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!

Montreal, QC

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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.

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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Friday, June 20, 2014

Your Body Thinks Obesity Is A Disease

sharma-obesity-adipose-tissue-macrophageYesterday, the 4th National Obesity Student Summit (#COSM2014) featured a debate on the issue of whether or not obesity should be considered a disease.

Personally, I am not a friend of such “debates”, as the proponents are forced to take rather one-sided positions that may not reflect their own more balanced and nuanced opinions.

Nevertheless, the four participants in this “structured” debate, Drs. Sharon Kirkpatrick and Samantha Meyer on the “con” team and Drs. John Mielke and Russell Tupling on the “pro” team (all from the University of Waterloo) valiantly defended their assigned positions.

While the arguments on the “con” side suggested that “medicalising” obesity would detract attention from a greater focus prevention while cementing the status quo and feeding into the arms of the medical-industrial complex, the “pro” side argued for better access to treatments (which should not hinder efforts at prevention).

But a most interesting view on this was presented by Tupling, who suggested that we only have to look as far as the body’s own response to excess body fat (specifically visceral fat) to determine whether or not obesity is a disease.

As he pointed out, the body’s own immunological pro-inflammatory response to excess body fat, a generic biological response that the body uses to deal with other “diseases” (whether acute or chronic) should establish that the body clearly views this condition as a disease.

Of course, as readers are well aware, this may not always be the case – in fact, the state of “healthy obesity” is characterized by this lack of immunological response both locally within the fat tissue as well as systemically.

Obviously, it will be of interest to figure out why some bodies respond to obesity as a disease and others don’t – but from this perspective, the vast majority of people with excess weight are in a “diseased” state – at least if you asked their bodies.

While this is a very biological argument for the case – it is indeed a very insightful one: it is not the existence of excess body fat that defines the “disease” rather, how the body responds to this “excess” is what makes you sick.

As readers, are well aware, there are several other arguments (including ethical and utilitarian considerations) that favour the growing consensus on viewing obesity as a disease.

Of course,  calling obesity a disease should not detract us from prevention efforts, but, as I often point out, just because be treat diabetes or cancer as diseases, does not mean that we do not make efforts to prevent them.

If calling obesity a disease increases resources towards better dealing with this problem and helps take away some of the shame and blame – so be it.

Waterloo, Ontario

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Tuesday, May 20, 2014

Mountain Living Reduces Obesity?

mountain pineLiving not too far from the Canadian Rockies, you cannot help but notice how vegetation gets short and stunted at higher elevations.

The same is apparently true for humans – while moving to higher altitudes may not make your shorter, it certainly appears to reduce your body fat and perhaps risk of obesity.

Indeed, there is ample evidence from both animal and human studies demonstrating that hypobaric hypoxia (lower oxygen levels combined with lower athmospheric pressure) may have a profound affect on body composition.

Now, a large epidemiological study by Jameson Voss and colleagues, published in PLOS|One provides strong evidence to support this hypothesis.

The researchers looked at all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 stationed in the United States and compared obesity related ICD-9 codes between those stationed at high altitudes (>1.96 kilometers above sea level) with those at low altitudes (<0.98 kilometers).

It turns out that service members stationed at higher altitudes were about 40% less likely to become obese than those stationed at lower altitudes.

Although one must always be careful to infer causality from epidemiological evidence, these findings are certainly in line with the experimental evidence on hypobaric hypoxia.

In light of these findings, I can already see the next opportunity for commercial weight loss – hypobaric hypoxic chambers at your local tan studio.

Edmonton, AB

ResearchBlogging.orgVoss JD, Allison DB, Webber BJ, Otto JL, & Clark LL (2014). Lower Obesity Rate during Residence at High Altitude among a Military Population with Frequent Migration: A Quasi Experimental Model for Investigating Spatial Causation. PloS one, 9 (4) PMID: 24740173

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Wednesday, April 30, 2014

Should Governments Concern Themselves With Obesity?

sharma-obesity-policy1Yesterday, I blogged about the right-wing Fraser Institute’s report, which claims that the obesity problem is overstated and that government policies are misguided.

An interesting discussion in the report pertains to the fundamental issue of whether governments should at all concern themselves with obesity (even if the problem were really as big as is generally assumed).

The report looks at this from the perspective of whether or not obesity places an economic burden on society and whether or not it would be in the Government’s interest to intervene with the aim to reduce this burden.

Here is how the report views this:

“What is interesting here—and what is important in public policy terms—is the burden of the costs of obesity. A closer examination of the consequences of excess weight…finds that the majority of the costs of obesity are borne directly by the individual in terms of lower income, reduced employment opportunities, reduced enjoyment of life, greater illness, and a potentially shorter lifespan. The only area where these costs are not borne almost entirely and directly by the individual is the increased burden on Canada’s tax-financed health care system….From an externality perspective then (though this is not the only justification used for government intervention, as we shall discuss in the next section) the only area of the “obesity epidemic” where governments may have a legitimate role to intervene is to resolve the costs imposed by the obese [sic] on all taxpayers through the tax-funded health care system.”

However, as the report goes on to argue, the lifetime health care costs for obese individuals may not be all that much higher – in part, because of a shorter life-span.

Here the report quotes studies showing that,

“…while obese individuals incurred higher health care costs than normal-weight non-smokers during their lifetimes, over an entire lifetime normal-weight non-smokers incurred greater health care costs in total because of differences in life expectancy and the costs of care associated with additional years of life….These findings suggest that obese individuals may in fact not be a net burden to all taxpayers over their entire lifetimes, despite imposing a cost burden while they are alive. That finding is bolstered by considerations of reductions in costs associated with public pensions and other old age income supports .”

Thus, economic arguments that governments need to intervene to reduce the burden of obesity may not hold water – while being obese is sad for the folks affected (and they already pay for it dearly), there may not be all that much incentive for governments to  reduce the burden of obesity with an aim to “protecting” the economic interests of the non-obese majority.

Or, as the report puts it,

“…while there is clearly a health and economic cost associated with a high prevalence of obesity, the problem may be much smaller than many have claimed. Importantly, it may be that the serious health consequences lie at the higher end of the weight spectrum, thus affecting a relatively small proportion of the population. And many of the economic costs associated with obesity are borne privately by the individual and thus may not justify government intervention. That is the framework within which policy options should be proposed, and within which they should be considered.”

Thus, given the rather modest economic burden on tax-payers in general (most of who are not obese), it becomes even more important to look at the economic downsides of the government stepping in to impose policies that (even if effective) may not be worth the considerable impacts on taxpayers, on the economy, and on particular industries.

“Many of these interventions would require increased bureaucracy, for example an agency to determine which foods or beverages qualify for targeting or for particular food categories. Interventions may also create barriers to entry for smaller businesses or artificial constraints on growth, generate higher business costs or increase costs for consumers, increase travel times for consumers, impact business prospects, and potentially lead to job losses. Interventions may also result in a transfer of funds from one group of legal businesses to another simply because one provides a product that is disliked by interventionists.”

But irrespective of which side of the political fence you may sit on, it should be obvious that decisions about government spending have to consider more than just economic benefits.

Thus, even if there was a net cost to spending tax-money on preventing and better treating obesity, would this still not be a worthwhile investment?

Indeed, little (if anything) we do in healthcare saves money – or, as I sometimes point out, the cheapest patient is a dead patient. To me at least, healthcare is never about saving cost – it is about easing pain and suffering. Treating cancer and heart attacks does not save money – yet, they are fully worthwhile expenses.

So for obesity treatments the issue of whether or not government should get involved is rather straightforward. If we accept that obesity (at least in extreme cases) is a disease that causes pain and suffering then it is the job of healthcare systems (and in Canada this job falls to the government) to provide treatments that can ease that pain and suffering – anything else would be discrimination. As long as the treatment benefits the individual and is reasonably cost-effective (as compared to treatments for other conditions) there is no ethical argument to deny that treatment.

When it comes to prevention, the issues are less clear (as discussed in the report). Here the responsibility of governments must balance the needs of all of its citizens by broadening its view of the impact that policies would have on the entire population. Thus, the question is not just what impact certain policies would have on those who have obesity (or are at risk of getting it) but also how such policies would impact the majority of the population that neither has obesity nor is at risk of getting it.

This is where the Fraser Institute report stays true to its ideology in that any policies that limit choice or put boundaries on free enterprise are something that governments should stay out of. Rather, it may be best to leave this to the free market to sort out:

“The private sector might also be a source of solutions to concerns about the prevalence of obesity, and already provides a broad range of options for those who wish to alter their lifestyles and diets in search of a reduction in excess weight. For example, the diet and exercise industries are working to counter the prevalence of excess weight through books, videos, weight loss clinics, gyms, and exercise equipment, among other approaches. Restaurants and food producers are also involved in helping people reduce excess weight by offering lower calorie, lower fat, or other more healthful options. Many businesses also support weight loss through employer funded programs. We may also soon see medicinal solutions for excess weight and weight management.” 

The third section of the report goes on to discuss several proposed public-health policies including taxes, restricting access to certain foods and drinks, calorie and nutrient labelling, graphic health warnings, healthier school meals, advertising restrictions, and zoning  laws.

As may be expected, the report highlights the lack of effectiveness and/or the unintended consequences of these proposed policies. For anyone working in the area of public health and health promotion, these sections will make a challenging and perhaps infuriating read.

But then again, that’s exactly what political debates are about – the clash of ideologies where each side cherry picks whatever “facts” support their position.

At least we now better understand where the right stands on this issue – a first step to begin countering their arguments.

Edmonton, AB

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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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