Thursday, July 24, 2014

Why Severe Obesity Is Not a Laughing Matter

sharma-obesity-risk1Regular readers know that I look at BMI as a rather crappy measure of health – indeed there is very little relationship between mortality and BMI across a wide range of BMI levels.

However, once we approach severe obesity (the most rapidly rising subset of obesity in the population), there is very little doubt that carrying all that extra weight is associated with a substantially increased risk for illness and death.

Just how severely severe obesity affects life expectancy becomes clear from a new analysis by Cari Kitahara and colleagues from the US National Cancer Institute, published in PLOS Medicine.

For their analysis they pooled data from 20 prospective studies from the United States, Sweden, and Australia, sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) were assessed for people classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2).

Class III obesity was strongly associated with an increased risk of death due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia.

Overall, compared to people with a normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5, 8.9, 9.8, and 13.7 years of life lost – a substantial amount by any standard.

So, while experts and others may quibble over the value of BMI as a measure of health, there should be little doubt that severe obesity in the BMI 40+ range is associated with a substantial reduction in life expectancy.

All the more reason to increase efforts to better prevent and provide appropriated treatments to people who need them.

@DrSharma
Kananaskis, AB

ResearchBlogging.orgKitahara CM, Flint AJ, Berrington de Gonzalez A, Bernstein L, Brotzman M, MacInnis RJ, Moore SC, Robien K, Rosenberg PS, Singh PN, Weiderpass E, Adami HO, Anton-Culver H, Ballard-Barbash R, Buring JE, Freedman DM, Fraser GE, Beane Freeman LE, Gapstur SM, Gaziano JM, Giles GG, Håkansson N, Hoppin JA, Hu FB, Koenig K, Linet MS, Park Y, Patel AV, Purdue MP, Schairer C, Sesso HD, Visvanathan K, White E, Wolk A, Zeleniuch-Jacquotte A, & Hartge P (2014). Association between Class III Obesity (BMI of 40-59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies. PLoS medicine, 11 (7) PMID: 25003901

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Wednesday, July 23, 2014

In Memorium: Albert (Mickey) J Stunkard

Stunkard twinsAs I spend my days at the 9th Canadian Obesity Network’s Summer Bootcamp for young trainees from Canada and around the world, I was saddened to learn of the passing of Mickey Stunkard, clearly one of the biggest names in obesity research – at a healthy age of 92.

With well over 500 publications to his name, Mickey is perhaps best known for his twin studies showing that the body weight of adopted identical twins reared apart resembles each other and that of their biological parents rather than the weight of their adoptive parents.

This work helped establish the basis for much of the genetic work on obesity that followed, clearly showing that differences in body weight between two individuals are much more accounted for by their difference in genetics than by differences in their “lifestyles”.

These findings were often misused in “nature vs. nurture” debates, an issue that serious scientists have long laid to rest in light of our current understanding that the two cannot be discussed separately, simply because genes and lifestyle interact on virtually every level – from molecules, to cells, to behaviours.

Here is what one obituary had to say about Mickey:

“He surveyed obesity treatment studies in the late ’50s and found that the nation’s diet programs could claim only a 2 percent success rate. He was an early advocate for the use of bariatric surgery to induce weight loss. He also published the first modern account of binge eating in obese individuals.”

I have had to pleasure to often hear him speak at conferences.

He will be dearly remembered.

@DrSharma
Kananaskis, AB

 

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Tuesday, July 22, 2014

9th Annual Canadian Obesity Network Obesity Research Bootcamp

CON Bootcamp 2014As regular readers will be well aware, each year I attend the Canadian Obesity Network’s Obesity Research Bootcamp, an intense 10-day course for hand-picked young obesity researchers from Canada and around the world.

This year the trainees from Canada (13), Germany (8), Argentina (3), Chile (1), Malaysia (2), Peru (1), Spain (1), USA (1) come from a wide range of research areas – from molecular genetics to health psychology.

Following the opening address by Philip Sherman, Director of the Canadian Institutes of Heath Institute for Nutrition, Metabolism and Diabetes (CIHR-INMD), the course began yesterday with small-group learning sessions on defining and measuring obesity (Ian Jannsen, Queen’s University), weight bias and discrimination (Mary Forhan, University of Alberta), mental health issues (Valerie Taylor, University of Toronto), and energy balance (Eric Ducet, University of Ottawa).

These were complemented by presentations from the trainees on their own work and journal-club style discussion of key papers on relevant issues.

Not least, the camp also encourages networking and discussions that push the trainees to remarkably broaden their perspective on obesity.

I certainly look forward to an intense week at bootcamp.

@DrSharma
Kananaskis, AB

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Sunday, July 20, 2014

Obesity Weekend Roundup, July 18, 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
Kanaskis, AB

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Friday, July 18, 2014

Birth Control And Obesity

sharma-obesity-birth-control-pillAlthough obesity is a well-recognised factor for female infertility, the vast majority of women with excess weight are probably more interested in effective birth control.

That this is not as simple as it seems is evident from an article by Sheila Mody and Michelle Han from the University of California, San Diego, published in Clinical Obstetrics and Gynecaology.

The paper succinctly reviews a wide range of issues related to birth control and obesity.

To begin with, the authors points out that unintended pregnancies in obese women are often a problem simply because obese women are far less likely to use effective contraception than non-obese women. This non-use may in part be attributable to fear of weight gain, when most studies show that modern hormonal contraception is associated with almost no weight gain. The exception appears to be depot-medroxyprogesterone (DMPA), which may cause about 5 lb weight gain in the first year of use.

As for efficacy, the data show that unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among nonoverweight women. The reasons for these higher rates are not exactly clear.

Fortunately, the efficacy of intrauterine devices (IUD) appear no different between obese and non-obese women although the insertion of an IUD maybe more difficult in obese women because of poor visualization of the cervix and limited assessment of uterine position (a problem that can often be solved with the help of an ultrasound).

The paper also discusses the suitability of the vaginal vaginal contraceptive ring, which has been hypothesized to offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first- pass liver metabolism.

Finally, the paper discusses issues around contraception for women who have undergone bariatric surgery (who have a particularly high rate of unintended pregnancies) as well as best practices for emergency contraception.

This is clearly information that all clinicians who counsel obese women should be aware of.

@DrSharma
Edmonton, AB

ResearchBlogging.orgMody SK, & Han M (2014). Obesity and Contraception. Clinical obstetrics and gynecology PMID: 25029338

 

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In The News

Diabetics in most need of bariatric surgery, university study finds

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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