Rebranding Exercise: Why Exercise is the World’s Best Drug, Just Not a Weight Loss Drug

I get to speak to doctors a lot and what I don't get to do is speak to folks like you and I think that folks like you have a lot more importance to this country in regard to health then we doctors do because you are the frontline workers you are the folks who can make a huge difference and Sasori well I fuss with this for a second and I'm gonna launch right into things we don't have a lot of time and I warn you in advance I am likely going to go over but you can start booing me if you decide that you've heard enough that's fine with me I will take a hint but let's get rolling and what I want to talk about today is what I call a rebrand we need to rebrand exercise you know exercise right now generally gets presented as something to help with childhood obesity as something to help with adult obesity as something to balance diet with and I am going to spend my time here trying to dissuade those of you who still believe those things from that message now we physicians we put these slides up a lot I don't know if you guys have to do them but I have to do them it's just a disclosure slide I've got some relationships with non-commercial interests like Ontario's Ministry of Health and then a whole pile of other people I do have two commercial interests I wrote a book which is purchasable and I own a medical institute and those are my disclosures none of those matter here because I don't know how to monetize the message that exercise doesn't help people to lose weight now what is exercise for well I will start off by reassuring you that I firmly and thoroughly believe that exercise is the single most important modifiable determinant of Health there is nothing that a person could do that would help and benefit their health more than regularly exercising I also want to make it very clear that I do not debate the fact that the laws of thermodynamics exist that calories can in fact be burned is true and that on paper that should affect weight significantly but I hope to explain over the course of time here that ultimately we can't outrun these forks these forks are very very fast now in terms of exercise in society and these actually all come out of Mosul and a lot of them come from the UK but these are the sorts of headlines we see that it's over policing play that leads to obesity and that to combat obesity we need more PE requirements that exercise could prevent childhood obesity that not allowing kids to run in the playground is pure madness and it's because of childhood obesity that's pure madness I agree that what we have been doing to playgrounds is madness but not because of childhood obesity this particular article over here said that the pre think fresh thinking around break time play at school will make a real difference it says here that overweight kids must have better access to sports facilities education bosses warned that pupils will buck the obesity trend with exercise this taught me that netball something I am not familiar with I gave this talk in the UK I learned that playing netball is making our daughters fat I have three daughters and thankfully they are not playing netball I guess you know so it's all good now what I want to go through with you right now because I think and as Doug mentioned I think evidence is a useful thing you know I think truthiness is a lot of fun and I adore Stephen Colbert but truthiness is not useful when we're trying to understand what are the drivers now in society and so I'm going to go through and I warn you I'm going to go through a lot of studies with you I will try to make them entertaining and not dry but I will be going through a lot of numbers but I will not put them up there the citations if you are interested you can pull the articles yourselves but I'm not going to bore you with slides full of numbers now the question is can children outrun 4 we're gonna start with kids and this particular study done in 2008 looked at 300 British children between the ages of 5 and 8 they looked at them from 54 different schools for four years worth of time what they found was that there was no amount of exercise associated with a change or improvement in body weight or body fat percentage and when I say no amount of exercise and no association what this study found actually was that those kids who were exercising 10 times as much as their peers they had no protective effect from that exercise on their weight or on their body fat percentage now as far as PE goes you guys may be familiar with this paper given what you do this paper was a Canadian paper done by at the time a medical resident Kevin Harris and he was looking with his colleagues at the effect of school based activity interventions on BMI and children this was a meta-analysis he looked at 18 different trials in this men analysis they had durations of between six months and three years they involved over 18,000 students and what he was looking for was an effect on children's obesity rates what he found was that there was no effect and this wasn't a one of so to more meta analyses have been published since then and the first one there from well actually the most recent one there from 2015 looked at 47 different randomized control trials from Europe again on children and the impact of school-based PE on their weights specifically and in that first one listed up there are a few studies showed any effect on BMI whatsoever the second study listed there another randomized control trial meta-analysis looking at kids between 6 and 12 where the activity interventions were longer than 6 months there were 11 interventions 11,000 students and again physical activity interventions were not not associated with any impact on body weight and so the question is why again I said before that thermodynamics exists if kids are moving more this should have an Packt right we're not sure kids are moving more so there's this theory and it's starting to have reproducible results and it's called the activity stat theory I don't know if you've heard of that one but that suggests that somehow inside kids bodies and actually maybe adults too there's something that keeps track of activity and that when you've exercised it knows and then it makes you slow down for the rest of the day and so the first study that coined this term in 2011 it was a fascinating study it used accelerometers so this isn't self-reported exercise this is objectively measured exercise and what they were comparing was the impact or the amount of exercise done by kids in three different school settings in England one was a school that had nine hours can you imagine a weekly PE built into the school the second was a school that was a public school that first one was a private school go figure and the second was a public school that had one award about merit awards for the amount of exercise they included when their facilities etc they had 2.2 hours and the third was an inner-city school had no facilities beyond a concrete schoolyard and they had 1.8 actually hours of exercise weekly what they found depending on how you want to spin it was that regardless of the school over the course of the weeks of study the kids were all equally active or inactive and depends on how you want to spend the actual findings but what they found was the kids who are doing more at school did less at home the kids who were doing less at home doing more at school less at school did more at home and you know it really is an interesting thing and it may also spill over into something called neat neat is an acronym for non-exercise activity thermogenesis it's fidgeting and maybe we fidget us we don't know but this was a weird finding and it actually led to a lot of this can't be real yet it was reproduced in 2014 in Denmark and where they have sports schools in Denmark where the sports schools activities had a minimum for hours a week of physical activity normal schools so to speak had 1.5 hours and again using objective accelerometry there was no difference in the activity levels of those kids and so you know again we are not seeing the impact we are expecting now this picture you might recognize from that newspaper article before and it's meant to suggest that that boy is sitting down and that his sitting down is the reason why he's struggling with weight versus the other boys who are happily about to climb those ropes now looking at looking at the study of which came first the inactivity or the weight you know is the weight leading to inactivity or is the inactivity leading to the weight the answer is actually pretty clear so this study looked at 200 children from 40 schools for 10 years again with accelerometers and what they found was that body fat percentage and weight they were predictive of changes in physical activity over three years but physical activity was not predictive of weight what that means is this is not surprising either the kids and adults who struggle more with weight move less because it's difficult to move more with that weight and especially the kids I work with parents of children who struggle with weight and you know they really are the kids they are embarrassed and shy when they struggle with their weights exercise in front of their peers and so their inactivity is not the cause of their weight but rather the other way around and so looking at adults the question becomes can we are as adults fix this problem and so looking at an 11 year period of men who exercised more than the recommended daily amounts what we found was that in fact yes over 11 years if you exercise more than 150 minutes weakly you gained 0.4 pounds less a year now you're still gaining but you're gaining point four pounds less a year what it means is the men in this study who reported exercising more than 150 minutes a week over an 11-year period of time gained twelve and a half pounds those who read they did know exercise also gained and they gained 16 pounds and so exercise more than the daily recommended amount and you can gain four pounds less over an 11-year period of your men what's amazing though is how this was spun this is from the same journal article that said do everything you're told to do and more and you will gain point four fewer pounds a year and it says these recommendations we should be encouraging people to exercise more for their weight and then of course that's how the media spins this as well and so I would argue and I will argue over time that that is not a realistic amount of exercise so I guess the question is for us as adults you know could it be that we're lazier in our day-to-day so now let's forget about exercise maybe we've just slowed down you know there's elevators and there's escalators and dishwashers and you can walk your dog in your car you know maybe we've just slowed down and we actually have answers to that question too so there's a something called doubly labeled water it's a radioactive method of determining actual energy expenditure over a course of a day and so it is again objective objectivity is important because when people ask you know how much do you exercise we always say more just like we always end up taller and lighter than we actually are when someone asks us so doubly labeled water is objective and what was what's interesting is we've had this methodology for a while and so in the 80s both in Holland and in America doubly labeled water experiments were conducted to determine what was the average calorie burn among individuals those numbers were repeated in the early 2000s and in that time period early 80s in the early 2000s obesity rates in both countries rose very very dramatically what they found was what did not change at all was energy expenditures and leading those authors of course to say that you know energy expenditure hasn't declined and therefore that doesn't explain why we are gaining weight we have not slowed down we are burning as much as we always burned at least between 1980 and 2005 but maybe we slowed down and we're just it's a slow gain right and so researchers also looked at the third world where perhaps all of those energy saving things don't exist and they compared the energy expenditures of subsistence farmers in Nigeria women specifically and this is a picture according to Google of a farmer from Nigeria and what they did was they compared them to urban Chicago women 50% of who were unemployed and they followed the women for three years looking at their energy expenditures to see if there was a difference and I saw this research presented before it got published and the authors were flabbergasted they did not expect their findings but they found we are burning or at least urban Chicago women are burning the same number of calories as these women and subsistence farming Nigeria which again is a very surprising result but science is not a body of facts science is a growing living breathing organism of its own and so we see these results we want to study more and so once we saw that there was no difference in energy expenditure a follow-up study looked at whether or not there was any impact of the energy expenditures measured on weight gain over the course of the next three years of the study and the answer was no but maybe it was a one of maybe it was just this weird happenstance finding where they got you know the subsistence farmers in Nigeria who had the easiest job and somehow all those urban Chicago women were CrossFitters in their spare time who knows and so another study was done and this was a massive massive meta-analysis that I am so happy I wasn't involved in of 98 different studies that used again doubly labeled water that is that objective measurement I was talking about it had a hundred and eighty three different cohorts of people five thousand subjects and it included studies from 14 different countries including countries like Nigeria with low or middle human development index and as you already are imagining given the tenor of what I've been telling you there was again no difference there was no difference and this is an unexpected result but just because it's unexpected doesn't make it wrong this is objective measurements and I know instinctively me too we have slowed down like we have I know that but yet these studies which again our objective say well we actually haven't as much as we think but put aside all that let's say we did slow down where we are doing less and again for the adults can we disco sweat it all away you know can we just make this better through exercise can we can we balance can we balance the energy that we're consuming clearly it must be an energy intake problem right because if we haven't slowed down at all we're eating more so can we can we can we burn it off and actually in theory as I mentioned thermodynamics work the answer is actually yes and so Bob Ross anybody here know who Bob Ross is Bob no Bob's actually a really important guy he's a researcher in Canada he works out of Queens and he is heavily involved in understanding exercise and he did a brilliant paper where he got 52 men with obesity and he randomly assigned them to either a diet only group or an exercise only group where what he was aiming to do in a laboratory setting was make sure that the died only group in the exercise group had the same calorie difference meaning that the diet only group ate 500 calories less today the exercise only group burned this many more calories a day and it was equivalent and he was mean he had TAS watching people on his treadmill and yelling at them if their Mets were below what they were supposed to be and he had food diaries and was checking them on a regular basis this was a hardcore experiment and he actually proved that yes the laws of thermodynamics do work and yes you can balance things the problem is and this isn't actually Bob's lab but it might as well be but we don't live in laboratories we live in the real world and the real world is a very different world people don't like Bob study keep food diaries people don't understand energy balance I'm gonna get more into that in a little bit and people often will eat because they exercised you know sometimes because we feel we earned it I know I feel I earned my extra beer or whatever I might want when I exercise more and sometimes because we've been fed a bill of goods that say we need to we need to refuel we need to recover which I don't think is actually true but we do eat because we exercise fairly regularly so what happens outside of Bob's lab what happens in the real world so this is a study done out of Holland five thousand adults monitored for ten years looking again at the impact of weight and exercise and specifically on what happens if during that ten year period of time you report that you markedly increased your activity levels over the decade those people who reported markedly increasing their exercise from the start of the study through to the end of the study after 10 years weighed 1.2 pounds less and had 1/5 of an inch smaller waist circumference and what was the conclusion in the study I will read you the conclusion of that finding the authors concluded these findings support the need for public health programs that promote physical activity no they don't you know these findings do not suggest that we promote phys collectivity to prevent weight gain since it didn't really prevent any weight gain 1.2 pounds in a decade that is not sellable now let's go to a JAMA study from 34,000 women from the Nurses Health Study monitored for 13 years looking again the impact of exercise on weight there were women who did not gain 13 percent of the subjects in this study did not gain they were women who at the study's outset had a healthy body weight and already reported exercising more than an hour every single day these are rare people of those women who did not have a healthy body weight at the start of this 13-year study there was no amount of exercise that prevented gain over that 13 year period no amount of exercise looking at men this is 3,500 adults followed for 20 years men who exercised a minimum of 5 hours a week and 5 hours a week it's a lot of exercise you know I exercise a lot but I don't exercise 5 hours a week that is a lot of exercise but men who exercised a minimum of 5 hours a week so it included men exercising more than that over 20 years and you'll all stress this word gained 5.7 fewer pounds and had a one-point to two smaller inch waist than men exercising less than 90 minutes a week that is not good um put it another way if you exercise an hour a day six days a week if you're a man you will gain gained 4.5 fewer ounces a year and so what was the conclusion of the authors of this study the conclusion was our results reinforce the role of physical activity in minimizing weight gain no no they really didn't but go figure how this was presented to the public which is an and peace well how about walking you know everybody talked about walking their weight away and plenty of people have lost weight when they've undertaken walking programs but what about walking programs that don't involve dietary change that was the question and so there was a study looking at walking programs that didn't include dietary change for every ten and a half extra miles walked you might expect to lose just over a tenth of a pound according to this particular study roughly 30 to 37 hours of walking will affect a one pound weight loss according to this study which as you might imagine was promoted as a useful tool for weight loss this study and I would love to know how they managed to get the adherence of this study it was 200 people with obesity who were explicitly asked not to change their diets and then exercise an hour a day six days a week for a year the men averaged six point one six hours a week of exercise the women averaged four point nine hours a week of exercise it was an awesome awesome adherence an awesome study over the course of a year of six point one six hours a week of exercise men lost three-and-a-half pounds women lost two point six pounds took 91 hours for a man or a woman of exercise to lose a pound it's a lot of exercise and I'm really I've almost done beaten this to death but bear with me this was John Jacket sixth uh Dijon jacket this is the rolls-royce of exercise studies John Jacket chick is one of the world's foremost researchers in this field he took 250 sedentary people with overweight or obesity and randomly assigned them to 3 different exercise interventions there was self-help you should exercise here's a pamphlet see you later then there was prescriptive amounts of exercise a hundred and fifty minutes a week or 300 minutes a week and it was supervised with weekly contact there were phone calls they were his encouragement there was on-site fitness facilities this was a real good intervention what was really heartening actually and truly I'm not this is not sarcasm and the self-help just you should exercise more actually led to an average increase of 75 minutes a week of exercise which I find staggering I wonder what that pamphlet was the people who were asked to exercise 150 minutes a week actually exercise less than the pamphlet people they did 66 minutes a week the folks who were asked to do 300 minutes a week did 155 despite an 18-month significant increase in exercise for all subjects 73 percent either stayed the same weight or gained weight only 27% lost more than 3 percent of their weight and of those losing more if you actually looked at the study they were eating better and so it gets worse um exercise definitely seems to keep the weight off so here I'm telling you it is not gonna help anybody lose but yet it would seem to keep the weight off folks who exercise more arm are much more likely to maintain their weight losses but again if you look and I saw I didn't put a reference for this one but it is a study as well as 200 women if you actually look at the study more carefully which again was promoted as a exercise as the ticket to the weight loss Express study turns out that yes the people who were exercising more they did lose and kept their weight off a bit better but their dietary changes were triple the caloric difference of their exercise changes so they they were burning a little bit more but they were eating a whole heck of a lot less and so what about just in terms of exercise and the impact on things like body fat percentage well again there are some studies and there's some guidelines and this particular guide light says women require 60 minutes of moderate intensity moderate this isn't strolling moderate intensity exercise every day to avoid gain and of course the this means according to the study authors that we should be increasing our recommendations to exercise of course adults who follow exercise guidelines still gain weight that was the finding of that last study this was the report from Reuters the study clearly shows we gained weight over time if we want to slow the gaining weight we need to increase the physical activity it's a lot of activity and what about weight training we'll weight training helped you know we talked a lot about aerobics we talked but what about specifically weight training as you might imagine the answer is no it didn't help ten and a half thousand doctors in the u.s. health professionals follow-up study after 12 years of weight training those who report the most weight training more than 25 minutes a day of weight training after adjusting for everything over 12 years gained point 4 or 5 kilograms less than there were people who reported doing no weight training whatsoever and what was the conclusion weight training had the strongest association with less less waist circumference increase less weight circumference increase you will gain less weight and have a slightly smaller waist if you exercise a whole heck of a lot again not a particularly good selling point and so from an exercise perspective and that's pretty much the end of all the numbers uh thankfully from an exercise perspective there is simply no realistically realistically prescribed Abul amount of exercise that will help people stop gaining weight let alone help them to lose and what is the message out there and I apologize for showing you this next jiff because it's a colleague of yours that at least I feel is rather loathsome this is Jillian Michaels I say colleague very loosely please don't be mad at me but this is the message right so the message is you need to exercise like stink if you want to help manage your weight and this is a message that we promote to not just you know from ridiculous television shows like The Biggest Loser this was on the back of a bus in the City of Ottawa saying that if you sit less you can have more giant mocha frappuccinos at Starbucks um but you guys know that that's not true I mean the calories involved in that mocha frappuccino are not going to be balanced by your a little bit more cycling to work step jockey is something that was built by the National Health System in the UK it's really cool it gamma Phi's walking up and down stairwells across the city it's very neat but of course it says it's for BMI reduction and for weight loss primarily this is from Weight Watchers that says when you start to move more you can earn activity points so you can eat more the bigger that further you go the bigger the sundae is the message from this ad and again we all live it anybody who does distance running knows that this is true but it's not actually useful from weight management we've got PI runs this is and there's lots of PI runs this one what is from Edmonton where again we are teaching we should reward exercise in this case with PI this is a lad who was at a track meet from his school that is the junk food smorgasbord buffet behind him that again was being encouraged as either healthful or important we know I've got three little girls if one of my kids so much as bends a blade of grass someone comes running at them to give them ice cream or a sport beverage we've got these milk ads right that talk about chocolate milk how we need to refuel with chocolate milk and it is true that the macronutrient breakdown of chocolate milk is the one that seems to be idealized for health you know elite athletes but you know the likelihood of you having even one student who is requiring this for that this will help them with either recovering or the it's zero almost like truly and then of course the food industry loves this message right so Indra Nooyi the CEO of Pepsi there's no question that sedentary lifestyles have caused the obesity crisis to spin out of control yet we were talking before how we burn the same as we always burned but if consumers exercise did what had to do exercise wouldn't exist and this is an important message for the food industry right because this message well this message means that you can eat all their crappy products so long as you exercise it's not our fault it's your fault for not exercising and you know this balanced lifestyle thing it's real here's Coca Cola's got an alum active balanced lifestyle McDonald's has a balanced active lifestyle General Mills is a balanced and healthy lifestyle PepsiCo a balanced lifestyle Unilever a balanced diet and lifestyle Mars a well balanced lifestyle Nestle a balanced lifestyle balance balance balance you can balance everything according to the food industry this is a curriculum that's being taught I hope not in Canada but it's in over 50% of elementary schools in the states it's called energy balance 101 it was literally designed by the food industry and it's in 53 percent of schools this was one of the things that it tells people to do when you know you'll be eating lots of treats as a birthday party the right answer is get a little extra exercise it's in 53 percent of schools this is the four commitments to fight overweight and obesity in a sedentary lifestyle coca-cola you know let's learn about those commitments balance matters that's our commitment we need to balance everything coca-cola launches free fitness classes part of 20 million pound obesity Drive that really helping us aren't they guys you know they're helping us to exercise more it's terrific and what is that exercise all about for them marketing this is marketing they actually have a VP of sports marketing that's the title of the person at this place this race for this little child which they can get away with because it's sport is marketing their time the emotions associated with races joy happiness competition pride - coca-cola we know these things work you know these are real pictures you know we've got partnerships again built off of this premise this is with Konami and the American Diabetes Association they partnered together to ruin people's gym by putting these things into them and suggesting this is exercise this is horrifying um you've got American Heart Association with fuel up to play 60 you guys know this program I mean I know it's American but you know what fueling up to play 60 is about it's about chocolate milk it's about selling chocolate milk that is what the program is all about it's part of Let's Move you know it's craziness and you know these are large glasses of chocolate milk and I don't even think these children moved right like you know we've got this here too we've got now the Nesquik postgame refueling run jump throw the the logo for run jump throw is now actually Hershey Kisses like that is the new logo I'm not even making it up it's the logo it when run jump throws part of athletics Canada and so what happens at these sorts of events so here's the Hershey track and field games also sponsored by athletics Canada it's the good guys right what happens that they're track and field event said this is like the the grand finale event it's craziness McDonald's has their version as well I don't remember what it's called but they've got their version with track and field we've got atomic hockey it looks like mr. Landon left which is a shame because I was going to encourage him directly to try to outbid and out buy the food industries purchase of sport from our children and I realize we do need money we do need sponsorship support but should we really be selling it on the backs of our children's health and the promotion of these sorts of products you guys know what these are right these are 10 bits guess what Timbits really owns Timbits own sports I mean I'm thrilled that Canadian tyres involved in sport but we got to get Canadian tires logo on this rather than Timbits everybody's got Timbits minor hockey but did you know there was Timbits soccer Timbits ring yet Timbits curling Timbits football Tim Betts to volleyball Timbits beach volleyball Timbits this is Tim bits lacrosse I couldn't find the pretty logo I'll keep looking this is Tim bits softball and this is from the old days when people actually told the truth this is what this is all about right it's Tim bits time this is what it's all about and now they have this new program where if you're kids involved in Timbits hockey or soccer you get this little doodad to put on the jersey and then if you show up at Tim Hortons you can get yourself and I just played I'm thirsty reward the I just played I'm thirsty award is a either a lemonade or a hot chocolate chock full of lots of calories and hold piles of sugar if you have kids playing hockey they don't have penalties they get free french fries and we know that this actually has an impact in Australia kids are seeing an average I think it was either four to six hours sorry I'll come have a peek so four hours a week of brand exposure through the purchase of Sport buy junk food companies we've got coca-cola family field-day this is with the American courage College of Cardiology this is from their website where you can balance your calories with physical act that's a really fast fork it's a really fast fork and there's a problem with this message that we give all the time this was floating around the Twitter Twitter feeds the last week or two weeks ago if we keep trying exercise to calorie burn if we keep tying it to weight is there risk to that I think the answer is yes so first of all and these are adults we know that the vast majority of adults believe that exercise is a very effective way to lose weight it's just not a very effective way to lose weight in exercise a very effective way to be healthy it helps everything I mean everything our sleep our moods our metabolic processes it affects our energy it affects our attitudes it is the single best drug ever but it is not a weight-loss drug and then what happens if someone thinks it's a weight loss stroke and they start exercising they get discouraged they stop we need to tell the truth there's nothing wrong with telling the truth the truth is exercise and food well the balance is unfair you guys are educators it's like there's an exam where 80 90 percent of the material is the first semester and only 10 20 percent the second semester telling people to only study for the second semester is not fair they are not going to get a good grade we need to tell the truth we need to take this away from exercise by continually tying exercise to weight control weight loss weight maintenance weight whatever by doing that we do to dis services we do a disservice to exercise because people won't realize the unbelievable benefits are worth having regardless of weight and we do a disservice to weight management because people are gonna try stupid things when they fail with the thing that they are told is supposed to help them so I'm sorry for going over thank you for your time and attention [Applause]

Channel: Physical and Health Education Canada

Views: 49,150

Keywords: physical activity, health, education, nutrition, obesity, exercise, Physical Education (Field Of Study), Health Education (Field Of Study), Weight

Id: x7FK8noIc5I

Length: 39min 13sec (2353 seconds)

Published: Wed May 13 2015