Wednesday, July 23, 2014

In Memorium: Albert (Mickey) J Stunkard

Stunkard twinsAs I spend my days at the 9th Canadian Obesity Network’s Summer Bootcamp for young trainees from Canada and around the world, I was saddened to learn of the passing of Mickey Stunkard, clearly one of the biggest names in obesity research – at a healthy age of 92.

With well over 500 publications to his name, Mickey is perhaps best known for his twin studies showing that the body weight of adopted identical twins reared apart resembles each other and that of their biological parents rather than the weight of their adoptive parents.

This work helped establish the basis for much of the genetic work on obesity that followed, clearly showing that differences in body weight between two individuals are much more accounted for by their difference in genetics than by differences in their “lifestyles”.

These findings were often misused in “nature vs. nurture” debates, an issue that serious scientists have long laid to rest in light of our current understanding that the two cannot be discussed separately, simply because genes and lifestyle interact on virtually every level – from molecules, to cells, to behaviours.

Here is what one obituary had to say about Mickey:

“He surveyed obesity treatment studies in the late ’50s and found that the nation’s diet programs could claim only a 2 percent success rate. He was an early advocate for the use of bariatric surgery to induce weight loss. He also published the first modern account of binge eating in obese individuals.”

I have had to pleasure to often hear him speak at conferences.

He will be dearly remembered.

@DrSharma
Kananaskis, AB

 

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Tuesday, July 22, 2014

9th Annual Canadian Obesity Network Obesity Research Bootcamp

CON Bootcamp 2014As regular readers will be well aware, each year I attend the Canadian Obesity Network’s Obesity Research Bootcamp, an intense 10-day course for hand-picked young obesity researchers from Canada and around the world.

This year the trainees from Canada (13), Germany (8), Argentina (3), Chile (1), Malaysia (2), Peru (1), Spain (1), USA (1) come from a wide range of research areas – from molecular genetics to health psychology.

Following the opening address by Philip Sherman, Director of the Canadian Institutes of Heath Institute for Nutrition, Metabolism and Diabetes (CIHR-INMD), the course began yesterday with small-group learning sessions on defining and measuring obesity (Ian Jannsen, Queen’s University), weight bias and discrimination (Mary Forhan, University of Alberta), mental health issues (Valerie Taylor, University of Toronto), and energy balance (Eric Ducet, University of Ottawa).

These were complemented by presentations from the trainees on their own work and journal-club style discussion of key papers on relevant issues.

Not least, the camp also encourages networking and discussions that push the trainees to remarkably broaden their perspective on obesity.

I certainly look forward to an intense week at bootcamp.

@DrSharma
Kananaskis, AB

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Thursday, June 26, 2014

Guidelines for Managing Overweight and Obesity in Adults

the obesity societyRegular readers may recall a previous post on guidelines on obesity management released by The Obesity Society (TOS) together with other organisations, including the American Heart Association and the American College of Cardiology, at Obesity Week in Atlanta last year (2013).

The bottom line, as I have blogged before, was the revelation of just how little we actually know about obesity.

For what it is worth, the complete guidelines are now published as a supplement to its July issue of the Obesity journal (Guidelines (2013) for Managing Overweight and Obesity in Adults: Full Report).

According to The Obesity Society’s press release,

TOS is investing in the improved treatment of obesity by making the full guidelines available in print so they can serve as a go-to resource for health practitioners around the world. Whether you are a physician, nurse, nutritionist or fitness trainer, every professional interacting with individuals with obesity can find value in this insightful treatment guide.

No doubt, a tremendous amount of work went into developing these guidelines – whether they will substantially change practice remains to be seen.

@DrSharma
Vancouver, BC

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Friday, June 20, 2014

Your Body Thinks Obesity Is A Disease

sharma-obesity-adipose-tissue-macrophageYesterday, the 4th National Obesity Student Summit (#COSM2014) featured a debate on the issue of whether or not obesity should be considered a disease.

Personally, I am not a friend of such “debates”, as the proponents are forced to take rather one-sided positions that may not reflect their own more balanced and nuanced opinions.

Nevertheless, the four participants in this “structured” debate, Drs. Sharon Kirkpatrick and Samantha Meyer on the “con” team and Drs. John Mielke and Russell Tupling on the “pro” team (all from the University of Waterloo) valiantly defended their assigned positions.

While the arguments on the “con” side suggested that “medicalising” obesity would detract attention from a greater focus prevention while cementing the status quo and feeding into the arms of the medical-industrial complex, the “pro” side argued for better access to treatments (which should not hinder efforts at prevention).

But a most interesting view on this was presented by Tupling, who suggested that we only have to look as far as the body’s own response to excess body fat (specifically visceral fat) to determine whether or not obesity is a disease.

As he pointed out, the body’s own immunological pro-inflammatory response to excess body fat, a generic biological response that the body uses to deal with other “diseases” (whether acute or chronic) should establish that the body clearly views this condition as a disease.

Of course, as readers are well aware, this may not always be the case – in fact, the state of “healthy obesity” is characterized by this lack of immunological response both locally within the fat tissue as well as systemically.

Obviously, it will be of interest to figure out why some bodies respond to obesity as a disease and others don’t – but from this perspective, the vast majority of people with excess weight are in a “diseased” state – at least if you asked their bodies.

While this is a very biological argument for the case – it is indeed a very insightful one: it is not the existence of excess body fat that defines the “disease” rather, how the body responds to this “excess” is what makes you sick.

As readers, are well aware, there are several other arguments (including ethical and utilitarian considerations) that favour the growing consensus on viewing obesity as a disease.

Of course,  calling obesity a disease should not detract us from prevention efforts, but, as I often point out, just because be treat diabetes or cancer as diseases, does not mean that we do not make efforts to prevent them.

If calling obesity a disease increases resources towards better dealing with this problem and helps take away some of the shame and blame – so be it.

@DrSharma
Waterloo, Ontario

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Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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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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