WHEREAS: The disease of obesity is a major source of concern across the nation. In California, the adult obesity rate is nearing a quarter of the population (24.7%) and in Los Angeles County, the percentage of adults affected by obesity continues its steady rise from 13.6% in 1997 to 24.3% in 2013, and
WHEREAS: Experts and researchers agree that obesity is not a lifestyle choice but rather, a complex disease influenced by various physiological, environmental factors, and
WHEREAS: While prevention programs, including the 2010 California Obesity Prevention Plan, have successfully established the seriousness of this public health crisis, it is also imperative that individuals and families currently affected by obesity receive comprehensive care and treatment, and
WHEREAS: Studies show that bias and stigma against people affected by obesity among general society and healthcare professionals are significant barriers to effectively treating the disease, and
WHEREAS: Healthcare professionals must treat patients with respect and compassion, and partner with patients to develop a comprehensive and individualized approach to weight-loss and weight management that considers all appropriate treatment options such as reduced-calorie diet and physical activity modifications, pharmacotherapy, or bariatric surgery, and
WHEREAS: It will take a long-term collaborative effort, involving partners from across all fields – individual, corporate and institutional – taking an active role, to ignite the betterment of obesity care and treatment:
NOW, THEREFORE, I, ERIC GARCETTI, as Mayor of the City of Los Angeles, and on behalf of its residents, do hereby proclaim the week of November 1-7, 2015 as Obesity Care Week in the City of Los Angeles, and encourage all our citizens to create the foundation of open communication to break barriers of misunderstanding and stigma, and improve the lives of all individuals affected by obesity and their families.
September 25, 2015
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In the context of severe obesity, this includes providing access to care in a setting that accommodates bariatric patients – larger blood pressure cuffs, larger gowns, larger scales and larger furniture.
But how is this viewed by the very people that these measures are meant to accommodate?
This is the topic of a thoughtful opinion piece by CON bootcamper Nicole Glenn and Marianne Clark, published in JAMA.
The paper describes comments of patients with severe obesity interviewed in a bariatric centre that tries its best to accommodate:
“Incredibly considerate and incredibly insulting at the same time.” This is how a woman describes the expanded chairs in the waiting room of the bariatric clinic….This woman is not describing the hospital administrators who purchased the chairs nor the designers from whose imaginations they sprung. Instead, she refers to the chairs directly, as if it were they doling out insults and praises in turn.
That these chairs were designed for the unique needs of these patients is obvious: they offer comfort and accommodation by way of sturdy metal arms and extended seats and backs. Nevertheless, these chairs are experienced in multiple ways; not all patients who encounter them find their welcome welcoming.
A woman waiting for her appointment at the bariatric clinic explains, “This giant chair makes me feel so very fat, and so very skinny at the same time…‘You are not normal,’ it seems to say to me.”
As the authors note,
By considering the experience of such ordinary things as enlarged chairs in the bariatric clinic waiting room, we must acknowledge how extraordinary these things actually are: how they have meaning and shape and are shaped by people’s lives. Listening to patients’ experiences allows us to see the world, if only momentarily, from their perspective, enabling deeper understanding of their lives, and ultimately leaving us better equipped to address their needs as they seek treatment and care.
At least it may be useful to consider that objects may be have unintended meanings and consequences:
Rather than finding chairs that accommodate larger bodies, these patients often seek a body that accommodates the world, one that slips easily and unthinkingly into “regular” chairs. Instead of providing rest and reprieve, the temporary comfort and accommodation afforded by the altered chairs in the bariatric clinic waiting room may act as a reminder of the shrunken world that exists outside these walls, ultimately marking a journey far from complete.
What are your thoughts on accommodation – what is the alternative?
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As Canada’s national representative in the World Obesity Federation (formerly IASO), the Canadian Obesity Network is proud to co-host the 13th International Congress on Obesity in Vancouver, 1-4 May 2016.
The comprehensive scientific program will span 6 topic areas:
Track 1: From genes to cells
- For example: genetics, metagenomics, epigenetics, regulation of mRNA and non–coding RNA, inflammation, lipids, mitochondria and cellular organelles, stem cells, signal transduction, white, brite and brown adipocytes
Track 2: From cells to integrative biology
- For example: neurobiology, appetite and feeding, energy balance, thermogenesis, inflammation and immunity, adipokines, hormones, circadian rhythms, crosstalk, nutrient sensing, signal transduction, tissue plasticity, fetal programming, metabolism, gut microbiome
Track 3: Determinants, assessments and consequences
- For example: assessment and measurement issues, nutrition, physical activity, modifiable risk behaviours, sleep, DoHAD, gut microbiome, Healthy obese, gender differences, biomarkers, body composition, fat distribution, diabetes, cancer, NAFLD, OSA, cardiovascular disease, osteoarthritis, mental health, stigma
Track 4: Clinical management
- For example: diet, exercise, behaviour therapies, psychology, sleep, VLEDs, pharmacotherapy, multidisciplinary therapy, bariatric surgery, new devices, e-technology, biomarkers, cost effectiveness, health services delivery, equity, personalised medicine
Track 5: Populations and population health
- For example: equity, pre natal and early nutrition, epidemiology, inequalities, marketing, workplace, school, role of industry, social determinants, population assessments, regional and ethnic differences, built environment, food environment, economics
Track 6: Actions, interventions and policies
- For example: health promotion, primary prevention, interventions in different settings, health systems and services, e-technology, marketing, economics (pricing, taxation, distribution, subsidy), environmental issues, government actions, stakeholder and industry issues, ethical issues
Early-bird registration is now open – click here
Abstract submission deadline is November 30, 2015 – click here
For more information including sponsorship and exhibiting at ICO 2016 – click here
I look forward to welcoming you to Vancouver next year.
Information On The Genetic Nature of Obesity Can Reduce Perceived Weight Discrimination and Increase Willingness to Eat Healthier
Continuing the theme of harmful effects of weight bias, a paper by Janine Beekman and colleagues published in Psychology & Health, suggests that providing patients information on the strong genetic nature of obesity may not only reduce perceived weight bias but also increase willingness to eat a healthier diet.
In this study 201 women with overweight or obesity aged 20-50 were allowed to interact with a virtual physician in a simulated clinical primary care environment, which included physician-delivered information that emphasized either genomic or behavioral underpinnings of weight and weight loss.
This research builds on previous evidence that provision of genomic information in a primary care context can reduce patients’ perceived stigma because they feel less blamed for their weight.
As the authors note,
“This relates to attribution theory, which posits that causal attributions play an important role in determining reactions to stigmatizing information. The more overweight is attributed to controllable causes (like diet and exercise), the more negative one’s reactions are to it.”
All aspects of the virtual encounter were identical except for the type of information given: Participants who received genomic information were told that body weight has a sizeable heritable component, and this may be relevant to their personal situation. Participants who received behavioral information were given a parallel message that it may be harder for those who are already overweight to lose weight (but with no mention of the role of genomics). Both groups were reminded of the importance of health-promoting behaviours related to physical activity and nutrition.
After controlling for BMI and race, participants who received genomic information stated that they perceived less blame from the doctor than participants who received behavioral information. In a serial multiple mediation model, reduced perceived blame was significantly associated with less perceived discrimination, and in turn, lower willingness to eat unhealthy foods.
“Providing patients with information about genomics and weight management reduced the extent to which they felt blamed for their weight, when compared to more traditional behavior-based information. Women who felt less blamed for their weight also felt less discriminated against based on their weight, and this reduced perceived discrimination was related to healthier eating and drinking cognitions”
These findings may not just have implications for clinical practice but also for public health messages about obesity:
“The proliferation of the “war on obesity” and social messages targeted at combating obesity are an attempt to tackle a public health problem by engaging stigma as a vehicle for social control, while stigmatizing individuals in the process. These messages, in turn, can lead self-perceived overweight women to, for example, consume more calories and feel more deflated about their prospects for weight loss. The present research provides another example of these ironic effects of stigmatizing weight – or, more specifically, the manifestation of that stigma as perceived blame and discrimination.”
Although the authors recognise that genomic information may in itself prove stigmatizing, in this context, they feel that the positive influence of genomic information provision in this context stems from its strong effect on reducing perceived blame.
Thus, for clinicians, the message may well be that acknowledging the importance of genetic factors (rather than simply diet and exercise) may positively influence interpersonal dynamics between patients and providers by reducing perceived blame and perceived discrimination. These improved dynamics, may in turn, positively influence health cognitions.
Recent visitors to the Canadian Obesity Network website may have noted a few changes.
For one, a new logo has replaced the time-worn “maple leaf + measuring tape“. This is in response to strong feelings among both the board and membership that the old logo, with its measuring tape no longer represents one of CON’s key messages, namely that health is not a number on a scale or measuring tape, and that there is no consensus as to what a healthy weight is and how it would be determined for any given individual.
This is particularly a sensitive issue and a mixed message when it comes to public engagement, which brings me to the second major change on the website – a section for the general public.
Until now, despite amassing an impressive membership that is fast approach 12,000, membership and information on the CON website was targeted and reserved to people with a professional interest in obesity – researchers, health professionals, decision makers, trainees, and a range of other stakeholders.
But the most important stakeholder of all – people living obesity – were excluded – both from membership and content.
Since last week, anyone with an interest in obesity can find general information on obesity on the CON website and anyone can subscribe to a soon to be launched regular newsletter for the public, which will feature the latest in obesity research and obesity relevant resources around the country – both in prevention and management.
Currently, the website is still under construction and at this time most of the information focusses on one of CON’s main goals – to reduce obesity stigma and weight-based discrimination.
Stay tuned for sections on prevention, public health, children and youth, pregnancy and a growing catalogue of evidence-based resources for obesity prevention and management.
While you will hardly find the usual “recipes and exercise tips” that are often featured on obesity related website, you will be sure to find a growing body of obesity knowledge that informs about the prevention and management of this chronic disease.
I hope you will agree that the new logo’s sleek icon is reflective of the network’s Canadian focus, with the bottom two segments suggestive of two supportive hands, perhaps representing the many professional members of CON working to find bette ways to prevent and manage obesity. The white dot focal point on the leaf icon can perhaps be interpreted as the head of a person with uplifted arms (i.e. the white space between the three leaf sections), an expression of hope and aspirations.
To subscribe to the forthcoming public newsletter click here
To follow CON on its new Facebook page click here
To join CON as someone with a professional interest click here