Friday, July 11, 2014

Is Weight Gain Typical in Atypical Depression?

sharma-obesity-depressionDepression or major depressive disorder (MDD) is not only one of the most common psychiatric problems, it also comes in many flavours.

While melancholic or “typical” depression is characterized by a loss of pleasure in most or all activities (anhedonia), a failure of reactivity to pleasurable stimuli, psychomotor retardation and a strong sense of guilt, “atypical” depression is characterized by mood reactivity (paradoxical anhedonia), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.

An important further distinction is that “typical” depression is commonly associated with loss of appetite and weight loss, whereas “atypical” depression typically involves increased appetite (comfort eating), often with significant weight gain.

Now a study by Aurélie Lasserre and colleagues from Switzerland, published in JAMA Psychiatry, looks at the risk for weight gain in patients with different forms of depression.

The prospective population-based cohort study, included 3054 randomly selected residents of the City of Lausanne (mean age, 49.7 years; 53.1% were women) with 5.5 years of follow-up.

Depression subtypes according to the DSM-IV, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured diagnostic interviews.

As expected, only participants with the “atypical” subtype of MDD at baseline had a higher increase in adiposity and were about 3.75 times more likely to have developed obesity during follow-up than participants without MDD.

This association remained robust even after adjustment for a wide range of confounders.

Thus, as the authors note,

The atypical subtype of MDD is a strong predictor of obesity. This emphasizes the need to identify individuals with this subtype of MDD in both clinical and research settings. Therapeutic measures to diminish the consequences of increased appetite during depressive episodes with atypical features are advocated.

Although we should be wary of those antidepressants that can cause weight gain, an early diagnosis and treatment of atypical depression may well prevent further weight gain and perhaps facilitate weight loss in patients with atypical depression.

Clearly, screening for “atypical” depression must be an essential part of obesity assessment and management.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLasserre AM, Glaus J, Vandeleur CL, Marques-Vidal P, Vaucher J, Bastardot F, Waeber G, Vollenweider P, & Preisig M (2014). Depression With Atypical Features and Increase in Obesity, Body Mass Index, Waist Circumference, and Fat Mass: A Prospective, Population-Based Study. JAMA psychiatry PMID: 24898270

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Thursday, June 19, 2014

Fat Activism in Canada

Dr. Jenny Ellison, Trent University, Peterborough, Ontario, Canada

Dr. Jenny Ellison, Trent University, Peterborough, Ontario, Canada

Yesterday’s opening plenary talk at the 4th Canadian Obesity Student Meeting, hosted by the Canadian Obesity Network’s Students and New Professionals (CON-SNP) network, was given by Dr. Jenny Ellison from the  Frost Centre for Canadian & Indigenous Studies at Trent University, on the history of fat activism in Canada.

In her talk, Ellison, presented a broad historical overview of how fat stigma and messaging around fat has evolved over the years.

From the early “Christian” view of obesity as a deadly sin, moral failing and lack of will power and the beginning of the obsession with body shape and size in the early half of the 20th century to the growing movement of fat acceptance and understanding of the negative consequences of fat stigma and fat politics for larger people.

She concluded with an overview of how informal networks within the fat activist movement are self-organising online sharing a wide range of information from finding physicians to identifying safe spaces where they can interact.

Ellison also complimented the Canadian Obesity Network on taking a strong stance against weight stigma and discrimination, thus opening up the possibility for a different future.

A recent paper by Ellison on this subject is available here.

@DrSharma
Waterloo, ON

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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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Thursday, May 22, 2014

Canada’s Bubble-Wrapped Kids Need More Free Play

sharma-obesity-active-healthy-kidsNo doubt Canadian parents think physical activity and sports is of utmost importance for their kids’ health – this is why, they have apparently sold them off to the multi-billion dollar sport and fitness industrial complex that has pretty much commercialized all aspects of physical activity.

This is why good ol’ get out doors and play (without your parents hand holding you, peering over your shoulder or tracking your whereabouts on GPS) is pretty much dead.

At least this is the gist of the latest Physical Activity Report Card presented by Active Healthy Kids Canada.

Here are some of the main findings:

Canadian parents look to structured activities and schools to get their kids moving:

- 82% of parents agree that the education system should place more importance on providing quality PE.

-  79% of parents contribute financially to their kids’ physical activities (through equipment, fees, etc.), but only 37% of parents often play actively with their children.

Organized sports and plenty of places and spaces for activity may never make up for lost (active) time:

- One study shows only 24% of kids got a full 60 minutes of moderate/ vigorous activity in one session of soccer, and only 2% got this at softball practice.

- Kids on hockey teams spend close to half of the time during practices in moderate/vigorous activity, but in an actual game they are sedentary nearly a third of the time.

So if you think you are doing your kids a favour by putting them in organiszed sporting activities, that break both your time and money budget, then think again.

Your kids may be way better off if you just kicked them outdoors (not to be seen again till the lights come on).

@DrSharma
Barcelona, ES

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Wednesday, May 21, 2014

Does Calling You Fat Make You Fat?

sharma-obesity-discriminationOne of the most troubling aspects of weight-bias and discrimination is that it has strong negative emotional and physical consequences for the individuals, who perceive these negative attitudes.

Now a study suggests that simply being labeled “fat” in childhood may be a strong predictor of obesity ten year later.

Thus, according to a longitudinal study by Jeffrey Hunger and Janet Tomiyama, published in JAMA Pediatrics, girls who reported being called “fat” at age 10 were about 60% more likely to have a BMI in the obese range at age 19.

Kids in this study were considered as “labeled”, if they responded “yes” to the question, whether they had ever been called fat by their father, mother, brothers, sister, best girl friend, boy you like best, any other girl, any other boy, or teacher.

Interestingly enough, this finding is not explained by the possibility that the labelled girls were indeed heavier – there was in fact no difference in BMI at age 10 between the kids who responded “yes” and those, who did not.

Indeed, the findings remained robust even after correction for various demographic confounders.

These findings are concerning, as they suggest that simply being called “fat” as a kid, may put you on a track to weight gain irrespective of whether or not you actually carry excess weight to start with.

I am sure many of my readers will relate to these findings and can tell their own stories of how being “labelled” fat may have influenced their weight journeys.

@DrSharma
Edmonton, AB

ResearchBlogging.orgHunger JM, & Tomiyama AJ (2014). Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years. JAMA pediatrics PMID: 24781349

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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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