Search Results for "why i support"
Why Addressing Weight Bias is the #1 Strategic Goal of the Obesity Network
Regular readers will recall a host of previous posts on the issue of weight bias and discrimination. Canadian Obesity Network members will hopefully also be aware that for the past four years, addressing weight bias and speaking out against weight-based discrimination has been the #1 strategic goal of the network. Rather than listing all of the activities that the Network has undertaken to address this issues (the latest one being the launch of the image gallery “Picture Perfect at Every Size“), in today’s post I would like to share a story and explain why I continue to believe that this is the central problem at the the very heart of finding solutions to the obesity issue. I remember this as though it was yesterday. I had just arrived with my family in Canada, having accepted a Tier 1 Canada Research Chair in Obesity at McMaster University. I was just discovering Canadian television and was quite impressed the first time I saw Peter Mansbridge on the CBC’s “The National”. Interestingly, that evening one of the news items that caught my attention was an announcement by then Health Minister Anne McLellan, that the Government would spend $15 million to support obesity research – certainly good news for an obesity researcher just arriving in Canada. This brief sense of having arrived in the right place at the right time, however, was shaken by what followed – a scathing, derisive, and contemptuous commentary by Rex Murphy, Canada’s premier TV commentator – not known to mince words. In brief, as far as I can recall, the gist of his commentary was that this funding for obesity research was another perfect example of wasteful spending of tax-payer dollars. To paraphrase his words, “so now the Government of Canada is spending millions of dollars to show that Canadians get fat by eating fast food and lounging in front of their TVs“. I don’t remember the exact wording or the many ‘humorous’ angles that Rex Murphy took in this typical meandering monologue but I do recall the immediate effect it had on me. In my mind I could see Canadians across the country nodding and agreeing with Murphy, that spending any money on obesity research was indeed a complete waste – we already know the reasons: ‘gluttony and sloth’ – what’s there to research? It became blindingly obvious that Rex Murphy was simply stating aloud what most people… Read More »
Senate Committee Calls on FDA to Support Development of Obesity Drugs
Yesterday, at the 47th EASD meeting, I spent most of my time in sessions dealing with the improvement of insulin. While there was a lot of fascinating basic and clinical science and, certainly, newer insulin analogues appear less obesogenic than their older cousins, this entire line of treatment at least for type 2 diabetes, by definition, cannot be considered anything other than palliative (even if diabetologists would argue that insulin treatment helps prevent many of the complications of diabetes). Indeed, if we consider obesity as one of the main ‘modifiable’ risk factors for type 2 diabetes (some would prefer the term ‘root cause’), then treating diabetes without also treating obesity, is hardly a solution. Unfortunately, our ability to treat obesity ranges from the notoriously limited “Eat-Less-Move-More” (ELMM) approaches to the rather drastic surgical treatments, with little in terms of conservative medical treatment in between. This, as I have often discussed in the past, is in part due to the rather ultra-conservative approach that regulators have taken towards approving obesity drugs – a situation that has considerably stifled enthusiasm of pharmaceutical companies to forge ahead with the necessary investments in this area. It is therefore perhaps occasion for guarded optimism to note that in a report accompanying the 2012 US appropriations bill for agriculture, rural development and FDA, the US Senate Committee on Appropriations has now directed the FDA to provide a report by March 30, 2012, regarding steps the agency will take to support the development of new treatments for obesity. The committee was apparently “concerned with the absence of novel medicines to treat obesity” and called the lack of obesity drugs “a significant unmet medical need,” noting that obesity is “a disease linked to cancer, high blood pressure, heart disease, diabetes, and stroke” and is the second leading cause of preventable deaths in the US. The committee’s directive for FDA to look at risk mitigation recognizes that safety issues have been a major stumbling block for developers of weight-loss drugs. Such steps, the report says, include the use of Risk Evaluation and Mitigation Strategies and other post-market authorities “to mitigate risk and ensure rigorous post-market scrutiny while increasing access to novel medications.” On a side note, the FY12 bill, as part of the Transforming Food Safety and Nutrition Initiative, states that “the FDA will also begin an $8.8 million program to improve nutrition labeling on restaurant menus and vending… Read More »
Why Bariatric Surgery Can Fail (Part 5)
So, just to wind down this series, I would like to finish with an aspect of bariatric surgery that is seldom talked about. It is particularly relevant to patients at the extreme end of obesity. Many of these patients will have lived with severe obesity for a long time. They will have very few social contacts (except perhaps on the internet). Many will not have partaken in what others would consider very ‘normal’ activities: going to a cinema, strolling around in a mall or park, shopping for shoes or clothes, having a mani-pedi or even just their hair done, getting on an airplane or even just into a regular car (let alone drive one). As they lose weight, gain back their health and energy, and begin venturing out again, they will face all kinds of challenges both physically and mentally. Many will have the support they need and do just fine. But others, will flounder, feel socially incompetent – like a new immigrant to a foreign country. Trips to a supermarket or the public library can be daunting. It even takes time to recognize that that person reflected in the store window is really and actually you! This process of ‘rehabilitation’, which eventually can encompass issues like facing the job market or considering going back to school is not easy. Very little research seems to have been done on these issues – I can only imagine a whole new field for occupational and recreational therapists and social workers. Bariatric surgery is truly life changing – in the real sense of the word. I hope that this series of articles has perhaps touched on some issues that many may not have considered before. I hope that those who have themselves experienced some of these issues or have seen them in their own patients can relate to some of these difficulties and see them reflected in my posts. Bariatric surgery is about far more than finding a competent surgeon. it is a very individual and personal decision – one that can empower – one that requires courage and determination. It is definitely not a ‘cop-out’ or ‘conceding defeat’ or even remotely ‘taking the easy way out’. It is most certainly not just about surgery. Never have so many people around the world been in the need of or decided to undergo surgery – this is work in progress. As for most conditions… Read More »
Why Bariatric Surgery Can Fail (Part 3)
Bariatric surgery is certainly life changing – for better or for worse! This can lead to some unexpected consequences that can include an important (positive or negative) impact on friendships and romantic relationships. Any reader of the past few posts will by now have realised that despite all of its potential benefits, undergoing bariatric surgery is certainly no walk in the park. Having good social support and being in a happy and stable relationship has been shown to be a good prognostic factor for success. In our program we ask patients to bring their spouses or partners to visits with the surgeons – we will often see the whole family if need be – bring a close friend – whoever. You cannot do this without their support – their support will determine your outcome. (Not telling your family or friends or even your family doctor about your plans to have surgery (e.g. on a quick trip to Mexico) – is NOT A GOOD IDEA!). To be clear – there is an overwhelming amount of evidence that most patients will experience positive improvements in virtually all dimensions of health and quality of life – from mobility and pain to energy levels, self-esteem and sexual function. However, there are important exceptions! In fact, the 1997 Guidelines of the American Society for Bariatric Surgery already notes, “Marital satisfaction increases, but only if marital satisfaction existed before surgery. If marital discord exists preoperatively, the improved self image may lead to divorce postoperatively“. This, may well be an understatement! There is no doubt that anecdotally, very significant partnership problems can arise resulting in all kinds of complex psychodynamic issues, including passive-aggressive behaviours, intimate sabotage, and ultimately divorce. While a full analysis of this problem is beyond the scope of this post – the problem is by no means trivial but perhaps not that hard to understand. Bariatric surgery is not simply life changing for the patient – it is also life changing for their partners, families, and anyone they may have a close relationship to. This, perhaps not unexpectedly, can lead to significant relationship problems that many couples may not be able to overcome. One commonly reported problem is jealousy that develops when the operated spouse begins receiving new and positive attention. As post-surgical patients develop a more positive self-image and a whole new appearance and outlook at life, their partners can very often feel… Read More »
Why Bariatric Surgery Can Fail (Part 1)
Last week, we looked at bariatric surgery, its risks, its benefits, its mode of action, and explored how it affects nutrition and eating behaviour. This week (continuing in this series), I would like to explore some very different (many would perhaps say even more important) aspects that needs careful consideration in any decision for or against surgery. In this week’s posts I will turn our attention to the substantial impact that surgery can have on mental health and psychosocial circumstances, which may ultimately make all the difference between ‘success’ and ‘failure’. Clearly, one of the biggest impacts that bariatric surgery (or for that matter, any significant dietary intervention) can have, is that food can no longer be readily used as a coping strategy. Simply turning to food for comfort, stress reduction, venting, boredom, or even celebration is hard to do, when your stomach is the size of a golf ball (or a small banana) or any overindulgence results in explosive diarrhea (as in the case of dumping syndrome). So while, ‘binging’ may no longer be a realistic option, the emotions that precipitated such behaviours in the first place may need (and will often find) other outlets. Just how intense such unresolved emotions can be, is perhaps illustrated by the case of a patient, who, having undergone adjustable gastric banding at another centre, came to us because she had begun ‘self-adjusting’ her band by deflating it on an almost daily basis to allow a binge and subsequently over-tightening it to prevent further eating during the rest of the day. Indeed, maladaptive coping behaviours following bariatric surgery have been widely described and assessing these should be part of any pre- and post-bariatric surgical assessment and follow-up. A related issue, is the often described recurrence of drug or alcohol misuse observed in some post-surgical patients, a behaviour, which not surprisingly and has been associated with weight regain. This problem can perhaps be conceptualised as a ‘natural’ response to no longer being able to use food as a drug and should certainly prompt caution and ongoing screening in patients with significant past histories of addiction disorders. Another major determinant of outcomes can be due to the fact that, as weight comes off, patients lose the ‘protective’ barrier and ‘isolation’ of excess weight, leaving them feeling exposed and vulnerable – they suddenly becomes ‘visible’ and attract attention – a situation that many patients do not… Read More »
