This is largely, because to win a debate you need to take a biased and one-sided view of the topic and speak with conviction – at least if the intention is to sway the audience.
The problem is that presenting a radical stand-point convincingly may lead the audience to believe that this is your actual position on the matter (rather than simply a role assigned to you by the organizer).
To not fall into that trap, these debates often end up with the debaters agreeing more than disagreeing.
Case in point a debate at Obesity Week, on whether or not people with obesity who are metabolically healthy should be advised to lose weight.
The pro side was represented by Mark Hamer, who essentially made the argument that truly metabolically healthy obesity (MHO) is a rather rare phenotype and will in most cases (sooner or later) progress to unhealthy obesity (UHO), so that differentiating between the two both in clinical practice and in public health recommendations to lose weight is neither practical nor necessary.
On the con side, Sam Klein argued that on the one hand, MHO individuals appear far more resistant to developing metabolic risk factors (even with weight gain) and that weight-loss always comes with a cost and that interventions should therefore be focussed on people who stand to benefit the most, i.e. people who already have metabolic problems.
Klein also pointed out that we not be tempted to treat “hyperBMIemia” – but take the actual health of the patient into account.
In the end, as expected, the debaters came to agree on the fact that everyone could stand to benefit from improving their “lifestyles”, particularly their activity levels (which really wan’t the question that was being debated).
If nothing else, the debate revealed the ongoing conflict between population messages (every one should strive for a “healthy” weight – whatever that is) and clinical decision making, where recommendations need to be personalized to the actual risk of the individual.
Recent visitors to the Canadian Obesity Network website may have noted a few changes.
For one, a new logo has replaced the time-worn “maple leaf + measuring tape“. This is in response to strong feelings among both the board and membership that the old logo, with its measuring tape no longer represents one of CON’s key messages, namely that health is not a number on a scale or measuring tape, and that there is no consensus as to what a healthy weight is and how it would be determined for any given individual.
This is particularly a sensitive issue and a mixed message when it comes to public engagement, which brings me to the second major change on the website – a section for the general public.
Until now, despite amassing an impressive membership that is fast approach 12,000, membership and information on the CON website was targeted and reserved to people with a professional interest in obesity – researchers, health professionals, decision makers, trainees, and a range of other stakeholders.
But the most important stakeholder of all – people living obesity – were excluded – both from membership and content.
Since last week, anyone with an interest in obesity can find general information on obesity on the CON website and anyone can subscribe to a soon to be launched regular newsletter for the public, which will feature the latest in obesity research and obesity relevant resources around the country – both in prevention and management.
Currently, the website is still under construction and at this time most of the information focusses on one of CON’s main goals – to reduce obesity stigma and weight-based discrimination.
Stay tuned for sections on prevention, public health, children and youth, pregnancy and a growing catalogue of evidence-based resources for obesity prevention and management.
While you will hardly find the usual “recipes and exercise tips” that are often featured on obesity related website, you will be sure to find a growing body of obesity knowledge that informs about the prevention and management of this chronic disease.
I hope you will agree that the new logo’s sleek icon is reflective of the network’s Canadian focus, with the bottom two segments suggestive of two supportive hands, perhaps representing the many professional members of CON working to find bette ways to prevent and manage obesity. The white dot focal point on the leaf icon can perhaps be interpreted as the head of a person with uplifted arms (i.e. the white space between the three leaf sections), an expression of hope and aspirations.
To subscribe to the forthcoming public newsletter click here
To follow CON on its new Facebook page click here
To join CON as someone with a professional interest click here
This morning, I presented a keynote address at the 31st Scientific Meeting of the Deutsche Adipositas Gesellschaft (German Obesity Society) on the issue of risk stratification beyond BMI.
As regular readers will be well aware, I have long stated that our current definition of obesity based on BMI is problematic when applied to individuals presenting with excess weight.
We have therefore proposed the use of the Edmonton Obesity Staging System as a simple clinical tool for risk stratification that can guide clinical decision making.
Judging by the response from the audience, this concept met overwhelming approval, especially from the clinicians in the audience.
If, how, and when this concept will find its way into German obesity management guidelines remains to be seen.
Thus, a study by Asheley Skinner and colleagues, published in the New England Journal of Medicine, shows that increased cardiometabolic risk is tightly linked with severe obesity both in children and young adults.
The study looks at cross-sectional data from overweight or obese children and young adults (3-19 yrs) who were included in the US National Health and Nutrition Examination Survey (NHANES) from 1999 through 2012.
Among 8579 children and young adults with a body-mass index at the 85th percentile or higher (according to the Centers for Disease Control and Prevention growth charts), 46.9% were overweight, 36.4% had class I obesity, 11.9% had class II obesity, and 4.8% had class III obesity.
Overall, for a given weight, males tended to have higher cardiometabolic risk than females.
Even after controlling for age, race or ethnic group, more severe obesity maps more likely to be associated with low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglyceride and glycated hemoglobin levels.
Importantly, while this relationship was constantly present in males, the there were fewer significant differences in these variables according to weight category among female participants, suggesting that for a given body weight, girls were less likely to be at cardiometabolic risk compared to boys.
Thus, while body weight (or body fat) may not be a precise measure of individual health, the risk for having one or more cardiometabolic risk factor increases substantially with increasing severity of obesity.
However, it is also important to note that even in kids and youth with class III obesity, 70% of participants had normal lipids and about 90% of participants did not have elevated blood pressure or glycated hemoglobin.
This points to the fact that for a given body weight there is indeed wide variability in whether or not someone actually has cardiometabolic risk factors.
Thus, whether or not it makes sense to target every kid that presents with an elevated BMI for intervention, remains to be shown – most likely such an approach would probably not be cost-effective.
As in adults, it seems that interventions in kids are probably best targeted by global risk rather than simply by numbers on a scale.
Earlier this year I participated in a two-day workshop on weight bias hosted by researchers at the University of Calgary. The over 40 participants included researchers, clinicians, health administrators and a number of other stakeholders, who discussed all aspects of weight bias and discrimination.
A particular focus of the workshop, supported by the Canadian Institutes of Health Research (INMD) and co-hosted by the Canadian Obesity Network was to explore a research agenda towards finding effective ways to reduce weight bias and its negative consequences for the health and well-being of those living with obesity.