Monday, October 6, 2014

Obesity Tip Sheet For Occupational Therapists

OT obesity tip sheet AHS Oct 2014

October is Occupational Therapist Month, an event celebrated by the Canadian Association of Occupational Therapists in a nation-wide campaign involving billboards and bumper stickers.

Reason enough to turn my readers attention to a “tip sheet” developed by members of the Alberta Health Services’ Bariatric Resource Team that explains when to refer their patients with obesity to an occupational therapist.

The preamble to this sheet notes that,

“Occupational therapists promote health and well being for people with obesity by facilitating engagement in occupations of everyday life, including addressing occupational performance issues in the areas of self-care, productivity and leisure. This can impact quality of life, including how people with obesity participate in their daily lives and in health and weight management activities.”

Occupational therapy referral may be indicated for a person with obesity presenting with challenges ranging from occupational engagement to completing simple activities of daily living.

To download this OT referral tip sheet click here.

Happy OT month!

@DrSharma
Hamilton, ON

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Friday, October 3, 2014

Obesity 5As At The Armed Forces

sharma-obesity-canadian-forcesThis morning I am presenting a workshop on the Canadian Obesity Network’s 5As of Obesity Management to members of the Canadian Armed Forces here in Ottawa.

As I discussed in a previous post, members of the Armed Forces are not immune to weight-gain – if anything, the considerable stressors encountered by military personnel make them perhaps even more prone to weight gain than civilians.

And, as for civilians, there are no easy solutions. Once the weight is on, military personnel face the same challenges in losing weight and keeping it off (if indeed their excess weight is affecting their health) as everybody else.

I look forward to an exciting discussion with the medical personnel on base about how best to apply the 5As of Obesity Management in their practice.

@DrSharma
Ottawa, ON

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Thursday, October 2, 2014

Shifting To Wellness

Practice Consultant at Association of New Brunswick Licensed Practical Nurses

Christie Ruff, Practice Consultant at Association of New Brunswick Licensed Practical Nurses

Yesterday, at the annual conference of the Canadian Occupational Health Nurses in Saint John, New Brunswick, I was delighted to hear a presentation by Christie Ruff, a nursing practice consultant for the Province of New Brunswick, who spoke on the impact of sleep and shift work on health and wellness.

As Ruff pointed out, shift work is “officially” defined as any work that happens on a regular basis outside of 8.00 am to 5.00 pm, Mondays to Fridays. Work includes any of the work you take home, any checking of work related e-mails or even carrying a pager so you can be reached.

Based on this definition, the vast majority of the working population is doing shift work. Yet, virtually none of us have any formal “education” on how best to deal with the many problems that regular shift work poses for our health and well-being.

One program that addresses this issue is a program called “Shifting to Wellness“, developed at Keyanu College in Fort MacMurray, Alberta, and provides a two-day workshop for employees, who work shifts. Ruff has been a Master Trainer for this program for over 10 years.

The program looks in detail at how better understanding natural circadian rhythms, can allow shift workers to better cope with burden of shift work – from catching up on sleep to healthy eating and physical activity patterns.

From an employer perspective, this is far from trivial. Shift workers are far more prone to making mistakes and having accidents (or simply clicking the “send” button a moment too soon). Many major workplace disasters were the direct result of workplace fatigue, inattention and errors made by shift workers often fatigued from lack of sleep.

Indeed, the presentation included a comprehensive review of the stages of sleep and how these are affected (and may be corrected) in shift workers.

The “crankiness” and “irritability” of shift workers is directly related to their lack of REM sleep, as is their higher rates of depression and decreased ability to deal with stressors.

These factors also affect other aspects including personal relationships and decisions.

As readers will be well aware, lack of sleep has also been linked to appetite and hunger as well as metabolic health.

No doubt, learning more about sleep, fatigue and how to address these issues is something that any health professional working in obesity prevention or management needs to pursue to better serve their clients (and themselves).

@DrSharma
Saint John

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Wednesday, October 1, 2014

How Does Stress Affect Eating Behaviour?

sharma-obesity-brainOne of the best recognized psychosocial factors tied to food intake is stress. However, this relationship is far from straightforward. While acute stress is often associated with loss of appetite, chronic stress is generally associated with an increase in appetite and weight gain.

Now, a series of articles assembled in Frontiers in Neuroendocrine Science by Alfonso Abizaid1 (Carlton University, Canada) and Zane Andrews (Monash University, Australia), describe in detail the rather complex neuroendocrine factors that link stress to changes in ingestive behaviour.

The series includes articles on the role of neuroendocrine factors like GLP-1, NPY, ghrelin, oxytocin, dopamin, and bombesin but also articles linking stress-related eating behaviours to adverse childhood experiences, perinatal influences, circadian rhythms and reward-seeking behaviours.

I look forward to some interesting reads over the next few days and hope to summarize some of these articles in subsequent posts.

@DrSharma
Saint John, NB

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Friday, September 19, 2014

Does Mandatory Weight Loss Before Surgery Harm Patients?

weight scale helpMany surgical clinics require “mandatory” weight loss before approving patients for surgery, a requirement for which there is very little evidence that it influences post-surgical outcomes (despite the rather firm belief of many that it does).

While one may perhaps accept the need for pre-surgical weight loss when the primary objective is to make the surgery easier for the surgeon and safer for the patient, of greater concern is the practice in many centres that require “mandatory” weight loss based on the notion that patients need to demonstrate their “suitability” for surgery by achieving an arbitrary amount of weight loss in order to “qualify” and prove themselves “fit” for surgery.

That this latter requirement is not without actual risk for the patient and can lead to significant frustration and disruption of the patient-provider relationship is described in a phenomological study by Nicole Glenn and colleagues, published in Qualitative Health Research.

The study is based on in-depth interviews with seven candidates considering bariatric surgery and describes their lived experience and views about what the requirement to lose weight in oder to obtain surgery meant for them.

The article begins with a touching account of one patient:

“The surgeon says, “We need you to get your weight down a little more before we can approve you for surgery.” I fight back the tears as I drive home. Then I think, “I have to do this. I need this surgery.” I work my ass off; I eat nothing but salad for three weeks while I prepare real food for the rest of my family. I go to the gym late at night and settle for five hours sleep because there is no other time in my day with two small children to care for and a husband who works long hours. I struggle, but I’ll do whatever I have to. I come back for my next visit with the surgeon, and I’ve lost more than he had asked me to, yet he doesn’t even notice. He doesn’t comment on my weight at all! He says, “You’ll hear from my office with a surgical date.” That’s it?”

The paper focusses on four themes that emerge from the narratives.

1. Nod your head and carry on:

“[I know a few people who’ve had the surgery, and they all tell me that same thing—just do what you are told! I ran into a friend who had the surgery and was telling him about my frustrations. He said, “If the clinic staff want you to lose five pounds then you need to get the five pounds off and don’t put your personal opinion in there. Just nod your head and carry on.”]“

This behaviour, while understandable, can have unintended consequences for the patient-client relationship:

“To become perfect, to appear to be the ideal patient, a person might find it necessary to act the part. Is it possible to show who one really is when it is the ideal patient who needs to be seen? A person who waits to have bariatric surgery, who feels the need to prove him- or herself to access the surgery, might also find it necessary to hide or become secretive, to leave things out of the food journal or the stories told.”

“Imagine if one awaiting a hip replacement, for example, was first obligated to walk without pain? Why then would one be required to lose weight before weight loss surgery—to do the very thing the surgery provides? To get help, a person must reveal her struggle to the nurse, to name it, and in so doing to show herself as a failure. Such a person finds that she has no other choice. Alone, she cannot lose the weight, and without weight loss, the surgery will not happen. Nevertheless, in revealing this struggle, she risks losing the very thing she hopes to gain.”

2. Waiting and Weighing: Promoting Weight Consciousness to the Weight Conscious:

This section deals with the negative impact that this practice has by reinforcing focus and obsession with numbers on the scale when the real focus should be on health behaviours.

3. Paying For Surgical Approval Through Weight Loss:

“[I feel as if the surgery is being held for ransom, and if I don’t behave perfectly, I won’t get a chance. I mean, I see them obsessing over my charts and journal. No one even tries talking to me. The nurse and psychologist tell me, “No black or white thinking,” but here they are practicing exactly that!]“

“The irony of the perfect behavior required to lose weight and ultimately access weight-loss surgery amid suggestions to reject black and white thinking is not lost on the woman who waits. She should resist the urge to see the world as all or nothing, either this or that, and instead accept the complexities of the grey that exists in the world between black and white, yet she knows that she either loses weight or she loses surgery. It is black or white.”

4. Presurgical Weight Loss and Questioning the Need for Weight-Loss Surgery Altogether:

This section addresses the issue that patients, who do manage to lose substantial weight before surgery, may be faced with having to reconsider the need for surgery altogether thereby increasing internal conflict and enhancing uncertainty as to whether they have made the right decision to have surgery in the first place.

This is clearly a paper that all practitioners in bariatric clinics should read and be aware of.

As the authors point out, given the lack of good evidence that presurgical weight loss has any relevant impact on surgical or post-surgical outcomes, it may be high time to reconsider this potentially harmful practice.

@DrSharma
Edmonton, AB

ResearchBlogging.orgGlenn NM, Raine KD, & Spence JC (2014). Mandatory Weight Loss During the Wait For Bariatric Surgery. Qualitative health research PMID: 25185162

 

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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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