Obesity Update 2022
Obesity groups across the globe have been meeting to develop new guidelines for treating adults living with obesity that have their roots in the hard work done by Obesity Canada in 2020, published in the Canadian Medical Association Journal.1
In May 2022, the World Health Organization warned that Europe faces an epidemic of increasing rates of overweight and obesity. In October 2022, Ireland became the first country to adopt the gold-standard set out by Obesity Canada and encouraged by the Irish Coalition for People Living with Obesity.
These meetings focused on a key aspect of obesity: it occurs due to a complex interaction of environmental factors and biology, not a conscious choice.
To address health inequalities, obesity needs to be recognized similarly to other diseases, such as type 2 diabetes, heart disease, hypertension, sleep apnea, multiple sclerosis, arthritis, and chronic lung disease. It is also essential that access to treatments for obesity be funded in the same way as other diseases, whether it be bariatric surgery, medications, or dietitian interventions.
The Canadian Adult Obesity Clinical Practice Guidelines, which stress that obesity is a prevalent, complex, progressive, and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity) that impairs health, are available online.2 They have key points for patients and healthcare professionals, along with pharmacology recommendations that have gone through academic rigour.
Regrettably, stigma ascribing obesity as a lifestyle rather than a chronic disease stands in the way.
“When a flower doesn’t bloom you fix the environment in which it grows, not the flower.” Alexander Den Heijer
Adult Obesity Stats in Canada3
In 2018, 26.8% of Canadians 18 years of age and older (roughly 7.3 million adults) reported height and weight that classified them as living with obesity. Another 9.9 million adults (36.3%) were classified as overweight, bringing the total population with increased health risks due to excess weight to 63.1% in 2018. This was an increase from 2015 where 61.9% of Canadians aged 18 and older were overweight or obese.
Overall, the proportion of adults who were overweight or obese was higher among males (69.4%) than among females (56.7%). In fact, the proportion who were overweight or obese was higher for males for all age groups starting at age 20.
Obesity and Gastrointestinal Conditions
A recent article published in the United European Gastroenterology Journal,4 looked at the connections between obesity and a variety of gastrointestinal (GI) conditions.
For some diseases, such as inflammatory bowel disease (IBD), the situation has changed dramatically over the past few decades, with a significant increase in the number of IBD patients who are overweight and suffer from obesity‐related problems. Crohn’s disease, which was previously almost synonymous with malnutrition and weight loss, is now characterised by overweight and obesity along with malnutrition and loss of muscle mass. Obesity in IBD patients significantly compromises the application of many treatments, such as biological therapy and surgery. In some cases, it is necessary to strive for weight loss before trying biological therapy or IBD surgery. The problem is slightly less pronounced in ulcerative colitis.
Overweight and obesity are becoming an increasingly common problem even in patients with celiac disease, as well as in patients with irritable bowel syndrome, which raises questions about a potential microbiome influence on all of these conditions. We need more research in this area.
The connection between gastroesophageal reflux disease and obesity is well known, and the interventions related to this disease range from lifestyle changes and weight loss diets to bariatric surgery.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common GI pathology associated with overweight and obesity.
Raising awareness about overweight and obesity in gastroenterology is of particular interest.
Diets
We are bombarded with advertisements for magic solutions to resolve obesity all across social media. Yet, these false claims have no basis in scientific fact. Some fad diets might work temporarily, because they cause you to hyper-focus and severely limit your food intake. But they don’t work in the long-term, because they are not sustainable and can lead to negative health effects.
In August 2022, Dr. Yoni Freedhoff, Medical Director of the Bariatric Medical Institute in Ottawa, wrote online that,5 “Truly, the world’s most backwards, upside-down, anti-science, nonsensical diets work over the short haul, fueled by the fact that short-term suffering for weight loss is a skillset that humanity has assiduously cultivated for at least the past 100 years. We’re really good at it!”
One of the diet claims that bothers us here at the GI Society is that you can alter the pH of your digestive tract. This is so far off basic biology that it is outright laughable. For example, promoters of the alkaline diet claim that eating foods with a high pH increases the pH of your blood, protecting you from all sorts of illnesses, even cancer. However, different parts of our bodies maintain very particular pH levels. For example, the stomach has a pH of 2-3.5, which is highly acidic while the blood has a pH of 7.35-7.45, which is slightly basic. These pH levels are tightly regulated within the body, and a deviation in the blood’s pH can be fatal. Most importantly for the purposes of the alkaline diet, the food we eat does not impact the blood’s pH.
Diet promoters might claim there’s a conspiracy to suppress their ideas, but they usually criticize mainstream nutrition science.
Many fad diets promise rapid weight loss, beyond what is safe or possible, with little effort. They often showcase people who claim to have had success and say that if they can do it, you should be able to do it as well. They usually sound too good to be true, but promoters convince you that by some magic or divine intervention, it will work.
Some villainize specific food or classes of foods and end up eliminating nutrients or overusing other foods. They often combine foods to create the illusion of discovery.
Another red flag is when you must buy uniquely formulated proprietary wonder-working supplements that no one else sells. They often claim you can achieve success without eating the mainstream way of healthy diets. Be cautious of signing up for a membership, or the purchase of expensive meal plans, and always check that it is from a credible source overseen by registered dietitians.
Sometimes they involve convoluted methods that require you to watch long videos or webinars on social media. They are usually supported by testimonials and unproven anecdotal stories, frequently from a celebrity or a bubbly person claiming to have renewed vim and vigour. They all claim to be the next best thing that no one in history has thought of, or some secret technique from centuries ago.
Then there are the detox diets, which make no sense at all, as the body is equipped with its own detoxing organ – the liver. The liver plays a large role in detoxifying and breaking down toxic poisons, drugs, alcohol, and waste products. In patients with liver failure, these unwanted substances tend to accumulate in the body and potentially lead to toxicities. The so-called detox diets don’t help with this.
The most dangerous of all are those who tout miracle cures for specific diseases, or even the cure to all disease. These diets can be harmful to even the healthiest among us but can lead to serious health problems for others. One product, promoted as a good fibre for Crohn’s disease, was pulled from the market because it caused an intestinal blockage. They had withheld the warnings, and only noted them in a book that you needed to buy from the product sellers separately.6
They prey on us with extravagant promotional materials and one-time, exclusive offers for your success. The only thing you are certain to lose long-term is your money, and maybe your peace of mind.
Think Artificial Sweeteners Help?
In an extensive, well documented study,7 researchers recently tested four non-nutritive sweeteners (NNS) – saccharin, sucralose, aspartame, and stevia – and compared them with two control groups, one using glucose and the other using no sweeteners at all. This was an open-label, multi-arm randomized control study that assessed the effects of short-term supplementation of non-caloric sweeteners on the microbiome, glucose tolerance, and additional health parameters, in healthy adults. They found that the four NNS groups showed significant and distinct altered intestinal and oral microbiome. Such an effect was not observed in the two control groups.
The researchers measured blood glucose levels during standardized glucose tolerance tests using a continuous glucose monitor. Secondary measures included microbiome readouts in stool and oral samples, and additional anthropometrics.
The core elements of anthropometry are height, weight, head circumference, body mass index (BMI), waist, hip, and limbs circumferences, and skinfold thickness.
A total of 120 participants, 20 in each group, successfully completed the trial and had enough glucose measurements for analysis. The researchers found that two of the NNS, saccharin and sucralose, significantly impaired glucose tolerance in healthy adults.
In addition, the NNS significantly affected the gut microbiome, with the strongest effect seen in sucralose. This could cause changes to the function of the microbiome that lead to glycemic alterations. NNS could potentially interact with the sweet and/or bitter taste receptors in the gut and have downstream effects on the microbiome and possible effects on the immune system. The study authors suggest that further research is necessary to monitor the effect of these artificial sweeteners.
Malnutrition and Obesity are Closely Related
With Canadian inflation rates, especially for food, skyrocketing in 2022, many of us are struggling to secure a nutritious food supply at an affordable cost. What happens when you try to do this in real life? You cut corners. Our grocery store shelves are filled with lower-cost foods that are high in calories yet low in nutrition. The availability of a variety of nutritious foods can also depend on where you live. Canada is a vast country with many people living in remote regions where accessing fresh produce is almost impossible.
While malnutrition is typically ascribed to those who eat too few calories, it is also about eating the wrong foods, typically out of financial need. Cheaper foods that are higher in carbohydrates are pro-inflammatory.
Sleep Patterns in Children Affect Eating
Inadequate sleep is also a strong independent risk factor for obesity in children. Interesting research from New Zealand shows that changing how children sleep affects what and when they eat and how active they are. During the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial,8 the researchers changed the sleep patterns of 8 to 12-year-old children and assessed whether this impacted their diet or physical activity levels.
The researchers followed children for several weeks, including one week to understand normal sleeping behaviour and two weeks of sleep intervention. During the sleep intervention there was one week that the children were asked to go to bed an hour earlier than normal, and one week that the children were asked to go to bed later than usual. Some careful measurements were done to help us understand whether being tired really does affect what children eat and how active they are.
The DREAM study researchers found that getting less sleep resulted in children consuming more energy, especially from poorer food choices and highly processed foods. Interestingly, there was little change in the physical activity patterns of the children.
The next step is to explore what resources are needed to improve sleep in children. Discovering effective interventions that focus on improving sleep in children may play an important role in the prevention and treatment of childhood obesity. Other studies looking at sleep and eating patterns show similar results.9,10,11,12