Arya M. Sharma, MD

Sangita Sharma, PhD

Last week I attended Medical Grand Rounds at the University of Alberta Hospital presented by our Faculty’s latest recruit Sangita Sharma (no relation), Professor in Aboriginal and Global Health and newly Endowed Chair in Aboriginal Health.

Sangita, who earned her PhD in nutritional epidemiology from the University of Manchester, UK, comes to Edmonton from the Nutrition Research Institute at the University of North Carolina at Chapel Hill. Prior to that, she was an associate professor at the University of Hawaii.

Her work focuses on the relationship between diet and disease in ethnic groups across the globe, including nutrient-gene interactions and the risk of cancer and heart disease.

Sangita spent nearly 10 years evaluating the diets of various ethnic groups in the US and through her research and recommendations, the USDA Pyramid Servings Database now includes food eaten by ethnic minority populations in the U.S. During this time she has conducted research in over 20 indigenous populations around the world.

Her current research focuses on Aboriginal health, nutritional and physical activity interventions to prevent chronic disease and improve dietary adequacies for Inuit/Inuvialuit populations in the Canadian Arctic, First Nations, Alaskan natives, Apache, Navajo and African-Americans, and monitoring the nutrition transition.

In her talk she presented a brief overview of her ongoing work in Canada’s Arctic, including Healthy Foods North, a culturally appropriate and community-based program to promote healthy eating and lifestyle amongst the Inuit and Inuvialuit population of Cambridge Bay and Taloyoak, NU and Inuvik and Tuktoyaktuk, NWT.

As Sangita pointed out, over 90% of the older population is presently medically obese and virtually 100% of the population does not meet the current recommendations for fibre, calcium, Vit A, D, E intake.

“Educating on healthy eating can be particularly challenging when the local language does not even have words for fibre, vitamins or minerals”, she notes.

By promote traditional food and activities, Sangita hopes to help improve people’s diet and activity levels thereby substantially reducing their risk of obesity and other diseases.

I was particularly impressed by the lengths Sangita goes to to ensure community engagement and ownership. Her strategy, described in a recent paper published in the American Journal of Health Behaviors, is certainly a strategy that can only be a model for interventions in any population.

With only a few community workshops, she demonstrated a huge impact on nutrition knowledge and behaviours, which will hopefully withstand the duration of the intervention.

In her presentation, Sangita also briefly touched on other ongoing projects including an intervention trial targeting salt intake in Barbados and a comparative study of the relationship between meat and the risk for colorectal cancer amongst the Japanese populations of Brazil, Hawaii and Japan.

On a personal note, I very much look forward to learning from and collaborating with Sangita on issues related to nutrition in another marginalized and understudied population - those living with severe obesity in Alberta and elsewhere.

AMS
Edmonton, Alberta

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Gittelsohn J, Roache C, Kratzmann M, Reid R, Ogina J, & Sharma S (2010). Participatory research for chronic disease prevention in Inuit communities. American journal of health behavior, 34 (4), 453-64 PMID: 20218757

Bannock Basket

Yesterday, Ashlee-Ann Pigford, currently completing her MSc under Noreen Willows and Geoff Ball here in the University of Alberta Department of Agriculture, Food and Nutritional Sciences, presented at the Alberta Diabetes Institute’s Research in Progress seminar series on her work in First Nations children.

Ashlee spent a Summer working in the Canadian Obesity Network office, so I was particularly interested in seeing her present.

The goal of her project was to perform both a quantitative and qualitative analysis of overweight and obesity amongst First Nation children living in an on-reserve Cree community in Alberta.

The qualitative part of her study included exploring the children’s traditional knowledge, preceptions about health, food and activity and to better understand their food and activity preferences.

The quantitative study included 105 First Nations children (Kindergarten to grade 6) and showed that almost half the children were overweight and almost one in five were obese. Around one in two had abdominal obesity, almost 65% were inactive (as assessed by pedometers) with only 36% meeting daily step recommendations.

In the qualitative study, which included having kids drawing pictures and sorting them into healthy and unhealthy piles, it became evident that the children had a strong identification with their traditional cultures and values. There was a great importance of both traditional foods and their role at cultural events as well as on hunting.

The children often cited their mothers or grandmothers as their source of health information and gained their beliefs from older relatives.

They clearly associated obesity, heart disease and diabetes to being unhealthy and considered natural foods and many sacred ceremonial practices associated with nature as healthy.

As Ashlee summarized, her findings clearly show the importance of community specific context of their health beliefs and choices, which emphasises the need for multilevel ecological approaches to tackling excess weight that need to be designed in a culturally relevant manner to promote healthy lifestyles.

It was also evident that it is crucial to involve the elders, extended family members and the parents in any meaningful initiatives to address childhood obesity in this (and probably other) First Nations community.

Congratulations Ashlee on completing your study and this most insightful presentation!

AMS
Edmonton, Alberta

This weekend I experienced my first trip to the Yukon, where I attended the 2008 Conference of the Canadian Association of Occupational Therapists (CAOT) in Whitehorse.

CAOT is a partner of the Canadian Obesity Network and I believe that this was the first time that a CAOT conference featured a professional issue forum on Obesity and Healthy Occupation. Speakers in this session, chaired by Mary Forhan (McMaster), included Kim Raine (U Alberta), Gaye Hanson (Hanson & Associates) and myself.

While Kim talked about how obesity has to be seen in the context of societal changes and pressures and I presented the medical perspective on obesity as a chronic disease, Mary talked about the role and opportunities for occupational therapists in obesity prevention, treatment and in allowing patients with obesity to live complete and dignified lives (no matter how good our prevention or treatments, there will always be obese individuals in our society). Gaye, a former Midwife and ex-Deputy Minister of Health and Social Services in the Yukon, herself of Cree Ancestry, presented a most enlightening view of the challenges of addressing obesity in Aboriginal populations.

But for me the most moving insights came from the closing remarks by Madeleine Dion Stout (picture), who was also the keynote speaker at the conference. Born and raised on the Kehewin First Nation in Alberta and nursing graduate from the Edmonton General Hospital, Madeleine worked for many years in the Medical Services Branch of Health Canada and has been a member of dozens of First Nations health committees and task forces aimed at improving the health of First Nations, Inuit and Metis.

The one sentence that I found particularly enlightening was (in the context of obesity - “apple and pears”) “don’t ever refer to an Indian as an apple!”. For an Indian, an apple implies being “red” on the outside but “white” on the inside - not a very polite thing to say! All goes to show how cultural context can fully change the meaning of even the most seemingly innocuous words.

Most interestingly, Madeleine, herself a “victim” of residential schools made the same connection between the pain, suffering, broken spirit and shame inflicted by residential schools and the increased risk for obesity that I had made in my blog posting a day earlier. Imagine my surprise, as Madeleine of course was unaware of my take on the “apology”.

Overall a most insightful weekend - much to think about.

Thank you CAOT for inviting me to Whitehorse.

AMS
Edmonton, Alberta

On Tuesday, Prime Minister Harper, on behalf of all Canadians, said “We are sorry” to the Aborginal peoples of Canada for putting generations of them through residential schools aimed at removing them from the influence of the wigwam.

These residential schools began in 1920 and attendance for all aboriginal children ages 7-15 years was made compulsory. Children were forcibly taken from their families by priests, Indian agents and police officers. The last federally run residential school was in Saskatchewan and closed its doors in 1996.

In his address, Harper said:

“The Government of Canada built an educational system in which young children were often forcibly removed from their home, often taken far from their communities. Many were inadequately fed, clothed and housed. All were deprived of the care and nurturing of their parents, grandparents and communities.”

This disastrous and cruel policy resulted in much pain and despair in the First Nations’, Inuit and Metis people that lasts to this day (known as the “generational effect”). Sexual, physical and mental abuse was widespread; students were broken in heart and spirit; culture and identities were destroyed.

Much (if not all) of what ails the Aboriginal peoples of Canada can be traced back to this policy – including possibly issues that affect Aboriginal health to this day.

It is no secret that obesity and its consequences (e.g. diabetes) are rampant amongst the Aboriginal peoples of Canada. While poverty, breakdown of traditional lifestyle and culture and even genetic factors (thrifty genotype) have all been implicated in this, I wonder how much the misery caused by the residential school program had to contribute.

Early traumatic life experiences including sexual, mental and physical abuse as well as neglect and grief have all been implicated in binge eating disorder (BED) – in its purest form – the uncontrollable urge to devour large quantities of highly palatable high-caloric foods in response to emotional hunger. This behaviour has been interpreted as an emotional coping strategy, “filling the inner void”, building a physical protective barrier, etc., the ultimate result being excessive weight gain with all its consequences (the typical binger does not compensate by purging or excessive exercise).

In “treatment-seeking” patients with obesity, the prevalence of BED is estimated at 20-40%. Although I was unable to find a study that has applied the DSM-IV criteria for BED to an Aboriginal population – my guess is: the rates are probably high!

Given its distinct psychopathology, BED is highly responsive to psychotherapeutic approaches. In contrast, educational initiatives based on simply providing information on healthy lifestyles are useless.

Obesity is never an issue of “choice”. I have yet to meet anyone who “chooses” to be obese. This is most certainly also true for Canada’s Aboriginal population.

I look forward to perhaps one day reading a thesis on “The Role of Residential Schools in the Aboriginal Obesity Epidemic”.

I’d be surprised if the author failed to find a clear link.

AMS
Edmonton, Alberta