The Canadian Obesity Network had its 3rd national conference May 1-4 in Vancouver. The conference covered a whole range of obesity related topics from policy, to clinical, to basic science. Obviously, we cannot cover all of the presentations but we are able to share some information on a few of the sessions.
Here are the highlights from fetal programming, policy interventions, and food addiction.
Dr. Rhonda Bell, University of Alberta
Fetal programming is an increasingly popular area of research that investigates the impact of mother’s health, diet, and lifestyle on the fetus. It can, and should also be extended to the mother’s health during pregnancy and postpartum.
A woman’s health, diet and lifestyle during pregnancy can have permanent effects on both the mother and child. Body weight is a concern during pregnancy because obese mothers are at a higher risk for complications during pregnancy. Obesity also increases the chance of a large-for-gestational age baby, which can predispose the infant to obesity and type 2 diabetes later on in life.
For more information on fetal programming and gestational weight gain, see our previous post When in Doubt, Blame Your Mother. Pregnancy does NOT mean eating for two!
Dr. Bell presented data from the APrON study, which assessed dietary intakes in a cohort of healthy mothers in Alberta. These mothers were health conscious, well educated, and financially secure; essentially, the best possible scenario. The research compared food intakes prior to and during pregnancy using food frequency questionnaires. They found that women in general are consuming too many calories during pregnancy and gaining too much weight.
When they assessed diet quality, they found that women increased their intakes from the fruit and vegetable and milk groups. Unfortunately, they seem to increase their fruit more than their vegetable intake, and consequently still had nutrient deficiencies including folate. Folate deficiency is a concern during pregnancy because it is required for the development of the fetus’ nervous system.
Despite the increase in fruit intake, many of the women still did not meet the Canada’s Food Guide recommendations for fruits and vegetables. During pregnancy women also tend not to eat red meat but rather chicken, which may explain the low dietary iron intakes. Shockingly, only 65% avoided alcohol during pregnancy. This is despite the Health Canada recommendation to abstain from alcohol during pregnancy.
Challenges women experience to achieving a healthy diet during pregnancy include: food safety concerns with undercooked meat and raw fish, food aversions and nausea. Conversely, they report eating food such as milk, sweets, fruits, and sugar-sweetened beverages for the following reasons:
- to get a nutrient – such as calcium
- to be healthy
- because they enjoy the food
- to reduce nausea
- because of cravings – either real or expected due to common societal beliefs
The question of appropriate body weight during pregnancy is changing, as is the past belief that weight gain is necessary for all women to ensure fetal health. Dr. Kristi Adamo suggests that weight loss during pregnancy may be appropriate depending on the starting point. Weight loss is certainly not appropriate for women who are normal weight or overweight but as the BMI approaches morbid obesity there may be health benefits to weight loss. Certainly it was suggested that the current guidelines for weight gain during pregnancy are too liberal when it comes to women with obesity.
Behavioural Responses to Obesity Policy Interventions
Dr. Sean Cash, Tufts University
There has been a significant amount of research into the environmental, social, dietary, and lifestyle factors that impact the risk of obesity; however, it remains a significant problem throughout most of the world. Some have suggested it is time to consider using this research to implement policies. This is a controversial idea with some in favour of “forcing” the public to be more healthy and those rebelling against the idea of a “nanny state”. Think Mayor Bloomberg’s soda tax (which was overturned recently)…
The government’s role in obesity prevention is still unclear; however, should they wish to get involved there are a variety of tools available including:
- Research and Development
- Market Restriction
- Agricultural Policies
- Behavioural Economics
Two additional tactics were discussed in more detail.
School Based Policies
Given the young age, educational mandate and rather controlled environment, schools have been a target for policy interventions. In some cases these policies have met with moderate success and in others less so. Barriers identified to school policies include: parent resistance, lack of knowledge, student preferences, the location of the school and surrounding environment, a lack of support for implementation, and a lack of financial and human resources.
Taxes and Subsidies
This policy is often discussed as it has been used with some success in other areas such as smoking. It also has the ability to generate revenue – ideally to support and promote healthy behaviours. Taxation can also influence behavior but not necessarily in the exact manner intended. For example a soft drink taxation did decrease consumption for the first month unfortunately, this effect soon wore off AND had the additional negative effect of increasing beer consumption.
Clearly additional research into effective obesity policies is necessary to impact positive change.
Is Obesity Caused by Food Addiction?
Dr. Alain Dagher, McGill University
Is hunger an Addiction? The short answer is it depends – the term “addiction” is not well defined in medical terms. He goes on to provide the following points for consideration.
Firstly, he explains that homeostasis – loosely described as the body’s natural ability to match needs to intakes such as thirst – does not apply to food intake. From an evolutionary perspective our body is able to overeat in order to create food reserves to draw on in times of fasting – which, of course almost never occur in most individuals with obesity.
He also explains that eating is a learned behavior and that we learn early on to value high calorie foods. He introduced the concept of neuroeconomics, the theory that we inherently value high caloric foods and that calories have gotten progressively less expensive.
In a study where people were asked to bid on a variety of foods, those with the most calories were those people were willing to pay the most for. Interestingly, this occurred subconsciously because people were not able to accurately estimate the calories in the food nor was there a strong correlation between the estimated price of the food and the price they bid.
Finally, it was noted that eating is similar to “addictive” drugs in that the same areas of the brain are activated and similar rewarding neurochemicals, such as dopamine, are released. Finally, further support for food addiction was provided by pointing out that, as with other addictive substances, people can experience a lack of control surrounding food.
No Baloney’s thoughts. Research into all areas of obesity is progressing; however, we still have a long way to go in order to find solutions that will work with the current obesogenic environment. Additionally, we require research to discover the most appropriate ways to modify our current environment to promote health and implement effective policies.
If you are interested in learning more about the Canadian Obesity Network, you can check out their website.