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Mentoring Update

So last week, I offered a free hour-long mentorship call to three folks interested in discussing any of the following questions:

  • Are you a medical practitioner interested in improving your approach to helping your patients manage their obesity?
  • Are you a new faculty member hoping to build an academic career in obesity research?
  • Are you interested in obesity but can’t decide whether a career in academia, medical practice, government, or industry is right for you?

Frankly, the response was overwhelming with close to 30 submissions from nine countries. All of the “entries” were extremely well thought through and I read all with great interest.

I received submissions from folks at all levels of their respective careers from post-docs to senior consultants, from researchers to health professionals – all interested or well on their way to establishing themselves in obesity research or practice.

While I have already spoken with three of the “applicants”, I did enjoy my conversations so much that I am seriously considering working my way down the list – although it may take a few weeks before I get to everyone.

Not only have I enjoyed the interaction, but it is also evident, that there are probably a lot of people out there with questions related to their careers in obesity. Perhaps I should be considering a side gig as professional mentor – lol.

In any case, thanks everyone for your overwhelming response (and your donations to Obesity Canada), please stay tuned for more.

@DrSharma
Edmonton, AB

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German Parliament Declares Obesity A Disease

Yesterday (July 3, 2020), the German parliament approved a rather comprehensive National Diabetes Strategy that clearly called out obesity as one of the principle root causes of diabetes and calls for its recognition as a disease in its own right.

The Strategy also calls on payers to support the creation of an infrastructure for obesity prevention and treatment within the public health care system, where people living with obesity are supported and treated respectfully and in compliance with current obesity management guidelines.

As pointed out by Alexander Krauss (CDU/CSU), “Today is an important milestone for people living with obesity – the recognition of their disease by the German Bundestag. People living with obesity are (currently) not adequately treated – when a patient with obesity goes to see their doctor, it is not enough to be told that they should eat less and move more – that is not an adequate treatment. There is a paucity of  professional ambulatory care, there is a paucity of educational programs, but there is also a paucity of sympathy for those affected as well as lack of information about this disease. The only thing that people living with obesity receive in abundance is scorn and ridicule……..We need obesity management by specialists and family doctors in ambulatory practice.”

The Strategy has the support of all ruling parties (CDU/CSU/SPD) and will now find its way into the regulatory framework.

While it has taken over six years to develop this joint strategy, its scope and focus on obesity prevention and management provides both perspective and hope.

One can now hopefully expect far-reaching changes to the way the German healthcare system supports the over 20 million German children and adults living with obesity.

@DrSharma
Edmonton, AB

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Free Mentorship Offer!

One of the consequences of the COVID epidemic is that I am now doing most of my work from home.

This has led to significant efficiencies, leaving me with some extra time on my hands, which I would like to put to good use.

So here is my offer to my professional readers:

I am offering a free 60 minute mentorship video-call to three individuals struggling with any one of the following questions:

  • Are you a medical practitioner interested in improving your approach to helping your patients manage their obesity?
  • Are you a new faculty member hoping to build an academic career in obesity research?
  • Are you interested in obesity but can’t decide whether a career in academia, medical practice, government, or industry is right for you?

If you are interested in talking to me about any of these issues, please send me an e-mail describing (in 500 words or less) your current situation and what you hope to get out of this call. Please also explain (in 300 words or less) why you think my advice would be of value to you.

Please provide your complete contact details including a phone number where you can be reached. You can e-mail me at amsharm@ualberta.ca

I will pick three individuals based on whether or not I feel I can be of help to them.

My only request to the “winners” is that they are willing to make a donation (you decide the value) to Obesity Canada.

Act now, as I will only be accepting entries over the next three days (end of day Friday, June 26).

Please note – these mentorship calls are for professionals only – I cannot give any personal medical advice to individuals living with obesity.

Looking forward to hearing from you.

@DrSharma
Edmonton, AB

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How COVID-19 has Changed Continuing Medical Education

Yesterday morning, I first gave a 60-min presentation on, “The Science of Obesity”, to colleagues from across Central America. An hour later, I gave a 45-minute key-note talk on, “Managing Obesity as a Chronic Disease in Primary Care”, to over 200 primary care physicians from the UAE and other Gulf countries. Both presentations were given sitting comfortably at home at my computer.

Before COVID, for a presentation like this, I would have had to hop on a plane to Dubai or Panama City, to deliver the talks in person – giving both talks on the same day would have been physically impossible.

As much as I enjoy the opportunity to fly across the globe, even for a day or two, I would dare say that all things considered, my presentations were probably not that much different from being there in person.

In fact, the only real advantage of physically being in Dubai or Panama City, would have been to personally meet my colleagues from the region, as many important conversations take place in the breaks and after the meeting. In the past, this would have been the key to building a network of personal professional relationships with colleagues from around the world.

However, looking back, I wonder if there would be any justification at all to going back to the way things were.

Never mind the ridiculous carbon-footprint of such endeavours, or the time factor, or the health and other risks of travelling across countless time zones – the real question is whether virtual conferences will from now on replace the conventional in-person meeting for medical education (or for that matter conferences in general).

The advantages for organisers, attendees, and speakers are obvious. No travel, no taking days off from work, lower registration costs (if any), attend at your own convenience – most virtual talks are recorded and can be viewed after the event.

So really, the only disadvantage of virtual events, is missing out on the informal networking that happens  around such meetings. Thus, sharing a coffee break with a group of colleagues from another country does much to foster a better of understanding not just of medical issues relevant to obesity management. There is also no doubt that in that past, having the good fortune of creating a personal global network of colleagues, many of who I would consider friends, has been invaluable in my own career as a researcher, teacher, and clinician.

Looking back, I would certainly not have liked to miss the countless opportunities I have had to travel the world as a speaker or visiting professor. Looking forward, it is hard to see how any of this travel will ever come back.

I guess, that’s the “new reality” (a term I much prefer to the “new normal”).

@DrSharma
Edmonton, AB

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Edmonton Obesity Staging System (EOSS) Predicts Use of Health Services and Pharmacotherapies in Australian Adults

The Edmonton Obesity Staging System (EOSS), which classifies obesity based on the presence of medical, mental, and functional impairments using a 5-point ordinal scale, is now increasingly used in the clinical assessment of individuals presenting with obesity.

We have previously shown that EOSS, which is largely independent of BMI, is a far better predictor of mortality than BMI, waist circumference, or the presence of metabolic syndrome (Padwal et al, CMAJ 2011).

Now, a cross-sectional analysis of data from the Australian Health Survey by Evan Atlantis and colleagues, published in Clinical Obesity, shows that EOSS is also significantly better than BMI for predicting polypharmacy and health service use.

The researchers examined data in a subgroup of individuals from the nationally representative sample of participants in the 2011-2013 Australian Health Survey for whom physical measurements of BMI and waist circumference were available (n = 9730).

Overall, the number of primary care physician and specialist consultations, encounters with allied health care, number of pharmacotherapies and hospitalisations increased by EOSS stages.

In contrast, BMI was a significantly better predictor of having discussed reaching a healthy weight, increasing physical activity, and eating healthy food with their primary care physician in the last 12 months than the EOSS.

Overall, the results are not surprising. EOSS is a measure of health rather than size, which readily explains why individuals in higher EOSS categories, who are sicker, also experience greater healthcare needs.

Although EOSS (by definition) identifies sicker individuals living with obesity, importantly, the data also shows that doctors’ advice to improve health behaviours is largely driven by patient size (BMI). It thus appears, that larger patients are more likely to receive advice on weight management, healthy eating or physical activity, irrespective of their actual health status.

With regard to hospital use, the authors note:

“Since hospitals account for the majority of health spending,31 preventing patients from progression through the higher EOSS stages should be a high priority in health policy and a key clinical objective rather than weight loss. For instance, there is likely to be a greater reduction in health costs if an individual at a lower BMI with higher complications status (EOSS stages 3 and 4) has early access to effective medical and surgical management of obesity than another at a higher BMI with no or few health impairments (EOSS stages 0‐2). Thus, health policy and clinical guidelines about access to clinical obesity services or intensity of treatments based on BMI alone will likely miss a considerable proportion of individuals who may well benefit from clinical obesity care. It could also lead to overtreatment in low‐risk individuals with high BMIs and under treatment of high‐risk individuals with lower BMIs.”

Clearly, wider use of EOSS in clinical practice and health services planning has the potential to better target obesity interventions to those individuals who stand to benefit the most,

@DrSharma
Edmonton, AB

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How Virtual Medicine Is Changing My Practice

If there is anything positive that can potentially come as a direct result of the COVID-19 pandemic, it is likely to be a turbo-charged advance in virtual medicine.

Although “tele-medicine”, in  one form or another, has been around for well over a decade (if not longer), it was essentially a side show. Even where widely used, tele-medicine was generally used to reach patients in settings where geographic distance made in-person consultations impractical.

In the past, this generally involved booking time in the tele-medicine suite where you could consult with the patient, who in turn had to travel to a local tele-medicine outlet at their end, for a video consult.

Thanks to the COVID lockdown and the advances in technology, this rather cumbersome process has dramatically changed (in a matter of weeks if not days!), thanks to smart phones.

By now most of us are routinely using Zoom or some other virtual platform (if not just the telephone) to consult and counsel our patients.

Not only have both providers and patients rapidly adopted this technology, but health authorities have, almost overnight, come up with new billing codes for virtual patient care that make this an economically feasible venture for healthcare providers, who in the past only got paid for office visits.

All of this has of course also affected by own practice (currently entirely virtual) and it is fair to say that both my patients and I are pretty happy on how things are going. In fact, looking back, one wonders why in the past we routinely expected our patients to endure lengthy commutes for a 20-min in-person appointment, which, as we now see, could easily have been dealt with using a smart phone during their coffee break.

Now, that everyone appears to be comfortable with this, it is hard to see us going back to the old ways. In fact, in Alberta, Alberta Health has just announced that they are making the newly instated billing codes for virtual consults permanent.

However, the fact that with virtual medicine, the geographic location of the patient becomes virtually irrelevant, one wonders what impact this will have on medical practice that crosses jurisdictions. Traditionally, the practice of medicine is tightly regulated from province to province – thus, for example, I am licensed to practice medicine in Alberta but not in neighbouring British Columbia or Saskatchewan, never mind outside of Canada.

Thus, although I probably receive twenty requests for consultation from people living with obesity from around the world each week, I currently have to decline giving any advice, as I am neither licencesd to provide medical care outside of Alberta, nor would this be covered by my medical liability insurance.

Virtual medicine of course has the potential to dramatically change this – in fact, there is now no technological barrier to me providing the exact same medical consultation to a patient living in Peace River, Alberta, than there would be to seeing a patient living in Dubai or Kuala-Lumpur.

It will certainly be interesting to see how the routine use of virtual medicine will challenge regulators as well as payers and insurers to come up with new models that will allow medical practitioners to provide direct medical consultations to patients, irrespective of where they my be on this planet.

Perhaps it will soon no longer matter if your patient lives in the same town, province, or even country as you do.

Vey much looking forward to reading your comments on these developments.

Interesting times indeed!

@DrSharma
Edmonton, AB

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