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Surviving Cancer Doesn’t Make You An Oncologist!

sharma-obesity-trust-me-im-a-doctorIn my TEDx talk “How to Lose 50 Pounds and Keep Them Off” released earlier this week, I recommend that people struggling with obesity seek help from a health care professional trained in chronic disease management.

Given that most of what we deal with in medicine is chronic disease, one would imagine that almost any health professional can give competent advice on living with a chronic disease.

Unfortunately, while this may be true for diabetes or hypertension or most of the other common chronic diseases that virtually all health professionals at some time in their careers will have learnt to manage, very few will have any experience at all in treating obesity – let alone even thinking of obesity as a chronic disease.

It is therefore not surprising that when it comes to weight management people often turn to lay “experts” who proclaim themselves as “experts” simply because they have somehow managed to lose weight and are (at least for now) managing to keep it off.

Often, these “experts” (not seldom with the help of a savvy publicist) will launch a lucrative speaking business including authoring self-help books, offering diet/exercise plans, appearing on TV talk shows, endorsing supplements or promoting whatever it is they believe helped them lose their weight.

Unfortunately, as I hear over and over from my patients, these self-proclaimed  “experts” who, having “conquered” their obesity, have now embarked on a mission to help you “conquer” yours, are about as effective as any other commercial fad diet.

This is because, we have long known that in obesity, what works for one person may be entirely ineffective in the next.

Just because you lost weight by following (insert your approach here), does not mean that you have found the Holy Grail of weight management and are now somehow professionally qualified to offer your help to everyone else.

Living with heart disease does not make you cardiologist!

Surviving cancer does not make you an oncologist!

Losing weight does not make you an obesity specialist!

This is not to say that the “patient” experience is not important or that “peer support” cannot be a valuable tool in chronic disease management.

Indeed many successful weight management programs including Taking Off Pounds Sensibly or Weight Watchers rely heavily on “peer support”, in that groups are generally run by lay people who are themselves “affected”.

While this makes a lot of sense, it does not replace the need for a professionally qualified health professional to ensure that all goes well.

Just because you are a member of the local diabetes support group does not mean you no longer need to meet with your diabetes educator or family doctor.

Just because your dearest friend survived a heart attack and is willing to share her experience and support, doesn’t mean you no longer need to see a cardiologist for your own heart problems.

This is an important distinction and should be a warning to not rely too heavily on people peddling their “success stories”.

While it may well of interest to listen and perhaps even examine their suggestions, hoping that what worked for them will work for you, is both shortsighted and can potentially do more harm than good.

Do I wish that all health professionals had a sound understanding of obesity management and are there to support people living with obesity – of course I do.

But I know we are not there yet and it will take time before health professionals begin seeing their role change from simply “recommending weight loss” t0 actually having the expertise and experience required to help patients better manage their weight and health.

@DrSharma
Edmonton, AB

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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 Remove A Gastric Band

sharma-obesity-adjustable-gastric-banding2When adjustable gastric banding was first introduced as a treatment for severe obesity, it was touted not only as a surgically simple procedure (which it is) but also as having the advantage of being “reversible”.

Unfortunately, as many patients who have had bands implanted only to discover that they either did not work or created all kinds of other problems, “simply” removing the band was often anything but “simple”.

Moreover, as with any obesity treatment, removing the band (or in other words, stopping the treatment) virtually guarantees weight regain, leaving the patients often back to where they were (if not worse off) than before the operation.

In reality this means that when bands need to be removed, they often have to be followed by a more definitive procedure like a sleeve gastrectomy (SG) or a Roux-en-Y gastric bypass (RYGB) (the operations that should probably have been done in the first place).

The debate that continues to rage between surgeons, is whether or not it is safer to remove the band and do the more definitive operation within a single procedure or in two separate operations.

Now my colleague Jerry Dang from the University of Alberta, Edmonton, Canada, has published a systematic review and meta-analysis of the two approaches in Obesity Surgery.

According to their analysis of 11 studies that included 1370 patients, there was no difference in the rates of complications, morbidity, or mortality between one-step and two-step revisions for both RYGB and SG groups.

Thus, the authors conclude that both immediate or delayed revisional bariatric surgeries are reasonable and comparable options for band revisions.

Overall however, this should not distract from the fact that a band removal in itself can be a difficult operation with its own set of complications and given the number of bands that have to be removed, it may be best be recommended that preference be given to doing an SG or RYGB as the primary procedure.

Fortunately, this is indeed proving to be the practice at an increasing number of surgical centres.

@DrSharma
Edmonton, AB

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Guest Post: Even if Oprah Can’t, Maybe You Can?

sharma-obesity-food-addiction

Today’s guest post is a response to my recent post about Oprah and her weight-loss struggles. The post comes from Dr Vera Tarman, MD, FCFP, ABAM, and author of Food Junkies: The Truth About Food Addiction and Mike MacKinnon a fitness trainer (Fit in 20).

Oprah’s experience of losing and regaining her weight on a regular basis, alongside Sarah, the Duchess of York and Kristie Allie – all spokespersons for weight loss programs ‐ certainly send us a dismal message. Sure, weight loss can occur but keeping it off is the challenge that trips up 90% of people who have tried these and other programs. So, isn’t it more compassionate to dissuade people from the inevitable yo‐ yo lifestyle and accept their current obese weight?

But … what if there are actually many success stores that we are not hearing about?

As an addictions physician I witnessed patients who have lost an average of 60 to 100 pounds and have kept that weight off for years. They are food addicts in recovery from their addiction. They have adopted a radical diversion from the traditional bariatric or eating disorder menu recommendations: Rather than ‘learning’ how to eat all foods in moderation, these people have identified and abstained from the trigger foods that spur their addictive eating. Sobriety, food serenity and long term weight loss result – on a consistent basis.

Look to the recovery circles and addiction treatment programs. Here you will unearth people who have succeeded where Oprah has not. We don’t hear about these victories because many have pledged anonymity in the church basements where they meet, strategize and buffer the messages that we are saturated with by our food‐obsessed culture. Because there is no money to be made with the simple abstinence of sugar, flour or processed foods, and no drugs, herbs or patented food packages to sell – no one is advertising or promoting this approach. Abstinence.

Here is the story of one clinician who has found long ‐ term weight loss. His is a case in point: Weight loss for 13 years and counting. He is not a “rare’” individual who has achieved the impossible. He and his clients have simply applied the solution to the underlying problem of their obesity – an undiagnosed food addiction.

I’m a strength and nutrition coach who specializes in helping people lose weight. My typical clients are female, age 35 and up, who have tried EVERYTHING under the sun, to no avail. Most have had some success, but usually they have lost their weight and gained back even more.

Often, by the time they get to me, they’re frustrated, angry and feel hopelessness.

Over the course of two years, I lost 95 lbs of body fat. I have maintained my weight loss for almost 13 years. I have also helped many others maintain similar weight loss. Last week I interviewed an ex‐client of mine ‐ a doctor ‐ who lost almost 50 lbs six years ago. How did we both do it?

How did we maintain our loss in the face of those who would tell us that it’s not possible, that most can’t?

We addressed the problem, not the symptom. The symptom is excess body fat. The problem however is multi‐factorial:

1) It is mental in that overweight people greatly misunderstand what healthy eating and healthy exercising looks like.

2) It is emotional. Overweight people tend to turn to food instead of healthier coping mechanisms when they experience stress or overwhelming emotions.

3) It is physical: they eat too much of the wrong stuff, and end up eating it compulsively.

I work with people to re‐program their thinking, so they learn to have a better relationship with food. I teach them reality‐based therapies (CBT, DBT, ACT, REBT) that help them deal with harmful thinking and negative emotions more constructively.

Mainly, I teach them what to eat, what foods are healthy versus which lead to addictive eating. Clients learn the tools they need to stay on track so that they don’t relapse back to compulsive eating. The truth is, for some, there are foods they must avoid permanently. This approach is not popular. But, I have found that some people treat certain foods the same way a drug addict treats their drug of choice. Once they start, they cannot stop.

Not everyone fits this category, but some do. When these people agree to give up the foods that are causing them trouble, they succeed.

So, when I hear someone say that most who are overweight are doomed to never lose their weight, my first thought is “nonsense”. What I suggest to my clients is a paradigm shift in thinking. We, who are led by the diet industry, misunderstand the nature of the problem. It is not a simple matter of eating less and excising more. People must accept that an equal portion of mental, emotional and physical work needs to be done AND they may also have to accept that there are certain foods they can never eat again.

Are you a food addict?

If you are, you may have to identify and abstain from your favorite foods in order to achieve long‐term weight loss. Those processed savory or sugary ‘drugs’ that comprise our daily snacks and fast food meals.

Is there good news? There are plenty of people out there who have sustained weight loss, but we have yet to capture them in our studies. They will tell you: You can, you can, you can.

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If Oprah Can’t Why Do You Think You Can?

sharma-obesity-oprah1There are no doubt long-term “success stories” out there – people who just by making (often radical) changes in their diet and activity behaviours have lost a substantial amount of weight AND are keeping it off.

However, there is also no doubt that these people are rare and far between – which is exactly what makes each one of them so exceptional.

I am not speaking of all the people we hear or read about who have lost tons of weight – we hear about their spectacular weight loss – cutting carbs, cutting gluten, going vegan, going paleo, alternate day fasting, running marathons, training for iron man competitions, going on the Biggest Loser or eating at Subway.

What we don’t hear about is the same people, when they put the weight back on – which, in real life is exactly what happens to the absolutely vast majority of “losers”. We hear of their “success” and then we never hear from them again – ever.

Oprah is different! Different because, we have had the opportunity to follow her ups and downs over decades.

When Oprah “succeeds” in losing weight, she does not disappear into the night – no – she puts the weight back right in front of our eyes, again and again and again and again.

Now, comedy writer Caissie St.Onge, in a comment posted on facebook, pretty much summarizes what it is we can all learn (and should probably have learnt a long time ago) from Oprah:

“Oprah is arguably the most accomplished, admired, able person in the world. She creates magic for other people and herself on the regular. So, if Oprah can’t do permanent lifelong weight loss, maybe it can’t be done. Oprah is also crazy rich. If Oprah can’t buy permanent lifelong weight loss, maybe it can’t be bought.”

“I’m not saying you should give up on your dreams of having the body you want. I’m just asking, if you never get that waist, will your life have been a waste? (I see what I did there.) Every day we are bombarded with media, content and products. Special foods and drinks. Programs and plans. None of this shit has ever worked for Oprah and it probably isn’t gonna work for me or you.”

“I know the reason isn’t because you’re weak. If you’re carrying around 10 or 20, or 50 or 150 pounds more than the tiny friend who always calls herself fat in front of you and you don’t kick her in the back of the knee, you’re the opposite of weak. You’re very, very strong in at least two different kind of ways.”

“I realize there are people who are DYING to tell you what they think about what you should do with your body. It always starts with, “No offense but…” or “Not to be mean, but…” And it’s always offensive and mean, but also, you probably say things to yourself every day that are way meaner than what any “well-intentioned” “friend” or internet troll could come up with. You’re gonna have to try harder if you want to beat us at our own game, internet trolls. I would pop someone in the chops if they spoke to me the way I speak to myself. And I would bet all of Oprah’s money that Oprah says mean shit to herself too. Oprah does.”

“You can do what you want. You knew that. But I’m gonna stop wishing that I didn’t have dimples on the backs of my hands or that my ankles were more flattered by strappy shoes. I’m gonna stop telling people that they look great and start telling them what I really mean, that’s it’s nice to see them. And I see you. And I like you so much just how you are right now, and not a year or five years from now when you may or may not be smaller….. Oprah. I’ll love you either way.”

Cassie’s entire post is available here

@DrSharma
Edmonton, AB

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