The short answer, for the vast majority of Canadians, would simply be, “no one”.

Last year, the Canadian Obesity Network undertook a representative survey to examine how Canadians manage their weight.

It turns out that over 65% of overweight Canadians have never talked to a licensed health professional (family doctor, dietitian, pharmacist, etc.) about losing weight. The same is true for over 40% of Canadians, who meet the clinical definition of obesity, i.e. have a BMI greater than 30.

This may probably be as well, because most health professionals are in fact ill-equipped to support individuals struggling with excess weight. Although, health professionals often cite lack of time and resources as the main reason for not broaching the topic, I suspect that the key problem is simply a lack of knowledge and training in weight management.

As I have said before, most health professionals have little more than a layman’s understanding of the complex socio-psycho-biology of energy homeostasis and have virtually no formal training in even the basics of behavioural, medical or surgical management of excess weight.

Add to this an (un)healthy dose of anti-weight prejudice and discrimination and it is probably no surprise why anyone who has ever solicited weight management advice from their health professional is more likely to receive simplistic slogans along the lines of “eat less and move more”, than a meaningful analysis of the problem with a personalized evidence-based management plan.

Indeed, weight management plans too often follow along the lines of well-meant but often ineffective diet or exercise recommendations, that virtually always fail to address the actual root of the problem (see my post - overeating is a symptom).

It should hardly come as a surprise when simply providing an impulsive overeater with a diet plan proves to be about as effective as providing a drinking plan to an alcoholic.

In contrast, teaching time-management skills to people who regularly fall back on fast food for lack of time or offering stress management classes to people who use food as a coping strategy may well be far more effective than simply educating them on healthy choices or handing them recipe books.

Of course patients can always turn to the billion-dollar weight-loss industry, that peddles everything from magical weight loss supplements to crash diets. While some of these program may well be better than others, there is no way a consumer can tell which of these many products and services are likely to be effective or just a waste of money.

Even if patients “successfully” lose weight with any of these products or services, this is rarely more than temporary “symptomatic” relief with a one-in-twenty chance of weight regain within weeks or months of stopping the program.

Rarely do these products or services truly diagnose and address the root cause of the problem - that would require far more than a cursory “one-size-fits-all” business model and is unlikely to deliver the same lucrative profits.

Perhaps, it is time to promote a better public understanding of the many societal and individual level drivers of excess weight and it certainly appears high time health professionals and health care systems seriously took on the challenge of addressing the greatest health problem of our times.

When the problem is excess weight, not helping patients deal with this issue is simply palliative care.

AMS
Edmonton, Alberta

Prof. Edward Shang

As the demand for bariatric surgery increases across Europe, there is increased recognition that this rapidly evolving field of medical care will require the same expertise, training, research and resources as other fields of medicine.

It was therefore only a matter of time before a leading German university would announce the appointment of a Full Professor and Chair for Bariatric Surgery.

This credit now goes to the University of Leipzig, which yesterday announced the formal appointment of Dr. Edward Shang, as the first Full Professor for Bariatric Surgery. The position is a cornerstone of the newly funded Integrated Research and Treatment Centre for Obesity, funded by the German Federal Ministry for Education and Research.

As blogged before, the University of Leipzig is now well poised to take the lead in obesity research and management for Germany, a clear first in the rather conservative German academic landscape.

Shang will head the new Division for Obesity Surgery in the Department of Visceral, Transplantation, Thorax and Vascular Surgery, which will deliver comprehensive multi-disciplinary care for patients with severe obesity.

Shang’s expertise in modern minimally invasive surgery, including natural orifice surgery (NOTES), which includes performing complex bariatric surgery without having to cut open the patient, will offer a wide range of opportunities for cutting-edge (no pun intended) research in this rapidly evolving field.

As a member of the Scientific Advisory Board to this German Centre of Excellence, i congratulate Dr. Shang on this distinction and very much look forward to meeting him on my next trip to Leipzig.

AMS
Lincolnshire, IL

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A few weeks ago, I read Lori Lansens’ bestselling book “the wife’s tale“.

The book tells the story of Mary Gooch, a 43 year-old woman with severe obesity, who lives her life in defensive, deflective blame, segregating herself in the small farming town of Leaford, Ontario.

When her husband dissapears on the eve of their 25th wedding anniversary, Mary abandons her comfortable position to take the next flight to look for him in California. Soon after arriving she loses her wallet and passport, which further complicates her situation.

With the help of some unlikely friendships that she makes along the way, Mary undertakes a journey of self discovery resulting in an amazing transformation. The deeply insightful story touchingly depicts the heart-wrenching daily reality of someone living with severe disabling obesity.

In an opening sequence, Mary describes how, as a nine year old, she heard her doctor whisper the word “obese” to her mother. Never having heard the word before, little Mary imagined that she was under the power of an “obeast”, a creature that had taken over her body and was manifesting itself in her starving gut.

As Lori Lansens, who hails from Chatham, Ontario, a rural community near the border to Detroit, notes in her self-penned author profile,

“I drove the curving roads of the Santa Monica Mountains thinking of the thousands of conversations I’ve had with women about loneliness, self acceptance, marriage, husbands, body image, food, denial, betrayal and more recently, encroaching middle-age. I thought about what it means to be a stranger, and how one can be transformed by circumstance, and as I found my own tribe of friends and settled into the new rhythm of a different life, the story of Mary Gooch unfolded.”

Although her biography makes no mention of any weight issues that Lansens herself may have experienced, she tells the story of many patients that I see in my clinic everyday.

Anyone who still believes that we will solve the obesity epidemic by simply telling people to eat less and move more should take the time to read this book - but my guess is that if you believe that the solution to obesity is as simple as eating less, then you may have little interest in a book which reveals uncomfortable layers of complexity to a problem for which there are no easy solutions.

If any of my readers have read “The Wife’s Tale”, I’d love to hear from you.

AMS
Edmonton, Alberta

CON-RCO Obesity Boot Camp 2010

As in the four previous camps, this year’s camp once again brought together some of the best and brightest students and new professionals from across Canada for over 100 hours of education and social activities (including the Tree Top Adventure, Kayaking, tour of Quebec City).

This year featured new memorable events like the 1st Obesity Boot Camp idol and the Saturday Night Live Karaoke Party - or as the students would say, “genial!”.

Overall I have no doubts that, as in previous camps, some friendships have been forged for life - both personal and professional.

For my part, I again learnt a lot from listening and interacting with the students and faculty. While there continue to be no easy solutions to obesity in sight, there certainly are reasons for optimism, seeing the enthusiasm with which the students are preparing to face the challenge of solving one of the greatest global health problem of our times.

The Canadian Obesity Network is grateful to all of the faculty and supporters who made this camp possible.

Personally, I look forward to continuing interactions with the now over 120 Boot Camp Alumni over the coming months and years.

AMS
Dushesnay, Quebec

Anyone working in academia is well familiar with the slogan, “publish or perish”.

Indeed, the quantity and quality of scientific publication continues to be a major measure of academic achievement. But how relevant are these publications really? Research shows that the vast majority of publications appearing even in top journals often have little if any measurable impact on decision makers or policy.

Is this because the science is truly irrelevant or is the science largely ignored because it faces a world of non-scientists who do not understand its significance and simply couldn’t be bothered?

This is the topic of a most interesting book that I just finished reading.

Unscientific America: How Scientific Illiteracy Threatens Our Future, is a short text written by Chris Mooney and Sheril Kirshenbaum, which explores the roots and consequences of the increasing divide between what science reveals and a population that largely ignores these revelations.

As Mooney and Kirschenbaum point out,

“For every five hours of cable news, less than a minute is devoted to science; 46 percent of Americans reject evolution and think the Earth is less than 10,000 years old; the number of newspapers with weekly science sections has shrunken by two-thirds over the past several decades. Meanwhile, only 18 percent of Americans have even met a scientist to begin with; more than half can’t name a living scientist role model.”

But rather than simply blaming schools or parents or politicians or the media or an increasingly anti-intellectual public, the authors point a finger directly at the scientific community itself - a community that is clearly failing to make itself relevant or interesting to policy makers or the general public (who will ultimately determine what policy makers care about).

Not only do Mooney and Kirshenbaum deplore the fact that very few scientists have communication skills that allow them to effectively convey the relevance and importance of their work to “outsiders” but that “there are too few collaborations between scientists and journalists, screenwriters, politicians, and religious leaders”.

They quote Preston Manning, who argued that scientists need to “establish a relationship with the political community on grounds other than the milk cow - milking machine relationship” and not only reach out to politicians when they want research funding. Rather, they should establish long-term mulitdirectional relationships, where they are helping as much as they are being helped.

In terms of communicating science, Mooney and Kirshenbaum are also not very happy with science bloggers (to which I dare count myself). They point out that the vast majority of science blogs serve rather specialised audiences - often preaching to the converted and can hardly be considered part of mainstream discourse.

Indeed, the fact that today anyone can find any information supporting any view is exactly one of the main problems with the new media. Like-minded readers congregate to whatever media best represents their opinions or beliefs, thereby essentially eliminating the need for serious discourse, the key to true understanding of any issue.

The authors have several pieces of advise on how to address this scientific illiteracy. One solution may be to train a small army of ambassadors who can translate science’s message and make it relevant to the media, to politicians, and to the public in the broadest sense. Another may be to stoke a cultural change at academic institutions that will specifically reward scientists for their public outreach and communication endeavours - efforts that will hopefully make all of society more scientifically engaged.

Certainly a book all scientists should read.

AMS
Stockholm, Sweden

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