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Laurie Twells

B.A. Memorial, M.Sc. London, Ph.D. Memorial

Associate Professor of Medicine and Pharmacy

Faculty of Medicine, HSC
Room 4M135
t: 709-864-6655


Dr. Laurie Twells MSc, PhD is an Associate Professor in the School of Pharmacy & Faculty of Medicine at Memorial University. Dr. Twells is a clinical epidemiologist with expertise in epidemiology, health economics, health policy, primary data collection and analysis of large administrative datasets. Current research publications are in the area of the epidemiology of adult obesity in Canada, bariatric surgery as a treatment for morbid obesity and the prevention of childhood obesity with a focus on infant nutrition. Dr. Twells is a member of the Canadian Obesity Network and a Fellow of The Obesity Society.

Areas of Expertise: Epidemiology-Population Health, Health Systems, Obesity, Vitamin D, the use of secondary data sets



Description of Research:

The increasing prevalence of overweight and obesity is of major concern to Canadians.

In Canada, Newfoundland and Labrador (NL) has the highest provincial rates of excess body weight as measured by the Body Mass Index.

Being classified as overweight or obese is associated with morbidity due to the increased risk of developing hypertension, cardiovascular disease, type 2 diabetes and some cancers. One area of research that I am particularly interested in is the impact of excess body weight on the health system.

I just recently finished a research study examining the impact of excess body weight on the use of the health system, specifically visits to GP’s and specialists and hospital utilization.

My study found that obese individuals had an increased utilization of GP services and increased total physician costs when compared to normal weight individuals. I am interested in further study of overweight and obese populations in NL especially the growing childhood obesity epidemic.

I am also involved in another research study on childhood obesity.

With a research team, we set out to determine if exclusive breastfeeding was protective of preschool obesity in children 4 to 5 years of age.

The composition of breast milk is such that it includes all the nutrients that a growing infant needs, as well this composition changes throughout the day to provide a growing infant with his/her daily requirements.

The process of breastfeeding allows an infant to be in full control of energy intake.

There is a growing body of evidence including that published by the World Health Organization supporting the suggestion that exclusive breastfeeding can have a protective effect on childhood obesity. This study found a protective effect.

Another line of research that I am interested in is low levels of Vitamin D in the population and the purported association with disease.

Most Vitamin D comes from exposure to the sun and is metabolized in the skin.

Other than salmon, tuna, mackerel and fortified milk there are limited food sources. We need a certain amount of Vitamin D to ensure adequate calcium absorption and reduce the risk of rickets in children and osteomalicia in adults.

There is a general consensus among researchers that many populations in the northern hemisphere have insufficient levels of Vitamin D.

In a study we recently published (2008), approximately 70% of the children, pregnant mothers and newborns tested in NL were classified as having insufficient levels of Vitamin D.

There is a growing body of evidence based on primarily observational studies that low levels of Vitamin D may be associated with an increased number of health conditions such as certain cancers, multiple sclerosis and type 1 diabetes.

As NL has a very high prevalence of many of these diseases, it is an opportune place to study Vitamin D.

With my appointment to the School of Pharmacy I also intend to pursue research in the area of Pharmacoepidemiology and drug utilization and the launch of the Pharmacy Network in March 2009 will facilitate this type of research in NL.

Selected Publications

Newhook LA, Sloka S, Grant M, Randell E, Kovacs C, Twells L. Vitamin D insufficiency common in newborns, children, and pregnant women living in Newfoundland and Labrador, Canada. (Published on-line in the Journal of Maternal and Child Nutrition)

Twells L, Doyle M, Gregory D, Barrett B, Parfrey P. Acute care restructuring in Newfoundland: the history and impact on costs. Journal of Health Services Research and Policy 2005;10(Suppl 2):4-11

Way C, Gregory D, Doyle M, Twells L, Barrett B, Parfrey P. Acute Care Restructuring in Newfoundland and Labrador: Impact of Hospital Aggregation on Health Care Provider Outcomes. Journal of Health Services Research and Policy2005;10(Suppl 2):58-67

Twells L. Obesity in Newfoundland and Labrador, Report to the Department of Health & Community Services, Government of Newfoundland and Labrador, September 2005

Barrett B, Gregory D, Way C, Kent G, Doyle M, Twells L, O’Reilly D, Parfrey P. The Impact of Restructuring on Acute Care Hospitals in Newfoundland. A report to the Canadian Health Services Research Foundation (CHSRF), March 2003

Birnbaum D, Twells L, Jandiciu E. Antimicrobial Resistance: A deadly burden no country can afford to ignore: A report to the Canadian Committee on Antimicrobial Resistance (CCAR), March 2002. Report can be found at www.ccar-ccra.com

Twells L. An Assessment of the Burden of Illness of Antibiotic Resistance in Canada. A Report submitted to Health Canada May 2001

Selected Presentations

Twells L. Adult Obesity in Newfoundland and Labrador and its Impact on Primary Health Care Services, Primary Health Care Research Unit, Memorial University. March, 2008

Newhook LA, Twells L. Is there an association between breastfeeding rates (initiation and duration) and body mass index (BMI) in pre-school children living in and near St. John’s, NL?Pediatric Grand Rounds, Eastern Health. December 2007

Twells L, Turner L, Pullman D. The Genetic Lottery, Burden of Disease and the Just Allocation of Resources. 17TH Annual Conference and Meeting of the Bioethics Society, Halifax, NS. October 2005

Twells L. Acute-Care Restructuring in NL: the History and its Impact on Costs. Strategic Conference on International Health System Reform. St. Andrew’s, Scotland. September 2004

Twells L. A Two-Tiered Publicly Administered Health Care System. The 10th Joint Canadian Conference on Health Economics. Halifax, NS. May 2002

Twells L, Knight J, Alaghebandan R, MacDonald D, Bridger T, Chen Y.
Adult Obesity and its Impact on a Provincial Health System in Canada. The Obesity Society's 2007 Annual Scientific Meeting, New Orleans, LA. September 2007 [Poster]