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Overweight And Obesity In Alberta; A Role For Primary Care

HQCA_Obesity_Info_graphic712x1160Yesterday, the Health Quality Council of Alberta, released a report called Overweight and obesity in adult Albertans: a role for primary healthcare, which provides an in-depth analysis of the prevalence, burden, and rates of use of a number of key healthcare services for overweight and obese individuals in Alberta. The report also provides a strong rationale for the role of primary healthcare in weight management for adult Albertans living with overweight and obesity.

In 2014, the HQCA conducted a survey of adult Albertans about their use and satisfaction with healthcare services. As part of this survey, self-reported height and weight were collected from individuals in order to calculate their body mass index. According to these findings, nearly six out of 10 Albertans over the age of 18 were either overweight or obese. The estimated provincial prevalence of adults with overweight and obesity was 35.2 per cent and 23.9 per cent, respectively. In addition, obesity was associated with an increased risk of multiple comorbidities, greater use of healthcare system services, and a lower self-rated individual quality of life.

Managing overweight and obese populations, as well as comorbid conditions, falls predominantly on primary healthcare providers. Evidence shows that diverse strategies for the management of overweight and obesity within primary healthcare are associated with benefits in weight management; however, the most effective mix of providers, interventions, and duration requires further evaluation. Moving forward, Alberta may benefit from working towards a more unified strategy for weight management that includes opportunities to engage Albertans in discussions about weight management, and to increase the use of team-based care across all weight categories.

The full report is available here.

A fact sheet is available here.

@DrSharma
Edmonton, Alberta

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Weight-Based Bullying Is The Most Common Form of Bullying in Youth

sharma-obesity-bullyingAccording to a study conducted by a team of researchers from the US, Canada, Australia and Iceland, published in Pediatric Obesity, weight-based bullying in children and youth is the most prevalent form of youth bullying in these countries, exceeding by a substantial margin other forms of bullying including race/ethnicity, sexual orientation or religion.

According to the almost 3000 participants in this study, parents, teachers and health professionals were seen as those with the greatest potential of reducing weight-based bullying.

In addition, the majority of participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying.

While these findings may not strike anyone living with obesity as surprising, they should be a reminder to the rest of us that weight-based bullying, with all of its negative consequences for mental, physical and social health, is something to be taken very seriously and needs to be opposed as much as we would oppose any other forms of bullying.

@DrSharma
Vancouver, BC

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Does Food Availability Have Much To Do With Obesity?

sharma-obesity-variety1Before you respond “of course” – you may wish to take a look at the systematic review by Laura Cobb and colleagues from Johns Hopkins University, published in OBESITY.

The authors looked at 71 Canadian and US studies that examined the relationship between obesity and retail food environments and concluded that,

“Despite the large number of studies, we found limited evidence for associations between local food environments and obesity. “

To be fair, the researchers also concluded that much of the research in this area lacks high-quality studies, that would lead to a more robust understanding  of this issue.

In fact, the authors had to slice and dice the data to tease out “positive” findings that included a possible relationship between fast food outlets and obesity in low-income children or an inverse trend for obesity with the availability of supermarkets (a supposed surrogate measure for availability of fresh produce).

Of course, not finding a robust relationship between the food environment and obesity should not be all that surprising, given the many factors that can potentially play a role in obesity rates.

(Readers may recall that there used to be similar enthusiasm between the role of the built environment (e.g. walkability) for rising obesity rates, till the research on this issue turned out to be rather inconclusive. )

None of this should be interpreted to mean that the food or built environments have nothing to do with obesity – however, we must remember that these type of studies virtually never prove causality and that the factors that determine food and built environments are in fact almost as complicated as the factors that determine individual body weights, so finding a robust relationship between the two would be rather surprising.

Allow me to predict that with the increasing trend of fast food outlets offering healthier (or rather less-unhealthy) choices and supermarkets offering ample amounts of “fast food” and a vast array of unhealthy packaged foods, any relationship between retail food environments and obesity (even if it does exist), will be even harder to prove that ever before (outliers are no better than anecdotal evidence and should generally be ignored).

Changing food environments to provide better access to affordable healthier foods should be a “no-brainer” for policy makers, irrespective of whether or not the current environment has anything to do with obesity or not (the same could be said for walkability of neighbourhoods and the prevention of urban sprawl).

@DrSharma
Edmonton, AB

 

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Canadian Obesity Network’s Toronto Chapter Takes Off

CON-Toronto Chapter Executive

CON-Toronto Chapter Executive

As regular readers may know, the Canadian Obesity Network is currently promoting the creation of local chapters across Canada. This is part of the Network’s strategy to continue growing and engaging researchers, health professionals, and others with an interest in obesity prevention and management to network and break down silos.

Following the very successful launch of local Obesity Network chapters in Calgary and Hamilton, last night saw the inaugural meeting of the Toronto Chapter (CON-YYZ), which got together to appoint their new executive and to exchange ideas on local activities that this chapter can pursue in the future.

I had the opportunity of joining in for part of this meeting via Skype and was delighted to see the diversity of attendees and their enthusiasm – certainly a promise of great things to come.

For anyone interested in learning more about how to start your own local CON chapter, more information is available here.

I look forward to seeing a number of new Obesity Network chapters created across Canada, as we continue to seek better ways to fight weight-bias, discrimination and find better ways to prevent and manage obesity.

@DrSharma
Edmonton, AB

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The Health And Social Benefits Of Risky Play

sharma-obesity-active-kidsThe recent report card on physical activity released by Participaction strongly recommends (unsupervised) free play as a means to increase physical activity in kids.

But free play has far greater benefits on children’s development than just physical fitness, especially when there is an element of risk involved.

That is the conclusion of a paper by Marianna Brussoni and colleagues, published in the International Journal of Environmental Research and Public Health.

For their paper, risky play was defined as play that involves an element of danger, including the possibility of physical injury.  Such types of play include play at height, speed, near dangerous elements (e.g., water, fire), with dangerous tools, rough and tumble play (e.g., play fighting), and where there is the potential for disappearing or getting lost.

This systematic review of 21 relevant research studies shows that risky outdoor play not only improves physical health (despite the inherent risk of injuries and even death), but also social health and behaviours, risk for injuries, and reduced aggression.

Specifically, studies have shown improvements in risk detection and competence, increased self-esteem and decreased conflict sensitivity and conflict resolution, better developed motor skills, enhanced social behaviour, greater independence, improved risk management strategies, and the ability to negotiate decisions about substance use, relationships and sexual behaviour during adolescence.

Obviously, risky behaviour is risky – according to the researchers,

“In Canada, approximately 2,500 children age 14 and under are hospitalized annually as a result of playground falls (play at height)—81% are for fractures.”

Nevertheless, weighing all of the available evidence, the researchers came to the following conclusions:

“Although these findings are based on ‘very low’ to ‘moderate’ quality evidence, the evidence suggests overall positive effects of risky outdoor play on a variety of health indicators and behaviours in children aged 3-12 years. Specifically, play where children can disappear/get lost and risky play supportive environments were positively associated with physical activity and social health, and negatively associated with sedentary behaviour.

Play at height was not related to fracture frequency and severity. Engaging in rough and tumble play did not increase aggression, and was associated with increased social competence for boys and popular children, however results were mixed for other children.

There was also an indication that risky play supportive environments promoted increased play time, social interactions, creativity and resilience.

These positive results reflect the importance supporting children’s risky outdoor play opportunities as a means of promoting children’s health and active lifestyles.”

Clearly, these finding go against the popular policies that focus on harm reduction and making kids’ play environments as safe as possible.

Perhaps these policies are doing more harm than good – as always, you never know where the unintended consequences of well-meant public policies rear their ugly head.

@DrSharma
Edmonton, AB

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