Establishing Common Ground in Obesity Prevention and Management
Obesity is complex. Few health professionals are specifically trained in obesity management – few health systems have invested in managing it. As regular readers will recall, Alberta Health Services recently launched a province-wide obesity initiative ranging from population health and community projects, across primary care, to establishing speciality centres for complex medical and surgical management of kids and adults with severe obesity. Currently, around 100 health professionals and administrators from across the province, working on getting this initiative off the ground are meeting in Edmonton to discuss details of the plan. Many have already worked in obesity and chronic disease management and bring their own views and experience to the table. This is immensely important as sharing of best practices is one of the key mechanisms to ensure that we do more of what works and less of what doesn’t. It is also essential that we establish common ground on the basic principles and practice of addressing this health problem – the sooner we are all on the same page, the sooner we can begin working towards consistency in obesity prevention and care across the province. This will not happen overnight – there will be learnings, there will be things that work well and things that don’t. But I am fully confident that in the end we will be moving in the right direction towards reducing the emotional, physical, and economic burden of obesity on all Albertans. We may not be able to cure obesity, but we can certainly do a much better job at preventing and treating it. AMS Edmonton, Alberta
How The Hedonic System Ratchets Up Your Weight
Earlier this week, Bill Colmers and I gave the inaugural Centennial Lecture for our Faculty of Medicine and Dentistry in anticipation of the upcoming 100 year anniversary of the University of Alberta medical school. In this talk, we discussed why it is so difficult to keep weight off. I presented the clinical problem, and Colmers, the neuroscientist, presented an overview of how the brain affects eating behaviour and regulates body weight. I was particularly impressed by how Colmers described the respective roles of the hedonic and homeostatic systems in human evolution. While the hedonic (pleasure seeking) system evolved to help our hunter-gatherer ancestors seek out and take advantage of any highly palatable energy dense foods they happened to come upon, the homeostatic system evolved to protect from wasting away those extra calories that they did ingest. Thus, according to Colmers, the hedonic system’s job was to make it hard to resist, in fact, make our ancestors to often go to considerable lengths to searching out those rare palatable energy dense foods and then to eat as much of them as possible, whether they were actually hungry or not. They could of course always store those extra calories as fat tissue for later use – a tremendous survival advantage. In contrast, the job of the homeostatic system was to ‘defend’ those stored calories – in fact, it is designed to regard any accumulation of fat stores as the ‘new normal’ and from then on make sure that this increased level of fatness was maintained (or regained) ever after. Indeed, the homeostatic system is ‘designed’ to readjust its set point of body weight – after all it has to do this starting from birth as body weight continues to increase as the baby grows into a toddler that grows into a kid and ultimately into an adult. Unfortunately, the mechanisms that allow the set point to reset to ‘defend’ a progressively higher body weight – generally works in only one direction – after all that is all that is required by nature, where people do not naturally ‘shrink’. Colmers used the analogy of a ratchet to describe how the homeostatic system is designed to defend ever increasing body weights without having the ability to reset itself to a lower body weight even if the person now wants to lose weight. Once set to a higher weight (e.g. resulting from ‘overindulgence’ driven by… Read More »
Is There a Role For Recreational Therapists in Obesity Management?
At a recent talk, I happened to meet a recreational therapist, who expressed an interest in perhaps getting involved in obesity management. I must admit that I had not seriously considered the potential contribution that recreational therapists may bring to the field of bariatric care. For readers, who are not be familiar with this profession, it may be important to point out that the field of therapeutic recreation recognizes leisure, recreation and play as an integral component of quality of life. Recreational therapists specialize in helping individuals, who have physical, mental, social, or emotional limitations which impact their ability to engage in meaningful leisure experiences. This is something that would certainly be of relevance to many patients that I see in our bariatric program – many express loss of interest and ability to engage in leisure activity due to the very real barriers posed by their excess weight. It turns out that recreational therapists are the professional experts in helping clients to rediscover and maximise independence in leisure, optimal health and quality of life. Recreational therapy has been shown to reduce depression, stress, anxiety, as well as recover or maintain motor functioning, reasoning abilities and build confidence that allows clients to enjoy greater independence and quality of life. Although, many readers may think that this is a new profession, recreational therapists have been around for a while. For e.g. the Alberta Therapeutic Recreation Association was founded in 1985, i.e. over 25 years ago and has over 400 members. Established benefits of therapeutic recreation include maintenance of physical and pscyhosocial health, cognitive functioning, personal and life satisfaction, and prevention of complications of physical disabilities and improved self-care and adherence to treatment plans. These services would most certainly be relevant to many of the severely obese patients that we see in our clinic, who have experienced social isolation due to their excess weight and have certainly lost much of their social network and interactions. I am not aware of ‘bariatric’ recreational therapists, who have specialized in managing clients with severe obesity or ‘recovering’ from severe obesity following bariatric surgery. If my reader have, I’d certainly be most interested in hearing about their experiences with recreation therapists and whether or not they found these services helpful. I most certainly would love to hear from recreational therapists working in this field or who happen to have ideas on what they would bring to obesity… Read More »
Help Teach a Computer to Recognise Obesity Websites
There are countless websites out there offering all forms of advice, programs, and services for obesity. Some are run by licensed health professionals, some by governments, some by non-profit organizations, some by self-appointed experts, some by commercial chains, some by scam artists – all of them promise help with managing your weight. The services range from cosmetic spas, personal coaches, and self-help groups, to registered dieticians, clinical psychologists, and surgeons. Some specialize in exercise, others in diets, some sell dietary supplements, others deliver lean cuisine to your doorstep or offer to surgically implant a gastric band around your stomach. There are literally 1000s of webpages out there – no one has the time to check them all. Imagine a computer that would help categorize these many sites into commercial and non-commercial, into those offering services by licensed health professionals and those by self-appointed ‘experts’ out to hawk their latest fad diet, into those focusing on psychological interventions vs. those focussing on exercise. For a human visitor, it actually does not take long to see what a website is about – often one glance is enough to determine where the focus is (e.g. diet, exercise, psychology, dietary supplement, surgery, etc.). A human visitor can often also easily tell if this is a government or non-profit site or a commercial weight-loss program. These tasks, while easy for humans are actually quite difficult for computers. But, thankfully, computers can be taught and they will learn from ‘experience’. But teaching a computer requires humans to first tell the computer the right answer. Over time the computer can actually learn to do this by itself – this works for chess, poker, Jeopardy, recognizing faces, and countless other complex processes – so why not for recognizing and categorizing ‘weight-loss’ websites. The Alberta Centre for Ingenuity and Machine Learning is currently attempting to do just that and this is where you can help. This link takes you to a random set of about 200 websites that would come up in an internet search on weight-loss. It is now your turn to try and label them into the following categories: 1. Primary type of service that is offered (e.g. alternative medicine, diet, exercise, medical, psychological, etc.) 2. Who offers this service (e.g. public, private, non-profit, commercial, etc.) 3. For whom (e.g. men, women, children, adolescents, etc.) All you have to do is click on the link – spend… Read More »
Weekend Roundup, January 13, 2012
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Obesity Network Now Canada’s Global Voice in Obesity Obesity in Canada: Challenges and Opportunities When Will We Bridge The Pharmaceutical Treatment Gap in Obesity? Childhood Predictors of Adult Obesity When Obesity Is a Sign Of Good Health Have a great Sunday! (or what is left of it) AMS Edmonton, Alberta You can now also follow me and post your comments on Facebook
Hindsight: Adipose Tissue Renin-Angiontensin System
Continuing in my series of Saturday posts on some of my previous work on obesity, here is a paper that I am particularly fond of, as it started me off on a whole new line of research, namely studying the potential link between obesity and the key system involved in sodium homeostasis. Prior to this paper, published in the Journal of Hypertension in 1999, I had already done extensive work on the relationship between salt intake and blood pressure and was quite interested in answering the question why obesity promotes sodium retention, volume expansion, and an increase in blood pressure. Leptin had been discovered a few years ago and we were beginning to consider fat cells as endocrine cells – although many of the ‘adipokines’ now known to be produced by fat cells had yet to be discovered. Interestingly, I happened to come across a paper suggesting that, in rats, adipose tissue may make angiotensinogen, the substrate for renin, which generates angiotensin 1, which in turn, is converted by angiotensin converting enzyme (ACE) to angiotensin 2. This is one of the most powerful pressor hormones and has a wide range of effects mediated through angiotensin type 1 and type 2 receptors. Medications like ACE and angiotensin receptor blockers (ARBs) are now amongst the most widely used blood pressure lowering medications. Thus, I wondered whether human adipose tissue likewise produces angiotensinogen and perhaps other components of this system. So I approached a surgical colleague (Norbert Runkel) and requested his help in obtaining some human fat tissue, which my student Stefan Engeli then used to demonstrate, that human adipocytes do in fact express all components of the renin angiotensin system. We not only demonstrated the ample expression of angiotensinogen, renin, renin-binding protein, angiotensin converting enzyme, chymase and type 1 and type 2 angiotensin receptors in RNA extracted from whole adipose tissue (subcutaneous and omental) but also in isolated cultured human adipocytes (mammary). Not only did these findings clearly demonstrate (for the first time) the presence of a local renin-angiotensin system in human adipose tissue, but also prompted us to speculate that this local renin-angiotensin system may well be involved in obesity-related disorders, including hypertension and the metabolic syndrome. Since then, we and others have done more work on this system – more on that in future posts. According to Google Scholar, this paper has been cited 145 times. AMS Bridgetown, Barbados Engeli… Read More »
Watch Dr. Sharma in the News!
Listen to Dr. Sharma!
