Should All Personal Trainers be Allowed to Treat Obesity?
In today’s edition of CMAJ there is a statement worth noting regarding the qualifications that exercise professionals should have before being allowed to work with obese individuals. The basic point of this statement (co-signed by a number of prominent Canadian Kinesiologists and Exercise Physiologists) is that because many overweight and obese individuals are at an increased risk of various co-morbidities, including cardiovascular disease, it is imperative that exercise professionals involved in treating such individuals have a clear knowledge of the absolute and relative contraindications to exercise for patients with obesity. The authors strongly believe that such knowledge can only be developed through formal and rigorous post-secondary academic training within a faculty of exercise science, which is in clear contrast to some personal training designations provided by “for-profit” organizations that do not require advanced college or university education in health or exercise science. In their statement, the authors go on to describe what they feel is an acceptable standard of qualification and certification that will best ensure patient safety. The points are certainly well taken and I fully agree that dealing with obese patients in particular requires sound medical knowledge and expertise in exercise physiology. Not only are obese patients at increased cardiovascular risk, but they are also at extreme risk for mechanical injury due to lack of flexibility, balance and coordination, particularly during weight-bearing exercises. Existing back, hip and knee problems can easily be exacerbated by a misguided “boot-camp-drill-sergeant” approach to “let’s-burn-off-those-calories”. Immobility resulting from musculoskeletal injury caused by improper and overzealous exercise routines can only exacerbate obesity and cardiovascular risk factors and will certainly pose a direct threat to effective weight management. The much bigger question here is not just about personal trainers or self-appointed exercise gurus but rather about the entire for-profit “weight-loss industry”. While there is certainly an important and often invaluable role for lay-persons in peer-support groups, buddy systems and walking clubs, the fact that patients often have no way of recognizing qualified from unqualified health professionals can indeed pose a health hazard, particularly for obese individuals who will clutch at any straw for help. The key question indeed is that if obesity is really a disease, should someone who is not a certified and regulated health professional be allowed to offer treatment? Can we forbid self-appointed “health advocates” to offer their services? Probably not. Would we recommend that our patients seek help or advise from… Read More »
Maternal Obesity and Neonatal Risk
Many of you are probably aware of the increasing discussion on the role of maternal obesity and excessive pregnancy-related weight gain as a key risk factor for childhood obesity. In fact, some folks now seriously believe that this is the real reason why the pediatric obesity epidemic appears to be spiraling out of control. Both animal studies and human observational data strongly support the notion that intrauterine epigenetic modification together with early post-natal influences on brain development may play an important role. A joint researcher team from the UofA and the UofC currently has a team grant in on exactly this issue. Now a recent study from Denmark delivers another important reason for addressing maternal obesity. Nohr and colleagues, examined the relationship between prepregnancy BMI and neonatal mortality in 85,375 liveborn singletons of mothers in the Danish National Birth Cohort (1996-2002). Information about pregnancy outcomes and neonatal deaths (n=230) was obtained from national registers. Compared with infants of mothers who were at a normal weight before pregnancy, neonatal mortality was increased in infants of mothers who were overweight or obese (adjusted hazard ratios 1.7 and 1.6, respectively). This observation of increased infant risk with maternal obesity is very much in line with previous reports, for e.g. a study by Heddersen and colleagues, who analysed a cohort of 45,245 women who delivered singletons at Kaiser Permanente Medical Care Program Northern California in 1996–1998 in which women who gained more than recommended by the IOM were three times more likely to have an infant with macrosomia than women whose weight gain was in the recommended range. This is relevant to us, because currently about 10% or mothers in our health region are obese. Should WW be working with the maternal and neonatal program on this? I reckon this is well worth looking at. Indeed, if there is any merit to these recent findings then aggressively targeting maternal obesity may help break the trans-generational obesity cycle and prevent obesity in the next generation. AMS
Does Weight Matter?
Some of you may have seen the news items in yesterday’s media – a new study by Flegal et al. from the CDC, published in the Nov 7 Issue of JAMA, finds that overweight individuals (BMI 25 to
Flying Blind?
I’ve posted before on the fact that Calories are the currency of weight management – if you don’t know how many Calories are coming in and how many are going out, how can you actively manage your Calorie account (read: weight!)? As most of us eat many of our meals outside the home, getting restaurants to post calories (not simply on some obscure website or on some pamphlets that you have to ask for) is a major topic of discussion amongst obesity experts. I was therefore particularly pleased that the CBC yesterday chose to devote its edition of Marketplace to the fact that restaurants make it hard (if not impossible) for consumers to actually find out exactly what they are ordering from the menu. For those of you, who missed it I suggest watching it online! Those of you working on the “Finding Balance” module – take note – may find some interesting ideas here. AMS p.s. Dr. Yoni Freedhoff, author of “Weighty Matters” is featured on this show
Barriers to Bariatrics?
So today we discussed how to best rename the combined Adult Weight Management Clinic at the Alex, which would provide all aspects of tertiary obesity care (behavioural, medical & surgical). An obvious suggestion was Weight Wise Adult Bariatric Clinic (WW-ABC). The question was, would people then assume that this is a purely surgical clinic as the term “bariatric” is generally associated with surgery? Well, the fact of the matter is that the term “bariatric” is actually simply the proper medical terminology for the branch of medicine that deals with the causes, prevention, and treatment of obesity. It stems from the Greek root baro (“weight,” as in barometer) and suffix -iatrics (“a branch of medicine,” as in pediatrics or geriatrics). The term “bariatrics” is increasingly used to describe all aspects of obesity care including: bariatric nursing bariatric psychiatry bariatric pharmacology bariatric psychology bariatric furniture bariatric rehabilitation bariatric skin care bariatric research etc. So if “bariatrics” is the official term for obesity care, then this should be an obvious choice as a name for the clinic (after all, that’s what we do). Will people understand what this means? I guess we’ll have to teach them. Appreciate all comments and takes on this! AMS
Watch Dr. Sharma in the News!
Listen to Dr. Sharma!
