As classes reopen and students flock back to their classes, here is an article that may be of particular interest to medical education.

In this study, published online in the International Journal of Obesity, Susan Persky and Colette Eccleston examined medical students’ care recommendations for an obese versus non-obese virtual patient.

A total of 76 clinical-level medical students were randomly assigned to interact with a digital, virtual female patient who was visibly obese or non-obese.

Studies were conducted in an immersive virtual (virtual reality) environment that allowed standardization of all patient behaviors and characteristics - all details were identical for the obese and non-obese patients (blood pressure, pulse, temperature, medications and so on) with the exception of weight and BMI. The obese patient’s weight was reported as 247 pounds with a BMI of 39.9 and the non-obese patient’s weight was reported as 134 pounds with a BMI of 21.6.

Students revealed more negative stereotyping, less anticipated patient adherence, worse perceived health, more responsibility attributed for potentially weight-related presenting complaints and less visual contact directed toward the obese version of a virtual patient than the non-obese version of the patient. Visual contact is a proxy for eye contact, a behavior that is linked to empathy expression by providers.

Interestingly though, there was no clear evidence of bias in clinical recommendations made for the patient’s care.

Student BMI was also not a significant predictor of the results of the analyses. Thus, students who had higher BMIs did not exhibit lower levels of bias.

As the authors point out, “Biases in attitudes, beliefs and interpersonal behavior have important implications because they can influence the tone of clinical encounters and rapport in the patient-provider relationship, which can have important downstream consequences.”

I, for one, am not sure that the results of this study would have turned out that differently for students of other health professions. Guess it is never early enough to start addressing this issue.

AMS
Edmonton, Alberta

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Persky S, & Eccleston CP (2010). Medical student bias and care recommendations for an obese versus non-obese virtual patient. International journal of obesity (2005) PMID: 20820169

The short answer, for the vast majority of Canadians, would simply be, “no one”.

Last year, the Canadian Obesity Network undertook a representative survey to examine how Canadians manage their weight.

It turns out that over 65% of overweight Canadians have never talked to a licensed health professional (family doctor, dietitian, pharmacist, etc.) about losing weight. The same is true for over 40% of Canadians, who meet the clinical definition of obesity, i.e. have a BMI greater than 30.

This may probably be as well, because most health professionals are in fact ill-equipped to support individuals struggling with excess weight. Although, health professionals often cite lack of time and resources as the main reason for not broaching the topic, I suspect that the key problem is simply a lack of knowledge and training in weight management.

As I have said before, most health professionals have little more than a layman’s understanding of the complex socio-psycho-biology of energy homeostasis and have virtually no formal training in even the basics of behavioural, medical or surgical management of excess weight.

Add to this an (un)healthy dose of anti-weight prejudice and discrimination and it is probably no surprise why anyone who has ever solicited weight management advice from their health professional is more likely to receive simplistic slogans along the lines of “eat less and move more”, than a meaningful analysis of the problem with a personalized evidence-based management plan.

Indeed, weight management plans too often follow along the lines of well-meant but often ineffective diet or exercise recommendations, that virtually always fail to address the actual root of the problem (see my post - overeating is a symptom).

It should hardly come as a surprise when simply providing an impulsive overeater with a diet plan proves to be about as effective as providing a drinking plan to an alcoholic.

In contrast, teaching time-management skills to people who regularly fall back on fast food for lack of time or offering stress management classes to people who use food as a coping strategy may well be far more effective than simply educating them on healthy choices or handing them recipe books.

Of course patients can always turn to the billion-dollar weight-loss industry, that peddles everything from magical weight loss supplements to crash diets. While some of these program may well be better than others, there is no way a consumer can tell which of these many products and services are likely to be effective or just a waste of money.

Even if patients “successfully” lose weight with any of these products or services, this is rarely more than temporary “symptomatic” relief with a nineteen-in-twenty chance of weight regain within weeks or months of stopping the program.

Rarely do these products or services truly diagnose and address the root cause of the problem - that would require far more than a cursory “one-size-fits-all” business model and is unlikely to deliver the same lucrative profits.

Perhaps, it is time to promote a better public understanding of the many societal and individual level drivers of excess weight and it certainly appears high time health professionals and health care systems seriously took on the challenge of addressing the greatest health problem of our times.

When the problem is excess weight, not helping patients deal with this issue is simply palliative care.

AMS
Edmonton, Alberta

Prof. Edward Shang

As the demand for bariatric surgery increases across Europe, there is increased recognition that this rapidly evolving field of medical care will require the same expertise, training, research and resources as other fields of medicine.

It was therefore only a matter of time before a leading German university would announce the appointment of a Full Professor and Chair for Bariatric Surgery.

This credit now goes to the University of Leipzig, which yesterday announced the formal appointment of Dr. Edward Shang, as the first Full Professor for Bariatric Surgery. The position is a cornerstone of the newly funded Integrated Research and Treatment Centre for Obesity, funded by the German Federal Ministry for Education and Research.

As blogged before, the University of Leipzig is now well poised to take the lead in obesity research and management for Germany, a clear first in the rather conservative German academic landscape.

Shang will head the new Division for Obesity Surgery in the Department of Visceral, Transplantation, Thorax and Vascular Surgery, which will deliver comprehensive multi-disciplinary care for patients with severe obesity.

Shang’s expertise in modern minimally invasive surgery, including natural orifice surgery (NOTES), which includes performing complex bariatric surgery without having to cut open the patient, will offer a wide range of opportunities for cutting-edge (no pun intended) research in this rapidly evolving field.

As a member of the Scientific Advisory Board to this German Centre of Excellence, i congratulate Dr. Shang on this distinction and very much look forward to meeting him on my next trip to Leipzig.

AMS
Lincolnshire, IL

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A few weeks ago, I read Lori Lansens’ bestselling book “the wife’s tale“.

The book tells the story of Mary Gooch, a 43 year-old woman with severe obesity, who lives her life in defensive, deflective blame, segregating herself in the small farming town of Leaford, Ontario.

When her husband dissapears on the eve of their 25th wedding anniversary, Mary abandons her comfortable position to take the next flight to look for him in California. Soon after arriving she loses her wallet and passport, which further complicates her situation.

With the help of some unlikely friendships that she makes along the way, Mary undertakes a journey of self discovery resulting in an amazing transformation. The deeply insightful story touchingly depicts the heart-wrenching daily reality of someone living with severe disabling obesity.

In an opening sequence, Mary describes how, as a nine year old, she heard her doctor whisper the word “obese” to her mother. Never having heard the word before, little Mary imagined that she was under the power of an “obeast”, a creature that had taken over her body and was manifesting itself in her starving gut.

As Lori Lansens, who hails from Chatham, Ontario, a rural community near the border to Detroit, notes in her self-penned author profile,

“I drove the curving roads of the Santa Monica Mountains thinking of the thousands of conversations I’ve had with women about loneliness, self acceptance, marriage, husbands, body image, food, denial, betrayal and more recently, encroaching middle-age. I thought about what it means to be a stranger, and how one can be transformed by circumstance, and as I found my own tribe of friends and settled into the new rhythm of a different life, the story of Mary Gooch unfolded.”

Although her biography makes no mention of any weight issues that Lansens herself may have experienced, she tells the story of many patients that I see in my clinic everyday.

Anyone who still believes that we will solve the obesity epidemic by simply telling people to eat less and move more should take the time to read this book - but my guess is that if you believe that the solution to obesity is as simple as eating less, then you may have little interest in a book which reveals uncomfortable layers of complexity to a problem for which there are no easy solutions.

If any of my readers have read “The Wife’s Tale”, I’d love to hear from you.

AMS
Edmonton, Alberta

CON-RCO Obesity Boot Camp 2010

As in the four previous camps, this year’s camp once again brought together some of the best and brightest students and new professionals from across Canada for over 100 hours of education and social activities (including the Tree Top Adventure, Kayaking, tour of Quebec City).

This year featured new memorable events like the 1st Obesity Boot Camp idol and the Saturday Night Live Karaoke Party - or as the students would say, “genial!”.

Overall I have no doubts that, as in previous camps, some friendships have been forged for life - both personal and professional.

For my part, I again learnt a lot from listening and interacting with the students and faculty. While there continue to be no easy solutions to obesity in sight, there certainly are reasons for optimism, seeing the enthusiasm with which the students are preparing to face the challenge of solving one of the greatest global health problem of our times.

The Canadian Obesity Network is grateful to all of the faculty and supporters who made this camp possible.

Personally, I look forward to continuing interactions with the now over 120 Boot Camp Alumni over the coming months and years.

AMS
Dushesnay, Quebec