Consider this: rates of obesity continue to grow at epidemic levels while at the same time weight loss is big business ($68B and growing). If what the weight loss industry promoted actually worked, wouldn't it be reasonable to think that obesity rates should be declining?
The problem is that dominant approaches to weight loss are one size fits all, quick fixes known as diets. Most diets are temporary and highly restrictive programs of eating pursued purely for the purpose of losing weight and are unfortunately damaging exercises in futility.
Research shows that dieting is ineffective for long term weight loss and maintenance of weight. Most people who lose weight by dieting will regain it after a year. Worse, many regain more weight than they ever lost in the first place. This pattern of weight loss followed by weight gain has been termed “yo-yo dieting” and has been linked to increased risk of obesity, diabetes and cardiovascular disease.
Contributing to these poor results are the abundance of fad diets, overly restrictive and often lacking in essential nutrients. Requiring massive will power, these diets may result in weight loss, but since the behaviour required is not sustainable the rebound in weight is swift. Inevitably, the dieter returns to the poor behaviours that led to the initial weight gain in the first place.
Finally, these restrictive diets can take the pleasure away from eating and lead to lifelong disordered eating.
If you are going to lose weight and keep it off - you have to address the root causes of weight loss and address the lifestyle behaviors that resulted in weight gain.
Rather than restriction, the initial focus of any sustainable and effective approach should be on improving the quality of food in the first place.
Healthy eating is all about eating and enjoying real food - not counting calories, points or tracking macros.
But what is real food?
There is now clear evidence that eating processed foods leads to increased food consumption and weight gain. Further, when diets do work, they often do so by having people shift from refined, processed, packaged and fast foods to real, whole foods (for more on this here is a previous post).
Along with making the shift to whole food eating, other keys to losing weight for the long term are:
Small, sustainable changes go a long way!
Finally, understanding your weight loss in context of your history and current health should come first. It is essential that you work with your physician to understand if there are any other potential causes for your weight gain - especially hormonal, metabolic or inflammatory abnormalities.
At Wellness Garage, we offer a medically directed lifestyle program for weight management.
All medical visits are covered by MSP, for those with a BMI over 30 or a BMI > 27, with an obesity related diagnosis.
Our program leverages a personalized, multidisciplinary lifestyle behavior change approach - your care team will consist of a physician, nutritionist, exercise professional and health coach who will get to know you from multiple perspectives and work with you to make lifelong habit changes.
Learn more about the Wellness Garage Sustainable Weight Management program and to see if you qualify.
A very compelling read from a New York Times op/ed, making the point that we have made previously on our blog: today's chronic diseases have their origin in the evolutionary mismatch between our current environment and behaviors and what our bodies evolved to be.
In this article, we learn how evolution set out to protect us from starvation, infections and injuries leaving us vulnerable to atherosclerosis - the disease process underlying heart disease.
At Wellness Garage - we take a precision health approach to atherosclerosis prevention, treatment and reversal, by working with our members through a structured change process: Assess, Change Behaviors, Re-assess and Adjust.
Learn more about what it looks like to do a Precision Health Tune Up and take control of your health.
Sleep apnea is one of the most serious medical conditions that often goes undiagnosed.
It is estimated that up to 30% of Canadians suffer from it, yet only 6.4% have recognized the diagnosis.
What is it?
Sleep apnea is a serious condition in which a person’s breathing is repeatedly interrupted during the night. During normal sleep, air moves in an unobstructed, regular rhythm, through the upper airway, the throat and into and out of the lungs. With obstructive sleep apnea (OSA), airway blockages, usually from soft tissue collapse, prevent the normal regular breathing rhythm
What are the symptoms?
The main symptoms of OSA are
However, some people have no symptoms or may not recognize that they have symptoms.
Other symptoms may include one or more of the following:
Perhaps the best way to determine risk is the use of the STOP-BANG questionnaire which uses a series of questions and results of physical measurements to calculate the risk for sleep apnea in adults aged 18 and older.
Snoring – Do you snore loudly (loud enough to be heard through closed doors)?
Tired – Do you often feel tired, fatigued or sleepy during the daytime?
Observed – Has anyone observed you stop breathing or choking/gasping during your sleep?
Pressure – Do you have or are being treated for high blood pressure?
Body mass index (BMI) – Body mass index more than 35kg/m2?
Age – Age older than 50?
Neck circumference – Neck size 17 inches or larger for males or 16 inches or larger for females?
Gender – Male?
Positive answers to the above questions are then used to determine risk:
Low risk – Yes to 0 to 2 questions
Intermediate risk – Yes to 3 to 4 questions
High risk – Yes to 5 to 8 questions
How common is it?
In 2017, 6.4% of Canadians self-reported a diagnosis of sleep apnea through the Canadian Health Measures Survey (CHMS) - this was more than double the rate reported in 2009.
In the US, using the broadest criteria is estimated that 20-30% of men and 10-15% of women have sleep apnea.
In all likelihood, sleep apnea is under-diagnosed - using the STOP-BANG risk tool, the CHMS found that nearly one-third (30%) of Canadian adults were considered to be at intermediate or high risk for sleep apnea - 15% were high risk and 15% were moderate risk.
Rates are increasing along with the rates of obesity.
What are the risk factors?
What happens if it is left untreated?
The initial consequences of untreated sleep apnea are daytime sleepiness and difficulty concentrating results in increased errors and accidents. People with severe sleep apnea are two to three times more likely to have a motor vehicle accident - this represents an impact on morbidity and mortality that is similar to the cardiovascular sequelae of OSA.
Over time untreated sleep apnea increase risk for cardiovascular disease, high blood pressure, abnormal heart rhythms, heart attack and stroke.
People with OSA have higher rates Insulin resistance and Type II Diabetes. This association is partly manifested by the shared risk factor of obesity, but also appears to be independent. In one study, patients with severe OSA had a 30% higher risk of diabetes even after controlling for age, obesity, pre-existing cardiovascular disease.
The physiological mechanisms underlying this risk are likely related to the increase in oxidative stress caused by lack of oxygen as well as activation of the sympathetic nervous system (with the insulin resistance effects of adrenaline and cortisol).
For patients with existing metabolic syndrome - OSA is associated with poorer metabolic biomarkers: increased glucose, triglycerides, inflammatory markers, and overall increased cardiovascular risk.
Nonalcoholic fatty liver disease (NAFLD) - given the increased risk of metabolic syndrome with OSA and the shared risk factors between NAFLD and metabolic dysfunction - OSA appears to contribute to the development and severity of nonalcoholic fatty liver disease (NAFLD), independent of shared risk factors such as obesity.
Mortality - Severe OSA increases the risk of death by 2-3 time independent of other risk factors - interestingly an increased risk of mortality does not appear to be present for untreated mild OSA. What isn’t completely clear is how treatment of severe OSA affects the risk of mortality.
Once suspected due to witnessed apneic episodes, loud snoring, daytime sleepiness, resistant hypertension, or ineffective sleep - the next step is to get a sleep assessment.
The gold standard is the polysomnogram - done overnight in a sleep lab (and requiring a referral from your physician), it measures breathing effort and airflow, blood oxygen level, heart rate and rhythm, duration of the various stages of sleep, body position, and movement of the arms/legs.
A more accessible alternative not requiring physician referral is a Level III sleep study - using portable devices that can be used at home.
Is it reversible?
This depends primarily on the underlying cause of the sleep apnea - if the primary cause is obesity then weight loss can improve symptoms and lead to a cure.
Brain damage caused by severe sleep apnea is reversible. A 2017 neuroimaging study is the first to show that white matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure therapy.
There is high quality evidence that in most adults positive airway pressure therapy reduces the frequency of respiratory events during sleep, decreases daytime sleepiness, improves systemic blood pressure (BP), lowers the risk of crashes, improves erectile dysfunction, and improves quality of life across a range of disease severities.
Unfortunately to date there have been no studies that have demonstrated that treatment improves mortality.
What are the treatments?
Canadian Thoracic Society Guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070752/pdf/crj18025.pdf
American Academy of Sleep Science: http://jcsm.aasm.org/ViewAbstract.aspx?pid=31513
STOP-Bang Questionnaire. Property of University Health Network, for further info: www.stopbang.ca modified from Chung F., et al. Anesthesiology. 2008. Vol. 108: 812-821; Chung F., et al. British Journal of Anaesthesia. 2012. Vol. 108:768-75; Chung F., et al. Obesity Surgery. 2013. Vol. 23: 2050-2057; Chung F., et al. Journal of Clinical Sleep Medicine. 2014.
Dr. Brendan Byrne