Monday, November 17, 2014

Obesity Myth: Obesity Is Caused By Simply Eating Too Much And Not Moving Enough

sharma-obesity-caloric-balance1In the latest issue of Canadian Family Physician, my colleagues JP Chaput, Zach Ferraro,Denis Prud’homme and I briefly address common myths about obesity.

Here is what we had to say about the commonly held notion that obesity is just about eating too much and/or not moving enough:

“Unhealthy diet and physical inactivity are the “big 2” on which almost all preventive and therapeutic programs for obesity are focused, thereby neglecting other possible contributors to excess body weight. Although intuitively appealing, clear evidence (eg, individual-level epidemiologic data and randomized experiments) beyond ecological correlations is lacking for the big 2.

Many other putative contributors to the increase in obesity (eg, insufficient sleep, psychological stress, endocrine disruptors, medications, intrauterine and intergenerational effects, etc) have supportive evidence that is as compelling as, if not more compelling than, the evidence for the big 2.

These nontraditional or new determinants of obesity influence energy input and output; overeating and reduced energy expenditure are perceived as “symptoms” and not as the root causes of the excess weight.

On the treatment side, an accumulating body of evidence shows that insufficient sleep can impede weight loss and addressing sleep for weight management has recently been endorsed by the Canadian Obesity Network.

Overall, accumulating evidence suggests that health practitioners and clinicians might need to consider a broader range of influential factors (eg, medications, lack of time, psychological stress, fatigue, chronic pain) to adequately identify and address the key factors responsible for the patient’s obesity, which is likely a clinical sign of chronic caloric “retention” (similar to edema being a clinical sign of fluid “retention”). This will enable health practitioners and clinicians to develop a personalized framework that addresses the root causes of patients’ weight gain.

Physicians must move beyond the simplistic and generally ineffective recommendation to “eat less and move more” by investigating and addressing the determinants of increased energy intake, decreased metabolic rate, and reduced activity.”

@DrSharma
Edmonton, AB

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Thursday, November 13, 2014

8 Ways In Which Nephrology Prepared Me For Bariatric Medicine

230px-Patient_receiving_dialysis_03Last night I gave McMaster University’s Karl E. Stobbe lecture on obesity management in St. Catherines, Ontario.

A commonly asked question is how my training in internal medicine and nephrology brought me to obesity.

While that story is rather simple (many problems in nephrology are related to people’s excess weight), the far more interesting aspect of this is how, over the years, I have realised how perfectly my experience in nephrology, especially working with patients who have chronic kidney disease, prepared me for my current work in bariatric medicine.

Here are some of the more salient reasons:

1) Both obesity and chronic kidney disease are complex often life-long disorders that can affect every aspect of a patients health and well-being.

2) Both necessitate a long-term (lifelong) management approach that must address both the underlying drivers as well as the health consequences of the problem as well as prevent further progression (whenever possible).

3) Both are best delivered in the context of multi-disciplinary care involving nurses, dietitians, physiotherapists, occupational therapists, social workers, mental health workers and many other allied health professionals.

4) Nephrologists are often the only doctors that patients with kidney failure see regularly  – this means that they have to deal with all aspects of patient care – both minor and major, not unlike family doctors. Indeed, nephrologists are often functioning as the “family docs” of their patients on dialysis.

5) Patients with kidney disease present with a wide range of health problems – cardiovascular, metabolic, infectious, auto-immune, respiratory, gastrointestinal, musculoskeletal, nutritional, and virtually every other kind of disease, including mental health problems.

6) Nephrologist often have to be aware of and help manage the many psychosocial problems that their patients can present with.

7) Nutrition plays a very significant role in  managing patients with kidney disease, especially in patients on dialysis. Management of macro and micronutrients is something nephrologists have to deal with on a daily basis whether it is protein intake, minerals (e.g. sodium, potassium, calcium, iron, etc.) or vitamins (e.g. Vit D, or water-soluble vitamins like B complex or Vitamin C).

8) Obsessing about body composition, fluid balance, sarcopenia and nutrition are all standard issues that nephrologists are trained to worry about.

I would not have know just how valuable my training in nephrology would have been for my current practice – but looking back, I don’t think I could have been better prepared for the challenges of bariatric medicine.

@DrSharma
Toronto, ON

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Wednesday, November 12, 2014

5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

@DrSharma
Ottawa, ON

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Thursday, November 6, 2014

STOP Obesity Alliance Guide to Discussing Health and Weight

STOPObesityAlliance-logoYesterday, at Obesity Week, the Strategies To Overcome and Prevent (STOP) Obesity Alliance released a guide for health professionals seeking to discuss obesity and health with their patients.

As readers are aware, weight is a complex and sensitive issue, and conversations about weight can be challenging, not least because such discussions, when done inappropriately, can promote feelings of failure, shame, and a sense of being judged by the health care provider.

Thus, the discussion tool focuses on skills for building a safe and trusting environment with patients to facilitate open and productive conversations with patients.

In principle, the issues discussed in the tool are very similar to the approach taken in the Canadian Obesity Network’s 5As of Obesity Management.

The tool addresses patient accommodation, building trust, beginning a conversation, adressing readiness, the use of people-first language, as well as goal setting and support.

There is a special mention of how to deal with patients who have experienced trauma as well as a discussion about providers who may have concerns about their own weight.

Finally, the guide also provides a list of links to additional resources that health care practitioners may find helpful in advising and working with their patients.

To visit the STOP Obesity Alliance – click here

@DrSharma
Boston, MA

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Friday, October 31, 2014

German TV Looks At Healthy Obesity

Arya Sharma on bike 3SATRegular readers will be familiar with the fact that not all people with excess weight necessarily have health problems. Now, the 3SAT television channel, which broadcasts in Germany, Austria and Switzerland has produced a 45 minute documentary on the science behind these findings.

Although the film is in German, I thought I would post the link anyway as many of my readers may well be able to grasp the story even if they are not entirely fluent.

To watch the documentary on line click here.

Incidentally, I am featured about 2.5 minutes into the film, discussing the Edmonton Obesity Staging System and related issues.

Appreciate all comments.

@DrSharma
Toronto, ON

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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

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