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.
As a clinician often dealing with patients presenting with binge-eating disorder (BED), I am quite aware of the often pathological cognitive and emotional relationship to food, eating, and body image presented by patients with this syndrome.
Whether or not this impairment in thinking and feeling also extends to other behavioural or emotional domains is the topic of a systematic review by Kittel and colleagues from the University of Leipzig, published in the International Journal of Eating Disorders.
The paper is based on the review of almost 60 studies and shows that, individuals with BED consistently demonstrate higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues) – in contrast, cognitive functioning in the context of neutral stimuli appear to be less affected.
With regard to emotional functioning, individuals with BED also report greater emotional deficits when compared to obese and normal-weight controls.
Thus, these findings confirm the clinical observation that patients with BED tend to have specific difficulties in cognitive and emotional functioning when it comes to food, eating or body image, however, appear to function adequately in other domains.
For clinicians these finding are relevant as they show that while people with BED may benefit from help in changing their cognitive and emotional response to food cues, such problems are indeed more often encountered in people with BED rather than in everyone living with obesity.
Screening for BED should be an essential element of workup in anyone presenting with excess weight gain.
According to a study conducted by a team of researchers from the US, Canada, Australia and Iceland, published in Pediatric Obesity, weight-based bullying in children and youth is the most prevalent form of youth bullying in these countries, exceeding by a substantial margin other forms of bullying including race/ethnicity, sexual orientation or religion.
According to the almost 3000 participants in this study, parents, teachers and health professionals were seen as those with the greatest potential of reducing weight-based bullying.
In addition, the majority of participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying.
While these findings may not strike anyone living with obesity as surprising, they should be a reminder to the rest of us that weight-based bullying, with all of its negative consequences for mental, physical and social health, is something to be taken very seriously and needs to be opposed as much as we would oppose any other forms of bullying.
Of all of the common complications of obesity, fatty liver disease is perhaps the most insidious. Often starting without clinical symptoms and little more than a mild increase in liver enzymes, it can progress to inflammation, fibrosis, cirrhosis and ultimate liver failure. It can also markedly increase the risk for hepatocellular cancer even in patients who do not progress to cirrhosis.
Now, a paper by Mary Rinella from Northwestern University, Chicago, published in JAMA provides a comprehensive overview of what we know and do not know about early detection and management of this condition.
The findings are based on a review of 16 randomized clinical trials, 44 cohort or case-control studies, 6 population-based studies, and 7 meta-analyses.
Overall between 75 million and 100 million individuals in the US are estimated to have nonalcoholic fatty liver disease with 66% of individuals older than 50 years with diabetes or obesity having nonalcoholic steatohepatitis with advanced fibrosis.
Although the diagnosis and staging of fatty liver disease requires a liver biopsy, biomarkers (e.g. cytokeratin 18) may eventually help in the detection of advanced fibrosis.
In addition, non-invasive imaging techniques including vibration-controlled transient elastography, ultrasound with acoustic radiation force impulse or even magnetic resonance elastography are fairly accurate in the detection of hepatic fibrosis and are the most reliable modalities for the diagnosis of advanced fibrosis (cirrhosis or precirrhosis).
Currently, weight loss is the only proven treatment for fatty liver disease. Pharmacotherapy including treatment with vitamin E, pioglitazone, and obeticholic acid may also provide some benefit (none of these treatments currently are approved for this indication by the UD FDA). Futhermore, the potential benefits of existing and emerging anti-obesity treatments on the incidence and progression of fatty liver remains to be established.
As Rinella points out,
“It is important that primary care physicians, endocrinologists, and other specialists be aware of the scope and long-term effects of the disease.”
Clearly, screening for fatty liver disease needs to be part of every routine work up of individuals presenting with excess weight.
If you are planning to attend the 4th Canadian Obesity Summit in Toronto next week (and anyone else, who is interested), you can now download the program app on your mobile, tablet, laptop, desktop, eReader, or anywhere else – the app works on all major platforms and operating systems, even works offline.
You can access and download the app here.
(To watch a brief video on how to install this app on your device click here)
You can then create an individual profile (including photo) and a personalised day-by-day schedule.
Obviously, you can also search by speakers, topics, categories, and other criteria.
Hoping to see you at the Summit next week – have a great weekend!