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Rapid Responses: Rapid Responses published:
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Walk and stay fit!
- Dr.Satheesha Nayak (10 June 2005)
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obesity confusion
- Benjmain Dean (13 June 2005)
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Walk, ride, drive and walk again
- Dr.Arunachalam Kumar (15 June 2005)
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Unabsorbed calories, an important consideration.
- David E. Brown (15 June 2005)
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Dr.Satheesha Nayak, Selection Grade Lecturer in Anatomy, Manipal Academy of Higher Education Manipal, Udupi District, Karnataka State, INDIA. 576104
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Editor, It was really a nice editorial message. It is very true that the lifestyle of most of the officials, doctors and professors has become sedentary. Why only them? Now, even the students do not walk as much as we used to walk when we were going to school. I can see the students getting up late, and rushing to class either on their bikes or auto rickshaws. In the lecture hall building, instead of taking the staircase, they take the lift. The explanation given is that they sweat a lot if they walk and also it will take a lot of time. If you see, in the evenings, professors, doctors and students go for evening walks and some for jogging. Some of them go to gym. They go to the gym on their vehicles, get down and enter the gym, come back and get on their vehicles. Cant we have a lifestyle where we can walk a lot? It is possible. If the classrooms are near, or the office is near, start a little early and walk. Don’t take the lift, use the staircase instead. If you don’t use the vehicle, you will save fuel and minimize pollution that you otherwise cause while driving your vehicle. You are saving money for you and helping others to breath fresh air right? Don’t use the staircase. This will save electricity and also you will not be stuck inside the lift if there is a power failure. If you keep walking the whole day, to your office, class or work station, cafeterias etc, in the evenings you need not go to gym or walk. Sweating is good for health. So next time, try to walk a bit and avoid using vehicles for short distances. Instead of going to a gym and working out or jogging and burning your calories, you can burn them by gardening or doing some work which will not only burn calories but earns money also. Competing interests: None declared |
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Benjmain Dean, sho oxford
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Dear Sir, It is certainly of interest that increases in birth weight are linked with increasing risks of obesity in childhood(1). However when the findings of this study (2) indicate that obesity limited to childhood has limited impact on many outcomes in later life, you cannot help but feel something is being missed? Given the adverse prognosis associated with obesity (3) in adulthood, surely it is important that the reasons for these findings become unravelled. Excuse me if what I say contains a little too much conjecture. Several studies have found a strong link between low birth weight and an increased risk of ischaemic heart disease in later life (4). The risk of death was nearly three times as great in light babies. Several subsequent studies have confirmed the health benefits of a heavier birth weight, including reduced risks of stroke, heart disease and diabetes. From these results in can be argued that the consequences of some influences, including a high body mass index in childhood, depend on events at early critical stages of development. Simplistically this can be understood as a poorly nourished baby's body, imprinted with its prenatal experience, is born expecting to live in a state of food deprivation throughout its life. Thus its whole metabolism is geared to being small. Once born, the baby then finds itself in a time of plenty, it compensates by growing fast and certain systems are put under greater stress than previosuly expected. The evidence for the Barker hypothesis is my no means conclusive and is still a source of much discussion. The complex interactions between mother and foetus at both the level of genes and environment are clearly key in this debate and new evidence is coming to light (5,6). The thrifty phenotype hypothesis ( which suggests foetal adaptation to an adverse intra-uterine environment ) as explained above, does appear to be a good explanation of events. However given the available evidence, it seems there may be two different groups of indiviuals who are go on to develop obesity in adulthood - one group with low birth weights and the other with high birth weights. The evidence also appears to suggest that there is a huge difference in the risk of various pathologies between the two groups. In the UK it seems that the latter group with higher birth weights may become more numerous over time, which may have some interesting consequences. Yours, Dr B Dean 1. John J Reilly et al.Early life risk factors for obesity in childhood: cohort study. BMJ, Jun 2005; 330: 1357. 2. Russell M Viner and Tim J Cole Adult socioeconomic, educational, social, and psychological outcomes of childhood obesity: a national birth cohort study. BMJ, Jun 2005; 330: 1354. 3. M E J Lean. Prognosis in obesity. BMJ 2005:1339-1340. 4. Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989 Sep 9;2(8663):577-80. 5. Kimm, Sue Y.S. Fetal origins of adult disease: the Barker hypothesis revisited-2004. Current Opinion in Endocrinology & Diabetes. 11(4):192 -196, August 2004. 6. Ong KK, Dunger DB. Birth weight, infant growth and insulin resistance. Eur J Endocrinol. 2004 Nov;151 Suppl 3:U131-9. 7. Flanagan DE et al. Reduced foetal growth and growth hormone secretion in adult life. Clin Endocrinol (Oxf). 1999 Jun;50(6):735-40. 8. Soto I N, Mericq G V. Fetal growth restriction and insulin resistance. New findings and review of the literature. Rev Med Chil. 2005 Jan;133(1):97-104. Epub 2005 Mar 10. Competing interests: None declared |
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Dr.Arunachalam Kumar, Professor of Anatomy Kasturba Medical College, Mangalore 575001 India
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He trudged four miles each way to work and back. A Tough taskmaster at the factory, extracting long hours of toil. But he wormed his way up. Sweating and saving, until one fine day, he bought a shining new bicycle. Six years of pedalling to worksite, and he moved on, bought himself a motorbike. Life and time move. As our man worked his way up the ladder of life and earnings, his final dream turned reality. He bought himself a used car. Twenty years down the line, he owns a swanky house with a manicured garden, with two cars parked in his garage. Prosperity has made changes, in both, lifestyle and lfe. Physical comforts and physique. He looked at himself in the full-length gold gilted mirror. A beer belly, sagging jaws, and a double chin too. His sedentary schedule was taking his toll. He shook his head,and made some resolutions. Today,he walks to work everyday, four miles either way. The irony of the situation made him laugh silently. years ago he did not want to walk, so he bought a cycle, then a motorbike, and finally a car. And now after all that, he again was walking. He recalled Tolstoy's classic "How much land does a man need?" For all we have or want to, when it is time for calling quits,we just need a six foot trench. Competing interests: None declared |
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David E. Brown, Nutrition science information analyst Self employed carpenter residing at 1925 Belmar Dr., Kalispell, MT 59901, USA
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Editor: Almost the whole world believes that too many calories and too little exercise are THE major factors driving the obesity epidemic. Further, since fat contains over twice as many calories as protein or carbohydrate, it is ASSUMED that cutting fat calories will prevent obesity. For example, in Rio state, Brazil, a law banning fat-rich, high-calorie foods in schools came into effect earlier this year. This action follows a trend already under way elsewhere in Brazil. The southern states of Santa Catarina and Rio Grande do Sul also banned high fat foods in an effort to prevent childhood obesity and promote "healthful" eating habits. This legislative action was a response to recent disclosure by a government agency that 1 in 10 Brazilians is Obese due to poor eating habits. Question is, will low-fat eating prevent obesity? Not likely and here's why. In the introduction to her first book, The Schwarzbein Principle, Endocrinologist Diana Schwarzbein, MD, of Santa Barbara, California remarks, "Both medicine and the media had promoted the belief that eating a low-fat diet while increasing complex carbohydrates caused people to lose body fat and stay healthy. But I had yet to meet anyone who was healthy or thriving on a low-fat diet." Having already experimented with having her diabetic patients reduce carbohydrate and add fat to their diets and seeing them lose weight, Dr. Schwarzbein then "searched the medical literature, looking for studies showing that low-fat diets are healthy" and "was surprised that there are no long-term studies showing such results." Dr. Schwarzbein's clinical experience and journal research eventually resulted in two books recommending increased fat intake and decreased carbohydrate intake to normalize hormone balance. Other independent researchers (among them biochemists, nutritionists, dentists, medical doctors, etc.) have shown that low-fat diets lead to hormone imbalance, increased appetite, less brown fat activity, and increased calorie absorption efficiency. This last matter of calorie absorption is key to understanding where all the calories go. Everyone knows that some people can consume high calorie diets without gaining weight while others cannot reduce body fat no matter how much they exercise and restrict calorie intake. An interesting example of high calorie consumption by a sedentary individual that was not resulting in weight gain was broadcast on USA National Public Radio on November 26, 2004. Mary-Ann Beltran, a low-income single mom was enrolled in a research project in which every piece of food she ate the day before was methodically recorded by a researcher, Jenny Donaldson. On the day before the interview, Ms. Beltran had consumed 6,501 calories as calculated by Donaldson. Correspondent Patricia Neighmond's remarked that, "Sixty-five hundred calories is high, particularly when you consider the average daily caloric intake for women of Mary-Ann's age and height is about 2'000 calories. And although Beltran is not overweight now, at age 34, if she keeps eating this way, she's at risk." For me, this interview raises two interesting questions. First, why isn't Beltran already overweight and second, what reason do we have to suspect that she will ever become overweight? Here's some more interesting observations involving force-feeding studies. In How To Lower Your Fat Thermostat (1983) by D.W. Remington, MD, A.G. Fisher, PhD, and E. A. Parent, PhD, the authors report (page 70) that "In some people, even huge amounts of extra eating will fail to cause weight gain. These people seem to have a weight-regulating mechanism that can vigorously defend the selected weight by wasting huge quantities of excess energy intake." They further observed that any forced weight gain did not last because "subjects will quickly return to pre-study weight even though no continuous effort is made to diet." On page 71 the authors described a case study in which "A German scientist carefully measured his caloric intake for a full year and noted that he ate an average of 1760 calories per day." For another year he ate an extra 400 calories per day and "At the end of the year, he was still very close to his original weight even though he had eaten enough extra energy to have gained over 40 pounds. He then increased his intake another 600 calories a day for another year without changing his original weight." There is a possible explanation for this; unabsorbed calories. The digestive tract is a tube open at both ends. Muscular contractions propel food through the tube at various rates depending on the amount of food eaten and on the amount of soluble and insoluble fiber present in the food. Since soluble fiber forms a gel in the intestinal tract, it both slows absorption of digested protein, carbohydrate, and fat into the bloodstream and prevents some calories from being absorbed altogether. Consequently, The unabsorbed calories exit the digestive tract in the fecal material. Discussion of absorption efficiency on page 78 of How to Lower Your Fat Thermostat: "There is some evidence that the surface area of the gut can be increased by food denial to increase the efficiency of absorption...Rats eating only meal a day have a markedly increased rate of food digestion and absorption. Many obese people also seem to digest food more quickly, perhaps because of dietary efforts and periods of food denial." I've only read a couple hundred books about weight control so I probably haven't found all existing discussions regarding unabsorbed calories. Here are a few more sources: The Bio-Diet / 1982 by Luis Guerra, MD pp 27-28. Why Calories Don't Count / 1982 by Paul Stitt, MS pp 81-82.(1) What the Bible Says About Healthy Living / 1996 by Rex Russell, MD p 183.(2) The Doctors Book of Food Remedies / 1998 by Selene Yeager and the Editors of Prevention p 419. Although research regarding unabsorbed calories is scant and mostly goes unnoticed or is even denied by the scientific community, it is an important consideration that ought to receive more attention by mainstream medical and obesity experts because current advice, based on assumed total absorption of calories into the bloodtstream, is hurting many people who would benefit from increased fat intake. Journal references: (1) A. Antonis et. al., "The Influence of Diet on Fecal Lipids in South African White and Bantu Prisoners," American Journal of Clinical Nutrition, Vol. 11, August 1962, pp 142-155. (2) J.O. Hill, H. Douglas and J.C. Peters, "Obesity Treatment: Can Diet Composition Play a Role?" Annals of Internal Medicine 119(2):7 (1993): 694-697. David Brown Nutrition Education Project Competing interests: None declared |
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