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Vote of Thanks From The Obesity Chair
10 years ago, I was enticed to take up an endowed “Chair” in obesity research and management at the University of Alberta with the task to develop and lead the fledgling bariatric program at the Royal Alexandra Hospital. The decision to move to the University of Alberta from a prestigious Tier 1 Canada Research Chair in obesity at McMaster University, where my research enterprise was moving along just fine, was largely prompted by the Ontario Government’s bumbling indecision (despite all of my considerable and enthusiastic advocacy efforts on behalf of my patients) about promoting much needed bariatric services in Ontario (as a side note, only six weeks after I had signed on with the University of Alberta, the Ontario government, after much to-and-froing, finally did announce substantial funding for a province-wide bariatric program, which continues to this date as the Ontario Bariatric Network). Despite my sadness at leaving my most wonderful and supportive colleagues at McMaster University, I have not for a moment regretted my move to Edmonton. Not only did I find another set of as supportive colleagues at the University of Alberta but also the committed and dedicated staff within Capital Health (now part of  Alberta Health Services), all of which enthusiastically supported the creation of a now world-class academic bariatric program in Edmonton. With well over 100 peer-reviewed publications to show for (with a notable mention to the colleagues who helped develop the Edmonton Obesity Staging System and the 5As of Obesity Management), the academic work in obesity was only a rather small part of my activities as “Chair”. Together with my colleagues at Alberta Health Services, we supported a total of 5 bariatric clinics across the province, all of which are now up and serving Albertans living with severe obesity –  each adapted to local resources and interests. Of these, the Edmonton Adult Bariatric Specialty Program at the Royal Alexandra Hospital of course continues as the flagship program, offering a full suite of behavioural, medical, and surgical treatments for Albertans with severe obesity. With my move to Edmonton, so did the national office of the Canadian Obesity Network (co-hosted by the University of Alberta and Alberta Health Services). As readers will be well aware, this pan-Canadian network of now well over 15,000 obesity researchers, health professionals, trainees, and now 1000s of public supporters, continues to grow and steadfastly pursue its important mission of promoting obesity research,… Read More »
Oral Semaglutide Is As Effective For Weight Loss As Injections
Readers will recall, that once-weekly injections of the novel long-acting GLP-1 analogue semaglutide was recently shown (in patients with type 2 diabetes) to result in a rather impressive weight loss. Now, a phase II dose-finding study comparing various oral doses of semaglutide to subcutaneous injections in patients with type 2 diabetes was just published in JAMA. The 26-week trial with 5-week follow-up included around 600 patients with type 2 diabetes and insufficient glycemic control using diet and exercise alone or a stable dose of metformin were randomized to once-daily oral semaglutide of 2.5 mg (n = 70), 5 mg (n = 70), 10 mg (n = 70), 20 mg (n = 70), 40-mg 4-week dose escalation (standard escalation; n = 71), 40-mg 8-week dose escalation (slow escalation; n = 70), 40-mg 2-week dose escalation (fast escalation, n = 70), oral placebo (n = 71; double-blind) or once-weekly subcutaneous semaglutide of 1.0 mg (n = 70) for 26 weeks. Mean change in HbA1c level from baseline to week 26 decreased with oral semaglutide (dosage-dependent range, −0.7% to −1.9%) and subcutaneous semaglutide (−1.9%) and placebo (−0.3%); Significant reductions were also seen in body weight with both oral (dosage-dependent range, −2.1 kg to −6.9 kg) and subcutaneous semaglutide (−6.4 kg) vs placebo (−1.2 kg)> Adverse events (largely consisting of mild to moderate gastrointestinal events) were as expected and relatively comparable between the treatment arms. Although this was a diabetes study, these findings clearly hold promise for the further development of an oral formulation of semaglutide for the obesity indication. @DrSharma Tønsberg, Noway Disclaimer: I have served as a consultant for Novo Nordisk, the maker of semaglutide. 
European Collaborating Centres for Obesity Management (EASO-COMs)
This week, I am in Tønsberg, Norway, speaking at the annual meeting of the European Association for the Study of Obesity (EASO) Collaborating Centres on Obesity Management (COMs). This is a pan-Euoropean network of over 75, that includes academic, public and private clinics where children and adults with obesity are managed by holistic teams of specialists delivering comprehensive state-of- the-art clinical care. The EASO-COMs also work closely to ensure quality control, data collection, and analysis as well as for education and research for the advancement of obesity care and obesity science. Current plans foresee establishing 100 new COMs by 2020. There are also plans to develop an international exchange and mentoring program to increase competencies and treatment knowledge across Europe. Other important EASO initiatives in this regard include a knowledge transfer series involving e-Learning modules for obesity management based on the Canadian Obesity Network’s initiative with mdBriefCase. I certainly look forward to networking with and learning from my European colleagues over the next couple of days. Further details on the criteria for becoming a EASO COM are available here. @DrSharma Tønsberg, Norway
Guest Post: Australian GPs Recognise Obesity As A Disease
The following is a guest post from my Australian colleague Dr. Georgia Rigas, who reports on the recent recognition of obesity as a disease by the Royal Australian College of General Practice (RACGP). Last week, the Royal Australian College of General Practice (RACGP) President, Dr Seidel recognised obesity as a disease. The RACGP is the first medical college in Australia to do so. This was exciting news given that we have just observed World Obesity Day a few days ago. According to the Australian Bureau of Statistics1, over 60% of Australian adults are classified as having overweight or obesity, and more than 25% of these have obesity [defined as a Body Mass Index (BMI) ≥30] (ABS2012). Similarly in 2007, around 25% of children aged 2–16 were identified as having overweight or obesity, with 6% classified as having obesity (DoHA 2008). These are alarming statistics. The recent published BEACH data for 2015-162, showed that the proportion of Australian adults aged 45-64yo presenting to GPs has almost doubled in the last 15+ years. Worryingly the numbers are predicted to continue rising, with 70% of Australians predicted to have overweight or obesity by 2025. Embarrassingly, the BEACH data also indicated that <1% of GP consultations centred around obesity management. So obviously what we, as GPs have been doing..,or rather not doing…isn’t working! The RACGP’s General Practice: Health of the Nation 2017 3report found Australian GPs identified obesity and complications from obesity as one of the most significant health problems Australia faces today and will continue to face in coming years as the incidence of obesity continues to rise. But what are we doing about it?…. I think the answer is evident… clearly not enough! Thus, we can only hope that this announcement by the RACGP will have a ripple effect, with other medical colleges in Australia and then the Australian Medical Association following suit. So what does this mean in practical terms? For those individuals with obesity (BMI ≥30) with no “apparent” comorbidities or complications from their excess weight…[though you could argue they will develop (if not already) premature osteoarthritis of the weight bearing joints…..] would be eligible for a chronic care plan [government subsidized access to a limited number of consultations with allied health services] given the chronic and progressive nature of the disease. It also highlights the need for GPs to start screening ALL patients in their practice-young and old; for… Read More »
World Health Organisation Warns About The Health Consequences Of Obesity Stigma
Yesterday (World Obesity Day), the European Regional Office of the World Health Organisation released a brief on the importance of weight bias and obesity stigma on the health of individuals living with this condition. The brief particularly emphasises the detrimental effects of obesity stigma on children: “Research shows that 47% of girls and 34% of boys with overweight report being victimized by family members. When children and young people are bullied or victimized because of their weight by peers, family and friends, it can trigger feelings of shame and lead to depression, low self-esteem, poor body image and even suicide. Shame and depression can lead children to avoid exercising or eatng in public for fear of public humiliation. Children and young people with obesity can experience teasing, verbal threats and physical assaults (for instance, being spat on, having property stolen or damaged, or being humiliated in public). They can also experience social isolation by being excluded from school and social activities or being ignored by classmates. Weight-biased attitudes on the part of teachers can lead them to form lower expectations of students, which can lead to lower educa onal outcomes for children and young people with obesity. This, in turn, can affect children’s life chances and opportunities, and ultimately lead to social and health inequities. It is important to be aware of our own weight-biased attitudes and cautious when talking to children and young people about their weight. Parents can also advocate for their children with teachers and principals by expressing concerns and promo ng awareness of weight bias in schools. Policies are needed to prevent weight-victimization in schools.” The WHO Brief has important messages for anyone working in public health promotion and policy: Take a life-course approach and empower people: Monitor and respond to the impact of weight-based bullying among children and young people (e.g. through an -bullying programmes and training for educa on professionals). • Assess some of the unintended consequences of current health-promo on strategies on the lives and experiences of people with obesity. For example: Do programmes and services simplify obesity? Do programmes and services use stigmatizing language? Is there an opportunity to promote body positivity/confidence in children and young people in health promotion while also promoting healthier diets and physical activity?• Give a voice to children and young people with obesity and work with families to create family-centred school health approaches that strengthen children’s resilience and… Read More »
Residential Schools And Indigenous Obesity – More Than Just Hunger?
A recent CMAJ article, by Ian Mosby and Tracey Galloway from the University of Toronto argues that one of the key reasons why we see obesity and diabetes so rampant in Canada’s indigenous populations, is the fact that widespread and persistent exposure to hunger during the notorious residential school system may have metabolically “programmed” who generations toward a greater propensity for obesity and type 2 diabetes. There is indeed a very plausible biological hypothesis for this, “Hunger itself has profound consequences for childhood development. Children experiencing hunger have an activated hypothalamic–pituitary–adrenal stress response. This causes increased cortisol secretion which, over the long term, blunts insulin response, inhibits the function of insulin-like growth factor and produces long-term changes in lipid metabolism. Through this process, the child’s physiology is essentially “programmed” by hunger to continue the cycle of worsening effects, with their bodies displaying a rapid tendency for fat-mass accumulation when nutritional resources become available.” While the impact of hunger may well have been one of the key drivers or metabolic changes, the authors failed to acknowledge another (even more?) important consequence of residential schools – the impact on mental health. Oddly enough, in a blog post I wrote back in 2008, I discussed the notion that the significant (and widespread) physical, emotional, and sexual abuse experienced by the generations of indigenous kids exposed to the residential school system would readily explain much of the rampant psychological problems (addictions, depression, PTSD, etc.) present in the indigenous populations across Canada today. The following is an excerpt from this previous post: This disastrous and cruel [residential school] policy resulted in much pain and despair in the First Nations’, Inuit and Metis people that lasts to this day (known as the “generational effect”). Sexual, physical and mental abuse was widespread; students were broken in heart and spirit; culture and identities were destroyed. Much (if not all) of what ails the Aboriginal peoples of Canada can be traced back to this policy – including possibly issues that affect Aboriginal health to this day. It is no secret that obesity and its consequences (e.g. diabetes) are rampant amongst the Aboriginal peoples of Canada. While poverty, breakdown of traditional lifestyle and culture and even genetic factors (thrifty genotype) have all been implicated in this, I wonder how much the misery caused by the residential school program had to contribute. Early traumatic life experiences including sexual, mental and physical… Read More »
New Course: Adult Obesity Management in Brazil
For my many colleagues in Brazil, there is now a free accredited online continuing professional development (CPD) program developed in a collaboration between ABESO and the Canadian Obesity Network. “Adult Obesity in Brazil” is a free, online continuing professional development (CPD) program that provides 1 hour of accredited learning on the following topics:   The importance of managing obesity   How to manage obesity to reduce disease burden   Behaviourial and pharmaceutical management The program was developed in collaboration my Brazilian colleagues Cintia Cercato, Bruno Halpern, and Nelson Nardo Jr. You can access the “Adult Obesity in Brazil” program online at no charge to receive one hour of accredited learning. Registration is free. For more information click here @DrSharma Edmonton, AB
Even Correlations Based On Billions Of Data Points Do Not Prove Causation
Readers may have already heard about a recent study by Tim Althoff and colleagues from Stanford University, published in Nature, that analyses physical activity data collected from smart phones consisting of 68 million days of physical activity for 717,527 people, in 111 countries (only 46 of which were included in the study). As one may expect, not only do activity levels vary widely across countries but also substantially within countries (which in general terms, the authors refer to as “activity inequality”). It turns out that activity inequality and not actual levels of activity predict obesity rates (based on BMI). Furthermore, “By quantifying the relationship between activity and obesity at the individual level, we were able to determine why a country’s activity inequality is a better predictor of obesity than average activity level. We find that the prevalence of obesity increases more rapidly for females than males as activity decreases. And while lower activity is associated with a substantial increase in obesity prevalence for low-activity individuals, there is little change in obesity prevalence among high-activity individuals. So given two countries with identical average activity levels, the country with higher activity inequality will have a greater fraction of low-activity individuals, many of them female, leading to higher obesity than predicted from average activity levels alone. These findings are analogous to the phenomenon revealed in past studies of the effects of income inequality on health, whereby a relatively small change in income (in our case, activity) for an individual at the bottom of the distribution can lead to substantial improvements in health. On the basis of our model relating activity inequality to obesity prevalence, we also performed a simulation experiment which, assuming perfect information (Methods), suggests that interventions focused on reducing activity inequality could result in a reduction in obesity prevalence up to four times greater than in population-wide approaches.” The authors go on to discuss various limitation of their study but fail to mention the biggest limitation of all, the simple fact that correlations, no matter how strong or how large the data set, simply cannot prove causality. Thus, while the data does prove the point that you can do all sorts of interesting analyses when you have large data sets, it simply does not not prove that activity levels (or activity inequality for that matter) actually has much to do with obesity at all. Indeed, one could think of a number of confounders… Read More »