Can Bariatric Educators Have a Role in Primary Care?
Readers may recall a recent post on a clinical trial by Wadden and colleagues on the feasibility of achieving clinically meaningful outcomes of ‘enhanced’ lifestyle counselling largely delivered by primary care practitioners with minimal training in obesity management. In that study, ‘health coaches’ (with no advanced expertise as one may expect from registered dieticians or exercise specialists), working under the guidance of a primary care physician, helped about 20-25% of patients achieve at least a 5% weight loss. A paper by Sean Wharton and colleagues, published in the latest edition of the Canadian Family Physician, now presents ‘real-life’ data from a similar primary care approach in 2739 consenting patients attending an interdisciplinary obesity-management program in Burlington Ontario. As described in the paper, “The Wharton Medical Clinic (WMC) is an interdisciplinary bariatric clinic located in Hamilton and Burlington, Ont, which includes a team of physicians, behavioural therapists, dietitians, and nutritionists. The clinic operates under principles outlined in the Canadian clinical practice guidelines for the treatment of obesity, which recommend dietary, exercise, and behavioural interventions for weight loss, with meal replacement, pharmacotherapy, and surgery as adjunct therapies when indicated. Patient visits consist of services charged to the Ontario Health Insurance Plan, including physician visits, calorimetry, and diagnostic testing such as blood work and electrocardiography. Complementary services (drop-in visits in which patients weigh themselves and educational sessions) that are not charged to the Ontario Health Insurance Plan or to patients are also offered to allow for greater patient contact without increasing the cost to the health care system. As obesity is a chronic, relapsing medical condition, there is no defined program length.” A key element of the program is the employment of ‘bariatric educators’, who have a university degree in nutrition, but no other formal training as health professionals. Under the guidance of the physicians, these bariatric educators deliver 20-minute educational sessions on nutrition and exercise to patients and monitor individualized weight-management strategies at each visit. The paper presents the results of all 2739 patients as well as for the 1085 patients, who attended the clinic for at least 3 months, and the 389 patients, who attended for at least 6 months. The average weight loss in these groups were 2.3, 3.5, and 4.3 Kg, respectively. Perhaps, more importantly, 17, 32, and 47% of patients achieved and maintained at least a 5% weight loss, whereas 4, 9, and 17% achieved a 10% weight loss, respectively. Although these results… Read More »
How Neighbourhoods Affect Physical Activity
Regular readers will appreciate how environmental determinants can affect complex behaviours such as physical activity and eating behaviours. New data on this topic is presented by Canadian Obesity Network Bootcamper Stephanie Prince and colleagues from the University of Ottawa in a paper just published in OBESITY. The paper examines in considerable detail the relationships between variables from built and social environments and physical activity with excess weight across 86 Ottawa neighborhoods. Individual-level data including self-reported leisure-time PA and other variables were analysed in a sample of 4,727 adults from four combined cycles (years 2001/03/05/07) of the Canadian Community Health Survey (CCHS) together with data on neighbourhood characteristics from the Ottawa Neighbourhood Study (ONS). For women greater park area was associated with increased odds of leisure time physical activity as well as overweight/obesity. Also, greater neighborhood density of convenience stores and fast food outlets were associated with increased odds of females being overweight/obese. Higher crime rates were associated with greater odds of leisure time physical activity in males, and lower odds of both male and female overweight/obesity. Incidentally, this being Canada, it was perhaps not surprising that season was significantly associated with physical activity in men and women with the odds of leisure time physical activity in winter being half that of summer. Based on these findings, the authors conclude that the impact of park area, crime rates, and neighborhood food outlets may has different effects on activity levels as well as the prevalence of overweight/obesity in men and women. This may certainly be consistent with the notion that men and women interact differently with their neighbourhoods both in terms of activity as well as food choices. AMS Toronto, Ontario Prince SA, Kristjansson EA, Russell K, Billette JM, Sawada MC, Ali A, Tremblay MS, & Prud’homme D (2012). Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City. Obesity (Silver Spring, Md.) PMID: 22262164 .
Obese Dragons And Other Stories
Today marks the beginning of the Chinese Lunar New Year, the year of the dragon, an event celebrated by ethnic Chinese worldwide – so Happy New Year to all my Chinese readers! As some readers may recall, last year I was in Beijing to speak on obesity and hypertension management, problems that most non-Chinese readers may not readily associate with China. No doubt, any Western visitor to China may find it hard to spot any Chinese obese men or women, at least by applying our Western definitions of ‘obesity’. Unfortunately, obesity and related metabolic diseases are alive and kicking across East Asia – which makes the recent rather enthusiastic announcement of Weight Watcher’s interest in growing their Chinese presence understandable. Thus, according to Weight Watcher’s CEO David Kirchhoff in an interview to the The Wall Street Journal, “What you see in China is that overnight, there’s this huge middle class that’s emerged: People who have all the money they could need to buy whatever food they want to buy. There are cars all over the place. People are on the Internet, doing lots of things other than being outside. They’re literally eating so much food they don’t know what to do with it. On top of that, you have the one-child policy, you have parents and two sets of grandparents spoiling one kid. Put all those things together, and it’s not surprising that China has one of the fastest growth rates in obesity of any country around.” So while festive occasions such as New Year celebrations should perhaps not be the time to brood about the potential adverse effects of the many less-than-healthy foods served at the traditional family reunions, the rise of obesity (and related disorders) in the Chinese community may well raise concerns over the coming year. I, for one, am quite confident that my trip to China last year to discuss obesity, will certainly not have been my last. AMS Toronto, Ontario
Weekend Roundup, January 20, 2012
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Is There a Roie for Recreational Therapists in Obesity Management? How The Hedonic System Ratchets Up Your Weight Weight Based Bullying in Ontario Youth Establishing Common Ground in Obesity Management Help Teach a Computer to Recognise Obesity Websites Have a great Sunday! (or what is left of it) AMS Edmonton, Alberta You can now also follow me and post your comments on Facebook
Hindsight: G-Protein Genetic Variants and Obesity
Continuing in my series of revisiting some of the obesity research I was involved in, here is a paper to which I contributed a fairly significant number of DNA samples from my patients. The paper, published in the Journal of the American Society of Nephrology in 1999, examined the relationship between obesity and a common genetic variant of the gene encoding the ß3 subunit of G protein, a molecule involved in transmitting chemical signals from outside a cell to the cell inside (though G-protein-coupled receptors). G proteins regulate metabolic enzymes, ion channels, transporters, and other parts of the cell machinery, controlling transcription, motility, contractility, and secretion, which in turn regulate systemic functions such as embryonic development, learning and memory, and homeostasis. The lead researcher on this project, Winfried Siffert, had just shown that the 825T allele of the GNB3, associated with the occurrence of a splice variant, termed Gß3-s (which, despite a deletion of 41 amino acids, is functionally active in a reconstituted system), was more common in individuals with high blood pressure. This study explored the possible association with obesity in young male Germans (samples that I contributed), Chinese, and black South Africans with low, intermediate, and high 825T allele frequencies, respectively. It turned out that in each of these three distinct cohorts, the 825T allele frequency was significantly higher in overweight and obese individuals compared to those with normal weight. Thus, the 825T allele frequencies in these three BMI groups were, respectively, 29.5, 39.3, and 47.7% in Germans, 46.8, 53.9, and 58.6% in Chinese, and 83.1, 87.7, and 90.9% in South Africans. In each of these three distinct groups, the 825T allele was significantly associated with obesity with odds ratios between 2 and 3. The paper also presents the results of genotyping of 5254 individuals from 55 native population samples from Africa, the Americas, Europe, Asia, Australia, and New Guinea showing the highest 825T allele frequencies in black Africans (82%) and intermediate values in east Asians (47%). This finding prompted us to suggest that “high frequencies of the 825T allele in Africans and Asians may contribute to an obesity and hypertension epidemic if Westernization of lifestyles continues”. While in hindsight, again, the notion, that a single genetic variant (no matter how common or functionally important) could even begin to explain increased general risk of such a complex multifactorial condition like obesity, may appear naive and it is therefore… Read More »
Weight-Based Bullying in Ontario Youth
At the 1st National Summit on Weight Bias and Discrimination organized by the Canadian Obesity Network in Toronto almost exactly a year ago, I learnt that weight-based bullying is one of the most common and pervasive forms of bullying experience by children and youth. This topic is further examined by Obesity Network Bootcamper Atif Kukaswadia and colleagues from Queens University, Kingston, Ontario in a paper just published in OBESITY FACTS. The researchers report on their findings in a longitudinal analysis of the Health Behaviour in School-Age Children Survey conducted in 2006 and then again in 2007, which included 1,738 youths from 17 Ontario high schools. Based on self-reports, excess adiposity preceded bullying involvement and obese and overweight males reported 2-fold increases in both physical and relational victimization, while obese females reported 3-fold increases in perpetration of relational bullying over the observation period. In addition, among those free of bullying at baseline (2006), significant increases in perpetration of relational bullying were reported by obese females in 2007 relative to normal-weight females (14.8 vs. 3.8% among normal-weight girls). These findings support previous findings on the increased risk for bullying faced by overweight and obese youth and certainly suggest that this problem, if anything, is getting worse. Given the many deleterious (and often lasting) effects of bullying on mental and physical health, this issue is certainly something that should concern us all. Thus, it is certainly not surprising that one of the strategic priorities identified at CON’s Weight-Bias Summit was to “address weight-bias and discrimination in education settings”. A full report of the Summit is available here. AMS Edmonton, Alberta Kukaswadia A, Craig W, Janssen I, & Pickett W (2011). Obesity as a determinant of two forms of bullying in ontario youth: a short report. Obesity facts, 4 (6), 469-72 PMID: 22248998 .
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