October 30, 2019 Editorials

Lifestyle, obesity and health: News from Australia!

The International Chair on Cardiometabolic Risk (ICCR) co-organized an international conference in collaboration with the Australian and New Zealand Obesity Society (ANZOS) and the Australasian Society of Lifestyle Medicine (ASLM). The ANZOS-ASLM-ICCR 2019 conference was held in Sydney, Australia from October 16 to 18. Through this partnership, the ICCR was able to contribute to the scientific program, which included presentations by five scientists from the ICCR international expert committee, including myself.

I had the privilege of giving the opening plenary conference where I presented the work from my research team showing the relevance and usefulness of measuring in clinical practice what I have called the four “vital signs”, which reflect our lifestyle and its health consequences: waist circumference, cardiorespiratory fitness (capacity for physical exertion), as well as the overall nutritional quality and physical activity level as reported by participants with the help of a validated questionnaire. In our cohort of workers assessed in the workplace not only for these four vital signs, but also for their health profile (e.g., cholesterol, blood pressure, blood glucose, diabetes, smoking), we found that the participants’ lifestyle habits were very robustly associated with their health profile. The key message was that primary care physicians should be equipped to measure and target their patients' lifestyles in addition to paying attention to their cholesterol, blood pressure, and blood sugar. Otherwise, how can patients be guided on their lifestyle if these aspects are not measured?

On the second day of the congress, my colleague André Tchernof from the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval gave a brilliant lecture where he showed how the characteristics of visceral fat (located in the abdominal cavity), obtained from patients undergoing surgery, predicted their health profile. He explained how this abdominal visceral fat is distinct from abdominal subcutaneous fat and plays a central role in determining health problems associated with abdominal obesity.

Dr. Marja-RiittaTaskinen, from the University of Helsinki, who is an eminent expert in lipid metabolism, showed how a fatty liver, a condition very often found in visceral obesity (even in individuals apparently of normal weight based on their body mass index), was largely responsible for the dyslipidemic state of type 2 diabetes and for the risk of cardiovascular disease in individuals characterized by this condition. Dr. Taskinen has also carried out studies where it was shown that a diet high in added sugar can quickly increase the fat content of the liver while a diet low in carbohydrates and added sugar (such as the ketogenic diet) could rapidly decrease the fat content of the liver.

Professor Robert Ross, from Queen’s University in Ontario, a world-renowned expert for his work on exercise and visceral adiposity, warned health professionals about the limitations of weight loss as the best single target. It is often a bad indicator of the success of an exercise-training program in patients with visceral obesity. Very often, these individuals will decrease their waist circumference and increase their muscle mass through regular exercise with little or no impact on weight loss. On that subject, Professor Ross and I are from the same school of thought: If you have the little belly of a sedentary man in his fifties or of a postmenopausal woman, you cannot always rely on the scale to evaluate the benefits of regular physical activity/exercise. Waist circumference will be a much better indicator of your success, as well as your heart rate at a given walking speed. Indeed, having a lower heart rate at the same walking speed after a few weeks of having been physically active is a sign of improved cardiorespiratory fitness and an excellent indicator of the training response.

Finally, Professor Miguel Ángel Martínez-González, from the University of Navarra, an expert in nutrition and cardiovascular health, described the spectacular results of the PREDIMED study which showed the benefits of the Mediterranean diet (including olive oil and nuts/almonds) on the incidence of cardiovascular events (including stroke) in 7,500 high-risk patients. In addition, he presented (as a world premiere) the interim results of the PREDIMED-Plus study where, this time, the Mediterranean diet is combined with a small caloric restriction for weight loss and an exercise prescription (results have just been published in the prestigious American journal JAMA). Interim results after one year show that it is possible to significantly improve adherence to a Mediterranean diet in high-risk patients followed by physicians, and that it is also possible to reduce their waist circumference, to make them move and to improve their risk factors for cardiovascular disease. Now, the question that remains is: will this approach reduce the incidence of cardiovascular events? To find out, these investigators will need to follow participants for an additional period of at least 5 years. As a Canadian scientist, I am proud but also envious of our Spanish colleagues who show world leadership in the conduct of major clinical trials in nutrition and health. We could do the same in Canada if we make prevention research a priority.