Friday, October 24, 2014

Social Network Analysis of the Obesity Research Boot Camp

bootcamp_pin_finalRegular readers may recall that for the past nine years, I have had the privilege and pleasure of serving as faculty of the Canadian Obesity Network’s annual Obesity Research Summer Bootcamp.

The camp is open to a select group of graduate and post-graduate trainees from a wide range of disciplines with an interest in obesity research. Over nine days, the trainees are mentored and have a chance to learn about obesity research in areas ranging from basic science to epidemiology and childhood obesity to health policy.

Now, a formal network analysis of bootcamp attendees, published by Jenny Godley and colleagues in the Journal of Interdisciplinary Healthcare, documents the substantial impact that this camp has on the careers of the trainees.

As the analysis of trainees who attended this camp over its first 5 years of operation (2006-2010) shows, camp attendance had a profound positive impact on their career development, particularly in terms of establishing contacts and professional relationships.

Thus, both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in obesity researcher (and possibly beyond).

Personally, participation at this camp has been one of the most rewarding experiences of my career and I look forward to continuing this annual exercise for years to come.

To apply for the 2015 Bootcamp, which is also open to international trainees – click here.

@DrSharma
Toronto, ON

ResearchBlogging.orgGodley J, Glenn NM, Sharma AM, & Spence JC (2014). Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. Journal of multidisciplinary healthcare, 7, 459-70 PMID: 25336965

 

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Thursday, October 23, 2014

Guest Post: My Weight Is Not Measured In Pounds

Fitness Header ColorToday’s guest post comes from Andrea Matthes, a Certified Personal Trainer and blogger, who I met at the annual meeting of the Obesity Action Coalition in Orlando – the post speaks for itself.

I recently attended the Obesity Action Coalition’s annual Your Weight Matters Convention and got the opportunity to hear Dr. Sharma’s keynote presentation titled, “Health is Not Measured in Pounds.” I found myself sitting in my chair, agreeing so emphatically that I was full-body nodding at the waist. By the end of his speech, I couldn’t contain myself– I jumped out of my chair making the first, very loud clap that echoed through the room, only to be followed by hundreds of other claps and a full-house standing ovation. Dr. Sharma’s message was something I needed to hear. Not because it was a new theory to me, but because up until that hour, his theory was what I was experiencing first-hand.

I am 5 feet, one inch tall and weigh 165lbs (when slightly dehydrated). At my current height/weight my BMI is 31.2, also known as: OBESE. A word that is often associated with laziness, overeating, diabetes, high blood pressure, bad cholesterol and overall ill health. According to this number, I need to lose at least 35lbs if I want to reach the “normal” range in order to be considered “healthy”.

Can I just tell you how frustrating that is?

I am living an exceptionally healthy, full and active lifestyle. My blood pressure is perfect, my cholesterol levels are great, and my A1C is consistently normal. My daily life consists of running, jumping, lifting heavy objects, and eating a diet that most people would consider ideal. I am extremely proud of the lifestyle I live. I am able to climb mountains, run races, surf, ski, and flip a perfectly executed cartwheel at the drop of a hat. Yet, I am told that in order to be healthy, I need to lose weight!

How ridiculous is that?

It’s extremely ridiculous and unfair that I have to live with a label that is based on a fancy formula for size; a label that says I need to lose weight in order to avoid potential misdiagnoses, higher insurance premiums, and social stigma. It’s unfair that my TRUE health has very little to do with pounds and everything to do with how I live my life. This is what my obesity looks like:

I am a running, swimming, cycling, heavy-lifting, nutrient-eating, LIFE-LOVING, 5-foot-one-inch-tall, 37-year-old woman who also weighs 165lbs which leaves me with a label that misrepresents the life I live and my health!

I may be obese according to BMI but that does not mean I am unhealthy.

My obese body is strong, it is capable, it is HEALTHY. In fact, my obese body is healthy enough to do things that many skinny people can’t do. So weigh me all you want, but please, do not measure my HEALTH in pounds.

ABOUT ANDREA

Andrea has lost 164 pounds with a jumpstart from gastric bypass surgery followed by a complete lifestyle overhaul. She is now a Certified Personal Trainer, Level One CrossFit Coach and has completed over 25 races since March of 2013. Andrea blogs about her REAL FOOD, REAL FITNESS, REAL LIFE approach at www.imperfectlife.net where she strives to inspire others to let go of perfection and learn to love their one and only I’mperfect Life.

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Wednesday, October 15, 2014

Disease Severity and Staging of Obesity

sharma-edmonton-obesity-staging-systemRegular readers will be well aware of our work on the Edmonton Obesity Staging System (EOSS), that classifies individuals living with obesity based on how “sick” rather than how “big” they are.

For a rather comprehensive review article on the issue of determining the severity of obesity and potentially using this as a guide to treatment, readers may wish to refer to a paper by Whyte and colleagues from the University of Surrey, UK, published in Current Atherosclerosis Reports.

This paper not only nicely summarizes the potential effects of obesity on various organs and organ systems but also discusses the use of staging systems (EOSS and Kings) as a way to better characterize the impact of excess weight on an individual.

As the authors note in their summary,

Using a holistic tool in addition to BMI allows highly informed decision-making and on a societal level helps to identify those most likely to gain and where economic benefit would be maximised.”

Not surprisingly, the Edmonton Obesity Staging System, which has been validated against large data sets as a far better predictor of mortality than BMI, waist circumference or metabolic syndrome, is being increasingly adopted as a practical tool to guide clinical practice.

@DrSharma
Merida, Mexico

ResearchBlogging.orgWhyte MB, Velusamy S, & Aylwin SJ (2014). Disease severity and staging of obesity: a rational approach to patient selection. Current atherosclerosis reports, 16 (11) PMID: 25278281

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Tuesday, October 14, 2014

Electronic Versus Pen And Paper Monitoring Of Food Intake

diet journalSelf-monitoring is one of the few proven strategies for long-term weight management (which is why all programs worth their weight use it).

But does it really matter how you self-monitor and are electronic forms more accurate than simply using pen and paper?

This issue was examined by Melinda Hutchesson and colleagues from the University of South Wales, Australia, in a paper published in the Journal of the Academy of Nutrition and Dietetics.

The researchers examined the acceptability and accuracy of three different 7-day food record methods (online accessed via computer, online accessed via smartphone, and paper-based) in 18 young normal-weight women.

Actual energy expenditure was measured using indirect calorimetry and physical activity levels derived from accelerometers.

All three methods revealed roughly the same amount of daily caloric intake, falling short by about 500 kcal of the actual measured expenditure.

Nevertheless, around 90% of the participants preferred an electronic method to the paper based method.

Thus, the author argue that,

“Because online food records completed on either computer or smartphone were as accurate as paper-based records but more acceptable to young women, they should be considered when self-monitoring of intake is recommended to young women.”

As far as I am concerned, you can use whatever method you want as long as you use some form of self-monitoring. After all, it is the act of self-monitoring that counts – as with diets, this only works when you actually do it.

@DrSharma
Edmonton, AB

ResearchBlogging.orgHutchesson MJ, Rollo ME, Callister R, & Collins CE (2014). Self-Monitoring of Dietary Intake by Young Women: Online Food Records Completed on Computer or Smartphone Are as Accurate as Paper-Based Food Records but More Acceptable. Journal of the Academy of Nutrition and Dietetics PMID: 25262244

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Friday, October 10, 2014

PHEN/TPM ER Improves Glycemic Control in Type 2 Diabetes

qsymia-300x224The fixed combination of phentermine/topiramate extended release (PHEN/TMP ER), is marketed in the US as the anti-obesity drug Qsymia.

Now a paper by Timothy Garvey and colleagues, published in Diabetes Care, describes the weight-lowering and anti-diabetic effect of this drug combination in individuals with type 2 diabetes.

The investigators studied the effect of 56-week treatment in 130 participants randomised either to placebo or PHEN/TPM ER (15 mg/92 mg) once-daily with change in A1c levels as the primary endpoint. Both treatment groups also received lifestyle interventions to improve diet and physical activity.

The authors also present data on a secondary analysis of individuals with type 2 diabetes (n=388), who participated in the CONQUER trial.

At week 56 individuals on PHEN/TMP ER lost about 9.4% compared to a 2.7% on placebo. This reduction in body weight was associated with a 1.6% reduction in A1c levels on PHEN/TMP ER compared to a reduction of 1.2% in participants on placebo.

In addition, greater numbers of patients randomized to receive PHEN/TPM ER treatment achieved HbA1c targets with reduced need for diabetes medications when compared with the placebo group.

As expected from these drugs, the most common adverse events included paraesthesia, constipation, and insomnia.

As the authors conclude, PHEN/TPM ER plus lifestyle modification can effectively promote weight loss and improve glycemic control as a treatment approach in obese/overweight patients with type 2 diabetes.

PHEN-TMP ER is currently not approved for obesity management outside the US.

@DrSharma
Edmonton, AB

disclaimer: I have served as a paid consultant and speaker for Vivus, the maker of Qsymia.

ResearchBlogging.orgGarvey WT, Ryan DH, Bohannon NJ, Kushner RF, Rueger M, Dvorak RV, & Troupin B (2014). Weight-Loss Therapy in Type 2 Diabetes: Effects of Phentermine and Topiramate Extended-Release. Diabetes care PMID: 25249652

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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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