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Early Bird Registration For Canadian Obesity Summit Ends March 3rd

For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd.

To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here.

Workshops:

Public Engagement Workshop (By Invitation Only)

Pre-Summit Prep Course – Overview of Obesity Management ($50)

Achieving Patient‐Centeredness in Obesity Management within Primary Care Settings

Obesity in young people with physical disabilities

CON-SNP Leadership Workshop: Strengthening CON-SNP from the ground up (Invitation only)

Exploring the Interactions Between Physical Well-Being and Obesity

Healthy Food Retail: Local public‐private partnerships to improve availability of healthy food in retail settings

How Can I Prepare My Patient for Bariatric Surgery? Practical tips from orientation to operating room

Intergenerational Determinants of Obesity: From programming to parenting

Neighbourhood Walkability and its Relationship with Walking: Does measurement matter?

The EPODE Canadian Obesity Forum: Game Changer

Achieving and Maintaining Healthy Weight with Every Step

Adolescent Bariatric Surgery – Now or Later? Teen and provider perspectives

Preventive Care 2020: A workshop to design the ideal experience to engage patients with obesity in preventive healthcare

Promoting Healthy Maternal Weights in Pregnancy and Postpartum

Rewriting the Script on Weight Management: Interprofessional workshop

SciCom-muniCON: Science Communication-Sharing and exchanging knowledge from a variety of vantage points

The Canadian Task Force on Preventive Health Care’s guidelines on obesity prevention and management in adults and children in primary care

Paediatric Obesity Treatment Workshop (Invitation only)

Balanced View: Addressing weight bias and stigma in healthcare

Drugs, Drinking and Disordered Eating: Managing challenging cases in bariatric surgery

From Mindless to Mindful Waiting: Tools to help the bariatric patient succeed

Getting Down to Basics in Designing Effective Programs to Promote Health and Weight Loss

Improving Body Image in Our Patients: A key component of weight management

Meal Replacements in Obesity Management: A psychosocial and behavioural intervention and/or weight loss tool

Type 2 Diabetes in Children and Adolescents: A translational view

Weight Bias: What do we know and where can we go from here?

Energy Balance in the Weight- Reduced Obese Individual: A biological reality that favours weight regain

Innovative and Collaborative Models of Care for Obesity Treatment in the Early Years

Transition of Care in Obesity Management : Bridging the gap between pediatric and adult healthcare services

Neuromuscular Meeting workshop – Please note: Separate registration is required for this event at no charge

To register – click here.

@DrSharma
Edmonton, AB

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Obesity In Cardiovascular Disease – A Canadian Perspective

sharma-obesity-exercise2Anyone interested in the issue of obesity and cardiovascular disease may want to get a copy of the latest edition of the Canadian Journal of Cardiology, which includes a number of review articles and opinion pieces on a wide range of issues related to obesity and cardiovascular disease.

Here is the table of contents:

Garcia-Labbé D, Ruka E, Bertrand OF, Voisine P, Costerousse O, Poirier P. Obesity and Coronary Artery Disease: Evaluation and Treatment.

Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to Choose and Use Bariatric Surgery in 2015.

Valera B, Sohani Z, Rana A, Poirier P, Anand SS. The Ethnoepidemiology of Obesity.

@DrSharma
Edmonton, AB

 

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Canadian Clinical Practice Guidelines For Obesity: We Need More Than Diet and Exercise

sharma-obesity-doctor-kidYesterday, saw the release of new Clinical Practice Guidelines from the Canadian Task Force on Preventive Health Care to help prevent and manage obesity in adult patients in primary care.

Similarly to the Endocrine Society’s Guidelines for the pharmacological treatment of obesity (see yesterday’s post), the authors use a GRADE system to rank and rate their recommendations.

Key recommendations are summarized as follows:

  • Body mass index should be calculated at primary health care visits to help prevent and manage obesity.
  • For normal weight adults, primary care practitioners should not offer formal structured programs to prevent weight gain.
  • For overweight and obese adults health care practitioners should offer structured programs to change behaviour to help with weight loss, especially to those at high risk of diabetes.
  • Medications should not routinely be offered to help people lose weight.

Virtually all of these recommendations are supported by evidence that is rated between moderate to very low, which essentially leaves wide room for practitioners to either do nothing or whatever they feel is appropriate for a given patient.

The guidelines do not discuss the role of bariatric surgery (arguably the most effective treatment for severe obesity) and make no recommendations for when this should be discussed with patients.

The rather subdued recommendations for the use of medications is understandable, given that the only prescription medication available for obesity in Canada is orlistat (why the authors chose to also discuss metformin, which is not indicated for obesity treatment, is anyone’s guess).

Overall, the reader could easily come away from these guidelines with a sense that obesity management in primary care is rather hopeless, given that behavioural interventions are modestly effective at best (which is probably why the authors recommend that these not be routinely offered to patients at risk of weight gain).

Indeed, it is hard to see how primary care practitioners can get more enthusiastic about obesity management given this rather limited range of treatment options currently available to Canadians.

If there is anything to take away from these guidelines, it is probably the simple fact that we desperately need more effective treatments for Canadians living with obesity.

@DrSharma
Edmonton, AB

The whole document is available here

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Endocrine Society Clinical Practice Guidelines For The Pharmacological Treatment of Obesity

sharma-obesity-medications6Last week, the US Endocrine Society released a rather comprehensive set of evidence-based clinical practice guidelines for the pharmacological management of obesity, published in the Journal of Clinical Endocrinology and Metabolism.

The recommendations in the 21-page document follow the rather rigorous Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group (from 0 to 4 stars) and goes beyond just evaluating the evidence in favour of pharmacological treatment of obesity itself but also for the pharmacological treatment of overweight and obese individuals presenting other medical conditions.

Here are the (in my opinion) most important recommendations from this document:

1) While diet, exercise and behavioural interventions are recommended in all patients with obesity,

“Drugs may amplify adherence to behavior change and may improve physical functioning such that increased physical activity is easier in those who cannot exercise initially. Patients who have a history of being unable to successfully lose and maintain weight and who meet label indications are candidates for weight loss medications.(****)”

2) “If a patient’s response to a weight loss medication is deemed effective (weight loss > 5% of body weight at 3 mo) and safe, we recommend that the medication be continued. If deemed ineffective (weight loss < 5% at 3 mo) or if there are safety or tolerability issues at any time, we recommend that the medication be discontinued and alternative medications or referral for alternative treatment approaches be considered. (****)”

3) “If medication for chronic obesity management is prescribed as adjunctive therapy to comprehensive life- style intervention, we suggest initiating therapy with dose escalation based on efficacy and tolerability to the recommended dose and not exceeding the upper approved dose boundaries. (**)”

The guidelines also make specific recommendations for the pharmacological treatment of overweight and obese individuals presenting with a wide range of other medical issues, including 2 diabetes mellitus (T2DM), cardiovascular disease, psychiatric illness, epilepsy, rheumatoid arthritis, COPD, HIV/AIDS and allergies.

For example:

“In patients with T2DM who are overweight or obese, we suggest the use of antidiabetic medications that have additional actions to promote weight loss (such as glucagon-like peptide-1 [GLP-1] analogs or sodium-glu- cose-linked transporter-2 [SGLT-2] inhibitors), in addi- tion to the first-line agent for T2DM and obesity, metformin. (***)”

The guidelines also discuss the pros and cons of the anti-obesity medications currently available in the US (phentermine, orlistat, phentermine/topiramate, lorcaserin, buproprion/naltrexone, and liraglutide), which we can only hope will soon also become available to patients outside the US.

The entire document is available here.

@DrSharma
Edmonton, AB

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GLP-1 Analogue Liraglutide For Obesity Gets Positive Vote In Europe

novo_nordiskJust one month after the GLP-1 analogue liraglutide 3 mg received approval for obesity treatment by the US-FDA, liraglutide 3 mg, yesterday, also got a positive nod from the Committee for Medicinal Products for Human Use (CHMP) under the European Medicines Agency (EMA).

Here is how the Novo Nordisk press release describes the mode of action and indication for liraglutide 3 mg:

Saxenda®, the intended brand name of liraglutide 3 mg, is a once-daily glucagon-like peptide-1 (GLP-1) analogue, with 97% homology to naturally occurring human GLP-1, a hormone involved in appetite regulation. The CHMP positive opinion recommends that Saxenda® will be indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management in adult patients with an initial Body Mass Index (BMI) of >=30 kg/m2 (obese), or >= 27 kg/m² to < 30 kg/m² (overweight) in the presence of at least one weight-related comorbidity such as dysglycaemia (pre-diabetes or type 2 diabetes mellitus), hypertension, dyslipidaemia or obstructive sleep apnoea.”

Regular readers will be aware of the role that the incretin GLP-1 plays in the  regulation of glucose metabolism as well as satiety and appetite.

Data for this approval come from the Phase 3 SCALE trial program involving over 5,000 patients with overweight and obesity, the majority of who also had related comorbidities.

Given that this is an injectable drug that will be available only with a  doctor’s prescription and, as any anti-obesity medication, will need to be used in the long-term, it will be interesting to see how this new approach to obesity treatment will be accepted by doctors and their patients.

Although liraglutide 3 mg may not work for or be tolerated by everyone, I am confident that this much-needed addition to the obesity treatment tool-box will provide a new treatment option to some patients – especially those with obesity related health problems.

@DrSharma
Edmonton, AB

Disclaimer: I have received honoraria for consulting and speaking from Novo Nordisk

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