Obesity Weekly

A weekly update about some aspect of Obesity. Published Monday mornings

Eat Breakfast

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Although you have heard it from you youth, that breakfast is the most important meal of the day, breakfast is still the meal that is most likely to be missed. I know that morning can be chaotic, getting dressed and ready for work, motivating the kids out the door for school and trying to impose some type of order on the day at the start.  Eating at that time can just slip away while trying to get everything else in order. Most people agree that having breakfast is important.  People who eat a healthy breakfast are less likely to be overweight or obese (1) and have a more positive outlook and mood (2).  It is amazing to think that if a safe medication were developed that would help you to control your weight and mood, that it would be a billion dollar drug.  However, a simple modification of behavior, eating a good nutritious breakfast, can produce excellent results for you and those in your household. Now there is some debate on whether a good breakfast causes a healthier person, or whether a healthier person is more likely to eat breakfast. I think that is is the former.  A good breakfast, even when you don’t feel hungry, will keep you from feeling hungry before lunch.   People who eat a balanced breakfast are less likely to snack and have a lower caloric intake during the morning.  Skipping breakfast tells your body that you are in an environment where calories are limited, so the food you eat later is more likely to be stored rather than used as fuel for the day.  So what is a balanced breakfast?  A good breakfast should contain protein, good fat and dietary fiber.  An egg and yogurt with fruit is an excellent start.  Of course, the less refined, the better.  The less you eat out of a box the better.  Try some new things that are less refined and see what happens over the next month.

1. http://www.ncbi.nlm.nih.gov/pubmed/17605303

2. http://www.ncbi.nlm.nih.gov/pubmed/10705080

Written by ecable

April 20, 2009 at 6:32 am

Posted in Diet, Health

100 Calorie Snack Alternatives

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One of the growing segments of the refined food market is the appearance of the 100 calorie snacks. Nabisco has several options for 100 calorie snacks they would like you to consume on a regular basis. They are 100 calories, but not particularly nutritious and are much more expensive than making your own 100 calorie snacks. Good Housekeeping has a list of 100 calorie snacks that are “healthy” but if you look at the list, they are all pre-packaged items. One rule of thumb that is important to remember in building a sustainable healthy lifestyle is “if it comes in a colorful packaged container, there is a better alternative available.”

For example, one of the items on the Good Housekeeping list is Motts apple sauce. While I think that this is a better alternative than the fudgsicles or the south beach diet bar, which are also on the GH list, why eat apple sauce when you can eat an apple? During processing to apple sauce about half the dietary fiber is lost. A high dietary fiber content produces a greater satiety effect (the feeling of fullness) and delays gastric emptying (making the feeling of fullness last longer). With apple sauce you are limited to the flavors that manufacturer produces, while with apples you can try different varieties until you find the ones that you like the best. Find a local produce store you trust and ask one of the people in produce for a sample. While the packaged sauce can seem like a convenient snack, it is no more convenient that an actual apple.

If you cut up your own vegetables, e.g. celery, peppers or cucumbers, an almost unlimited amount of these can be consumed. It would take over 2 pounds to give you 100 calories of these green vegetables. Carrots are a little higher in calories, but if you get the normal carrots, not the baby carrots, you can decrease the total calorie intake since some effort is required to prepare the carrot. These alternatives are all less expensive than the pre-packaged stuff. Of course, you could buy these already prepared at the store, but go out of your way to get the stuff in its most natural form and prepare it yourself. It plays a part in building a healthy lifestyle.

http://www.nabiscoworld.com/100caloriepacks/

http://www.goodhousekeeping.com/health/healthy-snacks/100-calorie-snacks

Written by ecable

April 13, 2009 at 5:00 am

Posted in Health

Sugar Sweetened Beverages

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An increase in the consumption of sugar sweetened beverages (SSBs) in the past 30 years has been observed (1).  Since obesity rates have increased at the same time, the correlation does suggest a cause and effect relationship. (For a further discussion on correlations versus cause and effect click here).  Just because something happens together (correlates) and even if it makes sense to us, does not mean there is a cause and effect relationship (a)  Figuring out the cause of anything in free range humans is difficult because our lives are so complex.  In a lab you can have two groups of animals where you can change one thing while keeping all other things equal.  As easy as this sounds it still is difficult to implement because animals will change their behavior and confound your studies.  Try to do this with a large group of humans.  Many investigators have explored the correlation between increased consumption of SSBs and attempted to ascertain if the correlation is indeed a cause and effect relationship.  Some studies have demonstrated a strong correlation (2) while several others have suggested that the evidence is insufficient (3,4) (b).  Now just because the conclusion is reached that the evidence is insufficient doesn’t mean that it is evidence of not being an effect. I just means that the data being analyzed doesn’t give enough confidence to support the conclusion.

In a recently published study, one aspect of SSB consumption was tested, the effect of removing SSBs during diet and its effect on weight loss (5).  The power of the current study is the large number of subjects (810), length of time (18 months) and the rigorous analysis of caloric consumption by the subjects. It was also a propective study, not a retrospective study. The effects of other beverage consumption was assessed as well, diet drinks, juice, milk, coffee and tea (sweetened or unsweetened), and alcoholic beverages.  Four findings emerged from the study:  1)  Decreasing the number of calories consumed as SSBs had a positive effect on weight loss;  2)  the effect of liquid calorie reduction had a stronger effect on weight than a decrease in solid calorie intake; 3) a reduction in SSB had a positive effect on weight loss at both 6 and 18 months, and; 4) no other beverage (diet drinks, juice, milk or alcohol) was associated with weight change.  Decreasing SSB consumption by a serving per day was associated with about a one pound weight loss at 6 moths and a one and a-half pound loss at 18 months.  Other studies with milk had suggested a benefit on weight loss, presumably due to an increase in calcium intake.  These findings were not confirmed, but milk intake did not have an adverse effect on weight loss either.  The authors went on to speculate as to the mechanism(s) of the findings, recruitment of satiety effects for milk, ease of oxidation as a fuel for alcohol.  It would be good to know why the effects of SSBs are observed, but the data are convincing, decrease the intake of SSBs and you will have a positive effect on weight loss.  So of all the things to change during a diet, decreasing the intake of full calorie beverages should be simple to implement and have a good effect on body weight (c,d).

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Interesting news just popped up.  Apparently in Australia, Coca-Cola South Pacific ran advertising claiming that Coke was “kiddy-safe.”  The reason that they could do this was to take one of the ambiguous studies and state that there is no effect of SSBs on body weight, not that the study was inconclusive.  There could be flaws in the study cited so that statistical significance was not achieved.  However, the Australian Competition and Consumer Commission ordered that the advertising be corrected.  For the full story see here.

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a. There are many investigators that have graduated from UTSW, the University of “That Should Work”.  Just because something makes sense and we think it should work, doesn’t mean that it actually works that way.  For several examples in modern medicine see the ideology of health care.

b. Cause and effect will require a correlation, but a correlation does not mean cause and effect.  To ascertain a true cause and effect correlation must be established and two different types of experiments must be performed, adding the cause to observe the effect and removing the cause and losing the effect.

c.  So this study tested the correlation of cause removal and removal itself.  These are two of the three, criteria required for establishing cause and effect.  The role of SSB in casuing weight gain was not addressed in the study.

d. These findings have important implications for effectiveness of weight loss by dietary intervention.  If you want to loose weight quit drinking SSBs. These data also support decreasing the availability of SSBs in a public setting, such as schools.

1. http://www.ajcn.org/cgi/content/full/89/1/372

2. http://www.ajcn.org/cgi/content/full/89/1/438

3. http://www.ncbi.nlm.nih.gov/pubmed/18541554

4. http://www.ajcn.org/cgi/content/full/85/3/651

5. http://dx.doi.org/10.3945/ajcn.2008.27240

Written by ecable

April 6, 2009 at 5:00 am

Posted in Health

Government initiatives to combat obesity.

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The US government has an initiative “OBESITY: Halting the Epidemic by Making Health Easier” (1) Decreasing weight and increasing fitness are excellent goals and would increase longevity and decrease comorbidities associated with obesity, such as discussed a couple weeks ago.  However, has the US government accepted the same premise that helped get us into the situation in the first place?  That getting fitter will happen if its easier?

Let’s go back a few thousand years.  Effectively storing excess energy provided a survival advantage. You couldn’t run down to the Alberston’s, or Piggly Wiggly, or Super Wal-mart and pick up whatever you were craving.  If you wanted something, you had to go and get it, either in your own garden,  finding it in the wild, or going and killing your dinner.  I guess, sometimes dinner would fight back. (Now there’s an exercise, getting chased out of the store by a angry package of spare ribs)  Then you had to prepare it, which took much more effort and time than it does today.  Now, don’t get me wrong, I don’t want to go back to those times, life expectancies in the 40’s, half the women dead during or because of childbirth, half the kids dead from childhood diseases, half the men dead from fighting each other, and hand-to-mouth survival for the vast remainder of the population.  The point is that we are not accustomed to living in an environment with readily available excess calories.  Let’s keep the extended longevity, the decreased fatality rates, the better hygiene and the effective vaccination programs for communicable childhood diseases.  Let’s face it, there has been no selective pressure for people to successfully exist in an environment with excess, readily available calories.  For almost all of our existence, obtaining calories has not been easy, now it is.  So burning excess calories is not going to be easy either.  We are hardwired to eat and to not burn excess calories.  Burning excess calories has not been a good survival strategy up until this point.  Gathering enough calories was hard enough, there was no reason to make it harder by running 5 or 10 miles or going to the gym. So we face a situation where we are not biologically equipped to know how to respond.  If we had a fullness switch we could adjust to suit each situation, or the ability to turn on the fat burning machinery when we overate, it would be easy.

The government initiatives are focused on making fitness opportunities more accessible.  Making trails around the communities.  Working with state governments; about half of the states are currently working with the CDC, holding meetings and doing research.  All of these are good efforts and there is much basic biologic information that we do not currently have.  For some reason, each individuals body will fight to maintain a certain weight, called a set point.  If we could consciously turn down the set point 10,15 or 20 pounds, then achieving that weight would be easy.  No one really understands how that set point works. We don’t all just consume all the available calories all the time, we do stop.  We will explore the basic biology behind hunger at a later date.  But we do know that our weights don’t vary all that much month to month. Therefore, getting a grasp on our weight problem, is never going to be easy, no matter what government initiatives are put in place. Just because it is not going to be easy, doesn’t mean that we shouldn’t try. Who ever thought that gaining something valuable was going to be easy?

1.  http://www.cdc.gov/NCCdphp/publications/AAG/obesity.htm

Written by ecable

March 30, 2009 at 7:00 am

Posted in Health

Diet or Diet and Exercise?

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Ideally any weight loss plan would incorporate both diet and exercise. However, the latter seems to be more difficult to implement and maintain.  Exercise takes time and effort while dieting is a modification of a daily behavior. A reason to incorporate both diet and exercise is that by decreasing calories intake and increasing calorie expenditure a quicker weight loss can be achieved.  Because, everyone knows, that calories in and calories out work like a balance right?  Decrease calories consumed and the weight will start to come off, right?  Well only for a while. Our bodies adapt to different calorie and fitness levels based on what we do and what we eat.  We will explore why the simple balance model is too simplistic to explain some of the challenges that lie in battling weight.

A recently published study by the Pennington Biomedical Research Center demonstrates important differences in diet and diet plus exercise that explain why it is difficult to maintain weight loss using just diet alone (1).  (These results are published on the Public Library of Science Online site.  It is an open access site, so if you want to download and read the paper in detail you can.)  The study tested the effects of calorie restriction (CR), calorie restriction and exercise (CR+EX), a low calorie diet (LC) compared with a control group (2).  The CR group consisted of decreasing calorie intake to 75% of what is required calculated from the subjects baseline energy requirement (a 25% reduction).  The CR+EX group had a 25% change from meeting the daily energy requirements, but 12.5% consisted of a decrease in calories, while exercise was added to increase calorie burn 12.5%.  The LC group subsisted on 890 Calories (3) per day until a 15% reduction in weight was achieved.  The CR and CR+EX groups had individual diets prepared for them for part of the time (3 months) and they were trained to adhere to the same type of diet while feeding themselves (months 3-6).  The diet consisted of 30% calories from fat, 15% from protein and 55% carbohydrate, so no special restrictions on nutrients were employed.  The study lasted for 6 months and changes in body composition and energy expenditure were assessed at baseline, month 3 and month 6. They were able to calculate total energy expenditure in the subjects using a whole room calorimeter and doubly-labeled water.  The latter method permits the measurement of energy expenditure in free-range humans and a more accurate assessment of real life energy expenditure.  Fat mass and fat free mass were also measured using a whole body imaging method called DEXA scanning. There were a total of 48 individuals, 21 males and 27 females, who were overweight (BMI>25) but were not obese (BMI<30) who started the study and only 2 of the subjects failed to complete the study. 1 was in the control group and 1 was in the LC group.

At month 3 and month 6 all intervention groups achieved significant reductions in weight, both in fat mass and fat free mass. The loss of fat free mass was slightly less for the exercise group, but it was a decrease none the less.   The LC group lost the most weight, (you try living on 890 Calories per day) about 24 pounds, which for an overweight, but not obese person would almost certainly take them into a normal BMI range.  The interesting results from this study were demonstrated when energy expenditure was measured.  Both the CR and the LC groups had a decrease in total daily energy expenditure of more than 10% at both 3 months and 6 months.  No decrease in daily energy expenditure was observed in the exercise group. The decrease in energy expenditure was explained by two main factors: 1) metabolic adaptation to decrease energy expenditure in an environment with fewer calories available and 2) a decrease in spontaneous physical activity.  That means that your body slows down to try and conserve and you unconsciously move less.  So if you are trying to loose weight, the last thing you want to happen is to have your body slow its metabolic rate and for you to move less during the day.  The addition of exercise prevented both changes. This has important implications for losing and maintaining weight loss.  Remember at the beginning I said that the simple balance model was too simple?  Well this demonstrates one aspect.  If you just try to diet, your body will fight back (as if you didn’t know that already) and slow itself down.  One way to prevent this adaptation is to make your body work.

So what do all these numbers and percentages mean for an individual?  I am going to calculate some of the study results for two hypothetical individuals, average Joe and average Joelle.  Lets say Joe is 6 ft and weighs 220 pounds.  He needs 2600 Cal/day to maintain his weight.  He has a BMI of 29.8% and a body fat percentage of 25%.  On the CR plan, Joe would consume 1950 Cal/day and weigh 207 pounds at month 3 and 201 pounds at month 6. His ending BMI would be 27.3 and body fat percentage would be 20.8%.  However, his metabolism would slow between 300-400 Calories per day.  That would be the equivalent of 1 hour of normal pace walking per day.  On the CR+EX plan, Joe would consume about 2300 Cal/day and his weights would be about the same at month 3 and 6.  However, his ending body fat % would be 20.1%, or 0.7% less fat than with just diet alone.  And no decrease in basal energy expenditure would occur.  He would be exercising just over 300 Calories per day, or about an hour of normal pace walking.  He could also run 3 miles in 30 minutes and burn about the same amount.

How about Joelle?  She is 5ft 6in and weighs 180 pounds.  She needs 1900 Cal/d to maintain his weight.  She has a BMI of 29.0% and a body fat percentage of 37.6%.  On the CR plan, Joelle would consume 1425 Cal/day and weigh 167 pounds at month 3 and 161 pounds at month 6. Her ending BMI would be 26 and her percentage of body fat would be 34.0%.  However, her metabolism would slow between 200-300 Calories per day, just on diet alone.  Again, the equivalent of 1 hour of normal pace walking per day.  On the CR+EX plan, Joelle would consume about 1650 Cal/day and weights would be about the same.  However, her ending body fat % would be 33.2%, or 0.8% less fat than with just diet alone with no decrease in basal energy expenditure.  She would be exercising just over 230 Calories per day, or about an hour of normal pace walking.  She could also run 3 miles in 30 minutes and burn about the same amount.

So with a little exercise you can prevent your body from decreasing its basal metabolic rate, burn a bit more fat and be able to get the same amount of weight loss while maintaining a slight calorie restriction.

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1. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0004377

2.  The statistical analysis of the study also combined the data from the CR and LC group, but in my opinion this unnecessarily complicated the analysis without adding any additional scientific insights.  I think the reason was to achieve significance in the total daily energy expenditure not explained by changes in fat free mass and fat mass at month 6 (Table 2, last column).  The CR and LC group are essentially diet alone groups but the daily caloric intake was different.  The CR group was a 25% reduction for each individual while the LC group was 890 Cal per day which was almost certainly more than a 25% reduction.

3.  In the paper, kcals are used.  One diet Calorie equals 1000 calories (or 1 kcal) from a chemistry/science perspective.  Diet Calories are typically written with a capital “C”, but since this is a peer-reviewed scientific paper, most journals require the use of standard units, so kcals are used and kilograms are used for weight.

Image from: http://www.fat2fitradio.com/wp-content/uploads/2008/10/1177970407-energy-balance.jpg

Written by ecable

March 23, 2009 at 5:00 am

Posted in 5755, Exercise, Health

Refined or Whole Grain?

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Increases in obesity rates correlate with increases in food portion sizes over time.  From 1910 to 1982 the average amount of food available for consumption remained within a range of 3000 to 3500 calories per day per person (1).  From 1982 to 2000 the calories available for consumption and the amount consumed increased in parallel by over 10%, or about 300 calories per day (1).  During the same time the rate of obesity went from 15-20% to approaching 30%.  For a dramatic visual of this effect see the map published by the CDC.  These data demonstrate the dramatic increase in obesity over time.  There are some really interesting data in the types of calories that are consumed.  The amount of carbohydrates consumed increased from just under 7 servings per day to almost 10 servings per day from 1970 to 2000.  Unfortunately, most of the carbohydrates were of the refined type, the least nutritious and satiating of the carbohydrates.  Examples of refined carbohydrates are white rice, white flour and white pasta.  If its white, its refined.  Whole grains still contain the outer bran and inner germ. The bran and germ contain fiber, B vitamins and antioxidants.  The white endosperm is the food supply for the developing seedling. Because it is supposed to support the rapid growth rate of the new seedling, it is calorie dense.  Whole grains tend to be darker in appearance and have more of a texture, or mouth feel, when eaten than the white variety.  Whole grains have a shorter shelf life than refined grains which explains why white is preferred by manufacturers.

Compare the nutritive value of white and wheat flour or white or brown rice (2).

nutrition-table2

One of the things that should be obvious from the nutritional chart is the decrease in dietary fiber, vitamins and minerals upon refining.  These nutrients are important and converting the product to a refined version is not in our interest as an informed consumer.  I think most understand that whole grains are more nutritive that refined grains, but still consumers prefer refined grains.  Why?  Is it because refined tastes better?  There have been only a couple studies actually testing this hypothesis.  It is one of the larger, untested assumptions in consumer America.  Ask any parent whether their child will prefer white bread to wheat bread, and the answer will most likely be white bread.  However, a study done by Zata Vickers at the University of Minnesota demonstrated that children either have an equal preference for white bread and wheat bread or that wheat bread was preferred (3).  In a follow-up study it was shown that participants liked Artisan bread, either white or whole grain, more than the bread made using standard production techniques (4).  Those participants who preferred white bread tended to like the white bread in the study.  Those who preferred refined bread cited familiarity and price as the significant contributing factors while those who preferred whole grain cited nutrition as a significant factor.  Reasons for preference including taste, texture, smell, freshness and convenience were not significant.  One of the novel aspects of this study was the use of 6-n-propylthiouracil (PROP) to assess the ability of the participants to taste bitter flavors.  The ability to taste PROP is genetically determined and those who are supertasters will avoid bitter food.  About 25% of the population are supertasters, 50% are medium tasters, and 25% are non-tasters. Interestingly, the supertasters were significantly averse to consuming whole grain bread, suggesting that some bitterness compounds in the unrefined flour contributed to the perceived bitter taste.

So about 1 in 4 people will have a real, biologic aversion to whole grain products.  3 out of 4 will have a small aversion or no aversion to whole grain products.  To assess which group you fall in, try a high quality whole grain bread to test if you can consume the product without an adverse taste.   If you really want to test whether your aversion to whole grain is due to the ability to taste bitterness, then you can have a friend give you samples in a blinded fashion, that way you don’t know what you are tasting and your expectations will not affect the results.  For the majority of the population, a good quality whole grain product is similar to a refined product in our perceived preference.  Since familiarity was a significant factor in the selection of a refined wheat bread, one just has to figure out which whole grain products they like.  There are a variety of options and choices and there is no nutritional reason to consume refined grain products when whole grain is better for you and when prepared in a preferred manner, a much more interesting and flavorful consumable.  And once the kids get used to it, they will continue a good nutritional habit as they mature.

1. http://ers.usda.gov/publications/FoodReview/DEC2002/frvol25i3a.pdf

2. USDA National Nutrient Database. http://www.nal.usda.gov/fnic/foodcomp/search/

3.Delk J, Vickers Z. 2007. Determining a series of whole wheat difference thresholds
for use in a gradual adjustment intervention to improve children’s liking of whole
wheat bread rolls. J Sensory Studies 22: 639-652.
4. Bakke and Vickers Journal of Food Science 2007

5.  For a complete nutritional comparison see the linked PDF file.

Written by ecable

March 16, 2009 at 5:00 am

Posted in Health

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Welcome to Obesity Weekly

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Why a weekly blog about obesity?  Well this blog will discuss the various aspects of obesity, including social implications, novel research about the causes and potential treatments for obesity, helpful insights into lifestyle modification techniques and successful strategies used by others in their battle for a healthy lifestyle. The topic of obesity touches every individual in some way, whether it is a personal struggle, an empathetic reaction to a friend or loved one’s own battle with weight, or (God forbid) an annoyance with someone who is too big for the neighboring seat on the airplane.  It is clear that the first world is gaining weight compared with 20 or 40 or 100 years ago.  This phenomenon fuels a multibillion dollar industry from gadgets and pills to reality TV shows.  We will discuss the obesity-associated industry later, but perhaps the current media responsible for bringing the discussion of obesity to our livingrooms and water coolers is NBC’s The Biggest Loser.  In my opinion, it is one of the most inspiring reality television shows on the air since it demonstrates that lifestyle modifications result in dramatic decreases in weight and, more importantly, in increased fitness.  Although not much medical detail is shared about the biophysical changes that the contestants undergo, the show’s physician, Dr. Rob Huizenga, does collect quite a bit of data on each of the contestants.  In previous seasons contestants successfully controlled their blood pressure, asthma, and diabetes by decreasing weight and increasing fitness; some to the point of being able to eliminate certain medications altogether.

One of the oddities of the show is just how high the expectations become for weight loss week after week.  Hydration loss can give a dramatic weight loss for a short time, but is not sustainable week after week. And obviously, a 0 or 1 pound loss would be disappointing, considering all of the time spent exercising. But when contestants continue to lose 4-8 pounds per week, a half to one pound a day, there should be no reason for disappointment.  A weight loss at that rate is phenomenal.   This phenomenon clearly demonstrates our obsession with weight as an endpoint.  Perhaps more emphasis should be placed on the drastic medical improvements made by the contestants which are not just related to weight loss but also to increased fitness.

In the US, and in particular southern California, appearance is nothing short of an obsession.  Fat is considered unfit and ugly while skinny is seen as fit and pretty.  Unfortunately, skinny does not equal fit.  There is a a phenomenon called skinny-obese in which a person can be a normal weight but actually be obese on the inside.  All fat is not the same.  Fat under the skin, subcutaneous fat, is different than fat contained in the abdominal cavity.  While subcutaneous fat can be readily observed, visceral fat, which is the fat packed around the internal organs, the heart, liver, lungs and intestines, is impossible to observe from the outside. It is not completely understood why some people are more susceptible to visceral obesity although there are clearly genetic factors involved.

Visceral obesity is predictive of long-term adverse medical consequences.  The reason we should be concerned about weight should not be from a vanity perspective but from a health and wellness perspective.  Obese individuals have a greater risks of:

Medical Name Parameters affected Increased risk of: What you should know
Dyslipidemia Decreased HDL cholesterol

increased LDL cholesterol and triglycerides

Cardiovascular diseases including heart attack and angina Fasting lipid profile
Insulin Resistance/Diabetes Increased fasting blood glucose/insulin/glucagon impact on quality of life, dizziness, weakness, lethargy and eventually diabetes complications including blindness and amputation Fasting blood glucose and insulin
Acanthosis nigricans Dermatology disorder Increased awareness of appearance
Systolic blood pressure First number of the blood pressure reading Heart disease, heart failure, stroke, kidney failure Resting blood pressure
Focal segmental glomerulosclerosis (FSGS) Increased urinary protein, decreased plasma protein and decreased glomerular filtration rate Acute or chronic renal failure Urinalysis results and any signs of swelling around the hands or feet or around the face
Gallstones No available blood tests for gallstones per se but blood tests can assess infections or obstructions

Gallstones are diagnosed by imaging

Liver or kidney damage, pancreatitis and potentially much PAIN when passing a stone
Sleep Apnea Sleeping patterns Quality of life decreases – lethargy, heart disease, high blood pressure headaches and memory problems Your sleeping patterns.  Normally told to you by someone else.
Weight associated skeletal issues:

slipped capital femoral epiphysis

genu valga, tibia vara (Blount disease)

flat kneecap pressure/pain, flat foot

spondylolesthesis (low back pain)

scoliosis

osteoarthritis

Joint pain and musculoskeletal issues Quality of life and mobility decreases

Many of these associated conditions can be decreased or eliminated with proper weight loss and increased fitness.  As this weekly blog continues we will explore a variety of subjects based on obesity, everything from hard-core science to popular culture and strategies to improve fitness in yourself, your family and your friends.

Written by ecable

March 9, 2009 at 12:45 pm

Posted in Health

Tagged with