The European Association for the Study of Obesity (EASO) had now released the new OMTF guidelines Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for Post-Bariatric Surgery Medical Management.
The guidelines provide the latest guidance on nutritional management, micronutrient supplementation, managing co-morbidities, pharmacotherapy, psychological management, and prevention and management of weight regain. The guidelines also address the issue of post-bariatric surgery pregnancy.
Not covered are issues related to dealing with excess skin and rehabilitation (e.g. return to work, reintegration in social activities, education, etc.), both of significant importance, especially in people with severe obesity.
As the authors note,
“Bariatric surgery is in general safe and effective, but it can cause new clinical problems and it is associated with specific diagnostic, preventive and therapeutic needs. Special knowledge and skills of the clinicians are required in order to deliver appropriate and effective care to the post-bariatric patient. A post-bariatric multidisciplinary follow-up programme should be an integral part of the clinical pathway at centres delivering bariatric surgery, and it should be offered to patients requiring it”
These guidelines are now available open access in Obesity Facts.
As someone who has often engaged in research projects, consultation, or speaking engagements sponsored or otherwise supported by industry (all of which I happily acknowledge and declare), I am a keen observer of the ongoing discussion about when and how researchers need to be wary of potential biases and conflicts.
As I pointed out in previous posts, among all of the potential conflicts, the financial one is perhaps the easiest to declare and otherwise manage.
A recent article by John Ionnadis and John Trepanowski, published in JAMA, discusses the wide range of conflicts (most of which may be non-financial), that one may wish to have declared and exposed, especially when it comes to nutrition research.
The authors single our nutrition research for good reasons:
“…the totality of an individual’s diet has important effects on health, most nutrients and foods individually have ambiguously tiny (or nonexistent) effects. Substantial reliance on observational data for which causal inference is notoriously difficult also limits the clarifying ability of nutrition science. When the data are not clear, opinions and conflicts of interest both financial and nonfinancial may influence research articles, editorials, guidelines, and laws. Therefore, disclosure policies are an important safeguard to help identify potential bias. “
While the potential for financial conflict in relationship to the food industry is well recognised and there are now well-established “disclosure norms”, other conflicts, of which there are many, are not routinely acknowledged, let alone, disclosed.
For one, there are significant financial conflicts that have nothing to do with taking money from industry:
“Many nutrition scientists and experts write books about their opinions and diet preferences. Given the interest of the public in this topic, books about nutrition, diets, and weight loss often appear on best-selling lists, even though most offer little to no evidence to support their frequently bold claims.”
“Financial conflicts of interest can also appear in unexpected places. For example, many not-for-profit nutrition initiatives require considerable donor money to stay solvent. Public visibility through the scientific literature and its reverberation through press releases, other media coverage, and social media magnification can be critical in this regard.”
Even these financial conflicts can perhaps be dealt with through established disclosure norms.
But conflicts can get even more complicated when it starts reflecting researchers’ own personal views and biases::
“Allegiance bias and preference for favorite theories are prevalent across science and can affect any field of study. It is almost unavoidable that a scientist eventually will form some opinion that goes beyond the data, and they should. Scientists are likely to defend their work, their own discoveries, and the theories that they proposed or espoused.”
While that is certainly true for any area of research,
“Nutrition scientists are faced with an additional challenge. Every day they must make numerous choices about what to eat while not allowing those choices to affect their research. Most of them also have been exposed to various dietary norms from their family, culture, or religion. These norms can sometimes be intertwined with core values, absolutist metaphysical beliefs, or both. For instance, could an author who is strongly adherent to some religion conclude that a diet-related prescription of his or her religion is so unhealthy as not to be worthwhile?”
“Advocacy and activism have become larger aspects of the work done by many nutrition researchers, and also should be viewed as conflicts of interest that need to be disclosed. These endeavors often spring from some of the noblest intentions and can lead to invaluable contributions to society and public health in particular. However, advocacy and activism are also orthogonal to a key aspect of the scientific method, which is to not take sides preemptively or based on belief or partisanship. Examples of white-hat bias (bias that distorts scientific evidence in support of a perceived righteous end such as better human health) have been reported.”
The authors therefore propose that,
“…it is important for nutrition researchers to disclose their advocacy or activist work as well as their dietary preferences if any are relevant to what is presented and discussed in their articles. This is even more important for dietary preferences that are specific, circumscribed, and adhered to strongly. For example, readers should know if an author is strongly adherent to a vegan diet, the Atkins diet, a gluten-free diet, a high animal protein diet, specific brands of supplements, and so forth if these dietary choices are discussed in an article. The types of articles in which relevant disclosure should be expected include original research, reviews, and opinion pieces (such as editorials).”
As with financial disclosures,
“Such disclosure should not be seen as an admission of lack of integrity. To the contrary, disclosure strengthens the perceived integrity of the author. Moreover, some disclosures may end up being advantageous depending on future research findings. For example, if at some point strict vegan diets are shown definitively to confer unmatched health benefits, an author who previously disclosed strong adherence to that diet may receive extra recognition and acclaim for his or her prescient wisdom….Availability of these disclosures would allow readers to be either more skeptical or more inspired (depending on how they view the presented evidence and arguments).”
Although the article focuses on nutrition research, the authors acknowledge that similar biases may exist in other areas of research. In my own experience, “ideological biases” (although well-intended) are pervasive through much of the research and publications on topics ranging from physical activity to public health, where I often see strong recommendations made based on evidence that is not even remotely as robust or rigorous as the evidence that comes from, say a large randomised clinical trials of a new prescription drug.
I certainly agree with the authors’ recommendation that,
“As a general rule, if an author’s living example could be reasonably expected to influence how some readers perceive an article, disclosure should be encouraged. Authors who have strong beliefs and make highly committed choices for diet or other behaviors should not hesitate to disclose them. Doing so may help everyone understand who is promoting what and why.”
Registration and Abstract submission for the Canadian Obesity Network’s 6th biennial Canadian Obesity Student Meeting (COSM), June 20-22, London, Ontario, is now open.
As attendees of past COSMs will be well aware, this is a pretty unique meeting organised entirely by the Canadian Obesity Network’s Student and New Professional (CON-SNP) network, open to 200 MSc/PhD students, young researchers, post-docs, clinical fellows, clinical researchers and young health professionals in their last, or within five years of, completing their training.
As in previous years, we expect attendance not just from across Canada but also the US, Mexico, and overseas.
The meeting will highlight important advances in obesity research and provide important opportunities for new professionals and trainees to present findings and network with their peers.
The presentations and discussions will range from cellular and molecular biology to childhood obesity, primary intervention, and population health.
However, the primary purpose of this meeting is to enhance student growth and development with ample opportunity to network and get to know your peers.
For more information on how to submit and abstract (deadline March 5) and to register for COSM 2018 click here
The assessment of weight history is no doubt a key feature of obesity assessment. Not only can weight history and trajectories provide important insights into obesity related risk but, perhaps more importantly, provide key information on precipitating factors and drivers of excessive weight gain.
Now, in a short article published in MedEdPublish, Robert Kushner discusses how the well-known OPQRST mnemonic for assessing a “chief complaint” can be applied to assess body weight.
In short, OPQRST is a mnemonic for Onset, Precipitating, Quality of Life, Remedy, Setting, and Temporal pattern. Applied to obesity, Kushner provides the following sample questions for each item:
Onset: “When did you first begin to gain weight?” “What did you weight in high school, college, early 20s, 30s, 40s?” “What was your heaviest weight?”
Precipitating: “What life events led to your weight gain, e.g., college, long commute, marriage, divorce, financial loss?” “How much weight did you gain with pregnancy?” “How much weight did you gain when you stopped smoking?” “How much weight did you gain when you started insulin?”
Quality of life: “At what weight did you feel your best?” “What is hard to do at your current weight?”
Remedy: “What have you done or tried in the past to control your weight?” “What is the most successful approach you tried to lose weight?” “What do you attribute the weight loss to?” “What caused you to gain your weight back?”
Setting: “What was going on in your life when you last felt in control of your weight?” “What was going on when you gained your weight?” “What role has stress played in your weight gain?” “How important is social support or having a buddy to help you?”
Temporal pattern: “What is the pattern of your weight gain?” “Did you gradually gain your weight over time, or is it more cyclic (yo-yo)?” “Are there large swings in your weight, and if so, what is the weight change?”
As Kushner notes,
“These features provide a contextual understanding of how and when patients gained weight, what efforts were employed to take control, and the impact of body weight on their health. Furthermore, by using a narrative or autobiographical approach to obtaining the weight history, patients are able to express, in their own words, a life course perspective of the underlying burden, frustration, struggle, stigma or shame associated with trying to manage body weight. Listening should be unconditional and nonjudgmental. By letting patients tell their story, the clinician is also able to assess the patients’ awareness, knowledge, motivation, decision-making, and resiliency regarding weight management. The narrative provides a basis for approaching the patients’ weight holistically, as well as beginning to formulate diagnostic and therapeutic options.”
There is no doubt much to be gained in understanding obesity by allowing patients to tell their own weight stories.
As readers will be well aware, n terms of health risks, fat is not fat is not fat is not fat.
Rather, whether or not body fat affects health depends very much on the type of body fat and its location.
While there have been ample attempts at trying to describe body fat distribution with simple anthropometric tools like measuring tapes and callipers, these rather crude and antiquated approaches have never established themselves in clinical practice simply because they are cumbersome, inaccurate, and fail to reliably capture the exact anatomical location of body fat. Furthermore, they provide no insights into ectopic fat deposition – i.e. the amount of fat in organs like liver or muscle, a key determinant of metabolic disease.
Recent advances in imaging technology together with sophisticated image recognition now offers a much more compelling insight into fat phenotype.
In this regard, readers may be interested in a live webinar that will be hosted by the Canadian Obesity Network at 12.00 pm Eastern Standard Time on Thu, Nov 23, 2017. The webinar provides an overview of a new technology developed by the Swedish company AMRA, that may have both important research and clinical applications.
The talk features Olof Dahlqvist Leinhard, PhD, Chief Scientific Officer & Co-Founder at AMRA and Ian Neeland, MD, a general cardiologist with special expertise in obesity and cardiovascular disease, as well as noninvasive imaging at the UT Southwestern Medical Center in Dallas, US.
Registration for this seminar is free but seats are limited.
To join the live event register here.
I have recently heard this talk and can only recommend it to anyone interested in obesity research or management.