Asthma and Airway Symptoms Improve After Bariatric Surgery
Although asthma is generally overdiagnosed in overweight and obese individuals, when present, excess weight tends to markedly exacerbate the symptoms of dyspnea and respiratory distress. It is therefore of interest to note that a study by Louis Philippe Boule and colleagues from the University of Laval, QC, published in the latest issue of Respiratory Medicine, reports marked improvement in respiratory symptoms following bariatric surgery. This prospective study carefully evaluated 12 asthmatic patients with severe obesity before, 6 and 12 months after bariatric surgery to respiratory parameters in 11 severely obese patients with asthma, who served as control. BMI decreased from 51.2 to 34.4 at 12 months, in the intervention group, and this fall in weight was associated with a marked improvement in PC(20) methacholine, FEV(1), FVC, FRC, FRC/TLC and ERV all improved (apologies to my lay readers – these are all standard measures in lung-function tests). Asthma symptoms total scores were also significantly reduced with 10 patients being able to stop all asthma drugs. No significant changes of these parameters from baseline were observed in asthmatic controls. Thus, these findings show a consistent and dramatic impact of weight loss with bariatric surgery on airway responsiveness, lung volumes, and asthma severity. Together with the well-known improvements in obstructive sleep apnea, this study certainly adds to the significant respiratory benefits of bariatric surgery for patients with severe obesity. AMS Freeman’s Village, Antigua Boulet LP, Turcotte H, Martin J, & Poirier P (2012). Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Respiratory medicine PMID: 22326605 ..
Personalizing Exercise Protocols Based on Genetics?
Earlier this week, I reviewed ‘The Cure For Everything‘ by Timothy Caulfied, who presented a rather devastating (some would say sobering) view of ‘personalized’ medicine based on genetic analyses. His take essentially is that little (if any) of the promise of genetics for complex conditions has panned out and little (if anything) is likely to pan out in the foreseeable future. This is not because genes (or rather their expression and function) do not influence virtually all of human structural, metabolic, and perhaps even our behavioural characteristics. In fact it is the very fact that there are countless genes that impart these effects and generally do so in complex harmony (or disharmony) with countless environmental factors, which makes ‘predictive’ medicine at the personal level so iffy. An example is a recent paper by Roth and colleagues published in Medicine and Science in Sports and Exercise that reviews the latest findings in genetics related to exercise, fitness and performance. The paper focusses on the highest impact papers such as one that described physical activity levels as being significantly lower in patients with mitochondrial DNA mutations compared to controls (not really a surprise given that exercise is no fun without high-performing mitochondria). Other studies found strong associations between sequence variation in the activin A receptor, type-1B (ACVR1B) gene and knee extensor strength, with rs2854464 emerging as a possible ‘marker’ of higher muscular strength. Genetic data has also been associated with aerobic exercise training-induced improvements in maximal oxygen consumption, but no genetic variants derived from candidate transcripts were associated with trainability. Finally, much of this paper looks at the fat mass and obesity-associated (FTO) gene, which has been associated with a modestly increased risk for obesity especially in sedentary individuals. Based on these findings (and a few others), the authors rather enthusiastically conclude: “…that a strong exercise genomics corpus of evidence would not only translate into powerful genomic predictors but would also have a major impact on exercise biology and exercise behavior research.” This is where the authors lost me (and would likely have lost Caulfield). Undeniable, genetic studies represent an amazing feat of science and teach us much about human biology. But the idea that a genetic ‘test’ will somehow reliably predict ‘performance’, ‘fitness’, ‘training response’, or any other features, may at best be of interest to extreme athletes (e.g. not having the right genes may make the quest for Olympic Gold… Read More »
What Does Adult Obesity Teach Us About Childhood Obesity?
Yesterday, I had the pleasure of giving presenting pediatric Grand Rounds at the University of Miami Miller School of Medicine. In my presentation, I sought to seek similarities between adult and childhood obesity. As in adults, simply looking at ‘what’ people are doing (diet and activity behaviours) without trying to understand the ‘whys’, will always lead to simplistic solutions (eat-less-move-more). These approaches do not work in adults – there is no reason why they should be any more effective in kids. Similarly, in adult obesity we now know that anthropometric measures (BMI, waist circumference, etc.) are rather poor predictors of actual health (or risk). In adults, we now have the Edmonton Obesity Staging System, as far as I am concerned, the new ‘gold standard’ for obesity assessment till someone comes up with a better system. Interestingly enough, my paediatric colleagues in Canada are working on defining a very similar approach to paediatric obesity, which I am sure will likely be as much welcomed by clinicians as EOSS was for adults. Finally, with regard to treatment approaches, I remain much more optimistic about finding a ‘cure’ for childhood obesity, as within reasonable limits, a child does stand a real chance of ‘growing out of’ their excess weight. On the other hand, severely obese children, who may already weight more than would be considered normal for an adult, may find themselves in a lifelong battle as their biology now ‘defends’ their excess weight. Judging by the subsequent discussion, I believe that my talk did strike some notes that very much appeared to resonate with my audience. As I have said before, I do not for a minute believe that the childhood obesity problem can be dealt with in isolation, i.e. without also dealing with adult obesity. While I fully appreciate the differences and challenges in managing obesity in kids, I do think that fundamental issues regarding environmental determinants as well as the underlying psychology and biology are probably more similar than many of us may think. AMS Freeman’s Village, Antigua
Ergonomic Office Furniture for Obese Employees
Regular readers may recall previous posts on how the increasing prevalence of obesity in the population requires design consideration from seat car belts to hospital equipment. It is therefore no surprise that someone has now considered the need for redesigning office furniture to accommodate those with excess weight. In a paper by Claire Gordon and Bruce Bradtmiller, published in the latest issue of WORK, the authors examine the potential impact of the increasing rates of obesity on office furniture design. As the authors note, despite a 5-fold increase in the prevalence of obesity (and an even higher fold increase in severe obesity), little work has been done on ergonomic design of office (or other) furniture. Based on data available from military personnel from1987-1988 and 2006-2007, the authors note that: “Examining those two data sets in particular, mean values increased for anumber of important ergonomic dimensions in ap-proximately 20 years. For example, malebiacromial (shoulder) breadth increased 12.7 mm; male bideltoid (upper arm) breadth increased 8.1 mm,while male torso circumferences – all important in personal protective equipment – increased 40 mm or more” “For many of the stature-related dimensions, the change was inconsequential for design. But for manyof the weight related dimensions, the changes weresubstantial. For example, male Forearm-Forearm Breadth increased by 33.9 mm (49.0 mm for females)and male Hip Breadth Sitting increased by 20.0 mm(39.9 mm for females).” Although the paper does focus on issues perhaps more relevant for military personal, the implications are probably the same for regular office workers. Given that the obesity epidemic is not going anywhere anytime soon and we will continue seeing an increasingly obese workforce, office furniture designers (and those who buy it) may wish to take note. AMS Miami, FL Gordon CC, & Bradtmiller B (2012). Anthropometric change: implications for office ergonomics. Work (Reading, Mass.), 41, 4606-11 PMID: 22317429 ..
The Cure For Everything – Or Not?
This weekend I read “The Cure For Everything“, a book by Timothy Caulfield, professor in the Faculty of Law and the School of Public Health at the University of Alberta and research director of the Health Law and Science Policy Group. (He is also a rather cool dude and someone who is quite a bit of fun to hang out with.) In this book, which can perhaps best be described as a romp through the science and business of health, Caulfield describes his interactions with a range of experts and coaches in his pursuit of toned muscles , losing fat, and generally trying to get healthier. On the way, he debunks some of the many myths around fitness, weight loss, and personalized medicine and takes a hefty stab at so-called ‘complementary’ medicine, while not shying away from also pointing to some of the problems with the pharma establishment. Without wanting to give away too much about, what I found to be a most light-hearted and easy read, I do wish to give a few pointers to prospective readers. While Caulfield, as a lifelong athlete, appears rather ‘obsessed’ with his body composition, it is not exactly clear to me why he would attempt to reduce his perfectly lower-end-of normal 18% body fat down to what I would consider a most unhealthy and rather concern-evoking 10%. It appears that Caulfield, like so many, tends to equate body fat with health, something regular readers of these pages are probably well aware is rather nonsensical and counterproductive. Rather than show some respect for what is a most useful and highly evolved tissue, Caulfield’s disdain for his poor old body fat certainly does not hark of a healthy body image or health ideal. I do know that athletes tend to easily buy into the culture of ‘fatlessness’ – but nowhere does Caulfield pause to reflect on why fat would be such an unhealthy tissue to have – a tissue only there to be searched out and destroyed. Of course, I get that much of what Caulfield pursues is simply in the spirit of a ‘self-experiment’ – an experiment where he provides some most interesting and revealing insights into the cult-like fitness conglomerate – one that generally tends to get off far lighter than the evil food industry, although some might argue that it is as ruthless, cynical and single-minded when it comes to wealth generation… Read More »
Weekend Roundup, February 10, 2012
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Why Banning Sugar Will Not Solve Obesity Interdisciplinary Bariatric Care Childhood Obesity: Role of Parents and Parenting Why Are There No Obese Men in Canada And Why Does Nobody Care? Do Heart Hormones Regulate Brown Fat? 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
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