Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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Tuesday, June 17, 2014

US Obstetricians and Gynecologists Weight In On Ethical Obesity Care

ACOG_Logo.svg_This month the the Committee on Ethics of the American College of Obstetricians and Gynecologists released a position statement on obesity that advices its fellows to be prepared to meet the challenges of women with obesity with compassion and without bias.

The statement offers the following recommendations and conclusions:

  • Physicians should be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity.
  • Recommendations for weight loss should be based on medical considerations.
  • An understanding that weight loss entails more than simply counseling a woman to eat less and exercise more and a willingness to learn about the particular causes of a patient’s obesity will assist physicians and other health care professionals working with them in providing effective care.
  • Physicians can serve as advocates within their clinical settings for the necessary resources to provide the best possible care to obese women.
  • It is unethical for physicians to refuse to accept a patient or decline to continue care that is within their scope of practice solely because the patient is obese. However, if physicians lack the resources necessary for the safe and effective care of the obese patient, consultation or referral or both are appropriate.
  • Physicians should work to avoid bias in counseling regardless of their own body mass index status.
  • Obesity education that focuses on the specific medical, cultural, and social issues of the obese woman should be incorporated into physician education at all levels.

The entire statement is available here.

It would certainly be nice to see similar statements from other professional bodies (e.g. orthopedic surgeons).

Hopefully, these recommendations will soon be reflected in clinical practice.

@DrSharma
Edmonton, Alberta

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Monday, June 16, 2014

Diagnosing Obesity

sharma-obesity-scale3I am currently attending the 74th Scientific Session of the American Diabetes Association in San Francisco, where obesity is certainly a topic that permeates its way through much of the program.

However, despite all this talk, obesity continues to not be “formally” recognized as a “diagnosis” when it comes to patient care.

Thus, a paper by Canadian Obesity Network boot camper Bliie-Jean Martin and colleagues from the University of Calgary, published in BMC Health Services Research, the coding for obesity in administrative data bases and hospital discharge data is rather sketchy.

For their study, Martin and colleagues used a large coronary catheterization registry and a hospital discharge abstract database, which together consisted of more than 17,000 patients.

Based on how often the ICD-10 codes for obesity (E65-68) appeared in these datasets, it is evident that obesity was poorly coded for in the discharge database – in fact, only 2.4% of the discharge abstracts had this diagnosis (in contrast to about 20% of patients in the cardiac registry – which is likely to be more accurate).

Assuming the actual prevalence of obesity to be at least as high in patients discharged from hospital, as it is in the cardiac registry, the sensitivity of identifying obese patients based on the coding of the diagnosis is only about 8% – this means the vast majority of cases of obesity would be missed.

On the other hand, in the few cases where obesity codes were included in the discharge data set, this label was indeed correct (99% specificity).

As the authors conclude, given this state of affairs, hospital discharge databases are highly unreliable when it comes to determining obesity prevalence or burden of disease.

While there may certainly be other conditions that are “under diagnosed” and do not find themselves well reflected in such databases, nowhere is the discrepancy between prevalence and coding likely to be as great as for obesity.

This rather cavalier attitude towards coding for obesity must change if we hope to better understand the importance of obesity related morbidity in the health care system.

@DrSharma
San Francisco, CA

ResearchBlogging.orgMartin BJ, Chen G, Graham M, & Quan H (2014). Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies. BMC health services research, 14 PMID: 24524687

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Friday, June 13, 2014

AMA Calls For Better Access To Obesity Treatments

American-Medical-Association-logoOn the anniversary of the American Medical Association (AMA) “recognising” obesity as a disease, the AMA delegation yesterday passed a resolution on “Patient Access to Evidence-Based Obesity Services”, which gives the AMA decisive direction to support advocacy efforts to improve patient access to all evidence-based obesity treatments.

These treatments for obesity range from bariatric surgery and obesity drugs to intensive lifestyle interventions and nutrition counseling.

Regular readers will recall my previous posts on the various US organisations that are now not only viewing obesity as a chronic disease but are also demanding better access to obesity treatments for people with this condition.

This decision is widely applauded by other organisations including The Obesity Society and the American Society of Bariatric Physicians.

Hopefully, these efforts will go a long way towards reducing the bias and discrimination that people with obesity face in the healthcare system (and elsewhere) and help dispel the myth that all it takes to control your weight is a healthy dose of willpower.

Indeed, there is reason to believe that this AMA resolution will have significant implications for patients and the health care communityincluding:

  • improved training in obesity at medical schools and residency programs,
  • reduced stigma of obesity by the public and physicians,
  • improved insurance benefits for obesity-specific treatment, and
  • increased research funding for both prevention and treatment strategies.

Unfortunately, in Canada we have yet to see the Canadian Medical Association take a leadership role in this regard – hopefully, this is just a matter of time.

@DrSharma
Edmonton, Alberta

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Thursday, June 5, 2014

There Is Still Time To Register For The Canadian Obesity Student Meeting, Waterloo, June 18-21

Uwaterloo_sealNo doubt, addressing the obesity issue will require a small army of young researchers and health professionals working together across disciplines.

The earlier this starts – the better.

This is what the biennial Canadian Obesity Student Meeting is all about – the 4th meeting will take place in a couple of weeks at the University of Waterloo, Ontario – not something young undergraduate, graduate, post-graduate or post-docs with an interest in any aspect of obesity would want to miss.

Given the past success of previous student meetings (Laval, Ottawa, Edmonton), I am confident that this meeting will again be fun and provide most-valuable networking opportunities.

After all, once again, the Canadian Obesity Network’s Students and New Professionals (CON-SNPs) Executive and Local Organising Committees have put in hours of enthusiastic work to make this happen.

I, for one, look forward to being there.

If you or your trainee has still not registered – there is still time to reserve your spot in the spotlight – click here!

To download the program – click here!

@DrSharma
Edmonton, AB

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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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