Search Results for "severe obesity"
Is Severe Obesity Associated With Increased Risk For Fractures?
According to conventional wisdom, one (of the few) health benefits of obesity is stronger bones. However, according to a study by Sarah Cawsey and colleagues (me included) from the University of Alberta, published in Osteoporosis International, these “stronger” bones may not be quite strong enough to prevent spontaneous and traumatic fractures. Our study examined the relationship between fracture history and bone mineral density (BMD measured by DEXA) in 400 women with a mean age of 44 yrs and a mean BMI of 46. Twenty two percent of women (n=87) reported a total of 178 fractures. Of particular note, fragility-type fractures (hip, vertebra, proximal humerus, distal forearm, and ankle/lower leg) were present in 58 (14.5%) of the women. There was a markedly higher proportion of fractures in women in the lowest femoral neck BMD quintile who had any fracture history (41.3 vs. 17.2%), any fragility-type fractures (26.7 vs. 11.7%), hand and foot fractures (16.0 vs. 5.5%), other fracture types (5.3 vs. 1.2 %), and osteoporotic fractures (8.0 vs. 1.2%) compared to the remaining population. No clinical or biochemical predictors of fracture risk were identified apart from BMD. Our finding show that severely obese women with the lowest BMD values, despite these being close to what would be considered “normal” in a non-obese woman, are at a significantly elevated risk of all types of fractures compared to severely obese women with elevated BMD. Given the substantial fracture risk seen in our study, it may well be worth considering evaluating the potential benefits of routine BMD assessments in pre-menopausal women with severe obesity. @DrSharma Gambach, Germany Cawsey S, Padwal R, Sharma AM, Wang X, Li S, & Siminoski K (2014). Women with severe obesity and relatively low bone mineral density have increased fracture risk. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA PMID: 25182230.
Why Severe Obesity Is Not a Laughing Matter
Regular readers know that I look at BMI as a rather crappy measure of health – indeed there is very little relationship between mortality and BMI across a wide range of BMI levels. However, once we approach severe obesity (the most rapidly rising subset of obesity in the population), there is very little doubt that carrying all that extra weight is associated with a substantially increased risk for illness and death. Just how severely severe obesity affects life expectancy becomes clear from a new analysis by Cari Kitahara and colleagues from the US National Cancer Institute, published in PLOS Medicine. For their analysis they pooled data from 20 prospective studies from the United States, Sweden, and Australia, sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) were assessed for people classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2). Class III obesity was strongly associated with an increased risk of death due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia. Overall, compared to people with a normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5, 8.9, 9.8, and 13.7 years of life lost – a substantial amount by any standard. So, while experts and others may quibble over the value of BMI as a measure of health, there should be little doubt that severe obesity in the BMI 40+ range is associated with a substantial reduction in life expectancy. All the more reason to increase efforts to better prevent and provide appropriated treatments to people who need them. @DrSharma Kananaskis, AB Kitahara CM, Flint AJ, Berrington de Gonzalez A, Bernstein L, Brotzman M, MacInnis RJ, Moore SC, Robien K, Rosenberg PS, Singh PN, Weiderpass E, Adami HO, Anton-Culver H, Ballard-Barbash R, Buring JE, Freedman DM, Fraser GE, Beane Freeman LE, Gapstur SM, Gaziano JM, Giles GG, Håkansson N, Hoppin JA, Hu FB, Koenig K, Linet MS, Park Y, Patel AV, Purdue MP, Schairer C, Sesso HD, Visvanathan K, White E, Wolk A, Zeleniuch-Jacquotte A, & Hartge P (2014). Association between Class III Obesity (BMI of 40-59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLoS medicine, 11 (7) PMID: 25003901
Why The 500% Increase in Severe Obesity Should Concern Us All
As someone working in a tertiary care bariatric clinic, I have often been accused of just seeing the tip of the iceberg. Unfortunately, it is this “tip” that is growing the fastest, when it comes to the increase in obesity rates across Canada. Thus, a paper by Laurie Twells and colleagues from Memorial University, St John’s, Newfoundland, published in CMAJ Open, not only predicts that overall obesity rates in Canada will continue to grow well into 2019, but also shows that between 1985 and 2011, the rates of Canadian adults with a BMI greater than 40 have increased from 0.3 to 1.6%. Over the same time period, rates of Canadians with Class I and Class II obesity have increased from from 5.1% to 13.1%, from 0.8% to 3.6%. So, while the efforts in obesity prevention may or may not eventually lead to fewer people getting obese in the first place, our strategies are miserably failing those, who already have the problem. This should come as no surprise, as Canada has yet to come up with a coherent strategy to address adult obesity. As the authors note, there is indeed a wide variability between provinces when it comes to access to obesity treatments, irrespective of whether this is bariatric surgery or behavioural programs in primary care. There also continues to be a significant deficit in training and education of health professionals in best-practices in the prevention of weight gain and obesity treatments. Unfortunately, the impact of this lack of access and resources affects those the most, who already have the problem. They neither have the time to wait for prevention measures to kick-in nor do I expect measures aimed at prevention to lessen their health burden – they need treatments. It would of course help if we actually had better treatments. Given a 95% failure rate of “Eat-Less-Move-More” approaches to obesity management, there is no doubt that the sooner we find more effective treatments, even if they only help prevent progression in those who already have the problem, the better for everyone. After all we are talking about our families, friends, colleagues, neighbours – people, whose struggles with this condition should concern us all. @DrSharma Edmonton, AB Please help this penguin grow wings and fly
What Can Best Practices Achieve in The Treatment of Severe Obesity?
Treating obesity is not easy. Despite “miracle” foods, diet “breakthroughs” and “success” stories promoted in popular media and by commercial weight-loss programs, the reality of achieving and sustaining weight loss, even with the best evidence-based medical care remains modest at best. A new paper by Raj Padwal and colleagues from the University of Alberta, published in Medical Care, now describes the weight outcomes from a prospective two-year naturalistic evaluation (APPLES) of parallel cohorts of 500 patients while on waiting list (n=150), undergoing medical (n=200) or surgical (n=150) management in a large Edmonton-based publicly funded multi-disciplinary bariatric program (Weight Wise). This comprehensive bariatric program delivers integrated, patient-focused, evidence-based care to the Edmonton Zone of Alberta Health Services. This region is one of the largest integrated health delivery systems in Canada and includes a catchment population of approximately 1.6 million residents. Specific features of the program include a central, region-wide single-point-of-access referral system; community education and weight management sessions; and bariatric specialty services offered to patients with BMI levels of great than 35 kg/m2 referred from a medical practitioner. The program is structured such that patients progress from the wait-list to intensive medical management through to bariatric surgery (if indicated). When the APPLES study, funded by the Canadian Institutes of Health Research (CIHR) as the first evaluation of representative outcomes in a publicly funded bariatric program in Canada, began in 2008, approximately 800 new patients were seen and about 200 surgeries were performed annually in the program. At that time there were also 1,500 adults waitlisted for clinic entry (2-y average wait time). The results of the APPLES study are of considerable interest, as publicly funded bariatric services in Canada differ from commercial and third-party payor programs in that they are universally accessible, centrally triaged and population-based. These features, likely also mean that patients seen in these programs are less highly selected and perhaps more treatment-refractory than those seen in private payor settings. Moreover, the evidence-based nature of the interdisciplinary services provided in this tertiary care setting represent the current standard of specialised bariatric care. However, the prime importance of these data lie in the fact that, contrary to the current “benchmark” weight-loss data derived largely from randomized controlled trials or programs enrolling highly selected populations, the APPLES study, for the first time, provides Canadian real-life data on the efficacy and effectiveness of publicly funded bariatric care (albeit at a specialised tertiary care… Read More »
Severe Obesity and Suicidality
Last night, I arrived in Leipzig after, a week in New Delhi (where I was reminded again of the incredible power of “gut bugs”), for another round of the IFB Obesity Diseases International Advisory Board meeting at the University of Leipzig. Part of this work on the Advisory Board involves reviewing the many publications that are emanating from this very productive and diverse obesity research network. One example is the recent paper by Birgit Wagner and colleagues, who examined the relationship between BMI and suicidality in a paper published in Depression and Anxiety. In this paper, Wagner and colleagues looked at interviews conducted in a German population-based sample of almost 2500 indiiduals regarding suicide attempts and suicidal behaviours. Not only did this analysis reveal a surprisingly high rate of suicidal behaviours (13% in men, 33% in women) and suicide attempts (13% in men, 27% in women) in individuals with a BMI greater than 40, but individuals in this category were were 12 times more likely to have attempted suicide compared to normal weight individuals. This is an important finding as it should prompt clinicians to undertake systematic and proactive exploration of suicidal behaviours in all patients presenting with severe obesity – most importantly those seeking bariatric surgery. AMS Leipzig, Germany Wagner B, Klinitzke G, Brähler E, & Kersting A (2013). EXTREME OBESITY IS ASSOCIATED WITH SUICIDAL BEHAVIOR AND SUICIDE ATTEMPTS IN ADULTS: RESULTS OF A POPULATION-BASED REPRESENTATIVE SAMPLE. Depression and anxiety PMID: 23576272
