There is no doubt that dietitians are the health professionals most often looked to for advise on weight management.

It may therefore come as a surprise to many readers that although dietitians have vast knowledge about healthy eating and the dietary management of a wide range of diseases like diabetes, kidney disease, celiac disease and many others, most dietitians interestingly do not have specific training in treating obesity (the same can sadly be also said for the vast majority of doctors, nurses, exercise physiologists, or any other health profession you can think of).

No one is more acutely aware of this lack of expertise than the dietitians themselves, especially as they are so often called upon for dietary advise by people trying to manage their weight.

As anyone working in this field quickly recognizes (and regular readers of these pages will know this by now), eating or ingestive behaviour is only one part of the energy balance equation and even there, the many socio-psycho-biological factors that determine caloric intake are anything but simple.

I am therefore particularly pleased that the Dietitians of Canada have partnered with the Canadian Obesity Network to co-host the first pan-Canadian Learning Retreat on the Principles & Practice of Interdisciplinary Obesity Management for Dietitians, that is currently being held in Winnipeg.

The aim of the retreat is of course not to teach dietitians about counseling clients on healthy eating or even about nutritive approaches to weight losst. Rather, the retreat focusses on all of the other topics that dietitians need to know about in order to fully understand and appreciate the many factors that are essential for effective obesity management.

It is therefore not surprising that there is a lot of room on the program for the discussion of topics like weight bias, psychosocial factors, mental health, neurobiology of hunger and satiety, exercise physiology, body composition, and of course medical and surgical management of obesity.

Judging by the enthusiasm of the attendees, it appears that such a learning opportunity has been long overdue and I am certainly hopeful that events like this will help ensure that patients struggling with excess weight will have an increasing number of dietitians to turn to, who have been specifically trained in obesity management.

AMS
Winnipeg, Manitoba

Yesterday, I hosted my second Bariatric Lunch Forum - available to viewers through the Alberta teleHealth system. This time the topic was obesity surgery. Although my guest, Dr. Shahzeer Karmali was stuck in the OR and only managed to join me during the last 10 mins of the forum, we did cover a lot of ground.

As I’ve blogged before, while the technical advances in surgery are certainly responsible for improving the perioperative outcomes, long-term success is highly dependent on patient selection, patient preparation and long-term follow-up.

Even if the results of obesity surgery are often nothing short of spectacular, it is never an easy way out. Being successful, requires daily diligent hard work - obesity surgery is a tool, not a cure!

Incidentally, yesterday, Sanofi-Aventis announced that after the recent decision of EMEA to suspend the authorisation of the obesity drug rimonabant (CB-1 antagonist), they have decided to discontinue the further development of this compound for all indications and have called off all ongoing clinical trials. In their press release, they base their decision on the fact that “certain national authorities” have made demands that make further development of this drug unfeasible. No doubt, overall, a major setback for the pharmacotherapy of obesity.

The two-horse derby rolls on…

AMS
Edmonton, Alberta

Today I hosted my first Bariatric Lunch Forum, a “talk-show style” noon-hour live “show”, where I plan to address and discuss issues relevant to bariatric care. The forum is televised via Alberta’s extensive telehealth network to any of the hundreds of telehealth sites in Alberta and beyond. The technology allows live questions to come in that I can answer and discuss with the guests on the forum.

For this first forum, I invited Jean-Jaque Lovely from the Weight Wise Adult Bariatric Clinic at the Royal Alexandra Hospital to discuss issues relevant to patient self-management (we discussed the Flinders model) and who the appropriate patients were for referral to the centre.

Despite a couple of technical hitches, the forum went pretty well - at least from my perspective. The plan is to make the recording available through the website in order to reach an even broader audience.

The fora are part of our strategy to help promote a better understanding of bariatric care amongst health professionals across Alberta and beyond (special welcome to today’s viewers from Regina, Saskatchewan - sorry the technology did not allow me to hear your question - we’ll fix this for next time).

I look forward to hosting these fora as often as I can, at least a couple per month as I know that there is a lot of interest out there.

Please feel free to send feedback and any questions you may have to weightwise@capitalhealth.ca

Hope you will join me for the next Bariatric Lunch Forum on November 5th, 12.00 MST.

AMS
Edmonton, Alberta

I spent all of last week at the 2008 Obesity Boot Camp co-organized by the Canadian Obesity Network (CON) and the Merck-Frosst/CIHR Obesity Chair at the University of Laval, QC.

As in the two 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 and the obligatory late night excursions to DD).

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 Boot Camp Alumni over the coming months and years.

AMS
Edmonton, Alberta

Yesterday was the beginning of the 3rd Annual Obesity Boot Camp co-hosted by the Canadian Obesity Network (CON) and the Merck-Frosst/CIHR Obesity Chair at the University of Laval, QC. The annual Boot Camp is one of CON’s most successful capacity-building initiatives as evidenced by the continuing enthusiastic feedback from the over 50 students and new professionals who have so far attended the camp.

Contrary to what the name suggests, this is not a weight-loss camp for students challenged by excess weight (in fact given the quality of the food at the camp – keeping weight off is a challenge). Rather, the 9-day camp is a teaching and networking exercise, offered to 24 of the top young obesity researchers in the country (this year’s attendees come from 19 different universities across Canada).

This year’s Boot Camp was again kicked off by Ian Janssen from Queen’s University (Kingston, ON), who talked about the definition and epidemiology of obesity. Apart from presenting a succinct overview of the topic, he also presented some of his original research on the health costs related to obesity.

New to the camp this year was Diane Finegood, Director of the CIHR Institute of Nutrition, Metabolism and Diabetes and Professor at Simon Fraser University (Vancouver, BC), who spoke on complex adaptive. Some key properties of complex systems include heterogeneity, nonlinearity, feedback, learning, evolution, stochastics, relevance of tails, interdependence and emergence.

According to Finegood, the obesity pandemic needs to be viewed as an emergent property of people living in our current obesogenic environment. Because emergent properties, by definition, emerge when parts of a system do together what they would not do by themselves, they are generally not best understood or tackled using a reductionistic approach. Thus, it would be quite difficult to reliably predict the obesity epidemic or find solutions simply by studying individual components of our environment (e.g. urban sprawl) or any single component of human biology (e.g. genetics) in isolation.

Given the complexity of the issues, her take home messages were: all individuals matter; we need to match complexity to capacity; manage expectations; establish networks and teams; create competition and feedback loops; build intersectoral trust; monitor behaviours; measure effectiveness; adopt a whole-of-government approach (no single ministry can solve the problem).

Definitely a great kick-off to the 2008 Obesity Boot Camp.

AMS
Duchesnay, Quebec