Friday, August 29, 2014

2014 Scopinaro Lecture

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

This morning, at the XIX World Congress of the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO2014), I have the great honour of presenting the 2014 Scopinaro Lecture.

This lecture is named after Nicola Scopinaro, who in 1976 performed the first biliopancreatic diversion for the treatment of obesity.

The Scopinaro Lecture is the highest recognition for a non-surgeon to be awarded by IFSO.

In thinking about what to present, I settled on discussing the topic of whether or not obesity is a disease. Looking back over the work that I have done over the past 25 years, I came to realise that the issue of why some people with excess weight develop health problems and others don’t, has indeed fascinated me for a long time.

Initially, this interest was focussed on trying to understand why some people with obesity develop high blood pressure and others don’t. We were indeed able to show that part of this may be explained by differences in the expression of hormones involved in blood pressure regulation from fat tissue.

More recently, as many regular readers are well aware, I have broadened this interest in describing the limitations of BMI and advocating for a clinical staging system that classifies overweight and obese individuals based on how “sick” they are rather than how “big” they are.

Clearly, this work is of considerable interest to those involved in bariatric care (including bariatric surgeons), as it provides a framework for better prioritizing and assessing risk/benefit ratios than BMI or other anthropometric measures alone.

As I point out in my talk,

- The etiology of obesity is complex and multifactorial.

- The physiology of energy regulation is complex and subverts volitional attempts at weight loss.

- Access to obesity prevention and treatments must be driven by the recognised medical needs to address this condition.

- Multidisciplinary management of this life-long disorder requires resources similar to those required for other chronic diseases

In receiving this honour, I am fully aware that all of my work stands on the shoulders of the many researchers and clinicians who came before me and the considerable support and help that I have been fortunate enough to receive from my many students, trainees, colleagues and supervisors.

This award will certainly serve an a strong incentive to continue my work and advocacy for better treatments for obesity and the advancement of bariatric care.

@DrSharma
Montreal, QC

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Abstract submission deadline: October 23, 2014
  • Notification of abstract review: January 8, 2014
  • Early registration deadline: March 5, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Wednesday, August 27, 2014

XIX World Congress on Obesity Surgery, Montreal

ifso14 logoFor the rest of this week I will be reporting from the XIX World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) here in Montreal, Canada.

Although I am not a surgeon, staying up to date on all aspects of bariatric surgery is essential for anyone working in the field of bariatric care – and advances there are.

But I am not just here to listen. This morning, together with my colleague Sean Wharton, I will be presenting a 4 hour masters course on obesity management for allied health professionals and later today, I will be presenting a talk on the use of the Edmonton Obesity Staging System as a better way to determine the risk and prognosis of bariatric patients.

I certainly look forward to an intense week of learning and networking in this wonderful city.

@DrSharma
Montreal, QC

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Thursday, August 21, 2014

The Grizzly Truth About Healthy Obesity

While we continue to debatgrizzly-bear_566_600x450e the incidence and physiology of healthy obesity (i.e. adiposity without any evident health problems), there are ample examples of adiposity in the animal kingdom, where the accumulation of vast amounts of fat tissue are entirely compatible with good health.

One of these fascinating example is the grizzly bear, which accumulates enough fat to last all winter without any apparent ill-effects on its health – indeed, the accumulation of fat to a level that would be considered “morbidly obese” in humans in vital to its survival.

Thus, not only is “healthy” obesity possible in mammals, it may also be an important area of study to better understand healthy obesity (or lack of it) in humans.

Insights into healthy obesity comes from a fascinating study by Lynne Nelson and colleagues from Washington State University, in a paper published in Cell Metabolism.

The researchers studied metabolism in four adult female grizzly bears, trained to “voluntarily” allow blood samples to be drawn for this study (for a video on how exactly this was done click here).

Their study shows that as grizzly bears accumulate fat in preparation for hibernation, they become exquisitely insulin sensitive, only to switch to a state of insulin resistance as they enter hibernation. This process reverses as they emerge from hibernation months later.

While the paper describes in detail the metabolic and hormonal pathways involved in this modulation of insulin sensitivity (via PTEN/AKT signaling in adipose tissue, it suggests that it is the ability to maintain insulin sensitivity in the face of increased adipose tissue that allows these animals to remain metabolically healthy.

As readers may recall, this is akin to the finding in humans that healthy obese individuals also display high levels of insulin sensitivity compared to metabolically unhealthy obese individuals, who display the more typical insulin resistance.

While much of this ability to maintain insulin sensitivity in a state of adiposity may be genetic (as in the rare case of humans with PTEN haploinsufficiency) other factors that enhance insulin sensitivity (e.g. regular aerobic exercise) may also help prevent or alleviate the metabolic consequences of excess fat.

Other factors may well include the actual location of the expanded fat depots, with peripheral accumulation of subcutaneous fat being far less likely to cause metabolic problems (and perhaps even protect against) than visceral or ectopic fat.

Now I guess, we need a study to see how well healthy obese humans do in hibernation.

@DrSharma
Edmonton, AB

Hat tip to Susan Jelinski for pointing me to this paper

ResearchBlogging.orgNelson OL, Jansen HT, Galbreath E, Morgenstern K, Gehring JL, Rigano KS, Lee J, Gong J, Shaywitz AJ, Vella CA, Robbins CT, & Corbit KC (2014). Grizzly Bears Exhibit Augmented Insulin Sensitivity while Obese Prior to a Reversible Insulin Resistance during Hibernation. Cell metabolism, 20 (2), 376-82 PMID: 25100064

 

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Monday, August 11, 2014

Open-Angle Keyboard Eases Typing Trauma for People Living With Obesity

goldtouch-ergonomic-keyboardThe ergonomics of standard QUERTY keyboards are bad enough for people of regular size – for larger people, the strain on the upper body is even worse resulting in significant upper-body muskuloskeletal discomfort and even injury.

Now a study by Matthew Smith and colleagues from the University of Georgia, published in Applied Ergonomics provides good evidence for the value of providing people with obesity ergonomically improved open-angle keyboards.

The researchers studied the use of these key boards in 22 office workers with overweight or obesity and found a significant decrease in lower back discomfort with no changes in overall typing performance.

The specific open-angle keyboards used in this study,

“…allows for up to 30° of angle in the keyboard as well as 30° of vertical inclination. The vertical inclination is referred to as a “tent” effect. These adjustments allow the user flexibility in the three-dimensional adjustment of the keyboard to allow for optimal hand placement while typing. These movement capabilities are intended to allow the users to make angular adjustments to the keyboard to minimize wrist supination and both radial and ulnar deviation, all of which are key factors in development of distal upper extremity musculoskeletal diseases.”

From this study the authors conclude that such relatively low-cost interventions can be introduced into the workforce to benefit workers without reducing short-term worker productivity.

@DrSharma
Edmonton, CA

ResearchBlogging.orgSmith ML, Pickens AW, Ahn S, Ory MG, DeJoy DM, Young K, Bishop G, & Congleton JJ (2014). Typing performance and body discomfort among overweight and obese office workers: A pilot study of keyboard modification. Applied ergonomics PMID: 25082778

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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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