Yesterday, I attended the inaugural networking event of the Canadian Obesity Network’s Toronto Chapter. Judging by the enthusiasm of the almost 100 folks who came out to this event, this chapter appears off to a great start.
As expected for any CON event, the participants came from virtually every walk of interest in obesity – from professional to personal – research, prevention, clinic, policy, industry, NGOs.
Hopefully, we will see similar activities and chapters starting across Canada in the coming months – the success off this event shows that there is a dire need for local networking to address local issues related to obesity prevention and management.
For more information on the Toronto Chapter (CON-YYZ) click here.
For more information on how to start a CON chapter in your city click here.
Dietitians play an often critical role in helping patients with obesity better manage their weight.
However, I also know that dietitians are the first to agree that obesity management is not just about diet (and exercise) but rather, that diet is just one aspect of an interdisciplinary management approach.
The two-day retreat (October 7-8, Toronto), which follows a highly intense interactive workshop format, covers all aspects of interdisciplinary obesity management including behavioural, medical and surgical treatments. There will also be a special focus on the nutritional management of bariatric patients as well as weight-sensitive behavioural modification.
Speakers at the event include Michael Vallis, Eric Doucet, Jennifer Brown-Vowles, Sean Wharton, and myself.
The course is open to all registered dietitians and anyone else interested in (not-just) nutritional aspects of obesity management.
For advanced registration (early bird registration ends Sept 15) and more information click here.
While the health benefits associated with intentional weight loss for some complications of obesity (such as elevated lipids and diabetes) are well documented, high-quality studies to back many other potential health benefits are harder to find.
Just how well (or poorly) the putative health benefits of long-term intentional weight loss are documented for each of the many conditions associated with obesity, is now detailed in a comprehensive review of the literature that we just published in the Annual Reviews of Nutrition.
The 40 page long review, which includes almost 250 relevant publications, supports the following main findings:
- Defining and assessing clinically relevant obesity and weight change are challenging tasks. In a given individual, there is often little relationship between the magnitude of obesity and measures of health.
- Despite its modest effect on long-term weight loss, behavioral modifications thatimprove eating behaviors and increase physical activity constitute a cornerstone for integral and sustainable weight management.
- Intentional weight loss is associated with a clinically relevant reduction in blood pressure, improvement in cardiac function, and reduction in cardiovascular events. The duration and magnitude of weight change required to achieve a significant benefit are still unclear.
- In individuals with impaired glucose metabolism at any stage, intentional weight loss achieved by any means is associated with a proportional reduction in T2DM prevalence, severity, and progression.
- Intentional weight loss is consistently associated with a clinically relevant reduction in triglycerides and increase in HDL cholesterol. The effects of weight loss on LDL cholesterol are less consistent.
- Overall, nonalcoholic fatty liver disease is commonly associated with excess weight and can show marked improvement with behavioral, pharmacological, and/or surgical weight loss. Very rapid weight loss, however, may worsen liver histology in some patients. Simi- larly, gallbladder disease is not only common in patients presenting with obesity but also highly prevalent after intentional weight loss.
- Obesity is widely recognized as a key modifiable risk factor for osteoarthritis, with sig- nificant improvements in pain and function reported with weight loss.
- Obstructive sleep apnea and obesity hypoventilation syndrome tend to improve with moderate weight loss; however, complete resolution is not common and is related to very significant weight loss.
- Asthma and COPD are clearly associated with obesity. Sustained weight loss seems to be associated with a significant improvement in asthma symptoms. Data for COPD are rather limited.
- Pregnant women who under go bariatric surgery seem to be less likely to present obstetric complications such as gestational diabetes, preeclampsia, and macrosomia.
- Data on weight loss and suicide are controversial. Caution may be in order when con- sidering bariatric surgery in patients with a history of suicide ideation or attempt.
- Data suggest that long-term weight loss is associated with an improvement in health- related quality of life. The amount of weight loss required to achieve a significant change, however, remains controversial.
However, there are many other issues where putative benefits of intentional weight loss remain even less clear than with the above.
For many conditions we will likely not know the long-term benefits of obesity treatments till better treatments become available and are tested in affected individuals.
As a clinician often dealing with patients presenting with binge-eating disorder (BED), I am quite aware of the often pathological cognitive and emotional relationship to food, eating, and body image presented by patients with this syndrome.
Whether or not this impairment in thinking and feeling also extends to other behavioural or emotional domains is the topic of a systematic review by Kittel and colleagues from the University of Leipzig, published in the International Journal of Eating Disorders.
The paper is based on the review of almost 60 studies and shows that, individuals with BED consistently demonstrate higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues) – in contrast, cognitive functioning in the context of neutral stimuli appear to be less affected.
With regard to emotional functioning, individuals with BED also report greater emotional deficits when compared to obese and normal-weight controls.
Thus, these findings confirm the clinical observation that patients with BED tend to have specific difficulties in cognitive and emotional functioning when it comes to food, eating or body image, however, appear to function adequately in other domains.
For clinicians these finding are relevant as they show that while people with BED may benefit from help in changing their cognitive and emotional response to food cues, such problems are indeed more often encountered in people with BED rather than in everyone living with obesity.
Screening for BED should be an essential element of workup in anyone presenting with excess weight gain.
Irrespective of the fact that bariatric surgery has now become so safe (at high-volume centres) that it compares well with other common surgical procedures like having your gall bladder removed, it is still surgery.
As even the safest surgery carries risk, it should never be taken lightly and thus the question of whether or not people with obesity but no related comorbidities stand to benefit from bariatric surgery is an important question.
One of the key outcomes (at least for patients) is the impact on quality of life which is why Hilde Risstad and colleagues from the University of Oslo, studied the effect of bariatric surgery on patients presenting with obesity related comorbidities and those without, published in Obesity Surgery.
They studied 232 patients with severe obesity before and 2 years after Roux-en-Y gastric bypass.
Obesity related disease was defined as having at least one of the following conditions: type 2 diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, obstructive sleep apnea, gastroesophageal reflux disease, or osteoarthritis.
Not only was baseline quality of life similar in patients with and without obesity-related disease prior to gastric bypass but it also improved equally in both groups.
This may not be entirely surprising.
Readers may recall that the Edmonton Obesity Staging System (EOSS), specifically designed to asses obesity related health risks, does not just consider medical comorbidities (as in this study) – EOSS gives as much importance to mental and functional health (not assessed in this study).
Thus, it is not surprising, that even without the presence of an obesity related medical complications like diabetes or sleep apnea, health (and thus quality of life) can be significantly affected by mental health and/or functional status, both of which can markedly improve after bariatric surgery.
This is why, pre-assessment or triaging patients for bariatric surgery should not only consider medical problems but also mental and functional health – as in EOSS.