Friday, October 31, 2014

German TV Looks At Healthy Obesity

Arya Sharma on bike 3SATRegular readers will be familiar with the fact that not all people with excess weight necessarily have health problems. Now, the 3SAT television channel, which broadcasts in Germany, Austria and Switzerland has produced a 45 minute documentary on the science behind these findings.

Although the film is in German, I thought I would post the link anyway as many of my readers may well be able to grasp the story even if they are not entirely fluent.

To watch the documentary on line click here.

Incidentally, I am featured about 2.5 minutes into the film, discussing the Edmonton Obesity Staging System and related issues.

Appreciate all comments.

@DrSharma
Toronto, ON

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Thursday, October 30, 2014

Obesity Is Not About Lack Of Willpower

Yo-Yo Rubber Band Feb 2014As I prepare to spend the rest of this week educating health professionals in Ontario on how to better manage obesity in their practice, it is perhaps appropriate to remind ourselves that Canada is not alone in attempting to tackle this problem.

Indeed, we need to look no further than the Australian Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children for a succinct summary of reasons just why obesity management is so difficult:

- Regulation of body weight involves complicated feedback systems that result in changes in appetite, energy intake and energy expenditure. 

- While excess weight in individuals usually results from a prolonged period of energy imbalance, the causes of overweight and obesity are complex.

- Diet and physical activity are central to the energy balance equation, but are directly and indirectly influenced by a wide range of social, environmental, behavioural, genetic and physiological factors—the relationships between which are not yet fully understood.

- Individuals may be at greater risk of weight gain at particular stages in their lives.

The guidelines remind practitioners of the fact that body weight underlies tight regulation through a complex homeostatic system:

“While this system defends against weight gain as well as weight loss under normal circumstances, energy balance cannot be maintained when an energy surplus is sufficiently large and sustained. Weight gain will begin and usually continue until a new weight results in increased energy expenditure and energy balance is re-established. The same physiological mechanisms then seek to maintain energy balance at the higher weight, and will defend against weight loss by increasing appetite and reducing energy expenditure) if there is an energy deficit. As a result, most overweight and obesity results from upward resetting of the defended level of body weight, rather than the passive accumulation of excess body fat.”

This acknowledgement is a vast step forward from previous simplistic views of obesity which falsely view it as just a matter of “calories in” and “calories out”, which falsely imply that individuals should be able to achieve any desired weight simply by volitionally changing this balance through willpower alone.

Indeed, the reality is that the vast majority of individual attempting this “balance” approach to weight management will fail miserably only to gain the weight back.

Thus, the Australian guidelines are not shy about declaring a better need for pharmacological treatments and promoting the more extensive use of bariatric surgery for individuals with sever obesity related health problems.

A clear reminder to all of us that current treatments for obesity are insufficient and better, safer and more accessible treatments are urgently needed.

@DrSharma
Toronto, ON

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Friday, October 24, 2014

Social Network Analysis of the Obesity Research Boot Camp

bootcamp_pin_finalRegular readers may recall that for the past nine years, I have had the privilege and pleasure of serving as faculty of the Canadian Obesity Network’s annual Obesity Research Summer Bootcamp.

The camp is open to a select group of graduate and post-graduate trainees from a wide range of disciplines with an interest in obesity research. Over nine days, the trainees are mentored and have a chance to learn about obesity research in areas ranging from basic science to epidemiology and childhood obesity to health policy.

Now, a formal network analysis of bootcamp attendees, published by Jenny Godley and colleagues in the Journal of Interdisciplinary Healthcare, documents the substantial impact that this camp has on the careers of the trainees.

As the analysis of trainees who attended this camp over its first 5 years of operation (2006-2010) shows, camp attendance had a profound positive impact on their career development, particularly in terms of establishing contacts and professional relationships.

Thus, both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in obesity researcher (and possibly beyond).

Personally, participation at this camp has been one of the most rewarding experiences of my career and I look forward to continuing this annual exercise for years to come.

To apply for the 2015 Bootcamp, which is also open to international trainees – click here.

@DrSharma
Toronto, ON

ResearchBlogging.orgGodley J, Glenn NM, Sharma AM, & Spence JC (2014). Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. Journal of multidisciplinary healthcare, 7, 459-70 PMID: 25336965

 

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Friday, October 10, 2014

PHEN/TPM ER Improves Glycemic Control in Type 2 Diabetes

qsymia-300x224The fixed combination of phentermine/topiramate extended release (PHEN/TMP ER), is marketed in the US as the anti-obesity drug Qsymia.

Now a paper by Timothy Garvey and colleagues, published in Diabetes Care, describes the weight-lowering and anti-diabetic effect of this drug combination in individuals with type 2 diabetes.

The investigators studied the effect of 56-week treatment in 130 participants randomised either to placebo or PHEN/TPM ER (15 mg/92 mg) once-daily with change in A1c levels as the primary endpoint. Both treatment groups also received lifestyle interventions to improve diet and physical activity.

The authors also present data on a secondary analysis of individuals with type 2 diabetes (n=388), who participated in the CONQUER trial.

At week 56 individuals on PHEN/TMP ER lost about 9.4% compared to a 2.7% on placebo. This reduction in body weight was associated with a 1.6% reduction in A1c levels on PHEN/TMP ER compared to a reduction of 1.2% in participants on placebo.

In addition, greater numbers of patients randomized to receive PHEN/TPM ER treatment achieved HbA1c targets with reduced need for diabetes medications when compared with the placebo group.

As expected from these drugs, the most common adverse events included paraesthesia, constipation, and insomnia.

As the authors conclude, PHEN/TPM ER plus lifestyle modification can effectively promote weight loss and improve glycemic control as a treatment approach in obese/overweight patients with type 2 diabetes.

PHEN-TMP ER is currently not approved for obesity management outside the US.

@DrSharma
Edmonton, AB

disclaimer: I have served as a paid consultant and speaker for Vivus, the maker of Qsymia.

ResearchBlogging.orgGarvey WT, Ryan DH, Bohannon NJ, Kushner RF, Rueger M, Dvorak RV, & Troupin B (2014). Weight-Loss Therapy in Type 2 Diabetes: Effects of Phentermine and Topiramate Extended-Release. Diabetes care PMID: 25249652

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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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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

» More news articles...

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