Yesterday, the 2nd International School on Obesity Research And Management (ISORAM), kicked off with a series of brief overviews of the basic sciences in obesity. Yvonne Böttcher (Leipzig) provided an update of obesity genetics. Although there are now 33 common genetic risk variants for BMI, even when combined, these markers explain only a small proportion (<10%) of the total heritability of obesity. Perhaps, there is a bigger than expected role for rare and low frequency genetic variants with highly penetrant effects (albeit in a smaller number of obese people). In addition, there may also be an important role for deletions and copy number variability that may contribute to the obesity phenotype. Nora Klöting (Leipzig) explained how animal models are essential to better understanding of the pathogenesis, genetics and mechanisms of human obesity as the basic physiology of molecules associated with obesity and obesity related diseases can frequently only be investigated in such models. In fact, it was the study of animal models of obesity that led to the discovery of leptin and a host of other important molecules that regulate energy homeostasis and metabolism. There is no doubt that generation and characterization of transgenic animal models will continue adding pieces to the puzzle, allowing us to better understand the pathophysiology of adipose tissue, obesity, lipodystrophy, and insulin resistance. Maria Keller (Leipzig) next spoke about the importance of epigenetics, which may explain many of the gene x environment interactions. Thus, while these interactions do not change the genetic code, they very can very much influence tissue specific gene expression patterns that significantly alter metabolism and other function. Mechanisms that can lead to epigenetic modification of genes include DNA methylation, micro RNAs, or modifications of histonses. These mechanisms may not only play a role in fetal programming but may also be influenced by factors such as diet, physical activity, or environmental toxins. Isabel Wagner (Leipzig) rounded off this first session by discussing the many roles of adipose tissue, particularly in the development of childhood obesity. She pointed out that fat mass can increase both by hyperplasia (increase in cell number) and hypertrophy (increase in cell size), the latter being most often associated with insulin resistance, adipose tissue inflammation, and other alterations that may contribute to obesity related health problems. The many bioactive adipokines, secreted by fat cells can act locally and systemically through autocrine, paracrine and endocrine effects that can modulate a… Read More »
Regular readers may recall previous posts on how the increasing prevalence of obesity in the population requires design consideration from seat car belts to hospital equipment. It is therefore no surprise that someone has now considered the need for redesigning office furniture to accommodate those with excess weight. In a paper by Claire Gordon and Bruce Bradtmiller, published in the latest issue of WORK, the authors examine the potential impact of the increasing rates of obesity on office furniture design. As the authors note, despite a 5-fold increase in the prevalence of obesity (and an even higher fold increase in severe obesity), little work has been done on ergonomic design of office (or other) furniture. Based on data available from military personnel from1987-1988 and 2006-2007, the authors note that: “Examining those two data sets in particular, mean values increased for anumber of important ergonomic dimensions in ap-proximately 20 years. For example, malebiacromial (shoulder) breadth increased 12.7 mm; male bideltoid (upper arm) breadth increased 8.1 mm,while male torso circumferences – all important in personal protective equipment – increased 40 mm or more” “For many of the stature-related dimensions, the change was inconsequential for design. But for manyof the weight related dimensions, the changes weresubstantial. For example, male Forearm-Forearm Breadth increased by 33.9 mm (49.0 mm for females)and male Hip Breadth Sitting increased by 20.0 mm(39.9 mm for females).” Although the paper does focus on issues perhaps more relevant for military personal, the implications are probably the same for regular office workers. Given that the obesity epidemic is not going anywhere anytime soon and we will continue seeing an increasingly obese workforce, office furniture designers (and those who buy it) may wish to take note. AMS Miami, FL Gordon CC, & Bradtmiller B (2012). Anthropometric change: implications for office ergonomics. Work (Reading, Mass.), 41, 4606-11 PMID: 22317429 ..
At a recent talk, I happened to meet a recreational therapist, who expressed an interest in perhaps getting involved in obesity management. I must admit that I had not seriously considered the potential contribution that recreational therapists may bring to the field of bariatric care. For readers, who are not be familiar with this profession, it may be important to point out that the field of therapeutic recreation recognizes leisure, recreation and play as an integral component of quality of life. Recreational therapists specialize in helping individuals, who have physical, mental, social, or emotional limitations which impact their ability to engage in meaningful leisure experiences. This is something that would certainly be of relevance to many patients that I see in our bariatric program – many express loss of interest and ability to engage in leisure activity due to the very real barriers posed by their excess weight. It turns out that recreational therapists are the professional experts in helping clients to rediscover and maximise independence in leisure, optimal health and quality of life. Recreational therapy has been shown to reduce depression, stress, anxiety, as well as recover or maintain motor functioning, reasoning abilities and build confidence that allows clients to enjoy greater independence and quality of life. Although, many readers may think that this is a new profession, recreational therapists have been around for a while. For e.g. the Alberta Therapeutic Recreation Association was founded in 1985, i.e. over 25 years ago and has over 400 members. Established benefits of therapeutic recreation include maintenance of physical and pscyhosocial health, cognitive functioning, personal and life satisfaction, and prevention of complications of physical disabilities and improved self-care and adherence to treatment plans. These services would most certainly be relevant to many of the severely obese patients that we see in our clinic, who have experienced social isolation due to their excess weight and have certainly lost much of their social network and interactions. I am not aware of ‘bariatric’ recreational therapists, who have specialized in managing clients with severe obesity or ‘recovering’ from severe obesity following bariatric surgery. If my reader have, I’d certainly be most interested in hearing about their experiences with recreation therapists and whether or not they found these services helpful. I most certainly would love to hear from recreational therapists working in this field or who happen to have ideas on what they would bring to obesity… Read More »
One of the most interesting booths here at the International Federation for Surgery of Obesity and Metabolic Disorders in Hamburg is that of a small Danish exhibitor that specializes in bariatric wheelchairs, beds, mattresses and other devices. This company, with the name XXL Rehab, has evidently put considerable research and expertise into the development of their products – and while I have seen many such devices and mobility aids before, I was particularly impressed by the considerable thought, research and testing that has gone into this particular line of products. Indeed, the long conversation I had with the young and most enthusiastic owner Keld Jørgensen, was absolutely delightful and educational. Although this company has yet to expand in North America (they’re still working at expanding in Europe), there is a clear need for such products – certainly not something you can find in your local mobility or medical aid stores. Interestingly, XXL Rehab is organising a Bariatric Rehabilitation Congress (BRC 2011) in Copenhagen in November, and, from what I see on the program, this two-day meeting (Nov. 9-10, 2011) will certainly be a most interesting meeting for any European colleagues interested in topics like patient and provider safety, skin care and hygiene, exercise interventions, seating and handling and other relevant issues. AMS Hamburg, Germany
Osteoarthritis is one of the most disabling and painful conditions attributable (in part) to excess weight. Once established, osteoarthritis significantly reduces quality of life and mobility, often precipitating further weight gain and posing an important barrier to weight management. A panel of experts (The Ottawa Panel) has now released a comprehensive set of evidence-based clinical practice guidelines for the management of osteoarthritis in overweight and obese patients, published in PHYSICAL THERAPY. The recommendations are based on an extensive review of published articles with strict application of quality criteria to rate the strength of evidence (A, B, C, C+, D, D+, or D-) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. The panel decided on a total of 79 recommendations: 36 positive (21 grade A and 15 grade C+) – all were of clinical benefit. Overall the data supports the recommendation that physical activity combined with (mildly restrictive) diet programs are beneficial for pain relief, functional status, strength and quality of life. Although 5% reduction in body weight reduced pain and functional status, this degree of weight loss was insufficient to slow disease progression. Both aquatic and land-based aerobic exercise were shown to be more effective in reducing pain than home-based strengthening exercises. On the other hand, land-based exercise performed in a gym that included strength, aerobic, stretching, and range-of-motion training was more effective in reducing pain compared with a home-based strengthening exercise program. These benefits of exercise are independent of any changes in body weight and the authors suggest: “The significant improvements in QoL among study participants with OA who were obese or overweight may be a reflection of mental health and social benefits associated with the participation in physical activities. Physical activity promotes psychological well-being by reducing feelings of fatigue, depression, and anxiety and improving self-esteem, confidence, concentration, and mental awareness. The social benefits of participation in physical activity include a reduction in the sense of isolation and loneliness, improved social networks and social capital, and increased community connectedness and cohesion.” Importantly, the authors also note that: “To the knowledge of the Ottawa Panel, there is no conclusive evidence on the most appropriate methodological scale to apply for OA and obesity research. The use of BMI, waist circumference, and body weight as valid indicators of successful weight loss… Read More »