diet – Page 2 – Dr. Noorali Bharwani

June 16, 2015

How Schools Teach our Children to be Fat

A beautiful view of the mountains in Canmore, Alberta. (Dr. Noorali Bharwani)

“Our children are getting fatter. They eat more and move less,” says Diane Kelsall, MD, deputy editor, Canadian Medical Association Journal (CMAJ April 7, 2015), in an editorial titled, “How schools teach our children to be fat.”

The editorial goes on to say that nearly 85 per cent of children aged three to four years meet activity levels recommended in Canadian guidelines, but this falls to only four per cent in teens.

Unfortunately, most of our overweight or obese children will not outgrow their weight problem. That means they develop adult diseases like hypertension and diabetes. And our schools hinder the fight against obesity in our youth, says the editorial.

If you look at a typical day for our children when they are at school then you will understand why Dr. Kelsall feels our schools are doing a poor job of preventing obesity. She makes the following points:

Our children’s school day starts early, often well before 9 am.
They are likely driven or take the bus to school.
They are tired when they arrive and sit for most of the day.
Physical education classes are usually not required after grade nine.
Lunch may be rushed, and food options available in the school may be high in fat or sugar.
At lunch or after classes, some students may participate in sports, but most don’t.
Students have hours of homework resulting in extended screen time.
They go to bed late, and the cycle starts all over again.

No wonder nearly one-third of our school-aged children are overweight or obese. Our schools should be helping our children to be healthy and that should lead to healthy adulthood. How can schools do that? Dr. Kelsall suggests the following:

Daily exercise should be mandatory for all school children. It should become part of daily life. Classes should include enough sustained, vigorous exercise to help students meet recommended activity levels, rather than the 20-minute requirement in some jurisdictions.
Walking or cycling to school is a good start.
Taking public transportation affords more opportunity for exercise than being driven by parents.

Lengthy sitting time has been shown to be a risk factor for early death in adults. The editorial says that a peek into most high school classrooms will show rows of students sitting for classes that are often 75 minutes in length, among the longest in the world. This sends the message that being sedentary is acceptable. Beyond physical education classes, getting students moving during school hours takes creativity.

We should do what Japan does. Make food education a part of the compulsory curriculum. We should encourage our kids to sleep early and get up early. Like adults, tired adolescents are at increased risk of obesity.

“Obesity is a complex disease and prevention requires multilevel intervention,” says Dr. Kelsall. It starts with the individual and family making good choices around exercise and food intake, but broader societal support is necessary. Our battle against smoking is slowly winning and message to people is clear – if you smoke then you kill yourself and hurt others. The message for obesity and overeating is the same – stop hurting yourself and the people you love.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

April 21, 2015

The Secret to Losing Weight – Eat Right and Eat Less

Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty five per cent of your effort should be spent on physical exercise. If you made a New Year’s resolution on losing weight then this is a good time to take stock of your achievement. We are into April. Have you lost at least four pounds?

If yes, then keep it up. Slow and steady wins the race. If you haven’t then you should know that there are 37,000 books in the market on how to eat right and lose weight. According to the Canadian Medical Association Journal (CMAJ March 17, 2015), dieting programs and books are a $66-billion industry. Now you know where all your money goes.

We all have different ideas on what is right and what is wrong. When it comes to eating, it will be hard to find two people following the same dietary regimen to lose weight. If you want to be a permanent loser (I mean losing weight) then eat less.

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2).

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level. There is no simple solution. It is determination and hard work.

So the secret is out – to lose weight you have to eat smart and eat less for life.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

December 2, 2014

Obesity is a Disease that Reduces Life Expectancy

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Obesity is most commonly caused by a combination of excessive eating, lack of physical activity, and genetic susceptibility with hormonal or psychiatric disorders. Obesity increases the likelihood of various diseases, particularly heart disease, type-2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

What is the solution? Is there a way to stop this epidemic of obesity, which is a disease, a medical condition?

A political solution is needed, just like the laws against smoking, says an article in the Canadian Medical Association Journal (CMAJ November 18, 2014) titled, “A political prescription is needed to treat obesity” by Fletcher and Patrick.

Last year, World Health Organization (WHO) member states declared a target to stop the rise in obesity by 2025. A report from the Global Burden of Disease Study on global, regional and national trends in overweight and obesity has shown that obesity is still increasing worldwide, including in Canada, particularly among young people.

Governments must recognize that individual-level interventions, nutritional advice and activity guidance are not working, says the CMAJ editorial. Obesity will only be curbed by population-level measures supported by legislation. There is no disagreement among experts that physical activity is not enough to prevent or treat obesity, unless it is combined with some kind of dietary intervention.

The editorial says family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy.

Bariatric surgery (surgery for obesity) has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort.

Drugs to suppress your appetite may work to some extent, but may have nasty adverse effects.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level, says the editorial.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available. We need to change our approach, says the article.

We should encourage school-based nutrition and activity, incentives for active commuting, restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products.

The editorial concludes by saying, “Our government needs to act to restrict the sale of high-calorie and nutrient-poor food products or reduce the incentive to buy them through increasing their prices via taxation.”

Can you think of a law that will make us exercise more, eat less and eat healthy? If yes, then a Nobel Prize may be waiting for you.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

January 22, 2013

The Importance of Vitamins in Our Diet

In general, most people know the importance of vitamins in our diet. But many people do not know which vitamins are really important in maintaining good health.

I would like to revisit an article I had discussed about ten years ago on this topic. Not much has changed since. The topic was also discussed in a Clinical Practice article in the New England Journal of Medicine (NEJM) titled, “What vitamins should I be taking, doctor?”

Medical teaching says that a healthy individual, who eats a good diet, does not require vitamin supplements. He should be able to meet his vitamin needs from his healthy diet. But the public interest in vitamin supplements is enormous – sometimes due to misguided reasons. Almost 30 percent of our population takes vitamin supplements. And there is no control over it.

Because the food we eat contains too many nutrients, it would be almost impossible to conduct double blind trials to see if vitamins do have improved clinical outcomes. Also the users of vitamin supplements may have healthier lifestyles or behaviours than nonusers. This would distort any clinical trial results.

The good thing about vitamin supplements is that there is greater likelihood of good than harm and cost of supplements is not that high so the authors of the article in the NEJM recommend the following vitamin supplements for healthy individuals. There is substantial evidence that higher intake of:
1. folic acid (400 ug/day),
2. vitamin B6 (2 mg/day),
3. vitamin B12 (6 ug/day), and
4. vitamin D (400 IU/day) will benefit many people, and a
5. a multivitamin will ensure an adequate intake of other vitamins for which the evidence of benefit is indirect.

The authors say a multivitamin is especially important:
-for women who might become pregnant
-for persons who regularly consume one or two alcoholic drinks per day
-for the elderly, who tend to absorb vitamin B12 poorly and are often deficient in vitamin D
-for vegetarians, who require supplemental vitamin B12 and
-for poor urban residents, who may be unable to afford adequate intakes of fruits and vegetables.

It should be noted that recent recommendation for vitamin D suggests all adults should take 1,000 to 2,000 IU daily. The upper level for safe vitamin D intake has not been well defined but is probably as high as 250 μg (10,000 IU) daily but in clinical practice, supplementation with this dose of vitamin D is rarely required.

Physicians who encourage their patients to take vitamin supplements should also educate their patients regarding healthy lifestyle and about healthy nutritious diet. Foods contain many additional important components, such as fiber and essential fatty acids and vitamin pills cannot be a substitute. Vitamin pills do not compensate for the massive risks associated with smoking, obesity, or inactivity, say the authors of the NEJM.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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