Comments for Dr. Sharma's Obesity Notes http://www.drsharma.ca Views and news on obesity research and management from the University of Alberta Obesity Chair Thu, 17 May 2012 06:25:34 +0000 http://wordpress.org/?v=2.6 Comment on Should Doctors Stop Telling Patients to Lose Weight? by SLCCOM http://www.drsharma.ca/should-doctors-stop-telling-patients-to-lose-weight.html#comment-13479 SLCCOM Thu, 17 May 2012 04:15:59 +0000 http://www.drsharma.ca/?p=9633#comment-13479 Or, how about telling ALL your patients to work towards a healthy lifestyle, not just the heavy ones? Thin is not the same thing as healthy. Or, how about telling ALL your patients to work towards a healthy lifestyle, not just the heavy ones? Thin is not the same thing as healthy.

]]> Comment on Should Doctors Stop Telling Patients to Lose Weight? by FatChickinLycra http://www.drsharma.ca/should-doctors-stop-telling-patients-to-lose-weight.html#comment-13475 FatChickinLycra Wed, 16 May 2012 18:23:31 +0000 http://www.drsharma.ca/?p=9633#comment-13475 In a word, yes. Stop. At least stop using it as a first line of treatment in every case. I had too much to say about this for a comment box, so I blogged about it here: http://fatchickinlycra.blogspot.com/2012/05/doctors-and-weight-loss.html In a word, yes. Stop. At least stop using it as a first line of treatment in every case. I had too much to say about this for a comment box, so I blogged about it here:
http://fatchickinlycra.blogspot.com/2012/05/doctors-and-weight-loss.html

]]> Comment on FDA AdCom Strongly Supports Abandoning Excess Weight Loss by josh http://www.drsharma.ca/obsity-fda-adcom-strongly-recommends-abandoning-excess-weight-loss.html#comment-13474 josh Wed, 16 May 2012 16:11:25 +0000 http://www.drsharma.ca/?p=9622#comment-13474 Dr. Sharma, your thoughts about the less-used (but perhaps more relevant) excess BMI loss % (%EBMIL) - i.e. what percentage of BMI over 25% is lost? I would agree that the old IBW tables are terribly flawed, and total body weight loss does help clinically evaluate how an individual patient is doing, but how does one use total body weight loss to compare therapies when the outcome seems magnified for a group of patients with a lower average body weight? (i.e. a selected group of patients with BMI 30-35 - and perhaps an EOSS of 1 - seems to lose "more" body weight with drug X than a group of patients with BMI of 40-50 does with adjustable gastric band...the headlines read "Drug X more powerful than surgery!") ...Maybe %EOSS reduction should be the new metric! Dr. Sharma, your thoughts about the less-used (but perhaps more relevant) excess BMI loss % (%EBMIL) - i.e. what percentage of BMI over 25% is lost? I would agree that the old IBW tables are terribly flawed, and total body weight loss does help clinically evaluate how an individual patient is doing, but how does one use total body weight loss to compare therapies when the outcome seems magnified for a group of patients with a lower average body weight? (i.e. a selected group of patients with BMI 30-35 - and perhaps an EOSS of 1 - seems to lose “more” body weight with drug X than a group of patients with BMI of 40-50 does with adjustable gastric band…the headlines read “Drug X more powerful than surgery!”)

…Maybe %EOSS reduction should be the new metric!

]]> Comment on Should Doctors Stop Telling Patients to Lose Weight? by DebraSY http://www.drsharma.ca/should-doctors-stop-telling-patients-to-lose-weight.html#comment-13473 DebraSY Wed, 16 May 2012 13:39:57 +0000 http://www.drsharma.ca/?p=9633#comment-13473 Hooray for Roger Ladouceur! Sadistic is both a courageous and precise word. And YES, the net effect is to shift guilt and dodge responsibility for prescribing a bogus therapy. Is there any other therapy that doctors prescribe with the knowledge that more than 90% of the time it will fail long-term? Worse, that its failure will likely create more problems (such as depression, gall stones, impaired immune function and a higher body fat percentage) than the presenting condition? Wow. I hope this editorial signals a sea change, and living in the states, I hope the waves are rushing south. Hooray for Roger Ladouceur! Sadistic is both a courageous and precise word. And YES, the net effect is to shift guilt and dodge responsibility for prescribing a bogus therapy. Is there any other therapy that doctors prescribe with the knowledge that more than 90% of the time it will fail long-term? Worse, that its failure will likely create more problems (such as depression, gall stones, impaired immune function and a higher body fat percentage) than the presenting condition? Wow.

I hope this editorial signals a sea change, and living in the states, I hope the waves are rushing south.

]]> Comment on Should Doctors Stop Telling Patients to Lose Weight? by Christina RD http://www.drsharma.ca/should-doctors-stop-telling-patients-to-lose-weight.html#comment-13472 Christina RD Wed, 16 May 2012 13:25:44 +0000 http://www.drsharma.ca/?p=9633#comment-13472 As most Canadians are slowly gaining a bit of weight over time, I would like to see reducing the amount gained or to stop gaining weight as the first goals / plan discussed with a patient and only if that is attained then losing weight could be reviewed. As you have said many times Dr. Sharma, if a person is able to avoid gaining weight each year that is certainly effective obesity management. As most Canadians are slowly gaining a bit of weight over time, I would like to see reducing the amount gained or to stop gaining weight as the first goals / plan discussed with a patient and only if that is attained then losing weight could be reviewed. As you have said many times Dr. Sharma, if a person is able to avoid gaining weight each year that is certainly effective obesity management.

]]> Comment on Gastric Bypass Reduces Bioavailability of Azithromycin by DeeLeigh http://www.drsharma.ca/gastric-bypass-reduces-bioavailability-of-azithromycin.html#comment-13469 DeeLeigh Wed, 16 May 2012 11:55:26 +0000 http://www.drsharma.ca/?p=9627#comment-13469 Thanks for clarifying that. Could be equally problematic for folks who start out fatter, though... Thanks for clarifying that. Could be equally problematic for folks who start out fatter, though…

]]> Comment on Gastric Bypass Reduces Bioavailability of Azithromycin by Arya M. Sharma, MD http://www.drsharma.ca/gastric-bypass-reduces-bioavailability-of-azithromycin.html#comment-13468 Arya M. Sharma, MD Wed, 16 May 2012 11:01:49 +0000 http://www.drsharma.ca/?p=9627#comment-13468 Sorry DeeLeigh, I should have been clearer, these were weight stable patients who are now BMI 36 a year or more after their surgery. Many had BMIs of 50 or greater before their surgery. AMS Sorry DeeLeigh, I should have been clearer, these were weight stable patients who are now BMI 36 a year or more after their surgery. Many had BMIs of 50 or greater before their surgery.
AMS

]]> Comment on Gastric Bypass Reduces Bioavailability of Azithromycin by DeeLeigh http://www.drsharma.ca/gastric-bypass-reduces-bioavailability-of-azithromycin.html#comment-13467 DeeLeigh Wed, 16 May 2012 09:01:01 +0000 http://www.drsharma.ca/?p=9627#comment-13467 Mean age 44 years and BMI 36.4? Jesus. That pretty much describes me. I wear a 16W and many people wouldn't even describe me as "fat." Why on earth would someone my size get a gastric bypass? What kind of doctor would recommend that? So disturbing... I know that's not the point of the article or the study, but isn't that average BMI below the minimum allowable for that type of surgery? Oh wait. It's allowable if they have a "comorbidity," right? So if their blood pressure is on the high end of what used be considered normal 30 years ago or if they have "insulin resistance," - which some ridiculous percentage of middle aged North Americans have regardless of size, and which isn't even a disease - then they're in. Shudder. But to each his own, I guess. You do what you have to do to escape discrimination. Cross your fingers and knock on wood that it doesn't end with a lethal case of pneumonia, helped along by an immune system damaged by undernutrition and an inability to absorb antibiotics. Mean age 44 years and BMI 36.4? Jesus. That pretty much describes me. I wear a 16W and many people wouldn’t even describe me as “fat.” Why on earth would someone my size get a gastric bypass? What kind of doctor would recommend that? So disturbing…

I know that’s not the point of the article or the study, but isn’t that average BMI below the minimum allowable for that type of surgery?

Oh wait. It’s allowable if they have a “comorbidity,” right? So if their blood pressure is on the high end of what used be considered normal 30 years ago or if they have “insulin resistance,” - which some ridiculous percentage of middle aged North Americans have regardless of size, and which isn’t even a disease - then they’re in.

Shudder. But to each his own, I guess. You do what you have to do to escape discrimination. Cross your fingers and knock on wood that it doesn’t end with a lethal case of pneumonia, helped along by an immune system damaged by undernutrition and an inability to absorb antibiotics.

]]> Comment on European Joint Statement on Obesity and Hypertension by David Brown http://www.drsharma.ca/european-joint-statement-on-obesity-and-hypertension.html#comment-13437 David Brown Sat, 12 May 2012 13:55:51 +0000 http://www.drsharma.ca/?p=9605#comment-13437 The current almost universally accepted dietary advice to restrict total fat intake(1) and replace saturated fats with polyunsaturated fats(2) appears to be, in large part, a factor in the current epidemic of obesity and hypertension. Laypersons(3), scientists(4), and health experts(5) are beginning to expost the methodology behind the low-fat ideology. References 1. http://jhmas.oxfordjournals.org/content/63/2/139.full 2. http://healthydietsandscience.blogspot.com/ 3. http://video.au.msn.com/watch/video/is-saturated-fat-good-for-you/x4goj61 4. http://www.nutritionjrnl.com/article/S0899-9007%2811%2900314-5/abstract 5. http://www.health24.com/fitness/Diet_Supplements/16-481-512,73175.asp The current almost universally accepted dietary advice to restrict total fat intake(1) and replace saturated fats with polyunsaturated fats(2) appears to be, in large part, a factor in the current epidemic of obesity and hypertension. Laypersons(3), scientists(4), and health experts(5) are beginning to expost the methodology behind the low-fat ideology.

References
1. http://jhmas.oxfordjournals.org/content/63/2/139.full
2. http://healthydietsandscience.blogspot.com/
3. http://video.au.msn.com/watch/video/is-saturated-fat-good-for-you/x4goj61
4. http://www.nutritionjrnl.com/article/S0899-9007%2811%2900314-5/abstract
5. http://www.health24.com/fitness/Diet_Supplements/16-481-512,73175.asp

]]> Comment on Close Concerns: Weight Loss and Weight Loss-Maintenance by eating disorder help http://www.drsharma.ca/close-concerns-weight-loss-and-weight-loss-maintenance.html#comment-13436 eating disorder help Sat, 12 May 2012 13:50:22 +0000 http://www.drsharma.ca/?p=9506#comment-13436 Hi there to every body, it's my first go to see of this blog; this weblog carries amazing and truly good stuff designed for readers. Hi there to every body, it’s my first go to see of this blog; this weblog carries amazing and truly good stuff designed for readers.

]]>