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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Monday, October 6, 2014

Obesity Tip Sheet For Occupational Therapists

OT obesity tip sheet AHS Oct 2014

October is Occupational Therapist Month, an event celebrated by the Canadian Association of Occupational Therapists in a nation-wide campaign involving billboards and bumper stickers.

Reason enough to turn my readers attention to a “tip sheet” developed by members of the Alberta Health Services’ Bariatric Resource Team that explains when to refer their patients with obesity to an occupational therapist.

The preamble to this sheet notes that,

“Occupational therapists promote health and well being for people with obesity by facilitating engagement in occupations of everyday life, including addressing occupational performance issues in the areas of self-care, productivity and leisure. This can impact quality of life, including how people with obesity participate in their daily lives and in health and weight management activities.”

Occupational therapy referral may be indicated for a person with obesity presenting with challenges ranging from occupational engagement to completing simple activities of daily living.

To download this OT referral tip sheet click here.

Happy OT month!

@DrSharma
Hamilton, ON

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Friday, October 3, 2014

Obesity 5As At The Armed Forces

sharma-obesity-canadian-forcesThis morning I am presenting a workshop on the Canadian Obesity Network’s 5As of Obesity Management to members of the Canadian Armed Forces here in Ottawa.

As I discussed in a previous post, members of the Armed Forces are not immune to weight-gain – if anything, the considerable stressors encountered by military personnel make them perhaps even more prone to weight gain than civilians.

And, as for civilians, there are no easy solutions. Once the weight is on, military personnel face the same challenges in losing weight and keeping it off (if indeed their excess weight is affecting their health) as everybody else.

I look forward to an exciting discussion with the medical personnel on base about how best to apply the 5As of Obesity Management in their practice.

@DrSharma
Ottawa, ON

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Monday, September 29, 2014

Does Lean Tissue Have More To Say About Your Health Than Your Body Fat?

Carla Prado, PhD,  Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

Carla Prado, PhD, Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

The common assumption is that people with more body fat are at greater risk for illness and overall mortality.

Surprisingly, an increasingly robust body of evidence now suggests that how much lean tissue you have may be far more important for your health than the amount of body fat.

This evidence as well as the methodologies used to study lean body mass are discusses in a paper by Carla Prado (University of Alberta) and Steve Heymsfield (Pennington Biomedical Research Center), in a paper published in the Journal of Parenteral and Enteral Nutrition.

As the authors point out,

“The emerging use of imaging techniques such as dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and ultrasound imaging in the clinical setting have highlighted the importance of lean soft tissue (LST) as an independent predictor of morbidity and mortality.

The paper discusses in depth the advantages and limitation of the many methods that can be used to assess body composition in research and clinical settings.

The paper also discusses the current definition and importance of sarcopenic obesity and notes that,

“The identification of different body composition phenotypes suggests that individuals have different metabolism and hence utilization of fuel sources.”

Thus,

“It is clear from emerging studies that body composition health will be vital in treatment decisions, prognostic outcomes, and quality of life in several nonclinical and clinical states.”

My guess is that it will not just be the absolute or relative amount of lean tissue mass that is important. Rather, similar to the increasingly recognised role of differences amongst fat depots, I would assume that different lean soft tissue depots may well play different roles in metabolic health.

@DrSharma
Charlottetown, PEI

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Tuesday, September 16, 2014

Is Food Addiction Better Described As Eating Addiction?

sharma-obesity-addiction-typesThe term “food addiction” has found its way into both the scientific and popular literature.

Now, a thoughtful paper by Johannes Hebebrand and colleagues, published in Neuroscience & Biobehavioral Reviews, argues that there is in fact little evidence for addiction to “food” per se (as you would see in addiction to a specific substance) and that therefore, it may be better to describe the addiction-like overconsumption of food as a behavioural addiction, in this case, an addiction to eating.

Eating is intrinsically rewarding and reinforcing, and food consumption is well-known to activate the reward system in the brain; this applies particularly in the physiological state of hunger. It is easy to see that the rewarding properties of food and their activation of the reward pathway might lead intuitively to the idea that food substances may have addictive properties. However, just because eating behavior engages these reward systems, it does not necessarily follow that specific nutrients (substances) are able to evoke a substance addiction. Instead, the complex activation of the reward system as the initial step of the process ending in addiction can be viewed as being dependent on eating (subjectively) palatable foods irrespective of their nutritional/chemical composition.”

Per se, foods are nutritionally complex and there is hardly any evidence to suggest that under normal physiological circumstances humans crave specific foods in order to ingest a specific ‘substance’. Instead, the diet of subjects who overeat typically contains a broad range of different, subjectively palatable foods. It can be argued that access to a diversity of foods, especially a diverse range of palatable foods, may be a pre-requisite for the development of addictive-like eating behavior.”

There is currently no evidence that single nutritional substances can elicit a Substance Use Disorder in humans according to DSM 5 criteria. In light of the lack of clinical studies that have aimed to detect addictions to specific nutrients, it cannot as yet be ruled out that a predisposed subgroup does indeed develop such a substance based addiction, which in theory may be substantially weaker than in the case of addictions based on well-known exogenous substances such as alcohol, cannabis, nicotine or opiates. The fact, that clinical case studies do not abound on an addiction like intake of specific nutrients or even specific foods, would suggest that such cases are rare, if they exist at all. Alternatively, the addiction is so weak that it is not adequately perceived and reported as such. This leads to the question as to the boundaries between excessive consumption and the beginning of a true addiction.”

Thus,

“…there is very little evidence to indicate that humans can develop a “Glucose/Sucrose/Fructose Use Disorder” as a diagnosis within the DSM-5 category Substance Use Disorders. We do, however, view both rodent and human data as consistent with the existence of addictive eating behavior. The novel DSM-5 (APA, 2013) currently does not allow the classification of an “Overeating Disorder” or an “Addictive Eating Disorder” within the diagnostic category Substance-Related and Addictive Disorders; indeed, the current knowledge of addictive eating behaviors does not warrant such a diagnosis. However, efforts should be made to operationalize the diagnostic criteria for such a disorder and to test its reliability and validity. It needs to be determined if such a disorder can occur distinct from other mental disorders.”

Overall I believe that reframing the perceived loss of control over food intake often reported by my patients as a “behavioural” rather than a “substance” addiction may be helpful in approaching this rather complex topic and may well open the path to novel therapeutic approaches more consistent with our current understanding of behavioural addictions.

@DrSharma
Vienna, Austria

ResearchBlogging.orgHebebrand J, Albayrak O, Adan R, Antel J, Dieguez C, de Jong J, Leng G, Menzies J, Mercer JG, Murphy M, van der Plasse G, & Dickson SL (2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neuroscience and biobehavioral reviews PMID: 25205078

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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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