Thursday, November 20, 2014

Obesity Myth: Losing Weight Is Always Beneficial For Your Health

sharma-obesity-scale2Another common misconception about obesity discusses in our recent paper in Canadian Family Medicine, is the notion that anyone with excess weight stands to benefit from losing weight.

The benefits of weight loss, however are far from as established as most of us may think:

“The strong biological response to weight loss (even the recommended 5% to 10% of baseline weight) involves comprehensive, persistent, and redundant adaptations in energy homeostasis that underlie the high recidivism rate of obesity treatment.

The multiple systems regulating energy stores and opposing the maintenance of a reduced body weight illustrate that fat stores are actively defended.

Among the adverse effects of weight loss, it is well known that body fat loss increases the drive to eat, reduces energy expenditure to a greater extent than predicted, and increases the tendency toward hypoglycemia.

Weight loss is also related to psychological stress, increased risk of depressive symptoms, and increased levels of persistent organic pollutants that promote hormone disruption and metabolic complications, all of which are adaptations that substantially increase the risk of weight regain.

In addition, there is considerable concern about the negative effect of “failed” weight-loss attempts on self-esteem, body image, and mental health.

Thus, clinicians should document and consider the powerful biological counter-regulatory responses and potential undesired effects of weight loss to maximize the success of their interventions. Obesity is a chronic condition and its management requires realistic and sustainable treatment strategies.

Successful obesity management requires identifying and addressing the obesity drivers as well as the barriers to and potential complications of weight management. Family physicians should discuss the possible adverse effects of weight loss with their patients and actively look for these effects in patients trying to lose weight.”

@DrSharma
Wellington, NZ

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Wednesday, November 19, 2014

Obesity Myth: Dieting Is The Best Way To Control Your Weight

sharma-obesity-fat-dietingHere is what we had to say about the third common misconception in our paper published in Canadian Family Medicine:

Approximately two-thirds of people who lose weight will regain it within 1 year, and almost all of them will regain it within 5 years.

Although dieting (ie, caloric restriction) to lose weight is a difficult task, the maintenance of lost weight requires the patient to deploy even greater efforts.

Rather than a simple lack of willpower, the relapse of most individuals to their previous weight after otherwise successful weight loss is largely driven by the coordinated actions of metabolic, neuroendocrine, autonomic, and behavioural changes that oppose the maintenance of reduced body weight.

The few individuals successful at maintaining weight loss (at least 13.6 kg for at least 1 year) generally have common behaviour and strategies that include consuming low-energy, low-fat diets; engaging in high levels of physical activity; consistent self-monitoring of body weight and food intake; eating breakfast regularly; and demonstrating a high level of dietary restraint.

It is highly unlikely that some of this behaviour can be emulated by most of the population with excess weight.

There is also concern that unhealthy weight control methods (eg, fasting, meal skipping, laxatives, diuretics, stimulants) might ultimately lead to a larger weight regain and pose a risk to both mental and physical health.

Thus, although sustained weight loss with diet alone can be possible for some individuals, agreeing on realistic weight-loss expectations and sustainable behavioural changes is critical to avoid disappointment and nonadherence.

Weight regain (relapse) should not be framed as failure but as an expected consequence of dealing with a chronic and complex condition like obesity.

@DrSharma
Wellington, NZ

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Tuesday, November 18, 2014

Obesity Myth: Obese Individuals Are Less Active

sharma-obesity-active-livingThe second most common misconception about obesity, addressed in our article in Canadian Family Physician, is the idea that people living with overweight are any less active than people with “normal” weight:

“It is very common to hear that obese people are lazy and should get off the couch. This discriminatory bias against those with excess weight is not only widespread among the lay public but also among health professionals, even those in regular contact with patients with obesity.

Yet, the most recent data from the Canadian Health Measures Survey, a study of a nationally representative sample that used accelerometers to measure physical activity, suggest otherwise.

Based on objective measures, only 7% of Canadian children and youth8 and 15% of Canadian adults9 meet physical activity guidelines. When split by body mass index categories, obese girls average 11 159 steps per day, while normal-weight girls average 10 224 steps per day. Obese boys average fewer steps (10 256 steps per day) than their normal-weight counterparts (12 584 steps per day), but they have a larger body to carry. Translating this physical activity level into calories expended (kcal per day) would likely show that obese boys actually burn more calories on a daily basis.

Similar findings are observed for Canadian adults. Overall, the message is that there is a physical inactivity crisis in Canada—most people do not meet the recommended amount of physical activity required each day for health benefits—and every Canadian, regardless of body size, would benefit from an increase in physical activity and a decrease in sitting time.

Rather than focusing on burning calories, interventions should aim at reducing sedentary activities and increasing physical activities to improve overall health and general well-being.”

@DrSharma
Auckland, NZ

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Monday, November 17, 2014

Obesity Myth: Obesity Is Caused By Simply Eating Too Much And Not Moving Enough

sharma-obesity-caloric-balance1In the latest issue of Canadian Family Physician, my colleagues JP Chaput, Zach Ferraro,Denis Prud’homme and I briefly address common myths about obesity.

Here is what we had to say about the commonly held notion that obesity is just about eating too much and/or not moving enough:

“Unhealthy diet and physical inactivity are the “big 2” on which almost all preventive and therapeutic programs for obesity are focused, thereby neglecting other possible contributors to excess body weight. Although intuitively appealing, clear evidence (eg, individual-level epidemiologic data and randomized experiments) beyond ecological correlations is lacking for the big 2.

Many other putative contributors to the increase in obesity (eg, insufficient sleep, psychological stress, endocrine disruptors, medications, intrauterine and intergenerational effects, etc) have supportive evidence that is as compelling as, if not more compelling than, the evidence for the big 2.

These nontraditional or new determinants of obesity influence energy input and output; overeating and reduced energy expenditure are perceived as “symptoms” and not as the root causes of the excess weight.

On the treatment side, an accumulating body of evidence shows that insufficient sleep can impede weight loss and addressing sleep for weight management has recently been endorsed by the Canadian Obesity Network.

Overall, accumulating evidence suggests that health practitioners and clinicians might need to consider a broader range of influential factors (eg, medications, lack of time, psychological stress, fatigue, chronic pain) to adequately identify and address the key factors responsible for the patient’s obesity, which is likely a clinical sign of chronic caloric “retention” (similar to edema being a clinical sign of fluid “retention”). This will enable health practitioners and clinicians to develop a personalized framework that addresses the root causes of patients’ weight gain.

Physicians must move beyond the simplistic and generally ineffective recommendation to “eat less and move more” by investigating and addressing the determinants of increased energy intake, decreased metabolic rate, and reduced activity.”

@DrSharma
Edmonton, AB

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Friday, November 14, 2014

Video: Principles of Obesity Management

Arya Sharma Kingston Nov 2014Over the past weeks, I have given a rather large number of talks on obesity management to a variety of health professionals. Now, there is a recording of one of my talks (which I gave a few days ago in Kingston, Ontario) on Youtube.

Although the quality of the recording is perhaps not the best and the talk is rather long (about 100 minutes), for those of you, who would like to have a better grasp of how I think about and approach obesity management, here is the link.

Feedback is very much appreciated.

@DrSharma
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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