As readers will be well aware, n terms of health risks, fat is not fat is not fat is not fat.
Rather, whether or not body fat affects health depends very much on the type of body fat and its location.
While there have been ample attempts at trying to describe body fat distribution with simple anthropometric tools like measuring tapes and callipers, these rather crude and antiquated approaches have never established themselves in clinical practice simply because they are cumbersome, inaccurate, and fail to reliably capture the exact anatomical location of body fat. Furthermore, they provide no insights into ectopic fat deposition – i.e. the amount of fat in organs like liver or muscle, a key determinant of metabolic disease.
Recent advances in imaging technology together with sophisticated image recognition now offers a much more compelling insight into fat phenotype.
In this regard, readers may be interested in a live webinar that will be hosted by the Canadian Obesity Network at 12.00 pm Eastern Standard Time on Thu, Nov 23, 2017. The webinar provides an overview of a new technology developed by the Swedish company AMRA, that may have both important research and clinical applications.
The talk features Olof Dahlqvist Leinhard, PhD, Chief Scientific Officer & Co-Founder at AMRA and Ian Neeland, MD, a general cardiologist with special expertise in obesity and cardiovascular disease, as well as noninvasive imaging at the UT Southwestern Medical Center in Dallas, US.
Registration for this seminar is free but seats are limited.
To join the live event register here.
I have recently heard this talk and can only recommend it to anyone interested in obesity research or management.
10 years ago, I was enticed to take up an endowed “Chair” in obesity research and management at the University of Alberta with the task to develop and lead the fledgling bariatric program at the Royal Alexandra Hospital.
The decision to move to the University of Alberta from a prestigious Tier 1 Canada Research Chair in obesity at McMaster University, where my research enterprise was moving along just fine, was largely prompted by the Ontario Government’s bumbling indecision (despite all of my considerable and enthusiastic advocacy efforts on behalf of my patients) about promoting much needed bariatric services in Ontario (as a side note, only six weeks after I had signed on with the University of Alberta, the Ontario government, after much to-and-froing, finally did announce substantial funding for a province-wide bariatric program, which continues to this date as the Ontario Bariatric Network).
Despite my sadness at leaving my most wonderful and supportive colleagues at McMaster University, I have not for a moment regretted my move to Edmonton. Not only did I find another set of as supportive colleagues at the University of Alberta but also the committed and dedicated staff within Capital Health (now part of Alberta Health Services), all of which enthusiastically supported the creation of a now world-class academic bariatric program in Edmonton. With well over 100 peer-reviewed publications to show for (with a notable mention to the colleagues who helped develop the Edmonton Obesity Staging System and the 5As of Obesity Management), the academic work in obesity was only a rather small part of my activities as “Chair”.
Together with my colleagues at Alberta Health Services, we supported a total of 5 bariatric clinics across the province, all of which are now up and serving Albertans living with severe obesity – each adapted to local resources and interests. Of these, the Edmonton Adult Bariatric Specialty Program at the Royal Alexandra Hospital of course continues as the flagship program, offering a full suite of behavioural, medical, and surgical treatments for Albertans with severe obesity.
With my move to Edmonton, so did the national office of the Canadian Obesity Network (co-hosted by the University of Alberta and Alberta Health Services). As readers will be well aware, this pan-Canadian network of now well over 15,000 obesity researchers, health professionals, trainees, and now 1000s of public supporters, continues to grow and steadfastly pursue its important mission of promoting obesity research, professional education in obesity management, fighting weight bias and discrimination, and advocating for better access to obesity prevention and management for all Canadian children and adults across the continuum of care.
Now, as the 2nd (non-renewable) 5-year term of my appointment as “Obesity Chair” comes to an end, I can only humbly express my sincere thanks to all of my many colleagues and staff at the University of Alberta and Alberta Health Services for supporting all of my activities. I also send out a sincere vote of thanks to all my patients, who continue to keep me well grounded in the reality of clinical obesity practice.
While I may no longer hold the “Chair”, I will of course continue serving in my role as Professor at the University of Alberta and fully aim to further pursue all of my academic and clinical activities while continuing to advocate for better access to obesity care for Albertans (and all Canadians). I also plan to continue to in my role as Medical Co-Director of Alberta Health Services’ Obesity Strategy.
As the search now commences for a new endowed “Chair” (and I know that the University will be looking for the best possible candidates from across Canada and the world), I look forward to working closely with whoever takes on this role to continue improving care for Albertan adults and children living with obesity.
Readers will recall, that once-weekly injections of the novel long-acting GLP-1 analogue semaglutide was recently shown (in patients with type 2 diabetes) to result in a rather impressive weight loss.
Now, a phase II dose-finding study comparing various oral doses of semaglutide to subcutaneous injections in patients with type 2 diabetes was just published in JAMA.
The 26-week trial with 5-week follow-up included around 600 patients with type 2 diabetes and insufficient glycemic control using diet and exercise alone or a stable dose of metformin were randomized to once-daily oral semaglutide of 2.5 mg (n = 70), 5 mg (n = 70), 10 mg (n = 70), 20 mg (n = 70), 40-mg 4-week dose escalation (standard escalation; n = 71), 40-mg 8-week dose escalation (slow escalation; n = 70), 40-mg 2-week dose escalation (fast escalation, n = 70), oral placebo (n = 71; double-blind) or once-weekly subcutaneous semaglutide of 1.0 mg (n = 70) for 26 weeks.
Mean change in HbA1c level from baseline to week 26 decreased with oral semaglutide (dosage-dependent range, −0.7% to −1.9%) and subcutaneous semaglutide (−1.9%) and placebo (−0.3%);
Significant reductions were also seen in body weight with both oral (dosage-dependent range, −2.1 kg to −6.9 kg) and subcutaneous semaglutide (−6.4 kg) vs placebo (−1.2 kg)>
Adverse events (largely consisting of mild to moderate gastrointestinal events) were as expected and relatively comparable between the treatment arms.
Although this was a diabetes study, these findings clearly hold promise for the further development of an oral formulation of semaglutide for the obesity indication.
Disclaimer: I have served as a consultant for Novo Nordisk, the maker of semaglutide.
This week, I am in Tønsberg, Norway, speaking at the annual meeting of the European Association for the Study of Obesity (EASO) Collaborating Centres on Obesity Management (COMs).
This is a pan-Euoropean network of over 75, that includes academic, public and private clinics where children and adults with obesity are managed by holistic teams of specialists delivering comprehensive state-of- the-art clinical care.
The EASO-COMs also work closely to ensure quality control, data collection, and analysis as well as for education and research for the advancement of obesity care and obesity science.
Current plans foresee establishing 100 new COMs by 2020. There are also plans to develop an international exchange and mentoring program to increase competencies and treatment knowledge across Europe.
Other important EASO initiatives in this regard include a knowledge transfer series involving e-Learning modules for obesity management based on the Canadian Obesity Network’s initiative with mdBriefCase.
I certainly look forward to networking with and learning from my European colleagues over the next couple of days.
Further details on the criteria for becoming a EASO COM are available here.
A recent CMAJ article, by Ian Mosby and Tracey Galloway from the University of Toronto argues that one of the key reasons why we see obesity and diabetes so rampant in Canada’s indigenous populations, is the fact that widespread and persistent exposure to hunger during the notorious residential school system may have metabolically “programmed” who generations toward a greater propensity for obesity and type 2 diabetes.
There is indeed a very plausible biological hypothesis for this,
“Hunger itself has profound consequences for childhood development. Children experiencing hunger have an activated hypothalamic–pituitary–adrenal stress response. This causes increased cortisol secretion which, over the long term, blunts insulin response, inhibits the function of insulin-like growth factor and produces long-term changes in lipid metabolism. Through this process, the child’s physiology is essentially “programmed” by hunger to continue the cycle of worsening effects, with their bodies displaying a rapid tendency for fat-mass accumulation when nutritional resources become available.”
While the impact of hunger may well have been one of the key drivers or metabolic changes, the authors failed to acknowledge another (even more?) important consequence of residential schools – the impact on mental health.
Oddly enough, in a blog post I wrote back in 2008, I discussed the notion that the significant (and widespread) physical, emotional, and sexual abuse experienced by the generations of indigenous kids exposed to the residential school system would readily explain much of the rampant psychological problems (addictions, depression, PTSD, etc.) present in the indigenous populations across Canada today.
The following is an excerpt from this previous post:
This disastrous and cruel [residential school] 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.”