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Surviving Cancer Doesn’t Make You An Oncologist!

sharma-obesity-trust-me-im-a-doctorIn my TEDx talk “How to Lose 50 Pounds and Keep Them Off” released earlier this week, I recommend that people struggling with obesity seek help from a health care professional trained in chronic disease management.

Given that most of what we deal with in medicine is chronic disease, one would imagine that almost any health professional can give competent advice on living with a chronic disease.

Unfortunately, while this may be true for diabetes or hypertension or most of the other common chronic diseases that virtually all health professionals at some time in their careers will have learnt to manage, very few will have any experience at all in treating obesity – let alone even thinking of obesity as a chronic disease.

It is therefore not surprising that when it comes to weight management people often turn to lay “experts” who proclaim themselves as “experts” simply because they have somehow managed to lose weight and are (at least for now) managing to keep it off.

Often, these “experts” (not seldom with the help of a savvy publicist) will launch a lucrative speaking business including authoring self-help books, offering diet/exercise plans, appearing on TV talk shows, endorsing supplements or promoting whatever it is they believe helped them lose their weight.

Unfortunately, as I hear over and over from my patients, these self-proclaimed  “experts” who, having “conquered” their obesity, have now embarked on a mission to help you “conquer” yours, are about as effective as any other commercial fad diet.

This is because, we have long known that in obesity, what works for one person may be entirely ineffective in the next.

Just because you lost weight by following (insert your approach here), does not mean that you have found the Holy Grail of weight management and are now somehow professionally qualified to offer your help to everyone else.

Living with heart disease does not make you cardiologist!

Surviving cancer does not make you an oncologist!

Losing weight does not make you an obesity specialist!

This is not to say that the “patient” experience is not important or that “peer support” cannot be a valuable tool in chronic disease management.

Indeed many successful weight management programs including Taking Off Pounds Sensibly or Weight Watchers rely heavily on “peer support”, in that groups are generally run by lay people who are themselves “affected”.

While this makes a lot of sense, it does not replace the need for a professionally qualified health professional to ensure that all goes well.

Just because you are a member of the local diabetes support group does not mean you no longer need to meet with your diabetes educator or family doctor.

Just because your dearest friend survived a heart attack and is willing to share her experience and support, doesn’t mean you no longer need to see a cardiologist for your own heart problems.

This is an important distinction and should be a warning to not rely too heavily on people peddling their “success stories”.

While it may well of interest to listen and perhaps even examine their suggestions, hoping that what worked for them will work for you, is both shortsighted and can potentially do more harm than good.

Do I wish that all health professionals had a sound understanding of obesity management and are there to support people living with obesity – of course I do.

But I know we are not there yet and it will take time before health professionals begin seeing their role change from simply “recommending weight loss” t0 actually having the expertise and experience required to help patients better manage their weight and health.

@DrSharma
Edmonton, AB

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Obesity As A Chronic Disease Is Not Doom And Gloom

Screen Shot 2016-05-22 at 8.54.34 PMThe last time I checked, my TEDx talk “How To Lose 50 Pounds And Keep Them Off“, had over 3,500 views on its first day!

While that is far from going “viral”, I do admit that it’s a lot more than I expected.

Although the overwhelming response and comments were positive, some viewers appeared frankly disappointed, not to say frustrated by the notion that obesity, once established, behaves like a chronic disease.

This may in part be due to the fact that, despite all evidence to the contrary, many people continue to believe (as suggested by the diet, fitness and weight-loss industry) that “permanent” weight loss is within anyone’s reach (it isn’t) and reaching your “dream weight” means winning the battle (it doesn’t).

But, I also believe that some of the frustration that comes with seeing obesity as a chronic disease for which we have no cure (which happens to be the definition of “chronic disease”), stems from the notion that living with a “disease” is terrifying and hopeless (it isn’t!).

In fact, most of what we deal with in our health care systems are “chronic diseases” – the exceptions being largely limited to accidents, acute infections and some cancers – these we can “cure”, by which I mean that we treat them for a given period of time after which they ceases to exist and the patient can be considered “cured”.

Unfortunately, as important as these “cures” may be, they constitute a rather small proportion of what goes on in the health care system. It is fair to say that for the vast majority of medical conditions, we may have treatments, but most certainly no “cures”.

However, this is not as depressing as it may seem. Indeed, it is one of the great achievements of modern medicine that we have turned diseases that would have been fatal in the not too-distant past (e.g. type 1 diabetes, coronary artery disease, HIV/AIDs, breast cancer), into conditions where, with proper treatments, most patients can enjoy decades of meaningful and productive life, despite living with their “chronic” disease.

Not that the treatments are always easy or cheap or well tolerated – but, when applied and adhered to properly, they generally do their job of allowing patients to go about their lives in a fairly acceptable manner.

So the idea that living with a chronic disease is all doom and gloom is certainly not true – ask anyone living with well-controlled diabetes, hypertension, coronary artery disease or even cancer.

Compared to a lot of these conditions, people living with obesity may well be a lot better off.

For one, while even with the best treatment many chronic diseases tend to get worse over time (take for e.g. chronic kidney disease with progressive loss of kidney function), stopping obesity form progressing (i.e. stopping further weight gain) is actually very achievable. In fact, as shown by the “placebo” groups in most obesity trials, even minimal intervention can help stabilize weight and prevent further weight gain – thus, while you may continue living with obesity, at least we can do a fairly good job of preventing it from getting worse.

Secondly, we have ample evidence that many of the health consequences associated with excess weight will improve with very little or even no weight loss through appropriate interventions that focus on improving mood, self-esteem, sleep, diet and physical activity. We know that with these interventions many people living with obesity will feel a lot healthier and better about themselves – which in the end should really be the principal goal of treating obesity in the first place.

Thirdly, there is hope on the horizon as both medical and surgical treatments for obesity are steadily getting better. Take for example bariatric surgery, which has gone from not too long being a highly invasive procedure ridden with often catastrophic complications in the days of open surgery, to a minimally invasive procedure with surprisingly minor risks and complications (in appropriate hands) with well-documented and often remarkable long-term benefits for health and well-being (not to say that there isn’t further room for improvement).

On the medical front, the last few years have seen the approval of several new obesity drugs, which have been rigorously tested for safety and efficacy in thousands of volunteers in randomised controlled trials. While these drugs may not be for everyone and come with a price tag (that varies from drug-to-drug and country-to-country), they do raise optimism that one day, medical treatment of obesity will be no more (or less) routine than treating diabetes, hypertension or any of the other many chronic diseases where long-term medical treatment is well established.

So, the notion that just because obesity is a chronic disease somehow means that all hope is lost, is simply nonsense.

Yes, the idea of thinking of of obesity as a “disease” may not sit well with everyone, especially with the minority of people, who happen to meet the BMI criteria for obesity but appear in perfect health – I do understand that for this minority, we do need a better definition of obesity that is not based on BMI and the Edmonton Obesity Staging System is certainly a start.

But for the vast majority of people with obesity (Stage 1-4), who do experience (or will experience) the health consequences of obesity, we can certainly do a better job of serving them, by looking at their obesity as a chronic disease rather than a “problem” that can be easily “fixed” by simply telling them to “eat less and move more”.

We know a lot about managing chronic diseases – we do this all the time.

It is now time to apply that knowledge to the benefit our patients living with obesity.

They deserve no less.

@DrSharma
Edmonton, AB

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May 21 Is European Obesity Day

obesity dayHere an announcement/reminder for my readers in Europe:

Please support European Obesity Day

European Obesity Day (EOD) takes place this coming Saturday, 21 May, and is aimed at raising awareness and increasing knowledge about obesity and the many other diseases on which it impacts.

EOD is a major annual initiative for the European Association for the Study of Obesity (EASO) and so would like to ask you to support the activities by joining in the conversation on social media. It will help us to reach more of the policymakers, politicians, healthcare professionals, patients and the media who we are targeting with important messages about the need to take obesity more seriously.

There are several ways you can show your support:

Like the European Obesity Facebook Page

Follow EOD on Twitter @EOD2016

Join the conversations on twitter using the hashtag #EOD2016

Pledge your support on the European Obesity Day website

Visit the EOD website to see what we have been doing

Encourage your friends and colleagues to support us too

In line with the Action for a Healthier Future theme for EOD 2016, we hope we can count on your support.

@DrSharma
Edmonton, AB

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Developing A Research Agenda In Weight Bias

sharma-obesity-weight-bias-conduit1Last year, the Canadian Obesity Network and the Werklund School of Education and departments of Psychology and Community Health Sciences at the University of Calgary co-hosted the 2nd Canadian Summit on Weight Bias and Discrimination in Calgary, AB.

The proceedings of this two-day summit, which was attended by 40 invitees representing education, healthcare, and public policy sectors in Alberta, British Columbia, and Ontario are now published in OBESITY.

The 40 attendees included 14 researchers, 11 practitioners, and 15 policy makers, although some participants represented multiple perspectives.

On the first day, speakers from across Canada presented their research on the prevalence and consequences of weight bias, as well as on interventions to reduce weight bias in the education, healthcare, and public policy arenas.

These daytime sessions concluded with an evening public outreach event in the form of an expert round table titled “Fear of Fat: Promoting health in a fat phobic culture” at a local community center with 100 attendees.

The second day consisted of a round table of facilitated discussions to identify what research question(s), if answered, would make the greatest impact on weight bias reduction efforts in Canada.

The key outcome from these deliberations include the identification of six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination.

It also became evident that progress in this field requires attention to three key issues: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included.

A 3rd Summit on Weight Bias and Discrimination that will build on the learning form the previous workshop will be held in Edmonton, May 26-27, 2016.

It will be interesting to see what progress has been made in field since the last meeting in 2015.

@DrSharma
Edmonton, AB

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Hands-On Obesity Training in The Bariatric Simulation Suite, Edmonton, May 24, 2016

bariatric patient in bedLater this month, the Canadian Obesity Network, in partnership with the University of Alberta’s Health Sciences Education and Research Commons, will once again be offering its one-day, intensive hands-on Obesity Certification Program for health professionals.

As on previous occasions, this course offers an immersive educational experience on practical aspects of obesity management and the role of interprofessional bariatric care.

The practical course provides a hands-on  learning experience with standardised patients and includes experiential learning  in challenges people living with obesity face in their home and clinical settings.

These include exercises in the Bariatric Speciality Care Suite and Smart Condo.

Group size is limited, but a few spots remain.

More information is available here.

@DrSharma
Vancouver, BC

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