The past two days, I’ve been at a young investigator’s meeting convened by the Canadian Institutes of Health Research Institute for Nutrition, Metabolism and Diabetes, in Kelowna, BC.
This annual event brings together promising and emerging young investigators working in the fields of metabolic, renal and digestive disease from across Canada.
The talks by experienced faculty are given on topics ranging from grant writing, finding a good mentor and building partnerships (my topic), to the importance of not forgetting about work-life balance.
There is no doubt that every year, the research environment for funding becomes yet more competitive. Thus, it is always refreshing to see the enthusiasm, passion and enthusiasm with which young researchers approach the many research questions that desperately need answers.
Finding better ways to prevent and treat obesity are certainly among the top issues on the list, and it was therefore not surprising to see several of the research projects presented by the young attendees focusing on various aspects of obesity.
I found attending this event particularly rewarding as this was a reunion with several past “bootcampers” (attendees of the Canadian Obesity Network’s annual Obesity Research Summer School), who, I am happy to say, have progressed nicely into junior faculty and new investigator positions.
Congratulations to the organisers and all who had the privilege of attending.
There is no doubt that bariatric surgery is currently the most effective long-term treatment for severe obesity, however, there is also some evidence to suggest that patients seeking bariatric surgery (or for that matter any kind of weight loss) are more likely to have accompanying mental issues that individuals with obesity who don’t and that such issues may affect the outcomes of surgery.
Now, a paper by Aaron Dawes and colleagues from Los Angeles, CA, published in JAMA presents a meta-analysis of mental health conditions among patients seeking and undergoing bariatric surgery.
They identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients).
Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, each affecting about one-in-five patients were depression and binge eating disorder.
However, neither condition was consistently associated with differences in post-surgical weight outcomes. Nor was there a consistent relationship between other mental health conditions including PTSD or bipolar disease and post-surgical outcomes.
Interestingly, bariatric surgery was consistently associated with a significant decrease in the prevalence and/or severity of depressive symptoms.
So what do these findings mean for clinical practice?
As the authors note,
“Guidelines from the American Society for Metabolic and Bariatric Surgery and the Department of Veterans Affairs/Department of Defense recommend routine preoperative health assessments, including a review of patients’ mental health conditions. Other groups advocate for a more comprehensive, preoperative mental health examination in addition to the general evaluation currently performed by medical and surgical teams. The results of our study do not defend or rebut such a recommendation.”
So why are these data not clearer than they should be? Here is what the authors have to offer:
“Much of the difficulty in determining the effectiveness of preoperative mental health screening is due to the limitations of current screening strategies, which use a variety of scales and focus on mental health diagnoses rather than psychosocial factors. Previous reviews have suggested that self-esteem, mental image, cognitive function, temperament, support networks, and socioeconomic stability play major roles in determining outcomes after bariatric surgery. Future studies would benefit from including these characteristics as well as having clear eligibility criteria, standardized instruments, regular measurement intervals, and transparency with respect to time-specific follow-up rates. By addressing these methodological issues, future work can help to identify the optimal strategy for evaluating patients’ mental health prior to bariatric surgery.”
At this time, perhaps to err on the side of caution, our centre (like many others) continues to screen for and address any relevant mental health issues in patients wishing to undergo bariatric surgery.
Thus, a study by Miram Salama and colleagues from Laval University, QC, published in Physiology and Behavior, shows that mental work may very much influence food preferences and satiety.
Using a cross-over design, 35 healthy young adults were randomly assigned the one of the two following conditions: mental work (reading a document and writing a summary of 350 words with the use of a computer) or control (rest in seated position).
After 45 mins of each condition, participant were offered a standardized ad libitum buffet-type meal. Appetite sensations (desire to eat, feeling of hunger, fullness level and estimated amount of food that can be consumed) were measured using a visual analogue scale (VAS).
While women not only had a higher caloric intake after the mental work (by about 100 extra Cal), men reduced their caloric intake (by about 200Cal).
While women selectively increased their preference for carbs, men reduced their intakes of dessert.
In both men and women, participants with the highest waist circumference also had the lowest satiety efficiency in response to mental work.
These results suggest that mental work can change energy intake and preferences in both men and women, albeit in different directions.
Why this would be is anyone’s guess – it is also not clear exactly how this mechanism works. One speculation would be that there are differences in how men and women respond to mental stress – but that is certainly work for a future study.
Today’s guest post comes from Jillian Avis, PhD Candidate, Department of Paediatrics, University of Alberta, Edmonton
Primary care providers (e.g., family doctor, kinesiologist, registered dietitian) play a key role in preventing childhood obesity. To assist with obesity prevention, providers use a variety of tools and resources in clinical practice to (i) assess and monitor children’s weight status (e.g., body mass index growth charts), (ii) communicate children’s weight status with families (e.g., 5As of Pediatric Obesity), (iii) educate families on healthy lifestyle behaviors (e.g., Canada’s Food Guide), and (iv) facilitate behavior change (e.g., magnetic place models).
Although such tools are regularly used by providers, little is known regarding their use and suitability in practice. Thus, in a recent publication, our team pilot‐tested a mixed methods study to preliminary assess these tools – Do they work? Do providers like them? How are they used?
We conducted one‐on‐ one interviews with multidisciplinary primary care providers (n=19) from 10 primary care clinics in Edmonton and Calgary. Following the interviews, we compiled a comprehensive list of all tools used by providers, which were subsequently evaluated using three assessment checklists (e.g., Suitability Assessment of Materials).
Our findings show that most tools score ‘average’, and criteria on the checklists (e.g., readability level, layout, graphics) overlap with providers’ perceptions of tool suitability.
However, the checklist criteria do not reflect providers’ views regarding the logistical factors that impact accessibility, such as cost, distribution, and production.
Conclusions from our research highlight that to assess the overall suitability and assist those developing tools for childhood obesity prevention, objective scoring using checklists should be considered in conjunction with contextual factors and providers’ perceptions of suitability.
If you’re interested in following Jill’s research, visit her blog
According to the Alberta economic dashboard, in October 2015, Alberta’s seasonally adjusted unemployment rate was 6.6%, up from the 4.4% rate a year earlier and from last month’s 6.5% rate. The youth unemployment rate was 11.6%, up from last year’s 9.0% rate, while male unemployment increased precipitously from 3.6% last October to 7.3% this year.
As no one seems to be expecting a rosier future for this industry, it may well be that many who lost their jobs in the wake of mass oil patch layoffs, will find the coming months (not to mention the festive season) both economically and emotionally challenging.
According to this report, suicide rates from January to June in Alberta this year are up 30% compared to the same period in 2014.
One challenge that may escape notice is the fact that this situation may also lead to significant weight gain in those affected.
Depression, anxiety, food insecurity, insomnia and simply being unable to afford healthy food are all important risk factors for weight gain.
Indeed it is hard to imagine how going from a high-paying job to being unemployed with little immediate hope of recovery will affect families.
Maintaining a positive spirit – necessary for eating healthy, engaging in physical activity and healthy sleep – will clearly be a challenge.
So while it may take some time for “official” statistics regarding overweight and obesity to change, I would not be surprised to see numbers go up.
Unfortunately, when this happens, people putting on the extra pounds will likely face the same blame and shame for “making poor choices” as everyone else who is struggling with this problem faces everyday.
As medical professionals, we need to acknowledge that unemployment and the worries that come with it can make our patients more susceptible to weight gain – let us not miss the opportunity for prevention.
If you’ve been affected by the economic downturn and this is affecting your health, please feel free to leave a comment.