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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Tuesday, March 25, 2014

Challenges in Pediatric Obesity Management

sharma-obesity-kids-scale2If treating obesity in adults is challenging, managing obesity in kids is even more daunting.

Now, a seminal paper by Jill Avis and colleagues (representing a virtual who-is-who of pediatric obesity management in Canada), published in Expert Reviews in Diabetes and Metabolism, with the fitting title, “It’s like rocket science…only more complex“, explores the many challenges in pediatric obesity management in Canada.

The thoughts and analyses presented in this narrative review are largely based on the responses to a national survey of folks providing pediatric “weight-management” services across Canada. Responses were sought to a range of questions, including:

In regards to managing pediatric obesity in Canada, what lessons have you learned related to: Caring for children?; Collaborating with clinicians and/or researchers?; and Working within the health care system? In addition, what do you consider to be important future directions for clinical care and research in Canada?

Apart from noting the importance and challenges of adopting a family centred approach, the paper highlights the importance of factors that go well beyond “eat-less-move-more” platitudes.

Thus, the authors note that,

“Internalizing (e.g., anxiety, depression) and externalizing (e.g., hyperactivity, aggression) disorders are common in children and adolescents with obesity, which can make management strategies more difficult to implement…..these realities highlight the need for mental health professionals to assume active roles in pediatric obesity management to explore, identify and manage families’ unique mental health concerns.”

With regard to the importance of weight bias, the authors state,

“Many parents in our care have experienced shame and blame from other family members, friends, coworkers and health professionals regarding the weight status of their children….The underlying assumption in this instance is that individuals with obesity just need to eat less and move more….a sentiment that demonstrates a lack of understanding and empathy.”

Thus,

” There is a clear need to shift from a singular focus on physical weight status to define the health of individuals with obesity to a nonjudgmental and unbiased appreciation of the complex causes and consequences
of obesity.”

Despite all efforts, the authors describe the outcomes of childhood obesity interventions as “modest”.

This has prompted a number of collaborative research initiatives including the Canadian Pediatric Weight Management Registry (CANPWR), the Should I Stay or Should I Go study and (in partnership with the Canadian Obesity Network) the development of a national network called Treatment and Research of Obesity in Pediatrics in Canada (TROPIC), whose purpose is to promote knowledge translation and dissemination of issues related to pediatric obesity management in Canada.

All of these activities demonstrate a high degree of collaboration and coordination among the pediatric obesity management community in Canada.

The paper also addresses the challenges of providing childhood obesity management services within the health care systems (which vary across provinces).

“…there is substantial heterogeneity across the multidisciplinary clinics we lead and work within; some are well-resourced (i.e., physical space, clinical, and administrative personnel), while others struggle with limited budgets to provide comprehensive and long-term care for families.”

“…relatively small numbers of patients (compared with other outpatient pediatric clinics [e.g.,general pediatrics]) and a lack of substantial weight loss for most children and adolescents with obesity…necessitate education, contextualization and justification to colleagues and administrators within the health care system so that obesity is viewed not as a simple problem that requires a quick fix in order to achieve weight loss, but as a chronic disease that requires ongoing support and management.”

Important work to aid clinicians include the adaptation of the Edmonton Obesity Staging System for pediatric populations (EOSS-P), the family centred adaptation of the 5As of Obesity Management for managing pediatric obesity in primary care, and CONversation cards, a tool to facilitate discussions between clinicians, parents and kids on issues related to healthy lifestyle changes.

Finally, the paper discusses the many barriers to accessing timely obesity management including costs (travel, parking, time off work), geography (distances) and wait times.

Clearly, despite all progress, significant challenges remain to be addressed – “it’s like rocket science…only more complex.”

@DrSharma
Edmonton, AB

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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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