Friday, October 31, 2014

German TV Looks At Healthy Obesity

Arya Sharma on bike 3SATRegular readers will be familiar with the fact that not all people with excess weight necessarily have health problems. Now, the 3SAT television channel, which broadcasts in Germany, Austria and Switzerland has produced a 45 minute documentary on the science behind these findings.

Although the film is in German, I thought I would post the link anyway as many of my readers may well be able to grasp the story even if they are not entirely fluent.

To watch the documentary on line click here.

Incidentally, I am featured about 2.5 minutes into the film, discussing the Edmonton Obesity Staging System and related issues.

Appreciate all comments.

@DrSharma
Toronto, ON

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Thursday, October 30, 2014

Obesity Is Not About Lack Of Willpower

Yo-Yo Rubber Band Feb 2014As I prepare to spend the rest of this week educating health professionals in Ontario on how to better manage obesity in their practice, it is perhaps appropriate to remind ourselves that Canada is not alone in attempting to tackle this problem.

Indeed, we need to look no further than the Australian Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children for a succinct summary of reasons just why obesity management is so difficult:

- Regulation of body weight involves complicated feedback systems that result in changes in appetite, energy intake and energy expenditure. 

- While excess weight in individuals usually results from a prolonged period of energy imbalance, the causes of overweight and obesity are complex.

- Diet and physical activity are central to the energy balance equation, but are directly and indirectly influenced by a wide range of social, environmental, behavioural, genetic and physiological factors—the relationships between which are not yet fully understood.

- Individuals may be at greater risk of weight gain at particular stages in their lives.

The guidelines remind practitioners of the fact that body weight underlies tight regulation through a complex homeostatic system:

“While this system defends against weight gain as well as weight loss under normal circumstances, energy balance cannot be maintained when an energy surplus is sufficiently large and sustained. Weight gain will begin and usually continue until a new weight results in increased energy expenditure and energy balance is re-established. The same physiological mechanisms then seek to maintain energy balance at the higher weight, and will defend against weight loss by increasing appetite and reducing energy expenditure) if there is an energy deficit. As a result, most overweight and obesity results from upward resetting of the defended level of body weight, rather than the passive accumulation of excess body fat.”

This acknowledgement is a vast step forward from previous simplistic views of obesity which falsely view it as just a matter of “calories in” and “calories out”, which falsely imply that individuals should be able to achieve any desired weight simply by volitionally changing this balance through willpower alone.

Indeed, the reality is that the vast majority of individual attempting this “balance” approach to weight management will fail miserably only to gain the weight back.

Thus, the Australian guidelines are not shy about declaring a better need for pharmacological treatments and promoting the more extensive use of bariatric surgery for individuals with sever obesity related health problems.

A clear reminder to all of us that current treatments for obesity are insufficient and better, safer and more accessible treatments are urgently needed.

@DrSharma
Toronto, ON

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Wednesday, October 29, 2014

5As Of Obesity Management Workshops in Ontario

sharma-obesity-5as-booklet-coverHere just a quick update on upcoming workshops on the 5As of Obesity Management that I will be presenting for family physicians and allied health care providers in Ontario in the coming days.

The course offers an interactive workshop  incorporates the conceptual structure of the Best Practices in Weight Management document, the Canadian Obesity Clinical Practice Guidelines and the 5As methodological framework to specifically address the needs of overweight and obese patients and improve practitioners’ willingness and efficacy in providing obesity management and counseling to their patients.

Family physicians can obtain Mainpro M1 credits for participation i this workshop.

Space is limited for these events, so please register early.

Toronto, ON - November 1, 2014, 8:00-9:30 AM

Keele Auditorium
2175 Keele Street
Toronto, ON
Cost: $Free*
For more information, please contact the bariatric clinic at bariatricclinic@hrh.ca

Kingston, ON - November 11, 2014, 8:00-10:00 AM

The Harbour Restaurant, Portsmouth Olympic Harbour Site
53 Yonge Street
Kingston, ON
Cost: $Free*
For more information, please contact Kristine Canty at: cantyk@hdh.kari.net

Ottawa, ON - November 12, 2014, 8:00 AM-4:00 PM

The Ottawa Hospital, General Campus, The Royal Room, 1st Floor
501 Smythe Road
Ottawa, ON
Cost: $Free*
For more information, please contact Shannon Porcari at: sporcari@toh.on.ca Click here to download the flyer and registration form

*Select Ontario workshops supported by the Ontario Ministry of Health
 

 

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Tuesday, October 28, 2014

Should A Political Prescription For Obesity Not Also Include Better Treatments?

sharma-obesity-policy1In the latest issue of the Canadian Medical Association Journal, the editors opine on the need for a political prescription for obesity – in short taxation and regulation of  high-calorie and nutrient-poor food products as the only viable approach to the obesity epidemic. As may be expected, they use the analogy of tobacco as a justification for this approach (given that actual data from government intervention on reducing the consumption of the said foods is so far lacking).

Be that as it may, what caught my attention in the article was the following passage:

“Treating obesity does not work well; preventing it would be better. The global failure to manage obesity, now considered by the American Medical Association to be a disease, may be considered a failure of the evidence-based medicine approach to treating disease….We know that most restrictive diets result in only short-term weight loss that frequently reverses and worsens in the long term, but dietary changes that are sustainable as a lifestyle choice may work. Physical activity is not enough to prevent or treat obesity and overweight, unless it is combined with some kind of dietary intervention. Family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy. Bariatric surgery has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort. Pharmaceutical agents may work to some extent, but may have nasty adverse effects.”

The interesting thought here is that the authors parade the lack of effective treatment as a justification for prevention, when I would rather have used this state of affairs to call for greater investments in finding better treatments.

Not that I am not in favour of prevention – indeed, I am all for preventing heart disease, diabetes, cancer, depression, bone and joint disease and everything else.

But, at no point would I ever call for prevention as an alternative to finding better treatments for any of these conditions.

The fact that people still die of cancer should never justify us abandoning the search for better treatments – indeed, as far I can see, the whole Pink Ribbon Industry apparently focusses on “finding the cure” – not on “finding better ways to prevent breast cancer” (even if most experts believe that much of breast cancer is indeed preventable).

Just because  we still have no effective treatments for a host of other conditions, should we abandon the search for better treatments for these conditions?

In short, what irks me most about this article is not the call for prevention – indeed I am all for it!

But when the lack of effective (or safe) treatments is used to justify this call, I must disagree.

No matter how much we restrict and tax the food industry, there will always be people around, who despite their best efforts, will struggle with excess weight. Indeed, there is no reason to believe (at least not for anyone who understands the physiology of obesity) that any form of “prevention” will reverse the epidemic in those who already have the problem – i.e. in about 6 Mill Canadians. (even if we somehow miraculously reduced obesity in the population by 30% through “preventive measures” (well beyond even the most optimistic predictions) – we would still need treatments for 4 Mill Canadians – adults and kids!)

The longer we wait to find and implement effective treatments, the longer these individuals will struggle with a condition that should deserve the same efforts at treatment as we afford individuals with other “lifestyle” diseases (including heart disease, diabetes and cancer).

Let us not forget that treatments for other common conditions (e.g. hypertension, hypercholesterolemia and diabetes) were once lacking – today millions around the world benefit from these treatments – indeed, it is probably safe to say that these medications probably save more lives each year than any known efforts at regulating industry that I know of.

Indeed, if we wish to find more effective ways to manage obesity, we need to vastly increase our efforts at finding better treatments – not abandon them.

Prevention is never an alternative to also having effective treatments. The two go hand-in-hand.

@DrSharma
Edmonton, AB

 

 

 

 

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Monday, October 27, 2014

Health-Related Quality of Life in Dogs with Obesity

Susan & Cooper

Dr. Susan Jelinski, PhD, and her Border Collie Cooper

Today’s guest post comes from Dr. Susan Jelinski, currently the Director of Chronic Disease Research for Alberta Health Services. Her team studies the effectiveness of bariatric care in Alberta. Susan completed her PhD in Clinical Epidemiology at Memorial University of Newfoundland followed by a Doctor of Veterinary Medicine degree at Oregon State University.

In a recent post, Dr. Sharma reported the findings from a 1970 study where the prevalence of obesity in dogs was shown to be 28%.

Although this study was done many years ago, obesity in dogs continues to be a common problem seen by veterinarians in general practice. As a result, some veterinary practices have developed specific weight management programs that focus on weight loss for our canine friends through dietary and exercise recommendations.

Just like humans with obesity, there are certain medical conditions that dogs may develop as a result of excess body weight. These conditions include diabetes mellitus, hypertension, cardiorespiratory conditions, urinary incontinence, reproductive disorders and osteoarthritis. Weight loss, even as little as 5-10%, helps to improve these conditions.

When evaluating weight management programs for both humans and dogs, weight loss and improvement in obesity-related comorbid conditions are often used to gauge success. Another potential measure of success in human research, including obesity studies, is improvement in health-related quality of life (HRQL). HRQL measurement tools are used to assess the physical, emotional and social aspects of an individual’s well-being.

HRQL can now be assessed in dogs thanks to the development of canine-specific HRQL measurement tool for use by owners and veterinary researchers (Wiseman-Orr et al., 2004, 2006). This questionnaire asks owners about their dogs’ activity, pain, sociability, aggression, anxiety, enthusiasm, happiness and mobility. Answers are then combined to provide scores on four factors: vitality, emotional disturbance, anxiety and pain.

This tool was used in a recent study to see if weight loss in obese dogs results in improved quality of life. Researchers at the University of Liverpool enrolled 50 dogs of varying breeds, age and gender in their study. Each dog underwent an individualized weight loss regimen consisting of caloric restriction and increase in physical activity. HRQL was measured at the start and end of the program.

On average, the dogs lost approximately 24% of their initial body weight. The researchers discovered that among the dogs who completed the program and lost weight, HRQL was improved specifically with regard to increased vitality and emotional well-being and decreased pain.

Although this study is small, it does show that, like human patients with obesity, quality of life can be improved in obese dogs who lose weight. Therefore weight loss can be one way of improving the health and happiness of our canine companions.

ResearchBlogging.orgWiseman-Orr ML, Nolan AM, Reid J, & Scott EM (2004). Development of a questionnaire to measure the effects of chronic pain on health-related quality of life in dogs. American journal of veterinary research, 65 (8), 1077-84 PMID: 15334841

Wiseman-Orr ML, Scott EM, Reid J, & Nolan AM (2006). Validation of a structured questionnaire as an instrument to measure chronic pain in dogs on the basis of effects on health-related quality of life. American journal of veterinary research, 67 (11), 1826-36 PMID: 17078742

German AJ, Holden SL, Wiseman-Orr ML, Reid J, Nolan AM, Biourge V, Morris PJ, & Scott EM (2012). Quality of life is reduced in obese dogs but improves after successful weight loss. Veterinary journal (London, England : 1997), 192 (3), 428-34 PMID: 22075257

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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