Lintang Kemukus

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German TV Looks At Healthy Obesity

German TV Looks At Healthy Obesity


German TV Looks At Healthy Obesity

Posted: 31 Oct 2014 05:00 AM PDT

Arya Sharma on bike 3SATRegular readers will be familiar with the fact that not all people with excess weight necessarily have health problems. Now, the 3SAT television channel, which broadcasts in Germany, Austria and Switzerland has produced a 45 minute documentary on the science behind these findings.

Although the film is in German, I thought I would post the link anyway as many of my readers may well be able to grasp the story even if they are not entirely fluent.

To watch the documentary on line click here.

Incidentally, I am featured about 2.5 minutes into the film, discussing the Edmonton Obesity Staging System and related issues.

Appreciate all comments.

@DrSharma
Toronto, ON

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Obesity Is Not About Lack Of Willpower

Obesity Is Not About Lack Of Willpower


Obesity Is Not About Lack Of Willpower

Posted: 30 Oct 2014 05:00 AM PDT

Yo-Yo Rubber Band Feb 2014As I prepare to spend the rest of this week educating health professionals in Ontario on how to better manage obesity in their practice, it is perhaps appropriate to remind ourselves that Canada is not alone in attempting to tackle this problem.

Indeed, we need to look no further than the Australian Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children for a succinct summary of reasons just why obesity management is so difficult:

- Regulation of body weight involves complicated feedback systems that result in changes in appetite, energy intake and energy expenditure. 

- While excess weight in individuals usually results from a prolonged period of energy imbalance, the causes of overweight and obesity are complex.

- Diet and physical activity are central to the energy balance equation, but are directly and indirectly influenced by a wide range of social, environmental, behavioural, genetic and physiological factors—the relationships between which are not yet fully understood.

- Individuals may be at greater risk of weight gain at particular stages in their lives.

The guidelines remind practitioners of the fact that body weight underlies tight regulation through a complex homeostatic system:

“While this system defends against weight gain as well as weight loss under normal circumstances, energy balance cannot be maintained when an energy surplus is sufficiently large and sustained. Weight gain will begin and usually continue until a new weight results in increased energy expenditure and energy balance is re-established. The same physiological mechanisms then seek to maintain energy balance at the higher weight, and will defend against weight loss by increasing appetite and reducing energy expenditure) if there is an energy deficit. As a result, most overweight and obesity results from upward resetting of the defended level of body weight, rather than the passive accumulation of excess body fat.”

This acknowledgement is a vast step forward from previous simplistic views of obesity which falsely view it as just a matter of “calories in” and “calories out”, which falsely imply that individuals should be able to achieve any desired weight simply by volitionally changing this balance through willpower alone.

Indeed, the reality is that the vast majority of individual attempting this “balance” approach to weight management will fail miserably only to gain the weight back.

Thus, the Australian guidelines are not shy about declaring a better need for pharmacological treatments and promoting the more extensive use of bariatric surgery for individuals with sever obesity related health problems.

A clear reminder to all of us that current treatments for obesity are insufficient and better, safer and more accessible treatments are urgently needed.

@DrSharma
Toronto, ON

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5As Of Obesity Management Workshops in Ontario

5As Of Obesity Management Workshops in Ontario


5As Of Obesity Management Workshops in Ontario

Posted: 29 Oct 2014 05:00 AM PDT

sharma-obesity-5as-booklet-coverHere just a quick update on upcoming workshops on the 5As of Obesity Management that I will be presenting for family physicians and allied health care providers in Ontario in the coming days.

The course offers an interactive workshop  incorporates the conceptual structure of the Best Practices in Weight Management document, the Canadian Obesity Clinical Practice Guidelines and the 5As methodological framework to specifically address the needs of overweight and obese patients and improve practitioners' willingness and efficacy in providing obesity management and counseling to their patients.

Family physicians can obtain Mainpro M1 credits for participation i this workshop.

Space is limited for these events, so please register early.

Toronto, ON - November 1, 2014, 8:00-9:30 AM

Keele Auditorium
2175 Keele Street
Toronto, ON
Cost: $Free*
For more information, please contact the bariatric clinic at bariatricclinic@hrh.ca

Kingston, ON - November 11, 2014, 8:00-10:00 AM

The Harbour Restaurant, Portsmouth Olympic Harbour Site
53 Yonge Street
Kingston, ON
Cost: $Free*
For more information, please contact Kristine Canty at: cantyk@hdh.kari.net

Ottawa, ON - November 12, 2014, 8:00 AM-4:00 PM

The Ottawa Hospital, General Campus, The Royal Room, 1st Floor
501 Smythe Road
Ottawa, ON
Cost: $Free*
For more information, please contact Shannon Porcari at: sporcari@toh.on.ca Click here to download the flyer and registration form

*Select Ontario workshops supported by the Ontario Ministry of Health
 

 

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Should A Political Prescription For Obesity Not Also Include Better Treatments?

Should A Political Prescription For Obesity Not Also Include Better Treatments?


Should A Political Prescription For Obesity Not Also Include Better Treatments?

Posted: 28 Oct 2014 05:00 AM PDT

sharma-obesity-policy1In the latest issue of the Canadian Medical Association Journal, the editors opine on the need for a political prescription for obesity – in short taxation and regulation of  high-calorie and nutrient-poor food products as the only viable approach to the obesity epidemic. As may be expected, they use the analogy of tobacco as a justification for this approach (given that actual data from government intervention on reducing the consumption of the said foods is so far lacking).

Be that as it may, what caught my attention in the article was the following passage:

“Treating obesity does not work well; preventing it would be better. The global failure to manage obesity, now considered by the American Medical Association to be a disease, may be considered a failure of the evidence-based medicine approach to treating disease….We know that most restrictive diets result in only short-term weight loss that frequently reverses and worsens in the long term, but dietary changes that are sustainable as a lifestyle choice may work. Physical activity is not enough to prevent or treat obesity and overweight, unless it is combined with some kind of dietary intervention. Family and community interventions may work somewhat better than interventions aimed at individuals, but their implementation is patchy. Bariatric surgery has good results in the treatment of morbid obesity, but its use is always going to be limited and a last resort. Pharmaceutical agents may work to some extent, but may have nasty adverse effects.”

The interesting thought here is that the authors parade the lack of effective treatment as a justification for prevention, when I would rather have used this state of affairs to call for greater investments in finding better treatments.

Not that I am not in favour of prevention – indeed, I am all for preventing heart disease, diabetes, cancer, depression, bone and joint disease and everything else.

But, at no point would I ever call for prevention as an alternative to finding better treatments for any of these conditions.

The fact that people still die of cancer should never justify us abandoning the search for better treatments – indeed, as far I can see, the whole Pink Ribbon Industry apparently focusses on “finding the cure” – not on “finding better ways to prevent breast cancer” (even if most experts believe that much of breast cancer is indeed preventable).

Just because  we still have no effective treatments for a host of other conditions, should we abandon the search for better treatments for these conditions?

In short, what irks me most about this article is not the call for prevention – indeed I am all for it!

But when the lack of effective (or safe) treatments is used to justify this call, I must disagree.

No matter how much we restrict and tax the food industry, there will always be people around, who despite their best efforts, will struggle with excess weight. Indeed, there is no reason to believe (at least not for anyone who understands the physiology of obesity) that any form of “prevention” will reverse the epidemic in those who already have the problem – i.e. in about 6 Mill Canadians. (even if we somehow miraculously reduced obesity in the population by 20% through “preventive measures” (well beyond even the most optimistic predictions) – we would still need treatments for 4 Mill Canadians – adults and kids!)

The longer we wait to find and implement effective treatments, the longer these individuals will struggle with a condition that should deserve the same efforts at treatment as we afford individuals with other “lifestyle” diseases (including heart disease, diabetes and cancer).

Let us not forget that treatments for other common conditions (e.g. hypertension, hypercholesterolemia and diabetes) were once lacking – today millions around the world benefit from these treatments – indeed, it is probably safe to say that these medications probably save more lives each year than any known efforts at regulating industry that I know of.

Indeed, if we wish to find more effective ways to manage obesity, we need to vastly increase our efforts at finding better treatments – not abandon them.

Prevention is never an alternative to also having effective treatments. The two go hand-in-hand.

@DrSharma
Edmonton, AB

 

 

 

 

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