Friday, December 12, 2014

Prevalence and Treatment of Depression In Canada

sharma-obesity-mental-health1Depression can be a significant factor both in the development of obesity and as an important barrier to its treatment.

Now a paper by Sabrina Wong and colleagues from the University of British Columbia, in a paper published in CMAJ open, present data on the prevalence and treatment of depression in Canadian primary care practices.

The authors analysed electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, of over 300,000 patients who had at least one encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012.

Of these, 14% had a diagnosis of depression.

Women with a BMI greater than 30 were about 20% more likely to also have depression than women with a BMI below 25. No such relationship was noted in men.

Overall, 25% of individuals with a diagnosis of depression also had at least one other chronic condition as well as about 50% more doctor visits than individuals without depression.

Clearly, depression is a common problem in primary care and weight management in patients (particularly women) presenting with this problem needs to be addressed (not least because many of the medications often used to manage depression may well be part of the problem).

@DrSharma
Edmonton, AB

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Wednesday, November 12, 2014

5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

@DrSharma
Ottawa, ON

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Wednesday, November 5, 2014

Obesity Medicine Gets More Tools

sharma-obesity-medications6This week I am in Boston attending Obesity Week, the annual conference co-hosted by The Obesity Society and the American Society for Metabolic and Bariatric Surgery.

As I sit through the lectures and the hundreds of abstract presentations I find that I need to keep reminding myself that obesity medicine is about making people living with obesity healthier and feel better and not just about helping them lose weight.

Indeed, patients who manage to adopt healthier behaviours may well experience significant improvements in their health even with minimal weight loss.

That said, it is encouraging to note that (at least in the US), the landscape of obesity management is potentially changing.

There are now at least five medications on the US market for treating obesity and there may soon be a sixth. This is a dramatic change in the pharmacotherapeutic landscape for this condition from just a few years ago.

Not surprisingly, the conference features a number of sessions and symposia on the use of these medications, which will hopefully, help make obesity a much more manageable condition than simply relying on the rather ineffective model of “diet and exercise”.

Will these medications find their way into clinical practice and deliver what they promise – I sure hope so, but only time will tell.

Nevertheless, it is encouraging to note that we may well be getting closer to offering more effective treatments to our patients living with obesity.

@DrSharma
Boston, MA

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Friday, October 24, 2014

Social Network Analysis of the Obesity Research Boot Camp

bootcamp_pin_finalRegular readers may recall that for the past nine years, I have had the privilege and pleasure of serving as faculty of the Canadian Obesity Network’s annual Obesity Research Summer Bootcamp.

The camp is open to a select group of graduate and post-graduate trainees from a wide range of disciplines with an interest in obesity research. Over nine days, the trainees are mentored and have a chance to learn about obesity research in areas ranging from basic science to epidemiology and childhood obesity to health policy.

Now, a formal network analysis of bootcamp attendees, published by Jenny Godley and colleagues in the Journal of Interdisciplinary Healthcare, documents the substantial impact that this camp has on the careers of the trainees.

As the analysis of trainees who attended this camp over its first 5 years of operation (2006-2010) shows, camp attendance had a profound positive impact on their career development, particularly in terms of establishing contacts and professional relationships.

Thus, both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in obesity researcher (and possibly beyond).

Personally, participation at this camp has been one of the most rewarding experiences of my career and I look forward to continuing this annual exercise for years to come.

To apply for the 2015 Bootcamp, which is also open to international trainees – click here.

@DrSharma
Toronto, ON

ResearchBlogging.orgGodley J, Glenn NM, Sharma AM, & Spence JC (2014). Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. Journal of multidisciplinary healthcare, 7, 459-70 PMID: 25336965

 

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Monday, September 15, 2014

Update on New Medications for Obesity

sharma-obesity-fda4Last week, while I was off on a brief holiday, two important events took place in the US with regard to obesity medications.

On September 10, the US-FDA granted approval for Contrave, a fixed combination of bupropion and naltrexone, two centrally active compounds, also used in the treatment of addictions.

Then, on September 11, an advisory panel appointed by the FDA, voted strongly in favour of approving the GLP-1 agonist liraglutide at the 3.mg dose for the treatment of obesity.

These two new entities would bring the currently approved prescription medications for the treatment of obesity in the US to six – a dramatic change from just a couple of years ago.

This is still a long shot away from the many effective treatments we have for treating other common conditions (e.g. there are more than 20 prescription medications approved for treating diabetes and almost 100 compounds for the treatment of hypertension).

Why would we need this many different medications for obesity? For the simple reason that not everyone will respond favourably or tolerate all of these compounds.

Given that obesity is a remarkably heterogeneous disorder and that these drugs have distinctly different modes of action, I would not expect all of these medications to work in all individuals.

It is also important to note that all of these drugs work best when combined with intense behaviour modification – no pill will ever serve as a substitute for a healthy diet and a daily dose of moderate to vigorous physical activity. But we also know that the latter alone, will rarely produce sustainable weight loss in the long-term.

Obviously, given the chronic nature of obesity, medications for obesity will need to be used long-term in the same manner that we use medications to treat other chronic conditions (e.g. diabetes, hypertension, etc.).

This means that we will need more long-term data on the efficacy and safety of these compounds.

Nevertheless, there is reason to hope that for many people with obesity related health problems, these new obesity medications will provide much-needed therapeutic options.

@DrSharma
Vienna, Austria

Disclaimer: I have served as a paid consultant and/or speaker for the makers of Contrave and liraglutide.

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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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