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Leaders Have To Understand, Accommodate, Embrace & Support Diversity

The Right Honourable Kim Campbell, PC, CC, OBC, QC, with Arya M. Sharma, MD, FRCPC

The Right Honourable Kim Campbell, PC, CC, OBC, QC, with Arya M. Sharma, MD, FRCPC

Earlier this week, I spoke at a leadership lecture series on barriers to participation at the Peter Lougheed Leadership College at the University of Alberta.

The speaker series was hosted by the principal of the college,the Right Honourable Kim Campbell, who served as Canada’s 19th prime minister in 1993.

While I spoke about the particular challenges and barriers faced by Canadians living with obesity and how these can be accommodated and supported in the workplace and society in general, other speakers spoke on the accommodation of individuals living with other challenges.

Thus, Kelly Falardeau, herself a victim and advocate for burn survivors and Deryk Beal, one of Canada’s  leading clinician scientists on stuttering and other speech impediments, joined me in speaking on the importance of diversity and the need to identify obstacles to social inclusion that keep individuals from reaching their full potential.

In my presentation I did my best to portray the biological, physical, emotional and societal challenges that Canadians living with obesity face everyday.

Here is what I asked the students to think about:

“So how can we help people living with such barriers?

For one, let us educate ourselves on the real issues – if there was an easy solution that actually worked, believe me my clinic would be empty.

Secondly, let us show some respect for people who wake up with this barrier every single morning and go through their day – for the most part doing everything everyone else does. 

Thirdly, let us acknowledge that once you have obesity there is no easy way back. I have patients who have lost their entire weight over on diet after diet after diet only to put the weight back again. Diet and exercise is simply not enough for most people – surgery works but is not available and not scalable – we cannot do surgery on 120,000 Albertans. So let us not pretend that there is an easy solution to the problem – we simply don’t have enough treatments that work.

Fourthly, till we do come up with more treatments that actually work or maybe even get our act together on prevention, let us not make life harder for people living with this barrier than it has to be. We can do many things to accommodate people living with obesity – we accommodate people with all kinds of “special needs” at home, in society in the workplace – just not for people living with obesity.

Fifth, let us show our support for people who struggle with their weight by the way we treat them, the way we talk about them, the way we engage with them – they are people like all of us. Just because they carry extra weight does not mean they are second class citizens or people we can simply make fun of or ignore – we are after all talking about 7 million Canadians – men, women and children.

Let us not be the barrier that makes their life even more difficult than it already is.”

Our presentations were followed by an enthusiastic ‘master class’ with students in the inaugural leadership class of the Peter Lougheed Leadership College.

I’d like to thank the organizers for giving me the opportunity to advocate on behalf of Canadians living with obesity.

Edmonton, AB

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Why Disclosure Statements Are Meaningless

t_journals1On a regular basis, whether it is for papers I write, conferences I speak at, or committees I sit on, I am deluged by “Conflict of Interest Declaration Forms” that seemingly require more personal information than my annual tax return.

The goal of all of this, apparently, is to provide “transparency”, so that the respective audience can judge the objectivity (or lack thereof) of my work based on whether or not I may or may not have a percieived “conflict of interest”.

In my humble opinion, this is an entirely irrelevant and useless exercise, which does nothing to actually ensure objectivity in how my work or actions are interpreted or perceived.

Yesterday’s post was meant to illustrate how non-declared “conflicts of interest” may be as (if not more) relevant to a real or perceived conflict than whether or not I have consulted for a company or received research funding from industry (or, for that matter, any other interest group – by definition an “interest group” is interested in the outcome of where its money goes  – no group that I am aware of is giving away free handouts).

Consider the issue of peer review. Although hardly perfect, the whole purpose of the time-honoured peer-review process is to allow knowledgeable peers to evaluate the scientific merit of a paper. It is their job to fairly evaluate the paper to the best of their ability: Is the topic important? Is the hypothesis relevant? Is the methodology valid? Are the proper statistical tests applied? Are the full data presented? Are the findings interpreted cautiously (and not overstated)? Are limitations acknowledged?

These are the questions that count – in fact, they are the only questions that count. Who funded the study, or what the personal relationship of the authors were to the funding source, is entirely irrelevant – all funders pursue goals, whether commercial, political, or ideological – who cares?

If the paper meets the scientific standards required by the journal (and we assume here that higher impact journals have higher standards and do a more thorough job of vetting all of the relevant aspects of a paper), the funding source should be irrelevant – if the study is well conducted, the findings should stand on their own merit. If anyone does not believe the data or findings or interpretations, they are welcome to disagree – but their criticism should be based on scientific arguments – not just by pointing fingers at the funding source (or ad hominem attacks on the authors).

If any serious doubts do arise about any of the above questions (e.g. methodology, analysis, interpretation, etc.), it is up to the reviewers and editors to either request clarification or to reject (or even retract) the paper. After all, that is what the whole notion of peer-review is about.

So what about the argument that industry funded studies are more likely to report positive findings than other research and should therefore be taken with a grain of salt?

I can think of several possible explanations including the simple fact that no industry that wants to stay in business is likely to fund a trial where there is not at least a fighting chance of having a favourable result.

I am therefore not at all surprised that industry often goes to great lengths to perform due diligence regarding what trials to fund (often more so than some peer-review committees I have sat on) in the hope for a “positive” outcome. Studies that don’t stand a fair chance of producing positive findings is not where industry is likely to (or can be reasonably expected to) put its money. This, however, is not the same as saying that the data or the study (or the investigators) are somehow manipulated to produce positive results – that would be outright scientific fraud.

So rather than wondering about why industry funded studies so often tend to be favourable, I am in fact surprised every time this “biased” funding by industry does leads to results that are far from favourable (or even damaging) to the sponsor (for e.g. I just happened to be one of the PIs of a 10,000 patient study on a an anti-obesity drug, which showed this drug to modestly increase the risk for non-fatal cardiovascular events, a finding which led to the drug being taken off all markets worldwide – hardly a result that the sponsor (who footed the cost of almost $200 million for the trial) wanted to see).

Every researcher I know would like to see their study confirm their favourite hypothesis (or rather discard the null-hypothesis) – the funding source has nothing to do with this – the rewards of a positive finding are evident: high-impact publications, peer-recognition, media interest, promotion, tenure, and funding for yet more studies. I have yet to meet a “successful” researcher who has build a career on a track record of “negative” studies.

But peer-review is not the only mechanism that provides checks and balances. Clinical trials have to be registered, study protocols have to be vetted by ethics committees, good clinical practice guidelines need to be followed, sites are monitored (including random and targeted checks by regulators), primary data sources have to be archived, raw data may have to be made available to the reviewers (or even the public), data monitoring boards must ensure participant safety, the list of checks and balances (at least in clinical trials) goes on and on.

None of this will provide 100% protection against fraud or criminal intent – but nor will a disclosure of the funding source or a statement as to what shares my grandkids happen to own in their education funds.

The only consequence that I see resulting from “disclosures gone wild” is the undermining of public trust in the scientific process. Thus, no matter how relevant, precise, accurate, arms-length or important the findings – simply seeing a statement of industry funding on a paper, is often automatically interpreted as tainting the study.

Oddly enough, the same folks who would criticize an industry funded study showing a positive result for a given product, would often have no problem citing that same study if it happened to show an outcome more in line with their own views and thinking on the matter.

So, rather than obsessing about who is funding what, let us allow the science speak for itself. Let us make sure we respect the peer-review process and ensure that all the other checks and balances are in place.

If we do not trust the scientific process, the addition of a disclosure statement will hardly make us trust it more.

Edmonton, AB


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Disclosure Statements I Would Like to See

sharma-obesity-tickboxStudy showing that exercise can promote weight loss

Disclosures: the lead author has been a lifelong sports enthusiast and firm believer in the notion that “exercise is medicine”. He is also actively fund raising for a new Institute of Sports Medicine and has made a lucrative side career as motivational speaker with regular media appearances to promote exercise as the cure for all that ails us (including excess weight). The positive message of this paper, which just happens to be very much in line with the author’s thinking on the subject, clearly justifies the lack of a control group and the exclusion of participants who did not lose weight as non-compliant “outliers”.

Study showing that low vitamin D intake causes diabetes

Disclosures: The lead author is on the verge of promotion to tenure but still needs a couple of “big” papers for his CV. Given that a negative study is unlikely to make the cut, extra efforts were taken to massage the data to ensure a positive finding (at least in one subgroup) to increase chances of acceptance in a high impact journal. Never mind that this cross-sectional study cannot actually prove causality, the “provocative” title and the assumptions of causality made in the paper should ensure welcome media attention.

Study showing that weight gain may be linked to lower cognitive function

Disclosures: The senior author has long harboured (in secret) the opinion that fat people cannot be very smart (after all how difficult is it to push away from the plate?). She is also the author of a book on using will-power and positive thinking on conquering obesity and another book on improving cognitive health. She also runs a website where she promotes the use of nutrition supplements to enhance brain function. Never mind that in this study unintentional weight loss had an even bigger effect on cognitive decline – that, after all, is nothing anyone can do much about (also makes for a less sexy paper).

Study showing that early breast cancer screening can save lives

Disclosures: At age 15, the principal investigator lost her mother to breast cancer. This is why the paper chooses to focus on the lives saved rather than on the potential harm caused by frequent false-positives findings or the poor cost-effectiveness of routine screening.

Study showing that individuals with obesity spend food stamps on sugar-sweetened beverages

Disclosures: The author is a card-holding member of the Libertarian party and would like to see government reduce taxes and end hand-outs to folks not willing to work for a living.

Study showing that industry funded research is more likely to show favourable results

Disclosures: The left-leaning senior author has long held the view that Big Pharma, Big Food, Big Energy, Big (take your pick) is the root of all evil and must be kept away from the holy church of independent science, even if much of the research funded by these organisations would never get done (even better!).

Study showing that a widely used cholesterol lowering drug has prevented over 1,000,000 heart attacks

Disclosures: The principle investigator has on several occasions been invited to a cup of coffee by the sales rep of the company that makes this drug. The masters student and post-doc involved in this study have each eaten a slice of pizza (may have been two slices) provided by another (unrelated) drug company at a science fair celebrating young researchers.

Edmonton, AB

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Representing Canada on The Obesity Society Council

the obesity societyThis week, I will be taking over from Mary-Ellen Harper as the At-Large Canada Representative at the Obesity Society’s Council.

This is just a shout out to all TOS members, who voted for me – thank you for your trust and support.

Here is what I put in my nomination package:

Background and Experience

I have over 25 years of experience in clinical and basic research related to obesity and metabolic health. With over 360 peer-reviewed publications, my research has spanned from studies in human genetics and cell biology to a leading role in numerous international epidemiological and multi-centre intervention trials in the prevention and management of cardiovascular and metabolic disease. I have also played a leading role in the development of numerous clinical practice guidelines and the development of clinical pathways and classification systems, including the Edmonton Obesity Staging System, which is now being adopted for the classification of obesityboth nationallly and internationally (e.g. The American Society of Bariatric Physicians). In my role as Medical Director of the Alberta Health Services Provincial Obesity Strategy and the Edmonton-based Weight Wise Program (2007-2013), I have overseen and guided the creation and establishment of multidisciplinary obesity management programs across Alberta (Edmonton, Red Deer, Calgary, Medicine Hat, Grande Prairie). In 2006, I founded the Canadian Obesity Network, which, with currently over 11,000 professional members, has significantly changed the landscape of obesity research, prevention and management across Canada. 

Service to The Obesity Society

Over the past decade, I have served on various committees of the Society including, finance, membership, outreach and development. I was also on the selection committee for the current CEO of the Society. In all of these interactions I have always emphasized the importance of engaging both researchers and health professionals in the activities of the Society. I have also noted the importance of mentoring young researchers and over the past few years, I have had the privilege of participating in “meet the professor” events with early career scientists and clinicians at the annual scientific meeting. 

Vision For The Obesity Society

In my role as founder and Scientific Director of the Canadian Obesity Network and candidate as Canada’s Representative on the Council I will strive to ensure that The Obesity Society’s work and impact grows beyond the borders of the US. Although there are significant differences in the way that health services are financed and delivered between the US and Canada, we all share the common interest in advancing the science and public understanding of obesity. We also share the common goal of ensuring that decision makers and health professionals learn to take obesity seriously. We also share the common goals of ensuring that policies to prevent and reduce obesity are based on the best evidence and do so without stigmatizing or discriminating against people living with obesity. I envision that The Obesity Society will be seen as an important and strong partner in international efforts to reduce the global burden of obesity and related health problems to improve the health and well-being of all those affected by the consequences of excess weight.

I hope to live up to this vision in the years to come.

Los Angeles, CA

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City of Los Angeles Proclamation on Obesity Care

Obesity Care Proclamation LA 2015WHEREAS: The disease of obesity is a major source of concern across the nation. In California, the adult obesity rate is nearing a quarter of the population (24.7%) and in Los Angeles County, the percentage of adults affected by obesity continues its steady rise from 13.6% in 1997 to 24.3% in 2013, and

WHEREAS: Experts and researchers agree that obesity is not a lifestyle choice but rather, a complex disease influenced by various physiological, environmental factors, and

WHEREAS: While prevention programs, including the 2010 California Obesity Prevention Plan, have successfully established the seriousness of this public health crisis, it is also imperative that individuals and families currently affected by obesity receive comprehensive care and treatment, and

WHEREAS: Studies show that bias and stigma against people affected by obesity among general society and healthcare professionals are significant barriers to effectively treating the disease, and

WHEREAS: Healthcare professionals must treat patients with respect and compassion, and partner with patients to develop a comprehensive and individualized approach to weight-loss and weight management that considers all appropriate treatment options such as reduced-calorie diet and physical activity modifications, pharmacotherapy, or bariatric surgery, and

WHEREAS: It will take a long-term collaborative effort, involving partners from across all fields – individual, corporate and institutional – taking an active role, to ignite the betterment of obesity care and treatment:

NOW, THEREFORE, I, ERIC GARCETTI, as Mayor of the City of Los Angeles, and on behalf of its residents, do hereby proclaim the week of November 1-7, 2015 as Obesity Care Week in the City of Los Angeles, and encourage all our citizens to create the foundation of open communication to break barriers of misunderstanding and stigma, and improve the lives of all individuals affected by obesity and their families.

September 25, 2015

Eric Garcetti

Los Angeles

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