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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Monday, September 29, 2014

Does Lean Tissue Have More To Say About Your Health Than Your Body Fat?

Carla Prado, PhD,  Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

Carla Prado, PhD, Assistant Professor and CAIP Chair in Nutrition, Food and Health, University of Alberta, Edmonton, Canada

The common assumption is that people with more body fat are at greater risk for illness and overall mortality.

Surprisingly, an increasingly robust body of evidence now suggests that how much lean tissue you have may be far more important for your health than the amount of body fat.

This evidence as well as the methodologies used to study lean body mass are discusses in a paper by Carla Prado (University of Alberta) and Steve Heymsfield (Pennington Biomedical Research Center), in a paper published in the Journal of Parenteral and Enteral Nutrition.

As the authors point out,

“The emerging use of imaging techniques such as dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and ultrasound imaging in the clinical setting have highlighted the importance of lean soft tissue (LST) as an independent predictor of morbidity and mortality.

The paper discusses in depth the advantages and limitation of the many methods that can be used to assess body composition in research and clinical settings.

The paper also discusses the current definition and importance of sarcopenic obesity and notes that,

“The identification of different body composition phenotypes suggests that individuals have different metabolism and hence utilization of fuel sources.”

Thus,

“It is clear from emerging studies that body composition health will be vital in treatment decisions, prognostic outcomes, and quality of life in several nonclinical and clinical states.”

My guess is that it will not just be the absolute or relative amount of lean tissue mass that is important. Rather, similar to the increasingly recognised role of differences amongst fat depots, I would assume that different lean soft tissue depots may well play different roles in metabolic health.

@DrSharma
Charlottetown, PEI

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Monday, September 22, 2014

What Can We Learn From the Sweetener and Gut Bug Study?

sharma-obesity-gut-buts1Last week, a paper by Jotham Suez and colleagues on the potential detrimental effect of artificial sweeteners (particularly saccharin) on glucose homeostasis, published in Nature grabbed media attention worldwide.

Using an elegant series of experiments, the research showed that saccharin not only appears to negatively affect glucose metabolism in mice, but does so through its effects on gut bugs.

Potential relevance to humans was demonstrated by exposing volunteers to 120 mg of saccharin a day for 7 days and then transplanting the stool of the four (out of seven) participants, who showed decreased glucose tolerance, to germ-free mice.

In their conclusions, the authors speculate that the widespread consumption of artificial sweeteners (as a means to prevent obesity and/or diabetes) may have played a paradoxical role in promoting these very health problems.

While that may or may not be the case (given that all we have is evidence in mice and short-term finding from a handful of humans), I find these observations most interesting for one simple reason alone and that is the demonstration that chemical composition of the diet can alter gut bacteriomes, which in turn can significantly affect metabolism.

Whether or not artificial sweeteners may have significantly altered the gut bacteria of people across the world (leading to obesity in Africa, India, South America and elsewhere) may not be entirely plausible but, if indeed sweeteners can do this, there are probably much more likely culprits in our modern diets.

For one, I would begin by suspecting the rather liberal use of antibiotics both in animal husbandry as well as human infection. Next, I would wonder about the widespread use of preservatives and pesticide. Finally, I’d wonder about the very likely impact of all the other chemicals including personal hygiene products and disinfectants in our environment on our intestinal flora (does washing your hands make you obese?).

If there is one thing that I learn from this study, it is the fact that we must now take into consideration a wide range of factors that can potentially alter our susceptibility to obesity and/or diabetes by changing our gut bugs.

Incidentally, the gut bugs are not just influenced by environmental or food-borne chemicals – the very foods we eat can substantially affect our gut bugs, which have now been implicated in everything from Alzheimer’s and autism to arthritis and cancer.

While every new area of research is often accompanied by considerable hype (promoted both by the media and the researchers themselves), this will probably be an interesting space to watch.

@DrSharma
Edmonton, AB

ResearchBlogging.orgSuez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, Israeli D, Zmora N, Gilad S, Weinberger A, Kuperman Y, Harmelin A, Kolodkin-Gal I, Shapiro H, Halpern Z, Segal E, & Elinav E (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature PMID: 25231862

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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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