2015 Weight Bias Summit: Full Report
Earlier this year I participated in a two-day workshop on weight bias hosted by researchers at the University of Calgary. The over 40 participants included researchers, clinicians, health administrators and a number of other stakeholders, who discussed all aspects of weight bias and discrimination. A particular focus of the workshop, supported by the Canadian Institutes of Health Research (INMD) and co-hosted by the Canadian Obesity Network was to explore a research agenda towards finding effective ways to reduce weight bias and its negative consequences for the health and well-being of those living with obesity. Click here to open an abbreviated summary of the event (PDF). Click here to open a detailed summary of the event (PDF). Click here to view the event program (PDF). @DrSharma Edmonton, AB
5th Annual Dietitian Learning Retreat For Obesity Management
Dietitians play an often critical role in helping patients with obesity better manage their weight. However, I also know that dietitians are the first to agree that obesity management is not just about diet (and exercise) but rather, that diet is just one aspect of an interdisciplinary management approach. This is why over the past several years, the Canadian Obesity Network has partnered with Dietitians Canada to host an annual learning retreat, especially for dietitians called upon to manage obesity. The two-day retreat (October 7-8, Toronto), which follows a highly intense interactive workshop format, covers all aspects of interdisciplinary obesity management including behavioural, medical and surgical treatments. There will also be a special focus on the nutritional management of bariatric patients as well as weight-sensitive behavioural modification. Speakers at the event include Michael Vallis, Eric Doucet, Jennifer Brown-Vowles, Sean Wharton, and myself. The course is open to all registered dietitians and anyone else interested in (not-just) nutritional aspects of obesity management. For advanced registration (early bird registration ends Sept 15) and more information click here. @DrSharma Edmonton, AB
What Are The Health Benefits of Intentional Weight Loss?
To conclude this brief series on our new exhaustive review of the putative health benefits of long-term weight-loss maintenance, published in Annual Reviews of Nutrition, here is the summary paragraph of our findings: “Obesity is well recognized as a risk factor for a wide range of health issues affecting virtually every organ system. There is now considerable evidence that intentional weight loss is associated with clinically relevant benefits for the majority of these health issues. However, the degree of weight loss that must be achieved and sustained to reap these benefits varies widely between comorbidities. Downsides of weight loss that is too rapid and/or extreme may occur, as in the increased risk of gallbladder disease, the presence of excess residual skin, or deterioration in liver histology. Uncertainty also remains about the potential benefit or harm of intentional weight loss on patients presenting with some chronic diseases and on overall mortality. Clearly, well- controlled prospective studies are needed to better understand the natural history of obesity and the impact of weight-management interventions on morbidity, quality of life, and mortality in people living with obesity.” The is much left to be done and answering some of these questions will become progressively easier as better treatments for obesity become available. @DrSharma Kananaskis
Health Benefits Of Intentional Long-Term Weight Loss?
Despite the difficulties inherent in achieving AND maintaining long-term weight loss, the health benefits for those who manage to do so are widely believed to be substantial. While the health benefits associated with intentional weight loss for some complications of obesity (such as elevated lipids and diabetes) are well documented, high-quality studies to back many other potential health benefits are harder to find. Just how well (or poorly) the putative health benefits of long-term intentional weight loss are documented for each of the many conditions associated with obesity, is now detailed in a comprehensive review of the literature that we just published in the Annual Reviews of Nutrition. The 40 page long review, which includes almost 250 relevant publications, supports the following main findings: Defining and assessing clinically relevant obesity and weight change are challenging tasks. In a given individual, there is often little relationship between the magnitude of obesity and measures of health. Despite its modest effect on long-term weight loss, behavioral modifications thatimprove eating behaviors and increase physical activity constitute a cornerstone for integral and sustainable weight management. Intentional weight loss is associated with a clinically relevant reduction in blood pressure, improvement in cardiac function, and reduction in cardiovascular events. The duration and magnitude of weight change required to achieve a significant benefit are still unclear. In individuals with impaired glucose metabolism at any stage, intentional weight loss achieved by any means is associated with a proportional reduction in T2DM prevalence, severity, and progression. Intentional weight loss is consistently associated with a clinically relevant reduction in triglycerides and increase in HDL cholesterol. The effects of weight loss on LDL cholesterol are less consistent. Overall, nonalcoholic fatty liver disease is commonly associated with excess weight and can show marked improvement with behavioral, pharmacological, and/or surgical weight loss. Very rapid weight loss, however, may worsen liver histology in some patients. Simi- larly, gallbladder disease is not only common in patients presenting with obesity but also highly prevalent after intentional weight loss. Obesity is widely recognized as a key modifiable risk factor for osteoarthritis, with sig- nificant improvements in pain and function reported with weight loss. Obstructive sleep apnea and obesity hypoventilation syndrome tend to improve with moderate weight loss; however, complete resolution is not common and is related to very significant weight loss. Asthma and COPD are clearly associated with obesity. Sustained weight loss seems to be associated with a significant improvement in asthma… Read More »
An Update On Non-Alcoholic Fatty Liver Disease
Of all of the common complications of obesity, fatty liver disease is perhaps the most insidious. Often starting without clinical symptoms and little more than a mild increase in liver enzymes, it can progress to inflammation, fibrosis, cirrhosis and ultimate liver failure. It can also markedly increase the risk for hepatocellular cancer even in patients who do not progress to cirrhosis. Now, a paper by Mary Rinella from Northwestern University, Chicago, published in JAMA provides a comprehensive overview of what we know and do not know about early detection and management of this condition. The findings are based on a review of 16 randomized clinical trials, 44 cohort or case-control studies, 6 population-based studies, and 7 meta-analyses. Overall between 75 million and 100 million individuals in the US are estimated to have nonalcoholic fatty liver disease with 66% of individuals older than 50 years with diabetes or obesity having nonalcoholic steatohepatitis with advanced fibrosis. Although the diagnosis and staging of fatty liver disease requires a liver biopsy, biomarkers (e.g. cytokeratin 18) may eventually help in the detection of advanced fibrosis. In addition, non-invasive imaging techniques including vibration-controlled transient elastography, ultrasound with acoustic radiation force impulse or even magnetic resonance elastography are fairly accurate in the detection of hepatic fibrosis and are the most reliable modalities for the diagnosis of advanced fibrosis (cirrhosis or precirrhosis). Currently, weight loss is the only proven treatment for fatty liver disease. Pharmacotherapy including treatment with vitamin E, pioglitazone, and obeticholic acid may also provide some benefit (none of these treatments currently are approved for this indication by the UD FDA). Futhermore, the potential benefits of existing and emerging anti-obesity treatments on the incidence and progression of fatty liver remains to be established. As Rinella points out, “It is important that primary care physicians, endocrinologists, and other specialists be aware of the scope and long-term effects of the disease.” Clearly, screening for fatty liver disease needs to be part of every routine work up of individuals presenting with excess weight. @DrSharma Edmonton, AB
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