Tuesday, October 28, 2014

Should A Political Prescription For Obesity Not Also Include Better Treatments?

sharma-obesity-policy1In the latest issue of the Canadian Medical Association Journal, the editors opine on the need for a political prescription for obesity – in short taxation and regulation of  high-calorie and nutrient-poor food products as the only viable approach to the obesity epidemic. As may be expected, they use the analogy of tobacco as a justification for this approach (given that actual data from government intervention on reducing the consumption of the said foods is so far lacking).

Be that as it may, what caught my attention in the article was the following passage:

“Treating obesity does not work well; preventing it would be better. The global failure to manage obesity, now considered by the American Medical Association to be a disease, may be considered a failure of the evidence-based medicine approach to treating disease….We know that most restrictive diets result in only short-term weight loss that frequently reverses and worsens in the long term, but dietary changes that are sustainable as a lifestyle choice may work. Physical activity is not enough to prevent or treat obesity and overweight, unless it is combined with some kind of dietary intervention. Family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy. Bariatric surgery has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort. Pharmaceutical agents may work to some extent, but may have nasty adverse effects.”

The interesting thought here is that the authors parade the lack of effective treatment as a justification for prevention, when I would rather have used this state of affairs to call for greater investments in finding better treatments.

Not that I am not in favour of prevention – indeed, I am all for preventing heart disease, diabetes, cancer, depression, bone and joint disease and everything else.

But, at no point would I ever call for prevention as an alternative to finding better treatments for any of these conditions.

The fact that people still die of cancer should never justify us abandoning the search for better treatments – indeed, as far I can see, the whole Pink Ribbon Industry apparently focusses on “finding the cure” – not on “finding better ways to prevent breast cancer” (even if most experts believe that much of breast cancer is indeed preventable).

Just because  we still have no effective treatments for a host of other conditions, should we abandon the search for better treatments for these conditions?

In short, what irks me most about this article is not the call for prevention – indeed I am all for it!

But when the lack of effective (or safe) treatments is used to justify this call, I must disagree.

No matter how much we restrict and tax the food industry, there will always be people around, who despite their best efforts, will struggle with excess weight. Indeed, there is no reason to believe (at least not for anyone who understands the physiology of obesity) that any form of “prevention” will reverse the epidemic in those who already have the problem – i.e. in about 6 Mill Canadians. (even if we somehow miraculously reduced obesity in the population by 30% through “preventive measures” (well beyond even the most optimistic predictions) – we would still need treatments for 4 Mill Canadians – adults and kids!)

The longer we wait to find and implement effective treatments, the longer these individuals will struggle with a condition that should deserve the same efforts at treatment as we afford individuals with other “lifestyle” diseases (including heart disease, diabetes and cancer).

Let us not forget that treatments for other common conditions (e.g. hypertension, hypercholesterolemia and diabetes) were once lacking – today millions around the world benefit from these treatments – indeed, it is probably safe to say that these medications probably save more lives each year than any known efforts at regulating industry that I know of.

Indeed, if we wish to find more effective ways to manage obesity, we need to vastly increase our efforts at finding better treatments – not abandon them.

Prevention is never an alternative to also having effective treatments. The two go hand-in-hand.

@DrSharma
Edmonton, AB

 

 

 

 

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Friday, October 24, 2014

Social Network Analysis of the Obesity Research Boot Camp

bootcamp_pin_finalRegular readers may recall that for the past nine years, I have had the privilege and pleasure of serving as faculty of the Canadian Obesity Network’s annual Obesity Research Summer Bootcamp.

The camp is open to a select group of graduate and post-graduate trainees from a wide range of disciplines with an interest in obesity research. Over nine days, the trainees are mentored and have a chance to learn about obesity research in areas ranging from basic science to epidemiology and childhood obesity to health policy.

Now, a formal network analysis of bootcamp attendees, published by Jenny Godley and colleagues in the Journal of Interdisciplinary Healthcare, documents the substantial impact that this camp has on the careers of the trainees.

As the analysis of trainees who attended this camp over its first 5 years of operation (2006-2010) shows, camp attendance had a profound positive impact on their career development, particularly in terms of establishing contacts and professional relationships.

Thus, both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in obesity researcher (and possibly beyond).

Personally, participation at this camp has been one of the most rewarding experiences of my career and I look forward to continuing this annual exercise for years to come.

To apply for the 2015 Bootcamp, which is also open to international trainees – click here.

@DrSharma
Toronto, ON

ResearchBlogging.orgGodley J, Glenn NM, Sharma AM, & Spence JC (2014). Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. Journal of multidisciplinary healthcare, 7, 459-70 PMID: 25336965

 

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Thursday, October 23, 2014

Guest Post: My Weight Is Not Measured In Pounds

Fitness Header ColorToday’s guest post comes from Andrea Matthes, a Certified Personal Trainer and blogger, who I met at the annual meeting of the Obesity Action Coalition in Orlando – the post speaks for itself.

I recently attended the Obesity Action Coalition’s annual Your Weight Matters Convention and got the opportunity to hear Dr. Sharma’s keynote presentation titled, “Health is Not Measured in Pounds.” I found myself sitting in my chair, agreeing so emphatically that I was full-body nodding at the waist. By the end of his speech, I couldn’t contain myself– I jumped out of my chair making the first, very loud clap that echoed through the room, only to be followed by hundreds of other claps and a full-house standing ovation. Dr. Sharma’s message was something I needed to hear. Not because it was a new theory to me, but because up until that hour, his theory was what I was experiencing first-hand.

I am 5 feet, one inch tall and weigh 165lbs (when slightly dehydrated). At my current height/weight my BMI is 31.2, also known as: OBESE. A word that is often associated with laziness, overeating, diabetes, high blood pressure, bad cholesterol and overall ill health. According to this number, I need to lose at least 35lbs if I want to reach the “normal” range in order to be considered “healthy”.

Can I just tell you how frustrating that is?

I am living an exceptionally healthy, full and active lifestyle. My blood pressure is perfect, my cholesterol levels are great, and my A1C is consistently normal. My daily life consists of running, jumping, lifting heavy objects, and eating a diet that most people would consider ideal. I am extremely proud of the lifestyle I live. I am able to climb mountains, run races, surf, ski, and flip a perfectly executed cartwheel at the drop of a hat. Yet, I am told that in order to be healthy, I need to lose weight!

How ridiculous is that?

It’s extremely ridiculous and unfair that I have to live with a label that is based on a fancy formula for size; a label that says I need to lose weight in order to avoid potential misdiagnoses, higher insurance premiums, and social stigma. It’s unfair that my TRUE health has very little to do with pounds and everything to do with how I live my life. This is what my obesity looks like:

I am a running, swimming, cycling, heavy-lifting, nutrient-eating, LIFE-LOVING, 5-foot-one-inch-tall, 37-year-old woman who also weighs 165lbs which leaves me with a label that misrepresents the life I live and my health!

I may be obese according to BMI but that does not mean I am unhealthy.

My obese body is strong, it is capable, it is HEALTHY. In fact, my obese body is healthy enough to do things that many skinny people can’t do. So weigh me all you want, but please, do not measure my HEALTH in pounds.

ABOUT ANDREA

Andrea has lost 164 pounds with a jumpstart from gastric bypass surgery followed by a complete lifestyle overhaul. She is now a Certified Personal Trainer, Level One CrossFit Coach and has completed over 25 races since March of 2013. Andrea blogs about her REAL FOOD, REAL FITNESS, REAL LIFE approach at www.imperfectlife.net where she strives to inspire others to let go of perfection and learn to love their one and only I’mperfect Life.

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Wednesday, October 22, 2014

There Is Not One Obesity

sharma-obesity-apple-varietiesRegular readers may recall my previous attempts at finding an etiological framework for defining obesity subtypes.

This idea is by no means new.

In my continuing search for historical but timely papers, I found this article by the late Mickey Stunkard, published in the Psychiatric Quarterly back in 1959!

Here is what Stunkard had to say about the need to differentiate different types of obesity:

“In the ambition to explain all instances of obesity, it has frequently been assumed, albeit implicitly, that obesity is a single disease with a single etiology. In the sense that the production of obesity requires at least a temporary disorder in the regulation of energy balance, obese persons do have something in common. But any physiological regulation is apt to require a complex piece of apparatus, and one as precise and vital as that controlling energy balance must contain a good many parts which could go awry. There seems to be no reason to assign all the possible disorders of all the possible parts to a single etiological agent.”

“Such considerations have persuaded investigators in several fields of research to consider obesity to be a symptom of multiple etiology… For’ if one did not feel obliged to find common features in every case of obesity, but could restrict one’s efforts to members of subgroups of obese persons, it should increase the likelihood of discovering common and distinctive psychological features…if there are indeed different types of obesity, it would be preferable to select samples by criteria which might be more closely related to differences in etiology.”

Unfortunately, over 50 years after this paper was published, we are still doing obesity research with BMI as the sole “defining variable” of this phenotype.

Imagine if we were to do studies in cancer research, where we included participants with any kind of cancer.

Or infectious disease research, in which we included participants with any kind of fever.

Or cadiac research, in anyone with heart disease.

You get the idea.

@DrSharma
Edmonton, AB

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Wednesday, October 15, 2014

Disease Severity and Staging of Obesity

sharma-edmonton-obesity-staging-systemRegular readers will be well aware of our work on the Edmonton Obesity Staging System (EOSS), that classifies individuals living with obesity based on how “sick” rather than how “big” they are.

For a rather comprehensive review article on the issue of determining the severity of obesity and potentially using this as a guide to treatment, readers may wish to refer to a paper by Whyte and colleagues from the University of Surrey, UK, published in Current Atherosclerosis Reports.

This paper not only nicely summarizes the potential effects of obesity on various organs and organ systems but also discusses the use of staging systems (EOSS and Kings) as a way to better characterize the impact of excess weight on an individual.

As the authors note in their summary,

Using a holistic tool in addition to BMI allows highly informed decision-making and on a societal level helps to identify those most likely to gain and where economic benefit would be maximised.”

Not surprisingly, the Edmonton Obesity Staging System, which has been validated against large data sets as a far better predictor of mortality than BMI, waist circumference or metabolic syndrome, is being increasingly adopted as a practical tool to guide clinical practice.

@DrSharma
Merida, Mexico

ResearchBlogging.orgWhyte MB, Velusamy S, & Aylwin SJ (2014). Disease severity and staging of obesity: a rational approach to patient selection. Current atherosclerosis reports, 16 (11) PMID: 25278281

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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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