Now a study by Jennifer Fenn and colleagues from the University of Vermont report significant weight gain with methadone treatment for opioid addiction in a paper published in the Journal of Substance Abuse Treatment.
The retrospective chart review included 96 patients enrolled in an outpatient methadone clinic for ≥ 6 months.
Overall mean BMIs increased by about 3 units (from 27.2 to 30.1), which corresponds roughly to an 18 lb or 10% increase in body weight.
Interestingly, the weight gain was predominantly seen in women, who gained about 28 lbs or 17.5% body weight compared to men, who only increased their weight by about 12 lbs or 6.4%.
As the study did not have access to food records, one can only speculate as to the causes. While better nutrition may well play a role, one could also speculate that there may be some addiction transfer from opioids to calorie-dense foods.
Whatever the cause, clinicians should probably be aware of this potential impact of methadone treatment on body weight, as prevention of excess weight gain may be easier than treating obesity once it is established.
Now, Mary Boggiano and colleagues from the University of Birmingham, Alabama, in a paper published in Appetite, report that using tasty foods as a coping strategy is associated with weight gain.
The study administered the Palatable Eating Motives Scale (PEMS), which assesses eating for coping motives (e.g., to forget about problems, reduce negative feelings), to 192 college students, who were reexamined after two years (with a few measures in between).
Not too surprisingly, PEMS scores predict changes in BMI over two years.
On a positive note, however, the researchers found that PEMS scores (i.e. using food for coping) can change over time and a reduction in PEMS scores was also associated with a lesser weight gain. In overweight subjects, a reduction in PEMS scores was even associated with modest weight loss.
Thus, the authors suggest that interventions aimed specifically at reducing palatable food intake for coping reasons, should help prevent obesity if this motive-type is identified prior to significant weight gain.
Today I will be attending a Summit on Weight Bias at the University of Calgary, that will explore the the issue of weight-based discrimination and ways to address this – especially in health care settings.
It should come as no surprise that weight bias and discrimination are a major barrier to providing proper preventive and therapeutic health care due to the widespread attitudes and beliefs about obesity that exist amongst health professionals and decision makers.
The scientific summit, co-sponsored by the Canadian Obesity Network, Campus Alberta, and the Canadian Institutes of Health Research (CIHR), is complemented by a public Cafe Scientifique that will be held on Thursday, March 12, 7.00 at the Parkdale Community Association, 3512 – 5 Ave NW, in Calgary.
For more information and pre-registration for this free public event, which features
Leora Pinhas, MD
Child & Adolescent Psychiatrist, Physician Lead, Eating Disorders Unit, Ontario Shores Centre for Mental Health Sciences Assistant Professor, University of Toronto
Tavis Campbell, PhD
Professor, Department of Psychology and Oncology & Director, Behavioural Medicine Laboratory, University of Calgary
Yoni Freedhoff, MD, CCFP
Medical Director, Bariatric Medical Institute, Assistant Professor, University of Ottawa
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.
To register – click here.
It would hardly come as a surprise to regular readers that I would be delighted to see the Edmonton Obesity Staging System featured quite prominently in the article on obesity management by Dietz and colleagues in the 2015 Lancet series on obesity.
Here is what the article has to say about EOSS:
“The Edmonton obesity staging system (EOSS) has been used to provide additional guidance for therapeutic interventions in individual patients (table 1). EOSS provides a practical method to address the treatment paradigm. In principle, EOSS stages 0 and 1 should be managed in a community and primary care setting. Recent data from the USA suggest that 8% of patients with severe obesity (BMI ≥35 kg/m²) account for 40% of the total costs of obesity, whereas the more prevalent grade 1 obesity accounts for a third of costs. These findings suggest that greater priority should be accorded to EOSS stages 3 and 4, resulting in greater focus on pharmacological and surgical management delivered in specialist centres.”
These recommendations are not surprising, as EOSS was specifically designed to provide a much better representation of how “sick” a patient is rather than just how “big” she is.
This is why EOSS has now found its way not just into the 5As of Obesity Management framework of the Canadian Obesity Network but also into the treatment algorithm of the American Society of Bariatric Physicians.
To download a slide presentation on how EOSS works click here.