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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Friday, September 19, 2014

Does Mandatory Weight Loss Before Surgery Harm Patients?

weight scale helpMany surgical clinics require “mandatory” weight loss before approving patients for surgery, a requirement for which there is very little evidence that it influences post-surgical outcomes (despite the rather firm belief of many that it does).

While one may perhaps accept the need for pre-surgical weight loss when the primary objective is to make the surgery easier for the surgeon and safer for the patient, of greater concern is the practice in many centres that require “mandatory” weight loss based on the notion that patients need to demonstrate their “suitability” for surgery by achieving an arbitrary amount of weight loss in order to “qualify” and prove themselves “fit” for surgery.

That this latter requirement is not without actual risk for the patient and can lead to significant frustration and disruption of the patient-provider relationship is described in a phenomological study by Nicole Glenn and colleagues, published in Qualitative Health Research.

The study is based on in-depth interviews with seven candidates considering bariatric surgery and describes their lived experience and views about what the requirement to lose weight in oder to obtain surgery meant for them.

The article begins with a touching account of one patient:

“The surgeon says, “We need you to get your weight down a little more before we can approve you for surgery.” I fight back the tears as I drive home. Then I think, “I have to do this. I need this surgery.” I work my ass off; I eat nothing but salad for three weeks while I prepare real food for the rest of my family. I go to the gym late at night and settle for five hours sleep because there is no other time in my day with two small children to care for and a husband who works long hours. I struggle, but I’ll do whatever I have to. I come back for my next visit with the surgeon, and I’ve lost more than he had asked me to, yet he doesn’t even notice. He doesn’t comment on my weight at all! He says, “You’ll hear from my office with a surgical date.” That’s it?”

The paper focusses on four themes that emerge from the narratives.

1. Nod your head and carry on:

“[I know a few people who’ve had the surgery, and they all tell me that same thing—just do what you are told! I ran into a friend who had the surgery and was telling him about my frustrations. He said, “If the clinic staff want you to lose five pounds then you need to get the five pounds off and don’t put your personal opinion in there. Just nod your head and carry on.”]“

This behaviour, while understandable, can have unintended consequences for the patient-client relationship:

“To become perfect, to appear to be the ideal patient, a person might find it necessary to act the part. Is it possible to show who one really is when it is the ideal patient who needs to be seen? A person who waits to have bariatric surgery, who feels the need to prove him- or herself to access the surgery, might also find it necessary to hide or become secretive, to leave things out of the food journal or the stories told.”

“Imagine if one awaiting a hip replacement, for example, was first obligated to walk without pain? Why then would one be required to lose weight before weight loss surgery—to do the very thing the surgery provides? To get help, a person must reveal her struggle to the nurse, to name it, and in so doing to show herself as a failure. Such a person finds that she has no other choice. Alone, she cannot lose the weight, and without weight loss, the surgery will not happen. Nevertheless, in revealing this struggle, she risks losing the very thing she hopes to gain.”

2. Waiting and Weighing: Promoting Weight Consciousness to the Weight Conscious:

This section deals with the negative impact that this practice has by reinforcing focus and obsession with numbers on the scale when the real focus should be on health behaviours.

3. Paying For Surgical Approval Through Weight Loss:

“[I feel as if the surgery is being held for ransom, and if I don’t behave perfectly, I won’t get a chance. I mean, I see them obsessing over my charts and journal. No one even tries talking to me. The nurse and psychologist tell me, “No black or white thinking,” but here they are practicing exactly that!]“

“The irony of the perfect behavior required to lose weight and ultimately access weight-loss surgery amid suggestions to reject black and white thinking is not lost on the woman who waits. She should resist the urge to see the world as all or nothing, either this or that, and instead accept the complexities of the grey that exists in the world between black and white, yet she knows that she either loses weight or she loses surgery. It is black or white.”

4. Presurgical Weight Loss and Questioning the Need for Weight-Loss Surgery Altogether:

This section addresses the issue that patients, who do manage to lose substantial weight before surgery, may be faced with having to reconsider the need for surgery altogether thereby increasing internal conflict and enhancing uncertainty as to whether they have made the right decision to have surgery in the first place.

This is clearly a paper that all practitioners in bariatric clinics should read and be aware of.

As the authors point out, given the lack of good evidence that presurgical weight loss has any relevant impact on surgical or post-surgical outcomes, it may be high time to reconsider this potentially harmful practice.

@DrSharma
Edmonton, AB

ResearchBlogging.orgGlenn NM, Raine KD, & Spence JC (2014). Mandatory Weight Loss During the Wait For Bariatric Surgery. Qualitative health research PMID: 25185162

 

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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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