Early Bird Registration For Canadian Obesity Summit Ends March 3rd
For all my Canadian readers (and any international readers planning to attend), here just a quick reminder that the deadline for early bird discount registration for the upcoming 4th Canadian Obesity Summit in Toronto, April 28 – May 2, ends March 3rd. To anyone who has been at a previous Canadian Summit, attending is certainly a “no-brainer” – for anyone, who hasn’t been, check out these workshops that are only part of the 5-day scientific program – there are also countless plenary sessions and poster presentations – check out the full program here. Workshops: Public Engagement Workshop (By Invitation Only) Pre-Summit Prep Course – Overview of Obesity Management ($50) Achieving Patient‐Centeredness in Obesity Management within Primary Care Settings Obesity in young people with physical disabilities CON-SNP Leadership Workshop: Strengthening CON-SNP from the ground up (Invitation only) Exploring the Interactions Between Physical Well-Being and Obesity Healthy Food Retail: Local public‐private partnerships to improve availability of healthy food in retail settings How Can I Prepare My Patient for Bariatric Surgery? Practical tips from orientation to operating room Intergenerational Determinants of Obesity: From programming to parenting Neighbourhood Walkability and its Relationship with Walking: Does measurement matter? The EPODE Canadian Obesity Forum: Game Changer Achieving and Maintaining Healthy Weight with Every Step Adolescent Bariatric Surgery – Now or Later? Teen and provider perspectives Preventive Care 2020: A workshop to design the ideal experience to engage patients with obesity in preventive healthcare Promoting Healthy Maternal Weights in Pregnancy and Postpartum Rewriting the Script on Weight Management: Interprofessional workshop SciCom-muniCON: Science Communication-Sharing and exchanging knowledge from a variety of vantage points The Canadian Task Force on Preventive Health Care’s guidelines on obesity prevention and management in adults and children in primary care Paediatric Obesity Treatment Workshop (Invitation only) Balanced View: Addressing weight bias and stigma in healthcare Drugs, Drinking and Disordered Eating: Managing challenging cases in bariatric surgery From Mindless to Mindful Waiting: Tools to help the bariatric patient succeed Getting Down to Basics in Designing Effective Programs to Promote Health and Weight Loss Improving Body Image in Our Patients: A key component of weight management Meal Replacements in Obesity Management: A psychosocial and behavioural intervention and/or weight loss tool Type 2 Diabetes in Children and Adolescents: A translational view Weight Bias: What do we know and where can we go from here? Energy Balance in the Weight- Reduced Obese Individual: A biological reality that favours… Read More »
The Lancet’s 2015 Take On Obesity
In 2011, The Lancet dedicated a special issue to the topic of obesity – the general gist being that obesity is a world wide problem which will not be reversed without government leadership and will require a systems approach across multiple sectors. The Lancet also noted that current assumptions about the speed and sustainability of weight loss are wrong. This week, The Lancet again dedicates itself to this topic with ten articles that explore both the prevention and management of obesity. According to Christina Roberto, Assistant Professor of Social and Behavioural Sciences and Nutrition at the Harvard T H Chan School of Public Health and a key figure behind this new Lancet Series, “There has been limited and patchy progress on tackling obesity globally”. Or, as Sabine Kleinert and Richard Horton, note in their accompanying commentary, “While some developed countries have seen an apparent slowing of the rise in obesity prevalence since 2006, no country has reported significant decreases for three decades.” As Kleinert and Horton correctly point out, a huge part of this lack of progress may well be attributable to the increasingly polarised false and unhelpful dichotomies that divide both the experts and the public debate, thereby offering policy makers a perfect excuse for inaction. These dichotomies include: individual blame versus an obesogenic society; obesity as a disease versus sequelae of unrestrained gluttony; obesity as a disability versus the new normal; lack of physical activity as a cause versus overconsumption of unhealthy food and beverages; prevention versus treatment; overnutrition versus undernutrition. I have yet read to read all the articles in this series and will likely be discussing what I find in the coming posts but from what I can tell based on a first glance at the summaries, there appears to be much rehashing of appeals to governments to better control and police the food environments with some acknowledgement that healthcare systems may need to step up to the plate and do their job of providing treatments to people who already have the problem. As much as I commend the authors and The Lancet for this monumental effort, I would be surprised if this new call to action delivers results that are any more compelling that those that followed the 2011 series. I can only hope I am wrong. @DrSharma Edmonton, AB
Do Do-It-Yourself Interventions For Obesity Work?
Given that most people do not look at obesity as a chronic disease that requires professional management, the most common approach to losing weight is still for people to try to lose weight on their own. But just how effective are these do-it-yourself approaches to weight management? This is the topic of a systematic review and meta-analysis by Jamie Hartmann-Boyce and colleagues from Oxford University, published in the American Journal of Public Health. Self-help programs were defined as self-directed interventions that do not require professional input to deliver (“self-help”) across a variety of formats, including but not limited to print, Internet, and mobile phone-delivered programs. As such programs come in all shapes and sizes, the researchers also distinguished between “tailored” interventions as those in which participant characteristics were used to provide individualized content (e.g., tailored based on information provided by participants at baseline), and “interactive” interventions as those programs in which participants could actively engage with intervention content (e.g., through online quizzes or entering their own content). For each intervention, the authors also coded the specific type of self-managment strategies ranging from goal setting to buddy systems. The researchers found 23 randomized controlled trials comparing self-help interventions with each other or with minimal controls in overweight and obese adults, with 6 months or longer follow-up. Together these studies included almost 10,000 participants in 39 intervention arms. Although the researchers noted considerable heterogeneity among studies, the average difference in weight loss at 6 months between the self-management and control groups was about 2 Kg, an effect that was no longer significant at 12 months. Overall the type of program (tailored vs. non-tailored, interactive vs. non-interactive, etc.) did not make any notable difference to the success of participants. The authors also noted that the only trial that examined a potential interaction with socioeconomic status found that the intervention was more effective for more advantaged populations. Despite these rather sobering results, the authors come to the rather astonishing conclusion that, “Results from this review show promising evidence of the effectiveness of self-help interventions for weight loss.” and that, “Public health practitioners and policymakers should look to implement self-help interventions as a component of obesity intervention strategies because of the high reach and potentially low cost of these programs.” How exactly, the authors would come to these recommendations is unclear – my view would be that this could be a rather substantial waste of public… Read More »
Canadian Clinical Practice Guidelines For Obesity: We Need More Than Diet and Exercise
Yesterday, saw the release of new Clinical Practice Guidelines from the Canadian Task Force on Preventive Health Care to help prevent and manage obesity in adult patients in primary care. Similarly to the Endocrine Society’s Guidelines for the pharmacological treatment of obesity (see yesterday’s post), the authors use a GRADE system to rank and rate their recommendations. Key recommendations are summarized as follows: Body mass index should be calculated at primary health care visits to help prevent and manage obesity. For normal weight adults, primary care practitioners should not offer formal structured programs to prevent weight gain. For overweight and obese adults health care practitioners should offer structured programs to change behaviour to help with weight loss, especially to those at high risk of diabetes. Medications should not routinely be offered to help people lose weight. Virtually all of these recommendations are supported by evidence that is rated between moderate to very low, which essentially leaves wide room for practitioners to either do nothing or whatever they feel is appropriate for a given patient. The guidelines do not discuss the role of bariatric surgery (arguably the most effective treatment for severe obesity) and make no recommendations for when this should be discussed with patients. The rather subdued recommendations for the use of medications is understandable, given that the only prescription medication available for obesity in Canada is orlistat (why the authors chose to also discuss metformin, which is not indicated for obesity treatment, is anyone’s guess). Overall, the reader could easily come away from these guidelines with a sense that obesity management in primary care is rather hopeless, given that behavioural interventions are modestly effective at best (which is probably why the authors recommend that these not be routinely offered to patients at risk of weight gain). Indeed, it is hard to see how primary care practitioners can get more enthusiastic about obesity management given this rather limited range of treatment options currently available to Canadians. If there is anything to take away from these guidelines, it is probably the simple fact that we desperately need more effective treatments for Canadians living with obesity. @DrSharma Edmonton, AB The whole document is available here
Activity Trumps Weight Loss For Health?
Despite the The fact that it is better to be fit and fat than skinny and unfit is not new – indeed, I would regard the evidence on this as pretty conclusive. Nevertheless, for those, who still harbour any remaining doubts, the study by Ulf Ekelund on behalf of the EPIC Investigators, recently published in the American Journal of Clinical Nutrition should drive this message home. This analysis looks at the relationship between physical activity and all-cause mortality in 334,161 European men and women followed for about 12.4 y (corresponding to 4,154,915 person-years). No matter how the researchers looked at the data, activity levels appeared a better predictor of mortality than BMI or waist circumference. Thus the authors calculated that while avoiding all inactivity would theoretcally reduce all-cause mortality by 7.35%, trying to maintain a “normal weight” (or rather a BMI less than 30) would reduce mortality by only 3.66% (although avoiding obesity AND inactivity did have the greatest effect). Despite the limitations of these type of cross-sectional analyses, which as a rule, tend to overestimate the potential benefits of an actual intervention, the message is clear – it appears that even small increases in physical activity in inactive individuals can have substantially greater benefits to health than obsessing about losing a few pounds. This is indeed useful information, as we have long known that increasing physical activity in most cases does surprisingly little in terms of weight loss but rather a lot in terms of increasing health and fitness. So do not despair if the hours your patients are putting in at the gym are not changing those numbers on the scale – the health benefits are still worth the effort. @DrSharma Reykjavik, Iceland
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