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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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, October 10, 2014

PHEN/TPM ER Improves Glycemic Control in Type 2 Diabetes

qsymia-300x224The fixed combination of phentermine/topiramate extended release (PHEN/TMP ER), is marketed in the US as the anti-obesity drug Qsymia.

Now a paper by Timothy Garvey and colleagues, published in Diabetes Care, describes the weight-lowering and anti-diabetic effect of this drug combination in individuals with type 2 diabetes.

The investigators studied the effect of 56-week treatment in 130 participants randomised either to placebo or PHEN/TPM ER (15 mg/92 mg) once-daily with change in A1c levels as the primary endpoint. Both treatment groups also received lifestyle interventions to improve diet and physical activity.

The authors also present data on a secondary analysis of individuals with type 2 diabetes (n=388), who participated in the CONQUER trial.

At week 56 individuals on PHEN/TMP ER lost about 9.4% compared to a 2.7% on placebo. This reduction in body weight was associated with a 1.6% reduction in A1c levels on PHEN/TMP ER compared to a reduction of 1.2% in participants on placebo.

In addition, greater numbers of patients randomized to receive PHEN/TPM ER treatment achieved HbA1c targets with reduced need for diabetes medications when compared with the placebo group.

As expected from these drugs, the most common adverse events included paraesthesia, constipation, and insomnia.

As the authors conclude, PHEN/TPM ER plus lifestyle modification can effectively promote weight loss and improve glycemic control as a treatment approach in obese/overweight patients with type 2 diabetes.

PHEN-TMP ER is currently not approved for obesity management outside the US.

@DrSharma
Edmonton, AB

disclaimer: I have served as a paid consultant and speaker for Vivus, the maker of Qsymia.

ResearchBlogging.orgGarvey WT, Ryan DH, Bohannon NJ, Kushner RF, Rueger M, Dvorak RV, & Troupin B (2014). Weight-Loss Therapy in Type 2 Diabetes: Effects of Phentermine and Topiramate Extended-Release. Diabetes care PMID: 25249652

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Thursday, October 9, 2014

Are Smokers More Deserving of Treatment Than People Living With Obesity?

sharma-obesity-teen-smokingThis certainly appears to be the opinion of the majority of people living in Denmark, as reported in a study by Thomas Lund and colleagues published in the European Journal of Clinical Nutrition.

The study examined public support for publicly funded treatment of obesity (weight-loss surgery and medical treatment) and two pulmonary diseases strongly associated with smoking (chronic obstructive pulmonary disease (COPD) and lung cancer) in Denmark.

While a large majority supported treatment for lung cancer (86.1%) and COPD 71.2% (even when described as ‘smoker’s lung’ 61.9%), only one in three supported publicly funded weight-loss surgery (30%) and medical treatment of obesity (34.4%).

Not surprisingly, respondents beliefs about the causes of lifestyle-related diseases (external environment, genetic disposition and lack of willpower) and agreement that ‘people lack responsibility for their life and welfare’ influenced support for these treatments, especially in the case of treatments for obesity.

My guess is that these finding will not be significantly different in other countries that have publicly funded health care systems, including the UK or Canada, where treatments for cigarette-related lung and heart disease (as well as treatments for smoking cessation) are by far more accepted and accessible than treatments for obesity.

While I am all for treating and perhaps even further improving the care of people with smoking-related health problems, not having the same degree of concern or accessibility to treatments for obesity should be unacceptable.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLund TB, Nielsen ME, & Sandøe P (2014). In a class of their own: the Danish public considers obesity less deserving of treatment compared with smoking-related diseases. European journal of clinical nutrition PMID: 25248357

 

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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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