Wednesday, November 12, 2014

5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

@DrSharma
Ottawa, ON

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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 23, 2014

Guest Post: My Weight Is Not Measured In Pounds

Fitness Header ColorToday’s guest post comes from Andrea Matthes, a Certified Personal Trainer and blogger, who I met at the annual meeting of the Obesity Action Coalition in Orlando – the post speaks for itself.

I recently attended the Obesity Action Coalition’s annual Your Weight Matters Convention and got the opportunity to hear Dr. Sharma’s keynote presentation titled, “Health is Not Measured in Pounds.” I found myself sitting in my chair, agreeing so emphatically that I was full-body nodding at the waist. By the end of his speech, I couldn’t contain myself– I jumped out of my chair making the first, very loud clap that echoed through the room, only to be followed by hundreds of other claps and a full-house standing ovation. Dr. Sharma’s message was something I needed to hear. Not because it was a new theory to me, but because up until that hour, his theory was what I was experiencing first-hand.

I am 5 feet, one inch tall and weigh 165lbs (when slightly dehydrated). At my current height/weight my BMI is 31.2, also known as: OBESE. A word that is often associated with laziness, overeating, diabetes, high blood pressure, bad cholesterol and overall ill health. According to this number, I need to lose at least 35lbs if I want to reach the “normal” range in order to be considered “healthy”.

Can I just tell you how frustrating that is?

I am living an exceptionally healthy, full and active lifestyle. My blood pressure is perfect, my cholesterol levels are great, and my A1C is consistently normal. My daily life consists of running, jumping, lifting heavy objects, and eating a diet that most people would consider ideal. I am extremely proud of the lifestyle I live. I am able to climb mountains, run races, surf, ski, and flip a perfectly executed cartwheel at the drop of a hat. Yet, I am told that in order to be healthy, I need to lose weight!

How ridiculous is that?

It’s extremely ridiculous and unfair that I have to live with a label that is based on a fancy formula for size; a label that says I need to lose weight in order to avoid potential misdiagnoses, higher insurance premiums, and social stigma. It’s unfair that my TRUE health has very little to do with pounds and everything to do with how I live my life. This is what my obesity looks like:

I am a running, swimming, cycling, heavy-lifting, nutrient-eating, LIFE-LOVING, 5-foot-one-inch-tall, 37-year-old woman who also weighs 165lbs which leaves me with a label that misrepresents the life I live and my health!

I may be obese according to BMI but that does not mean I am unhealthy.

My obese body is strong, it is capable, it is HEALTHY. In fact, my obese body is healthy enough to do things that many skinny people can’t do. So weigh me all you want, but please, do not measure my HEALTH in pounds.

ABOUT ANDREA

Andrea has lost 164 pounds with a jumpstart from gastric bypass surgery followed by a complete lifestyle overhaul. She is now a Certified Personal Trainer, Level One CrossFit Coach and has completed over 25 races since March of 2013. Andrea blogs about her REAL FOOD, REAL FITNESS, REAL LIFE approach at www.imperfectlife.net where she strives to inspire others to let go of perfection and learn to love their one and only I’mperfect Life.

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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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Thursday, October 9, 2014

Are Smokers More Deserving of Treatment Than People Living With Obesity?

sharma-obesity-teen-smokingThis certainly appears to be the opinion of the majority of people living in Denmark, as reported in a study by Thomas Lund and colleagues published in the European Journal of Clinical Nutrition.

The study examined public support for publicly funded treatment of obesity (weight-loss surgery and medical treatment) and two pulmonary diseases strongly associated with smoking (chronic obstructive pulmonary disease (COPD) and lung cancer) in Denmark.

While a large majority supported treatment for lung cancer (86.1%) and COPD 71.2% (even when described as ‘smoker’s lung’ 61.9%), only one in three supported publicly funded weight-loss surgery (30%) and medical treatment of obesity (34.4%).

Not surprisingly, respondents beliefs about the causes of lifestyle-related diseases (external environment, genetic disposition and lack of willpower) and agreement that ‘people lack responsibility for their life and welfare’ influenced support for these treatments, especially in the case of treatments for obesity.

My guess is that these finding will not be significantly different in other countries that have publicly funded health care systems, including the UK or Canada, where treatments for cigarette-related lung and heart disease (as well as treatments for smoking cessation) are by far more accepted and accessible than treatments for obesity.

While I am all for treating and perhaps even further improving the care of people with smoking-related health problems, not having the same degree of concern or accessibility to treatments for obesity should be unacceptable.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLund TB, Nielsen ME, & Sandøe P (2014). In a class of their own: the Danish public considers obesity less deserving of treatment compared with smoking-related diseases. European journal of clinical nutrition PMID: 25248357

 

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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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