Wednesday, November 26, 2014

McKinsey on Obesity: Doing Something Beats Doing Nothing

McKinsey Overcoming ObesityLast week the McKinsey Global Institute, with much media fanfare, released a 120 page discussion paper titled, “Overcoming obesity: An initial economic analysis“, which estimates that the economic cost of the global obesity epidemic is upwards of $2 trillion, a number similar to the economic cost of tobacco consumption or armed conflicts.

The report identifies 74 interventions in 18 areas (ranging from policy and population health to health care) deemed to be cost effective, which, if implemented, could lead to annual savings of $1.2 billion in the UK National Health Services alone.

However, when it comes to the actual impact of these 74 strategies, the report is far more sobering in that it notes that many of these interventions are far from proven:

“The evidence base on the clinical and behavioral interventions to reduce obesity is far from complete, and ongoing investment in research is imperative. However, in many cases this is proving a barrier to action. It need not be so. We should experiment with solutions and try them out rather than waiting for perfect proof of what works, especially in the many areas where interventions are low risk. We have enough knowledge to be taking more action than we currently are.”

In other words, let’s not wait to find out what works – let’s just do something – anything (and keep our fingers crossed).

Thus, the report urges us to

“(1) deploy as many interventions as possible at scale and delivered effectively by the full range of sectors in society; (2) understand how to align incentives and build cooperation; and (3) do not focus unduly on prioritizing interventions because this can hamper constructive action.”

I can see why politicians would welcome these recommendations, as they are essentially a carte blanche to either doing nothing (we don’t have the evidence) or doing whatever they want (anything is better than nothing).

The fact that,

“Based on existing evidence, any single intervention is likely to have only a small overall impact on its own. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden.”

means that when any measure fails, it is not because it was the wrong measure but because there was either not enough of it or it was not complemented by additional measures.

Again, a free pass for politicians, who can pass whatever measures they want (based on their political ideologies or populistic pressure from their constituencies), without having to demonstrate that what they did, had any effect at all.

Of course, no report on obesity would be complete without also stressing the importance of “personal responsibility”, as if this was somehow more important for obesity than it is for diabetes, lung disease, heart disease, or any other disease I can think of.

Unfortunately, the report also includes rather nonsensical statements like,

“44 interventions bring 20% of overweight/obese Britons back to normal weight”

a sentence that defies the very chronic nature of obesity, where once established excess weight is vigorously “defended” by complex neuroendocrine responses that will counteract any change in energy balance to sustain excess body weight.

Thus, unfortunately, the authors fall into the common misconception about obesity simply being a matter of calories in and calories out, a balance that can be volitionally adjusted to achieve whatever body weight you wish to have.

Indeed, there is very little discussion in this “discussion paper” of the underlying biology of obesity, although it is acknowledged in passing:

“Even though there are important outstanding questions about diet composition, gut microbiome, and epigenetics, we are not walking blind with no sense of what to address. However, interventions to increase physical activity, reduce energy consumption, and address diet composition cannot just seek to reverse the historical trends that have left the population where it is today. For example, we cannot, nor would we wish to, reverse the invention of the Internet or the industrialization of agriculture. We need to assess what interventions make sense and are feasible in 2014.”

Will this report move governments to action? Or, even more importantly, will this report bring us any closer to reversing the epidemic or providing better treatments to people who already have obesity?

Readers may appreciate that I am not holding my breath quite yet.

ƒƒ@DrSharma
Edmonton, AB
ƒƒ

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Tuesday, November 25, 2014

Obesity Myth: Success Is Measured In Pounds Lost

sharma-obesity-5as-booklet-coverFinally, in this series of common misconceptions about obesity management, discussed in our article in Canadian Family Physician, we address the notion that success in obesity management is best measured in the amount of weight loss:

“Given the importance of obesity as a public health problem, there is widespread effort to encourage people with excess weight to attempt weight loss.

However, a growing body of evidence suggests that a focus on weight loss as an indicator of success is not only ineffective at producing thinner, healthier bodies, but could also be damaging, contributing to food and body preoccupation, repeated cycles of weight loss and regain, reduced self-esteem, eating disorders, and social weight stigmatization and discrimination. 

There is also concern that “anti-fat” talk in public health campaigns might further promote weight bias and discrimination. 

Therefore, it might be time to shift the focus away from body weight to health and wellness in public health interventions.

Recently, the Canadian Obesity Network launched a tool called the 5As of Obesity Management (www.obesitynetwork.ca/5As) to guide primary care practitioners in obesity counseling and management. 

Minimal intervention strategies such as the 5 As (ask, assess, advise, agree, and assist) can guide the process of counseling a patient about behaviour change and can be implemented in busy practice settings.

Obesity management should focus on promoting healthier behaviour rather than simply reducing numbers on the scale. The 5As of Obesity Management is a practical tool to improve the success of weight management within primary care.”

@DrSharma
Edmonton, AB

 

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Monday, November 24, 2014

Obesity Myth: Anyone Can Lose Weight

scaleHere is another common misconception about obesity discussed in our article in Canadian Family Physician:

“It is common to hear that weight loss is a matter of willpower and compliance with the weight-reducing program.

However, the magnitude of weight loss is very different among individuals with the same weight-loss intervention and prescription, and the same compliance to the program—one size does not fit all.

Thus, for some people (especially those who have already lost some weight), simply putting more effort into a weight-loss program will not always result in additional weight loss given the different compensatory adaptations to weight loss.

For example, the decrease in energy expenditure that occurs during weight loss is highly variable between people and might dampen efforts to lose additional body fat.

Such compensatory mechanisms might sometimes fully counteract the 500 kcal per day decrease recommended in most dietary interventions, making it very difficult for such “poor responders” to lose weight.

Physicians should remember that obesity is not a choice and weight-loss success is different for every patient.

Success can be defined as better quality of life, greater self-esteem, higher energy levels, improved overall health, or the prevention of further weight gain.”

@DrSharma
Edmonton, AB

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Sunday, November 23, 2014

Obesity Weekend Roundup, November 21, 2014

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

@DrSharma
Edmonton, AB

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Friday, November 21, 2014

Obesity Myth: Exercise is the Best Way to Lose Weight

sharma-obesity-exercise2Here is what we had to say about the role of exercise in weight management in our recent article published in Canadian Family Physician:

There is now a consistent body of evidence showing that exercise alone, despite a range of health benefits associated with regular exercise, results in rather modest weight loss (less than 2 kg on average).

One of the explanations is that exercise is often accompanied by an increase in sedentary activities and appetite and a decrease in dietary restraint that counteract the increased energy expenditure of exercise.

However, increased exercise has been shown to reduce visceral adiposity (even with minimal changes in body weight).

Individuals who include regular exercise and active living as part of a weight-loss program are more likely to improve their overall health and keep the weight off.22 This latter finding might be attributable to the effect of regular exercise on caloric intake rather than on caloric expenditure per se.

Exercise alone generally promotes modest weight loss; however, individuals who exercise regularly might improve their overall health independent of weight loss and are more likely to keep their weight off.

@DrSharma
Wellington, NZ

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In The News

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Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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