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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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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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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Thursday, September 18, 2014

Efficacy of Vagal Blockade For Obesity Treatment Remains Vague

VBLOC

VBLOC

Regular readers may recall past posts on the use of intermittent electrical blockade of the vagus nerves (VBLOC) as a means of reducing food intake to promote weight loss.

Now a large randomised controlled study of vagal blocakade, published by Sayeed Ikramuddin and colleagues, published in JAMA, reports on rather disappointing outcomes with this treatment.

In this study (ReCharge), conducted  at one of 10 sites in the United States and Australia between May and December 2011, 239 participants with a BMI greater than 40 (or greater than 35 with at least one comorbidity), were randomised to receiving an active vagal nerve block device (EnteroMedics’ Maestro® Rechargeable (RC) System, n=162) or a sham device (n=77).

Over the 12-month blinded portion of the 5-year study (completed in January 2013), the vagal nerve block group lost about 9% or their initial body weight compared to only 6% in the sham group.

In addition to this rather modest difference in weight loss between the groups (about 3%), participants in the active treatment group also experienced a number of clinically relevant adverse effects (heartburn or dyspepsia and abdominal pain).

Thus, overall these rather disappointing results are in line with the previously disappointing observations in the smaller MAESTRO trial.

Based on these findings, it seems that intermittent electrical blockade of the vagal nerve may not hold its promise of a safe and effective long-term treatment for severe obesity after all.

@DrSharma
Edmonton, AB

ResearchBlogging.orgIkramuddin S, Blackstone RP, Brancatisano A, Toouli J, Shah SN, Wolfe BM, Fujioka K, Maher JW, Swain J, Que FG, Morton JM, Leslie DB, Brancatisano R, Kow L, O’Rourke RW, Deveney C, Takata M, Miller CJ, Knudson MB, Tweden KS, Shikora SA, Sarr MG, & Billington CJ (2014). Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial. JAMA, 312 (9), 915-22 PMID: 25182100

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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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