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Bariatric Research Agenda For Canada



Dr. Yves Bolduc (centre) Quebec Minister for Health and Social Services, Dr. Arya Sharma (left) Scientific Director CON-RCO, Dr. Angelo Tremblay (right) 2011 CON-RCO Distinguished Lecturer Award Recipient at the opening of the 2nd National Obesity Summit, Montreal, QC

Dr. Yves Bolduc (centre) Quebec Minister for Health and Social Services, Dr. Arya Sharma (left) Scientific Director CON-RCO, Dr. Angelo Tremblay (right) 2011 CON-RCO Distinguished Lecturer Award Recipient, at the opening of the 2nd National Obesity Summit, Montreal

Regular readers may recall a previous post on a workshop organised by the Canadian Institutes of Health Research (CIHR) Institute for Nutrition, Metabolism and Diabetes (INMD) and the Canadian Obesity Network held in Montreal last year.

The objectives of this workshop, with experts from across Canada, were to

1. define strengths, gaps, and opportunities in Canadian bariatric care research.

2. develop a Canadian bariatric care research agenda that will ultimately improve
health services available to morbidly obese patients.

3. identify opportunities for international collaboration in the area of bariatric care.

4. engage potential research funders that can support an emerging bariatric care research agenda in Canada.

Yesterday, at the opening of the 2nd National Obesity Summit here in Montreal, CIHR-INMD released the final report from this workshop with the following recommendations for a bariatric research agenda.

The following were the top three research priorities identified in terms of knowledge gaps for bariatric care:

Intervention research: understanding variation in response to treatment intervention, matching treatment to need; phenotyping; complications of care; role of co‐morbidity. Topic areas include research on both children and adults.

Health Services and Health Policy research: understanding optimal systems of care focused on continuity of care and integration of pediatric and adult services (i.e., cradle to grave); medical/surgical/rehabilitation/mental health/self‐care; primary care, including collaborative models and intervention strategies for practitioner and practice change.

Access and barriers to treatment: understanding what brings people to treatment and what are the major barriers; weight bias and discrimination including causal factors, impact, and interventions; evaluation of wait‐list management strategies and decision rules for access to bariatric surgery; understanding factors driving demand; forecasting models based on need and demand analyses and projections.

The following were the top three priorities identified in terms of building Canadian research capacity:

Research consortia/collaborations: includes a shift in emphasis to multi‐site, collaborative studies; database development and other capacity building for longitudinal studies.

Outcome and cost assessment: includes an assessment of metabolic and health outcomes beyond weight reduction, such as effects on blood pressure and glucose levels; longer term outcomes includingeconomic impact assessments of both intervention and systems research.

Qualitative/participatory research: required for an exploration of the patient’s lived experience, empowerment, knowledge base and satisfaction with health services and health service models.

The following were the three themes identified in terms of priorities for knowledge translation:

National strategy and standardization of care: decision‐trees for access to surgery; assessment and outcome measures; waiting list prioritization; guidelines for bariatric care team size and composition; accreditation and evaluation; and remuneration of health care providers for delivery of obesity care.

Environmental scans: assessing “what is out there”, who is doing what beyond surgery; level of collaboration and partnerships; building upon the pediatric scan undertaken in Alberta and the adult scan in Quebec.

Engaging policy makers: improving access to existing data; engaging earlier in the research process, including study design; providing better costing data for the development of relevant business cases, including cost effectiveness of treatment interventions (health costs, productivity).

It is anticipated that CIHR-INMD will now prepare targeted requests for applications to address these identified research and capacity building priorities.

The release of this report certainly demonstrates the intent of CIHR to take the needs of the the bariatric population in Canada very seriously.

Even a quick glance at the research excellence present here at this Summit should certainly reassure CIHR that Canadian researchers are ready and willing to address this important research agenda.

Reader can follow events happening here at Montreal on Twitter #con11

AMS
Montreal, Quebec

5 Comments

  1. Wow. Stunning. No interest in empirical research into the what is triggering the “obesity epidemic.” Just resignation that it’s happening and an assumption favoring treatment. So is it that:

    1. We have figured out the cause of the rise in average weight (though we haven’t articulated it beyond some cultural mythology that people are eating more and moving less in these modern times), and we just gotta let it happen and treat it.

    2. We don’t have it figured out. We’re not interested in figuring it out. That’s not our department. We just want to treat it.

    3. Knowing why people, on average, are getting fatter is irrelevant to how we treat those people. We just want funding to treat them.

    Maybe in another session you guys can just step back from the trees and consider the forest a little?

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  2. “No interest in empirical research into the what is triggering the “obesity epidemic.” Just resignation that it’s happening and an assumption favoring treatment.”

    OK, just to clarify, there is already substantial funding and research underway on etiology and prvention of obesity – everything from genetics to psychology to environmental factors. That is already well underway as one glance at the Summit program would make evident.

    This agenda specifically targets bariatric care (which may or may not involve weigjt loss). Like it or not, there are millions of Canadians living with severe obesity, who need and desperately seek care and accomodation. Notably, patient engagement is a significant part of this agenda.

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  3. Dr, Sharma,
    You say above..

    ” ..there is..funding and research on .. prevention of obesity..”

    I would be very interested in reading more about the research on prevention of obesity, what groups are funded to do that in Canada, what their results are, and what measures are being taken to use those results in medical care and public policy.

    I hope to hear more about this in your future posts.

    Thank you for your interesting website.

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  4. OK, just to clarify, there is already substantial funding and research underway on etiology and prvention of obesity – everything from genetics to psychology to environmental factors. That is already well underway as one glance at the Summit program would make evident.

    This is still the wrong focus. It still assumes that fat people must be made thin by any means necessary. That is the measure of success; that is always the underlying assumption.

    Here’s a new idea for you: for each health problem that is “linked to obesity,” don’t publicize the studies until you know exactly why the link exists and can give advice to fat people on how to mitigate it, without necessarily losing weight. You admit that permanent weight loss is not just a matter of “eat less move more.” Since becoming and staying thin without employing unhealthy means isn’t a reasonable goal for most people, then why not concentrate of how to make fat people healthier rather than on how to make us thin?

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  5. Since becoming and staying thin without employing unhealthy means isn’t a reasonable goal for most people, then why not concentrate of how to make fat people healthier rather than on how to make us thin?

    Sorry, again you misunderstand the agenda: obesity management is not about making people thin – it is entirely about making people healthier and happier. Only yesterday, I sent three patients, who came to the clinic seeking ‘weight loss’, home with the advise to focus more on nutritional hygiene and emotional eating and to stop obsessing about their weight (their median BMI was 47). The latter is easier said than done – this is why dealing with issues like self esteem, body image, relationships, all-or-none thinking, etc. are such an important part of obesity management – whether anyone loses weight or not in the process is frankly irrelevant. The only indicator of success in our program is better health and quality of life.

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