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Welcome To The International Congress on Obesity, Vancouver 2016

ICO2016This weekend sees the start of the XIII International Congress on Obesity (ICO), hosted by the World Obesity Federation in partnership with the Canadian Obesity Network (CON) in Vancouver, Canada.

As this year’s Congress President, together with World Obesity Federation President Dr. Walmir Coutinho, it will be our pleasure to welcome delegates from around the world to what I am certain will be a most exciting and memorable event in one of the world’s most beautiful and livable cities.

The program committee, under the excellent leadership of Dr. Paul Trayhurn, has assembled a broad and stimulating program featuring the latest in obesity research ranging from basic science to prevention and management.

I can also attest to the fact that the committed staff both at the World Obesity Federation and the Canadian Obesity Network have put in countless hours to ensure that delegates have a smooth and stimulating conference.

The scientific program is divided into six tracks:

Track 1: From genes to cells

  • For example: genetics, metagenomics, epigenetics, regulation of mRNA and non–coding RNA, inflammation, lipids, mitochondria and cellular organelles, stem cells, signal transduction, white, brite and brown adipocytes

Track 2: From cells to integrative biology

  • For example: neurobiology, appetite and feeding, energy balance, thermogenesis, inflammation and immunity, adipokines, hormones, circadian rhythms, crosstalk, nutrient sensing, signal transduction, tissue plasticity, fetal programming, metabolism, gut microbiome

Track 3: Determinants, assessments and consequences

  • For example: assessment and measurement issues, nutrition, physical activity, modifiable risk behaviours, sleep, DoHAD, gut microbiome, Healthy obese, gender differences, biomarkers, body composition, fat distribution, diabetes, cancer, NAFLD, OSA, cardiovascular disease, osteoarthritis, mental health, stigma

Track 4: Clinical management

  • For example: diet, exercise, behaviour therapies, psychology, sleep, VLEDs, pharmacotherapy, multidisciplinary therapy, bariatric surgery, new devices, e-technology, biomarkers, cost effectiveness, health services delivery, equity, personalised medicine

Track 5: Populations and population health

  • For example: equity, pre natal and early nutrition, epidemiology, inequalities, marketing, workplace, school, role of industry, social determinants, population assessments, regional and ethnic differences, built environment, food environment, economics

Track 6: Actions, interventions and policies

  • For example: health promotion, primary prevention, interventions in different settings, health systems and services, e-technology, marketing, economics (pricing, taxation, distribution, subsidy), environmental issues, government actions, stakeholder and industry issues, ethical issues

I look forward to welcoming my friends and colleagues from around the world to what will be a very busy couple of days.

For more information on the International Congress on Obesity click here

For more information on the World Obesity Federation click here

For more information on the Canadian Obesity Network click here

@DrSharma
Edmonton, AB

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How To Interpret Studies On Screen Time And Eating Behaviour

sharma-obesity-kids-watching-tvMuch of the research on the contribution of screen time, sedentariness, food consumption and other factors comes from cross-sectional or longitudinal studies, where researchers essentially describe correlations and statistical “effect sizes”.

To be at all meaningful, analyses in such studies need to be adjusted for known (or at least likely) confounders (or at least the confounders that happen to available).

No matter how you turn and wind the data, such studies by definition cannot prove causality or (even less likely) predict the outcome of actual intervention studies.

Nevertheless, such studies can be helpful in generating hypotheses.

Thus, for example, I read with interest the recent paper by Lei Shang and colleagues from the University of Laval, Quebec, Canada, published in Preventive Medicine Reports.

The researchers looked at cross-sectional data on 630 Canadian children aged 8-10 years with at least one obese biological parent.

While the overall median daily screen time was about 2.2 hours, longer screen time was associated with higher intake of energy (74 kcal) and lower intake of vegetables & fruit (- 0.3 serving/1000 kcal).

This unhealthy “effect” of screen time on diet appeared even stronger among children with overweight.

Thus, there is no doubt that the study shows that,

“Screen time is associated with less desirable food choices, particularly in overweight children.”

The question of course remains whether or not this relationship is actual causal or in other words, does watching more television lead to an unhealthier diet (I am guessing no one assumes that eating an unhealthier diet leads to more TV watching).

Unfortunately, this is not a question that can be answered by this type of research.

Nor, is this type of research likely to predict whether or not reducing screen time will get the kids to eat better.

Indeed, it doesn’t take a lot of imagination to come up with other explanations for these findings that would not require any assumption of a causal link between eating behaviours and television watching.

For one, TV watching could simply be a surrogate measure for parenting style – perhaps parents that let their kids watch a lot of TV are also less concerned about the food they eat.

And, for all we know, reducing TV time may (e.g. by cutting the kids off from TV – or cutting the parents off from a convenient babysitter) in the end make the kids eating behaviours even worse.

Who knows – that’s exactly the point – who knows?

To be fair, the authors are entirely aware of the limitations of such studies:

“This study was cross-sectional, so no causal inference could be made and the possible mechanism is not clear. Although our data collection strictly followed the detailed manual procedure to guarantee the quality control (QUALITY Cohort Technical Documents, 2011), potential bias and errors may still exist in those self-reported questionnaires. A number of potential confounding factors have been adjusted in the regression models, but the results may still be confounded by other known and unknown factors.”

So, while the findings may well fit into the “narrative” of sedentariness -> unhealthy diets -> obesity, we must remain cautious in not overinterpreting findings from these type of studies or jumping to conclusions regarding policies or other interventions.

@DrSharma
Edmonton, AB

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Skinny Kids Eat More Candy

candyA common assumption is that kids with obesity consume more high-caloric foods – which of course includes confectionary items like chocolate and non-chocolate sweets.

Now, a study by Constantin Gasser and colleagues from Melbourne, Australia, in a paper published in the American Journal of Clinical Nutrition, present a systematic review and meta-analysis of confectionary consumption and overweight in kids.

The researchers identified 19 studies fort their systematic review, 11 of which (∼177,260 participants) were included in the meta-analysis.

Overall, odds of excess weight of kids in the highest category of sweets consumption was about 20% less than in the reference category.

This inverse association was true for both chocolate and nonchocolate confectioneries.

Furthermore, in the longitudinal studies and the randomised controlled trial included in the review, no associations were observed between confectionery consumption and overweight, obesity, or obesity-related outcomes.

Thus, based on data from well over 175,000 kids, there appears to be no relationship between sweets consumption and excess weight – if anything, the relationship is the opposite of what one may expect.

As so often, when data don’t fit the “accepted” hypothesis, the authors are also quick to point out that these findings could well be explained by reverse causality (overweight kids avoiding sweets) or underreporting by heavier kids (a polite way of saying that heavier kids may be less honest about their candy consumption).

On the other hand, it may also well be that regular (non-restrictive) sweet consumption actually does in fact make kids less vulnerable to overeating, simply by ruining their appetite (just as grandma always warned you it would – as in, “No sweets before supper!”).

Overall, the findings remind me of a previous study that failed to find any association between sugary pop consumption and body weight in Ontario and PEI kids (if anything skinny kids in PEI drank more pop than those with excess weight).

Whatever the true answer may be, these findings certainly do not support the notion that sweet or chocolate consumption is a key factor in childhood obesity.

@DrSharma
Edmonton, AB

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Reducing Infant Food Reinforcement Through Music

baby-musicEven infants know to pick one reward over the other – but obviously, as in adults, the one they pick depends on the choices available to them.

Given the highly rewarding nature of food, picking a favourite food over. almost anything else appears the natural choice. Thus food reinforcement is generally established at an early age and tends to continue throughout life.

One hypothesis is that the development of obesity is due to a lack of access to pleasurable alternatives in one’s environment, thereby increasing the reinforcing value of eating

Now, Kai Ling Kong and colleagues, in a paper published in OBESITY, test the hypothesis that conditioning infants as young as 9-16 months to an cognitively stimulating alternative reinforcer may reduce the appeal of food as the default goto reward.

The researchers studied 27 infants, who were found to have rather high food reinforcing ratios at baseline, half of who were randomised to 6 weeks of a program that provided them with a rich variety of music and playful activities, which encouraged infants and parents to participate at their own level in singing, moving, listening, or exploring musical instruments. Participating parents and infants attended weekly, 45-min classes as a group for 6 weeks and parents were encouraged to listen and sing together with their infants at home during everyday home activities such as bath time, meal time, and bed time using the CD and instructional song book provided by the program.

The remaining infants in the active control group consisted of weekly, 45-min play dates held during the same 6 weeks as the music group and were provided with a variety of age appropriate toys (no musical toys) and books for participating parents and infants to play with and enjoy during everyday home activities such as bath time, meal time, and bed time using the toy provided by the program.
The reinforcing value of food and music was assessed using a computerized task by having infants press a mouse button to earn rewards (either food or 10 secs of a song) both before and after the interventions. The song used for both pre- and post-intervention assessments was not used in the 6-week music program to avoid familiarity and biases.
While the researchers found a significant decrease in the food reinforcing ratio (a measure of food preference) for the infants in the music group, the food reinforcing ratio in the control group actually increased. 
As the authors note,
Our findings provide initial evidence that alternatives to food may be cultivated at a young age to alter the reinforcing value of food in children who are strongly motivated to eat…..Interventions targeting non-food behavior may be a new and promising avenue for the prevention of obesity in infants.
Obviously, music may only be one of several possible cognitively stimulating alternatives to eating and one would certainly want to see if the effect seen in this short-term study is indeed durable over time.
Nevertheless, it seems that in infants as in adults – if you want to reduce the relative reward from food you have to provide an alternative that is at least as if not more rewarding.
@DrSharma
Edmonton, AB
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Leading The Charge In Addressing Weight-Bias in Canada

sharma-obesity-accuracyIn 2008, the Canadian Obesity Network’s  Board of Directors identified weight bias and stigma as one of the Network’s top strategic priority.

The board firmly believes that everyone deserves to be treated with respect and dignity independent of size.

To this end, the Network is working hard towards reducing weight bias and stigma through research, education and action.

The following are just some of the examples resulting from the Network’s many collaborates with researchers, patients, knowledge users and partners to develop education initiatives and practitioner resources to address weight bias in health care settings, the media and public policies:

  1. Incorporated weight bias and stigma in all CON-RCO education and knowledge exchange programs such as the Canadian Obesity Summits (2009, 201120132015 and biennially thereafter); Dietitian Learning Retreats (2010-present); Canadian Obesity Student Meetings (2010, 2012, 2014); Obesity Research Summer School (formerly known as Obesity Research Boot Camp); Obesity Management Certificate for Post-Graduates (2013-2015).
  1. In collaboration with health services and primary care experts, CON-RCO has developed the 5As of Obesity Management framework to support primary care practitioners in their interactions with patients with obesity. This was a two-year initiative supported by the Canadian Institutes of Health Research (Knowledge Translation Supplement Grant) and the Public Health Agency of Canada (Innovation Strategy Grant). The resources incorporate weight bias sensitivity training and have now been adapted for pediatric and pregnancy populations.
  1. CON-RCO under the leadership of Dr. Mary Forhan, associate professor, University of Alberta, Faculty of Rehabilitation Medicine, Department of Occupational Therapy, coordinated the first Canadian Weight Bias and Discrimination Summit in Toronto, Ontario (January 2011). The purpose of the summit was to raise awareness about weight bias and discrimination as it relates to obesity and its association to the health and well being of Canadians.  The event drew a capacity crowd of 150 health professionals, students, policy makers, industry representatives, and educators who heard from an expert panel of eight speakers from Canada and the United States.
  1. CON-RCO partnered with the Canadian Institutes of Health Research to inform a Canadian Bariatric Research Agenda, which included a priority on weight bias and discrimination.
  1. CON-RCO and the Public Health Agency of Canada collaborated to poll CON-RCO members to identify and counteract some of the most common obesity myths.  Results of this study were published and disseminated to CON members and partners.
  1. CON-RCO partnered with the Rudd Centre for Food Policy and Obesity to develop an image bank to combat stigmatizing images of people with obesity in the media.
  1. In 2012, CON-RCO partnered with the World Obesity Federation (formerly known as International Association for the Study on Obesity) to host the first International Hot Topic Conference on Obesity and Mental Health. The outcome of this conference was a Charter calling for action for health system funders, researchers and health practitioners to deal with the stigma associated with both obesity and mental illness.
  1. In 2015, CON-RCO partnered with the University of Calgary research leaders Drs. Angela Alberga, Shelly Russell-Mayhew, Kristin Von Ranson and Lindsay McLaren to participate in a two-day Weight Bias Summit (March 12-13, 2015). The objective of the summit was to bring together stakeholders (researchers, practitioners and policy makers) to discuss and facilitate the design of research projects aimed to reduce weight bias in three sectors (education, health care & public policy) in the province of Alberta.
  1. In May 2015, CON-RCO established its first Public Engagement Committee (PEC) comprised of people living with obesity from across the country. The mandate of the PES Committee is to be the voice of individuals affected by obesity within CON-RCO and to elevate the conversation of obesity and its impact on health in the community.
  1. In August 2015, CON-RCO established a collaborative called EveryBODY Matters. This group is composed of CON-RCO members working in research, healthcare, education, public engagement and policy. The mandate of this collaborative is to exchange knowledge, identify opportunities for collaboration across research and practice/policy sectors, and support CON-RCO’s efforts to reduce weight bias and obesity stigma in Canada.

Not least as a result of these many activities, the Network has seen an impressive increase in weight bias and obesity stigma research in Canada.

Thus, while the first Canadian Obesity Summit (2009) only received a handful of abstracts focused on obesity stigma. CON-RCO began to see a shift at the second (2011) and third (2013) Canadian Obesity Summits with more inclusion of weight bias research in the program.

In 2015, the summit included four plenary presentations on weight bias, three workshops, and ten oral and poster abstract presentations on this topic.

This remarkable shift in research interest in better understanding and addressing weight-bias is reflective of the Network’s considerable efforts to increase awareness of weight bias as well as the growing body of literature focused in this area.

Clearly, all of this should be of interest to anyone living with obesity, who, unfortunately, continue to suffer the emotional, physical, social, and financial consequences of weight-bias and discrimination.

To learn more about the Network’s continuing efforts to foster greater respect and a better understanding of people living with obesity click here.

@DrSharma
New York, NYC

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