As regular readers will be aware, the recent Canadian Obesity Summit in Vancouver hosted a debate on the issue of public-private partnerships, including the support for the Summit by Coca-Cola and McDonalds.

Here are the opening statements of the various proponents.

Introduction by Samantha Hajna and Diane Finegood

Con by Yoni Freedhoff

Pro by Michael Lyon

Con by Kim Raine

Pro by Richard Ellis

My previous post on this debate.

AMS
New Delhi, India

This evening, I will be presenting a brief talk on obesity to my colleagues here in New Delhi.

As readers will have noted, obesity is an increasing problem in the Indian subcontinent, with urban prevalence (based on the lower definition of BMI 25) reaching rates comparable to the West.

In the overwhelmingly private healthcare system in India, ethical and evidence-based obesity management becomes an even bigger challenge than in a country like Canada, where we have publicly funded healthcare.

While, in a public system, we can point to the health benefits of modest weight loss and take a long-term approach based on the principles of chronic disease management, in a private health care system, where the customer is king, people will only pay for what they want – and that is to lose as much weight as quickly as possible.

As in Canada, it is hard convincing patients (and even most health professionals) that just losing 5% of your weight has significant health benefit. Indeed few patients would be willing to pay for a 10-15 lb weight loss – and keep paying for your help to keep them off.

Unless you can (at least claim to) offer 25 or 50% weight loss, it is unlikely that you will have many clients – there is simply no money in ethical obesity management. I have yet to find the patient who would pay me to simply help them stop gaining weight.

In the end, weight loss is really what everyone is after – I guess this is why surgeons still refer to bariatric surgery as “weight-loss surgery” – weight-loss sells!

For my colleagues in India, where they have to compete with an entirely unregulated and ruthless commercial weight-loss industry that promises a seemingly unlimited number of “slimming miracles”, practicing “evidence-based” obesity management is simply not a viable way to make a living.

This, perhaps is the greatest challenge to health professionals who wish to offer ethical weight management to their clients – they simply have no treatments that can match the weight-loss expectations of their potential clients.

Thus, I know that my talk this evening will disappoint most of my listeners, who may well be hoping that I can reveal the latest “magic solution” for weight-loss.

I truly wish I had a happier message for them.

AMS
New Delhi, India

While in India, I have plenty of time to read the Indian newspapers and magazines, that have circulations Western publications can only dream of.

Not surprisingly, “health and beauty tips” are a staple feature with articles proclaiming the benefits of everything from yoga to bariatric surgery.

And of course, when it comes to traditional Indian herbs or spices, almost every ingredient is offered as a panacea.

Here, for example, are the virtues of using coriander (dhanya or cilantro), a commonly used spice and garnish (taken from a recent article in the Times of India):

- It lowers blood sugar levels

Given that osteoarthritis often severely limits physical activity, I have long suspected that individuals with joint problems should be at higher risk of cardiovascular disease.

Now, Mushfiqur Rahman and colleagues from the University of British Columbia, in a paper published in BMJ Open report a rather strong relationship between osteoarthritis and cardiovascular disease.

Based on cross-sectional data from the nationally representative Canadian Community Health Survey, about 40,000 self-reported subjects with osteoarthritis were matched 1-1 by participants without joint problems of similar age, sex and CCHS cycles.

After adjusting for sociodemographic status, obesity, physical activity, smoking status, fruit and vegetable consumption, medication use, diabetes, hypertension and chronic obstructive pulmonary disease, individuals with osteoarthritis were significantly more likely to have angina and congestive heart failure (in both men and women), and for myocardial infarction (in women).

As this risk remained elevated even after adjusting for risk factors including physical activity, the question remains whether or not osteoarthritis and heart disease may in fact be causally linked by other mechanisms including chronic systemic inflammation.

As clinicians, we should certainly be aware to screen our patients with osteoarthritis for the presence of additional cardiometabolic risk factors and occult heart disease.

AMS
New Delhi, India