If Oprah Can’t Why Do You Think You Can?
There are no doubt long-term “success stories” out there – people who just by making (often radical) changes in their diet and activity behaviours have lost a substantial amount of weight AND are keeping it off. However, there is also no doubt that these people are rare and far between – which is exactly what makes each one of them so exceptional. I am not speaking of all the people we hear or read about who have lost tons of weight – we hear about their spectacular weight loss – cutting carbs, cutting gluten, going vegan, going paleo, alternate day fasting, running marathons, training for iron man competitions, going on the Biggest Loser or eating at Subway. What we don’t hear about is the same people, when they put the weight back on – which, in real life is exactly what happens to the absolutely vast majority of “losers”. We hear of their “success” and then we never hear from them again – ever. Oprah is different! Different because, we have had the opportunity to follow her ups and downs over decades. When Oprah “succeeds” in losing weight, she does not disappear into the night – no – she puts the weight back right in front of our eyes, again and again and again and again. Now, comedy writer Caissie St.Onge, in a comment posted on facebook, pretty much summarizes what it is we can all learn (and should probably have learnt a long time ago) from Oprah: “Oprah is arguably the most accomplished, admired, able person in the world. She creates magic for other people and herself on the regular. So, if Oprah can’t do permanent lifelong weight loss, maybe it can’t be done. Oprah is also crazy rich. If Oprah can’t buy permanent lifelong weight loss, maybe it can’t be bought.” “I’m not saying you should give up on your dreams of having the body you want. I’m just asking, if you never get that waist, will your life have been a waste? (I see what I did there.) Every day we are bombarded with media, content and products. Special foods and drinks. Programs and plans. None of this shit has ever worked for Oprah and it probably isn’t gonna work for me or you.” “I know the reason isn’t because you’re weak. If you’re carrying around 10 or 20, or 50 or 150 pounds more than the tiny… Read More »
Should People With Obesity Who Are Metabolically Healthy Lose Weight?
Despite having once been on my high-school’s debating team, I generally do not like debates at scientific conferences (but many of my colleagues seem to love them). 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. @DrSharma Los Angeles
Sneak Peak at The Canadian Obesity Network’s Rebranding
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… Read More »
Obesity Staging in Berlin
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. @DrSharma Berlin, Germany
Risks Of Severe Obesity In Children And Young Adults
Yes, body fat is not a measure of health and it is possible to be healthy across a wide range of body weights. However, this may become harder and harder, the more weight you gain. 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. @DrSharma Edmonton, AB
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