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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Tuesday, October 28, 2014

Should A Political Prescription For Obesity Not Also Include Better Treatments?

sharma-obesity-policy1In the latest issue of the Canadian Medical Association Journal, the editors opine on the need for a political prescription for obesity – in short taxation and regulation of  high-calorie and nutrient-poor food products as the only viable approach to the obesity epidemic. As may be expected, they use the analogy of tobacco as a justification for this approach (given that actual data from government intervention on reducing the consumption of the said foods is so far lacking).

Be that as it may, what caught my attention in the article was the following passage:

“Treating obesity does not work well; preventing it would be better. The global failure to manage obesity, now considered by the American Medical Association to be a disease, may be considered a failure of the evidence-based medicine approach to treating disease….We know that most restrictive diets result in only short-term weight loss that frequently reverses and worsens in the long term, but dietary changes that are sustainable as a lifestyle choice may work. Physical activity is not enough to prevent or treat obesity and overweight, unless it is combined with some kind of dietary intervention. Family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy. Bariatric surgery has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort. Pharmaceutical agents may work to some extent, but may have nasty adverse effects.”

The interesting thought here is that the authors parade the lack of effective treatment as a justification for prevention, when I would rather have used this state of affairs to call for greater investments in finding better treatments.

Not that I am not in favour of prevention – indeed, I am all for preventing heart disease, diabetes, cancer, depression, bone and joint disease and everything else.

But, at no point would I ever call for prevention as an alternative to finding better treatments for any of these conditions.

The fact that people still die of cancer should never justify us abandoning the search for better treatments – indeed, as far I can see, the whole Pink Ribbon Industry apparently focusses on “finding the cure” – not on “finding better ways to prevent breast cancer” (even if most experts believe that much of breast cancer is indeed preventable).

Just because  we still have no effective treatments for a host of other conditions, should we abandon the search for better treatments for these conditions?

In short, what irks me most about this article is not the call for prevention – indeed I am all for it!

But when the lack of effective (or safe) treatments is used to justify this call, I must disagree.

No matter how much we restrict and tax the food industry, there will always be people around, who despite their best efforts, will struggle with excess weight. Indeed, there is no reason to believe (at least not for anyone who understands the physiology of obesity) that any form of “prevention” will reverse the epidemic in those who already have the problem – i.e. in about 6 Mill Canadians. (even if we somehow miraculously reduced obesity in the population by 30% through “preventive measures” (well beyond even the most optimistic predictions) – we would still need treatments for 4 Mill Canadians – adults and kids!)

The longer we wait to find and implement effective treatments, the longer these individuals will struggle with a condition that should deserve the same efforts at treatment as we afford individuals with other “lifestyle” diseases (including heart disease, diabetes and cancer).

Let us not forget that treatments for other common conditions (e.g. hypertension, hypercholesterolemia and diabetes) were once lacking – today millions around the world benefit from these treatments – indeed, it is probably safe to say that these medications probably save more lives each year than any known efforts at regulating industry that I know of.

Indeed, if we wish to find more effective ways to manage obesity, we need to vastly increase our efforts at finding better treatments – not abandon them.

Prevention is never an alternative to also having effective treatments. The two go hand-in-hand.

@DrSharma
Edmonton, AB

 

 

 

 

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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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Tuesday, October 21, 2014

The Cultural Drivers and Context of Obesity

sharma-obesity-family-watching-tvIn my continuing review of not too recent publications on obesity, I found this one by Hortense Powdermaker, Professor of Anthropology, Queens College, Flushing, New York, published in the Bulletin of the New York Academy of Medicine in 1960.

The following quotes could all have been written last week:

“We eat too much. We have too much of many things. According to the population experts, there are too many people in the world, due to the decline in mortality rates. A key theme in this age of plenty-people, food, things-is consumption. We are urged to buy more and more things and new things: food, cars, refrigerators, television sets, clothes, etcetera. We are constantly advised that prosperity can be maintained only by ever-increasing consumption.”

“…physical activity is almost non-existent in most occupations, particularly those in the middle and upper classes. We think of the everincreasing white-collar jobs, the managerial and professional groups, and even the unskilled and skilled laborers in machine and factory production. For some people there are active games in leisure time, probably more for males than females. But, in general, leisure time activities tend to become increasingly passive. We travel in automobiles, we sit in movies, we stay at home and watch television. Most people live too far away to walk to their place of work.”

“The slender, youthful-looking figure is now desired by women of all ages. The term “matronly”, with its connotation of plumpness, is decidedly not flattering. Although the female body is predisposed to proportionately more fat and the male to more muscle, the plump or stout woman’s body is considered neither beautiful nor sexually attractive.”

“The desire for health, for longevity, for youthfulness, for sexual attractiveness is indeed a powerful motivation. Yet obesity is a problem. We ask, then, what cultural and psychological factors might be counteracting the effective work of nutritionists, physicians, beauty specialists, and advertisements in the mass media?”

“Although there are probably relatively few people today who know sustained hunger because of poverty, poor people eat differently from rich people. Fattening, starchy foods are common among the former, and in certain ethnic groups, particularly those from southern Europe, women tend to be fat. Obesity for women is therefore somewhat symbolic for lower class. In our socially mobile society this is a powerful deterrent. The symbolism of obesity in men has been different. The image of a successful middle-aged man in the middle and upper classes has been with a “pouch”, or “bay-window”, as it was called a generation ago.”

The paper goes on to discuss some (rather stereotypic) notions about why some people overeat and others don’t – an interesting read but nothing we haven’t heard before.

Nevertheless, given that this paper was written over 50 years ago – one wonders how much more we’ve actually learnt about the cultural aspects of this issue – it seems that we are still discussing the same problem as our colleagues were half a century ago.

Perhaps it really is time for some new ideas.

@DrSharma
Edmonton, AB
ResearchBlogging.orgPOWDERMAKER H (1960). An anthropological approach to the problem of obesity. Bulletin of the New York Academy of Medicine, 36, 286-95 PMID: 14434548

 

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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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