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CONDUIT is not your average corporate newsletter—it’s a glossy, full-colour magazine that celebrates leading, collaborative obesity research in Canada and the people and partnerships that make it happen.
Citation preview
Fall/Winter 2007/08
insideThe obesity-asthma connectionBariatric designs for hospital furniture
Size mattersNew help for choosing portionssee page 10
Index sets world
standardsee page 13
Dr. Sue Pedersen, Faculty of Medicine, University of Calgary
Volume I · Number 2 · $4.95
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conduit 3
CONDUIT a moving tribute
photo: sittriscover photo by charles hope
Fall/Winter 2007/08 · Volume I · Number 2
The official publication of the Canadian Obesity Network (con) © 2007 Canadian Obesity Network
executive editor Dr. Arya M. Sharma, con Scientific Director
editor Owen Roberts
associate editors Kim Waalderbos Brad Hussey
project co-ordinator Arthur Churchyard
project management Lilian Schaer
copy editor Barbara Chance
design linddesign
Printed at Ampersand Printing
Address correspondence to: Canadian Obesity Network Royal Alexandra Hospital Room 102 Materials Management Centre 10240 Kingsway Avenue, Edmonton, ab t5h 3v9 E-mail: [email protected]
For address changes, contact: [email protected] Please put “conduit Magazine Address Change” in the subject line.
conduit is a publication designed to promote dialogue and understanding about obesity research and networking activities across Canada. The opinions expressed in the articles do not necessarily reflect those of con, its members, its partners or its supporters. con does not endorse any products, services, methods or research results contained herein.
conduit is written and co-ordinated by students in the Students Promoting Awareness of Research Knowledge (spark) program at the University of Guelph in Ontario, Canada. Read more about spark at www.sparkguelph.ca.
con is funded by the federal Networks of Centres of Excellence program (www.nce.gc.ca), a joint initiative of the Natural Sciences and Engineering Research Council, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council and Industry Canada.
Visit the con website: www.obesitynetwork.ca
Publications Mail Agreement Number 41467026
Please return undeliverable Canadian addresses to: Canadian Obesity Network Royal Alexandra Hospital Room 102 Materials Management Centre 10240 Kingsway Avenue, Edmonton, ab t5h 3v9
Welcome to the second issue of CONDUIT, the official publication of the Canadian Obesity Network (CON). Once again, we’ve scoured the coun-try to find outstanding examples of ingenuity and dedication in obesity
and related research. The following pages highlight just some of the people who are making real progress in the fight against the disease, and celebrate the partnerships that make it all possible.
I am pleased to report that CON’s move to the University of Alberta (with adminis-trative offices located at the Royal Alexandra Hospital) in Edmonton is progressing well. We hope to announce our new contact information and staffing details very soon, and we look forward to the new opportunities that await us in the Capital Health Region of Alberta.
On that note, I would like to express the network’s appreciation for McMaster University’s support over the first two years of our mandate. I also thank current and former staff members who worked tirelessly to get us up and running, and who helped CON achieve so much in a short period of time.
Their efforts – as well as the efforts of our board of directors, our members and our partners – have not gone unnoticed. CON has made great strides in attracting new members, building partnerships and collaborat-ing with numerous stakeholders on innovative knowledge-sharing and outreach programs too numerous to summarize here (but check out www.obesitynetwork.ca for more information). Recently, we were pleased to learn that CON’s core funding has been continued by the Networks of Centres of Excellence program, following an in-depth review of our progress to date.
I hope you enjoy this issue of CONDUIT, and I look forward to your ongoing and active membership in the Canadian Obesity Network.
Dr. Arya M. SharmaScientific DirectorCanadian Obesity Network
New furniture for obese patients. See page 12.
conduit 4
CONTRIBUTORS
As a fourth-year biological engineering student at the University of Guelph, Ashley McCArl has a passion for intricate science. In this edition of CONDUIT, she writes about how safflowers are being developed to produce insulin and about scanning software that distinguishes between types of body fat. For more, see pages 14 and 17.
KAITlyN lITTle, a third-year public management student at Guelph, is interested in policy and human behaviour within organizations. Inside this issue, she looks at the effects of new Canadian obesity guidelines for practitioners (page 6) and how accommodations are being made for obese people (page 12).
MIhIrI De sIlVA is in her third year of environmental science at Guelph and keen to learn more about the role of sustainability and regulations in consumer choices and healthy diets. Turn to page 10 for her article about tableware designed to help people eat healthy food portions.
In his third year of Guelph’s arts and sciences program, ArThur ChurChyArD is exploring links between science and social issues. He pursues more connections in his articles about obesity-related asthma rates on page 8 and public awareness of healthy weight on page 16.
conduit 5
CONTENTS
6 New guidelines prepare practitioners
8 Obesity-linked asthma may be reversible
10 Portioned plate encourages weight loss
12 safe, comfortable furniture designed for obese patients
13 Worldwide standard set for glycemic index test
14 healthy messages missing from children’s food packaging
16 survey finds gaps in Canadians’ knowledge of fat dangers
17 software pinpoints fat types in medical scans
18 ultrasound technology measures overweight health risks
20 safflowers give rise to cholesterol and diabetes treatments
||| All contributors to conduit are part of the University
of Guelph research writing program called Students
Promoting Awareness of Research Knowledge (spark).
www.sparkguelph.ca
Have a story idea for conduit? Want to give us your
suggestions? Contact us at [email protected].
Check out con online at www.obesitynetwork.ca
for network news, events and networking opportunities.
Fall/Winter 2007/08 · Volume I · Number 2
opposite: olivia brown · top: robert skeoch
Student thesis competition winner Navneet Singh, left, accepts his award from Prof. Jay Rosenfield, vice dean of Undergraduate Medical Education at the University of Toronto. See page 18.
conduit 6
By KAitlyn little
Most consumers don’t see obesity as a serious public health problem – rather, they consider it a simple cosmetic or body-image issue. But
it’s an epidemic, and Canadian researchers have developed comprehensive guidelines to put it in the spotlight by more clearly defining the problem and how it can be addressed. They hope the guidelines will help practitioners improve patient care and be an information piece for the public and policy-makers.
“The serious personal and societal consequences of inaction on the obesity epidemic can no longer be ignored,” says Dr. David Lau of the University of Calgary and chair of the Cana-dian Obesity Network’s science committee. “Obesity should be considered a pressing societal and public health issue, and we hope these guidelines will better define it as such.”
Lau co-ordinated and chaired the Canadian clinical prac-tice guidelines committee on the management and preven-tion of obesity in adults and children. This expert panel, made up of a large number of leading Canadian researchers and clinicians, did a rigorous literature review focused on clinical trials to create evidence-based recommendations. Before publication, the recommendations were sent out for external review and validation by leading international
experts. The resulting guidelines address major gaps of knowledge in the treatment and prevention of obesity, and establish priorities for future research and policy.
Dr. Shafiq Qaadri, a family practitioner and member of the Ontario parliament for Etobicoke North, says the guidelines (see sidebar) have the power to directly influence public policies. They not only address gaps in knowledge but also outline possible areas for research funding and development.
“Like all guidelines, they give us the goals we want to achieve but also show us what still needs to be done,” says Qaadri.
Now that the guidelines have been created, reviewed and published in the Canadian Medical Association Journal, the challenge shifts to communi-cating the findings and recommendations to the audience they were intended for, he says.
“Guidelines itemize what we need to do. They give detailed messages, but they can only be successful if we communi-cate them properly.”
neW GUiDelineS Set to FiGHt FAt
Information to help public, practitioners, policy-makers
conduit 7brian fray
Canadian researchers have
developed comprehensive
guidelines to better define obesity,
so it can be managed. these
guidelines are intended to be a
tool for practitioners when treat-
ing patients and a touchstone
for the public and policy-makers.
Some of the key recommendations
for health practitioners are:
||| Measure body mass index and
waist circumference in all adults
and adolescents to determine the
degree and distribution of body
fat.
||| Assess and screen for depres-
sion, eating disorders and mood
disorders.
||| Gauge readiness to change and
barriers to weight loss.
||| Provide dietary counselling and
prescribe optimal energy-reduced
dietary plan for achieving weight-
loss goals (an example being five
to 10 per cent of body weight over
six months).
||| Prescribe 30 minutes of daily
activity of moderate intensity,
increasing to 60 minutes or more
when appropriate.
||| Assess and treat obesity-
related health risks.
||| Do regular reviews and
reinforce goals for weight loss or
maintenance, as well as preven-
tion of weight regain.
For the complete list of guide-
lines and recommendations, visit
www.cmaj.ca.
GuIDING OBesITy MANAGeMeNT
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conduit 8 simon mcconico
Weight loss
encourages recovery from obesity-related respiratory problems, which affect women in particular, according to a recent Canadian survey.
BUt not oUt oF tiMeOut Of breath
By ARtHUR CHURCHyARD
obesity and asthma are sometimes a package deal, Université Laval researchers have found.
Multiple studies have demonstrated the impact of obesity on respiratory problems, including one recent survey of 330,000 adults that revealed obese individuals are significantly more likely to have received a diagnosis of asthma. The large-scale Canadian study, led by Laval respirologists, sets this country dead centre in the trend.
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conduit 9conduit 9
Boulet cautions, however, that not all shallow breathing seen in obese patients is the result of asthma. Asthma is characterized by bronchial inflammation that leads to increased airway “twitchiness,” as he describes it. The airway responsiveness is greater, closing more easily if trig-gered by allergens or stress. He says it’s unclear whether obesity actually causes asthma or whether the extra weight forces temporary changes in airway integrity. He points to animal research that shows obesity can increase hormones in the body that promote asthma. Another possibility is that asthma and obesity are genetically more likely to occur together.
That makes it tough to give an accurate diagnosis, says asthma researcher Dr. Shawn Aaron of the University of Ottawa. A misdiagnosis could lead to unnecessary use of expensive inhalers, medication and injections currently used to treat asthma.
Aaron is studying reported asthma cases in eight large Canadian cities to see how many patients actually have the condition. He estimates that 30 per cent of obese patients who have been diagnosed with asthma because of short-ness of breath may have been misdiagnosed and may not have active asthma at all. His study will clarify some of the reasons behind obesity’s connection to asthma. It will also promote weight loss and public awareness of the connection.
Aaron and Boulet – both Canadian Obesity Network members – agree that losing weight isn’t easy, especially in cases of extreme obesity. Deeper understanding of the mechanisms that link obesity and asthma could make it possible to find treatments that stop asthma early on for people with obesity.
New treatments aren’t the only solution. Both physicians stress that using Canada’s food and exercise guidelines would not only reduce obesity-related breathing problems but would also help asthma patients already at a healthy weight. The end result is health-care dollars in the bank and more opportunities to breathe deeply at work and play.
Dr. Louis Philippe Boulet of Laval’s Department of Medicine has found that obese Canadians – particularly women – report higher asthma rates. Canadians are also more likely to use asthma medication when they have a higher body mass index ratio (a measurement of weight class based on weight and height).
“Obesity is frequently associated with asthma-like respira-tory symptoms, and it’s important to confirm the diagno-sis of asthma in order to provide adequate treatment and counselling,” says Boulet. “Doctors should be warning their patients that significant weight gain may be detrimental not only for heart disease and diabetes but also for respiratory problems.”
For the study, he analyzed data from the most recent Canadian Community Health Survey to establish the connection between obesity and asthma. But his personal practice has led him to believe this trend is reversible for some patients. He has seen weight-loss surgery patients recover from asthma symptoms after losing a significant amount of weight.
Improvements can be seen even with milder degrees of weight loss, Boulet adds. Losing 10 to 15 per cent of body weight may also be associated with significant asthma improvements.
“It’s fascinating to see such improvements achieved in respiratory function simply by losing weight,” he says.
Although obese patients can reduce severe asthma attacks by shedding extra pounds, the mechanisms by which weight loss improves lung function need to be studied more care-fully, he adds.
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Recovery is possible for women, who are more susceptible to obesity-linked asthma
conduit 10
By MiHiRi De SilvA
People with diabetes, especially those on medica-tion, could benefit from a new plate that outlines appropriate portion sizes. That’s the word from a
study on “The Diet Plate,” a trademarked set of dishes that were found to be as effective as weight-loss medications, without the side effects or a need to cut out favourite foods.
The six-month study was led by Dr. Sue Pedersen, an endocrinologist at the University of Calgary’s Faculty of Medicine and a member of the Canadian Obesity Network. Pedersen emphasizes that although poor food choices are strongly correlated with obesity, inappropriate portions cause just as many problems.
“People today don’t understand what an appropriate portion is,” she says. “Patients with diabetes are taught to use their fists or palms as measuring tools, but this advice is impractical and not often followed.”
The Diet Plate and its accompanying breakfast bowl are carefully calibrated using lines and visuals to help users ration carbohydrates, proteins, cheese and sauces. The plates allow different calorie counts for each gender and are designed for a wide variety of foods; the bowls are unisex and used only with cereal.
The study involved 130 clinically obese subjects with type 2 diabetes. Half of the participants were assigned to a control group and maintained their usual diet routine. The other half were given a Diet Plate and breakfast bowl and were
DRAWinG tHe line on PoRtionS
Study finds partitioned plate encourages weight loss
asked to use the plate once daily with their largest meal and the breakfast bowl whenever they ate cereal.
The dishes proved to be effective, says Pedersen. Those using them were more than three times as likely to lose five per cent of their body weight compared with those not using the plate and bowl. This loss in body weight is clini-cally significant for people with obesity because it reduces
conduit 11charles hope photography
the risk of heart disease and cancer, as well as other weight-related illnesses, she says.
Using portion-control tools to manage weight is nothing new, but Pedersen’s clinical study of The Diet Plate is the first of its kind. Her results are especially promising because they showed success despite three-quarters of the partici-pants taking medication to treat diabetes. Almost half of the participants regularly used insulin, a hormone known to stimulate weight gain.
Pedersen also found a decline in the amount of medication needed to control blood glucose levels, reported by 26 per cent of the intervention group and 11 per cent of the control. This decline could take the edge off cumulative costs of daily diabetic medication, along with associated side effects, she says. Lower medication needs counter the tendency of patients with type 2 diabetes to increase medication doses over time, she adds.
Overall, says Pedersen, the plate improved eating habits by demonstrating appropriate portion sizes and reduced dependency on weight-inducing diabetes drugs, making it an effective ingredient in the recipe for healthy daily choices. She notes that anyone who is overweight could use the plate to lose weight.
Dr. Arya Sharma, scientific director of the Canadian Obesity Network, hails Pedersen’s results as a much-needed development in society’s shift towards healthy eating habits.
“These special plates are a practical option for managing portion sizes,” he says. “Any tool that makes it easier for people to make the right choices when it comes to eating is extremely useful, and to now have validation that this particular approach works is good news for those who are counselling patients to manage their weight.”
||| others involved in this research were Dr. Gregory
Kline and post-graduate student Jian Kang of the Faculty
of Medicine at the University of Calgary. Funding was
provided by the Stewart Diabetes education Fund. Plates
and bowls were donated by Diet Plate ltd.
Tableware outlined with balanced portions is a new and creative mealtime approach to weight control.
conduit 12
Comfort and safety are the central features of this special hospital furniture for people with obesity.
By KAitlyn little
the unique needs of obese people have long been over-looked when it comes to design-
ing accommodating furniture. This is especially noticeable in the hospital setting, where something as basic as a well-designed chair that could boost patients’ comfort and safety levels
– and be a boon to health-care profes-sionals as well – is often missing.
Industrial designer Helen Kerr, presi-dent of Toronto-based design firm Kerr and Company Inc., is helping to fill this unmet need with a chair designed specifically for obese patients that is both functional and visually appealing.
“An enormous portion of the popula-tion going into the hospital has been completely overlooked in terms of their need for bariatric furniture,” says Kerr.
To begin, she toured bariatric clin-ics to gain an understanding of what this population needs from furniture. She says there’s a lot to be considered when designing new furniture, includ-ing how people fit into chairs, how the furniture enables them to breathe and the degree to which patients can access the chair.
Kerr’s design features strong flat
armrests that provide a sturdy grip for pushing out of the chair, cut-outs along the outer edges between the back and seat that allow caregivers to help patients stand up, and reinforced legs to secure the chair.
Inclusive and accommodating health-care environments are also of key interest to Mary Forhan, an occupational therapist and Canadian Obesity Network (CON) member.
Forhan plans to evaluate the impact of bariatric suites in hospitals to deter-mine how an ideal room could be designed to meet the needs of obese patients and their caregivers in hospi-tal environments. She is a graduate of CON’s 2007 Obesity Summer Boot Camp.
“Patient and caregiver safety is a paramount concern,” she says.
“Bariatric hospital suites are impor-tant as they make people more willing to seek out health care and enable health-care professionals to do their job safely and more efficiently, lead-ing to a decrease in lengths of stay for hospital patients.”
Forhan, who works in the research and service unit called Accessibly Yours at McMaster University, recently led a meeting of key stakeholders interested in obesity accessibility and mobility equipment. She gathered together designers, engineers, retail-ers, clinicians, nurses and patients to lay out several directions for future research initiatives to secure funding for equipment that meets the need of obese patients. The report from that meeting is available online at www.obesitynetwork.ca.
“Helping people with obesity is beyond a moral obligation,” she says. “It’s a safety issue in the same way that access to care is a fundamental right. The cost of the suites is nothing compared with the costs of accidents and loss of productivity incurred if we don’t make the changes.”
The hospital setting is not the only place where researchers are helping to make room for obesity. Ambulances, offices and automobiles are also being better outfitted to accommodate the growing number of people who are obese.
New designs increase both safety and comfort levels
The shAPe OF ThINGs TO COMe
sittris
conduit 13
Lentils, pearl barley and spaghetti are three favourite low-glycemic foods for Prof. Thomas Wolever of the University of Toronto. He created a standardized test that measures the influence of carbohydrates on blood sugar.
By MAtt teeteR
D iet and exercise play an important role in preventing and controlling diabetes and obesity. People with diabetes make special room in their
diet for foods that increase blood sugar levels slowly. These are known as foods with a low glycemic index (GI).
Prof. Thomas Wolever, a Canadian Obesity Network (CON) member in the University of Toronto’s Department of Nutritional Sciences, helped develop the GI, a tool to measure the speed at which a food’s carbohydrates increase blood sugar. The index was developed to aid people with diabetes and is now catching on for weight management, but Wolever says GI measurements have been inconsistent across the food industry.
“So far, it’s been difficult for industry to implement GI measurements because they vary so widely,” he says.
In response, Wolever created the Glycemic Index Labora-tories to provide reference testing for members of the food industry. Food companies from around the world contract the firm to ensure that testing of their products is done accurately and confidentially and to refine their own testing protocols.
His U.S. clients can use the test results in product advertis-ing, but in Canada, current regulations don’t allow GI claims, so these companies are building the knowledge for potential future use.
To calculate a food’s GI, Wolever compares it with a refer-ence food, usually pure sugar or glucose, which is assigned a GI of 100. A food that produces half the blood sugar response of the reference is assigned a GI of 50.
low-GI energy bar manufacturer Solo GI Nutrition, calls “spike, crash and crave.” This cycle increases risk for diabetes, obesity and cardiovascular disease by keeping blood sugar in a chronically unbalanced state. This might suggest that carbohydrates are bad, but Katz says that’s not the case.
“Carbohydrates are the preferred energy source of the body. It’s the quality of the carbs that matters, not the quantity.”
Katz agrees with Wolever that consistent testing is required. He points to Australia’s leadership in including GI measurements on food labels. But current Health Canada regulations prevent such labelling.
“GI information should be seen as nutrient content, not a health claim,” says Wolever. “Industry must lead the charge to get this changed.”
He and Katz say consumers, as well as industry, need to be better educated about the value of the GI. Education is one of the reasons they’re members of the CON, with Wolever describing the network as a valuable forum for raising aware-ness. Both he and Katz are working to educate consumers about GI to encourage healthier eating choices.
PASSinG tHe Gi teStCanadian researcher is setting worldwide standard to measure food’s influence on blood sugar
Eating a high-GI food raises blood sugar rapidly, which the body coun-ters by flooding the blood with insu-lin. Insulin plunges blood sugar lower again, which creates more hunger and leads to metabolic processes that store more calories as fat.
The whole cycle is what functional food developer Saul Katz, CEO of
arthur churchyard
conduit 14
By ASHley McCARl
Supermarket marketing strategies used for most children’s food products may promote poor eating habits, says a Carleton University researcher.
Canadian Obesity Network (CON) member Charlene Elliott of Carleton’s School of Journalism and Communica-tion evaluated food products targeted specifically at children in supermarkets and found that kids’ fare typically empha-sizes the entertainment and artificial or unnatural aspects of food.
“The supermarket is important because it’s an overlooked area when it comes to researching the impact of food promo-tion on children,” says Elliott. “There is much focus on the influence of television advertising of junk and fast food on children’s food preferences, but less attention is placed on supermarkets and the ways that ordinary foods have been designed to appeal to children.”
For the study, she analyzed the expanding category of fun foods in Canadian supermarkets. Fun food is not junk food
– rather, it’s food symbolically positioned as children’s fare and often framed in contrast to so-called adult food.
Fun foods are identifiable by their packaging and graphics or by the unusual shapes, tastes and colours of the food itself. Elliott assessed 367 products for package claims, images and nutritional profile.
She found that messages contained on fun food labels were strongly focused on entertainment. Whereas adult products tended to emphasize natural functions, tastes and textures, the children’s food focused on more unnatural qualities, such as yogurt tubes that glow in the dark and drink mixes that “magically” change colour.
Fun foods were once limited to the cereal aisle in super-markets but are now seen throughout the entire store. Elliott argues that promoting food as sport or entertainment to young children has significant implications.
fun foodIs
faIr?
conduit 15sean locke
“Behaviour modification programs for overweight adults stress that particular habits, such as eating when bored or for entertainment, work to make people fat,” she says. “Yet the very habits proven to encourage obesity in adults are being promoted to children through the messages of fun food. Viewing food solely entertainment is an unhealthy message to be sending to our children.”
CON member Prof. Guy Faulkner of the University of Toronto’s Department of Physical Education and Health says the impact of media messages on human behaviour
fun foodis highly complex, but is clearly understood by the multi-billion-dollar food marketing industry.
“Ultimately, if advertising did not have an impact, then who would bother spending all that money?”
With the recent surge in physical activity messaging, Faulkner is finding that food companies are increas-ingly sending messages about “energy balance” rather than healthy eating – suggesting that it doesn’t matter what children eat as long as they become more active to compensate for the extra calories. This affects the choices shoppers make as they examine packaging at the point of purchase.
In future research, Elliott will study the parental role in children’s food choice behaviour, to see if the adult healthy-eating messages are being passed down. She’s also conduct-ing focus groups with children to test their understanding of nutrition claims and to see how they respond to the food products specifically marketed to them.
||| Funding for elliott’s project was provided by the
Canadian institutes of Health Research and Carleton
University.
Researchers evaluate food products and messages being promoted to kids
Kids and parents can reach for healthy foods instead of foods marketed to entertain.
conduit 16conduit 16 robert skeoch
By ARtHUR CHURCHyARD
Canadians are in denial about the personal health conse-quences of extra weight.
That’s the message from a recent report card survey conducted by the Canadian Obesity Network (CON). It revealed that a majority of Canadians know they’re overweight and believe extra weight carries health conse-quences, but they don’t think they’re very much at risk themselves.
The survey drew information from 4,990 respondents in the Vancou-ver, Edmonton, Calgary, Hamilton, Ottawa and Montreal areas. It shows Canadians are aware of health risks associated with being overweight but aren’t taking the lesson to heart, says a McMaster University physician.
“There’s this disconnect between what we know about the consequences of obesity and what we believe will happen to us personally,” says Dr. Rich-ard Tytus of McMaster’s Department of Family Medicine, who was involved in the study.
He says that fewer than a quarter of respondents in the Hamilton region thought they had a higher health risk
even if they were overweight, although general awareness of obesity health risks was high.
One health risk escaped many survey respondents’ awareness, however. Only half knew that fat concentrated in the abdominal area poses greater health risks than fat distributed around the body. Tytus says it’s well-known in the medical community that, for every inch of extra flab around the midsec-tion, the risk of heart disease and diabetes increases dramatically.
He notes that knowledge about healthy waist size was alarmingly absent – only 25 per cent correctly
identified 102 centimetres as the at-risk point for men, and even fewer could identify 88 cm as the cut-off for women. Only 12 per cent of survey respondents had ever talked to their doctor about obesity.
Tytus stresses that doctors can’t act as educators about health basics with-out more open communication lines.
“How many people even know how to measure their waist circumference? Doctors could easily explain that waist size is measured at the top of the hip bones, not over the belly button. But these conversations are not being initiated.”
Dr. Bob Dent, director of the Weight Management Clinic at the Ottawa Hospital and head of the CON’s mental health section, blames lack of funding in the health-care system for the short amount of time Canadian doctors spend with patients. The average patient gets three minutes of attention.
But Dent also notes studies have shown that if a health professional takes time to point out weight prob-lems, patients are much more likely to take action than if they’d initiated discussion themselves.
The survey was conducted by Ipsos-Reid Canada on behalf of Sanofi-Aventis Canada Inc. and the CON.
CANADIANs sTruGGle WITh BAsIC heAlTh MessAGesSurvey of six major cities finds health lessons not being taken to heart
Canadians aren’t making the necessary link between obesity and personal health risks, says Dr. Richard Tytus.
conduit 17bob ross
Body scans can reveal various types of fat distribution using images produced by specialized software.
By ASHley McCARl
D ifferentiating fat types using medical scans is easier thanks to Montreal-based TomoVision’s cutting-edge software that
accurately tags and tabulates specific fat tissues. The software sets the standard for measuring fat and is used in obesity research across North America. TomoVision is a partner of the Canadian Obesity Network (CON).
TomoVision president Yves Martel says medical scans such as magnetic resonance imag-ing (MRI) and computed tomography (CT) are commonly used to determine body composition. But differentiating between fats with MRI scans has always been a consuming and daunting manual task because there was no software to support it. That’s why he developed a program he’s dubbed “SliceOmatic.”
“There was a need for a program that could help differenti-ate between the various fat types in medical images,” says Martel. “SliceOmatic fills this need and gives researchers the same standard tool to use.”
SliceOmatic allows users to semi-automatically tag each pixel – an individual point in an image – on an MRI or CT scan. Once this is complete, the program tallies the tagged pixels to calculate the volumes of different fats and other tissue ratios.
Fat, pixel by pixelNew tissue-tagging program slices and dices body composition
Martel explains that fat tissues in the human body take two forms: fat that lies directly under the skin
(subcutaneous) and fat that surrounds internal organs (intra-abdominal). Research has recently focused on the intra-abdominal fats, which are linked to higher rates of diseases such as diabe-
tes. The SliceOmatic allows for quick and easy differentiation between the fats, so that disease
risks can be more easily identified. His original interest in medical analysis software
was fostered by Prof. Bob Ross of the Department of Physical and Health Education at Queen’s Univer-sity, also a CON member. In the late 1980s, Ross was completing his thesis on fat tissues displayed in full-body medical scans at l’Université de
Montréal. He needed a user-friendly way to analyze MRI images and turned to Martel to develop a solu-
tion. Since then, Martel has continued to improve his program, and it has taken off in popularity with the research community.
The program, developed entirely in Canada, has been verified and used in dozens of studies around the
world. Ross says it has helped researchers learn more about the relationships between disease and different body shapes of obese people, and how those relationships are affected by gender, age and race.
“SliceOmatic has been used by numer-ous researchers to understand the effects of differences in fat distribution in groups of people,” says Ross. “It’s an accurate tool that can be adapted to individual needs.”
One adaptation Martel made was to develop image format converters. At one point, there was a different image format for each individual scanner. He says a lot of those old scan-ners are still being used, producing images that are difficult to import to a computer. His software now has the tools to read scanner archives and convert images to a standard format.
conduit 18
By ARtHUR CHURCHyARD
echocardiography and the echo generation share a common champion: Navneet Singh, the 2007 winner of the Canadian Obesity Network (CON)
thesis competition. Singh’s winning paper about echocar-diography – a new way to measure a risky type of fat around the heart – shows the ingenuity young people can bring to the fight against obesity.
“At this point, researchers are playing catch-up to see how well fat around the heart can predict obesity-related health risks,” says Singh. “Echocardiography is undoubtedly a good technique to measure this fat, but it requires more investigation.”
Echocardiography measures the thickness of visceral epicardial fat (found around the heart and blood vessels). The emerging technique helps determine a person’s risk for obesity-related diseases such as heart disease.
Singh notes in his thesis that echocardiography has signif-icant advantages over other risk-measurement techniques. It uses ultrasound technology that health practitioners can easily implement, and it’s less expensive than MRI scanning, which is often inaccessible for obese people.
Still, he acknowledges there is another way to measure disease risk that is even faster and relatively simple. Measuring waist circumference can serve as a good warn-ing flag for obesity-related diseases. The only catch is that waist measurements include both the subcutaneous fat just under the skin and the deeper abdominal fat surrounding the organs, but it’s the latter that poses the greater health risk.
Singh’s research paper suggests that echocardiographic measurement of epicardial fat could be a competitive way to assess risk for obesity-related diseases, but it remains to be proven over time as obesity interventions are carried out.
Singh, who just completed a term as co-chair of the CON’s Students and New Professionals initiative, an organization he co-founded that links students and mentors in the network, says mentors have defined his research career. Dr. Gianluca Iacobellis of McMaster University’s Department of Endocri-nology and Dr. Arya Sharma, CON’s scientific director, have both inspired and guided him through his research.
Iacobellis, who was the first to propose and validate epicar-dial fat measurement by echocardiography, says Singh’s enthusiasm and genuine interest made all the difference in his research paper, which was published in the McGill Journal of Medicine this year.
“Navneet has the potential to become an excellent clinical scientist,” says Iacobellis. “His work with me in epicardial fat measurement and other clinical studies has been tremendous.”
Singh remains in an advisory role on the Students and New Professionals board at the University of Toronto, where he’s in his second year of medical school. He continues to do research with Iacobellis on the effect of weight loss on epicardial fat.
||| Singh’s winning research paper was supported by
the John D. Schultz Scholarship provided by the Heart
and Stroke Foundation of Canada. Con received dozens
of submissions for this year’s contest, which was
adjudicated by a panel of multidisciplinary obesity experts
chosen from the network’s membership.
SoUnD PRoGReSS
Student wins Canadian Obesity Network thesis competition with research paper on ultrasound technology
conduit 19
conduit 20 sembiosys
By ASHley McCARl
Safflower has traditionally been known as an oilseed-producing plant grown mainly in Califor-nia for use in the food industry. But it also provides
a sustainable method of producing insulin at a price people worldwide can afford.
That’s the word from a Calgary-based pharmaceutical company called SemBioSys. It’s working with the plant to develop treatments for diabetes and high cholesterol by integrating the genes for two important proteins – insulin and a high-density lipoprotein (HDL) called Apo AI – into safflower. These proteins are key components in treatments for people with diabetes and heart disease, both of which are commonly linked to obesity.
SemBioSys chief scientific officer Maurice Moloney says current production techniques for insulin and HDL are expensive, increasing the cost of treatment and making it unaffordable for many around the world.
But because safflower can be grown on low acreage with high yields, the plant can provide a significant boost to insu-lin and Apo AI production, he says.
“The advantage of using plants is that we can increase production of these proteins with less money and low capital. Using safflower to produce pharmaceuticals such as insulin opens a lot of doors globally.”
Moloney has found that safflower is an ideal production and packaging plant for insulin or Apo AI. The genes that code for the synthesis of the proteins can be inserted into safflower plants to make them mini-solar factories that produce either insulin or HDL. The genes direct the flowers to produce the proteins, which are packaged in bundles and then moved to storage with the oil of the seeds. The proteins are extracted through grinding the seeds and mixing with water, which allows the protein-rich oil to rise to a top layer, where it can easily be removed and purified to separate out the protein.
The gene for Apo AI was identified by Italian scientists. In later clinical trials in the United States, it was found that Apo AI could bind to cholesterol and remove years of plaque buildup in the arteries. That meant, for the first time in medi-cal history, a drug could reverse arterial damage built up over time. That excited the medical community, which is likewise enthused about the Apo AI gene being incorporated into
SAFFloWeR PoWeR
Alberta company develops home-grown solution to treat obesity-linked diseases
Safflowers are being designed to yield oil containing insulin and a protein that binds cholesterol.
The Canadian Obesity Network’s Premium Obesity literature services
OBESITY+ provides the best evidence for obesity practice in medicine, nursing, nutrition and rehabilitation from over 130 premier clinical journalsCitations are:
Pre-rated for quality by •research staffRated for clinical relevance •and interest by at least three members of a worldwide panel of practising health professionals with an interest in obesity.
Knowledge Translation+ (KT+) is provided by McMaster University’s Health information Research Unit, and provides access to the current evidence on “t2” knowledge translation. t2 Kt is about understanding and enhancing the application of research-derived knowledge in health care and this online alerting service and database will be of special interest to Kt researchers and professionals.
Preliminary Research Evidence-ObesItY+ expands coverage on ObesItY+ to include preliminary clinical research evidence. its purpose is to inform obesity researchers of current clinical care and preliminary clinical research as it is published, matched to your information needs.
Professionals with an interest in obesity can join the Network for free and gain access to
OBESITY+, Kt+ and PRE-OBESITY+
OBESITY+, Kt+ and PRE-OBESITY+ are accessible via the Canadian obesity network home page at
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safflower to produce HDL medicines efficiently and cheaply, and to help reduce the risk of heart attack.
Safflower has also been modified to produce insulin, which is expected to be increasingly in demand as user-friendly inhalers are used more frequently. Compared with the injec-tion method, inhalers require 10 to 20 times more insulin to be effective. Moloney says safflower-derived insulin could meet this increased demand. And he notes that Canada, where insulin was discovered in 1922, could provide the right agricultural climate to grow the insulin-producing safflower.
“It would be poetic to have the birthplace of insulin also become the world’s major supplier,” he says.
Fellow researcher Prof. Peter Jones, who holds the Canada Research Chair in Nutrition and Functional Foods at the University of Manitoba, focuses on the disease triad of diabetes, obesity and heart disease. With more people becoming affected by these diseases worldwide, Jones notes the need for alternative production methods.
“For the first time in history, our children will have a shorter life expectancy than their parents,” he says. “We need leading-edge, innovative solutions to these problems, and using safflower is a great example of that.”
conduit 22conduit 22
PARTNERSHIPS
universities (Canada)Dalhousie UniversityLakehead UniversityMcGill UniversityMcMaster UniversityMemorial UniversityQueen’s UniversityRyerson UniversitySimon Fraser UniversityUniversité de SherbrookeUniversity of AlbertaUniversity of British ColumbiaUniversity of CalgaryUniversity of GuelphUniversité LavalUniversity of ManitobaUniversité de MontréalUniversity of New BrunswickUniversity of OttawaUniversity of Prince Edward IslandUniversity of SaskatchewanUniversity of TorontoUniversity of VictoriaUniversity of WaterlooUniversity of Western OntarioYork University
universities/Institutes (International)Karolinska Institutet, SwedenMax-Delbrück-Centrum für Molekulare Medizin, Germany
Mayo Clinic Department of Medicine, Rochester, Minn.Medical University of Gdansk, PolandPennington Biomedical Research Center, Baton Rouge, La.Rockefeller University, New York, N.Y.The Royal Veterinary and Agricultural University, DenmarkUniversity of Cincinnati, Cincinnati, OhioUniversity of Colorado, Denver, Colo.University of Kansas, Lawrence, Kan.
GovernmentCanadian Institutes of Health Research — INMDCommunications Research Centre CanadaHealth Canada, Office of Nutrition Policy and PromotionNational Research Council Canada Institute for Information TechnologyOntario Ministry of Agriculture, Food and Rural AffairsOntario Ministry of Education and TrainingOntario Ministry of Health PromotionPublic Health and Community Services, Hamilton, Ont.
hospitals/health-Care Networks Capital Health, Primary Care Division, Edmonton, Alta.Hamilton Health Sciences Corporation, Hamilton, Ont.Hôpital Laval Research Centre, Sainte-Foy, Que.Ottawa Hospital, Ottawa, Ont.St. Boniface General, Winnipeg, Man.St. Joseph’s Healthcare, Hamilton, Ont.
Non-Government Organizations (Canada) Active Healthy Kids CanadaCanadian Association of Bariatric Physicians and SurgeonsCanadian Association of Cardiac RehabilitationCanadian Association of GastroenterologyCanadian Association of Occupational Therapists Canadian Council for Food and NutritionCanadian Diabetes AssociationCanadian Hypertension SocietyOntario Pharmacists Association Canadian Physiotherapy Association Canadian Public Health AssociationCanadian Society for Exercise PhysiologyCanadian Society for Clinical NutritionCanadian Urological AssociationConference Board of CanadaDietitians of CanadaHeart and Stroke Foundation of CanadaObesity Canada
Society of Obstetricians and Gynaecologists of CanadaThe Arthritis Society
Non-Government Organizations (International) European Association for the Study of ObesityInternational Association for the Study of ObesityInternational Obesity Task ForceThe Obesity Society
IndustryAbbott Laboratories Ltd.Boehringer Ingelheim Ltd.GeneOb Inc.Global DiagnosticsGlycemic Index Laboratories Inc.Innovus Research Inc.Isotechnika DiagnosticsJohnson & Johnson Medical Devices DivisionJSS Medical ResearchEli LillyMedtronics Inc.Merck Frosst Canada Ltd.Natural FactorsNew Era NutritionNovartis NutritionNovartis PharmaceuticalsPfizerSanofi-AventisTM BioscienceUniversity Technologies InternationalWyeth
OtherActing Living AllianceAdvanced Foods and Materials Network, Guelph, Ont.
Atlantic Health Promotion Research Centre, Halifax, N.S.Canadian Health Services Research FoundationCentre for the Advancement of Minimally Invasive Surgery, Alta.Connex HealthChild and Family Research Institute, Vancouver, B.C.Dairy Farmers of CanadaDe dwa da dehs nye>s Aboriginal Health Centre, Hamilton, Ont.Drug Information and Research CentreFood and Consumer Products of CanadaFirestone Institute for Respiratory Health, Hamilton, Ont.Golden Horseshoe Bioscience Network, Hamilton, Ont.Obesity SurgeryOntario Science Centre, Toronto, Ont.Ontario Training Centre in Health Services and Policy Research, Hamilton, Ont.MaRS Discovery District, Toronto, Ont.Metabolic Modulators Research Ltd., Edmonton, Alta.PATH, McMaster University, Hamilton, Ont.Population Health Research Institute, Hamilton, Ont.Refreshments CanadaSociety of Rural Physicians of Canada, Shawville, Que.Technical Standards and Safety Authority, Toronto, Ont.
… and more partners are coming on board daily.
||| if you’d like to know more about how to partner with the Canadian obesity network or if you have suggestions for possible partnering opportunities, contact:
[email protected] Canadian obesity network Royal Alexandra Hospital Room 102, Materials Management Centre 10240 Kingsway Avenue edmonton, ab t5h 3v9 www.obesitynetwork.ca
CANADIAN OBESITY NETWORK
Put Your StrengthBehind Us
Universities (Canada)Dalhousie University, Halifax, NSLakehead University, Thunder Bay, ONLaval University, Quebec City, QCMcGill University, Montreal, QCMcMaster University, Hamilton, ONMemorial University, St. John’s, NLQueen’s University, Kingston, ONRyerson University, Toronto, ONSimon Fraser University, Burnaby, BCUniversité de Sherbrooke, Sherbrooke, QCUniversity of Alberta, Edmonton, ABUniversity of British Columbia, Vancouver, BCUniversity of Calgary, Calgary, ABUniversity of Guelph, Guelph, ONUniversity of Manitoba, Winnipeg, ABUniversity of Montreal, Montreal, QCUniversity of New Brunswick, Fredericton, NBUniversity of Ottawa, Ottawa, ONUniversity of Prince Edward Island, Charlottetown, PEUniversity of Saskatchewan, Saskatoon, SKUniversity of Toronto, Toronto, ONUniversity of Victoria, Victoria, BCUniversity of Waterloo, Waterloo, ONUniversity of Western Ontario, London, ONYork University, Toronto, ON
Universities/Institutes (International)Karolinska Institutet, SwedenMax Delbruck Centrum fur Molekulare Medizin, GermanyMayo Clinic Department of Medicine, Rochester, MNMedical University of Gdansk, PolandPennington Biomedical Research Center, Baton Rouge, LARockefeller University, New York, NYThe Royal Veterinary and Agricultural University, DenmarkUniversity of Cincinnati, Cincinnati, OHUniversity of Colorado, Denver, COUniversity of Kansas, Lawrence, KS
Provincial/Communal GovernmentsCanadian Institutes of Health Research - INMDOntario Ministry of Agriculture, Food and Rural AffairsOntario Ministry of Education and TrainingOntario Ministry of Health PromotionPublic Health and Community Services, Hamilton, ON
Hospitals/Health Care NetworksCapital Health, Primary Care Division, Edmonton, ABHamilton Health Sciences Corporation, Hamilton, ONHôpital Laval Research Centre, Sainte-Foy, QCOttawa Hospital, Ottawa, ONSt. Boniface General, Winnipeg, MBSt. Joseph’s Healthcare, Hamilton, ON
Non-Government Organizations (Canada)Active Healthy Kids CanadaCanadian Association of Bariatric Physicians and SurgeonsCanadian Association of Cardiac RehabilitationCanadian Association of Gastroenterology
Canadian Council for Food and NutritionCanadian Diabetes AssociationCanadian Hypertension SocietyCanadian Public Health AssociationCanadian Society for Clinical NutritionCanadian Urological AssociationConference Board of CanadaDairy Farmers of CanadaDietitians of CanadaHeart and Stroke Foundation of CanadaObesity CanadaSociety of Obstetricians and Gynaecologists of CanadaThe Arthritis Society
Non-Government Organisations (International)European Association for the Study of ObesityInternational Association for the Study of ObesityInternational Obesity Task Force
IndustryAbbott Laboratories Ltd.Boehringer Ingelheim Ltd.Glycemic Index Laboratories Inc.Innovus Research Inc.Isotechnika DiagnosticsJohnson & Johnson Medical Devices DivisionJSS Medical ResearchEli LillyMedtronics Inc.Merck Frosst Canada Ltd.New Era NutritionNovartis NutritionNovartis PharmaceuticalsPfizerSanofi-AventisTM BioscienceUniversity Technologies InternationalWyeth
OtherActing Living AllianceAdvanced Foods and Materials Network, Guelph, ONAtlantic Health Promotion Research Centre, Halifax, NSCanadian Health Services Research FoundationCenter for Advancement of Minimally Invasive Surgery, AlbertaChild and Family Research Institute, Vancouver, BCDe Dwa Da Dehs Nye>s, Aboriginal Health Centre, Hamilton, ONFirestone Institute for Respiratory Health, Hamilton, ONGolden Horseshoe Bioscience Network, Hamilton, ONObesity Surgery JournalOntario Science Centre, Toronto, ONOntario Training Centre in Health Services and Policy Research,
Hamilton, ONMaRS Discovery District, Toronto, ONMetabolic Modulators Research Ltd., Edmonton, ABPATH, McMaster University, Hamilton, ONPopulation Health Research Institute, Hamilton, ONSociety of Rural Physicians of Canada, Shawville, QCTechnical Standards and Safety Authority, Toronto, ON
CON Supporting Institutions & OrganizationsAs of September 1, 2006
The Canadian Obesity Network is funded by the federalNetworks of Centres of Excellence program (www.nce.gc.ca)
The Canadian Obesity Network is hosted byMcMaster University
09/06
the full weight of the obesity problem in
Canada is only now coming into focus, and
the news so far is bleak. the crisis is rooted
in a complex web of economic, psychosocial,
behavioural, biological and other contributing
factors, and its negative impact on our health,
quality of life and economy is profound.
there will be no simple solution to the
problem. Significant improvements in the
understanding, prevention and treatment of
obesity that result in tangible humanistic and
economic benefits for Canadians can be made
only through a collaborative effort across
many sectors and disciplines.
the Canadian obesity network is pleased to
work with the following partners:
Eating Well with
Canada’s Food Guide
Bien manger avec le
Guide alimentaire canadien
Canada’s Food Guide recommends eating well and being active every day.
For more information and interactive tools you can use in your practice, including Canada’s Food Guide and Canada’s Physical Activity Guides, visit us online at:
www.healthcanada.gc.ca/ foodguide
Le Guide alimentaire canadien recommande de bien manger et d’être actif chaque jour.
Pour obtenir de plus amples informations et des outils interactifs que vous pouvez utiliser dans le cadre de votre pratique, y compris le Guide alimentaire canadien et les Guides d’activité physique canadiens, consultez notre site Web :
www.santecanada.gc.ca/guidealimentaire
Eating Well with
Canada’s Food Guide
Bien manger avec le
Guide alimentaire canadien
Canada’s Food Guide recommends eating well and being active every day.
For more information and interactive tools you can use in your practice, including Canada’s Food Guide and Canada’s Physical Activity Guides, visit us online at:
www.healthcanada.gc.ca/ foodguide
Le Guide alimentaire canadien recommande de bien manger et d’être actif chaque jour.
Pour obtenir de plus amples informations et des outils interactifs que vous pouvez utiliser dans le cadre de votre pratique, y compris le Guide alimentaire canadien et les Guides d’activité physique canadiens, consultez notre site Web :
www.santecanada.gc.ca/guidealimentaire
Networks of Centres of Excellence
Ontario
Québec
British Columbia
Alber ta
Manitoba
Newfoundland & Labrador
Nova Scotia
New Brunswick
Saskatchewan
Prince Edward Island
40.9%
2,408
1,337192
231
15979868
694
2
56
54
23.9%
11.5%
10.8%
5.0%
2.8%
2.4%
1.2%
1.0%
0.6%
NCE PERSONNEL NCE EXPENDITURES
Mobilizing Research Excellence, Creating ValueCanada has 23 Networks of Centres of Excellence (NCE). Each network builds partnerships between academia, industry and government to put new knowledge, research and technology to work to create a better Canada. Their work in the natural, social and health sciences involves everything from improving children’s literacy skills, to the quality of the food we eat and the water we drink. NCE are helping to keep our forests flourishing and ease the impacts of climate change. By in-volving thousands of talented young Canadians in their work, they are training tomorrow’s scientific leaders and ensuring Canada’s continued role as a world science and technology leader.
Currently the NCE Program supports more than 6,000 researchers and highly qualified persons in 71 Canadian universities. The program partners include 756 Canadian companies, 329 provincial and federal government departments, and 525 agencies from Canada, along with 430 international partners – making it a truly national and international program.
In 2006, the networks stimulated outside cash and in-kind investments totaling almost $70 million, including more than $27 million by the participating private sector companies. With the program’s own investment, the total dedicated to research, commercialization and knowledge transfer was more than $149 million.
www.nce.gc.ca
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