Thursday, January 15, 2015

FDA Approves VBLOC Treatment For Obesity

enteromedicslogowithtechlarge3x2We don’t have great treatments for obesity, so every new evidence-based tool in the obesity treatment tool box is something to look at closely.

The latest addition, just approved by the US FDA for the treatment of obesity  in adults with a BMI of 40 to 45 kg/m2 or a BMI of 35 to 39.9 kg/m2 with a related health condition, is something I’ve posted about before - VBLOC or the vagal “pacemaker” as it is sometimes referred to.

Indeed, Enteromedics‘ rechargeable Maestro system is very much like an implantable cardiac pacemaker, in that it delivers an electronic signal – in this case to block the action of the vagus nerve. The exact mode of action is not entirely clear but the weight-loss mediating effect (in the 10-15% average range) is largely a result of reduced appetite and increased satiety.

Here is how Enteromedics describes its system:

The Maestro® System consists of a subcutaneously implanted rechargeable neuroregulator and two electrodes that are laparoscopically implanted by a bariatric surgeon. It delivers VBLOC® vagal blocking therapy via these electrodes that are placed in contact with the trunks of the vagus nerves just above the junction between the esophagus and the stomach. The device intermittently blocks vagal nerve signals throughout the patient’s waking hours. The Maestro System is recharged using an external mobile charger and transmit coil worn by the patient. The device can be non-invasively programmed, and it can be adjusted, deactivated, reactivated or completely removed if desired.”

Obviously this is far from the be-all and end-all of obesity treatments – especially as it does not seem to work for everyone. Thus, the recently published results from the pivotal study (discussed here),  was certainly far less impressive than the company may have hoped for.

Just where VBLOC treatment will ultimately find its place in bariatric care remains to be seen – this is certainly a space to watch.

@Dr. Sharma
Edmonton, AB

 

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Wednesday, January 14, 2015

Guest Post: Bariatric Foodie

Nikki Massie, Bariatric Foodie

Nikki Massie, Bariatric Foodie

Last year, at the Obesity Action Coalition’s annual conference, I met Nikki Massie, who underwent Roux-en-Y gastric bypass surgery seven years ago and writes a blog with recipes and other advice for people post bariatric surgery (“Bariatric Foodie“).

As I am always eager to hear the perspective of someone living with bariatric surgery, I invited Nikki to send me a guest post – here it is:

My name is Nikki Massie and seven years ago I underwent Roux-en-Y gastric bypass surgery in Baltimore, Md.

Last year I wrote an article on my journey in the National Inquiry of Bioethics and in it I described having weight loss surgery as, “stepping off the edge of the earth and trusting there’d be a soft place to land.” I had been overweight my entire life. I was over 9 lbs. at birth and trended above the top of the growth charts throughout my childhood.

The decision to have surgery came by way of motherhood. I was 31 years old and I had two daughters, aged 8 and 6. One day, watching them play at the playground I realized that if I didn’t do something soon, I would probably miss many moments in their lives due to lack of energy and the myriad health problems associated with obesity. At the time I was 340 lbs.

In January 2008, I had my surgery.

That was the start of my journey, and it’s where I’d like to start with a few things I’d like you to know from the patient perspective.

All the tests in the world can’t predict how a patient will react emotionally. I realized shortly after my surgery that I am a food addict. Restriction plunged me into a deep depression and anxiety. Some days the only way I knew how to cope was wandering supermarket aisles looking at food. Thankfully I found a great resource in Overeaters Anonymous and I’m working on my own recovery.

Bottom Line: Stress to your patients the importance of having mental health support. Encourage them to find a therapist, come to support group or utilize any other mental health tools at their disposal.

Weight and self-image vary from culture to culture. I think that’s important to note because within my own African-American culture, being a curvy woman is not stigmatized, but often celebrated. Being “skinny” is not necessarily a cultural value. I hear from many African-American women post-ops that they worry they will get too small and they work against losing past a certain amount. There is also familial and community pressure share in traditional foods and to look a certain way.

Bottom Line: It helps to ask about traditions and culture and how food plays into them and then help them find a healthier alternative!

In the long-term many post-ops feel abandoned. In a blog series I wrote for Obesity Action Coalition, I noted that many long-term post-ops felt alienated at their support groups. Many shared the feeling that they seemed more geared toward newer post-ops than long-termers. In addition, many weren’t sure what follow-up they needed after the two-year post-op mark.

Bottom Line: Does your office see patient’s long-term? If so, reach out to them and get them into the office. If not, make sure your patients know how to talk to their primary care physician about any issues that might arise and also make them aware of the existence of bariatricians!

The Bottom Line For Me

I recently celebrated the seven-year anniversary of my surgery. I’ve regained about 30 lbs. I continue many of the lifestyle habits I adopted: I go to the gym several times a week, I follow a high protein eating plan, but most of all I have more energy and I am in good health, even though I have regained.

These days I stay connected via my website, Bariatric Foodie, which encourages readers to reimagine their favorite foods in a healthier way, but also challenges them to make goals, practice accountability and think realistically and critically about their weight loss process.

If you have any questions I’m happy to answer them in the comments or via email at bariatricfoodie@yahoo.com

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Monday, December 8, 2014

Effectiveness Of Obesity Management For Osteoarthritis

sharma-obesity-knee-osteoarthritis1Osteoarthritis is one of the most common and disabling complications of obesity. Irrespective of whether or not the osteoarthritis is directly caused by excess weight, there is little doubt that the sheer mechanical forces acting on the affected joints will significantly impact mobility and quality of life.

Now the Canadian Agency for Drugs and Technologies in Health (CADTH) has released a report on the Clinical Effectiveness of Obesity Management Interventions Delivered in Primary Care for Patients with Osteoarthritis.

This systematic review of the literature leads to the following findings:

1) Dietary weight loss interventions, either alone or in combination with exercise produce greater reductions in the peak knee compressive force and plasma levels of interleukin-6 (IL-6) in knee OA patients compared with exercise-induced weight loss.

2) There is a significantly greater reduction in pain and improvements in functions in patients who received diet plus exercise interventions compared with either diet–only or exercise–only interventions.

3) Regardless of the type of weight-loss interventions, participants who lost 10% or more of baseline body weight had greater reductions in knee compressive force, systemic IL-6 concentrations, and pain, as well as gained greater improvement in function than those who lost less of their baseline weight.

4) Participants who lost the most weight also experienced greater loss of bone mass density at the femoral neck and hip, but not the spine, without a significant change of their baseline clinical classification with regards to osteoporosis or osteopenia.

Thus, in summary, weight loss, particularly when achieved through a combination of both diet and exercise can result in significant improvement in physical function, mobility, and pain scores in individuals with osteoarthritis.

Unfortunately, this is by no means easy to achieve and even harder to sustain.

Although I may sound like a broken record – we desperately need better treatments for obesity.

@DrSharma
Edmonton, AB

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Tuesday, November 25, 2014

Obesity Myth: Success Is Measured In Pounds Lost

sharma-obesity-5as-booklet-coverFinally, in this series of common misconceptions about obesity management, discussed in our article in Canadian Family Physician, we address the notion that success in obesity management is best measured in the amount of weight loss:

“Given the importance of obesity as a public health problem, there is widespread effort to encourage people with excess weight to attempt weight loss.

However, a growing body of evidence suggests that a focus on weight loss as an indicator of success is not only ineffective at producing thinner, healthier bodies, but could also be damaging, contributing to food and body preoccupation, repeated cycles of weight loss and regain, reduced self-esteem, eating disorders, and social weight stigmatization and discrimination. 

There is also concern that “anti-fat” talk in public health campaigns might further promote weight bias and discrimination. 

Therefore, it might be time to shift the focus away from body weight to health and wellness in public health interventions.

Recently, the Canadian Obesity Network launched a tool called the 5As of Obesity Management (www.obesitynetwork.ca/5As) to guide primary care practitioners in obesity counseling and management. 

Minimal intervention strategies such as the 5 As (ask, assess, advise, agree, and assist) can guide the process of counseling a patient about behaviour change and can be implemented in busy practice settings.

Obesity management should focus on promoting healthier behaviour rather than simply reducing numbers on the scale. The 5As of Obesity Management is a practical tool to improve the success of weight management within primary care.”

@DrSharma
Edmonton, AB

 

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Friday, November 14, 2014

Video: Principles of Obesity Management

Arya Sharma Kingston Nov 2014Over the past weeks, I have given a rather large number of talks on obesity management to a variety of health professionals. Now, there is a recording of one of my talks (which I gave a few days ago in Kingston, Ontario) on Youtube.

Although the quality of the recording is perhaps not the best and the talk is rather long (about 100 minutes), for those of you, who would like to have a better grasp of how I think about and approach obesity management, here is the link.

Feedback is very much appreciated.

@DrSharma
Edmonton, AB

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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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