Thursday, October 9, 2014

Are Smokers More Deserving of Treatment Than People Living With Obesity?

sharma-obesity-teen-smokingThis certainly appears to be the opinion of the majority of people living in Denmark, as reported in a study by Thomas Lund and colleagues published in the European Journal of Clinical Nutrition.

The study examined public support for publicly funded treatment of obesity (weight-loss surgery and medical treatment) and two pulmonary diseases strongly associated with smoking (chronic obstructive pulmonary disease (COPD) and lung cancer) in Denmark.

While a large majority supported treatment for lung cancer (86.1%) and COPD 71.2% (even when described as ‘smoker’s lung’ 61.9%), only one in three supported publicly funded weight-loss surgery (30%) and medical treatment of obesity (34.4%).

Not surprisingly, respondents beliefs about the causes of lifestyle-related diseases (external environment, genetic disposition and lack of willpower) and agreement that ‘people lack responsibility for their life and welfare’ influenced support for these treatments, especially in the case of treatments for obesity.

My guess is that these finding will not be significantly different in other countries that have publicly funded health care systems, including the UK or Canada, where treatments for cigarette-related lung and heart disease (as well as treatments for smoking cessation) are by far more accepted and accessible than treatments for obesity.

While I am all for treating and perhaps even further improving the care of people with smoking-related health problems, not having the same degree of concern or accessibility to treatments for obesity should be unacceptable.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLund TB, Nielsen ME, & Sandøe P (2014). In a class of their own: the Danish public considers obesity less deserving of treatment compared with smoking-related diseases. European journal of clinical nutrition PMID: 25248357

 

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Monday, October 6, 2014

Obesity Tip Sheet For Occupational Therapists

OT obesity tip sheet AHS Oct 2014

October is Occupational Therapist Month, an event celebrated by the Canadian Association of Occupational Therapists in a nation-wide campaign involving billboards and bumper stickers.

Reason enough to turn my readers attention to a “tip sheet” developed by members of the Alberta Health Services’ Bariatric Resource Team that explains when to refer their patients with obesity to an occupational therapist.

The preamble to this sheet notes that,

“Occupational therapists promote health and well being for people with obesity by facilitating engagement in occupations of everyday life, including addressing occupational performance issues in the areas of self-care, productivity and leisure. This can impact quality of life, including how people with obesity participate in their daily lives and in health and weight management activities.”

Occupational therapy referral may be indicated for a person with obesity presenting with challenges ranging from occupational engagement to completing simple activities of daily living.

To download this OT referral tip sheet click here.

Happy OT month!

@DrSharma
Hamilton, ON

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Friday, October 3, 2014

Obesity 5As At The Armed Forces

sharma-obesity-canadian-forcesThis morning I am presenting a workshop on the Canadian Obesity Network’s 5As of Obesity Management to members of the Canadian Armed Forces here in Ottawa.

As I discussed in a previous post, members of the Armed Forces are not immune to weight-gain – if anything, the considerable stressors encountered by military personnel make them perhaps even more prone to weight gain than civilians.

And, as for civilians, there are no easy solutions. Once the weight is on, military personnel face the same challenges in losing weight and keeping it off (if indeed their excess weight is affecting their health) as everybody else.

I look forward to an exciting discussion with the medical personnel on base about how best to apply the 5As of Obesity Management in their practice.

@DrSharma
Ottawa, ON

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Wednesday, October 1, 2014

How Does Stress Affect Eating Behaviour?

sharma-obesity-brainOne of the best recognized psychosocial factors tied to food intake is stress. However, this relationship is far from straightforward. While acute stress is often associated with loss of appetite, chronic stress is generally associated with an increase in appetite and weight gain.

Now, a series of articles assembled in Frontiers in Neuroendocrine Science by Alfonso Abizaid1 (Carlton University, Canada) and Zane Andrews (Monash University, Australia), describe in detail the rather complex neuroendocrine factors that link stress to changes in ingestive behaviour.

The series includes articles on the role of neuroendocrine factors like GLP-1, NPY, ghrelin, oxytocin, dopamin, and bombesin but also articles linking stress-related eating behaviours to adverse childhood experiences, perinatal influences, circadian rhythms and reward-seeking behaviours.

I look forward to some interesting reads over the next few days and hope to summarize some of these articles in subsequent posts.

@DrSharma
Saint John, NB

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Monday, September 29, 2014

Does Lean Tissue Have More To Say About Your Health Than Your Body Fat?

Carla Prado, PhD,  Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

Carla Prado, PhD, Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

The common assumption is that people with more body fat are at greater risk for illness and overall mortality.

Surprisingly, an increasingly robust body of evidence now suggests that how much lean tissue you have may be far more important for your health than the amount of body fat.

This evidence as well as the methodologies used to study lean body mass are discusses in a paper by Carla Prado (University of Alberta) and Steve Heymsfield (Pennington Biomedical Research Center), in a paper published in the Journal of Parenteral and Enteral Nutrition.

As the authors point out,

“The emerging use of imaging techniques such as dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and ultrasound imaging in the clinical setting have highlighted the importance of lean soft tissue (LST) as an independent predictor of morbidity and mortality.

The paper discusses in depth the advantages and limitation of the many methods that can be used to assess body composition in research and clinical settings.

The paper also discusses the current definition and importance of sarcopenic obesity and notes that,

“The identification of different body composition phenotypes suggests that individuals have different metabolism and hence utilization of fuel sources.”

Thus,

“It is clear from emerging studies that body composition health will be vital in treatment decisions, prognostic outcomes, and quality of life in several nonclinical and clinical states.”

My guess is that it will not just be the absolute or relative amount of lean tissue mass that is important. Rather, similar to the increasingly recognised role of differences amongst fat depots, I would assume that different lean soft tissue depots may well play different roles in metabolic health.

@DrSharma
Charlottetown, PEI

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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