Friday, June 20, 2014

Your Body Thinks Obesity Is A Disease

sharma-obesity-adipose-tissue-macrophageYesterday, the 4th National Obesity Student Summit (#COSM2014) featured a debate on the issue of whether or not obesity should be considered a disease.

Personally, I am not a friend of such “debates”, as the proponents are forced to take rather one-sided positions that may not reflect their own more balanced and nuanced opinions.

Nevertheless, the four participants in this “structured” debate, Drs. Sharon Kirkpatrick and Samantha Meyer on the “con” team and Drs. John Mielke and Russell Tupling on the “pro” team (all from the University of Waterloo) valiantly defended their assigned positions.

While the arguments on the “con” side suggested that “medicalising” obesity would detract attention from a greater focus prevention while cementing the status quo and feeding into the arms of the medical-industrial complex, the “pro” side argued for better access to treatments (which should not hinder efforts at prevention).

But a most interesting view on this was presented by Tupling, who suggested that we only have to look as far as the body’s own response to excess body fat (specifically visceral fat) to determine whether or not obesity is a disease.

As he pointed out, the body’s own immunological pro-inflammatory response to excess body fat, a generic biological response that the body uses to deal with other “diseases” (whether acute or chronic) should establish that the body clearly views this condition as a disease.

Of course, as readers are well aware, this may not always be the case – in fact, the state of “healthy obesity” is characterized by this lack of immunological response both locally within the fat tissue as well as systemically.

Obviously, it will be of interest to figure out why some bodies respond to obesity as a disease and others don’t – but from this perspective, the vast majority of people with excess weight are in a “diseased” state – at least if you asked their bodies.

While this is a very biological argument for the case – it is indeed a very insightful one: it is not the existence of excess body fat that defines the “disease” rather, how the body responds to this “excess” is what makes you sick.

As readers, are well aware, there are several other arguments (including ethical and utilitarian considerations) that favour the growing consensus on viewing obesity as a disease.

Of course,  calling obesity a disease should not detract us from prevention efforts, but, as I often point out, just because be treat diabetes or cancer as diseases, does not mean that we do not make efforts to prevent them.

If calling obesity a disease increases resources towards better dealing with this problem and helps take away some of the shame and blame – so be it.

@DrSharma
Waterloo, Ontario

VN:F [1.9.22_1171]
Rating: 9.0/10 (4 votes cast)
VN:F [1.9.22_1171]
Rating: +2 (from 2 votes)


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

VN:F [1.9.22_1171]
Rating: 10.0/10 (3 votes cast)
VN:F [1.9.22_1171]
Rating: +2 (from 2 votes)


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

VN:F [1.9.22_1171]
Rating: 10.0/10 (1 vote cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Tuesday, June 17, 2014

US Obstetricians and Gynecologists Weight In On Ethical Obesity Care

ACOG_Logo.svg_This month the the Committee on Ethics of the American College of Obstetricians and Gynecologists released a position statement on obesity that advices its fellows to be prepared to meet the challenges of women with obesity with compassion and without bias.

The statement offers the following recommendations and conclusions:

  • Physicians should be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity.
  • Recommendations for weight loss should be based on medical considerations.
  • An understanding that weight loss entails more than simply counseling a woman to eat less and exercise more and a willingness to learn about the particular causes of a patient’s obesity will assist physicians and other health care professionals working with them in providing effective care.
  • Physicians can serve as advocates within their clinical settings for the necessary resources to provide the best possible care to obese women.
  • It is unethical for physicians to refuse to accept a patient or decline to continue care that is within their scope of practice solely because the patient is obese. However, if physicians lack the resources necessary for the safe and effective care of the obese patient, consultation or referral or both are appropriate.
  • Physicians should work to avoid bias in counseling regardless of their own body mass index status.
  • Obesity education that focuses on the specific medical, cultural, and social issues of the obese woman should be incorporated into physician education at all levels.

The entire statement is available here.

It would certainly be nice to see similar statements from other professional bodies (e.g. orthopedic surgeons).

Hopefully, these recommendations will soon be reflected in clinical practice.

@DrSharma
Edmonton, Alberta

VN:F [1.9.22_1171]
Rating: 10.0/10 (1 vote cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Monday, June 16, 2014

Diagnosing Obesity

sharma-obesity-scale3I am currently attending the 74th Scientific Session of the American Diabetes Association in San Francisco, where obesity is certainly a topic that permeates its way through much of the program.

However, despite all this talk, obesity continues to not be “formally” recognized as a “diagnosis” when it comes to patient care.

Thus, a paper by Canadian Obesity Network boot camper Bliie-Jean Martin and colleagues from the University of Calgary, published in BMC Health Services Research, the coding for obesity in administrative data bases and hospital discharge data is rather sketchy.

For their study, Martin and colleagues used a large coronary catheterization registry and a hospital discharge abstract database, which together consisted of more than 17,000 patients.

Based on how often the ICD-10 codes for obesity (E65-68) appeared in these datasets, it is evident that obesity was poorly coded for in the discharge database – in fact, only 2.4% of the discharge abstracts had this diagnosis (in contrast to about 20% of patients in the cardiac registry – which is likely to be more accurate).

Assuming the actual prevalence of obesity to be at least as high in patients discharged from hospital, as it is in the cardiac registry, the sensitivity of identifying obese patients based on the coding of the diagnosis is only about 8% – this means the vast majority of cases of obesity would be missed.

On the other hand, in the few cases where obesity codes were included in the discharge data set, this label was indeed correct (99% specificity).

As the authors conclude, given this state of affairs, hospital discharge databases are highly unreliable when it comes to determining obesity prevalence or burden of disease.

While there may certainly be other conditions that are “under diagnosed” and do not find themselves well reflected in such databases, nowhere is the discrepancy between prevalence and coding likely to be as great as for obesity.

This rather cavalier attitude towards coding for obesity must change if we hope to better understand the importance of obesity related morbidity in the health care system.

@DrSharma
San Francisco, CA

ResearchBlogging.orgMartin BJ, Chen G, Graham M, & Quan H (2014). Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies. BMC health services research, 14 PMID: 24524687

.

VN:F [1.9.22_1171]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.22_1171]
Rating: 0 (from 0 votes)

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

» More news articles...

Publications

  • Subscribe via Email

    Enter your email address:

    Delivered by FeedBurner




  • Arya Mitra Sharma
  • Disclaimer

    Postings on this blog represent the personal views of Dr. Arya M. Sharma. They are not representative of or endorsed by Alberta Health Services or the Weight Wise Program.
  • Archives

     

  • RSS Weighty Matters

  • Click for related posts

  • Disclaimer

    Medical information and privacy
    Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.


  • Meta

  • Obesity Links

  • If you have benefitted from the information on this site, please take a minute to donate to its maintenance.

  • Home | News | KOL | Media | Publications | Trainees | About
    Copyright 2008–2014 Dr. Arya Sharma, All rights reserved.
    Blog Widget by LinkWithin