Follow me on

The Birds And Bees Don’t Do It

In case you’re wondering what the birds and bees don’t do – the answer is simple – breast feeding! Why blog about this? For one, even if breast feeding may not be quite the magical solution to obesity prevention that it is often touted to be (see this article on common obesity myths), it certainly has more benefits for infants (and perhaps the moms) than your could even begin to count. Reason enough for me to enthusiastically support my daughter, Linnie von Sky’s latest children’s book venture, which has breast feeding as its central theme. Readers, who may have seen (and supported the creation of Linnie’s first three children’s books – on immigration, weight bullying, and depression), will likely rally to support her latest venture by pre-ordering her new book on Indigogo. Readers unfamiliar with Linnie’s wonderful whimsical books, may wish visit Linnie’s website and check things out for themselves. If you feel strongly about breast feeding and its many benefits and think that it’s never too early to teach kids about it, please take a minute to support Linnie’s campaign by pre-ordering her books (or even acquiring a piece of the original artwork). Proud Dad Edmonton, AB

Full Post

Why Would Anyone Want Access to Prescription Medications For Obesity?

Just imagine if the question in the title of this post was, “Why would anyone want access to prescription medications for diabetes?” (or heart disease? or lung disease? or arthritis? or, for that matter, cancer?) Why would anyone even ask that question? If there is one thing we know for sure about obesity, it is that it behaves just like every other chronic disease. Once you have it (no matter how or why you got it) – it pretty much becomes a life-long problem. Our bodies are so efficient in defending our body fat, that no matter what diet or exercise program you go on, ultimately, the body wins out and puts the weight back on. In those few instances where people claim to have “conquered” obesity, you can virtually bet on it, that they are still dealing with keeping the lost weight off every single day of their life – they are not cured, they are just treated! Their risk of putting the weight back on (recidivism) is virtually 100% – it’s usually just a matter of time. Funnily enough, this is no different from people trying to control any other chronic disease with diet and exercise alone. Take for e.g. diabetes. It is not that diet and exercise don’t work for diabetes, but the idea that most people can somehow control their diabetes with diet and exercise alone is simply not true. No matter what diet they go on or what exercise program they follow, sooner or later, their blood sugar levels go back up and the problems come back. You could pretty much say the same for high blood pressure or cholesterol, or pretty much any other chronic health problem (that, in fact, is the very definition of “chronic”). So why medications for obesity? Because, like every other chronic disease, medications can help patients achieve long-term treatment goals (of course only as long as they stay on treatment). Simply put, if the reason people virtually always regain their lost weight (no matter how hard they try to lose it) is simply because of their body’s ability to resist weight loss and promote weight regain, then medications that interfere with the body’s ability to resist weight loss and promote weight regain, will surely make it far more likely for them to not only lose the weight but also keep it off. Now that we increasingly understand many of the body’s mechanisms to defend… Read More »

Full Post

Canadians Have Virtually No Access To Interdisciplinary Obesity Care

Every single guideline on obesity management emphasises the importance of interdisciplinary obesity management by a team that not only consists of a physician and a dietitian but also includes psychologists, exercise specialists, social workers, and other health professionals as deemed necessary. As is evident from the evident from the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, the overwhelming majority of Canadians living with obesity have no access to anything that even comes close. Thus, the report finds that Among the health services provided at the primary care level for obesity management, dietitian services are most commonly available. Access to exercise professionals, such as exercise physiologists and kinesiologists, at the primary care level is limited throughout Canada. Access to mental health support and cognitive behavioural therapy for obesity management at the primary care level is also limited throughout Canada. bariatric surgery programs often have a psychologist or a social worker that offers mental health support and cognitive behavioural therapy to patients on the bariatric surgery route, but the availability of these supports outside of these programs is scarce. Centres where bariatric surgery is conducted also have inter- disciplinary teams that work within the bariatric surgical programs and provide support for patients on the surgical route. Alberta and ontario have provincial programs with dedicated bariatric specialty clinics that offer physician-supervised medical programs with interdisciplinary teams for obesity management. Interdisciplinary teams for obesity management outside of the bariatric surgical programs are available in one out of five regional health authorities (RHa) in british Columbia, one out of 18 RHas in Québec, one out of two RHas in new brunswick and one out of four RHas in newfoundland and labrador. Among the territories, only yukon has a program with an interdisciplinary team focusing on obesity management in adults. I hardly need to remind readers, that this is in stark contrast to the resources and teams available to patients with diabetes, heart disease, lung disease, or any other common chronic disease, that are regularly available in virtually every health jurisdiction across the country (not to say that they are perfect or sufficient – but at least there is some level of service available). I understand that our current obesity treatments are extremely limited (at least when effectiveness is measured in terms of weight loss). But even if access to these resources could simply help stabilise and… Read More »

Full Post

High Time For Canadian Governments To Recognise Obesity As A Chronic Disease

It has now been almost two years since the Canadian Medical Association declared obesity to be a chronic medical disease. This declaration was widely praised by people living with obesity as well as healthcare and academic professionals (not least myself), who supported the notion that recognition of obesity as a disease would help precipitate a shift in thinking of obesity as just a lifestyle choice to a medical disease with an obligation to prevent and treat it as other chronic diseases. Not much has happened since then – at least not as far as Canadian policy makers are concerned. Thus, it is evident from the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, that so far, neither the federal government nor any of the provincial/territorial governments in Canada have recognized obesity as a chronic disease. As discussed in the report, this has a significant negative trickle-down effect on access to obesity treatment for the over 6,000,000 Canadians living with this chronic disease, not to mention the millions of Canadians at high risk of developing this disease in the near future. As a reminder, in preparing the Report Card, the Canadian Obesity Network extensively reviewed all publicly accessible resources and documents for evidence of policies, guidelines and services for obesity treatment and management in each province and territory. In addition, the Canadian Obesity Network tried to identify and speak directly to government officials in each province and territory regarding their take on obesity as a chronic disease. This was by no means an easy task, “The search for information on the recognition of obesity as a chronic disease and treatment guidelines or recommendations by provincial/territorial governments and identifying appropriate policy makers in each province/ territory required significant effort. many provinces and territories do not have a person or department dedicated to the bariatric or obesity-treatment portfolio.”  As the Report Card highlights, “Since the declaration, none of the provincial or territorial governments have officially recognized obesity as a chronic disease.” “Health Canada has also not officially recognized obesity as a chronic disease and has continued to consider obesity as a lifestyle risk factor. There is no directive from Health Canada on the treatment and management of obesity in adults.” It also notes that the 2016 report of the senate standing Committee on social affairs, science and technology titled Obesity in Canada, referred to obesity as a… Read More »

Full Post

Redefining Obesity Beyond Numbers

As I pointed out in yesterday’s post, there appeared to be broad acceptance for the notion that obesity is a chronic medical disease at the recent 5th Canadian Obesity Summit. In my opening address to the delegates, however, I emphasised that acceptance of obesity as a chronic medical diagnosis requires modification of the definition of obesity to ensure that people diagnosed with this condition do in fact have significant health impairments that warrant them being considered ‘sick’. This is where, the current commonly used ‘definition’ of obesity based on BMI breaks down, as it would ‘misdiagnose’ a significant proportion of Canadians with having a ‘disease’, when in fact they may be perfectly healthy. Moreover, the current BMI-based ‘definition’ of obesity would exclude an even larger group of individuals, who may stand to benefit from anti-obesity treatments as having a BMI that is too low. Let us recall that BMI is really just a measure of size and not a direct measure of actual health. As discussed in a recent editorial published in OBESITY, we have suggested that it would only take a minor (but important) modification of the current WHO definition of obesity to ensure that this label is only applied to people whose health is in fact affected by their body fat. Thus, we have suggested that the current WHO definition, “The presence of abnormal or excess body fat that may impair health.”   be modified to “The presence of abnormal or excess body fat that impairs health.”  This simple change to the wording would have significant implications in that obesity would move from simply being a term used to describe a risk factor (“may impair health“) to being an actual disease (“impairs health“), with all of its consequences for policy, regulators, healthcare systems, research, and clinical practice. Before anyone thinks that this would be far too cumbersome or impractical, let us remind ourselves that such diagnostic approaches are standard practice for a wide range of other diseases that require a clinical encounter, laboratory testing, and/or diagnostic imaging for their diagnosis. In fact, there are very few diseases that can be reliably diagnosed with just a single measure or test. Thus, “…in clinical practice, assessing whether or not abnormal or excess weight is impairing someone’s health should not pose a major diagnostic dilemma. In the vast majority of patients, a few interview questions, a brief physical exam, and a short panel of routine lab tests should readily establish (or… Read More »

Full Post

Another Canadian Obesity Summit Exceeds Expectations

Wow, what a week! Just back from the 5th Canadian Obesity Summit, there is no doubt that this summit will live long in the minds (and hearts) of the over 500 attendees from across Canada and beyond. As anyone would have appreciated, the future of obesity research, prevention and practice is alive and kicking in Canada. The over 50 plenary review lectures as well as the over 200 original presentations spanning basic cellular and animal research to health policy and obesity management displayed the gamut and extent of cutting-edge obesity research in Canada. But, the conference also saw the release of the 2017 Report Card on Access to Obesity Treatment for Adults, which paints a dire picture of treatment access for the over 6,000,000 Canadians living with this chronic disease. The Report Card highlights the virtually non-existant access to multidisciplinary obesity care, medically supervised diets, or prescription drugs for the vast majority of Canadians. Moreover, the Report Card reveals the shocking inequalities in access to bariatric surgery between provinces. Merely crossing the border from Alberta to Saskatchewan and your chances of bariatric surgery drops from 1 in 300 to 1 in 800 per year (for eligible patients). Sadly, numbers in both provinces are a far cry from access in Quebec (1 in 90), the only province to not get an F in the access to bariatric surgery category. The presence of patient champions representing the Canadian Obesity Network’s Public Engagement Committee, who bravely told their stories to a spell-bound audience (often moved to tears) at the beginning of each plenary session provided a wake up call to all involved that we are talking about the real lives of real people, who are as deserving of respectful and effective medical care for their chronic disease as Canadians living with any other chronic disease. Indeed, the clear and virtually unanimous acceptance of obesity as a chronic medical disease at the Summit likely bodes well for Canadians, who can now perhaps hope for better access to obesity care in the foreseeable future. Thanks again to the Canadian Obesity Network for hosting such a spectacular event (in spectacular settings). More on some of the topics discussed at the Summit in coming posts. For an overview of the Summit Program click here @DrSharma Edmonton, AB

Full Post

Public Engagement For Obesity

This week, the Canadian Obesity Network will host its 5th National Obesity Summit in Banff, Alberta. While the formal program begins on the evening of the 26th with the delivery of Award lectures, there are plenty of pre-conference workshops to chose from. One such workshop is the strategy meeting of the Network’s Public Engagement Committee, which will meet in person to discuss the Network’s public engagement strategy. As reader may know, this committee was formed two years ago at the last Canadian Obesity Summit in Toronto (image) and has been extremely active since in helping plan and provide direction for the Network’s activities to tie in and meet the interests and needs of the nearly 7,000,000 Canadians living with obesity. It is fair to say, that their voice has been largely ignored in the policy discussions around obesity prevention and management and there is little evidence that Canadians living up with obesity are speaking up for themselves. This is a crying shame, as who should know more about the realities and challenges that Canadians living with obesity face everyday in settings including education, workplace, and society in general? Unfortunately, the challenges also extend to health care – as will become evident from the Report Card on Access to Obesity Treatments in Canada, which will be released at the Summit later this week. With this work, the Network is following closely in the footsteps of the Obesity Action Coalition and the EASO Patient Council to provide a voice at the table for Canadians living with this chronic disease. I look forward to a most exciting and informative week. @DrSharma Banff, AB

Full Post

Do SGLT-2 Inhibitors Change Fat Metabolism?

Since the introduction of SGLT-2 inhibitors (“gliflozins” or “glucoretics), as an insulin-independent treatment for type 2 diabetes, that works by blocking glucose reabsorbtion in the kidney resulting in loss of glucose (and calories) through the kidney, much has been written about the (albeit modest) weight loss associated with this treatment. Several studies have documented that the weight loss leads to a change in body composition with an often significant reduction in fat mass. Now, Giuseppe Daniele and colleagues, in a paper published in Diabetes Care, show that treatment with these compounds may enhance fat oxidation and increase ketone production in patients with type 2 diabetes. The researchers randomized 18 individuals with type 2 diabetes to dapagliflozin or placebo for two weeks. As expected, dapagliflozin reduced fasting plasma glucose significantly (from 167  to 128 mg/dL). It also increased insulin-stimulated glucose disposal (measured by insulin clamp) by 36%, indicating a significant increase in insulin sensitivity. Compared to baseline, glucose oxidation decreased by about 20%, whereas nonoxidative glucose disposal (glycogen synthesis) increased by almost 50%. Moreover, dapagliflozin increased lipid oxidation resulting in a four-fold increase in plasma ketone concentration and and a 30% increase in fasting plasma glucagon. Thus, the authors note that treatment with dapagliflozine improved insulin sensitivity and caused a shift from glucose to lipid oxidation, which, together with an increase in glucagon-to-insulin ratio, provide the metabolic basis for increased ketone production. While this may explain the recent observation of a greater (albeit still rather rare) incidence of ketoacidosis with the use of these compounds, these findings may also explain part of the change in body composition previously noted with SGLT-2 treatment. While this still does not make SGLT-2 inhibitors “weight-loss drugs”, there appears to be more to the fat loss seen with these compounds than just the urinary excretion of glucose. @DrSharma Edmonton, AB

Full Post