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The Obesity Alphabet Soup And Its Implications

Yesterday, I gave a day-long presentation to Aboriginal nurses and other health care workers from several First Nation reserves in Southern Saskatchewan. The event was organized and hosted by the Onion Lake Health Board with support from Health Canada.

It was not difficult for me to fill the almost seven hours of the meeting with a roundup of the obesity problem – everything from the societal and environmental drivers of obesity, its economic and humanitarian implications, the problem of weight bias and discrimination, to obesity definitions, classification, genetics, biology, and management.

During the talk I realized that some of my work has significantly contributed to what is now turning out to be an ‘alphabet soup’ that goes well beyond just BMI, WC, or WHR.

As regular readers will recall, we have added EOSS (the Edmonton Obesity Staging System), the 4Ms (Mental, Mechanical, Metabolic, and Monetary drivers, complication and barriers), and now, the 5As (Ask, Assess, Advice, Agree, Assist), to the basics of obesity assessment and management. (some may wish to add HAES to this list)

Although this alphabet soup may seem mysterious and perhaps daunting to some readers, it is gradually but steadily developing into a framework, which is beginning to flesh out a lot of what needs to change and happen in obesity management.

This, at least, became quite clear to me during my presentation and the rather positive response of the almost 200 attendees only served to validate that these concepts have largely been missing in our clinical approach to obesity management.

Supplement this alphabet soup with the etiological framework and ‘Best Weight‘, and we have a whole different way of approaching patients affected by excess weight.

As I know that many of the attendees are also avid readers of these pages, I’d certainly appreciate any feedback and thoughts on yesterday’s workshop.

Regina, Saskatchewan

p.s. obviously the obesity alphabet soup has far more letter – I wonder how many readers can decipher and name the following (in no particular order): PCOS, NAFLD, RNY, LABG, OSA, DVT, PCOS, PYY, GLP-1, T2D, OA, LVH, a-MSH, DEXA, ADHD, PTSD, RMR, NEAT, BAT, WAT.


  1. Dr. Sharma, you were extremely engaging and very informative yesterday. With the strong weight bias occurring in our modern society, your discussion was timely and much appreciated. As you mentioned, weight discrimination, judgement and blame all create barriers for people to create a pathway to wellness. Your discussion engaged the audience to think of obesity in terms of illness not weight scale numbers, which I too believe can help reduce these barriers and allow all people access to happiness and health. Your thought provoking discussion included all the elements health care providers need to make necessary changes in the obesity world.
    I am grateful for your inspiring session delivered yesterday. Your message had a profound effect and one that will surely change the way people think about weight and chronic disease. I’d like to think we all made a few steps forward in positively impacting the lives of Saskatchewan First Nations. Thank you so much.

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  2. Dear Dr. Sharma,

    After your talk yesterday, I was reassured that obesity is a multifaceted chronic illness that is poorly understood and therefore poorly treated in many health care organizations. I was reminded of the strong similarities between the obesity issue and mental health in general. Stigma is a powerful barrier to care for both these illnesses. I very much appreciated your straight talk on the common reaction that society and professionals within society hold about overweight individuals. The fact that many people do not like “the fat guy” or “the depressed person” really shows how much people don’t know or even want to know. I will be talking about your framework in my workplace and using it when I work with obese patients. Thank you.

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  3. Any answers for the alphabet quiz?

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  4. Dr. Sharma:

    Yet again you have provided SK educators and caregivers with a though provoking day on weight bias, discrimination and stigmatism. The more we work to understand the true drivers of obesity and focus our efforts on real life solutions, the better the system will be for everyone who needs it.

    I am once again highly motivated to make changes to my practice to better assess our on reserve clients and help them receive the best interventions possible.

    Here are my quiz answers. Not 100% but not bad either.

    PCOS Poly cystic ovarian syndrome
    NAFLD Non alcoholic fatty liver disease
    RNY Roux N Y
    LABG Is this Laproscopic adjustable gastric banding with letters reversed?
    DVT Deep vein thrombosis
    GLP-1 glucacon like peptide
    T2D type 2 diabetes
    OA osteoarthritis
    LVH left ventricular hypertrophy
    ADHD Attention Deficit Hyperactivity Disorder
    PTSD Post traumatic stress disorder
    RMR resting metabolic rate

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  5. In addition to those mentioned above:
    Osa: obstructive sleep apnea
    Pyy: protein yy
    a-Msh: alpha-melanocyte stimulating hormone
    Dexa: dual-energy xray absorptiometry
    Neat: nonexercise activity thermogenesis
    Bat: brown adipose tissue
    Wat: white adipose tissue

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  6. Dr. Sharma, I hope you pointed out to the First Nation folks the kind of info that Dr. Jeffrey Freidman once talked about — that the increase in weight in the USA for example is very much genetically oriented — much higher in some groups than others… and the follow-on effect of this is that for any native lines which are more prone to obesity than some other genetic groups, it means anything that any government does to institutionalize bias against obesity — including issues with parenting, adoption, healthcare, etc. — are going to be unfairly biased against their people as a result. PJ

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