Wednesday, July 23, 2014

In Memorium: Albert (Mickey) J Stunkard

Stunkard twinsAs I spend my days at the 9th Canadian Obesity Network’s Summer Bootcamp for young trainees from Canada and around the world, I was saddened to learn of the passing of Mickey Stunkard, clearly one of the biggest names in obesity research – at a healthy age of 92.

With well over 500 publications to his name, Mickey is perhaps best known for his twin studies showing that the body weight of adopted identical twins reared apart resembles each other and that of their biological parents rather than the weight of their adoptive parents.

This work helped establish the basis for much of the genetic work on obesity that followed, clearly showing that differences in body weight between two individuals are much more accounted for by their difference in genetics than by differences in their “lifestyles”.

These findings were often misused in “nature vs. nurture” debates, an issue that serious scientists have long laid to rest in light of our current understanding that the two cannot be discussed separately, simply because genes and lifestyle interact on virtually every level – from molecules, to cells, to behaviours.

Here is what one obituary had to say about Mickey:

“He surveyed obesity treatment studies in the late ’50s and found that the nation’s diet programs could claim only a 2 percent success rate. He was an early advocate for the use of bariatric surgery to induce weight loss. He also published the first modern account of binge eating in obese individuals.”

I have had to pleasure to often hear him speak at conferences.

He will be dearly remembered.

@DrSharma
Kananaskis, AB

 

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Friday, July 18, 2014

Birth Control And Obesity

sharma-obesity-birth-control-pillAlthough obesity is a well-recognised factor for female infertility, the vast majority of women with excess weight are probably more interested in effective birth control.

That this is not as simple as it seems is evident from an article by Sheila Mody and Michelle Han from the University of California, San Diego, published in Clinical Obstetrics and Gynecaology.

The paper succinctly reviews a wide range of issues related to birth control and obesity.

To begin with, the authors points out that unintended pregnancies in obese women are often a problem simply because obese women are far less likely to use effective contraception than non-obese women. This non-use may in part be attributable to fear of weight gain, when most studies show that modern hormonal contraception is associated with almost no weight gain. The exception appears to be depot-medroxyprogesterone (DMPA), which may cause about 5 lb weight gain in the first year of use.

As for efficacy, the data show that unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among nonoverweight women. The reasons for these higher rates are not exactly clear.

Fortunately, the efficacy of intrauterine devices (IUD) appear no different between obese and non-obese women although the insertion of an IUD maybe more difficult in obese women because of poor visualization of the cervix and limited assessment of uterine position (a problem that can often be solved with the help of an ultrasound).

The paper also discusses the suitability of the vaginal vaginal contraceptive ring, which has been hypothesized to offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first- pass liver metabolism.

Finally, the paper discusses issues around contraception for women who have undergone bariatric surgery (who have a particularly high rate of unintended pregnancies) as well as best practices for emergency contraception.

This is clearly information that all clinicians who counsel obese women should be aware of.

@DrSharma
Edmonton, AB

ResearchBlogging.orgMody SK, & Han M (2014). Obesity and Contraception. Clinical obstetrics and gynecology PMID: 25029338

 

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Tuesday, July 15, 2014

The Molecular Biology of Food And Mood

sharma-obesity-brainThe neuroendocrine systems that control ingestive behaviour are intimately linked to the parts of the brain that control mood.

Thus, it is increasingly evident that factors that affect energy homeostasis (diet and exercise) can have profound effects on mood while changes in mood can have significant effects on appetite and energy homeostasis.

But this relationship is far from straightforward – rather, it appears to be rather complex.

Readers interested in an overview of how these two systems interact in the brain may find a recent review by Chen Liu from the University of Texas Southwestern Medical Center, Dallas, published in Cell Metabolism of interest.

The authors review our current understanding of how mood and food are linked with particular attention to appetite, ingestive behaviour and energy homeostasis.

The article also touches on the effects of pharmacological and surgical treatments for obesity on mood.

Clearly clinicians need to be aware of the close links between these systems and draw on our current understanding of both in their counselling of patients presenting with weight gain and/or depression.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLiu C, Lee S, & Elmquist JK (2014). Circuits Controlling Energy Balance and Mood: Inherently Intertwined or Just Complicated Intersections? Cell metabolism, 19 (6), 902-909 PMID: 24630814

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Monday, July 14, 2014

How To Prevent Gallstones During Weight Loss

GallstonesOne of the best recognised complications of weight loss – especially if this occurs too rapidly – are the development of gallstones, which can result in acute symptoms and often require surgery.

Now Caroline Stokes and colleagues from the Saarland University Medical Center, Homburg, Germany, publish a systematic review of strategies to prevent weight-loss associate gallbladder stones in Clinical Gastroenterology and Hepatology.

Their analysis includes 13 randomised-controlled trials, comprising 1836 participants undergoing weight loss through dieting (8 trials) or bariatric surgery (5 trials).

Ursodeoxycholic acid (UDCA) reduced the risk of ultrasound-verified gallstones compared with control interventions with a risk ratio of 0.33 and a number-needed-to-treat (NNT) of only 9.

They also found a significant risk reduction with high-fat weight loss diets (risk ration 0.09).

No adverse effects were noted for either intervention.

Thus, it is evident that UDCA and/or higher dietary fat content prevent the formation of gallstones during weight loss and these treatments should likely be initiated particularly in patients, who are undergoing rapid weight loss (particularly those at high risk of gallbladder stones).

@DrSharma
Edmonton, AB

ResearchBlogging.orgStokes CS, Gluud LL, Casper M, & Lammert F (2014). Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 12 (7), 1090-110000 PMID: 24321208

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Thursday, June 26, 2014

Guidelines for Managing Overweight and Obesity in Adults

the obesity societyRegular readers may recall a previous post on guidelines on obesity management released by The Obesity Society (TOS) together with other organisations, including the American Heart Association and the American College of Cardiology, at Obesity Week in Atlanta last year (2013).

The bottom line, as I have blogged before, was the revelation of just how little we actually know about obesity.

For what it is worth, the complete guidelines are now published as a supplement to its July issue of the Obesity journal (Guidelines (2013) for Managing Overweight and Obesity in Adults: Full Report).

According to The Obesity Society’s press release,

TOS is investing in the improved treatment of obesity by making the full guidelines available in print so they can serve as a go-to resource for health practitioners around the world. Whether you are a physician, nurse, nutritionist or fitness trainer, every professional interacting with individuals with obesity can find value in this insightful treatment guide.

No doubt, a tremendous amount of work went into developing these guidelines – whether they will substantially change practice remains to be seen.

@DrSharma
Vancouver, BC

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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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