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, December 10, 2014

Introducing Sadly The Line-Dancing Owl

Sadly The Line Dancing Owl

Sadly The Line Dancing Owl

Yesterday, I posted about my daughter Linnie von Sky’s 2nd children’s book Pom Pom A Flightless Bully Tale, that is now available here.

Today, I would like to introduce you to Sadly The Line-Dancing Owl, who one morning wakes up with a dark cloud over his head.

Learn how Sadly in the end overcomes his sadness and how he finds the help he needs to be his happy self again. 

After tackling immigration and bullying, Linnie turns her attention to depression – in a children’s book that she admits is somewhat autobiographical,

“Depression is REAL and it SUCKS…at least it sucked the living daylight out of me and consumes too many people I love.”

Along for the ride is the incredibly talented Ashley O’Mara as the new illustrator.  Ashley is a Vancouverite, Emily Carr Graduate, Bird Lover (she draws the cutest darn chickens I’ve ever seen) and like Linnie, knows a thing or two about how much depression hurts.  

Please consider supporting Linnie’s fundraising campaign by pre-ordering your personal copy(ies) of Sadly The Line-Dancing Owl, which will again be 100% made in Canada.

To learn more about Sadly and how you can support this venture, please take a minute to visit Linnie’s Indiegogo page.

@DrSharma
Edmonton, AB

 

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Thursday, December 4, 2014

Can Gut Bugs Cause Depression?

sharma-obesity-gut-buts1Regular readers will by now be well aware of the rapidly growing body of researcher supporting the idea that your gut bugs (of which you have more than you have cells in your body) may well play a key role in determining your risk for obesity and other metabolic disorders.

Now, a paper by Ruth Ann Luna and Jane Foster from Baylor College of Medicine and McMaster University, respectively, published in Current Opinion in Biotechnology, review the evidence that gut bugs may well also have significant effects on your stress response as well as other aspects of mental healthy, including depression.

As one example, they cite a study that shows,

“…a general underrepresentation of the Bacteroidetes phylum in depressed patients and an association of the Lachnospiraceae family with the depression group, and interestingly, even with a decrease in Bacteroidetes, specific operational taxonomic units (OTUs) identified as members of the Bacteroidetes phylum correlated with depression.”

They also cite a number of studies showing that stress can affect gut bug populations and that certain gut bacteriomes are associated with a greater stress response, suggesting that the relationship between gut bugs and stressors may well be a two-way street.

The authors go on to describe a number of pathways that may link gut bugs to humoral, neural, and cellular signaling pathways to brain function.

Clearly, this appears a rich area of research that may well reveal pathways common to both neurological and metabolic issues, both of which may turn out to be amenable to dietary and probiotic interventions.

@DrSharma
London, UK

ResearchBlogging.orgLuna RA, & Foster JA (2014). Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression. Current opinion in biotechnology, 32C, 35-41 PMID: 25448230

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Thursday, November 20, 2014

Obesity Myth: Losing Weight Is Always Beneficial For Your Health

sharma-obesity-scale2Another common misconception about obesity discusses in our recent paper in Canadian Family Medicine, is the notion that anyone with excess weight stands to benefit from losing weight.

The benefits of weight loss, however are far from as established as most of us may think:

“The strong biological response to weight loss (even the recommended 5% to 10% of baseline weight) involves comprehensive, persistent, and redundant adaptations in energy homeostasis that underlie the high recidivism rate of obesity treatment.

The multiple systems regulating energy stores and opposing the maintenance of a reduced body weight illustrate that fat stores are actively defended.

Among the adverse effects of weight loss, it is well known that body fat loss increases the drive to eat, reduces energy expenditure to a greater extent than predicted, and increases the tendency toward hypoglycemia.

Weight loss is also related to psychological stress, increased risk of depressive symptoms, and increased levels of persistent organic pollutants that promote hormone disruption and metabolic complications, all of which are adaptations that substantially increase the risk of weight regain.

In addition, there is considerable concern about the negative effect of “failed” weight-loss attempts on self-esteem, body image, and mental health.

Thus, clinicians should document and consider the powerful biological counter-regulatory responses and potential undesired effects of weight loss to maximize the success of their interventions. Obesity is a chronic condition and its management requires realistic and sustainable treatment strategies.

Successful obesity management requires identifying and addressing the obesity drivers as well as the barriers to and potential complications of weight management. Family physicians should discuss the possible adverse effects of weight loss with their patients and actively look for these effects in patients trying to lose weight.”

@DrSharma
Wellington, NZ

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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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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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