Friday, August 29, 2014

2014 Scopinaro Lecture

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

Nicola Scopinaro, MD, Professor of Surgery, University of Genoa Medical School, Italy

This morning, at the XIX World Congress of the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO2014), I have the great honour of presenting the 2014 Scopinaro Lecture.

This lecture is named after Nicola Scopinaro, who in 1976 performed the first biliopancreatic diversion for the treatment of obesity.

The Scopinaro Lecture is the highest recognition for a non-surgeon to be awarded by IFSO.

In thinking about what to present, I settled on discussing the topic of whether or not obesity is a disease. Looking back over the work that I have done over the past 25 years, I came to realise that the issue of why some people with excess weight develop health problems and others don’t, has indeed fascinated me for a long time.

Initially, this interest was focussed on trying to understand why some people with obesity develop high blood pressure and others don’t. We were indeed able to show that part of this may be explained by differences in the expression of hormones involved in blood pressure regulation from fat tissue.

More recently, as many regular readers are well aware, I have broadened this interest in describing the limitations of BMI and advocating for a clinical staging system that classifies overweight and obese individuals based on how “sick” they are rather than how “big” they are.

Clearly, this work is of considerable interest to those involved in bariatric care (including bariatric surgeons), as it provides a framework for better prioritizing and assessing risk/benefit ratios than BMI or other anthropometric measures alone.

As I point out in my talk,

- The etiology of obesity is complex and multifactorial.

- The physiology of energy regulation is complex and subverts volitional attempts at weight loss.

- Access to obesity prevention and treatments must be driven by the recognised medical needs to address this condition.

- Multidisciplinary management of this life-long disorder requires resources similar to those required for other chronic diseases

In receiving this honour, I am fully aware that all of my work stands on the shoulders of the many researchers and clinicians who came before me and the considerable support and help that I have been fortunate enough to receive from my many students, trainees, colleagues and supervisors.

This award will certainly serve an a strong incentive to continue my work and advocacy for better treatments for obesity and the advancement of bariatric care.

@DrSharma
Montreal, QC

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Abstract submission deadline: October 23, 2014
  • Notification of abstract review: January 8, 2014
  • Early registration deadline: March 5, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Wednesday, August 27, 2014

XIX World Congress on Obesity Surgery, Montreal

ifso14 logoFor the rest of this week I will be reporting from the XIX World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) here in Montreal, Canada.

Although I am not a surgeon, staying up to date on all aspects of bariatric surgery is essential for anyone working in the field of bariatric care – and advances there are.

But I am not just here to listen. This morning, together with my colleague Sean Wharton, I will be presenting a 4 hour masters course on obesity management for allied health professionals and later today, I will be presenting a talk on the use of the Edmonton Obesity Staging System as a better way to determine the risk and prognosis of bariatric patients.

I certainly look forward to an intense week of learning and networking in this wonderful city.

@DrSharma
Montreal, QC

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Monday, August 25, 2014

How Does Bariatric Surgery Work?

sharma-obesity-gastric_bypass_roux-en-y3Regular readers will be well aware of the fact that bariatric (unfortunately, often referred to as “weight-loss surgery”) is currently the most effective treatment for severe obesity.

However, exactly why and how surgery works remains unclear. Earlier concepts of surgery working either because it creates a mechanical restriction to food intake and/or reduces caloric load due to malabsorption are not borne out by newer studies.

Rather, it seems that complex neurohormonal changes together with often profound changes in ingestive behaviour act together to account for the resulting weight loss (and more importantly) for the long-term weight-loss maintenance.

Just how many factors interact in specific and unspecific ways to lower body weight is now discussed in a review paper by Timothy Sweeney and John Morton, from Stanford University, in a paper published in Clinical Gastroenterology.

As the authors discuss, there is a complex interaction between a wide range of factors including several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and changes to the gut microbiome.

The most profound changes in these systems are seen with the roux-en-Y gastric bypass, which induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signaling. This may well explain why this operation appears to be the most effective and durable procedure.

Clearly, hope remains that by better understanding the exact mechanisms through which surgery (which will only ever be available to a vanishingly small minority of people with excess weight) works, we will identify mechanisms and targets for desperately needed pharmacological treatments.

@DrSharma
Edmonton, AB

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Friday, August 22, 2014

Do Bite Counters Count Bites?

bite counterWith the current electronic self-montioring craze, it was only a matter of time before someone would try to come up with a device that counts the number of bites it takes you to finish a meal.

The device (Bite Counter), is worn no the wrist of the dominant hand and contains a tri-axial accelerometer that detects an upward, arcing motion from the table to the mouth.

Now a study by Jenna Desendorf and colleagues from the University of Tennessee, tested the accuracy and validity of this device in 15 adults (23–58 years old) while eating a meal consisting of foods/beverages, each consumed with different utensils: meat (knife and fork), side items (fork), soup (spoon), pizza (hands), can of soda (hands), and a smoothie (straw), while being observed them through a one-way mirror and counted the number of bites taken.

As the paper, published in Eating Behaviors reports, the overall accuracy of the device was around 80%. However, this varied substantially between foods: meat (127%), side items (82.6%), soup (60.2%), pizza (87.3%), soda (81.7%), and smoothie (57.7%).

So, while this device may well underestimate the number of bites taken during a mixed meal, the real question is what people will start monitoring next – number of chews? (I joke about this on my show) Saliva flow? Numbers of swallows per bite? Oesophageal transit time?

I can perhaps see some research applications but as a way to help improve your eating?

The company claims that limiting your number of daily bites to 100 will help you lose weight.

I am yet to be convinced.

@DrSharma
Edmonton, AB

ResearchBlogging.orgDesendorf J, Bassett DR Jr, Raynor HA, & Coe DP (2014). Validity of the Bite Counter device in a controlled laboratory setting. Eating behaviors, 15 (3), 502-4 PMID: 25064306

 

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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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