Following a rather relaxed August, which included meeting my new grand daughter and turning my attention to jazz guitar, I spent the last week in Australia speaking at the Australian Diabetes and Diabetes Educator conference in Adelaide and visiting colleagues at the Melbourne Baker Institute and Sydney University’s Charles Perkins Centre.
Clearly, Australia has an obesity problem that easily rivals that of most “western” countries, with no real solutions in sight (as in most “western” countries).
As virtually everywhere else, much government talk (and millions of dollars) focusses on prevention, while access to obesity management within the healthcare system (public or private) remains as sparse and unfunded as everywhere else.
Whilst other countries are gradually grappling with the idea that obesity, once established, must be considered a chronic disease (and thus requires the same approach to management as any other chronic disease), it appears that government and professional agencies in Australia are particularly resistant to accepting this reality.
This is especially surprising, as some of the best and strongest evidence for the chronicity of obesity and the complex biological responses that occur to defend against weight loss and virtually guarantee weight regain (including studies published in the New England Journal of Medicine and the Lancet), come from my colleague Joe Proietto’s group Down Under.
I guess the fact that even the best science rarely translates into effective policies is not just a problem in Canada.
To conclude this brief series on our new exhaustive review of the putative health benefits of long-term weight-loss maintenance, published in Annual Reviews of Nutrition, here is the summary paragraph of our findings:
“Obesity is well recognized as a risk factor for a wide range of health issues affecting virtually every organ system. There is now considerable evidence that intentional weight loss is associated with clinically relevant benefits for the majority of these health issues. However, the degree of weight loss that must be achieved and sustained to reap these benefits varies widely between comorbidities. Downsides of weight loss that is too rapid and/or extreme may occur, as in the increased risk of gallbladder disease, the presence of excess residual skin, or deterioration in liver histology. Uncertainty also remains about the potential benefit or harm of intentional weight loss on patients presenting with some chronic diseases and on overall mortality. Clearly, well- controlled prospective studies are needed to better understand the natural history of obesity and the impact of weight-management interventions on morbidity, quality of life, and mortality in people living with obesity.”
The is much left to be done and answering some of these questions will become progressively easier as better treatments for obesity become available.
In our exhaustive review of the potential health benefits of intentional long-term weight loss, published in Annual Reviews in Nutrition, I discussed in yesterday’s post, we also noted a number of issues that remain unresolved.
- The precise definition of success in terms of weight loss remains controversial, and the dogmatic assumption that prolonged periods of sustained weight loss (greater than 10 years) are more likely than shorter periods to have a beneficial effect on health out- comes has never been challenged.
- Some evidence suggests that intentional weight loss may lead to meaningful reductions in several conditions, such as COPD, and cancer risk with a short latency time, although data from randomized trials are not yet available to support this hypothesis.
- Future studies on the relationship between long-term weight loss and suicide are needed, especially in diverse populations, subgroups of patients, and those who engage in other long-term weight-loss strategies apart from the use of antiobesity medications and bariatric surgery. The potential relationship between failed weight-loss attempts and suicide ideation needs to be evaluated.
- There is ongoing controversy over the findings from epidemiological studies on the relationship between weight loss and mortality. Data from controlled studies in this regard are very limited.
Clearly, as we discussed at length here at the ongoing Canadian Obesity Network’s Obesity Research Summer School (Boot camp), much remains to be done for young researchers planning a career in this field.
Hard to believe, but this weekend I am off to my 10th annual Canadian Obesity Network Summer Boot Camp – once again in Kananaskis in the Canadian Rockies.
As every year, I look forward to spending 9 days with an enthusiastic bunch of young obesity researchers and professionals as well as my faculty colleagues, who will teach about everything from genetics and molecular biology to public health and clinical management.
More importantly, the intense networking involved in this event, as in the past, should lead to a lasting network of professional friendship across disciplines, research interests and countries.
I am certain that the almost 300 alumni of this camp can attest to how much this experience has influenced their thinking and professional development.
Thanks to all at the Canadian Obesity Network, who make this annual event possible.
According to a study conducted by a team of researchers from the US, Canada, Australia and Iceland, published in Pediatric Obesity, weight-based bullying in children and youth is the most prevalent form of youth bullying in these countries, exceeding by a substantial margin other forms of bullying including race/ethnicity, sexual orientation or religion.
According to the almost 3000 participants in this study, parents, teachers and health professionals were seen as those with the greatest potential of reducing weight-based bullying.
In addition, the majority of participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying.
While these findings may not strike anyone living with obesity as surprising, they should be a reminder to the rest of us that weight-based bullying, with all of its negative consequences for mental, physical and social health, is something to be taken very seriously and needs to be opposed as much as we would oppose any other forms of bullying.