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Obesity Weekend Roundup, April 17, 2015

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

@DrSharma
Frankfurt, Germany

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Epode’s Canada Obesity Forum

Epode canadaAs part of the 4th Canadian Obesity SummitEPODE Canada presents its first Canadian Regional Forum. This one-day workshop is designed for program managers, local community coordinators or program advisors of childhood obesity prevention programs, and to share knowledge and practical advice between EPODE and Canadian programs.

Senior members of the EPODE global team including program managers from programs in Belgium and the Netherlands will share their practical experience on program design, social marketing actions, private public partnerships and program evaluation. Canadian program managers will report on their experience and learnings and discuss barriers and levers to working in the Canadian context. A special workshop on program evaluation, chaired by Dr. Emile Levy of Hospital St. Justine in Montreal will discuss practical approaches to evaluating process and outcomes. A special luncheon presentation on kids and nutrition will be given by the founders of Real Foods for Real Kids. A networking event will be held afterwards for more informal discussion or questions. By attending this landmark event you will find ideas that can help you improve the efficiency and effectiveness of your childhood obesity prevention program.

The cost of the full day workshop includes lunch and the networking event. Attendees can choose to attend only the EPODE Canada workshop or to continue on with the full Summit program and presentations. Program members of the EPODE International Network may attend at a significantly reduced rate.

Learning objectives:

Through these presentations and workshops, participants will learn to improve the efficiency and effectiveness of a community-based childhood obesity prevention program by learning:

  1. The 23 year evolution of the EPODE methodology and its critical success factors. e.g. the four pillars.
  2. Best practices from community-based programs around the world in program design, social marketing actions, private public partnershipsand program evaluation methodologies.
  3. Valuable insights into barriers and opportunities in the Canadian context via experts in the field presenting their findings and experience.
  4. Participants will share knowledge with other similar programs, and become part of a Canada-wide network of childhood obesity prevention programs.

Who should attend:

Anyone interested in improving the efficiency and effectiveness of implementing a childhood obesity prevention programs. This includes:

    • program managers
    • local community coordinators
    • program advisors (academics, health care professionals) of childhood obesity prevention programs

Topics include:

See a full list of topics in our schedule (as of January 19th 2015).

Registration (ends April 28, 2015)

Members of EPODE Canada and the Canadian Obesity Summit receive discounts on registration! Become a member of the EPODE International Network today!

General – $350

EPODE Network members- $225

Registration is now open!  

@DrSharma
Edmonton, AB

 

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Epigenetic Obesity In The Fruit Fly

sharma-obesity-drosophila1Regular readers are well aware of the considerable evidence now supporting the notion that inter-generational transmission of obesity risk through epigenetic modification may well be a key factor in the recent global rise in obesity rates (over the past 100 years or so).

Now a brief review article by Susan Ozanne from the University of Cambridge, UK, published in the New England Journal of Medicine, describes how researchers have now identified a clear and conserved epigenetic signature that is associated with obesity across species (from the fruit fly all the way to humans).

The article discusses how the transmission of susceptibility to obesity can occur as a consequence of “developmental programming,” whereby environmental factors (e.g. a high-fat diet) encountered at the point of conception and during fetal and neonatal life can permanently influences the structure, function, and metabolism of key organs in the offsprin, thus leading to an increased risk of diseases such as obesity later in life.

There is now evidence that such intergenerational transmission of disease can occur through environmental manipulation of both the maternal and paternal lines – thus, this is not something that is just a matter of maternal environment.

Thus, as Ozanne points out,

“Epigenetic mechanisms that influence gene expression have been proposed to mediate the effects of both maternal and paternal dietary manipulation on disease susceptibility in the offspring (these mechanisms include alterations in DNA methylation, histone modifications, and the expression of microRNAs).”

Work in the fruit fly has linked the effect of paternal sugar-feeding on the chromatin structure at a specific region of the X chromosome and transcriptome analysis of embryos generated from fathers fed a high-sugar diet, revealed dysregulation of transcripts encoding two proteins (one of them is called Su(var)) known to change chromatin structure and gene regulation.

Subsequent analyses of microarray data sets from humans and mice likewise revealed a depletion of the Su(var) proteins in three data sets from humans and in two data sets from mice.

Thus,

“This finding is consistent with the possibility that the depletion of the Su(var) pathway may be brought about by an environmental insult to the genome that is associated with obesity.”

Not only do these studies provide important insights into just how generational transmission of obesity may work but it may also lead to the development of early tests to determine the susceptibility of individuals to the future development of conditions like obesity or diabetes based on epigenetic signatures.

All of this may be far more relevant for clinical practice than most readers may think – indeed, a focus on maternal (and now paternal?) health as a target to reduce the risk of childhood (and adult) obesity is already underway.

This issue will certainly be a “hot topic” at the Canadian Obesity Summit in Toronto later this month.

@DrSharma
Edmonton, AB

 

 

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What Happens To Patients With Severe Obesity In Hospitals?

bariatric patient in bedWith the increasing number of Canadians living with severe obesity (BMIs 50+), it is not unexpected that more of them will be seen in healthcare settings.

However, whether or not Canadian hospitals are ready to look after these patients with in the right setting with the right equipment and whether healthcare providers are aware of and sensitive to the special needs of these patients is not clear.

This is why, Mary Forhan and her team at the University of Alberta is currently conducting a qualitative and quantitative assessment of exactly what problems patients with severe obesity face in healthcare settings.

The study, funded by Alberta Innovates Health Solution (AIHS) will look at the special challenges that these patients present in a range for settings – acute care, cancer, cardiology and rehabilitation.

A substudy will also examine the issues faced by kids and adolescent with severe obesity in healthcare settings.

Together, this project should lead to a better understanding on how healthcare systems better prepare themselves to deliver compassionate and professional care to adults and children living with severe obesity in Alberta. The learnings will likely also inform healthcare systems elsewhere.

For more on this study visit the AIHS website.

If you are someone living with severe obesity, who has experienced issues in your healthcare that could have been prevented or addressed with appropriate equipment and/or training, I’d love to hear your story.

@DrSharma
Edmonton, AB

Conflict: I am a co-investigator on this project.

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Adolescents Undergoing Bariatric Surgery Are Severely Ill

sharma-obesity-bariatric-surgery21The recently released Canadian Practice Guidelines on the prevention and management of overweight and obesity in children and youth released by the Canadian Task Force on Preventive Health Care (CMAJ 2015), rightly recommended that surgery not be routinely offered to children or youth who are overweight or obese.

Nevertheless, there is increasing evidence that some of these kids, especially those with severe obesity, may well require rather drastic treatments that go well beyond the current clinical practice of doing almost nothing.

Just how ill kids can be before they are generally considered potential candidates for bariatric surgery is evident from a study by  Marc Michalsky and colleagues, who just published the baseline characteristics of participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study, a prospective cohort study following patients undergoing bariatric surgery at five adolescent weight-loss surgery centers in the United States (JAMA Pediatrics).

While the mean age of participants was 17 with a median body mass index of 50, the prevalence of cardiovascular risk factors was remarkable: fasting hyperinsulinemia (74%), elevated hsCRP (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%).

Not reported in this paper are the many non-cardiovascular problems raging from psychiatric issues to sleep apnea and muskuloskeletal problems, that often dramatically affect the life of these kids.

While surgery certainly appears rather drastic, the fact that these kids are undergoing surgery is merely an indicator of the fact that we don’t have effective medical treatments for this patient population, which would likely require a combination of behavioural interventions and polypharmacy to achieve anything close to the current weight-loss success of bariatric surgery.

That this cannot be the ultimate answer to obesity management (whether for kids or adults), is evident from the rising number of kids and adults presenting with ever-higher BMI’s and related comorbidity – not all of these can or will want surgery.

Thus, while current anti-obesity medications cannot compete with the magnitude of weight-loss generally seen with surgery, medications together with behavioural interventions may well play a role in helping prevent progressive weight gain in earlier stages of the disease.

Unfortunately, I am not aware of any studies that have explored the use of medications in kids to stabilize weight in order to avoid surgery. This would, in my opinion, be a very worthwhile use of such medications.

@DrSharma
Edmonton, AB

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Targeting Gut Inflammation Can Reduce Insulin Resistance?

sharma-obesity-adipose-tissue-macrophageWith all of the recent interest in the gut microbiota as a mediator of systemic inflammation and metabolic disease, it was only a matter of time before researchers would begin targeting pro-inflammatory pathways in the gut to change metabolism.

A proof-of-principle, that this is indeed possible, is presented by Helen Luck and colleagues from the University of Toronto in a paper published in Cell Metabolism.

Using mice models, the researchers not only show that a high-fat diet can alter the gut immune system but also that the chronic phenotypic pro-inflammatory shift in bowel lamina propria immune cell populations is reduced in genetically altered mice that lack beta7 integrin-deficient mice (Beta7null), a driver of gut inflammatory response.

Further more, treatment of high-fat-fed normal mice with the local gut anti-inflammatory agent 5-aminosalicyclic acid (5-ASA), reverses bowel inflammation and improves metabolic parameters including insulin resistance (although it had no effect on body weight).

These beneficial effects are are associated with reduced gut permeability and endotoxemia as well as decreased visceral adipose tissue inflammation.

Moreover, treatment with ASA also improved antigen-specific tolerance to luminal antigens.

Thus, as the authors conclude,

“…the mucosal immune system affects multiple pathways associated with systemic insulin resistance and represents a novel therapeutic target in this disease.”

Clearly gut inflammation both in relationship to gut microbiota as well as response to dietary factors is likely to be a hot topic in obesity and metabolic research for the foreseeable future.

@DrSharma
Edmonton, AB

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Collect Almost 100 Hours of Mainpro-M1 Credits At the Canadian Obesity Summit

Westin Harbour Castle, Toronto, ON

Westin Harbour Castle, Toronto, ON

Here is a bit of good news for all physicians planning to attend the upcoming Canadian Obesity Summit in Toronto, April 28-May 2: the  College of Family Physicians of Canada has approved talks and workshops at this conference for a total of 89 hours of Mainpro-M1 credits. This is a substantial number of credits, given that family doctors in Canada are required to report at least 125 hours of Mainpro-M1 and/or Mainpro-C per 5-year CPD cycle.

For everyone else, here is a quick rundown of what to expect at the Summit:

WHO: Health care providers, researchers, policy makers, trainees and all public and private stakeholders with an interest in childhood and adult obesity treatment and prevention, weight loss, conditions related to obesity (diabetes, heart disease, arthritis, cancer, mental health, etc.), surgery, health economics, policy, public health, weight bias and discrimination, exercise, nutrition, physical activity and more.

WHAT: 4th Canadian Obesity Summitpresented by the Canadian Obesity Network – Réseau canadien en obésité (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS).

WHEN: April 28th – May 2nd, 2015

WHERE: Westin Harbour Castle Hotel, Toronto, ON

Join the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) as they welcome more than 1,000 delegates to the 4th Canadian Obesity Summit – a unique interdisciplinary conference designed to share current understanding of the causes, complications, treatments and prevention approaches for obesity.

Multidisciplinary focus for all areas of interest:

  • Environmental, Behavioural, Biological and Socio-Cultural Determinants
  • Prevention, Treatment, and Rehabilitation
  • Health Economics and Policy

Featuring:

  • 230 speakers from Canada and around the world
  • 80 oral abstract & 14 symposia sessions
  • 32 Hot Topics & Controversies sessions
  • 30+ workshops organized by leading organizations

Full information: www.con-obesitysummit.ca

About the Canadian Obesity Summit – The Summit is the biennial scientific conference of the Canadian Obesity Network (CON-RCO), the world’s largest national obesity organization (with more than 10,000 members) of researchers, health professionals and others with an interest in obesity.www.obesitynetwork.ca

@DrSharma
Copenhagen, DK

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Online Course on Weight Bias With Dr. Sara Kirk

Sara Kirk, PhD., Canada Research Chair in Health Services Research, Dalhousie University, Halifax, Nova Scotia

Sara Kirk, PhD., Canada Research Chair in Health Services Research, Dalhousie University, Halifax, Nova Scotia

Regular readers will be well of the very real social and health impact of weight bias and discrimination.

Now, Sara Kirk of Dalhousie University, Halifax, NS, invites you to join her free Massive Open Online Course (MOOC), on weight bias and stigma in obesity, which will be starting on April 20th 2015 (just a week before the Canadian Obesity Summit in Toronto).

The course builds on Kirk’s extensive research in this area and the dramatic presentation that was created from her findings.

Participants will be able to explore some of the personal and professional biases that surround weight management and that impact patient care and experience.

This will hopefully give health professionals better insight into how to approach individuals experiencing obesity in a respectful and non-judgmental manner and provide strategies to build positive and supportive relationships between health care providers and patients.

While targeted at health care providers, the course should also be of interest to anyone interested in learning more about what weight bias is and how it can impact health and relationships.

Participants who complete the course requirements can apply for a citation of completion (for a nominal fee).

For your FREE registration, please visit the course listing and registration page here.

@DrSharma
Copenhagen, DK

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