Saturday Story: Just One This Week. A Must Read If You Haven’t Yet

Ed Yong, in the Atlantic, with the sadly all too believable (yet still unbelievable) story of how SARS-CoV2 defeated America

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From Blog Posts To Guidelines

Yesterday saw the release of the long-awaited Canadian Adult Obesity Clinical Practice Guidelines. Getting to these guidelines was a long journey, that started well before the decision, about three years ago, to begin the daunting task of assembling the steering committee, the chapter authors, the literature review, the crafting of recommendations, the rating of recommendations, preparing the publication and the actual launch. Looking back, I realise that many of the so-called “novel” concepts included in the guidelines, stem back to topics and ideas about obesity, its nature, its causes, and management that I have thought about and discussed on this blog almost a decade ago. To illustrate this thought process, I have provided links to some of my previous posts on topics which have now found their way into the guidelines. They certainly make for some interesting reading: October 2007: Why I Don’t Like BMI March 2008: Obesity Classification: Time to Move Beyond BMI? April 2008: Recognising Barriers Key to Obesity Management? August 2008: Obesity is a Sign, Overeating is a Symptom February 2009: Edmonton Obesity Staging System October 2009: Do Mental Health Problems Predict Obesity? Novermber 2009: The M & Ms of Obesity Assessment August 2011: Weight Loss is Not a Goal September 2011: The 5 As Approach To Obesity Counseling It is indeed humbling to realise just how many of these ideas, first discussed in these decade-old blog posts, are now reflected in the new CPGs. @DrSharmaEdmonton, AB

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Canada’s Obesity In Adults: A Clinical Practice Guideline, Released Today, A Huge Step Forward

I’m proud to have played a small part in the release of today’s Obesity In Adults: A Clinical Practice Guideline as it is the first (I think, though I’m biased) to truly take a patient-centred approach while simultaneously treating obesity like a chronic disease

Not a small endeavour, this years long effort includes chapters never before seen in any other obesity treatment guideline including those on weight bias and stigma, virtual medicine, commercial weight loss programs, living with obesity, as well as issues specific to indigenous peoples.

It explicitly steers away from diet culture (but does speak to the need for individualized medical nutrition therapy), teaches readers that neither BMI nor weight measures the presence or absence of health and introduces them to the concept that obesity should be considered a chronic disease only when excess adiposity impairs health, and it recognizes that obesity is anything but a choice.

While going through the entirety of the guideline isn’t doable in a short blog post, here are the guideline’s overarching summary points:

  • Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.
  • People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index.
  • This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.
  • Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity.
  • People living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.

Kudos to all of my fellow authors and especially to Dr. Sean Wharton the project’s chief cat wrangler.

To have a peek at the CMAJ’s published guideline summary, click here.

To access the guideline in its 19 chapter entirety, click here.

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The Canadian Obesity Guidelines Are Here – Time To Join The Conversation!

As of this morning, the 2020 Canadian Clinical Practice Guidelines for Obesity Management in Adults are out on the CMAJ and Obesity Canada websites, respectively. These guidelines present a departure from previous guidelines on a number of important issues. For one, Obesity is clearly defined as “a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.” Although BMI and waist circumference can still be used for populations surveillance and screening purposes, the ultimate diagnosis should be based on the impact that adiposity has on health and not some arbitrary anthropometric cutoffs. Other topics that receive strong consideration include the role of weight bias in clinical practice, a departure from solely weight-centric outcome with a focus on health and wellbeing, learning from the body positivity movement, recognising the importance of root causes including psychosocial factors and mental health, and much more. Given that there will be many questions and issues around many of these topics, especially with regard to implementation in practice, Obesity Canada is also launching an online information and discussion platform OC-Connect-Pro, where health professionals can connect and share information, tap into tools and education about the guidelines. To join OC-Connect-Pro click here. @DrSharmaEdmonton, AB

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Early Registration For Obesity Guideline Webinars Now Open

We are now just one day from the long-anticipated release of the 2020 Canadian Obesity Clinical Practice Guidelines in the Canadian Medical Association Journal (CMAJ) and on the Obesity Canada website. But, registration for a first series of six webinars, starting Aug 11, by some of the leading chapter authors is already open. This interactive webinar series is offered through a partnership between Obesity Canada and the University of Alberta’s Office of Lifelong Learning. For a nominal fee of just $50 (Canadian) for all six webinars (i.e. less than $10 per webinar), participants will be able to: Provide obesity chronic disease management in a planned, proactive manner Support patients to understand how their root causes, comorbidities and personal context are related to their obesity management List, review and select therapeutic approaches (behavioural, medical, surgical) to help patients develop personalized plans to manage their obesity as a chronic disease. Speakers include Drs. Sean Wharton (Toronto), Sara Kirk (Halifax), Michael Vallis (Halifax), Sue Pedersen (Calgary), Rita Hendersen (Calgary), and myself. For more information visit the Obesity Canada website by clicking here. @DrSharmaEdmonton, AB

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Saturday Stories: Vaccine Reality Check, Early Warning Failure, And Maybe We Should Talk About Ventilation

Sarah Zhang, in The Atlantic, with a vaccine reality check.

Grant Robertson, in The Globe and Mail, on how Canada’s pandemic early warning system failed with COVID19.

Zeynep Tufecki, in The Atlantic, wonders why we’re not talking more about ventilation

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The 2020 Canadian Obesity Guidelines for Adults are Coming!

Finally, after about three years of hard work by a panel of over 60 authors (not to mention the incredible staff at Obesity Canada), the 2020 Canadian Clinical Practice Guidelines for Obesity Management in Adults will be released in the Canadian Medical Association Journal next week (Aug 4). This monumental undertaking, that began with extensive literature searches (identifying over 550,000 potentially relevant articles), which was systematically whittled down to about 80 GRADEd recommendations, represents a state-of-the-art evidence and practice informed overview of managing obesity as a complex progressive chronic disease. Without divulging too much, I can share that the guidelines will cover a broad range of topics from re-defining obesity, to the importance of recognizing weight bias in obesity medicine, to taking a patient-centred approach, where the focus is on improving health and well-being rather than just changing numbers on the scale. Importantly these guidelines are perhaps unique in the field of obesity, as they include analyses of both quantitative and qualitative research, the latter having often being largely ignored by previous guidelines. In addition, there was ample involvement and representation of the patient voice in the discussion of findings and wording of recommendations. Targeted at primary care practitioners, the guidelines outline what we know about obesity management but also outlines the often extensive and important gaps in our knowledge. So please stay tuned, as more information becomes available over the next few days and weeks. @DrSharmaEdmonton, AB

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The UK Releases a Pie-in-the Sky Plan to Tackle Obesity

Last week, the UK released a pie-in-the-sky plan to address their obesity problem. Although, I’am sure it is well-intended, I find it impossible to fathom that anyone with even an ounce of knowledge of the complex, multifactorial, chronic, and often progressive nature of obesity should in this day and age still fail to understand that the proposed plan, which includes the usual talk of changing the food environment (largely by appealing to personal responsibility) and a 12-week weight loss plan app [sic], focussed on healthy living (read, “eat-less-move-more”), is about as likely to noticeably reduce obesity in the UK population, as taking out a full page ad in The Sunday Times stating that “Obesity is bad!”. Let us for an instance assume that millions of UK citizen download the app and somehow manage to lose 12-pounds in 12 weeks. Why on earth would anyone expect this weight loss to be “permanent” (never mind have lasting health benefits)? After all, if there is one single thing that decades of obesity interventions have taught us, it is that, short of bariatric surgery, there are no “permanent” weight loss solutions (and even surgery is by no means a guarantee!). This is exactly why any serious analysis of the published science on this issue today generally ignores any study of less than 12 months duration – because the results of anything shorter are entirely irrelevant in terms of informing long-term obesity management. This is not because you cannot lose weight in 12 weeks – of course you can! But because it should be well known by now that it will take most people less than 6 weeks to put it all back on. This is not because they are stupid, or not-motivated, or simply don’t get it, or lack will power, or are not trying hard enough – it is simply because of the fundamental biology of how bodies regulate body weight. As I never cease to explain to my patients, “bodies like to gain weight but don’t like to lose it”. Today, we not only understand the complex and powerful biological mechanisms that defend the body against long-term weight loss but also that these very same biological mechanisms virtually guarantee weight regain (except perhaps in a handful of the most dedicated individuals). So, as the UK embarks on a NHS-sponsored nation-wide exercise in yo-yo dieting, one must wonder about who exactly came up… Read More »

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Professional Networking in COVID Times

Colleagues have often referred to me as a professional networker par excellence. Indeed, there is no doubt that I consider countless colleagues around the world, at all stages of their careers, across a wide area of interests, as acquaintances and often friends – people in my professional network that I have personally met and can readily call on for professional (and sometimes personal) advice. Beginning in the early days of my career, I have accumulated and cultivated this wide-ranging professional network and it has always served me well. Indeed, I am fully aware of the importance of maintaining active ties, weak ties, and even dormant ties to people who have influenced me and I may, in turn, have influenced. As I look back to well over three decades of my professional life, this professional social network has always been my go-to resource at every decision point in my career – it has enriched by academic life, my research, my teaching, my clinical practice, my professional advocacy and much else. How did I meet all these people (a practice that started well before social media or even the internet)? It was usually at medical and scientific conferences! As a young researcher, presenting my first poster at a major international conference, I remember waiting nervously in line to introduce myself and shake the hands of the famous professor, whose papers I had studied. I remember attaching myself to the coattails of my supervisor in the hope that he would introduce me to his colleagues (which he did) hoping to eavesdrop on their conversations (which I did). I remember standing at my poster waiting for the important professors to stop by and look at my work (which they did). I remember attending all the social events and gala dinners and late night last drinks at the hotel bar, where I met colleagues from around the world, who I now consider close friends and colleagues. I remember standing in line at breakfast and coffee breaks, sharing cab rides to and from hotels or airports with strangers, who I now count as my associates. I remember the friendships forged with colleagues during countless memorable walks and touristic outings during time off between busy scientific sessions. Over the years, meeting the same colleagues year after year at various places around the world, seeing their careers develop as did mine, sharing in their successes and challenges, was… Read More »

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Saturday Stories: COVID Orphans, A Must Read Piece, The Currency of Risk, And COVID19 Vaccine Side Effects


Dr. Anna DeForest

John Woodrow Cox, in the Washington Post, with a heartbreaking story about 3 coronavirus orphans.

Anna DeForest, in The New England Journal of Medicine, with what I would describe as an absolutely must read piece highlighting the crushing devastation COVID is wreaking on front-line physicians.

Maggie Koerth, in Five Thirty Eight, explains how every decision is a risk, and how every risk is a decision.

Hilda Bastian, in Wired, explains why there needs to be frank transparency around any possible COVID19 side effects even if they’re minor.

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