Tuesday, August 5, 2014

Evidence for Benefit of Psychological Intervention Before Bariatric Surgery

sharma-obesity-psychotheralyCurrent bariatric surgery guidelines recommend psychological assessment prior to undergoing bariatric surgery. In some centres, this assessment is less than rigorous and, in cases where patients have been denied surgery because of psychological findings, providers have been accused of bias and discrimination.

Nevertheless, most people working in the field, tend to agree that, when present, emotional drivers of weight gain are best dealt with before rather than after surgery.

Now, a randomised controlled trial by Hege Gade and colleagues from Tromsø, Norway, published in The Journal of Obesity, shows the benefit of 10 weeks or cognitive behavioural intervention in patients seeking bariatric surgery, who present with dysfunctional eating behaviours.

A total of 98 (70% females) patients with a mean age of 43 years and BMI of 43.5 kg/m2 were randomly assigned to 10 weeks of weekly CBT-group therapy or usual nutritional support and education (controls).

The CBT sessions were included learning to recognize triggers of dysfunctional eating, identifying associated cognitions and emotions, initiating plans for change, and home-work tasks between sessions.

Compared the controls, the CBT-group showed a remarkable improvement in eating behaviours as well as improvements in depression and anxiety scores at the end of the intervention. They also experienced some modest weight loss (~3 kg).

While these benefits speak for the effectiveness of CBT, the study does not provide any outcome data post-surgery to show that these patients do better after surgery than the controls – that, I believe, remains to be shown.

Nevertheless, common sense suggests that dysfunctional (emotional) eating (when present) is perhaps best dealt with prior to surgery than after the procedure.

@DrSharma
Edmonton, AB

 

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Friday, August 1, 2014

The 5As of Healthy Pregnancy Weight Gain

5AsPregnancy_PractitionerGuide_rf-final_Page_01Yesterday, the Canadian Obesity Network released the 5As of Healthy Pregnancy Weight Gain.

This follows the release of the 5As of Obesity Management (adults) and the 5As of Pediatric Weight Management.

The 5As of Health Pregnancy Weight Gain, was developed by a working group of nurses, midwives, primary care physicians, obstetricians, researchers and policy makers convened by the Network.

It is based on the best available evidence on this topic and is intended to help primary care practitioners discuss and manage gestational weight with their patients.

The 5As of Healthy Pregnancy Weight Gain is based on the following 5 key principles:

  • Discussion about gestational weight gain should occur with every pregnant women and with every woman planning a pregnancy.

  • Achieving healthy gestational weight gain is about improving the health and well-being of both mothers and babies.

  • Early action means addressing root causes and removing roadblocks.

  • Pregnancy related health beliefs can be powerful influences on weight gain in pregnancy.

  • Achieving goals is different for every woman.

The 5As of Health Pregnancy Weight Gain can be downloaded here – pdfppt

@DrSharma
Edmonton, AB

p.s. if you did not receive the Obesity Network Newsletter with this announcement due to Canada’s new anti-spam legislation, please click here.

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Tuesday, July 29, 2014

5th Conference on Childhood and Adolescent Obesity, Winnipeg, Sept 23-26, 2014

Jonathan McGavock, PhD, Assoc. Professor, Manitoba Institute of Child Health, Winnipeg, MB

Jonathan McGavock, PhD, Assoc. Professor, Manitoba Institute of Child Health, Winnipeg, MB

For readers interested in the prevention and management of childhood and adolescent obesity, there is still time to submit your abstract (deadline Aug 5) and to register for this event in Winnipeg.

Those of you, who have been to previous meetings in this series, will know that this meeting (interspersed biennially with the Canadian Obesity Summit) brings together clinicians, researchers, policy makers and other stakeholders for 4 days of intense networking and knowledge exchange.

This year’s conference is being organised by Jon McGavock from the Manitoba Institute of Child Health and is sure to be a blast.

Given Jon’s interest in this area, this year’s conference will include a strong focus on the burden of obesity among Indigenous Youth and showcase examples of the best and promising practices within Indigenous communities across Canada and the US.

This special theme will include presentations from Indigenous youth living in communities with a high burden of obesity, sharing circles with Indigenous leaders and stakeholders and will explore interventions designed to promote these strengths and enhance resiliency among children and adolescents.

Of course, the conference will also cover a wide range of other topics related to childhood obesity across the age and care continuum.

View CE Credits HERE.

Brochure is available HERE.

Register for the conference HERE.

Registration for the pre-conference only HERE.

Submit your abstract HERE.

Incidentally, I will be having the privilege of giving a keynote at the opening of the pre-conference.

While in Winnipeg, I will also be performing my “Stop Being a Yo-Yo” show at the Colin Jackson Studio Theatre on Sept. 24, Show time: 7:00 p.m. (click HERE for online tickets).

See you in Winnipeg!

@DrSharma
Edmonton, AB

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Wednesday, July 23, 2014

In Memorium: Albert (Mickey) J Stunkard

Stunkard twinsAs I spend my days at the 9th Canadian Obesity Network’s Summer Bootcamp for young trainees from Canada and around the world, I was saddened to learn of the passing of Mickey Stunkard, clearly one of the biggest names in obesity research – at a healthy age of 92.

With well over 500 publications to his name, Mickey is perhaps best known for his twin studies showing that the body weight of adopted identical twins reared apart resembles each other and that of their biological parents rather than the weight of their adoptive parents.

This work helped establish the basis for much of the genetic work on obesity that followed, clearly showing that differences in body weight between two individuals are much more accounted for by their difference in genetics than by differences in their “lifestyles”.

These findings were often misused in “nature vs. nurture” debates, an issue that serious scientists have long laid to rest in light of our current understanding that the two cannot be discussed separately, simply because genes and lifestyle interact on virtually every level – from molecules, to cells, to behaviours.

Here is what one obituary had to say about Mickey:

“He surveyed obesity treatment studies in the late ’50s and found that the nation’s diet programs could claim only a 2 percent success rate. He was an early advocate for the use of bariatric surgery to induce weight loss. He also published the first modern account of binge eating in obese individuals.”

I have had to pleasure to often hear him speak at conferences.

He will be dearly remembered.

@DrSharma
Kananaskis, AB

 

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Friday, July 18, 2014

Birth Control And Obesity

sharma-obesity-birth-control-pillAlthough obesity is a well-recognised factor for female infertility, the vast majority of women with excess weight are probably more interested in effective birth control.

That this is not as simple as it seems is evident from an article by Sheila Mody and Michelle Han from the University of California, San Diego, published in Clinical Obstetrics and Gynecaology.

The paper succinctly reviews a wide range of issues related to birth control and obesity.

To begin with, the authors points out that unintended pregnancies in obese women are often a problem simply because obese women are far less likely to use effective contraception than non-obese women. This non-use may in part be attributable to fear of weight gain, when most studies show that modern hormonal contraception is associated with almost no weight gain. The exception appears to be depot-medroxyprogesterone (DMPA), which may cause about 5 lb weight gain in the first year of use.

As for efficacy, the data show that unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among nonoverweight women. The reasons for these higher rates are not exactly clear.

Fortunately, the efficacy of intrauterine devices (IUD) appear no different between obese and non-obese women although the insertion of an IUD maybe more difficult in obese women because of poor visualization of the cervix and limited assessment of uterine position (a problem that can often be solved with the help of an ultrasound).

The paper also discusses the suitability of the vaginal vaginal contraceptive ring, which has been hypothesized to offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first- pass liver metabolism.

Finally, the paper discusses issues around contraception for women who have undergone bariatric surgery (who have a particularly high rate of unintended pregnancies) as well as best practices for emergency contraception.

This is clearly information that all clinicians who counsel obese women should be aware of.

@DrSharma
Edmonton, AB

ResearchBlogging.orgMody SK, & Han M (2014). Obesity and Contraception. Clinical obstetrics and gynecology PMID: 25029338

 

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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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