Wednesday, November 12, 2014

5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

@DrSharma
Ottawa, ON

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Friday, October 31, 2014

German TV Looks At Healthy Obesity

Arya Sharma on bike 3SATRegular readers will be familiar with the fact that not all people with excess weight necessarily have health problems. Now, the 3SAT television channel, which broadcasts in Germany, Austria and Switzerland has produced a 45 minute documentary on the science behind these findings.

Although the film is in German, I thought I would post the link anyway as many of my readers may well be able to grasp the story even if they are not entirely fluent.

To watch the documentary on line click here.

Incidentally, I am featured about 2.5 minutes into the film, discussing the Edmonton Obesity Staging System and related issues.

Appreciate all comments.

@DrSharma
Toronto, ON

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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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Thursday, October 23, 2014

Guest Post: My Weight Is Not Measured In Pounds

Fitness Header ColorToday’s guest post comes from Andrea Matthes, a Certified Personal Trainer and blogger, who I met at the annual meeting of the Obesity Action Coalition in Orlando – the post speaks for itself.

I recently attended the Obesity Action Coalition’s annual Your Weight Matters Convention and got the opportunity to hear Dr. Sharma’s keynote presentation titled, “Health is Not Measured in Pounds.” I found myself sitting in my chair, agreeing so emphatically that I was full-body nodding at the waist. By the end of his speech, I couldn’t contain myself– I jumped out of my chair making the first, very loud clap that echoed through the room, only to be followed by hundreds of other claps and a full-house standing ovation. Dr. Sharma’s message was something I needed to hear. Not because it was a new theory to me, but because up until that hour, his theory was what I was experiencing first-hand.

I am 5 feet, one inch tall and weigh 165lbs (when slightly dehydrated). At my current height/weight my BMI is 31.2, also known as: OBESE. A word that is often associated with laziness, overeating, diabetes, high blood pressure, bad cholesterol and overall ill health. According to this number, I need to lose at least 35lbs if I want to reach the “normal” range in order to be considered “healthy”.

Can I just tell you how frustrating that is?

I am living an exceptionally healthy, full and active lifestyle. My blood pressure is perfect, my cholesterol levels are great, and my A1C is consistently normal. My daily life consists of running, jumping, lifting heavy objects, and eating a diet that most people would consider ideal. I am extremely proud of the lifestyle I live. I am able to climb mountains, run races, surf, ski, and flip a perfectly executed cartwheel at the drop of a hat. Yet, I am told that in order to be healthy, I need to lose weight!

How ridiculous is that?

It’s extremely ridiculous and unfair that I have to live with a label that is based on a fancy formula for size; a label that says I need to lose weight in order to avoid potential misdiagnoses, higher insurance premiums, and social stigma. It’s unfair that my TRUE health has very little to do with pounds and everything to do with how I live my life. This is what my obesity looks like:

I am a running, swimming, cycling, heavy-lifting, nutrient-eating, LIFE-LOVING, 5-foot-one-inch-tall, 37-year-old woman who also weighs 165lbs which leaves me with a label that misrepresents the life I live and my health!

I may be obese according to BMI but that does not mean I am unhealthy.

My obese body is strong, it is capable, it is HEALTHY. In fact, my obese body is healthy enough to do things that many skinny people can’t do. So weigh me all you want, but please, do not measure my HEALTH in pounds.

ABOUT ANDREA

Andrea has lost 164 pounds with a jumpstart from gastric bypass surgery followed by a complete lifestyle overhaul. She is now a Certified Personal Trainer, Level One CrossFit Coach and has completed over 25 races since March of 2013. Andrea blogs about her REAL FOOD, REAL FITNESS, REAL LIFE approach at www.imperfectlife.net where she strives to inspire others to let go of perfection and learn to love their one and only I’mperfect Life.

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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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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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