Wednesday, April 16, 2014

Shame And Blame Has No Role In Addressing Obesity

Balancing the scales Kirk et alAs a regular reader you will be well aware of my recent excursions into the use of comedy to promote a better public understanding of obesity.

A very different (and I dare say more scientific) approach to harnessing the performing arts to promote a discourse on obesity is that taken by Sara Kirk and colleagues, Balancing The Scales, now described in a paper published in Qualitative Health Research.

Their approach is based on the recognition that,

“…individuals living with obesity are caught in the middle, facing judgment by society if they fail to manage their weight successfully and exposing themselves to health professionals who are unable to fully support them…if an individual is unable to make the changes prescribed for weight loss, resentment builds on both sides of the therapeutic relationship.”

This led Kirk and colleagues to extensively explore the issue of obesity from a variety of perspectives resulting in rather unique insights into similarities, differences, points of consensus, and tension associated with values, beliefs, perceptions, and practices among key stakeholders.

The 42 semistructured interviews were conducted in 22 individuals living with obesity, 4 policy makers, and 16 health professionals (8 dietitians, 4 family physicians, and 4 nurses).

Three major themes emerged from the analysis of the interviews:

Blame as a Devastating Relation of Power

“Individuals living with obesity shared feelings of shame and embarrassment with their inability to control their weight on their own. This blaming discourse can easily be seen in messages of “eat less, move more” promoted by health professionals, the health system, and wider society.”

“Individuals living with obesity spoke about the complexities of trying to lose weight, inclusive of cultural, social, and organizational barriers. Despite this insight, however, they placed the final explanation for their weight status on themselves and expressed immense feelings of guilt and shame.”

“All of the individuals living with obesity had tried multiple methods to manage their weight, with limited or no success. This was extremely frustrating for them and compounded their tendency, wholly or at least partially, to blame themselves for this perceived failure.”

“Similar to individuals living with obesity, health professionals struggled to understand the complexity of the issue, which often led to blaming the individual. Health professionals commented on the unrealistic expectations of people who wanted to lose weight quickly and how their role as a health professional could not possibly be supportive of this.”

“The health professionals we interviewed also blamed themselves for not having the answers, and described feeling ill-equipped to assist individuals to make successful changes.”

Tensions in Obesity Management and Prevention

“Both the individuals living with obesity and the health professionals did not feel supported by the health care system. Health professionals [and policy makers] also struggled to know how to approach the issue.”

“Individuals living with obesity also experienced exclusion when attempting to find appropriate support within the health care system. Most individuals in the study began to access this system when they believed they could no longer manage their weight by themselves.”

The Prevailing Medical Management Discourse

“Health professionals experienced many frustrations and contradictions in their experiences with obesity management, and at times questioned the notion of obesity as a disease. Being obese was often in itself not enough to receive health care. Health professionals in this study found it easier to work with individuals living with obesity when they also had another diagnosed chronic condition, such as diabetes or cardiovascular disease. They could then more confidently prescribe a specific treatment regime.”

As for policy makers,

“[One] policy maker questioned whether medical treatment for individuals living with obesity is necessary…. As an alternative to medicalizing obesity, the policy maker suggested addressing the issue of population health and using health promotion to support the majority of people who are not morbidly obese but are still struggling with weight problems.”

“Overall, individuals living with obesity sought validation for requiring support in a system that currently does not provide the support they need.”

Based on these findings, the authors note that,

“…our findings highlight the need to reframe the public debate on obesity. However, we suggest that rather than choosing one discourse over another (management vs. prevention; system vs. individual), we should engage aspects of both. This requires not only consideration of socioecological perspectives, but also a greater awareness among health professionals of the need to offer support, not advice.”

“Furthermore, relationships between patients and health care providers should be supportive (not blaming), recognizing the widespread prevalence of weight bias in society and working hard to challenge the stereotypes that dominate the discourse on body weight”

“It was also evident in the language and experiences provided by health care providers that training, resources, and support for weight management were a substantive part neither of their professional training nor of the health care system.”

To facilitate improved training of health professionals, the authors have developed the rich narratives obtained in this study into a dramatic presentation, depicting the relationship between a health professional and an individual living with obesity.

This narrative can be viewed here.

For interviews with the researchers – click here.

Clearly, it is work like this that is essential to understanding the current discourse (or rather lack of it) about obesity and finding strategies that do justice to those living with obesity.

There is simply no room for “shame and blame” in such a discourse.

@DrSharma
Edmonton, AB

ResearchBlogging.orgKirk SF, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, Vallis TM, Curran J, & Aston M (2014). Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management. Qualitative health research PMID: 24728109

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Tuesday, April 15, 2014

Energetic Offerings From Alabama

David Allison, PhD, Distinguished Professor, University of Alabama

David Allison, PhD, Distinguished Professor, University of Alabama

This week, I am paying a brief visit to my friend and colleague David Allison at the University of Alabama at Birmingham (UAB).

To those working in the field, David needs no introduction. He is certainly one of the most prolific researchers with hundreds of high-ranking papers covering an astonishing array of topics.

As some readers may recall, David was also instrumental in helping us validate the Edmonton Obesity Staging System in the NHANES population.

During my visit I will have the opportunity of meeting with several of his esteemed colleagues and will certainly leave with a number of stimulating insights into the obesity work happening here in Birmingham.

These are delivered weekly from David’s group in a compilation fittingly called Obesity and Energetics Offerings from the UAB Nutrition & Obesity Research Centre (NORC) – to subscribe to this newsletter click here.

@DrSharma
Birmingham, AL

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Thursday, April 10, 2014

Managing Weight Loss Expectations

sharma-obesity-great-expectationsWhile there are almost no limits to short-term weight loss goals (anyone can starve themselves thin) – the reality of long-term weight loss is rather sobering.

While diet and exercise generally provide an average long-term (3-5 years) sustainable weight loss or about 3-5% of initial weight, even bariatric surgery patients tend on average to sustain a weight loss of only 20-30% of their initial weight.

Surgery, although much safer than generally thought, still bears a risk of complications and the question is how much risk patients are willing to assume if they really knew and understood how much weight they are likely to lose with surgery.

This was the subject of a study by Christina Wee and colleagues, published in JAMA Surgery, in which they examined weight loss expectations and willingness to accept risk among patients seeking bariatric surgery.

The researchers interviews 650 patients interested in bariatric surgery at two bariatric centres in Boston.

On average, patients expected to lose as much as 38% of their weight after surgery and expressed disappointment if they did not lose at least 26%.

In fact, 40% of patients were unwilling to undergo a treatment that would result in only 20% weight loss.

Most patients (85%) accepted some risk of dying to undergo surgery, but the median acceptable risk was only 0.1%.

On the other hand, some patients (20%) appeared more desperate, willing to accept a risk of 10% or greater.

As one may expect, there were important gender differences in these findings: while women were more likely than men to be disappointed with a 20% weight loss, they were also less likely to accept a greater mortality risk.

An important finding for clinicians was that patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve “any” health benefits were more likely to have unrealistic weight loss expectations.

This study not only shows that most patients seeking bariatric surgery have rather unrealistic weight loss expectations but also that   a substantial number may well be be disappointed with their weight loss after surgery.

It is also evident that many patients believe that they need to lose a rather substantial amount of weight to derive “ANY” health benefits, when in reality even rather modest (and certainly the average 20-30% weight loss seen with surgery) carries substantial health benefits for patients. (Many patients would in fact benefit substantially if they simply stopped gaining weight).

I certainly wonder what educational efforts may be necessary to align expectations with the clinical reality of bariatric surgery and whether better managing expectations is likely to alter current practice?

@DrSharma
Edmonton, AB

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Tuesday, April 8, 2014

Join The Crowd: Support Pom Pom – A Flightless Bully Tale

Screen Shot 2014-04-07 at 1.13.00 PMThis week, my daughter’s crowdsourcing campaign to fund her second children’s book Pom Pom – A Flightless Bully Tale (her first one was Our Canadian Lovestory) is in its final stages – only 5 days left to meet her funding goal (over 85% there).

Please visit her site and join the “crowd” of 250 supporters to secure your very own personal copy(s) of this delightful anti-bullying children’s book (will make a great Christmas gift for your kids or grandkids – there are also school packages available for your local school library).

To visit the crowdsourcing site click here.

To hear Linnie read her story click here.

Thank you for helping her cross the finish line!

@ProudDad
Saskatoon, SK

 

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Friday, March 28, 2014

Why Watching Your Kid’s Media Use May Affect Their Weight

sharma-obesity-family-watching-tvElectronic media consumption has been linked to childhood obesity – but does monitoring your kid’s media use affect their body weight?

This question was now addressed by Tiberio and colleagues in a paper published in JAMA Pediatrics.

The researchers examined longitudinal data from a community sample in the US Pacific Northwest that indluced 112 mothers, 103 fathers and their 213 kids aged five to nine years old.

The data included what parents reported on their general monitoring of their children (whereabouts and activities), specific monitoring of child media exposure, children’s participation in sports and recreational activities, children’s media time (hours per week), household annual income, and educational level as well as parental BMI was recorded.

It turns out that maternal (but not paternal) reports of monitoring their kid’s media exposure was associated with lower BMI z scores at age seven as well as less weight gain between five and seven years of age.

These findings remained significant even after adjustment for several other variables including total media time as well as sports and recreational activities.

From these findings, the authors conclude that,

Parental behaviors related to children’s media consumption may have long-term effects on children’s BMI in middle childhood.

And that these finding,

“…underscore the importance of targeting parental media monitoring in efforts to prevent childhood obesity.”

I would not go quite that far for several reasons.

Firstly, associations do not prove causation. In addition, we don’t know much about other aspects of parenting style from this study that may well also have impacted body weight.

Thus, we could well speculate that moms who monitor their kid’s media consumption may also be more adamant about bed times, healthy eating, or even just spending more time talking to or listening to their kids – all of which may well have positive effects on their kid’s weight.

This is why simply getting parents to be stricter about monitoring their kid’s media consumption may not result in better weights at all.

As always, I  find it disconcerting when epidemiological data is used to predict what may or may not happen when interventions target a proposed “cause”.

Nevertheless, for anyone interested in this topic, the following event may be of interest:

Details:

On May 1, 2014 the Alberta Teachers’ Association, in partnership with the Alberta Centre for Child, Family and Community Research, is pleased to invite Dr. Michael Rich and Dr. Valerie Steeves to Edmonton for a discussion on how technology is impacting children, youth and society. This is a continuation of our series of evening public lectures with world renowned and distinguished speakers that has included Sir Ken Robinson, Sherry Turkle, Yong Zhao, Jean Twenge, and Carl Honore.

Dr. Valerie Steeves, Associate Professor, University of Ottawa, and principal investigator of the largest Canadian research study on children & teens’ online habits.

Young Canadians in a Wired World (2013) – Explore the highlights of Dr. Steeves’ pioneering Canadian research on children & teens’ online habits.

Ø  Cyberbullying: Dealing with Online Meanness, Cruelty and Threats

Ø  Online Privacy, Online Publicity 

Ø  Life Online

Dr. Michael Rich, Associate Professor of Pediatrics at Harvard Medical School and Associate Professor of Society, Human Development, and Health at Harvard School of Public Health, Boston, United States.

Ø Centre on Media and Child Health – Explore Dr. Rich’s extensive work on behalf of Children’s Hospital Boston, Harvard Medical School and the Harvard School of Public Health:

Ø CBC national panel discussion on Youth and Technology (February 2014):

Ø Ask the “Mediatrician” a question

There will also be a public lecture on Thursday evening May 1, 2014 entitled “Connected or Disconnected? Technology and Canadian Youth”.

Who: Dr. Michael Rich (Harvard University) and Dr. Valerie Steeves (University of Ottawa)

When: Thursday Evening, May 1, 2014

Where: Barnett House, Alberta Teachers’ Association, 11010 – 142 street NW Edmonton, Alberta

•6:00 pm Registration and reception (hors d’oeuvre and no host bar)

•7:00 pm to 9:30 pm Public lectures and discussions

Order Tickets ($10) Online at http://www.event-wizard.com/promiseperil2014/0/register/

For further information or any questions about this event please email karin.champion@ata.ab.ca or call 1-800-232-7208.

@DrSharma
Edmonton, AB

ResearchBlogging.orgTiberio SS, Kerr DC, Capaldi DM, Pears KC, Kim HK, & Nowicka P (2014). Parental Monitoring of Children’s Media Consumption: The Long-term Influences on Body Mass Index in Children. JAMA pediatrics PMID: 24638968

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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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