This week I will be giving a key note address on the use of the Edmonton Obesity Staging System (and the shortcomings of BMI) at the 2015 Minimally Invasive Surgery Symposium (MISS) in Las Vegas.
Without doubt, minimally invasive laparoscopic surgery has revolutionised bariatric surgery – what was once a messy, life-threatening operation is now an elegant procedure, which usually has patients up and about the next day.
But are the BMI-based indications for bariatric surgery still the best way to go? Not when we have better systems like the Edmonton Obesity Staging System (EOSS) to determine how “sick” someone is rather than just how “big”.
This morning, in a separate presentation, I will also be providing an extensive overview on the efficacy and safety of the modern anti-obesity medications that have recently become available in the US.
While these medications may still not help patients achieve or maintain quite the degree of weight loss seen with surgery, they are certainly viable treatment options for individuals with less severe obesity or those unwilling or unable to undergo surgery.
Although evidence for this is still scarce, these medications may well also come to play a role in helping prevent the weight gain that some patients experience after surgery.
If nothing else, minimally invasive bariatric surgeons should certainly be aware of the available medical treatments as they counsel their patients about the pros and cons of surgery.
Las Vegas, NV
For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd.
To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here.
To register – click here.
The title of this post may sound like a “no-brainer”, but the research literature on the long-term health benefits of weight loss from longitudinal intervention studies in people with severe obesity is much thinner than most people would expect.
Thus, a new study from our group, that looks at the relationship between changes in body weight and changes in health status over two years in patients with severe obesity enrolled in the Alberta Population-based Prospective Evaluation of the Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, published in OBESITY, may well be of considerable interest.
As described previously, APPLES is a 500-patient cohort study in which consecutive, consenting adults with BMI levels > 35 kg/m2 were recruited from the Edmonton Adult Bariatric Specialty Clinic. The 500 patients enrolled were between 18 and 60 years old and were either wait-listed (n=150), beginning intensive medical treatment (n=200) or had just been approved for bariatric surgery (n=150). Complete follow-up data at 24 months was available for over 80% of participants.
At study enrollment, the proportion of patients who reported >2 and >3 chronic conditions was 95.4% and 85.8%, respectively. The most common single chronic conditions at baseline were joint pain (72.2%), anxiety or depression (65.4%), hypertension (63.4%), dyslipidemia (60.4%), diabetes mellitus (44.6%), gastrointestinal reflux disease (35.4%), and sleep apnea (33.5%).
After 2 years, just over 50% of participants had maintained a weight loss > 5%, with a mean weight change for the entire cohort of about 13 kg.
Losing > 5% weight was associated with an almost 2-fold increased likelihood of reporting a reduction in multimorbidity at 2-year follow-up, whereby outcomes varied between treatment groups: in the surgery group, the top three chronic conditions that decreased in prevalence over follow-up were sleep apnea (43% at baseline vs. 25% at 2 years,), dyslipidemia (60% vs. 47%), and anxiety or depression (59% vs. 47%); in the medically treated group anxiety or depression (69% vs. 57%) and joint pain (77% vs. 67%); and none in the wait-listed group.
As expected, any reduction in multimorbidity was associated with a clinically important improvement in overall health status.
In summary, this paper not only documents the considerable multimorbidity associated with severe obesity, it also documents the clinically important improvement in health status associated even with a rather modest 5% weight loss over 2 years in these individuals.
Since its inception in 2006, the Canadian Obesity Network (CON) has grown into a 10,000 member strong organisation of researchers, health professionals, policy makers, and anyone working in the private or public sector with an interest in obesity.
In short, CON as we know it, is a professional network – all you have to do to become a member is to sign up on the website and state your professional expertise and area of interest.
While CON has undeniably changed the landscape of obesity research, practice and policy in Canada, the most important voice in this dialogue has been missing – the voice of people living with obesity and their families.
As decided by CON’s Board of Directors, this is about to change. It is now time for CON to engage directly with people who have the problem – not just experts who study or treat it.
To help guide CON on this new venture, anyone living with obesity or working with individuals living with obesity (of any age and in any setting) is requested to complete this brief survey (4 questions – takes less than 2 minutes).
Your response will help inform a Bariatric Patient Engagement Workshop to be held on April 27, 2015 at the upcoming 4th Canadian Obesity Summit in Toronto.
The purpose of the Bariatric Patient Engagement Workshop is to hold a focused conversation and seek insights about the need for and function of a public engagement strategy to inform, support, and empower individuals affected by obesity in Canada.
This workshop is CON’s first step towards building a Canada-wide community of individuals affected by obesity that is willing to participate in public engagement initiatives in support of patient-oriented research, practice, and policy.
Your help and support is very much appreciated as CON prepares itself for this next chapter of its commitment to engage all relevant stakeholders towards its mission to prevent and reduce the physical, mental and economic burden of obesity on Canadians.
To take the survey click here.
According to a study by Thomas Reinehr from the University of Witten/Herdecke, Germany, published in Pediatric Obesity, extremely obese children respond better than extremely obese adolescents to behavioural interventions.
The researchers looked at data from a one-year intensive behavioural intervention 1291 children (mean age 11.0years, mean BMI 27.5, 55.8% female, 37.6% extremely obese (defined by BMI-SDS >2.3) at end of intervention and 1 year later.
While the overall mean BMI-SDS wqs indeed reduced (−0.20 ± 0.32 at end of intervention and −0.14 ± 0.37 1 year later), and there were no significant differences in the outcomes of overweight and obese kids vs. overweight and obese adolescents, this was not the case for the severely obese group.
Here, the group of extremely obese kids (>10 years), showed only a rather modest treatment effect compared to younger extremely obese kids (<10 years).
Thus the authors conclude that,
“Our study demonstrated an encouraging effect of lifestyle intervention in extremely obese children ≤10 years at the end of intervention and 1 year later, but only a limited effect in extremely obese adolescents >10 years.”
This is not unlike the situation for other chronic diseases, where management in adolescents tends to be more challenging than managing younger kids or adults.
I guess this is simply another fact that obesity management shares with the management of other chronic diseases.
If you have experience with managing adolescent obesity, I’d certainly like to hear from you.