Search Results for "why I support"

Guest Post: Why Gynecologists Should Learn About Obesity Medicine

Today’s guest post comes from Emilia Huvinen, MD, PhD, Gynecologist, Helsinki, Finland My first step into the world of obesity research and care began with my PhD studies on gestational diabetes.  For a young gynecologist, it was all new in the beginning but soon I found myself immersed in the world of behavioural medicine, adiposity and glucose metabolism. As years went by, and I learned more and more about different aspects of healthy behaviours and the complex biology of weight regulation, I finally got involved in actually treating women with obesity for their obesity. As a gynecologist, it is not difficult to see how obesity can play a crucial role in several periods of a woman’s life; starting from having early puberty and continuing to heavy menstrual bleeding, infertility, pregnancy complications, and stronger menopausal symptoms. Treating obesity can also be beneficial when treating women with polycystic ovaries syndrome (PCOS), infertility and endometrial hyperplasia, a pre-stage of uterine cancer. As obesity is associated with several pregnancy complications, helping our patients better manage their weight preconceptionally can improve pregnancy outcomes and hopefully even influence the health of the next generation. As a gynecologist, being the trusted long-term doctor for women, we have the privilege of being really close to our patients’ lives. We are also very used to discussing intimate and even very delicate issues in our everyday practice. However, it is apparently still a million-dollar-question how to get more gynecologists involved in obesity care.  Unfortunately, the general advice currently given to women living with obesity is still to just “eat less and exercise more”. Many of us are still unaware that obesity is a chronic disease, and that people need care and treatment, not guilt and accusations.  I suspect that the most common obstacle preventing more gynecologists getting involved in obesity medicine, is simply lack of information. Starting a conversation on obesity feels uncomfortable and delicate, and there’s a general assumption that specific skills are needed that are best left to obesity specialists. Often it is also a question of time, and many feel that it might not be worth the effort. For gynecologists, medications for obesity treatment are also unfamiliar and different from the ones we typically use. My wish is to develop a sustainable and practical protocol for treating and supporting my patients living with obesity. Developing multi-professional networks together with skilled dietitians and psychologists is crucial. I also… Read More »

Fecal Transplants Need The Right Support

The fact that the gut microbiota plays an important role in digestion and metabolism should by now be common knowledge. There is now also abundant evidence that obesity is associated with a rarefied microbiome, the causes for which are not entirely clear.  One of the more adventurous approaches to rectifying this issue has been the idea of using fecal transplants from lean people in an attempt to ‘repoopulate’ (pardon the pun) the gut of people living with obesity. In one such study by Valentin Mocanu and colleagues from the University of Alberta, in which I happened to be peripherally involved, now published in Nature Medicine, suggests that it may not be enough to just transplant the bugs, but that you also need to support them. The double-blind study involved 70 volunteers with severe obesity and metabolic syndrome, who were randomised into two groups, one receiving fecal transplants from lean donors (in the form of capsules) vs. placebo capsules. Each of these groups were then further randomised to receive daily supplements of either high-fermentable (HF) or low-fermentable (LF) fiber over 6 weeks.  This treatment resulted in a significant improvement in HOMA as a measure of insulin resistance in the Fecal-Microbial-Transplant-Low-Fermentable fibre group (FMT-LF), with no changes in any of the other groups. In addition, there was also restoration of the physiologic patterns of GLP-1 secretion in the FMT-LF group.  As for the microbiome itself, the FMT-LF intervention was associated with increases in bacterial richness (Chao1 index) from baseline to week 6 with the FMT-LF intervention resulting in changes in seven genera and 12 amplicon sequence variants (ASVs), several of which were detectable at week 6, including increases in the relative amounts of Phascolarcobacterium, Christensenellaceae, Bacteroides and Akkermansia muciniphila and decreases in Dialister and Ruminococcus torques. Most of these changes were no longer apparent after 12 weeks.  As for why these changes were only seen in the FMT-LF group, the authors have the following speculation to offer, “Possible explanations include the ability of cellulose to act as a bulking and binding agent, which could alter metabolite luminal concentrations, influence gastrointestinal transit and modulate the donor microbe–host mucus layer interface. Cellulose supplementation may also directly alter the function of specific taxa, including cellulose-degrading H2-producing methanogens, leading to changes in gut microbial fermentation efficiency and by-products. Together these factors might constitute mechanisms through which the FMT-LF intervention increases microbial diversity and richness while also… Read More »

Why The Insulin-Obesity Hypothesis is Iffier Than You Think

I have personally never bought into overly simplistic notions of what may or may not cause obesity (or what we can do about it). One of these “simplistic” notions that has gained considerable traction recently is the idea that insulin resistance (caused by over-consumption of high-sugar/high-glycemic foods) leads to “internal starvation” and provides a (calorie-independent) stimulus for weight gain. While this hypothesis has garnered much recent popularity due to enthusiastic and outspoken supporters like Dr. David Ludwig (Always Hungry?) and Gary Taubes (Why We Get Fat), the basic idea is neither new nor unchallenged. While insulin may well be involved in the “non-caloric” regulation of body weight – there are numerous bits and pieces of the hypothesis (as popularly presented by Ludwig and Taubes) that are inconsistent and not backed by hard observational and/or experimental data. For an enlightening read on why the insulin-hypothesis of obesity may not be all that accurate, readers may wish to read an elegant discussion of this issue by Dr. Stephan Guyenet, a neuroscientist at the University of Washington, and author of Whole Health Source, a popular health blog. Without going through all the pros and cons of the insulin argument here (these are eloquently discussed by Guyenet on his site), allow me to quote his summary, “In summary, several key predictions of the insulin model are not supported by the evidence, explaining why this model doesn’t get much traction in my field (neuroscience).  There is essentially no direct evidence that the proposed mechanism occurs during or after normal weight gain, a fair amount of direct evidence that it doesn’t, and the arguments in favor of it are based on indirect evidence whose relevance to common obesity is often questionable.” While I have no stake in this discussion either way, I generally remain sceptical of overly simplistic explanations for complex biological phenomena. Guyenet’s arguments are anything but simplistic. @DrSharma Edmonton, AB

Why Metabolic Surgery Cannot Be A Population Solution To the Obesity Problem

Ludicrous as the thought that any form of surgery could be even remotely considered a possible solution to a problem that affects billions of people around the world may seem, the metabolic surgery literature continues to suggest that it may. There is no doubt that bariatric (or metabolic) surgery is highly effective in reducing body weight and putting diabetes into remission, at least compared to any existing behavioural or medical treatment. Be this as it may, a commentary by Robin Blackstone, published in JAMA Surgery in response to a paper by Chih-Cheng Hsu and colleagues showing favourable 5-year outcomes in surgical treated patients with type 2 diabetes with BMI lower than 35, makes some salient points. “Should metabolic surgery be more widely adopted? The barriers are significant. Cost of the procedure, complications, lack of surgical manpower, poor access to financially supported care, the problems of weight regain, and clinician and payer bias against surgery limit application as a population solution. These barriers are unlikely to change and may be magnified in very large populations.” No one can argue with this assessment. Nor can anyone argue with the statement that what we really need is “…disruptive innovation that can be widely applied to the population at risk, is inexpensive to administer, and can be repeated as necessary. The pace of this work needs to be accelerated with increased funding and collaboration.” Although “Our collective response has neither the scope nor the scale to stem or reverse the tide of this disease. Access to all modalities of treatment should be expanded, keeping our collective fingers in the dike to salvage people in this generation.” This would of course  require an astronomical hike in funding for the search of innovative and disruptive treatments for obesity – funding that may need to approach the cost dimensions of a manned mission to Mars. Whether or not there is any political will to do this, given the stigma and discrimination that people living with obesity experience on all fronts, remains rather unlikely at best. @DrSharma Edmonton, AB

Can Public Support For Obesity Prevention Be Harnessed Without Stigmatizing People Living With Obesity?

A key paper in the 2015 Lancet Series on obesity, by Terry Huang and colleagues, argues for a “bottoms-up” approach to obesity policies – i.e. to mobilise public support for policies aimed at obesity prevention. Citing examples from tobacco, gun control and climate change, the authors describe various theoretical frameworks for harnessing the power of the public to demand and support policies to promote healthy eating and increased physical activity to reduce obesity. As the authors note, this may require reframing of the obesity problem, in ways that may vary depending on the target audience. For example, “Findings of a study in the USA showed that conservative voters’ support for government policies increased substantially when obesity was linked to military readiness.” Or, “The framing of obesity issues can also incorporate how the medical care cost of obesity is distributed. These costs are not entirely borne by individuals with obesity. Some of the medical care costs of obesity are paid by the non-obese in the form of higher health insurance premia (for private health insurance) and in the form of higher taxes (for public health insurance).” Importantly, “Support might also depend on whether such taxes and subsidies are framed as rewards for healthy behaviour or penalties for unhealthy behaviour.” As the authors discuss, key to harnessing public support, is to foster public dialogue on the problem. Unfortunately, in the case of obesity, this dialogue is far from simple. Thus, one aspect, not discussed by the authors, is the very real potential of this public dialogue to inadvertently promote weight-bias and discrimination by reinforcing simplistic messages about obesity and its causes. After all, it is difficult to convince the public that we need to regulate the food industry to prevent obesity, without also implying that fat people are fat because they simply chose to eat too much, are too stupid to realise that obesity is hurting them, and/or are too weak-willed to resist the temptation of what the food industry throws at them. Ergo, if they cannot put down their forks, it is only understandable that we need the government to step in and force them to do so for their own good. Clearly such a line of argument may well harness public support for policies (at least among the naturally slim), but will do so at the cost of stigmatizing the very people we hope to help. Indeed, as long as the public health rhetoric focusses… Read More »