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What A Lottery Winner Registry Can Teach You About Winning A Lottery

Clearly the vast majority of people who buy lottery tickets never win – however some do. In fact, there are tens of thousands of people out there who have defied the odds and have indeed held the winning ticket – there are even people who have had a winning streak and won the lottery several times over. How can we emulate this success? Well, as a first step, we could create a National Lottery Winner Registry, where anyone with a significant lottery win can sign up and answer a bunch of questions regarding their demographics and winning strategy.  From this vast database of real-life lottery winners, we can surely deduct commonalities that should guide us in our own lottery endeavours.  As it turns out, there are indeed important features that all lottery winners share – for one, they all held at least one ticket! Most had played the lottery several times before winning (although there were some lucky exceptions). Many bought more than one ticket. Many (especially those with lower winnings) played lotteries with better odds. A substantial number of winners participated in lottery pools.  On the other hand, there is also a long list of strategies that seem to have worked particularly well for some people. For e.g. some have always played the same numbers, while others have taken pains to chose different numbers every time. Some chose to bet on birthdays whilst others preferred anniversaries. Some bought their tickets early, others waited to the last minute. Some always bought their tickets at the same gas station others chose a random location. Some had more complex game plans and strategies others just trusted their guts or happened to feel lucky that day. Nevertheless from these interesting data derived from proven “winners” we can certainly create a list of sure-fire strategies that should allow us to follow in their footsteps: Buy at least one ticket Buy more tickets if you can Play low-odd stakes Be persistent, if your ticket does not win, buy another one Do whatever works for you. With this important information gleaned from my Lottery Winner Registry I should surely now be in a much better position to win the next lottery. If the above seems rather absurd to you, then you’re not wrong.  On the other hand, some of you may be wishing you had your own Lottery Winner Registry – after all the approach sounds… Read More »

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Rethinking Agency in Obesity: it’s Not a Choice

In over 35 years of medical practice, I have yet to meet a patient who conscioulsy chose to be fat. This is clearly contrary to the popular belief that your weight is under your control and that all it takes is a bit of willpower to be thin. As a consequence of this belief, it is easy to see why failure to control weight gain is widely attributed to a lack of will power or failure to make the right “choices”. To anyone, even remotely following the complex science of energy homeostasis, the notion that anyone can chose to be whatever weight they want to be just by altering their “lifestyle”, must appear increasingly ridiculous. Anyone, who is still not “buying it” should probably read the article by Andrew Grannell and colleagues from the University College Dublin, Ireland, just published in Obesity Reviews.  In this paper, the authors challenge the idea that individuals are free to choose how much they weigh, and that achievement of long-term weight loss maintenance is just a matter of conscious choice. As they note,  “the regulation of hunger, satiety, energy balance, and body weight takes place in subcortical regions of the brain. Thus, hunger and satiety signals are generated in regions of the brain, which are not associated with conscious experience. This points towards biological determinism of weight and challenges ideas of willpower and resultant moralization regarding body weight regulation.” Accordingly, obesity results from a dysregulation of hunger and satiety, which may in turn result from a wide array of biological, psychological, and environmental causes.  This understanding of obesity is not only essential in order to counter the continuing misconceptions regarding personal responsibility (which feed the stigma of obesity) but also to recognise obesity as a chronic disease requiring personalized (often life-long) treatment.  In my own practice I have indeed seen patients display the most amazing feats of will power to try and “conquer” their obesity, only to regain all the weight they lost. Lack of willpower was clearly not their problem! On the other hand, our increasing ability to pharmacologically or surgically address the underlying subconscious biological drivers of weight gain holds significant promise for the future of obesity treatments, as is documented by consistently superior long-term outcomes with anti-obesity medications and surgery than with behavioural interventions alone.   This is not because medications or surgery somehow increase “will power” or change the environment or… Read More »

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Retired – Though Not Quite Done Yet!

The COVID epidemic has no doubt disrupted business as usual in virtually every aspect of our lives. Some have been hit harder than others, some have struggled while others have thrived. Although perhaps not the most serious problem, the epidemic has certainly had a profound effect on clinical and academic life – most of us had to virtually overnight adapt to virtual clinics, teaching, and research.  As every major life event, the epidemic was also a chance to rethink and perhaps redirect professional (and sometime personal) life plans. In my case, this has led me to take the rather drastic step of requesting early-retirement from my tenured university position at the University of Alberta, in order to eventually move closer to my family and aging parents in Berlin (my home town).  As you may imagine, giving up a secure university position in a time of global crisis, was not an easy choice. On the other hand, this is in fact the third time that I have given up a secure tenured position as professor in favour of seeking new pastures. Oddly enough, these decisions have been far less disconcerting to me than to my friends and family, who generally responded with rather profound shock (“you must be nuts”!). However, this time around things may be a bit different. After spending virtually all my professional life in the ivory tower of academia, deciding now to try my hand at freelancing as a consultant, strategic advisor, and all-round visionary, is going to be an interesting ride.  No doubt I am counting on my considerable experience, well-established reputation (notoriety?), and, perhaps, a few notable contributions to the field of obesity to help me manoeuvre this next stage of my professional life.  Some of you may recall that the my ruminations on the issue of weight bias, the inadequacy of BMI, the etiological framework for obesity, the importance of mental health, the need for accommodation, the Edmonton Obesity Staging System, the 4Ms of obesity assessment, the 5As of obesity management – all of these ideas originated from my postings on these very pages. You may also recall that I have long championed changing the very definition of obesity to one that aligns itself with the clinical definition of a chronic disease rather than just a matter of size. Some of you are probably also aware that the tiny organisation I founded with a few… Read More »

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Don’t Miss Out: Joint Offer For European and Canadian Obesity Conferences

In just a few weeks, the European Association for the Study of Obesity (EASO) and Obesity Canada (OC) will be hosting their 2021 annual conferences on-line. Both conferences will run on the same days (10-13 May) and both organisations are delighted to offer a heavily-discounted joint registration for both meetings. For just an extra CAN$ 120 (€ 50), EASO and OC members can register for both conferences, which, thanks to the different time zones, will comfortably run with minimal overlap – thus, when the European Conference closes for the evening, delegates can join the live sessions in Canada (starting at 17:00 CET) for a few more hours of cutting-edge presentations on obesity research and practice.  Of course, registrants to both conferences will have full access to all live and on-demand content for several weeks following the conferences.  Students can attend both conference for just an extra CAN$ 40 (€ 25) – definitely a steal!  Registering for both conferences gives you access to hundreds of presentations with countless hours of CME credits – more than anyone could wish for. For Europeans wondering why they would bother with a Canadian conference – here just a humble reminder that some of the most forward-thinking research in obesity and some of the most advanced concepts on obesity management are currently being developed in Canada (the recent Canadian Obesity Practice Guidelines are just one example).  For Canadians wondering why they would bother with a European conference – here a reminder that EASO represents the leading voices in obesity research, management and policy from 36 European countries – nothing anyone working in obesity would wish to or could afford to miss.  To take advantage of the discounted joint registration for both conferences, head over to Obesity Canada or ECO now! @DrSharmaBerlin, D

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Setting up an Obesity Centre: Standards and Procedures

No matter how large or how specialised your centre, it will serve you well to establish clear standards and procedures. Topics that need to be defined and agreed upon would include not only what patients get accepted into the clinic but also treatment pathways, standards of care, sequencing of care, measuring outcomes, and ensuring on-going quality improvement.  The particulars of these topics will of course vary according to the nature, scope, and funding of the clinic, but certain aspects will be common to any kind of centre. Thus, ideally, any respectable obesity centre would likely need to adhere to the accepted obesity treatment guidelines in that country. Where there are no clear standards set up by a national professional organization, you may have to look to other countries for guidance. Obviously, some of the guidance found in such guidelines may not translate directly to the situation in your own country or region (e.g. access to medications, surgery, psychological interventions, etc.), but adhering to them as closely as possible is probably a good idea. In any case, disregarding evidence-based standards would require clear acknowledgement and justification. Most obesity guidelines provide at least an outline of an assessment and treatment pathway or algorithm. Virtually all recommend a multi-disciplinary multi-modal approach that covers the five elements of obesity management: nutrition, physical activity, psychological intervention, medications, and surgery. Although most guidelines recommend a hierarchical approach to using these interventions (if one “fails”, move to the next), this may not be the most efficient or even most cost-effective approach.  Thus, for example, spending a lot of time and effort on trying to help someone with Class III EOSS Stage 2 obesity to try to “conquer” their obesity with diet and exercise alone, when overwhelming evidence points to the general futility of such an approach (anecdotal exceptions are just that, anecdotal exceptions!), can eat up a lot of staff time (never mind the patient’s efforts), and lead absolutely nowhere. In fact, it can make things a lot worse, as in the long run this will only lead to demotivation and learned helplessness (never mind any detrimental effects on metabolism).  In practice it may be better to think of these five approaches as complementary rather than as distinct therapeutic pathways. Patients start at different stages of motivation, knowledge, past experience, expectations, and socioeconomic circumstances. Furthermore, patients present with varying levels of complications and impairments, necessitating varying intensity… Read More »

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