Arya M. Sharma, MD

Last week, according to the New York Times, GlaxoSmithKline (which sells the weight-loss drug Alli in many countries) announced that it will provide a yet-undisclosed sum of money to the Creative Coalition for a documentary on obesity - a film that is already being compared to “An Inconvenient Thruth”. Although a budget has not been set, an Academy Award-winning director will be named on Jan. 25 at the Sundance Film Festival

The Creative Coalition is the premier nonprofit, nonpartisan social and political advocacy organization of the entertainment industry. In an interview to Sharon Waxman, Robin Bronk, the executive director of the Creative Coalition had this to say: “It’s reverse product placement. It’s issue placement. It’s organic for us. We’re using filmmaking to promote a film message. Art influences. Look at Al Gore; he could not move the needle on global warming until he went Hollywood. And he was the vice president.”

As to GSK’s role in the documentary? “They have absolutely no creative control. Zero.”

Sure, GSK, as the maker of Alli, has a vested interest in obesity. So is this just going to be a pricey infomercial for Alli? Probably not. As pointed out in the New York Times, “As a rule, documentary makers are an aggressively anticorporate crowd.”

Personally, I very much hope that this documentary will also take on the issue of weight-bias and discrimination that faces obese people and will not simply portray obesity as the result of stupid lazy slobs making poor choices. Based on the generally negative depictions of obese people and the abundant discriminatory fat jokes in Hollywood films, I will be watching keenly to see how much finger pointing and blame will find its way into the final cut.

AMS
Edmonton, Alberta

Although these pages are primarily intended for a “professional” audience, I am well aware that a lot of people struggling with weight read my blog.

Not surprisingly, I get countless e-mails everyday from people telling me heartbreaking stories about themselves or their loved ones and their struggles with excess weight.

Unfortunately, I simply cannot answer any of these e-mails or provide any specific medical advise on the many questions.

Nevertheless, occasionally, certain letters very nicely illustrate what this blog is all about.

The following is taken from such an e-mail - the personal data has been edited to maintain anonymity: 

“I heard you on a recent podcast on CBC Radio and I want to thank you. I just wish everyone in Canada heard this. I am a 28 year old female, stand five foot five with a weight of 480lbs and a BMI of 79.9. I am currently fighting for weight loss surgery. I saw a surgeon in September. He made me and my mother feel hopeful until he told me that I am looking at a 2- 5 year wait.

I have written letters to the Prime Minister, Health Minister and my local MLA. The replies from them have not been helpful at all.

I recently lost my job a day after learning they couldn’t get me a uniform to fit me at all but of course they didn’t say that when they let me go. You said something in the podcast about laughing or coughing and leaking. You’re the first I’ve heard bring that up but I know all about it all to well.

I just want to thank you very much for the information you shared on that podcast. The 3-5 year wait kills me inside to hear. It hit me hard as I am a single parent to a very amazing 9 year old boy and with a 3-5 year wait, I’ll be lucky to see his 14th birthday.

Ive tried everything: not eating, eating little, making myself get sick, Jenny Craig, Weight Watchers, TOPS, Pills, Atkins, Soups everything. Im pretty healthy for my size: no high blood pressure etc. The only things wrong with me due to my weight are sleep apnea, sores all over, my knee cracks nonstop, can’t stand or walk any longer then 5 mins as my lower back causes me so much pain and my bum almost goes numb and I do leak a lot. But I have been told due to my weight lots can go wrong fast.

I don’t go out anymore due to stares, giggles, rude people, fear of not fitting somewhere. I just wanted to share with you my story and to thank you. I know if I don’t get this procedure soon it will for sure be too late for me. I just wish people knew more about all this so it can save the next person who truly needs this life saving chance.”

What can I say? The letter speaks for itself - this is just one of many that reach me every day.

Click here to listen to the CBC 1 podcast referred to in this letter.

Additional reactions to the podcast are available here and here.

Appreciate your comments,

AMS
Berlin, Germany

There are many things that are holding our health care system back from increasing access of competent care to people struggling with excess weight - my not spending enough time getting the message out is perhaps not one of them.

On Friday, I first spoke about obesity to allied health professionals working for primary networks in Edmonton, I then held the Key Note Lecture at the Annual Research Day of the Alberta Diabetes Institute, from where I went straight to a talk at the 22nd Annual Urological Excellence Conference of the Urology Nurses of Canada, followed by a brief visit to the Grand Opening of Me Without Measure, an eating disorder centre located on Edmonton’s busy Whyte Avenue.

On Saturday, I travelled to Banff, to give a workshop on obesity assessment and management to around 90 psychiatrists from across Canada, who were attending the 12th Annual Update in Medicine for Psychiatrists.

In total, that’s another 400 people, who have hopefully heard the message and will perhaps slightly change their views on obesity.

At of these events, the messages were almost the same: obesity is a huge problem, it needs to be addressed and managed as a chronic disease, and simply telling people to “eat-less and move-more” seldom works. The complex psychosocial and biological factors contributing to obesity make this a most challenging condition to deal with - something that cannot be achieved without a substantial investment in training of health professionals and provision of resources.

Interestingly, obesity was also the topic of this week’s edition of Dr. Brian Goldman’s widely heard radio documentary series on CBC Radio One, White Coat, Black Art that examines the world of the health care system.

The entire 30 min program, which includes a conversation with me and a few colleagues and patients regarding bariatric health care, can be accessed by clicking here. I believe Dr. Goldman did well to capture the essence of what bariatric care is all about.

I would certainly like to hear your comments on this radio documentary - I am sure that not everyone will agree with everything that was said - the more we have an open discussion of these issue, the better.

AMS
Edmonton, Alberta

Notwithstanding the widely held notion that exercise is the best and most effective measure to prevent obesity and lose those extra pounds, it is in fact, despite its manifold other health benefits, neither of the above. (Readers should pick up the latest issue of TIME Magazine (Why exercise won’t make you thin) if they doubt my words).

In fact, it now turns out, that telling people to exercise may in fact simply make them eat more (without exercising of course).

This is the gist of an article published in this month’s issue of OBESITY by Dolores Albarracin and colleagues from the University of Illinois.

In two controlled experiments, college students exposed to either print messages typical of exercise campaigns or subliminal presentation of action words associated with exercise (e.g., “active”), immediately increased their food intake compared to subjects provided with “neutral” messages.

The authors suggest that these inadvertent effects may in part explain the limited efficacy of exercise-promotion programs for weight loss.

If even subtle messaging on the topic of increasing activity will make you eat more, I wonder about the effect of watching sports (whether at the sports arena or in front of your TV) on ingestive behaviour.

What if simply watching others engage in exercise or sports also turns out to promote overeating?

Imagine if ignoring all activity messaging and switching TV channels to avoid any coverage of sporting events was the solution to the obesity epidemic - obesity would definitely be here to stay.

Certainly a controversial topic if I ever saw one…

AMS
Edmonton, Alberta

The following is a brief commentary, I was asked to write for the Metro Newspaper on the recent decision to introduce a “self-esteem” badge for Girl Guides. It appeared in the May 15 edition of the Metro News Toronto:

Anyone interested in promoting the health of young girls is faced with a seemingly impossible challenge. On one hand, in recent years we have seen a dramatic increase in the incidence of eating disorders — now one of the most common and dangerous chronic condition in young women.

On the other hand, the obesity epidemic has also adversely affected girls and women, with unprecedented numbers developing excess weight and related health issues, ranging from polycystic ovary syndrome and infertility to Type 2 diabetes and sleep apnea.

While those concerned about eating disorders are careful to not reinforce a negative focus on body weight, those concerned about obesity are unsure how to broach this issue without further diminishing self-esteem. There is clearly concern about the unintended harmful consequences from overweight and obesity prevention initiatives, particularly those delivered in schools.

But overemphasis on weight or group weigh-ins can trigger fat prejudice, weight-based teasing, or the ostracizing of larger children, or, cause children to react to healthy eating messages by adopting extreme approaches to dieting and consequently losing weight to a degree that negatively impacts their health.

Perhaps the common ground lies in recognizing both eating disorders and obesity as psychosocial health issues. At one end of the spectrum girls and young women seek to control their weight by resorting to extreme dieting, excessive exercise and other destructive behaviours. At the other end, girls and young women turn to food to cope with negative emotions, stress, boredom, abandonment, emotional neglect and isolation.

Now, the Girl Guides of Canada have taken up the challenge of dealing with negative body image by introducing the Love Yourself Challenge badge, which girls aged five to 17 can earn by completing tasks that promote self-esteem, healthy eating and a positive body image.

Whether this initiative will indeed help to reduce the risk of eating disorders while promoting healthy weight remains to be seen. Increased self-esteem is clearly beneficial whether you are dealing with under- or overweight people.

The societal causes of eating disorders and obesity may well be the same: Media, advertising, disintegration of nuclear families, lack of role models, loss of control over an excessively demanding, stressful and fast-paced society that takes little time to play, eat or reflect on the things that truly matter in life.

Let us hope that the Girl Guides’ approach can manage to help girls walk the fine line between pathological dieting and numbing their emotions with food.

If it can help dissociate self-esteem from body weight, much will have been won.