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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Monday, November 24, 2014

Obesity Myth: Anyone Can Lose Weight

scaleHere is another common misconception about obesity discussed in our article in Canadian Family Physician:

“It is common to hear that weight loss is a matter of willpower and compliance with the weight-reducing program.

However, the magnitude of weight loss is very different among individuals with the same weight-loss intervention and prescription, and the same compliance to the program—one size does not fit all.

Thus, for some people (especially those who have already lost some weight), simply putting more effort into a weight-loss program will not always result in additional weight loss given the different compensatory adaptations to weight loss.

For example, the decrease in energy expenditure that occurs during weight loss is highly variable between people and might dampen efforts to lose additional body fat.

Such compensatory mechanisms might sometimes fully counteract the 500 kcal per day decrease recommended in most dietary interventions, making it very difficult for such “poor responders” to lose weight.

Physicians should remember that obesity is not a choice and weight-loss success is different for every patient.

Success can be defined as better quality of life, greater self-esteem, higher energy levels, improved overall health, or the prevention of further weight gain.”

@DrSharma
Edmonton, AB

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Friday, November 21, 2014

Obesity Myth: Exercise is the Best Way to Lose Weight

sharma-obesity-exercise2Here is what we had to say about the role of exercise in weight management in our recent article published in Canadian Family Physician:

There is now a consistent body of evidence showing that exercise alone, despite a range of health benefits associated with regular exercise, results in rather modest weight loss (less than 2 kg on average).

One of the explanations is that exercise is often accompanied by an increase in sedentary activities and appetite and a decrease in dietary restraint that counteract the increased energy expenditure of exercise.

However, increased exercise has been shown to reduce visceral adiposity (even with minimal changes in body weight).

Individuals who include regular exercise and active living as part of a weight-loss program are more likely to improve their overall health and keep the weight off.22 This latter finding might be attributable to the effect of regular exercise on caloric intake rather than on caloric expenditure per se.

Exercise alone generally promotes modest weight loss; however, individuals who exercise regularly might improve their overall health independent of weight loss and are more likely to keep their weight off.

@DrSharma
Wellington, NZ

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Wednesday, November 19, 2014

Obesity Myth: Dieting Is The Best Way To Control Your Weight

sharma-obesity-fat-dietingHere is what we had to say about the third common misconception in our paper published in Canadian Family Medicine:

Approximately two-thirds of people who lose weight will regain it within 1 year, and almost all of them will regain it within 5 years.

Although dieting (ie, caloric restriction) to lose weight is a difficult task, the maintenance of lost weight requires the patient to deploy even greater efforts.

Rather than a simple lack of willpower, the relapse of most individuals to their previous weight after otherwise successful weight loss is largely driven by the coordinated actions of metabolic, neuroendocrine, autonomic, and behavioural changes that oppose the maintenance of reduced body weight.

The few individuals successful at maintaining weight loss (at least 13.6 kg for at least 1 year) generally have common behaviour and strategies that include consuming low-energy, low-fat diets; engaging in high levels of physical activity; consistent self-monitoring of body weight and food intake; eating breakfast regularly; and demonstrating a high level of dietary restraint.

It is highly unlikely that some of this behaviour can be emulated by most of the population with excess weight.

There is also concern that unhealthy weight control methods (eg, fasting, meal skipping, laxatives, diuretics, stimulants) might ultimately lead to a larger weight regain and pose a risk to both mental and physical health.

Thus, although sustained weight loss with diet alone can be possible for some individuals, agreeing on realistic weight-loss expectations and sustainable behavioural changes is critical to avoid disappointment and nonadherence.

Weight regain (relapse) should not be framed as failure but as an expected consequence of dealing with a chronic and complex condition like obesity.

@DrSharma
Wellington, NZ

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Monday, November 17, 2014

Obesity Myth: Obesity Is Caused By Simply Eating Too Much And Not Moving Enough

sharma-obesity-caloric-balance1In the latest issue of Canadian Family Physician, my colleagues JP Chaput, Zach Ferraro,Denis Prud’homme and I briefly address common myths about obesity.

Here is what we had to say about the commonly held notion that obesity is just about eating too much and/or not moving enough:

“Unhealthy diet and physical inactivity are the “big 2” on which almost all preventive and therapeutic programs for obesity are focused, thereby neglecting other possible contributors to excess body weight. Although intuitively appealing, clear evidence (eg, individual-level epidemiologic data and randomized experiments) beyond ecological correlations is lacking for the big 2.

Many other putative contributors to the increase in obesity (eg, insufficient sleep, psychological stress, endocrine disruptors, medications, intrauterine and intergenerational effects, etc) have supportive evidence that is as compelling as, if not more compelling than, the evidence for the big 2.

These nontraditional or new determinants of obesity influence energy input and output; overeating and reduced energy expenditure are perceived as “symptoms” and not as the root causes of the excess weight.

On the treatment side, an accumulating body of evidence shows that insufficient sleep can impede weight loss and addressing sleep for weight management has recently been endorsed by the Canadian Obesity Network.

Overall, accumulating evidence suggests that health practitioners and clinicians might need to consider a broader range of influential factors (eg, medications, lack of time, psychological stress, fatigue, chronic pain) to adequately identify and address the key factors responsible for the patient’s obesity, which is likely a clinical sign of chronic caloric “retention” (similar to edema being a clinical sign of fluid “retention”). This will enable health practitioners and clinicians to develop a personalized framework that addresses the root causes of patients’ weight gain.

Physicians must move beyond the simplistic and generally ineffective recommendation to “eat less and move more” by investigating and addressing the determinants of increased energy intake, decreased metabolic rate, and reduced activity.”

@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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