Second Life – Virtual Fitness Centres: What’s it all about?

If you’re more concerned about getting involved with this virtual gym as quickly as possible, and don’t really care about this science stuff, then skip down to the third heading.

A Quick Outline

My avatar pumping iron.

My avatar, Jaye Jeffries, pumping iron.

A relatively recent news article in the science media highlights some of the discoveries of a longitudinal study conducted in the virtual environment Second Life, with the goal of delivering a weight loss and exercise program and comparing the differences between a face-to-face approach with a virtual online approach. After looking at the paper it appears promising, though there are certainly some questions that should be addressed about the methodology. First we’ll look at the research, then we’ll delve into an actual virtual gym in Second Life which is freely and publicly available to all.

Study Design Details

The study split 20 participants, 17 of which were female, into two groups, the face-to-face (FTF) group and the virtual group, and was conducted over a 9 month period with the first 3 months focussing on shorter-term weight loss and the following 6 months focussing on weight maintenance. Results showed that the FTF group had a greater degree of weight loss overall, though the virtual group had a greater degree of weight maintenance. With weight maintenance being an essential factor for long-term weight loss, that probably makes the virtual approach a little more superior even though the FTF group showed slightly higher degrees of weight loss.

Let me be honest here, while the study talks about “statistical significance” and differences between the two groups in this regard, there is also the concept of “clinical significance”, meaning that, in the real world – is there really enough of a difference to make it noticable and worthy of use as an intervention? In this regard we might consider the two groups identical in a clinically significant manner, and that’s a good thing! Perhaps the only drawback for this study is that the exercise intervention itself isn’t elaborated on, so I’m left to conclude that it wasn’t very thorough, but taking into account that the research focusses more on nutrition than exercise this can be overlooked with the expectation that future research will focus more on that aspect.

There were other benefits too for the virtual group over the FTF group, including signficantly greater fruit and vegetable consumption and higher levels of exercise (walking) as measured with a pedometer. Finally, to finish with the authors conclusions with which I completely agree:

“An adequately powered, longer-duration trial, with adequate assessment of potential mediators and moderators, is warranted to further evaluate the potential of Second Life as a delivery system for successful weight management.”

In my view, virtual and online environments continue to hold an untapped potential for helping to decrease barriers to exercise, and this study is the tip of the iceberg in many studies to follow that will help to unveil this hidden potential.

What’s all this about a gym in SL that you can access?

The most interesting part is that you can access Second Life fitness centres yourself, for free, where you can discuss exercise technique with real life professionals, get advice on nutrition and exercise programming, or just socialise and meet new people who are going through a similar experience. What makes this different to a real gym? There’s no cost, it’s far more accessible, and it acts as an introduction for people who might be too nervous or self-conscious to step foot into gym or fitness centre. I stress that there is a real need for translation of this platform into real life, which is what the discussed study begins to explore – the exposure and delivery of weight management techniques and how they translate into real life.

There are a number of Second Life fitness centres available, but my favourite by far – and which is actually funded by the United States Department of Agriculture (USDA) based on the above research study out of Kansas University, is the Avatar Fitness Club, hosted and run by the eXtension team. While there aren’t any events planned as yet, though promised to come, be sure to check it out and if you run into Thynka Little, DFox Spitteler, or even myself (Jaye Jeffries), be sure to say hi!

If you need more convincing, check out their Facebook page for more info.

Contemplating the potential for virtual exercise prescription.

Jaye Jeffries contemplating the potential for virtual exercise prescription.

(I’m a Second Life nerd from way back, so you’ll have to excuse the excitement from this post. The possibilities of combining two of my passions is an almost overwhelming possibility)

Have you visited the Avatar Fitness Club in Secondlife, and if so, what did you think? Share your thoughts in the comments!

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ESSA, Michelle Bridges, and Why You Shouldn’t Say That Exercise is “Fun”.

English: Michelle Bridges at the film premiere...

Michelle Bridges (Photo credit: Wikipedia)

The Media Article

Back in August, Michelle Bridges, a personal trainer popularised by the Australian hit tv-series “The Biggest Loser“, came out with this article in the Sydney Morning Herald, on why personal trainers should stop calling fitness “fun”. Let me say straight up I’m inclined to agree with her, at least to an extent.

Her views are well balanced and seem to be in line with managing clients expectations about what exercise entails. While exercise certainly can be fun, particularly in the case of team sports and aerobics, activities such as high intensity training, sprinting, jogging, and weight lifting – all those that probably carry a majority of the benefits seen from exercise – probably aren’t best encapsulated with the noun “fun”.

My Thoughts

Challenging? Yes. Life altering? Yep. Healthy? Of course. Self-esteem building? You bet. But fun?
Ummm, no, no not really, not the first concept I would be using to introduce exercise to a newcomer. With that said I think it’s important to have an element of fun in all of the workouts we participate in, but to white-wash exercise in general as “fun” is definitely misleading for the average customer.

Now I’m neither a fan nor an opposition of Michelle Bridges, and I’ve probably seen a total of 10 accumulated minutes of The Biggest Loser over it’s entire duration, but I think it should be clear from her article that she’s targeting personal trainers who are using the “fun” concept as a way to draw in new customers, regardless of their expectations as to what exercise may actually entail. This could potentially destroy their motivation to exercise when they discover that it’s really not as fun as they were lead to believe.

The Plot Thickens with ESSA’s Response

Now to the crux of the matter. How did ESSA (Exercise & Sports Science Australia), the registration and organisational body for exercise physiologists and scientists respond to Michelle’s article via their Facebook page? Well yes, I’ll tell you because if you’ve read this far you’re probably keen to find out. The response was along the lines of:

“Dear Michelle, we here at ESSA believe that exercise is not only good for your health, but that it’s also fun!”

Isn’t that trite? A nice one sentence sound-byte for the masses.  And why did I say “along the lines of” instead of quoting them directly? Well they removed their quoted response from their FB page after I criticised their reaction, though I assume it was still sent in some public form as a Tweet, article response or message to Michelle Bridges (My Googling skills failed me on this instance, sorry I can’t provide the exact phrasing).

English: A senior citizen while practicing his...

A senior citizen while practicing his fitness exercise. Is this ‘exercise’, and is it ‘fun’?  (Photo credit: Wikipedia)

This response came from the registration body who we’d hope have a better and more complex understanding of the issues surrounding the psychological and physiological complexities of exercise compared to the average professional provider, but nope, Michelle’s article was passively denegrated without truly understanding her message.

Tensions Between Personal Trainers and Exercise Physiologists

Why? I have a theory. I’ve noticed a lot of tension between personal trainers and exercise physiologists – if you’re in the field, tell me why you think I’m wrong. I’ve noticed two primary characteristics of the tension that exists between PT’s and EP’s:

  1. Many PT’s believe they already possess the knowledge and expertise of an EP, while being unaware of the complexities involved in training chronically ill clients
  2. Many EP’s continually denegrate the role of PT’s, while being unaware of the valuable role that PT’s play in exercise delivery to healthy populations
  3. The fields overlap to some extent, and although EP’s are more highly qualified they may not possess as much hands-on experience (due to EP being a relatively new profession) as PT’s in the field, some of which may have 20+ years of experience.

These observations come from both my experience as a professional personal trainer and the views espoused by my lecturers and peers (eg ESSA) while studying exercise physiology. I won’t lie, I’ve denegrated personal trainers on countless occasions myself – the degree of appalling quality exercise delivery and outright commercialism for every fad exercise modality that comes to my attention is overwhelming, but there are certainly good PT’s out there who are experienced and know what they’re doing, they’re just hard to find.

I’m at a loss for a solution to this divide between the two professions, but I will say this – I was disappointed with ESSA’s trite response.

In Summary

Nobody’s perfect, but let’s be humble, and to the PT’s out there – let’s stop telling clients that “exercise is fun” and make more of an effort to manage their expectations. That doesn’t mean there can’t be fun aspects to exercise, nor does it mean we should torture clients in the way that Michelle Bridges does on TV, but let’s try to find a happy middle ground where benefits are seen while managing expectations and avoiding making exercise a chore.

Exercise should be for life, not for the term of the contract.

What are your thoughts? Should fitness be advertised as “fun”, or is the term overused?

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Counterproductive Cliche’s of the ‘Big & Beautiful’

There’s a dangerous attitude out there, one which has been festering for a number of years and is probably a proponent of the Oprah Winfrey movement, I like to call it the “Big is Beautiful” syndrome. This particular group of people spout cliche after cliche, using faulty logic to support their denial that there is anything wrong with being overweight or obese and that people are spending far too much time on the topic of health, fitness and weight.

Obesity Campaign Poster

Obesity Campaign Poster (Photo credit: Pressbound)

Playing the Victim

These venomous types will twist and turn, claiming that they are discriminated against based on their size, that anorexic supermodels and superstars are providing negative role models for our youth (let’s do a reality check: are America and Australia full of overweight and obese, or have anorexics suddenly taken hold of the streets?), and that women should not be worried about their weight at any rate when, and I quote (from some random journo’s blog):

“Whining about weight is the ultimate shiny object that women continue to focus their attention on, instead of:
– fighting for social justice, at home and abroad
– running for political office and kicking ass when we win
– creating astonishing works of art
– waking up every single day grateful for their health and strength, the not-so-simple ability to walk and stand and reach for things without pain
– knowing that women all over the world are dying of starvation, malnutrition and in childbirth”

Etc etc ad nauseum, supposedly an extensive list of why you are misplacing your concerns, but in reality it’s an excuse list.

Did you get that? If there are problems in the world, or in politics, or with animal cruelty, or perhaps just your kitchen tap isn’t working properly, then you shouldn’t be “whining” or even thinking about your weight as there are more important things to worry about, and after all, you can only fix one problem at a time, right? RIGHT? (well…no, actually).

My Thoughts

I won’t lie, it irks me particularly when journo’s who have a good deal of exposure spout drivel continually, as they have a duty of care to do their best to dispense useful and accurate information, not catering to the fragile ego of a particular demographic who want to be coddled until they’re feeling the full glory of a  diabetes induced coma. Sure it feels good telling people what they want to hear, and everybody’s feeling-the-feels and congratulating each other on accepting themselves for ‘who they are’, but in the long-term there’s serious damage being done by this blatant disregard of reality (On the matter of journalists being scientifically illiterate and ignorant and dispensing horrendous advice is one which I plan to write about in the future).


Bad health and excessive weight is a shaky foundation on which to build your emotional, intellectual and spiritual development.

The Moral

What’s the moral here? This isn’t just a whine about people who (ironically) tend to spend their time whining about people who are whining about their weight. The moral is this – do not let people like this, with their superficial facade of positivity and “oh honey you’re gawdjuss just the way you are!”, don’t let them tell you that you can’t or shouldn’t spend time improving yourself, your health, and your well-being, just because they have failed to do so themselves and need to surround themselves with other failures while propagating superficially positive but truly negative beliefs and attitudes. Don’t let them delude you into ignoring the consequences of being overweight or obese, nor how big these problems are in America and Australia and their impact on the healthcare system. If you find yourself tiring of conversations about health and weight, perhaps it’s time to do something about it.

Every person on this earth has the right and the obligation to take care of themselves and each other, but (and now it’s my turn for a cliche, so why not?) how can we take care of each other if we can’t or won’t take care of our own physical health? If we don’t create a very solid foundation, there is no chance of building a stable structure on top.

Don’t surround yourself with fake and dangerous, self-delusional positivity. Sometimes, a good hard smack in the face is good for us, and forces us to see what we’ve been ignoring for way to long. Let’s not delude ourselves or let others delude us, let’s stay true to our goals. Don’t ever let a random Joe tell you to “give it up”, because you can and will achieve greater health and well being if you just ignore those coddlers.

Is Big Really ‘Beautiful’?

Big is not “beautiful”, big is heart disease, obesity, diabetes, metabolic syndrome, arthritis, cancer, fatty liver disease and sleep apnoea, to name a few.

What are your thoughts? Is the “big is beautiful” attitude a problem that you often experience, and is it something that we should spend more time addressing?

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Fitness Measurements: The basics that every fitness enthusiast needs to know

Let’s keep it simple, but not too simple. This is a topic that I generally wouldn’t cover, but I’ve come to realise that too many people still don’t differentiate between fat body mass and muscle body mass. With some simple measurements you can ensure that you’re not confusing the numbers on your scales for fat, when in fact the increase is due to muscle, or vice versa.


Firstly, when performing basic weight measurements it is next to useless to measure your total body weight without also taking other measurements. Most fitness enthusiasts are interested in how much fat mass they have lost, or muscle mass they have gained, or both. If your muscle mass has increased while fat mass has decreased, regular scales might not shift at all. Invest in some tanita scales which, while not being the most accurate measure of absolute bodyfat, at least help to give you an idea how your bodyfat percentage (bf%) has shifted from week to week.

This brings us to our second point. When using tanita scales, the measurement should be performed at the same time, on the same day, each week – preferably before eating, and if possible after using the toilet and after consuming 500ml’s of water. This helps to ensure that you’re measuring body mass as opposed to last nights meal and are in a suitably hydrated state, since tanita scales can be affected by the hydration level of the body.

Also keep in mind that the relative movement of the bf% (eg it might move from 15% to 14%) is what’s really important, not necessarily how this percentage compares to a table of norms in the population. Tanita scales tend to overestimate total bf% by a few %, so if you want an absolute reading have a DEXA scan done and simply determine the difference between the scan results and the reading given by your tanita scales.

When comparing how your bf% has shifted from week to week alongside a general body weight reading, you’ll get a better idea for whether or not you have added or lost fat or muscle. For example:

  • Week 1, Sunday morning: 15%, 70kg
  • Week 2, Sunday morning: 15%, 71kg (normal fluctuation in bodyweight)
  • Week 3, Sunday morning: 14%, 70kg (possible normal fluctuation in bf%)
  • Week 4, Sunday morning: 14%, 71kg (probably a 1% shift in bf%, normal fluctuation in total bodyweight)

Final point for tanita scales – both bodyweight and bf% might shift a little from week to week, this is normal. It’s best not to mark it down as a definite change unless it sticks for 2 weeks or longer.


Girth measurements are a useful addition alongside weight and bf% measurements for determining which part of your body has gained or lost fat or muscle. The most useful sites for measurement:

  • Arms – taken at the midway point
  • Neck – taken below the adam’s apple (or at the same approximate point on a woman)
  • Chest – nipple height
  • Waist – a few cm’s above the bellybutton
  • Hips – around the apex (largest girth)
  • Thighs – taken when standing with arms at your sides, the furthermost point where the fingers touch the thighs in a relaxed position.

All of these recommendations are for ascertaining relative readings, which enable you to compare your progress from week to week. Don’t measure more often than this – there is quite a bit of variation in readings from day to day as a result of fluid, food, and other factors, so it would be essentially frivolous. Also try to ensure that you take the measurements in the same exact location so that relative readings can be compared.

Waist and hip measurements are useful for determining your risk of cardiovascular disease, diabetes, obesity and other chronic illness:



Finally, a good iPhone app for recording your weekly body measurements is Gym Buddy, one of several iPhone apps I reviewed in this post, which although no longer receives support or updates (nor is it available to other smartphone users) allows you to keep fully customised measurements along with statistics and graphs and is still more than worth the price.

What smartphone apps have you found that have made your fitness habits easier to track and plan? Share any recommendations in the comments!

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Book Review: 5/3/1 by Jim Wendler

I read 5/3/1, a strength training book, for the first time back in January 2012 on the advice of a classmate and friend, and reread it this week with the intention of putting it into action. Taking into account that I’ve now set up my 5/3/1 training template and will provide an update on my progress with this plan in coming months, here is my review of the book itself.


5/3/1 is a strength training guide aimed at medium to advanced level weight lifters who have experienced a plateau in their lifting. It offers a somewhat unique approach to lifting, employing a ‘1 step backward and 2 steps forward’ approach by recalculating 90% of the 1RM to determine the weight to lift, rather than the actual 1RM, effectively lowering the true 1RM by 10%.

5/3/1 focusses on the fou531 Imager main lifts; barbell bench press, barbell deadlift, barbell squat, and barbell military press, and aims to increase the strength of the lifter through a 4 weekly cycle of strength training by methodically adding incremental amounts of weight, while lowering the reps, until a new 1RM is achieved (above and beyond both the recalculated and actual 1RM). This approach focuses on the last set of each exercise, with a maximal number of reps being pushed out on the third/last set, while the first two sets strictly adhere to the rep limit – being either 5, 3, or 1 reps depending on the week. The weekly breakdown for this plan is as follows for each main lift:

• Week1: 5 reps, 3 sets, (65%, 75%, 85%)
• Week2: 3 reps, 3 sets (70%, 80%, 90%)
• Week3: 5 reps in the first set, 3 reps in the second set, 1+ rep in the third set (75%, 85%, 95%)
• Week4: 5 reps, 3 sets (40%, 50%, 60%)

‘Assistance’ exercises are included, these being any exercises that can be considered to help improve the strength or technique for lifting of any of the main lifts. The fourth week is a deloading week, and is essentially providing a low level stimulus for the body while giving it a chance to recover from the previous weeks of lifting.


The author includes plenty of anecdotes and success stories, and plenty of detail for his approach. He includes some basic weight lifting technique and advice along with a short warmup and stretching guide, as well as a description of what types of exercises to use as assistance exercises. He provides useful plans for slightly different preferences, includes plans for training 4, 3, 2 or even 1 day per week – so there’s really no excuse for destroying your entire workout schedule, which is incremental, due to a busy week. He also provides a quick guide on the useful and basic functions in Excel for using his plan, a fairly good FAQ (which answered most of my questions), as well as some training templates at the end of the book.


This book, and indeed the authors method of approach, would have much more credibility if he actually had science or non-anecdotal evidence for support. Unfortunately he only provides anecdotes and stories as support, and various unveiled and ardent anti-intelluctal remarks by the author, including the memorable “You want science and studies? Fuck you. I’ve got scars and blood and vomit.”, hardly help his cause.
The author has a no-nonsense attitude which is refreshing at times but grating at others, and leaves large gaping holes in the text where he could provide more information for the readers (or at least references to other sources) but instead chooses to belittle them in classic meat-head style.


Overall, a reasonable book with a possibly great methodology. The author is at times entertaining with his quips and descriptions, for example “don’t be a Cheater McCheaterstein…or a Half Rep McGee” and such, though his oversimplifications or misunderstanding of basic anatomy leave something to be desired. For example “Before lifting the bar, fill your diaphragm (not your chest) with air”, which is a patently ridiculous statement, though he perhaps shouldn’t be taken too literally with his advice. Also, some of his dietary advice (“eat 4-6 meals per day”) may leave the reader simply scratching their head asking “why”, if the old myth about stoking the metabolic fire is not to be believed.

Unfortunately there’s a single question left on the readers lips: “will this approach actually increase my muscle mass?”. The author perhaps unintentionally avoided addressing this, with his focus being entirely on “strength”. Granted, the title of the book does reads “the simplest and most effective training system for raw strength”, which while correlated tightly with muscle mass, need not be indicative of girth improvements.

Stay tuned for my personal experience with 5/3/1 in the coming months, where I will put this methodology into action and record full body anthropometry (yes, including basic girth measurements and body fat % readings from both tanita scales and calipers!).

Have you read 5/3/1, and if so, what were your thoughts on Wendler’s program and exercise recommendations?

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To Breakfast or Not To Breakfast?

   Breakfast skipping, or intermittent fasting, has gained a lot of steam in the past year or two (“Big Breakfast Has Little Effect on Appetite“, “Extended Daily Fasting Overrides Harmful Effects of a High-Fat Diet“, “Skipping Breakfast Can Lead to Unhealthy Habits All Day Long“, “Could fasting be good for us?“, “Is breakfast making you fat?“, “The new appetite for fasting“). In fact I put the principle to use myself, and so thought this would be a great topic for my pathology research assignment. This report might be dry reading for those who aren’t used to reading scientific literature or associated nomenclature, so I’ll start by quoting the most relevant part of this report – the conclusion:

  “The key findings of this report are that breakfast appears to be clearly associated with weight gain in a dose-dependent relationship, though the direction of this relationship is not clearly established. Depending on the type of descriptive research method employed, different results are apparent, though the study by Schusdziarra et al. (2011) addressed some of these apparent contradictions.

   In conclusion, when interpreting the data in light of the contradictory nature of the research, there appears to be little evidence that breakfast skipping significantly contributes to overweight and obesity in adults, though individual factors such as age, obesity, exercise history, TDEE and TDEI should be taken into account and may in fact play a large role in the interpretation of the associations and correlations investigated in fasting and meal-skipping studies.”

   And there you have it, no real evidence for a causal relationship between breakfast skipping and weight gain, though the correlational data shouldn’t be dismissed out of hand and does provide us with some insight. Also, take into account that my critical analysis within this report only covers two pieces of primary literature, but that dozens of articles were accessed in the process. That said, I was forced to neglect the biochemical (grehlin, leptin, insulin, glucose, not to mention the interplay with lipid cells) physiological point of view somewhat in order to remain within the word limit for my report. If it’s the biochemistry of breakfast skipping that you’re after however, then I won’t reinvent the wheel – just head on over to Martin Berkhan’s blog “Leangains“, linked in the side panel, for more fasting biochemistry and references to primary literature than you can poke a stick at.

Without further delay, here’s the nuts and bolts!

(Feel free to comment at the bottom – what are your thoughts on breakfast consumption?)

Skipping breakfast: is it a significant contributor to overweight and obesity in adults?


Overweight and obesity are growing health problems in Australia, with an increase from 57% of the population in 1995, to 61% in 2007-2008 (Health Risk Factors, 2012), having an enormous cost to the Australian government and society at an estimated $58 billion in 2008. Figure 1 shows data from the National Health Survey 2007-08, in which a larger proportion of overweight and obesity is prevalent amongst the aged adult population, particularly amongst males, with younger adults showing lower prevalence rates.

Figure 1: Proportion of Australian Adults Overweight or Obese (by age and sex). This figure illustrates increasing incidence of obesity with age (Health Risk Factors, 2012)

The importance of experimental investigation into the causal mechanisms of obesity becomes obvious in light of this data. This report sets out to examine associations between meal skipping (breakfast in particular), and overweight and obesity, and to challenge the long-held belief that breakfast is “the most important meal of the day” – a notion which has been picked up and discussed by the media in recent years (Roan, 2009) and mainstreamed by popular books such as Eat-Stop-Eat (Pilon, 2007).

This report will cover background information on obesity, including definitions, aetiology, pathogenesis, diagnosis and treatment. Two descriptive, observational studies will be analysed, summarised and critically evaluated in the context of other descriptive and experimental scientific research, and the strengths and weaknesses of each study and their separate contributions to this research question discussed. Finally, key-findings from the two studies will be restated and summarised.

Background Information

There are typically four different categories into which diseases may be placed; pathological, hereditary, physiological and deficiency disease. For the purposes of this report, obesity and overweight are considered from the context of their most prevalent cause, being physiological disease as a result of excessive nutrient intake and inadequate physical exercise (Obesity, 2012).

Bodyweight categories are grouped based on body mass index (BMI) measurements, with obese being in excess of 30kg/m2, overweight within the range of 25-29.9kg/m2, and a normal bodyweight falling in the range of 18.5-24.9kg/m2 (Overweight & Obesity, 2012).

Obesity is a chronic disease in which excessive amounts of adipose tissue are accumulated over time, leading to potential systemic issues and increased likelihood of comorbid disease (Weiss & Elixhauser, 2006). A caloric surplus is required over an extensive period of time for obesity to develop, usually necessitating low levels of exercise and a surplus in nutritional intake in order for total daily energy intake (TDEI) to exceed total daily energy expenditure (TDEE). Though this is the predominating cause of obesity, there are rare genetic disorders in which leptin insensitivity may cause obesity from childhood (Farooqi et al., 2007).

The pathogenesis of obesity is complex and only partially understood, though it’s clear that it depends on the function of several key metabolic hormones, including glucagon, insulin, leptin and ghrelin (Carlson et al., 2007), with adipose tissue itself also producing important mediators for the metabolism of triglycerides to adipose, including adiponectin, cytokines, chemokines and steroid hormones (Stanley L Robbins, 2012). Leptin is known to play a key role in the suppression of appetite (Duntas & Biondi, 2012), with decreasing levels of leptin being secreted when fat is lost from adipocytes – making long term weight loss more difficult. Insulin and glucagon control the transport of glucose into and out of the cells respectively, with long term blood-glucose levels and excessive lipid intake being tightly correlated with insulin resistance and type 2 diabetes (Fu, Gilbert, & Li, 2012). In addition, the risk of other comorbid diseases such as cardiovascular disease, gall bladder disease, osteoarthritis, bowel cancer and diabetes are increased in the presence of obesity (Schienkiewitz, Mensink, & Scheidt-Nave, 2012).

As obesity is defined as a BMI above 30kg/m2, diagnosis is simply made by utilising the formula BMI = weight/height2. The drawbacks of the simplicity of this formula lie in the fact that there is no distinction made between fat and muscle mess, therefore an incredibly muscular bodybuilder might be considered “obese” if only the BMI were used as a measurement. Obviously BMI needs to be utilised in the context of other available information to ensure the wrong demographic of “overweight” individuals are not captured and misclassified.

    Treatment for obesity typically lies in nutritional and exercise interventions, more specifically improving the quality of nutritional intake and decreasing the number of overall calories consumed along with implementation of an effective exercise program. Though this treatment is successful in a large number of obese subjects, particularly when delivered with cognitive behavioural therapy (Jakicic et al., 2012), those who suffer from hereditary causes and complications may require more medical intervention. Finally, some of the latest research by Mestdagh et al. (2012) involving intestinal bacteria and their role in the development of obesity opens interesting avenues for future exploration.

Annotated Bibliography & Critical Evaluation

Annotation 1

Huang, C. J., Hu, H. T., Fan, Y. C., Liao, Y. M., & Tsai, P. S. (2010). Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan. International Journal of Obesity, 34(4), 720-725. doi: 10.1038/ijo.2009.285

This cross-sectional, descriptive study by Huang et al. used data from a National Health Interview survey in Taiwan which surveyed 15,340 individuals between the ages of 18 and 64. The study tested the association between breakfast skipping and obesity, as well as examining the possibility of a dose-dependent relationship between frequency of breakfast consumption and obesity.

The authors hypothesise that there exists an association between breakfast skipping and obesity, as well as a dose-dependent relationship in which an increased frequency of breakfast skipping is associated with an increased prevalence of obesity (amongst other behaviours deemed detrimental to health). The authors aimed to investigate these associations in adults as the majority of research conducted in this area in the past has focussed on a much younger demographic; primarily children and adolescents, making that research difficult to generalise to adults.

Although published in the International Journal of Obesity, the authors concede that the intended audience is specifically Taiwanese, and that the results are less applicable to other demographics, therefore these results are likely more relevant to Taiwanese health specialists and policy makers who are tasked with examination of potential causes and treatments for the growing obesity epidemic.

After careful analysis of the data, the authors conclude that breakfast skipping is associated with higher prevalence rates of obesity, in addition to being associated with other unhealthy behaviours such as smoking, alcohol consumption (though at what point this was considered detrimental to health was never addressed by the authors), and lack of exercise.

This study was chosen for analysis as it utilises a large segment of the adult population and is able to draw meaningful statistics due to this large sample size (n = 15,340).

Critical Evaluation

This study is relevant to this report as it directly investigates the association between frequency of breakfast skipping and prevalence of obesity, though there are advantages and disadvantages to their method of approach. One advantage is the fact that the authors utilised survey data, which allows a large breadth of information and amount of data to be acquired, however a major drawback of this approach is the inability to control confounding variables or tailor the data collected to include information such as macronutrient and micronutrient content and meal timing.

This study contributed to this report by confirming initial impressions that the majority of research is not applicable to the general adult population, as most studies examining the association between skipping breakfast (or fasting) and obesity are performed on a much younger demographic. This study also introduced the concept of a dose-dependent relationship, and more specifically that as breakfast-skipping increases so too does the prevalence of obesity. It also introduced the fact that breakfast skipping is associated with other unhealthy behaviours, including smoking, alcohol consumption, and lack of exercise. Finally, the associations found between breakfast skipping and lower scores of general health, vitality, mental health and social functioning helped to inform this report.

The authors addressed the research question by categorising the existing data into two groups: breakfast skippers and breakfast eaters (with breakfast skippers being those who ate breakfast once a week or not at all). The authors then analysed the percentage and P-value for each group, and subcategorised them into obese, smokers, alcohol drinkers, physically active, level of education, monthly income, marital status, and gender. The data was finally analysed using odds ratios.

This study gives direction for ongoing research into the links between breakfast dose (weekly frequency) and obesity, and helps to provide a basis for comparison of the results with other cross-sectional data as well as comparison with experimental, randomised controlled trials to compare and contrast the similarities and differences in outcomes.

Annotation 2

Schusdziarra, V., Hausmann, M., Wittke, C., Mittermeier, J., Kellner, M., Naumann, A., . . . Erdmann, J. (2011). Impact of breakfast on daily energy intake–an analysis of absolute versus relative breakfast calories. Nutr J, 10, 5. doi: 10.1186/1475-2891-10-5

This study sets out to investigate whether the reduction of caloric intake at breakfast can reduce the total daily caloric intake in a free-living and cross-sectional segment of the population, without compensatory eating behaviour. The study utilised 380 participants, 280 of which were obese and 100 of which were normal weight. Macronutrient and micronutrient intake were not analysed, though full nutrient details were gathered and recorded by each patient in the form of a food diary. This study focussed on the ratio of calories consumed at breakfast compared with those consumed throughout the entire day.

The authors introduce background information that shows seemingly contradictory studies and research around the effects of skipping breakfast or reducing caloric intake at breakfast and the prevalence of overweight and obesity. It’s proposed that these contradictory results between studies are a likely result of the different methodologies employed to manipulate the variables and analyse the data, particularly with regard to cross-sectional data vs. intraindividual analysis. The aim of this study was to compare two separate testing methodologies (cross-sectional data of a free living population and intraindividual analysis) on one data set and compare the results, helping to bridge the gap between studies utilising these separate methodologies.

This article was published in the Nutrition Journal, with the intended audience being those who are interested in nutritional research and have an understanding and appreciation of the application of the scientific process. This might include doctors, dieticians, exercise physiologists and other specialists with a nutritional interest, with repercussions for all segments of the healthy, overweight or obese populations.

The primary conclusion drawn by the authors is that a lower caloric intake at breakfast decreases the total daily caloric intake (with no compensatory eating behaviour), though this is put in the context of equivocal and at times contradictory research. This text was chosen for evaluation in part due to this balanced perspective of the available and contradictory studies, and the intent by the authors to resolve some of these differences.

Critical Evaluation

This study is relevant to this report as it puts into context the apparently conflicting research. It increases understanding by showing that a higher energy intake at breakfast is associated with an increased TDEI, but that this should be put into context of the energy expended during the day – particularly the amount of physical exercise engaged in. It also demonstrates the complexity of the issue and the difficulty of drawing clear conclusions on the issue of breakfast skipping or breakfast size and its association with overweight and obesity.

The authors address the research question by utilising patients from a hospital outpatient department, having them keep accurate logs of all food that was consumed and at what time of the day it was consumed. Both intra-individual data and ratio of daily energy intake were analysed from records taken over a two week period.

This study can be used for ongoing research into the differences in ratio between breakfast and total daily energy intake, and how this relates to obesity in studies that utilise different methodologies (preferably randomised controlled trials).


The key findings of this report are that breakfast appears to be clearly associated with weight gain in a dose-dependent relationship, though the direction of this relationship is not clearly established. Depending on the type of descriptive research method employed, different results are apparent, though the study by Schusdziarra et al. (2011) addressed some of these apparent contradictions.

In conclusion, when interpreting the data in light of the contradictory nature of the research, there appears to be little evidence that breakfast skipping significantly contributes to overweight and obesity in adults, though individual factors such as age, obesity, exercise history, TDEE and TDEI should be taken into account and may in fact play a large role in the interpretation of the associations and correlations investigated in fasting and meal-skipping studies.



Carlson, O., Martin, B., Stote, K. S., Golden, E., Maudsley, S., Najjar, S. S., . . . Mattson, M. P. (2007). Impact of reduced meal frequency without caloric restriction on glucose regulation in healthy, normal-weight middle-aged men and women. Metabolism, 56(12), 1729-1734. doi: 10.1016/j.metabol.2007.07.018

Duntas, L. H., & Biondi, B. Md. (2012). The interconnections between obesity, thyroid function, and autoimmunity: the multifold role of leptin. Thyroid. doi: 10.1089/thy.2011.0499

Farooqi, I. S., Wangensteen, T., Collins, S., Kimber, W., Matarese, G., Keogh, J. M., . . . O’Rahilly, S. (2007). Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor. N Engl J Med, 356(3), 237-247. doi: 10.1056/NEJMoa063988

Fu, Z., Gilbert, E. R., & Li, D. (2012). Regulation of Insulin Synthesis and Secretion and Pancreatic Beta-Cell Dysfunction in Diabetes. Curr Diabetes Rev.

Health Risk Factors. (2012). Australian Bureau of Statistics, Retrieved 16/09/12, from

Jakicic, J. M., Tate, D. F., Lang, W., Davis, K. K., Polzien, K., Rickman, A. D., . . . Finkelstein, E. A. (2012). Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial. JAMA, 307(24), 2617-2626. doi: 10.1001/jama.2012.6866

Mestdagh, R., Dumas, M. E., Rezzi, S., Kochhar, S., Holmes, E., Claus, S. P., & Nicholson, J. K. (2012). Gut microbiota modulate the metabolism of brown adipose tissue in mice. J Proteome Res, 11(2), 620-630. doi: 10.1021/pr200938v

Obesity. (2012). Medline Plus, Retrieved 18/09/12, from

Overweight & Obesity. (2012). Centers for Disease Control and Prevention, Retrieved 16/09/12, from

Pilon, Brad. (2007). Eat Stop Eat. Ontario, Canada: Strength Works Inc.

Roan, Shari. (2009). The new appetite for fasting, Sydney Morning Herald. Retrieved 25/08/12, from

Schienkiewitz, A., Mensink, G. B., & Scheidt-Nave, C. (2012). Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years. BMC Public Health, 12(1), 658. doi: 10.1186/1471-2458-12-658

Schusdziarra, V., Hausmann, M., Wittke, C., Mittermeier, J., Kellner, M., Naumann, A., . . . Erdmann, J. (2011). Impact of breakfast on daily energy intake–an analysis of absolute versus relative breakfast calories. Nutr J, 10, 5. doi: 10.1186/1475-2891-10-5

Stanley L Robbins, Vinay Kumar, Ramzi S. Cotran (2012). Robbins Basic Pathology (NINTH EDITION ed.).

Weiss, A. J., & Elixhauser, A. (2006). Obesity-Related Hospitalizations, 2004 versus 2009: Statistical Brief #137 Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville MD.

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