Monday, July 14, 2014

How To Prevent Gallstones During Weight Loss

GallstonesOne of the best recognised complications of weight loss – especially if this occurs too rapidly – are the development of gallstones, which can result in acute symptoms and often require surgery.

Now Caroline Stokes and colleagues from the Saarland University Medical Center, Homburg, Germany, publish a systematic review of strategies to prevent weight-loss associate gallbladder stones in Clinical Gastroenterology and Hepatology.

Their analysis includes 13 randomised-controlled trials, comprising 1836 participants undergoing weight loss through dieting (8 trials) or bariatric surgery (5 trials).

Ursodeoxycholic acid (UDCA) reduced the risk of ultrasound-verified gallstones compared with control interventions with a risk ratio of 0.33 and a number-needed-to-treat (NNT) of only 9.

They also found a significant risk reduction with high-fat weight loss diets (risk ration 0.09).

No adverse effects were noted for either intervention.

Thus, it is evident that UDCA and/or higher dietary fat content prevent the formation of gallstones during weight loss and these treatments should likely be initiated particularly in patients, who are undergoing rapid weight loss (particularly those at high risk of gallbladder stones).

@DrSharma
Edmonton, AB

ResearchBlogging.orgStokes CS, Gluud LL, Casper M, & Lammert F (2014). Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 12 (7), 1090-110000 PMID: 24321208

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Thursday, June 26, 2014

Guidelines for Managing Overweight and Obesity in Adults

the obesity societyRegular readers may recall a previous post on guidelines on obesity management released by The Obesity Society (TOS) together with other organisations, including the American Heart Association and the American College of Cardiology, at Obesity Week in Atlanta last year (2013).

The bottom line, as I have blogged before, was the revelation of just how little we actually know about obesity.

For what it is worth, the complete guidelines are now published as a supplement to its July issue of the Obesity journal (Guidelines (2013) for Managing Overweight and Obesity in Adults: Full Report).

According to The Obesity Society’s press release,

TOS is investing in the improved treatment of obesity by making the full guidelines available in print so they can serve as a go-to resource for health practitioners around the world. Whether you are a physician, nurse, nutritionist or fitness trainer, every professional interacting with individuals with obesity can find value in this insightful treatment guide.

No doubt, a tremendous amount of work went into developing these guidelines – whether they will substantially change practice remains to be seen.

@DrSharma
Vancouver, BC

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Tuesday, June 24, 2014

Time To Go Nuts About Nuts?

sharma-obesity-nutsNuts are reportedly chock full of all kinds of nutrients and are probably among the healthiest of snacks. However, they are also among the most calorie-dense foods – a small handful of nuts (~30 g) can easily add up to 150-200 cals.

So, do high consumers of nuts run the risk of weight gain?

This issue is discussed in depth by Sze Yen Tan and colleagues in a paper published in the American Journal of Clinical Nutrition, in which they review the effects of nuts on appetite, food intake, metabolism, and body weight.

While eating nuts may not exactly lead to weight loss, most studies find that consumption of “extra” calories as nuts leads to substantially less weight gain than may be expected based on their caloric content.

Their review reflect a number of ways in which nuts may have this effect:

Effect on hunger and appetite:

“…nut ingestion suppresses hunger and desire to eat and promotes fullness. These sensations may aid dietary compensation that offsets much of the energy contributed by nuts. However, strong compensation can also occur independently of reported appetitive effects. This may reflect imprecision in appetite measurement or a truly independent uncharacterized mechanism.”

Mastication (chewing):

“Nuts require considerable oral processing effort and this may, in part, account for the often-noted less-than-predicted effect of their consumption on body weight. The mechanical act of chewing reportedly generates satiation signals through cognitive, neural, endocrine, and physical (eg, gastric emptying) mechanisms; augments cephalic phase responses linked to appetite; influences digestion efficiency; modestly increases energy expenditure; and elicits dietary compensation.”

Nutrient absorption:

“A number of studies have evaluated the efficiency of energy absorption from ground and tree nuts through feeding trials. All showed substantive increases in fecal fat loss with nut consumption, although the values ranged widely from ∼5% to >20%”

Energy expenditure:

“Collectively, there is some evidence that nut consumption increases thermogenesis, but the data are not robust and there is no clear mechanism. One possibility is that the lipid from nuts is absorbed over a prolonged period of time, leading to a small but sustained source of substrate that fuels thermogenesis and could appear as an increase in REE.”

Fat metabolism:

“It has been proposed that nut consumption elevates fat oxidation and preferentially reduces body fat mass, especially in the viscera. These actions are attributed to their high unsaturated fat content….Human studies incorporating different nuts into the diet at realistic doses are needed to determine the effect of nut consumption on body composition.”

With regard to impact on body weight, the authors reach the following conclusions:

Adding nuts to habitual diets:

“Although there are reports of small, but significant increases in body weight with nut consumption, the preponderance of evidence indicates that under controlled or free-living situations, nut consumption does not promote weight gain.”

Eating nuts in calorie-restricted diets:

“The inclusion of nuts in energy-restriction regimens does not impede weight loss. In several trials in which nuts did not augment weight loss, there was a reduction in cardiovascular disease risk indexes in the nut-consuming groups, suggesting that such benefits derive from properties of the nuts rather than just weight change.”

Eating nuts in weight maintenance:

“Several studies assessing the role of nut consumption in weight-maintenance programs have noted a decrease in body weight from baseline. Whether this is due to a greater thermic effect of food or REE effect of the nuts compared with the foods they displaced in the diet has not been established. Nevertheless, current data indicate that the inclusion of nuts in a weight-maintenance program will not lead to weight gain and may aid weight loss.”

Thus, in summary, the authors conclude that,

“…evidence indicates that they pose little challenge to and may even aid weight management. This is attributable to the strong dietary compensation effects they elicit, inefficiency in the absorption of the energy they provide, and possibly an elevation of energy expenditure and fat oxidation.”

As a general caveat to all of these data, it needs to be noted that results varied widely depending on the types of nuts and how exactly these nuts were consumed (e.g. as snacks or added to meals – the former often being more favourable than the latter).

Also, many of the studies had relatively small number of participants and were of rather short duration.

Nevertheless, it does appear that going nuts about nuts may not be quite as detrimental to your weight as their energy content would suggest.

@DrSharma
Toronto, ON

ResearchBlogging.orgTan SY, Dhillon J, & Mattes RD (2014). A review of the effects of nuts on appetite, food intake, metabolism, and body weight. The American journal of clinical nutrition, 100 (Supplement 1) PMID: 24920033

 

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Thursday, June 19, 2014

Fat Activism in Canada

Dr. Jenny Ellison, Trent University, Peterborough, Ontario, Canada

Dr. Jenny Ellison, Trent University, Peterborough, Ontario, Canada

Yesterday’s opening plenary talk at the 4th Canadian Obesity Student Meeting, hosted by the Canadian Obesity Network’s Students and New Professionals (CON-SNP) network, was given by Dr. Jenny Ellison from the  Frost Centre for Canadian & Indigenous Studies at Trent University, on the history of fat activism in Canada.

In her talk, Ellison, presented a broad historical overview of how fat stigma and messaging around fat has evolved over the years.

From the early “Christian” view of obesity as a deadly sin, moral failing and lack of will power and the beginning of the obsession with body shape and size in the early half of the 20th century to the growing movement of fat acceptance and understanding of the negative consequences of fat stigma and fat politics for larger people.

She concluded with an overview of how informal networks within the fat activist movement are self-organising online sharing a wide range of information from finding physicians to identifying safe spaces where they can interact.

Ellison also complimented the Canadian Obesity Network on taking a strong stance against weight stigma and discrimination, thus opening up the possibility for a different future.

A recent paper by Ellison on this subject is available here.

@DrSharma
Waterloo, ON

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Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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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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