Core Principles of Obesity Management
Today sees the launch of the Canadian Obesity Network’s 5As of Obesity Management™, a step-by-step framework for the management of obesity in primary care. The framework is based on five core principles (different from the 5As) that emerged from extensive consultation with patients, primary care providers and obesity experts – a process that involved numerous interviews, focus groups and surveys, spanning the past two years. In addition, the principles and messages were crafted and tested with primary care providers at conferences and workshops across Canada. The following is a summary of the core principles, that emerged from these efforts and together provide a significant departure from traditional (‘all excess weight is bad’ and ‘eat-less-move-more’) approaches to weight management: Obesity is a Chronic Condition: Obesity is a chronic and often progressive condition not unlike diabetes or hypertension. Successful obesity management requires realistic and sustainable treatment strategies. Short-term “quick-fix” solutions focusing on maximizing weight loss are generally unsustainable and therefore associated with high rates of weight regain. Obesity Management is About Improving Health and Well-being, and not Simply Reducing Numbers on the Scale: The success of obesity management should be measured in improvements in health and well-being rather than in the amount of weight lost. For many patients, even modest reductions in body weight can lead to significant improvements in health and well-being. Early Intervention Means Addressing Root Causes and Removing Roadblocks: Successful obesity management requires identifying and addressing both the ‘root causes’ of weight gain as well as the barriers to weight management. Weight gain may result from a reduction in metabolic rate, overeating, or reduced physical activity secondary to biological, psychological or socioeconomic factors. Many of these factors also pose significant barriers to weight management. Success is Different for Every Individual: Patients vary considerably in their readiness and capacity for weight management. ‘Success’ can be defined as better quality-of-life, greater self-esteem, higher energy levels, improved overall health, prevention of further weight gain, modest (5%) weight loss, or maintenance of the patient’s ‘best’ weight. A Patient’s ‘Best’ Weight May Never be an ‘Ideal’ Weight: An ‘ideal’ weight or BMI is not a realistic goal for many patients with obesity, and setting unachievable targets simply sets up patients for failure. Instead, help patients set weight targets based on the ‘best’ weight they can sustain while still enjoying their life and reaping the beneits of improved health. Based on these core principles, the 5As of… Read More »
Register Now: Workshop on Obesity and Mental Health, Toronto, June 26-28
Regular readers will be well aware of the important relationship between obesity and mental health. Not only can excess weight affect self-esteem, body image, eating behaviours and even promote depression and anxiety, the opposite is also true – virtually all mental health problems ranging from depression and attention deficit disorder to PTSD and addictions can promote weight gain or pose important barriers to weight management. Health practitioners, researchers and policy makers wanting to learn more about Obesity and Mental Health can join the Canadian Obesity Network, the International Association for the Study of Obesity and the Centre for Addiction and Mental Health at the upcoming Hot Topic Conference: Obesity & Mental Health, June 26-28, 2012, in Toronto. More than 20 Canadian and internationally renowned experts from a variety of disciplines will provide participants with a sound understanding of the scientific and methodological issues in obesity and mental illness research and practice. LEARNING OBJECTIVES Build your knowledge and understanding in the areas of: · Clinical assessment and management of patients with obesity and mental illness. · Current evidence and best practices in psychological and behavioural interventions. · Emerging pharmacological treatments for obesity and mental illness. · The neuropsychobiology of ingestive behaviour and mental health disorders. · Interdisciplinary obesity research and practice. · Bias and stigma associated with obesity and mental illness. · Research priorities in the emerging field of obesity and mental illness. To view the preliminary program and to register click here. Space is Limited – Register Today! Look forward to seeing you in Toronto next month! AMS Edmonton, Alberta
Weekend Roundup, May 18, 2012
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Should Doctors Stop Telling Patients to Lose Weight? The Downside of Weight Loss? Do Low-Calorie Sweetners Affect Body Weight? FDA AdCom Strongly Supports Abandoning Excess Weight Loss Gastric Bypass Reduces Bioavailability of Azithromycin Have a great Sunday! (or what is left of it) AMS Edmonton, Alberta
Hindsight: Angiotensin Blockade Prevents Type 2 Diabetes By Formation of Fat Cells?
Readers may recall last week’s Hindsight post on our paper in which we described our finding that angiotensin II inhibits the adipogenic differentiation of fat cells, and conversely, blocking the AT 1 receptor resulted in an accelerated differentiation of adipocyte precursor cells. While many would think that growing more fat cells may be a bad thing, it is important to remember that in a state of positive energy balance, the best place to store those extra calories is indeed in your fat tissue. Not being able to expand your fat tissue to accommodate excess calories may lead to the deposition of the extra fat in other tissues, which in turn, may prompt many of the metabolic problems associated with excess weight. This, at least, was the main tenor of a ‘hypothesis’ paper, we published in HYPERTENSION in 2002, in which we proposed the notion that blockade of the renin-angiotensin system may prevent the development of diabetes by promoting the recruitment and differentiation of adipocytes. This was based on our reasoning that the increased formation of adipocytes would counteract the ectopic deposition of lipids in other tissues (muscle, liver, pancreas), thereby improving insulin sensitivity and preventing the development of type 2 diabetes. Interestingly enough, this mechanism of diabetes prevention and treatment was harnessed by the use of thiazolidinediones also known as glitazones, a class of medications used in the treatment of type 2 diabetes. According to Google Scholar, this paper has been cited 257 times. AMS Edmonton, Alberta
Do Low-Calorie Sweetners Affect Body Weight?
One of the ongoing debates, when it comes to the role of calories in weight management, is whether or not low-calorie sweeteners (LCS) are part of the problem or part of the solution. This is certainly one of those topics that attracts vehement and passionate views and arguments on both side – arguments, for which, it turns out, there is little more than ‘circumstantial’ evidence (on both sides). Readers interested in this issue are directed to a rather entertaining and thought-provoking review by the University of Toronto’s Harvey Anderson, co-authored by my good friend and colleague David Allison from the University of Birmingham, Alabama, published in the Journal of Nutrition. The article appears in a supplement reporting the proceedings of a conference on Low-Calorie Sweeteners, Appetite and Weight Control: What the Science Tells Us, held in Washington, DC, April 7–8, 2011. The conference was sponsored by the Committee on Low-calorie Sweeteners of the International Life Sciences Institute North America. The short answer to the question at hand, in the words of the authors, following their review of the scientific evidence, is simply: “We conclude that there is no evidence that LCS can be claimed to be a cause of higher body weights in adults. Similarly, evidence supporting a role for LCS in weight management is lacking. Due to the confounders in most observational studies, randomized controlled trials are needed to advance understanding.” Because much of the speculations about whether or not LCS is part of the problem (or the solution) is based on observational studies (rather than well-designed definitive randomised-controlled trials), the authors provide a rather succinct and insightful primer into what we can (or cannot) learn from this type of studies. Here is a brief summary of their arguments: “Observational studies only tell us about the associations among variables. Relative to true experiments, observational studies offer only weak information and they may suggest the plausibility of causation but cannot demonstrate causation.” “…the fundamental limitation is the possibility of confounding. …. Confounding cannot be unequivocally eliminated, because we can only control for those variables that we think to measure, can measure well, and know how to statistically model appropriately. Unfortunately, knowledge is limited (if it were not, research would not be needed) and measurement capabilities for many potentially confounding factors such as diet, physical activity patterns, drug intake, acculturation, and social status are often quite limited. Therefore, there is no certainty that… Read More »
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