Friday, December 12, 2014

Prevalence and Treatment of Depression In Canada

sharma-obesity-mental-health1Depression can be a significant factor both in the development of obesity and as an important barrier to its treatment.

Now a paper by Sabrina Wong and colleagues from the University of British Columbia, in a paper published in CMAJ open, present data on the prevalence and treatment of depression in Canadian primary care practices.

The authors analysed electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, of over 300,000 patients who had at least one encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012.

Of these, 14% had a diagnosis of depression.

Women with a BMI greater than 30 were about 20% more likely to also have depression than women with a BMI below 25. No such relationship was noted in men.

Overall, 25% of individuals with a diagnosis of depression also had at least one other chronic condition as well as about 50% more doctor visits than individuals without depression.

Clearly, depression is a common problem in primary care and weight management in patients (particularly women) presenting with this problem needs to be addressed (not least because many of the medications often used to manage depression may well be part of the problem).

@DrSharma
Edmonton, AB

VN:F [1.9.22_1171]
Rating: 10.0/10 (2 votes cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Wednesday, December 10, 2014

Introducing Sadly The Line-Dancing Owl

Sadly The Line Dancing Owl

Sadly The Line Dancing Owl

Yesterday, I posted about my daughter Linnie von Sky’s 2nd children’s book Pom Pom A Flightless Bully Tale, that is now available here.

Today, I would like to introduce you to Sadly The Line-Dancing Owl, who one morning wakes up with a dark cloud over his head.

Learn how Sadly in the end overcomes his sadness and how he finds the help he needs to be his happy self again. 

After tackling immigration and bullying, Linnie turns her attention to depression – in a children’s book that she admits is somewhat autobiographical,

“Depression is REAL and it SUCKS…at least it sucked the living daylight out of me and consumes too many people I love.”

Along for the ride is the incredibly talented Ashley O’Mara as the new illustrator.  Ashley is a Vancouverite, Emily Carr Graduate, Bird Lover (she draws the cutest darn chickens I’ve ever seen) and like Linnie, knows a thing or two about how much depression hurts.  

Please consider supporting Linnie’s fundraising campaign by pre-ordering your personal copy(ies) of Sadly The Line-Dancing Owl, which will again be 100% made in Canada.

To learn more about Sadly and how you can support this venture, please take a minute to visit Linnie’s Indiegogo page.

@DrSharma
Edmonton, AB

 

VN:F [1.9.22_1171]
Rating: 7.0/10 (5 votes cast)
VN:F [1.9.22_1171]
Rating: +1 (from 3 votes)


Tuesday, December 9, 2014

Pom Pom A Flightless Bully Tale Takes Flight

Pom Pom A flightless bully tale coverToday’s post is to announce the arrival of my daughter Linnie von Sky’s second children’s book, “Pom Pom A Flightless Bully Tale“, that hundreds of you helped fund by pre-ordering your copy(ies) about 12 months ago – your books are in the mail and should be there in time for the Holidays (a big THANK YOU from me for your support!).

To those of you, who are new to these pages, Pom Pom is the story of the slightly rotund little penguin Pomeroy Paulus Jr III., who simply hates it when people call him “Pom Pom”.  Like any boy his age he’s busy trying to impress ‘the birds’, particularly one bird: Pia. Pomeroy dreams of a pair of orange swim trunks; the ones that Pete, Pucker and Piper own. The same ones Pia said she loved. There’s just one little hiccup. The antAmart doesn’t carry them in his size.

The story tells of how mom helps Pomeroy get his own pair of orange swim trunks and how Pia saves the day when she steps up and puts bullies in their place.

Here is what Linnie had to say about the reason for writing this book in an interview with Lindsay william-Ross for VancityBuzz:

“When you talk about bullying you have to talk about how much it hurts. Kids understand that,” says von Sky, who hopes her stories ignite conversations. Of “Pom Pom,” von Sky remarks: “I think it’s an encouragement to talk about emotions. What triggers certain actions, what makes somebody want to hurt someone else. Are they hurting?”

For von Sky, whose protagonist in “Pom Pom” is picked on because of his size, the pain of bullying in the story echoes the passion she first tapped into working with the Canadian Obesity Network. “Weight bullying happens to be the one thing I’m extremely allergic to,” affirms von Sky.

For any of you  who would like to order your own copy of this delightful little children’s book about bullying, friendship, respect, sadness, empathy, standing up for friends, antarctica, penguins & above all, love (for ages 3 and up) – click here.

@DrSharma
Edmonton, AB

VN:F [1.9.22_1171]
Rating: 10.0/10 (2 votes cast)
VN:F [1.9.22_1171]
Rating: +2 (from 2 votes)


Monday, December 1, 2014

Are Sedentary Moms Promoting Childhood Obesity?

Edward Archer, PhD, University of Alabama Birmingham

Edward Archer, PhD, University of Alabama Birmingham

Last week, Edward Archer from the University of Alabama at Birmingham (UAB), published a paper in the Mayo Clinic Proceedings (to much media fanfare), suggesting that the primary driver of childhood obesity is the shifting of nutrient energy to fetal adipose tissue as a result of increased maternal energy availability paired with decreased maternal energy expenditure, resulting in fetal pancreatic b-cell and adipocyte hyperplasia – a theory, which Edwards labels the “maternal resource hypothesis”.

The primary process for these changes, as readers of these pages will have read before, is through epigenetic modification of DNA, which, together with other non-genetic modes of transmission including learned behaviours and environmental exposures (socioenvironmental evolution), leads to “phenotypic evolution”, which Edward describes as,

“…a unidirectional, progressive alteration in ontogeny that is propagated over multiple successive generations and may be quantified as the change over time in the population mean for the trait under examination (eg, height and obesity).”

Since the beginning of the 20th century, socioevironmental factors have significantly altered the energy balance equation for humans

“Socioenvironmental evolution has altered the evolution of human energy metabolism by inducing substantial decrements in EE imposed by daily life while improving both the quality and the quantity of nutrient-energy availability.”

“For example, as thermoneutral environments became ubiquitous, the energy cost of thermoregulation declined, and improved sanitation (eg, clean water and safer food) and vaccinations decreased the energy cost of supporting parasites (eg, fleas) and resisting pathogens (eg, communicable diseases and diarrheal infections).”

Over the past century, these developments have led to profound phenotypic changes including,

“progressive and cumulative increases in height, body stature and mass, birthweight, organ mass, head circumference, fat mass/adiposity as well as decreases in the age at which adolescents attain sexual maturity…”

Archer goes on to describe some of the many factors that may have changed in the past century, whereby, he singles out sedentariness as one of the key drivers of these developments (not surprising given Archer’s background in exercise science).

Thus, although one could perhaps make very similar arguments for any number of factor that may have changed in the past century to, in turn, affect insulin resistance and ultimately energy partitioning (change in diet, sleep deprivation, increasing maternal age, endocrine disruptors, antibiotic use, gut microbiota, medication use and many other factors I ca think of), Archer chooses to elevate sedentariness to being the main culprit.

While this may or may not be the full story, it does not change the thrust of the paper, which implies that we need to look for the key drivers of childhood obesity in the changes to the maternal-fetal (and early childhood) environment that have put us on this self-perpetuating unidirectional cycle of phenotypic evolution.

Ergo, the solution lies in focussing on the health behaviours (again, Archer emphasizes the role of physical activity) of moms.

While Archer largely focusses on maternal transmission, we should perhaps not forget that there is now some also evidence implicating a role for epigenetic modification and intergenerational transmission through paternal DNA – yes, dads are getting older and more sedentary too (not to mention fatter).

I do however agree with Edward, that this line of thinking may well have important implications for how we approach this epidemic.

For one,

“…the acknowledgment that obesity is the result of non-genetic evolutionary forces and not gluttony and sloth may help to alter the moralizing and demoralizing social and scientific discourse that pervades both public and clinical settings.”

Secondly,

“Future research may be most productive if funding is directed away from naive examinations of energy balance per se and redirected to investigations of interventions that alter the competitive strategies of various tissues.”

Thirdly,

“From the standpoint of the clinician, accurate patient phenotyping (inclusive of family obstetric history and metabolic profiling) may allow the targeting of women most likely to be a part of populations that have evolved beyond the metabolic tipping point and therefore require significant preconception intervention.”

While none of this may be easier or more feasible than other current efforts, they may well point us in a different direction than conventional theories about what is driving childhood obesity.

@DrSharma
Calgary, AB

VN:F [1.9.22_1171]
Rating: 6.7/10 (3 votes cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Wednesday, November 26, 2014

McKinsey on Obesity: Doing Something Beats Doing Nothing

McKinsey Overcoming ObesityLast week the McKinsey Global Institute, with much media fanfare, released a 120 page discussion paper titled, “Overcoming obesity: An initial economic analysis“, which estimates that the economic cost of the global obesity epidemic is upwards of $2 trillion, a number similar to the economic cost of tobacco consumption or armed conflicts.

The report identifies 74 interventions in 18 areas (ranging from policy and population health to health care) deemed to be cost effective, which, if implemented, could lead to annual savings of $1.2 billion in the UK National Health Services alone.

However, when it comes to the actual impact of these 74 strategies, the report is far more sobering in that it notes that many of these interventions are far from proven:

“The evidence base on the clinical and behavioral interventions to reduce obesity is far from complete, and ongoing investment in research is imperative. However, in many cases this is proving a barrier to action. It need not be so. We should experiment with solutions and try them out rather than waiting for perfect proof of what works, especially in the many areas where interventions are low risk. We have enough knowledge to be taking more action than we currently are.”

In other words, let’s not wait to find out what works – let’s just do something – anything (and keep our fingers crossed).

Thus, the report urges us to

“(1) deploy as many interventions as possible at scale and delivered effectively by the full range of sectors in society; (2) understand how to align incentives and build cooperation; and (3) do not focus unduly on prioritizing interventions because this can hamper constructive action.”

I can see why politicians would welcome these recommendations, as they are essentially a carte blanche to either doing nothing (we don’t have the evidence) or doing whatever they want (anything is better than nothing).

The fact that,

“Based on existing evidence, any single intervention is likely to have only a small overall impact on its own. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden.”

means that when any measure fails, it is not because it was the wrong measure but because there was either not enough of it or it was not complemented by additional measures.

Again, a free pass for politicians, who can pass whatever measures they want (based on their political ideologies or populistic pressure from their constituencies), without having to demonstrate that what they did, had any effect at all.

Of course, no report on obesity would be complete without also stressing the importance of “personal responsibility”, as if this was somehow more important for obesity than it is for diabetes, lung disease, heart disease, or any other disease I can think of.

Unfortunately, the report also includes rather nonsensical statements like,

“44 interventions bring 20% of overweight/obese Britons back to normal weight”

a sentence that defies the very chronic nature of obesity, where once established excess weight is vigorously “defended” by complex neuroendocrine responses that will counteract any change in energy balance to sustain excess body weight.

Thus, unfortunately, the authors fall into the common misconception about obesity simply being a matter of calories in and calories out, a balance that can be volitionally adjusted to achieve whatever body weight you wish to have.

Indeed, there is very little discussion in this “discussion paper” of the underlying biology of obesity, although it is acknowledged in passing:

“Even though there are important outstanding questions about diet composition, gut microbiome, and epigenetics, we are not walking blind with no sense of what to address. However, interventions to increase physical activity, reduce energy consumption, and address diet composition cannot just seek to reverse the historical trends that have left the population where it is today. For example, we cannot, nor would we wish to, reverse the invention of the Internet or the industrialization of agriculture. We need to assess what interventions make sense and are feasible in 2014.”

Will this report move governments to action? Or, even more importantly, will this report bring us any closer to reversing the epidemic or providing better treatments to people who already have obesity?

Readers may appreciate that I am not holding my breath quite yet.

ƒƒ@DrSharma
Edmonton, AB
ƒƒ

VN:F [1.9.22_1171]
Rating: 10.0/10 (4 votes cast)
VN:F [1.9.22_1171]
Rating: +3 (from 3 votes)

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

» More news articles...

Publications

  • Subscribe via Email

    Enter your email address:

    Delivered by FeedBurner




  • Arya Mitra Sharma
  • Disclaimer

    Postings on this blog represent the personal views of Dr. Arya M. Sharma. They are not representative of or endorsed by Alberta Health Services or the Weight Wise Program.
  • Archives

     

  • RSS Weighty Matters

  • Click for related posts

  • Disclaimer

    Medical information and privacy
    Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.


  • Meta

  • Obesity Links

  • If you have benefitted from the information on this site, please take a minute to donate to its maintenance.

  • Home | News | KOL | Media | Publications | Trainees | About
    Copyright 2008–2014 Dr. Arya Sharma, All rights reserved.
    Blog Widget by LinkWithin