Obesity is a growing concern in industrialized nations, including North America, where it's a leading cause of preventable illness and death. Defined by a body mass index (BMI) of 30 or greater, obesity affects approximately 27% of Canadian adults, with another 36% classified as overweight. While overeating and under-exercising are significant contributing factors, obesity is a complex medical problem involving genetic, environmental, behavioral, and social factors. This article explores various aspects of weight management, including a critical look at specific products like Cellasene, previously marketed by Rexall.
Understanding Obesity and Weight Management
Obesity occurs when the body consumes more calories than it burns. Although genetic factors may influence appetite and fat metabolism, environmental and behavioral factors such as consuming excess calories from high-fat foods and lack of physical activity have a greater influence. Insufficient sleep and certain medications can also contribute to weight gain, leading to obesity. Childhood obesity that persists beyond early childhood can make weight loss in adulthood more difficult. Certain medical conditions such as binge eating disorder (BED), Cushing’s disease, and polycystic ovary syndrome can also lead to weight gain and obesity. Psychological factors such as low self-esteem, guilt, emotional stress, or trauma can lead to overeating as a means to cope with the problem. People who are obese may have symptoms of medical conditions such as high blood pressure, high cholesterol levels, breathing problems, and joint pain.
A BMI between 18.5 and 24.9 is considered within the healthy range. For people 65 years and older, the "normal" range is higher, beginning slightly above 18.5 and extending into the "overweight" range. Doctors may also use other measurements, such as waist size, to evaluate health risks associated with excess abdominal fat.
An appropriate weight management program usually combines physical activity, a healthy diet, and changes in daily habits. Other programs may also involve psychological counseling and, in some cases, drug therapy. Fad and crash diets don't work and can be dangerous. The body needs a minimum amount of energy from food to function normally. No daily diet with less than 1,200 calories should be used without medical supervision. "Crash diets" are never successful in the long term because once the diet is stopped, the weight usually comes back. Additionally, such diets may be associated with a host of nutritional deficiencies and imbalances that could endanger your health. To lose weight successfully, and to maintain a healthy weight, requires lifelong changes in eating and exercise habits as well as an understanding of emotional factors that lead to overeating. It also involves setting and achieving specific and realistic goals. People who are medically obese should consult a doctor or dietitian for a safe and personalized weight-loss program. Behavioral therapy or modification can also help.
Regular physical activity is an important part of weight management. In addition to managing weight, exercise also improves overall health and can help reduce the risk of diseases such as certain cancers, heart disease, and osteoporosis. It can be as simple as climbing the stairs instead of taking the elevator, walking or cycling to work and leaving the car at home, or going for a walk at lunchtime with coworkers.
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Medications may be part of a weight management program. Medications aren't "magic cures" leading to permanent weight loss. They're generally used in combination with a proper diet and exercise program. Some medications are approved for short-term use only. One example of a weight-loss medication available in Canada is orlistat, which blocks the absorption of fat from the bowel. Glucagon-like peptide 1 (GLP-1) analogs, medications used traditionally in managing diabetes with appetite-suppressing effects, may also be used for weight loss. A combination of naltrexone and bupropion may be used to help with weight loss. Naltrexone is thought to help by suppressing appetite, while bupropion (traditionally used as an antidepressant) changes the amount of certain chemicals in the brain which causes a reduction in food intake. Surgery is only considered when other weight management options have not been successful. There are many forms of obesity surgery, but often surgery reduces the size of the stomach so that only a small amount of food can be eaten comfortably. When reviewing suitable management options, it's important to consider the risks and benefits of each option.
A Critical Look at Rexall's Cellasene
In the past, Rexall faced scrutiny regarding weight-loss claims associated with its product Cellasene. The Federal Trade Commission (FTC) charged Rexall, then a subsidiary of Royal Numico, with fabricating clinical data and making false claims that Cellasene helped consumers lose weight. The FTC said such a settlement would also resolve separate class-action lawsuits in California and Florida, provided both states sign off on the deal.
In 1999, Rexall launched a nationwide marketing campaign for the drug, citing “impressive” clinical results in all its advertising and promotional materials, the FTC said in its lawsuit, filed in July 2000. Sales of the product, which cost consumers $200 for an eight-week supply, reached $40 million in the United States. Rexall voluntarily stopped selling Cellasene one month after the FTC sued.
Rexall agreed to give back to consumers as much as $12 million to settle charges that its weight-loss drug Cellasene did not work as advertised. Rexall did not admit guilt as part of the settlement, but the company has agreed to refrain from making unsubstantiated claims about Cellasene or other weight-loss drugs in the future.
This case underscores the importance of critically evaluating weight-loss products and being wary of unsubstantiated claims.
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The Role of Supplements in Weight Management
The role of supplements in weight management is complex. While some supplements are popular, their effectiveness and safety are often debated. ConsumerLab.com conducts surveys and tests on various supplements to assess their quality and efficacy. These include supplements like:
- Vitamin C: Many people take large doses of vitamin C believing it will improve their health, prevent colds or reduce the risk of disease.
- Magnesium: Magnesium supplements have become extremely popular, surpassing even calcium among frequent users of supplements.
- Melatonin: An estimated 60 million Americans experience insomnia each year, and they increasingly turn to the supplement melatonin for potential help.
- CoQ10: Findings from a recent study by ConsumerLab.com highlights the difficulty consumers have in selecting a supplement containing the highly-popular anti-oxidant CoQ10 or its activated form, ubiquinol.
- Fish Oil: Plant seed oils are popular supplements that provide omega-3 and omega-6 fatty acids, but which products offer the best value and quality?
- Joint Health Supplements: Do popular joint health supplements with ingredients such as glucosamine, chondroitin, Boswellia, and MSM really work to relieve pain or slow the progression of osteoarthritis?
However, it's important to note that some supplements have been found to have issues. For example, ConsumerLab.com found arsenic in testing of potassium supplements, and announced a recall on January 16, 2012 of Rexall Calcium 1200 mg plus 1000 IU Vitamin D3, 60 softgels. Two magnesium supplements failed testing due to lead contamination.
Milk Intake and Weight Management
The relationship between milk intake and weight management, particularly in children and adolescents, is complex and not fully understood.
- In overweight adolescents, drinking skim milk (1 L/d) compared to water (1 L/d) for 12 weeks resulted in greater increases in BMI, BAZ, and weight but did not change waist circumference or waist to height ratio. It also resulted in increased fat mass index. Both groups increased lean mass index over the 12 week intervention, with no difference between groups.
- In children, change in milk intake was not significantly associated with BMI change. Children who remained “normal weight” after 2 years, consumed less milk at the 2 year follow-up compared to baseline. However, there was no difference in milk intake change over 2 years among children who remained overweight or children who changed from normal to overweight or overweight to normal weight. Change in milk intake did not vary by BMIZ group.
- Higher milk intake at 4 years was associated with higher HAZ at 5 years, but was not associated with BMI z-score or WHZ.
- Among children, increases in full-fat and low-fat milk intake over a 3-year period were associated with excessive weight gain (increase in BMI z-score).
- In adolescent boys, greater baseline milk intake and greater increases in milk intake were associated with lower odds of incident overweight at 5-year follow-up.
- In toddlers, total, reduced-fat, and 1%/nonfat milk intake at 2 years of age was not associated with BMI z-score or incident overweight at 3 years of age.
- In children, when controlling for total energy intake, total milk intake was significantly associated with decreased BF% at 1-year follow-up, but not at 3-year follow-up.
- In overweight/obese children, consuming flavored milk at age 10 was significantly associated with smaller reductions in body fat and greater weight gain at age 13 compared with non-consumers.
- Among children with overweight/obesity, those who changed from whole milk to low-fat milk improved their weight status compared to those who did not change to lower fat milk.
- In children, milk consumption was not significantly associated with changes in BMIZ or %BF. In children, when controlling for energy intake, milk intake was not significantly associated with changes in BMIZ and body weight.
These findings suggest that the impact of milk consumption on weight can vary depending on age, type of milk, and other dietary factors.
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