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Plan Your Personalized Program For The Canadian Obesity Summit Now

Summit15appIf you are planning to attend the 4th Canadian Obesity Summit in Toronto next week (and anyone else, who is interested), you can now download the program app on your mobile, tablet, laptop, desktop, eReader, or anywhere else – the app works on all major platforms and operating systems, even works offline.

You can access and download the app here.

(To watch a brief video on how to install this app on your device click here)

You can then create an individual profile (including photo) and a personalised day-by-day schedule.

Obviously, you can also search by speakers, topics, categories, and other criteria.

Hoping to see you at the Summit next week – have a great weekend!

@DrSharma
Gurgaon, Haryana

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What Happens To Patients With Severe Obesity In Hospitals?

bariatric patient in bedWith the increasing number of Canadians living with severe obesity (BMIs 50+), it is not unexpected that more of them will be seen in healthcare settings.

However, whether or not Canadian hospitals are ready to look after these patients with in the right setting with the right equipment and whether healthcare providers are aware of and sensitive to the special needs of these patients is not clear.

This is why, Mary Forhan and her team at the University of Alberta is currently conducting a qualitative and quantitative assessment of exactly what problems patients with severe obesity face in healthcare settings.

The study, funded by Alberta Innovates Health Solution (AIHS) will look at the special challenges that these patients present in a range for settings – acute care, cancer, cardiology and rehabilitation.

A substudy will also examine the issues faced by kids and adolescent with severe obesity in healthcare settings.

Together, this project should lead to a better understanding on how healthcare systems better prepare themselves to deliver compassionate and professional care to adults and children living with severe obesity in Alberta. The learnings will likely also inform healthcare systems elsewhere.

For more on this study visit the AIHS website.

If you are someone living with severe obesity, who has experienced issues in your healthcare that could have been prevented or addressed with appropriate equipment and/or training, I’d love to hear your story.

@DrSharma
Edmonton, AB

Conflict: I am a co-investigator on this project.

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Adolescents Undergoing Bariatric Surgery Are Severely Ill

sharma-obesity-bariatric-surgery21The recently released Canadian Practice Guidelines on the prevention and management of overweight and obesity in children and youth released by the Canadian Task Force on Preventive Health Care (CMAJ 2015), rightly recommended that surgery not be routinely offered to children or youth who are overweight or obese.

Nevertheless, there is increasing evidence that some of these kids, especially those with severe obesity, may well require rather drastic treatments that go well beyond the current clinical practice of doing almost nothing.

Just how ill kids can be before they are generally considered potential candidates for bariatric surgery is evident from a study by  Marc Michalsky and colleagues, who just published the baseline characteristics of participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study, a prospective cohort study following patients undergoing bariatric surgery at five adolescent weight-loss surgery centers in the United States (JAMA Pediatrics).

While the mean age of participants was 17 with a median body mass index of 50, the prevalence of cardiovascular risk factors was remarkable: fasting hyperinsulinemia (74%), elevated hsCRP (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%).

Not reported in this paper are the many non-cardiovascular problems raging from psychiatric issues to sleep apnea and muskuloskeletal problems, that often dramatically affect the life of these kids.

While surgery certainly appears rather drastic, the fact that these kids are undergoing surgery is merely an indicator of the fact that we don’t have effective medical treatments for this patient population, which would likely require a combination of behavioural interventions and polypharmacy to achieve anything close to the current weight-loss success of bariatric surgery.

That this cannot be the ultimate answer to obesity management (whether for kids or adults), is evident from the rising number of kids and adults presenting with ever-higher BMI’s and related comorbidity – not all of these can or will want surgery.

Thus, while current anti-obesity medications cannot compete with the magnitude of weight-loss generally seen with surgery, medications together with behavioural interventions may well play a role in helping prevent progressive weight gain in earlier stages of the disease.

Unfortunately, I am not aware of any studies that have explored the use of medications in kids to stabilize weight in order to avoid surgery. This would, in my opinion, be a very worthwhile use of such medications.

@DrSharma
Edmonton, AB

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Targeting Gut Inflammation Can Reduce Insulin Resistance?

sharma-obesity-adipose-tissue-macrophageWith all of the recent interest in the gut microbiota as a mediator of systemic inflammation and metabolic disease, it was only a matter of time before researchers would begin targeting pro-inflammatory pathways in the gut to change metabolism.

A proof-of-principle, that this is indeed possible, is presented by Helen Luck and colleagues from the University of Toronto in a paper published in Cell Metabolism.

Using mice models, the researchers not only show that a high-fat diet can alter the gut immune system but also that the chronic phenotypic pro-inflammatory shift in bowel lamina propria immune cell populations is reduced in genetically altered mice that lack beta7 integrin-deficient mice (Beta7null), a driver of gut inflammatory response.

Further more, treatment of high-fat-fed normal mice with the local gut anti-inflammatory agent 5-aminosalicyclic acid (5-ASA), reverses bowel inflammation and improves metabolic parameters including insulin resistance (although it had no effect on body weight).

These beneficial effects are are associated with reduced gut permeability and endotoxemia as well as decreased visceral adipose tissue inflammation.

Moreover, treatment with ASA also improved antigen-specific tolerance to luminal antigens.

Thus, as the authors conclude,

“…the mucosal immune system affects multiple pathways associated with systemic insulin resistance and represents a novel therapeutic target in this disease.”

Clearly gut inflammation both in relationship to gut microbiota as well as response to dietary factors is likely to be a hot topic in obesity and metabolic research for the foreseeable future.

@DrSharma
Edmonton, AB

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Does Intentional Weight Loss Reduce Mortality?

sharma-obesity-scale2Given that virtually every risk-factor guideline (from hypertension to diabetes) recommends “weight-loss” as “first-line” treatment, to many this may seem a rather stupid question, but in reality, there is in fact almost no high-qulaity evidence to show that intentional (non-surgical) weight loss actually reduces mortality.

This may well be simply because randomised controlled studies on intentional weight loss have either never been long enough, big enough, or able to sustain large enough differences in body weight between the interventions arms.

Nevertheless, now a meta-analysis by Stephen Kritchevsky and colleagues from the Wake Forest School of Medicine, published in PLOS one, suggests that being randomised to the intervention arm in a weight-loss study may reduce mortality by 15%.

The researchers identified 15 randomised controlled trials of behavioural interventions for weight loss of at least 18 months duration, of which 12 reported at least one death in either of the intervention arms.

These studies included 17,186 participants (53% female, mean age 52 years, mean BMI range 30–46 kg/m2 ) with follow-up times ranging from 18 months to 12.6 years (mean: 27 months), and an average weight loss of 5.5±4.0 kg.

Based on  a total of 264 deaths in weight loss groups compared to 310 in non-weight loss groups, the authors calculated a 15% lower all-cause mortality risk (RR = 0.85; 95% CI: 0.73–1.00) in the weight-loss group.

Thus, the authors conclude that being randomized to the weight-loss arm in a behavioural weight-loss study may indeed reduce mortality risk.

However, as readers may realise, this study certainly does not “prove” that it is the actual weight loss that mediates these effects. After all, to achieve and sustain weight-loss through behavioural interventions, participants would have had to change their diet and activity levels to a greater extent that those in the control group. Thus it is very possible that the difference in mortality between the groups could well have been due to changes in health behaviours rather than due to the actual weight loss.

Nevertheless, the findings are reassuring in that they at least do not show an increase in mortality, something that people have feared may happen with intentional weight loss, especially in older individuals.

I guess the most we can conclude from this study is that being lucky enough to be randomised into the “weight-loss arm” of a behavioural weight-loss RCT may just help reduce your mortality risk.

@DrSharma
Edmonton, AB

 

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