Conduit Magazine Fall 07 - Canadian Obesity Network

Fall/Winter 2007/08

Volume I  ·  Number 2  ·  $4.95

Index sets world standard

see page 13

Size matters

New help for choosing portions see page 10

Dr. Sue Pedersen, Faculty of Medicine, University of Calgary

inside

The obesity-asthma connection Bariatric designs for hospital furniture

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CONDUIT

a moving tribute

executive editor Dr. Arya M. Sharma, con Scientific Director

W

editor Owen Roberts

making real progress in the fight against the disease, and celebrate the partnerships

Fall/Winter 2007/08  ·  Volume I  ·  Number 2 The official publication of the Canadian Obesity Network (con) © 2007 Canadian Obesity Network

associate editors Kim Waalderbos Brad Hussey

elcome to the second issue of CONDUIT, the official publication of the Canadian Obesity Network (CON). Once again, we’ve scoured the country to find outstanding examples of ingenuity and dedication in obesity

and related research. The following pages highlight just some of the people who are

that make it all possible. I am pleased to report that CON’s move to the University of Alberta (with adminis-

project co-ordinator Arthur Churchyard

trative offices located at the Royal Alexandra Hospital) in Edmonton is progressing

project management Lilian Schaer

well. We hope to announce our new contact information and staffing details very

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

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 collaborating with numerous stakeholders on innovative knowledge-sharing and outreach programs too numerous to summarize here (but check out www.obesitynetwork.ca

for

more

New furniture for obese patients. See page 12.

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. Sharma Scientific Director Canadian Obesity Network

cover photo by charles hope

photo: sittris

conduit 3

CONTRIBUTORS Kaitlyn Little, a thirdyear 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).

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.

condu it 4

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 obesityrelated asthma rates on page 8 and public awareness of healthy weight on page 16.

CONTENTS

Fall/Winter 2007/08  ·  Volume I  ·  Number 2

guidelines prepare 6 New practitioners asthma 8 Obesity-linked may be reversible  

10 12 13 14 16

 ortioned plate P encourages weight loss

Safe, comfortable furniture designed for obese patients

Worldwide standard set for glycemic index test

Healthy messages missing from children’s food packaging Survey finds gaps in Canadians’ knowledge of fat dangers

17 18

Software pinpoints fat types in medical scans 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

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.

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.

conduit 5

Information to help public, practitioners, policy-makers

New guidelines set to fight fat By Kaitlyn Little

M

experts. The resulting guidelines address major gaps of knowledge in the treatment

ost consumers don’t see obesity as a serious

and prevention of obesity, and establish

public health problem – rather, they consider

priorities for future research and policy.

it a simple cosmetic or body-image issue. But

Dr. Shafiq Qaadri, a family practitioner

it’s an epidemic, and Canadian researchers have developed

and member of the Ontario parliament

comprehensive guidelines to put it in the spotlight by more

for Etobicoke North, says the guidelines

clearly defining the problem and how it can be addressed.

(see sidebar) have the power to directly

They hope the guidelines will help practitioners improve

influence public policies. They not only

patient care and be an information piece for the public and

address gaps in knowledge but also outline

policy-makers.

possible areas for research funding and

“The serious personal and societal consequences of inaction

development.

on the obesity epidemic can no longer be ignored,” says Dr.

“Like all guidelines, they give us the goals

David Lau of the University of Calgary and chair of the Cana-

we want to achieve but also show us what still

dian Obesity Network’s science committee. “Obesity should

needs to be done,” says Qaadri.

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-

Now that the guidelines have been created, reviewed and published in the Canadian Medical Association Journal, the challenge shifts to communi-

tice guidelines committee on the management and preven-

cating the findings and recommendations to the audience

tion of obesity in adults and children. This expert panel,

they were intended for, he says.

made up of a large number of leading Canadian researchers

“Guidelines itemize what we need to do. They give detailed

and clinicians, did a rigorous literature review focused on

messages, but they can only be successful if we communi-

clinical trials to create evidence-based recommendations.

cate them properly.”

Before publication, the recommendations were sent out for external review and validation by leading international

condu it 6

[email protected]

||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| Guiding obesity management

C

anadian 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 treating 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 depression, 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 weightloss 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 obesityrelated health risks. |||  Do regular reviews and reinforce goals for weight loss or maintenance, as well as prevention of weight regain. For the complete list of guidelines and recommendations, visit www.cmaj.ca.

brian fray

conduit 7

|||||||||||||||||||||||||||||||||

Out of breath but not out of time By Arthur Churchyard

O

besity 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.

Weight loss encourages recovery from obesity-related respiratory problems, which affect women in particular, according to a recent Canadian survey.

condu it 8

simon mcconico

|||||||||||||||||||||||||||||||||

Recovery is possible for women, who are more susceptible to obesity-linked asthma

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 triggered 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

Dr. Louis Philippe Boulet of Laval’s Department of Medicine has found that obese Canadians – particularly

that asthma and obesity are genetically more likely to occur together.

women  –  report higher asthma rates. Canadians are also

That makes it tough to give an accurate diagnosis, says

more likely to use asthma medication when they have a

asthma researcher Dr. Shawn Aaron of the University of

higher body mass index ratio (a measurement of weight

Ottawa. A misdiagnosis could lead to unnecessary use of

class based on weight and height).

expensive inhalers, medication and injections currently

“Obesity is frequently associated with asthma-like respira-

used to treat asthma.

tory symptoms, and it’s important to confirm the diagno-

Aaron is studying reported asthma cases in eight large

sis of asthma in order to provide adequate treatment and

Canadian cities to see how many patients actually have the

counselling,” says Boulet. “Doctors should be warning their

condition. He estimates that 30 per cent of obese patients

patients that significant weight gain may be detrimental not

who have been diagnosed with asthma because of short-

only for heart disease and diabetes but also for respiratory

ness of breath may have been misdiagnosed and may

problems.”

not have active asthma at all. His study will clarify some

For the study, he analyzed data from the most recent

of the reasons behind obesity’s connection to asthma. It

Canadian Community Health Survey to establish the

will also promote weight loss and public awareness of the

connection between obesity and asthma. But his personal

connection.

practice has led him to believe this trend is reversible for

Aaron and Boulet – both Canadian Obesity Network

some patients. He has seen weight-loss surgery patients

members – agree that losing weight isn’t easy, especially

recover from asthma symptoms after losing a significant

in cases of extreme obesity. Deeper understanding of the

amount of weight.

mechanisms that link obesity and asthma could make it

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

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.

loss improves lung function need to be studied more carefully, he adds.

[email protected]

conduit 9

Study finds partitioned plate encourages weight loss

Drawing the line on portions By Mihiri De Silva

P

eople with diabetes, especially those on medication, 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

asked to use the plate once daily with their largest meal and

designed for a wide variety of foods; the bowls are unisex

the breakfast bowl whenever they ate cereal.

and used only with cereal.

The dishes proved to be effective, says Pedersen. Those

The study involved 130 clinically obese subjects with type 2

using them were more than three times as likely to lose

diabetes. Half of the participants were assigned to a control

five per cent of their body weight compared with those not

group and maintained their usual diet routine. The other

using the plate and bowl. This loss in body weight is clini-

half were given a Diet Plate and breakfast bowl and were

cally significant for people with obesity because it reduces

condu it 10

the risk of heart disease and cancer, as well as other weightrelated 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 participants 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.”

Tableware outlined with balanced portions is a new and creative mealtime approach to weight control.

|||  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. [email protected]

charles hope photography

conduit 11

The shape of things to come

“Patient and caregiver safety is a paramount concern,” she says. “Bariatric hospital suites are important as they make people more willing to seek out health care and enable

New designs increase both safety and comfort levels

health-care professionals to do their job safely and more efficiently, leading to a decrease in lengths of stay for hospital patients.”

By Kaitlyn Little

T

Forhan, who works in the research he unique needs of obese

and service unit called Accessibly

people have long been over-

Yours at McMaster University, recently

looked when it comes to design-

led a meeting of key stakeholders

ing accommodating furniture. This is

interested in obesity accessibility and

especially noticeable in the hospital

mobility equipment. She gathered

setting, where something as basic as

together designers, engineers, retail-

a well-designed chair that could boost

ers, clinicians, nurses and patients to

patients’ comfort and safety levels

lay out several directions for future

– and be a boon to health-care profes-

research initiatives to secure funding

Comfort and safety are the central features of this special hospital furniture for people with obesity.

for equipment that meets the need

dent of Toronto-based design firm Kerr

armrests that provide a sturdy grip

that meeting is available online at

and Company Inc., is helping to fill

for pushing out of the chair, cut-outs

www.obesitynetwork.ca.

this unmet need with a chair designed

along the outer edges between the

“Helping people with obesity is beyond

specifically for obese patients that is

back and seat that allow caregivers to

a moral obligation,” she says. “It’s a

both functional and visually appealing.

help patients stand up, and reinforced

safety issue in the same way that access

legs to secure the chair.

to care is a fundamental right. The

sionals as well – is often missing. Industrial designer Helen Kerr, presi-

“An enormous portion of the popula-

of obese patients. The report from

accommodating

cost of the suites is nothing compared

completely overlooked in terms of their

health-care environments are also

with the costs of accidents and loss of

need for bariatric furniture,” says Kerr.

of key interest to Mary Forhan, an

productivity incurred if we don’t make

occupational therapist and Canadian

the changes.”

tion going into the hospital has been

To begin, she toured bariatric clinics to gain an understanding of what

Inclusive

and

Obesity Network (CON) member.

The hospital setting is not the only

this population needs from furniture.

Forhan plans to evaluate the impact

place where researchers are helping to

She says there’s a lot to be considered

of bariatric suites in hospitals to deter-

make room for obesity. Ambulances,

when designing new furniture, includ-

mine how an ideal room could be

offices and automobiles are also being

ing how people fit into chairs, how

designed to meet the needs of obese

better outfitted to accommodate the

the furniture enables them to breathe

patients and their caregivers in hospi-

growing number of people who are

and the degree to which patients can

tal environments. She is a graduate

obese.

access the chair.

of CON’s 2007 Obesity Summer Boot

Kerr’s design features strong flat

condu it 12

Camp.

[email protected]

sittris

Passing the GI test Canadian researcher is setting worldwide standard to measure food’s influence on blood sugar By Matt Teeter

D

Eating a high-GI food raises blood sugar rapidly, which the body coun-

iet and exercise play an important role in

ters by flooding the blood with insu-

preventing and controlling diabetes and obesity.

lin. Insulin plunges blood sugar lower

People with diabetes make special room in their

again, which creates more hunger

diet for foods that increase blood sugar levels slowly. These

and leads to metabolic processes that

are known as foods with a low glycemic index (GI).

store more calories as fat.

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.

Prof. Thomas Wolever, a Canadian Obesity Network

The whole cycle is what functional

(CON) member in the University of Toronto’s Department

food developer Saul Katz, CEO of

of Nutritional Sciences, helped develop the GI, a tool to

low-GI energy bar manufacturer Solo GI Nutrition, calls

measure the speed at which a food’s carbohydrates increase

“spike, crash and crave.” This cycle increases risk for diabetes,

blood sugar. The index was developed to aid people with

obesity and cardiovascular disease by keeping blood sugar

diabetes and is now catching on for weight management,

in a chronically unbalanced state. This might suggest that

but Wolever says GI measurements have been inconsistent

carbohydrates are bad, but Katz says that’s not the case.

across the food industry. “So far, it’s been difficult for industry to implement GI measurements because they vary so widely,” he says.

“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

In response, Wolever created the Glycemic Index Labora-

required. He points to Australia’s leadership in including GI

tories to provide reference testing for members of the food

measurements on food labels. But current Health Canada

industry. Food companies from around the world contract

regulations prevent such labelling.

the firm to ensure that testing of their products is done

“GI information should be seen as nutrient content, not a

accurately and confidentially and to refine their own testing

health claim,” says Wolever. “Industry must lead the charge

protocols.

to get this changed.”

His U.S. clients can use the test results in product advertis-

He and Katz say consumers, as well as industry, need to be

ing, but in Canada, current regulations don’t allow GI claims,

better educated about the value of the GI. Education is one

so these companies are building the knowledge for potential

of the reasons they’re members of the CON, with Wolever

future use.

describing the network as a valuable forum for raising aware-

To calculate a food’s GI, Wolever compares it with a reference food, usually pure sugar or glucose, which is assigned

ness. Both he and Katz are working to educate consumers about GI to encourage healthier eating choices.

a GI of 100. A food that produces half the blood sugar response of the reference is assigned a GI of 50.

arthur churchyard

[email protected]

conduit 13

Is

fun fo fair?

By Ash ley Mc Carl

S

upermarket 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 Communication evaluated food products targeted specifically at children in supermarkets and found that kids’ fare typically emphasizes 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 promotion 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.”

She found that messages contained on fun food labels were strongly focused on entertainment. Whereas adult products

For the study, she analyzed the expanding category of fun

tended to emphasize natural functions, tastes and textures,

foods in Canadian supermarkets. Fun food is not junk food

the children’s food focused on more unnatural qualities,

– rather, it’s food symbolically positioned as children’s fare

such as yogurt tubes that glow in the dark and drink mixes

and often framed in contrast to so-called adult food.

that “magically” change colour.

Fun foods are identifiable by their packaging and graphics

Fun foods were once limited to the cereal aisle in super-

or by the unusual shapes, tastes and colours of the food itself.

markets but are now seen throughout the entire store. Elliott

Elliott assessed 367 products for package claims, images and

argues that promoting food as sport or entertainment to

nutritional profile.

young children has significant implications.

condu it 1 4

ood

Researchers evaluate food products and messages being promoted to kids

is highly complex, but is clearly understood by the multibillion-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 increasingly sending messages about “energy balance” rather

Kids and parents can reach for healthy foods instead of foods marketed to entertain.

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 healthyeating messages are being passed down. She’s also conduct-

“Behaviour modification programs for overweight adults

ing focus groups with children to test their understanding

stress that particular habits, such as eating when bored or

of nutrition claims and to see how they respond to the food

for entertainment, work to make people fat,” she says. “Yet

products specifically marketed to them.

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

|||  Funding for Elliott’s project was provided by the

message to be sending to our children.”

Canadian Institutes of Health Research and Carleton

CON member Prof. Guy Faulkner of the University of

University.

Toronto’s Department of Physical Education and Health says the impact of media messages on human behaviour

sean locke

[email protected]

conduit 15

Canadians struggle with basic health messages Survey of six major cities finds health lessons not being taken to heart

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

By Arthur Churchyard

C

identified 102 centimetres as the

doctor about obesity. anadians are in denial about

Tytus stresses that doctors can’t act

the personal health conse-

as educators about health basics with-

quences of extra weight.

out more open communication lines.

That’s the message from a recent

“How many people even know how

report card survey conducted by the

to measure their waist circumference?

Canadian Obesity Network (CON). It

Doctors could easily explain that waist

revealed that a majority of Canadians

size is measured at the top of the hip

know they’re overweight and believe

bones, not over the belly button. But

extra weight carries health conse-

these conversations are not being

quences, but they don’t think they’re very much at risk themselves. The survey drew information from 4,990 respondents in the Vancou-

Canadians aren’t making the necessary link between obesity and personal health risks, says Dr. Richard Tytus.

initiated.” Dr. Bob Dent, director of the Weight Management Clinic at the Ottawa Hospital and head of the CON’s mental

ver, Edmonton, Calgary, Hamilton,

even if they were overweight, although

health section, blames lack of funding

Ottawa and Montreal areas. It shows

general awareness of obesity health

in the health-care system for the short

Canadians are aware of health risks

risks was high.

amount of time Canadian doctors

associated with being overweight but

One health risk escaped many survey

spend with patients. The average

aren’t taking the lesson to heart, says a

respondents’ awareness, however. Only

patient gets three minutes of attention.

McMaster University physician.

half knew that fat concentrated in the

But Dent also notes studies have

“There’s this disconnect between

abdominal area poses greater health

shown that if a health professional

what we know about the consequences

risks than fat distributed around the

takes time to point out weight prob-

of obesity and what we believe will

body. Tytus says it’s well-known in the

lems, patients are much more likely

happen to us personally,” says Dr. Rich-

medical community that, for every

to take action than if they’d initiated

ard Tytus of McMaster’s Department

inch of extra flab around the midsec-

discussion themselves.

of Family Medicine, who was involved

tion, the risk of heart disease and

in the study.

diabetes increases dramatically.

He says that fewer than a quarter of

He notes that knowledge about

respondents in the Hamilton region

healthy waist size was alarmingly

thought they had a higher health risk

absent – only 25 per cent correctly

condu it 16

The survey was conducted by IpsosReid Canada on behalf of SanofiAventis Canada Inc. and the CON. [email protected]

robert skeoch

Martel explains that fat tissues in the human body

Fat, pixel by pixel

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 diabetes. The SliceOmatic allows for quick and easy differentiation between the fats, so that disease risks can be more easily identified.

New tissue-tagging program slices and dices body composition

His original interest in medical analysis software was fostered by Prof. Bob Ross of the Department of Physical and Health Education at Queen’s University, also a CON member. In the late 1980s, Ross

By Ashley McCarl

D

was completing his thesis on fat tissues displayed ifferentiating fat types using medical

in full-body medical scans at l’Université de

scans is easier thanks to Montreal-based

Montréal. He needed a user-friendly way to analyze

TomoVision’s cutting-edge software that

MRI images and turned to Martel to develop a solu-

accurately tags and tabulates specific fat tissues. The

tion. Since then, Martel has continued to improve his

software sets the standard for measuring fat and

program, and it has taken off in popularity with the

is used in obesity research across North America.

research community. The program, developed entirely in Canada, has

TomoVision is a partner of the Canadian Obesity

been verified and used in dozens of studies around the

Network (CON). TomoVision president Yves Martel says medical

world. Ross says it has helped researchers learn more about the relationships between disease

scans such as magnetic resonance imaging (MRI) and computed tomography (CT) are commonly used to determine body composition. But differentiating

Body scans can reveal various types of fat distribution using images produced by specialized software.

and different body shapes of obese people, and how those relationships are affected by gender, age and race. “SliceOmatic has been used by numer-

between fats with MRI scans has always been a consuming and daunting manual task because there

ous researchers to understand the effects of differences in fat

was no software to support it. That’s why he developed a

distribution in groups of people,” says Ross. “It’s an accurate

program he’s dubbed “SliceOmatic.”

tool that can be adapted to individual needs.”

“There was a need for a program that could help differenti-

One adaptation Martel made was to develop image format

ate between the various fat types in medical images,” says

converters. At one point, there was a different image format

Martel. “SliceOmatic fills this need and gives researchers the

for each individual scanner. He says a lot of those old scan-

same standard tool to use.”

ners are still being used, producing images that are difficult

SliceOmatic allows users to semi-automatically tag each

to import to a computer. His software now has the tools

pixel – an individual point in an image – on an MRI or CT

to read scanner archives and convert images to a standard

scan. Once this is complete, the program tallies the tagged

format.

pixels to calculate the volumes of different fats and other tissue ratios.

bob ross

[email protected]

conduit 17

Student wins Canadian Obesity Network thesis competition with research paper on ultrasound technology

Sound progress By Arthur Church yard

E

Singh’s research paper suggests that echocardiographic measurement of epicardial fat could be a competitive way to

chocardiography and the echo generation share

assess risk for obesity-related diseases, but it remains to be

a common champion: Navneet Singh, the 2007

proven over time as obesity interventions are carried out.

winner of the Canadian Obesity Network (CON)

Singh, who just completed a term as co-chair of the CON’s

thesis competition. Singh’s winning paper about echocar-

Students and New Professionals initiative, an organization he

diography – a new way to measure a risky type of fat around

co-founded that links students and mentors in the network,

the heart – shows the ingenuity young people can bring to

says mentors have defined his research career. Dr. Gianluca

the fight against obesity.

Iacobellis of McMaster University’s Department of Endocri-

“At this point, researchers are playing catch-up to see how well fat around the heart can predict obesity-related

nology and Dr. Arya Sharma, CON’s scientific director, have both inspired and guided him through his research.

health risks,” says Singh. “Echocardiography is undoubtedly

Iacobellis, who was the first to propose and validate epicar-

a good technique to measure this fat, but it requires more

dial fat measurement by echocardiography, says Singh’s

investigation.”

enthusiasm and genuine interest made all the difference

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.

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

Singh notes in his thesis that echocardiography has signif-

measurement and other clinical studies has been tremendous.”

icant advantages over other risk-measurement techniques.

Singh remains in an advisory role on the Students and

It uses ultrasound technology that health practitioners can

New Professionals board at the University of Toronto, where

easily implement, and it’s less expensive than MRI scanning,

he’s in his second year of medical school. He continues to

which is often inaccessible for obese people.

do research with Iacobellis on the effect of weight loss on

Still, he acknowledges there is another way to measure

epicardial fat.

disease risk that is even faster and relatively simple. Measuring waist circumference can serve as a good warn-

|||  Singh’s winning research paper was supported by

ing flag for obesity-related diseases. The only catch is that

the John D. Schultz Scholarship provided by the Heart

waist measurements include both the subcutaneous fat just

and Stroke Foundation of Canada. CON received dozens

under the skin and the deeper abdominal fat surrounding

of submissions for this year’s contest, which was

the organs, but it’s the latter that poses the greater health

adjudicated by a panel of multidisciplinary obesity experts

risk.

chosen from the network’s membership.

condu it 18

conduit 19

Safflower power Alberta company develops home-grown solution to treat obesity-linked diseases “The advantage of using plants is that we can increase By Ash ley Mc Carl

S

production of these proteins with less money and low capital. Using safflower to produce pharmaceuticals such as insulin

afflower has traditionally been known as an

opens a lot of doors globally.”

oilseed-producing plant grown mainly in Califor-

Moloney has found that safflower is an ideal production and

nia for use in the food industry. But it also provides

packaging plant for insulin or Apo AI. The genes that code

a sustainable method of producing insulin at a price people

for the synthesis of the proteins can be inserted into safflower

worldwide can afford.

plants to make them mini-solar factories that produce either

That’s the word from a Calgary-based pharmaceutical

insulin or HDL. The genes direct the flowers to produce

company called SemBioSys. It’s working with the plant to

the proteins, which are packaged in

develop treatments for diabetes and high cholesterol by

bundles and then moved to storage

integrating the genes for two important proteins – insulin

with the oil of the seeds. The proteins

and a high-density lipoprotein (HDL) called Apo AI – into

are extracted through grinding the

safflower. These proteins are key components in treatments

seeds and mixing with water, which

for people with diabetes and heart disease, both of which are

allows the protein-rich oil to rise to a top layer, where it can

commonly linked to obesity.

easily be removed and purified to separate out the protein.

Safflowers are being designed to yield oil containing insulin and a protein that binds cholesterol.

SemBioSys chief scientific officer Maurice Moloney says

The gene for Apo AI was identified by Italian scientists.

current production techniques for insulin and HDL are

In later clinical trials in the United States, it was found that

expensive, increasing the cost of treatment and making it

Apo AI could bind to cholesterol and remove years of plaque

unaffordable for many around the world.

buildup in the arteries. That meant, for the first time in medi-

But because safflower can be grown on low acreage with

cal history, a drug could reverse arterial damage built up over

high yields, the plant can provide a significant boost to insu-

time. That excited the medical community, which is likewise

lin and Apo AI production, he says.

enthused about the Apo AI gene being incorporated into

condu it 2 0

sembiosys

safflower to produce HDL medicines efficiently and cheaply,

Fellow researcher Prof. Peter Jones, who holds the Canada Research Chair in Nutrition and Functional Foods

and to help reduce the risk of heart attack. Safflower has also been modified to produce insulin, which

at the University of Manitoba, focuses on the disease triad

is expected to be increasingly in demand as user-friendly

of diabetes, obesity and heart disease. With more people

inhalers are used more frequently. Compared with the injec-

becoming affected by these diseases worldwide, Jones notes

tion method, inhalers require 10 to 20 times more insulin

the need for alternative production methods.

to be effective. Moloney says safflower-derived insulin could

“For the first time in history, our children will have a

meet this increased demand. And he notes that Canada,

shorter life expectancy than their parents,” he says. “We

where insulin was discovered in 1922, could provide the right

need leading-edge, innovative solutions to these problems,

agricultural climate to grow the insulin-producing safflower.

and using safflower is a great example of that.”

“It would be poetic to have the birthplace of insulin also become the world’s major supplier,” he says.

[email protected]

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 journals Citations are: • Pre-rated for quality by research staff • Rated for clinical relevance and interest by at least three members of a worldwide panel of practising health professionals with an interest in obesity.

OBESITY+ Online Best Evidence Service In Tackling obesitY

PRE-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 researchderived knowledge in health care and this online alerting service and database will be of special interest to KT researchers and professionals.

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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

obesitynetwork.ca

        In collaboration with 

PARTNERSHIPS 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. CON Supporting Institutions & Organizations As of September 1, 2006

Universities (Canada) Dalhousie University, Halifax, NS Lakehead University, Thunder Bay, ON Laval University, Quebec City, QC McGill University, Montreal, QC McMaster University, Hamilton, ON Memorial University, St. John’s, NL Queen’s University, Kingston, ON Ryerson University, Toronto, ON Simon Fraser University, Burnaby, BC Université de Sherbrooke, Sherbrooke, QC University of Alberta, Edmonton, AB University of British Columbia, Vancouver, BC University of Calgary, Calgary, AB University of Guelph, Guelph, ON University of Manitoba, Winnipeg, AB University of Montreal, Montreal, QC University of New Brunswick, Fredericton, NB University of Ottawa, Ottawa, ON University of Prince Edward Island, Charlottetown, PE University of Saskatchewan, Saskatoon, SK University of Toronto, Toronto, ON University of Victoria, Victoria, BC University of Waterloo, Waterloo, ON University of Western Ontario, London, ON York University, Toronto, ON

Universities/Institutes (International) Karolinska Institutet, Sweden Max Delbruck Centrum fur Molekulare Medizin, Germany Mayo Clinic Department of Medicine, Rochester, MN Medical University of Gdansk, Poland Pennington Biomedical Research Center, Baton Rouge, LA Rockefeller University, New York, NY The Royal Veterinary and Agricultural University, Denmark University of Cincinnati, Cincinnati, OH University of Colorado, Denver, CO University of Kansas, Lawrence, KS

Provincial/Communal Governments Canadian Institutes of Health Research - INMD Ontario Ministry of Agriculture, Food and Rural Affairs Ontario Ministry of Education and Training Ontario Ministry of Health Promotion Public Health and Community Services, Hamilton, ON Hospitals/Health Care Networks Capital Health, Primary Care Division, Edmonton, AB Hamilton Health Sciences Corporation, Hamilton, ON Hôpital Laval Research Centre, Sainte-Foy, QC Ottawa Hospital, Ottawa, ON St. Boniface General, Winnipeg, MB St. Joseph’s Healthcare, Hamilton, ON

Canadian Council for Food and Nutrition Canadian Diabetes Association Canadian Hypertension Society Canadian Public Health Association Canadian Society for Clinical Nutrition Canadian Urological Association Conference Board of Canada Dairy Farmers of Canada Dietitians of Canada Heart and Stroke Foundation of Canada Obesity Canada Society of Obstetricians and Gynaecologists of Canada The Arthritis Society

Industry Abbott Laboratories Ltd. Boehringer Ingelheim Ltd. Glycemic Index Laboratories Inc. Innovus Research Inc. Isotechnika Diagnostics Johnson & Johnson Medical Devices Division JSS Medical Research Eli Lilly Medtronics Inc. Merck Frosst Canada Ltd. New Era Nutrition Novartis Nutrition Novartis Pharmaceuticals Pfizer Sanofi-Aventis TM Bioscience University Technologies International Wyeth

Other Acting Living Alliance Advanced Foods and Materials Network, Guelph, ON Atlantic Health Promotion Research Centre, Halifax, NS Canadian Health Services Research Foundation Center for Advancement of Minimally Invasive Surgery, Alberta Child and Family Research Institute, Vancouver, BC De Dwa Da Dehs Nye>s, Aboriginal Health Centre, Hamilton, ON Firestone Institute for Respiratory Health, Hamilton, ON Golden Horseshoe Bioscience Network, Hamilton, ON Obesity Surgery Journal Ontario Science Centre, Toronto, ON Ontario Training Centre in Health Services and Policy Research, Hamilton, ON MaRS Discovery District, Toronto, ON Metabolic Modulators Research Ltd., Edmonton, AB PATH, McMaster University, Hamilton, ON Population Health Research Institute, Hamilton, ON Society of Rural Physicians of Canada, Shawville, QC Technical Standards and Safety Authority, Toronto, ON

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. Non-Government Organizations (Canada) Active Healthy Kids Canada Canadian Association of Bariatric Physicians and Surgeons Canadian Association of Cardiac Rehabilitation Canadian Association of Gastroenterology

The Canadian Obesity Network is hosted by McMaster University

Universities (Canada)

Universities/Institutes (International) Karolinska Institutet, Sweden Max-Delbrück-Centrum für Molekulare Medizin, Germany

condu it 22

CANADIAN OBESITY NETWORK

09/06

The Canadian Obesity Network is funded by the federal Networks of Centres of Excellence program (www.nce.gc.ca)

The Canadian Obesity Network is pleased to work with the following partners:

Dalhousie University Lakehead University McGill University McMaster University Memorial University Queen’s University Ryerson University Simon Fraser University Université de Sherbrooke University of Alberta University of British Columbia University of Calgary University of Guelph Université Laval University of Manitoba Université de Montréal University of New Brunswick University of Ottawa University of Prince Edward Island University of Saskatchewan University of Toronto University of Victoria University of Waterloo University of Western Ontario York University

Put Your Strength Behind Us

Non-Government Organisations (International) European Association for the Study of Obesity International Association for the Study of Obesity International Obesity Task Force

Mayo Clinic Department of Medicine, Rochester, Minn. Medical University of Gdansk, Poland Pennington Biomedical Research Center, Baton Rouge, La. Rockefeller University, New York, N.Y. The Royal Veterinary and Agricultural University, Denmark University of Cincinnati, Cincinnati, Ohio University of Colorado, Denver, Colo. University of Kansas, Lawrence, Kan.

Government Canadian Institutes of Health Research — INMD Communications Research Centre Canada Health Canada, Office of Nutrition Policy and Promotion National Research Council Canada Institute for Information Technology Ontario Ministry of Agriculture, Food and Rural Affairs Ontario Ministry of Education and Training Ontario Ministry of Health Promotion Public Health and Community Services, Hamilton, Ont.

Society of Obstetricians and Gynaecologists of Canada The Arthritis Society

Non-Government Organizations (International) European Association for the Study of Obesity International Association for the Study of Obesity International Obesity Task Force The Obesity Society

Industry 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 Canada Canadian Association of Bariatric Physicians and Surgeons Canadian Association of Cardiac Rehabilitation Canadian Association of Gastroenterology Canadian Association of Occupational Therapists Canadian Council for Food and Nutrition Canadian Diabetes Association Canadian Hypertension Society Ontario Pharmacists Association Canadian Physiotherapy Association Canadian Public Health Association Canadian Society for Exercise Physiology Canadian Society for Clinical Nutrition Canadian Urological Association Conference Board of Canada Dietitians of Canada Heart and Stroke Foundation of Canada Obesity Canada

Abbott Laboratories Ltd. Boehringer Ingelheim Ltd. GeneOb Inc. Global Diagnostics Glycemic Index Laboratories Inc. Innovus Research Inc. Isotechnika Diagnostics Johnson & Johnson Medical Devices Division JSS Medical Research Eli Lilly Medtronics Inc. Merck Frosst Canada Ltd. Natural Factors New Era Nutrition Novartis Nutrition Novartis Pharmaceuticals Pfizer Sanofi-Aventis TM Bioscience University Technologies International Wyeth

Other Acting Living Alliance Advanced Foods and Materials Network, Guelph, Ont.

Atlantic Health Promotion Research Centre, Halifax, N.S. Canadian Health Services Research Foundation Centre for the Advancement of Minimally Invasive Surgery, Alta. Connex Health Child and Family Research Institute, Vancouver, B.C. Dairy Farmers of Canada De dwa da dehs nye>s Aboriginal Health Centre, Hamilton, Ont. Drug Information and Research Centre Food and Consumer Products of Canada Firestone Institute for Respiratory Health, Hamilton, Ont. Golden Horseshoe Bioscience Network, Hamilton, Ont. Obesity Surgery Ontario 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 Canada Society 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

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PHOTOS COURTESY OF: ArcticNet • Canadian Institute for Photonic Innovations • Canadian Language and Literacy Research Network • Canadian Stroke Network • ISIS Canada

Mobilizing Research Excellence, Creating Value Canada 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 involving 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.

NCE PERSONNEL

NCE EXPENDITURES

2

Networks of Centres of Excellence

54

694

868 79

56 159

1,337 2,408

www.nce.gc.ca

192 231

Ontario

40.9%

Québec

23.9%

British Columbia

11.5%

Alber ta

10.8%

Manitoba

5.0%

Newfoundland & Labrador

2.8%

Nova Scotia

2.4%

New Brunswick

1.2%

Saskatchewan

1.0%

Prince Edward Island

0.6%