Wednesday, July 23, 2014

In Memorium: Albert (Mickey) J Stunkard

Stunkard twinsAs I spend my days at the 9th Canadian Obesity Network’s Summer Bootcamp for young trainees from Canada and around the world, I was saddened to learn of the passing of Mickey Stunkard, clearly one of the biggest names in obesity research – at a healthy age of 92.

With well over 500 publications to his name, Mickey is perhaps best known for his twin studies showing that the body weight of adopted identical twins reared apart resembles each other and that of their biological parents rather than the weight of their adoptive parents.

This work helped establish the basis for much of the genetic work on obesity that followed, clearly showing that differences in body weight between two individuals are much more accounted for by their difference in genetics than by differences in their “lifestyles”.

These findings were often misused in “nature vs. nurture” debates, an issue that serious scientists have long laid to rest in light of our current understanding that the two cannot be discussed separately, simply because genes and lifestyle interact on virtually every level – from molecules, to cells, to behaviours.

Here is what one obituary had to say about Mickey:

“He surveyed obesity treatment studies in the late ’50s and found that the nation’s diet programs could claim only a 2 percent success rate. He was an early advocate for the use of bariatric surgery to induce weight loss. He also published the first modern account of binge eating in obese individuals.”

I have had to pleasure to often hear him speak at conferences.

He will be dearly remembered.

@DrSharma
Kananaskis, AB

 

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Tuesday, July 15, 2014

The Molecular Biology of Food And Mood

sharma-obesity-brainThe neuroendocrine systems that control ingestive behaviour are intimately linked to the parts of the brain that control mood.

Thus, it is increasingly evident that factors that affect energy homeostasis (diet and exercise) can have profound effects on mood while changes in mood can have significant effects on appetite and energy homeostasis.

But this relationship is far from straightforward – rather, it appears to be rather complex.

Readers interested in an overview of how these two systems interact in the brain may find a recent review by Chen Liu from the University of Texas Southwestern Medical Center, Dallas, published in Cell Metabolism of interest.

The authors review our current understanding of how mood and food are linked with particular attention to appetite, ingestive behaviour and energy homeostasis.

The article also touches on the effects of pharmacological and surgical treatments for obesity on mood.

Clearly clinicians need to be aware of the close links between these systems and draw on our current understanding of both in their counselling of patients presenting with weight gain and/or depression.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLiu C, Lee S, & Elmquist JK (2014). Circuits Controlling Energy Balance and Mood: Inherently Intertwined or Just Complicated Intersections? Cell metabolism, 19 (6), 902-909 PMID: 24630814

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Monday, July 14, 2014

How To Prevent Gallstones During Weight Loss

GallstonesOne of the best recognised complications of weight loss – especially if this occurs too rapidly – are the development of gallstones, which can result in acute symptoms and often require surgery.

Now Caroline Stokes and colleagues from the Saarland University Medical Center, Homburg, Germany, publish a systematic review of strategies to prevent weight-loss associate gallbladder stones in Clinical Gastroenterology and Hepatology.

Their analysis includes 13 randomised-controlled trials, comprising 1836 participants undergoing weight loss through dieting (8 trials) or bariatric surgery (5 trials).

Ursodeoxycholic acid (UDCA) reduced the risk of ultrasound-verified gallstones compared with control interventions with a risk ratio of 0.33 and a number-needed-to-treat (NNT) of only 9.

They also found a significant risk reduction with high-fat weight loss diets (risk ration 0.09).

No adverse effects were noted for either intervention.

Thus, it is evident that UDCA and/or higher dietary fat content prevent the formation of gallstones during weight loss and these treatments should likely be initiated particularly in patients, who are undergoing rapid weight loss (particularly those at high risk of gallbladder stones).

@DrSharma
Edmonton, AB

ResearchBlogging.orgStokes CS, Gluud LL, Casper M, & Lammert F (2014). Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 12 (7), 1090-110000 PMID: 24321208

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Thursday, June 26, 2014

Guidelines for Managing Overweight and Obesity in Adults

the obesity societyRegular readers may recall a previous post on guidelines on obesity management released by The Obesity Society (TOS) together with other organisations, including the American Heart Association and the American College of Cardiology, at Obesity Week in Atlanta last year (2013).

The bottom line, as I have blogged before, was the revelation of just how little we actually know about obesity.

For what it is worth, the complete guidelines are now published as a supplement to its July issue of the Obesity journal (Guidelines (2013) for Managing Overweight and Obesity in Adults: Full Report).

According to The Obesity Society’s press release,

TOS is investing in the improved treatment of obesity by making the full guidelines available in print so they can serve as a go-to resource for health practitioners around the world. Whether you are a physician, nurse, nutritionist or fitness trainer, every professional interacting with individuals with obesity can find value in this insightful treatment guide.

No doubt, a tremendous amount of work went into developing these guidelines – whether they will substantially change practice remains to be seen.

@DrSharma
Vancouver, BC

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Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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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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