Tuesday, December 16, 2014

Holiday Break

Arya Sharma Globe&Mail CartoonFollowing the rather exciting announcement of the triple hormone discovery in yesterday’s post, it is time to sign off for the rest of the year.

It’s been an exciting year to say the least – having spent the last few months over a hundred (!) of presentations to audiences on three continents, it’s time for some down time with family.

Wishing all my colleagues, friends, staff, supporters, patients and you my readers Happy Holidays!

Unless something really remarkable happens in the obesity arena in the  next couple of weeks, don’t expect another post till the new year.

I’ll be back,

@DrSharma

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Monday, December 15, 2014

Triple-Homone Breakthrough For Obesity?

The new peptide offers a triple hormone effect in a single-cell molecule. Credit: Indiana University

The new peptide offers a triple hormone effect in a single-cell molecule.
Credit: Indiana University

This week, a group of researchers working from Munich, Germany and Indiana, USA, report, what may be a major breakthrough in the treatment of obesity and type 2 diabetes.

In their paper, published in Nature Medicine, the researchers use a range of sophisticated experiments to demonstrate that a novel peptide, which combines agonistic actions of three hormones (GLP-1, GIP and glucagon) into a single molecule, can fully reverse diabetes and reduce body weight by over 30% in mice.

Despite this just being a mouse study, the triple combination findings are no accident. Rather, these researchers have rationally designed this molecule based on the known actions of these three hormones.

As the authors describe it, their finding

predominantly results from synergistic glucagon action to increase energy expenditure, GLP-1 action to reduce caloric intake and improve glucose control, and GIP action to potentiate the incretin effect and buffer against the diabetogenic effect of inherent glucagon activity.”

According to their report, this “designer” peptide,

“…demonstrates supraphysiological potency and equally aligned constituent activities at each receptor, all without cross-reactivity at other related receptors. Such balanced unimolecular triple agonism proved superior to any existing dual coagonists and best-in-class monoagonists to reduce body weight, enhance glycemic control and reverse hepatic steatosis in relevant rodent models.”

Similar activity in humans would indeed represent a breakthrough, potentially providing a medical treatment that may be as (if not more) potent than bariatric surgery.

While the path to human development is generally long and stony, there are at least some folks who are optimistic: the molecule has been licensed to  Marcadia Biotech Inc., now fully owned by the Swiss pharma giant Roche. 

Clearly, this will be an exciting space to watch.

@DrSharma
Edmonton, AB

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Friday, December 12, 2014

Prevalence and Treatment of Depression In Canada

sharma-obesity-mental-health1Depression can be a significant factor both in the development of obesity and as an important barrier to its treatment.

Now a paper by Sabrina Wong and colleagues from the University of British Columbia, in a paper published in CMAJ open, present data on the prevalence and treatment of depression in Canadian primary care practices.

The authors analysed electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, of over 300,000 patients who had at least one encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012.

Of these, 14% had a diagnosis of depression.

Women with a BMI greater than 30 were about 20% more likely to also have depression than women with a BMI below 25. No such relationship was noted in men.

Overall, 25% of individuals with a diagnosis of depression also had at least one other chronic condition as well as about 50% more doctor visits than individuals without depression.

Clearly, depression is a common problem in primary care and weight management in patients (particularly women) presenting with this problem needs to be addressed (not least because many of the medications often used to manage depression may well be part of the problem).

@DrSharma
Edmonton, AB

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Thursday, December 11, 2014

How Effective Is Obesity Management In Primary Care?

sharma-obesity-doctor-kidLosing weight with behavioural interventions in the context of a clinical trial, where you are often dealing with volunteers who are generally provided interventions that are far better structured and standardised than we can ever hope to deliver in a primary care settings, tells us little about the effectiveness of such interventions in real life.

Now a paper by Tom Wadden and colleagues from the University of Pennsylvania, published in JAMA, presents a systematic review of the behavioral treatment of obesity in patients encountered in primary care settings as delivered by primary care practitioners working alone or with trained interventionists (eg, medical assistants, registered dietitians), or by trained interventionists working independently..

A search of the literature yielded 12 trials, involving 3893 participants, that met inclusion-exclusion criteria and prespecified quality ratings.

At 6-months weight changes in the intervention groups ranged from a loss of 0.3 kg to 6.6 kg compared to a gain of 0.9 kg to a loss of 2.0 kg in the control group.

As one may expect, interventions that prescribed both reduced energy intake (eg, ≥ 500 kcal/d) and increased physical activity (eg, ≥150 minutes a week of walking), with traditional behavioral therapy, generally produced larger weight loss than interventions without all three specific components.

Also, more treatment sessions (in person or by telephone) were associated with greater mean weight loss and likelihood of patients losing 5% or more of baseline weight.

Unfortunately, overtime, weight loss in both groups declined with longer follow-up (12-24 months).

Thus, the authors conclude that,

“Intensive behavioral counseling can induce clinically meaningful weight loss, but there is little research on primary care practitioners providing such care. The present findings suggest that a range of trained interventionists, who deliver counseling in person or by telephone, could be considered for treating overweight or obesity in patients encountered in primary care settings.”

Whether any of this is worth the cost and effort was not discussed. My guess is that to see greater success in primary care we need better treatments that move well beyond the rather simplistic ‘eat-less move-more’ paradigm.

@DrSharma
Edmonton, AB

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Wednesday, December 10, 2014

Introducing Sadly The Line-Dancing Owl

Sadly The Line Dancing Owl

Sadly The Line Dancing Owl

Yesterday, I posted about my daughter Linnie von Sky’s 2nd children’s book Pom Pom A Flightless Bully Tale, that is now available here.

Today, I would like to introduce you to Sadly The Line-Dancing Owl, who one morning wakes up with a dark cloud over his head.

Learn how Sadly in the end overcomes his sadness and how he finds the help he needs to be his happy self again. 

After tackling immigration and bullying, Linnie turns her attention to depression – in a children’s book that she admits is somewhat autobiographical,

“Depression is REAL and it SUCKS…at least it sucked the living daylight out of me and consumes too many people I love.”

Along for the ride is the incredibly talented Ashley O’Mara as the new illustrator.  Ashley is a Vancouverite, Emily Carr Graduate, Bird Lover (she draws the cutest darn chickens I’ve ever seen) and like Linnie, knows a thing or two about how much depression hurts.  

Please consider supporting Linnie’s fundraising campaign by pre-ordering your personal copy(ies) of Sadly The Line-Dancing Owl, which will again be 100% made in Canada.

To learn more about Sadly and how you can support this venture, please take a minute to visit Linnie’s Indiegogo page.

@DrSharma
Edmonton, AB

 

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Leading information on COPD. Receive new GOUT treatment information and find clinical trials at www.discoverclinicaltrials.com

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Dr. Shafiq Qaadri - Official Site
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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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