy group.

While each of these studies could be discussed with chapters of detail, for purposes of brevity I'll highlight just a couple of important caveats.  While a strength of these studies is that they are randomized clinical trials (very hard to do in the area of bariatrics), both studies are small.  In the Mingrone study, BPD was used as a surgical technique, which is a fairly drastic surgery (it bypasses more of the bowel than gastric bypass), and is currently only experimental.  The longer term follow up of these patients is important, as other studies now suggest that at 5 years after bariatric surgery, about half of the diabetes cases that initially went into remission come back (though the diabetes-free years are undoubtedly still of substantial health benefit).   In the Schauer study, one could argue that the diabetes control goal (A1C 6% or less) was too tight and not appropriate for routine clinical care, given that we no longer strive for this tight control in most cases of type 2 diabetes because of the potential risk of harm (see the ACCORD trial).  What is interesting to me, however, is that the overall control was better in the surgical groups compared to the control group.

So what does this mean?  These studies show us that bariatric (obesity) surgery can put type 2 diabetes into remission, and can improve control of diabetes in those who don't go into remission.  However, it must be noted that remission does NOT mean cure - each patient must be followed on a lifelong basis and monitored for possible recurrence of diabetes down the road.  These surgeries have significant risk associated with them, and the balance of benefit versus risk has to be considered on a patient-by-patient basis.  The improvement in diabetes does not appear to depend on how much the person weighs before surgery, implying that the current body mass index (BMI) critieria for selecting patients for surgery may not be the right way to determine who would benefit the most. (More research needs to be done to figure out what does predict best success with bariatric surgery.)

Overall, (and as noted in the accompanying editorial), studies such as these suggest that bariatric surgery should perhaps not be a 'last resort' in the treatment of patients with obesity and type 2 diabetes.

Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

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The Science Behind Comfort Foods and the Stomach Brain Connection

Have you ever wondered why you might feel the urge to reach for a chocolate bar or a bowl of ice cream after receiving some bad news?   Or why that baked mac n' cheese really does fit the bill of a 'comfort food'?  The effect on mood that we often feel after eating these foods is not a figment of our imaginations - it is a physiologic reality that high fat foods affect our emotions, and it turns out that it goes farther than the enjoyable taste, smell, or texture of these foods.  In fact, a recent study provides some interesting evidence to suggest that a direct message from the stomach to the brain in response to a fatty meal may play a role in this fascinating phenomenon.

A rather ingenious study (in my opinion) published by Van Oudenhove and colleagues in the Journal of Clinical Investigation infused a solution of either fats or salt water directly into the stomachs of 12 healthy, non obese volunteers (thereby bypassing any satisfaction or pleasure derived from the taste, smell, or texture sensations of a fatty meal).  Along with these infusions, they induced feelings of either sadness or neutral emotion, using pictures and music, and asked them to rate their mood.

The researchers found that hunger scores were higher during the sad emotion than during the neutral emotion (supporting that a down mood promotes hunger).  While they did not find that the fat infusion decreased hunger compared to the salt water infusion, they did find that the difference in hunger ratings between the sad and neutral conditions was less during the fat infusions than it was during the salt water infusions, suggesting that the fat infusion has an effect to take the edge off of, or lessen the blow of, the effect of sadness on hunger.

They also found that while there was no difference in sadness ratings in the fat infusion versus the salt water infusion, the difference in sadness ratings between the sad and neutral conditions was less during the fat infusions than during the salt water infusion.  Again, this suggests that fat has an effect to moderate sadness such that it feels like less of a roller coaster ride.

The researchers also looked at parts of the brain involved in sadness using functional MRI, and found that the fat infusions had an attenuating (lessening) effect on the activity of some of these areas of the brain in response to induction of sadness, compared to the salt water infusions.

Putting these findings together, it suggests that there may be a direct signal from the stomach to the brain  after taking in a fatty meal, which may lessen the feeling of hunger that sadness induces, and may lessen the swing between neutral mood and sadness.  What this message is, exactly, is unknown, but it is likely that gut hormones are involved in this fascinating response.

These findings beg the question:  Is the effect of a fatty meal on mood, or mood swings, or perception of sadness, different in people who struggle with their weight, compared to normal weight individuals?  Do people with obesity have less mood modulation after consuming a similar amount of fatty food than nonobese individuals, thereby resulting in the need to eat a larger fatty meal in order to feel better or more emotionally stable?  Or, do individuals with obesity have more mood improvement or stability with eating a fatty meal, thereby providing a greater emotional reward and causing that individual to be more inclined to seek out high fat meals in the future (eg in the case of food addiction)?


Very, very interesting, and most deserving of further research.



Dr Sue Pedersen www.drsue.ca © 2012 drsuetalks@gmail.com

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Is Global Warming Contributing to Obesity?

In parallel with the rising obesity rates around the world over the last decades, so too have we seen an environmental trend of global warming.  I never stopped to consider that the two might be related - until now.

A thought provoking paper just published by my Danish colleagues suggests that there may be a link between increasing atmospheric carbon dioxide levels (as observed with global warming) and obesity.  Breathing in air containing higher carbon dioxide (CO2) level causes the pH of the blood to decrease ever so slightly.   The brain is exquisitely sensitive to these small changes, and the activity of neural cells that are involved in appetite regulation are affected.  In addition, these decreases in pH may affect neurons that regulate wakefulness, resulting in less sleep, which is a known risk factor for obesity.

Therefore, they hypothesize that these small pH changes in our blood seen with higher CO2 concentrations in the air could lead to an increase in appetite as well as energy storage, and could therefore be one of the many contributors to the high rates of obesity that we currently see.

My colleagues went on to test this theory in a small study of six participants, and found that study participants consumed 6.1% more calories when exposed to higher CO2 concentrations in the air, compared to ambient air.  It is noted that this difference was not significant in the study, but a study of a larger size is now needed to see if there is a real difference here.

The obesity endemic, therefore, may be one more important item to add to the list of reasons to put a stop to global warming.

Dr Sue Pedersen www.drsue.ca © 2012

drsuetalks@gmail.com 

Follow me on Twitter for daily tips! @drsuepedersen 

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