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Tuesday, 31 July 2012
Sleep Over Homework for Better Health and Academic Performance
Not only does too much homework negatively affect students’ test scores, but new research suggests that even an hour or two of homework each night gives no measurable advantages to students before they enter grades 10 through 12. Sydney University’s Richard Walker headed up the study outlined in his new book “Reforming Homework: Practices, Learning [...]
Research Sez: It’s Carbs, Not Fats, That Fatten Us
(CC) Daniel Oines/Flickr
Why Your Supermarket May Never Be the Same
There are two things taken as virtual gospel in the nutritional and health sciences when it comes to weight control:
- Calories are calories, and if you take in more than you burn off, regardless of the source, you’ll gain weight.
- It’s difficult but demonstrably possible to lose a significant amount of weight; unfortunately, it’s nearly impossible to keep that weight off permanently because the body wants that weight restored and will drive its owner mad with hunger to get it back.
The are two problems with No. 1. First, this truism has been around for 134 years, and it’s hard to believe that the biological sciences haven’t learned any more on the subject of weight gain in all that time. Second, even during most of those years there were some scientists who believed it was more complicated than that; that there are calories in protein, calories in fat and calories in carbohydrates, and the body may not treat them all the same way.
As for No. 2, it still holds true. Unless, that is, the body actually does treat calories differently depending on their source, in which case keeping weight off may be more or less difficult depending on one’s calorie sources.
This reality is what makes the latest issue of the AMA Journal such a hot read in weight-loss circles. It contains a report on a study conducted by Dr. David Ludwig of Boston Children’s Hospital which indicates that when it comes to calories, those from fat and protein are not the problem: it’s those derived from carbs that are the fat-creators. This has shaken a lot of pillars of the medical community, where the standard dietary recommendation endorsed by everyone from the USDA to the American Heart Association has been to go with low-fats and plenty of carbs. But Ludwig’s findings are awfully persuasive.
In a nutshell, he crash-dieted 10 to 15 percent of the weight off some obese volunteers, whose bodies responded as expected: by burning far fewer calories than normal to store more energy as fat. And then he divided them into three groups, and put each group through a rotation of three different diets. One diet was low-fat, high-carb. One was the Atkins diet, high-fat and low-carb. And one was not just low-carb, but selectively so, avoiding sugars and starchy, refined or processed food items and substituting “complex” carbohydrates, which take more energy to digest.
The results were striking: The volunteers burned off 300 more calories per day on the low/complex-carb diet than they did on the low-fat — an amount equal to 60 minutes’ worth of moderate physical exercise — and 150 more per day than on the Atkins, although all three diets provided the same number of total daily calories.
The implications of this — that it is carbohydrates, not fats, that pack on the pounds — have rocked a lot of people back on their heels. Especially people in the Food Industry, High Carbohydrate Division, such as purveyors of sodas, desserts, baked goods, breakfast cereals, sweets, snacks and other high-carb items. These enterprises can be expected to dig in their heels. There will be PR blowback. They will point out that fats contain twice as many calories per gram as carbohydrates, which is true, and that Ludwig’s study was far too brief — just one month long — to be remotely conclusive, which is also true.
But follow-up studies on a larger and more independent scale will not be long in coming, and if Ludwig’s conclusions turn out to be correct — and the AMA Journal does not traffic in half-baked research — the effect will be earthquake-like in the fields of medicine, nutrition, commerce, agriculture and food marketing. In the 1990′s, the fat-is-bad doctrine resulted in literally countless food products replacing the tasty fats in their ingredients with equally tasty sweeteners. A shift to a carbs-are-bad doctrine would most likely result in a similar 180-degree shift.
In just a few years, the American diet could be significantly different, especially to American dieters. And also to people whose fortunes are linked to the consumption of sugar and high fructose corn syrup, who may at best be looking for work, and at worst for bridges to leap from.
(By Robert S. Wieder for CalorieLab Calorie Counter News):
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Research Sez: It’s Carbs, Not Fats, That Fatten Us is a post from: CalorieLab - Health News & Information Blog
Source: http://calorielab.com/news/2012/07/18/research-sez-its-carbs-not-fats-that-fatten-us/
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Book Review: Practical Paleo by Diane Sanfilippo
Diane Sanfilippo of Balanced Bites has been a fantastic resource for people looking to learn more about following a Paleo diet and how to maximize their overall health and digestion. I’m a big fan of her blog as well as her podcast, and I’ve been a guest on her show. She provides excellent information in a way that is easily understood by the general population, making her an asset to the ancestral nutrition community.
For these reasons, I was very excited when I received my copy of Diane’s much-anticipated book, Practical Paleo, which is a gold mine for those new to the Paleo diet or struggling to integrate it into their everyday lives. I’ve always believed that personalization is the key to long term success, and Diane’s 30-Day Meal Plans will help you achieve just that. Practical Paleo will prove to be a resource I recommend to my patients and online community again and again.
There are a few components of this book that stand out as being especially unique and useful for anyone from the newbie Paleo eater to the well-established nutrition junkie who is looking for ways to tweak their diet. One of my favorite sections of the book is the collection of meal plans specific to certain health conditions and goals. Diane has developed recipes for conditions ranging from autoimmune disease, digestive disorders, thyroid health, and even athletic performance and fat loss. She includes over 150 pages of recipes to help support these meal plans, making it even easier to follow her detailed plans that are customized to your individual needs. Though she calls her diet Paleo, Diane brings in great information from sources such as Weston A. Price’s work, and provides this information with illustrations to help clarify her explanations.
Another aspect of Diane’s book that I appreciate is her detailed but easily understood explanation of a variety of health issues. She gives a thorough overview of general nutrition principles, and then dives deeper into certain common health conditions that can be greatly improved using a healthy diet. Diane’s passion is digestion, and she provides readers a great deal of information on leaky gut disorders, gluten intolerance, digestive distress, and even an illustrated guide to poop! Diane answers the digestion questions you never thought to ask, as well as those that you might have been too timid to discuss, making this book a great resource for anyone struggling with digestive disorders.
One other component of this book that is creative and hugely useful is the tear-out guides featured at the back of the book. Diane has provided a collection of Paleo food lists, pantry staples, and guides to common food substances that may need to be avoided depending on your health condition, such as gluten and sweeteners. Any of these guides can be easily removed from the book and posted on the fridge or carried to the grocery store, making your transition to an individualized Paleo diet even smoother.
Besides just being a great educational resource, this book is really fun to look at. The illustrations are highly informative, and the food photographs are beautiful. Sometimes a book with a great deal of information can be somewhat boring to read, but Diane has combined useful health information with a great flair for style and imagery. And if the food tastes as good as it looks in the photographs, taken by Bill Staley of the Primal Palate, then readers are in for a treat when they prepare the great recipes.
Diane’s Practical Paleo will be a great resource for everyone interested in improving their health using the principles of an ancestral diet. She does a fantastic job of explaining complicated biological and biochemical systems in the human body, allowing the reader to understand the reasons why they may benefit from adding or eliminating certain foods in their diet. Without a doubt, I will recommend this book to my patients and readers, as well as any person seeking to optimize their health using a whole foods approach.
You can purchase Diane’s book Practical Paleo on Amazon. Preorder it now to get the best price before it launches on August 7th!
Note: I earn a small commission if you use the links in this article to purchase the products I mentioned. I only recommend products I would use myself or that I use with patients in my practice. Your purchase helps support this site and my ongoing research.
Source: http://chriskresser.com/book-review-practical-paleo-by-diane-sanfilippo
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The New Home AIDS Test: Not Perfect, But Close Enough
(CC) PLoS/Wikimedia Commons
As Long As We Use It Wisely
“We don’t have a sign on purpose. We have patients who are scared to death that people will find out about their condition. People in the South are still in the dark ages about HIV.” — Mel Prince, director, AIDS Information and Referral Center, Selma, Alabama, 2012.
AIDS and I go back a long way.
No, no, not in that sense. I mean journalistically. Years ago, I was writing an advice column for a men’s magazine on subjects including health, and on Sundays I would listen to a young eye surgeon who’d passed through his hippie dropout phase and now did a one-hour-a-week medical advice call-in show on local radio. His name was Dr. Dean Edell, and he would later go on to rather bigger things.
Because this was San Francisco in 1979, he was one of the very first to hear and take note of a local epidemic of Kaposi’s sarcoma, an otherwise uncommon connective tissue cancer that seemed to suddenly be rampant among male homosexuals, and reported it on his show. That’s where I heard about it in early 1980, and in passing it on in my column I became, to my knowledge, the first to report in a national publication what later became known as the “gay cancer” and still later, a sign of a new disease called AIDS.
Then, in 1986, I was tested for HIV myself. And no, not for that reason. Ostensibly it was at at the request of, and to reassure, a woman I had just begun dating, who was in her own words “really paranoid” about the disease, which was about as good an argument for paranoia as you could find at the time. But in reality, I decided to be tested because I had never read a first-person report from someone who’d done so, and thought it might make an interesting, i.e. marketable, article.
And so it did, for the S.F. Chronicle, whose editors seemed most impressed that I would undergo, and publicly discuss, an AIDS test when I didn’t really have to. That’s how strong the stigma was at that time: merely taking the test as a journalistic exercise seemed somehow disreputable. It’s as if I had told them I was volunteering to actually get AIDS. (My doctor at Kaiser Hospital in fact suggested I get the test done at a confidential facility because, “If we do the test, the record will go into your files here.) So it was with a sense of personal, if remote, satisfaction that I recently read the news about the new AIDS home-test kit.
As noted here in a Lab Notes posting, the Food and Drug Administration has just approved the first over-the-counter home test kit to detect the presence of HIV, the virus that causes AIDS. It’s called the OraQuick In-Home HIV Test, and it involves simply taking a swab of fluid from the upper and lower inner gums, inserting it into a vial, and waiting for 20 to 40 minutes for the results.
This is terrific news, since there are, according to CDC estimates, some 240,000 people living in the U.S. with an HIV infection that they are currently unaware of. A number of them — my personal guess would be roughly one-quarter — remain in the dark by choice, because they’re ashamed to find out; because they don’t want to appear, even if it’s just to a few impersonal and indifferent clinic workers, to be the kind of person who might contract the HIV virus. And there’s this: if the tests turn out negative, they’ll have tainted themselves for nothing.
It’s been 25 years since my HIV-test article, and yet some people still would rather risk AIDS than their reputation. Therein lies the importance of the new in-home test: given the option of privacy and anonymity, it can reasonably be expected that a lot of people who would not have gotten tested otherwise now will test themselves, and some will discover their infections and take action, and their lives will be better and longer as a result. So hooray for that.
But before we start organizing parades in celebration, let’s review the following cautionary excerpt from the FDA’s very own press release announcing the OraQuick approval:
A positive result with this test does not mean that an individual is definitely infected with HIV, but rather that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months.
This takes some of the air out of the balloon, since a test that isn’t necessarily accurate does not sound like a test that is necessarily worth taking. But it’s not that bad. In fact, by FDA math, only about one in 5,000 uninfected test takers can be expected to get a false positive, an error that is easily exposed and corrected by a follow-up test at a clinic or doctor’s office. Unfortunately, the math in the converse situation is less reassuring. One false negative can be expected in every 12 tests of infected persons.
Given that the size of the pool of the unknowingly infected is a robust 240,000, that one-in-twelve ratio works out to 20,000, a dangerously large number of people to have returning to their social lives with the blithe, if incorrect, assurance that they won’t be passing on HIV. Of course, the actual number of unwitting carriers won’t be anywhere near the maximum of 20,000, but the total number of people they go on to have sex with could come fairly close.
And there are other questions. For one, an acquaintance who read about the OraQuick breakthrough wondered how we’ll actually use it. Will women now carry the test kits on dates or to singles’ gatherings, tucked away in their purses right next to the condoms? (And if the test is negative, do you get to skip the condom?) Could you surreptitiously swab a new lover’s toothbrush or a can or bottle they’d been drinking from and run a test on it? How about an ex-lover? Or a co-worker?
The fact that these may be bonehead ploys won’t stop some people from trying them, and since the test was not designed for such questionable, haphazard fluid sources, the result will most likely be nothing but negative results, some of them perhaps false. The prospect of people engaging in sex in the mistaken assumption that they or their partners are AIDS-free is almost as dangerous as no home test at all.
Bottom line, the Ora-Quick Test is excellent news and if used sensibly and meticulously, can save a great number of lives. Even so, I can’t shake the notion that somehow, to some extent, too many of us will find a way to misuse, misinterpret or otherwise screw it up.
(By Robert S. Wieder for CalorieLab Calorie Counter News):
Ed. note: Enjoyed this post? Click the “Like” button below and be sure to “Like” the CalorieLab Facebook page.
The New Home AIDS Test: Not Perfect, But Close Enough is a post from: CalorieLab - Health News & Information Blog
Source: http://calorielab.com/news/2012/07/25/the-new-home-aids-test-not-perfect-but-close-enough/
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Astronaut Menu for NASA Mars Mission in 2030 is Already Being Planned
There are no restaurants or convenience stores between Earth and Mars. This means astronauts will have to pack their food for the history-making trip to Mars in the 2030s. And since a cooler won’t cut it on the spaceship, the meals are already being planned for this epic trip. Maya Cooper is a senior research [...]
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Weight Loss Tips That Make You Lose Fat Weight Fast!
Here are some weight loss tips that can make you lose fat weight extremely fast! You also want to make sure that you start today! Because the thing about losing weight is the simple fact that there is a lot of misinformation out there and it can be pretty easy to get distracted!
Okay, so you want some weight loss tips to make you lose weight extremely fast right? Well we are going to give you some of these tips right now!
Eat More Meals
Well, everybody knows exercising and dieting is the key, but when you tell someone that they should eat “more” meals, people will look at me like I’m absolutely crazy, but it’s true. You want to eat more meals.
Now that’s not saying to actually eat more food, we’re just saying that you should try to eat more meals so that the food that you eat in one sitting is not stored as fat – that’s what happens when you eat a big meal, you store more energy than your body needs, so it is stored as fat – which, as you guessed, makes you gain more fat weight!
Join a Community
The key to losing long term weight and keeping it off, is joining some type of online community or online forum. This is extremely key when trying to get that fat off and keeping it off. You can relate to other people who are in your situation, you’ll be absolutely alarmed about how motivated you are to succeed because there is a group of people doing the same thing as you!
Just make sure that you start today!
Drinking Plenty of Water
This is something that is overlooked but to be honest, most people simply do not drink enough water. You want to make sure that you are drinking water each and every single day because it gets rid of the toxins and helps make the weight loss process much easier!
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Monday, 30 July 2012
Bob Greene’s Best Motivation Secrets for Weight Loss
By Bob Greene for TheBestLife.com I get asked a lot of questions about weight loss, fitness and diet, but the topic most people want to know about is motivation—how can I find the drive to get going? How can I maintain it once I get started? How do I get back on track after a [...]
Source: http://www.dietsinreview.com/diet_column/07/bob-greenes-best-motivation-secrets-for-weight-loss/
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Irregular Work Hours Can Shorten Your Life, Study Shows
If you’ve ever thought working the graveyard shift sounded like the least appetizing schedule imaginable, you’re not alone. I for one would much rather wake up at 6 a.m. and work until 3 if it meant I could have my precious evening hours to myself. Now there’s more reason to loathe the night shift: it’s [...]
Source: http://www.dietsinreview.com/diet_column/07/irregular-work-hours-can-shorten-your-life-study-shows/
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Lab Notes: Anemia Drugs Yield Big Profits, Few Benefits
On our Lab Notes page CalorieLab’s editors select and rank the day’s essential health news items in real time. Readers can suggest, vote and comment on items. Below are brief summaries of yesterday’s (July 22, 2012) Lab Notes items. To see today’s items, visit Lab Notes.
1. Anemia Drugs Yield Big Profits, Few Benefits
Anemia drugs Epogen, Procrit and Aranesp, which have generated over $8 billion a year for more than 20 years for Amgen and Johnson & Johnson, provide nowhere near the benefits the makers claim, and have side-effects that include strokes and cancer.
(By CalorieLab editors)
Lab Notes: Anemia Drugs Yield Big Profits, Few Benefits is a post from: CalorieLab - Health News & Information Blog
Source: http://calorielab.com/news/2012/07/23/yesterdays-health-news-from-labnotes-839/
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Jordin Sparks’ Bikini Body Credited to Zumba and a 50 Pound Weight Loss
Jordin Sparks has been known for her curvy body since the sixth season of American Idol. When she was 17 years old, Jordin was a size 14. The singer and actress remembers constantly feeling tired and sick by the time she was 21. Not feeling healthy and energetic was a big concern for her. “I [...]
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How to Cook with Watermelon
Watermelon is one of my all-time favorite fruits. Its sweet flavor and light texture is refreshing every time I bite into it. While I’ve always known that watermelon is a fairly healthy food, especially if it’s taking the place of a heavy dessert, I had no idea how dense it was with good-for-you vitamins and [...]
Source: http://www.dietsinreview.com/diet_column/07/how-to-cook-with-watermelon/
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Do You Want Fries With That? Choice and the McDonald’s Fry Monopoly at the London Olympics
Contributor: “Dr. J”Dr. J offers his irreverent, slightly irrelevant, but possibly useful opinions on health and fitness. A Florida surgeon and fitness freak with a black belt in karate, he runs 50 miles a week and flies a Cherokee Arrow 200.
I don’t know what you think about New York Mayor Bloomberg’s proposal to limit soda servings to 16 ounces or less in the city, but I think that I know how McDonald’s feels about the issue.
McDonald’s should vote for limiting personal choice, freedom be dammed! Why do I think this, considering that McDonald’s is a major purveyor of the Coca-Cola products that are among the ban’s many targets? Because Ronald McDonald’s very large shoe is on the other personal-choice foot in merry old London, England.
When it comes to the Olympics in London, rather than arguing for more personal choice, McDonald’s has decided to put its money-laden foot down. It has banned the sale of any chips, as in French Fries, kicking any seller of these chips out of the field of play like a 56-meter rugby field goal unless they are selling fish with those chips.
Freedom of Choice Depends on Who’s Selling the Chips
It appears that the McDonald’s corporation has banned hundreds of food retailers at the Olympic Games venues across Britain from selling French fries during the Games.
The London Organizing Committee of the Olympic Games has made this decision due to “sponsorship obligations” with the biggest commercial food partner at the Games, our “I’m lovin’ it, if I’m sellin’ it and you’re buyin’ it,” McDonald’s.
The one exception to this rule will be the selling of the British classic, fish and chips, probably arrived at after a tense meeting between the Queen and the Clown at an undisclosed location.
The committee has warned consumers that if there is any significant resistance to this proclamation, they will take away the fish and chips and send customers to their rooms for a time-out until they can get a grip on their threatening appetites.
“Please do not give the staff grief,” the memo states. “This will only lead to us removing fish and chips completely.”
The obvious solution to this culinary roadblock was suggested years ago by the Jack Nicholson character in “Five Easy Pieces.”
I suspect there will be a lot of fish in those Olympic-sized dumpsters.
Freedom of Choice
I suppose when it comes to our freedom of choice, it is all a relative thing, but two things are certain when it comes to the temporary “world’s biggest McDonald’s ever” next to the Olympic Stadium: The world’s biggest chip fryer will be running at a world record pace, and the corporation’s profits will be “Citius, Altius, Fortius!”
Ed. note: Enjoyed this post? Click the “Like” button below and be sure to “Like” the CalorieLab Facebook page.
Do You Want Fries With That? Choice and the McDonald’s Fry Monopoly at the London Olympics is a post from: CalorieLab - Health News & Information Blog
Source: http://calorielab.com/news/2012/07/16/choice-and-the-mcdonalds-fry-monopoly-at-the-london-olympics/
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HealthyShare App Makes Olympic Athletes Your Personal Trainers
The entire globe is getting Olympic fever. With the games officially kicking off tonight, the excitement is only going to get higher. Whether you’ve had the bug or are just now getting bitten, are you aware you can still train like an Olympian, with the help of Olympians? Earlier this summer General Electric (GE) and Facebook [...]
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Sunday, 29 July 2012
7th Obesity Research Summer Bootcamp
Faithful readers will be well aware that around this time of the year, I spend well over a week at the Canadian Obesity Network’s Summer Bootcamp, which offers 24 handpicked trainees and new professionals a remarkably intense educational event dealing with all aspects relevant to obesity research - from molecular mechanisms to epidemiology, from nutrition and exercise research to medical and surgical treatments, from policy to health economics.
This camp has been a longstanding collaboration with the University of Laval (with strong input and support from the University of Alberta) and has resulted in a rather tightly knit network of over 150 young obesity professionals across Canada (and now internationally).
As anyone involved in the Canadian obesity research community is well aware, it is hard not to stumble across a former ‘Bootcamper’ at scientific meetings or (increasingly) in government, health care systems and NGOs (where many of the Bootcampers have since found employment - no surprise given that they represent the ‘best-of-the-best’ among the next generation of Canadian obesity experts).
Unfortunately, funding this rather exclusive but important initiative remains a challenge, which is why we have had to reduce the length of the camp from nine to seven days - making the program even more crowded - all of obesity is a lot of ground to cover by any standard.
I certainly look forward to another exciting week of learning and friendships - all former Bootcampers will know exactly what I am talking about.
AMS
Station touristique Duchesnay, QC
Source: http://feedproxy.google.com/~r/AryaSharma/~3/cFBGNAS53mk/7th-obesity-research-summer-bootcamp.html
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7th Obesity Research Summer Bootcamp
Faithful readers will be well aware that around this time of the year, I spend well over a week at the Canadian Obesity Network’s Summer Bootcamp, which offers 24 handpicked trainees and new professionals a remarkably intense educational event dealing with all aspects relevant to obesity research - from molecular mechanisms to epidemiology, from nutrition and exercise research to medical and surgical treatments, from policy to health economics.
This camp has been a longstanding collaboration with the University of Laval (with strong input and support from the University of Alberta) and has resulted in a rather tightly knit network of over 150 young obesity professionals across Canada (and now internationally).
As anyone involved in the Canadian obesity research community is well aware, it is hard not to stumble across a former ‘Bootcamper’ at scientific meetings or (increasingly) in government, health care systems and NGOs (where many of the Bootcampers have since found employment - no surprise given that they represent the ‘best-of-the-best’ among the next generation of Canadian obesity experts).
Unfortunately, funding this rather exclusive but important initiative remains a challenge, which is why we have had to reduce the length of the camp from nine to seven days - making the program even more crowded - all of obesity is a lot of ground to cover by any standard.
I certainly look forward to another exciting week of learning and friendships - all former Bootcampers will know exactly what I am talking about.
AMS
Station touristique Duchesnay, QC
Source: http://feedproxy.google.com/~r/AryaSharma/~3/cFBGNAS53mk/7th-obesity-research-summer-bootcamp.html
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Hindsight: Bariatric Medicine Without Surgery is Like Nephrology Without Dialysis
One of the first articles I wrote after arriving in Canada as Canada Research Chair (Tier 1) in Cardiovascular Obesity Research and Management at McMaster University, was an editorial published in OBESITY SURGERY, in which I expressed my frustration about not having ready access to bariatric surgery for my patients, who desperately needed it.
In this article I noted that
“On accepting the position, I knew that I would be required to do some pioneering work: obesity or rather bariatric medicine is not a ‘recognized’ medical speciality. Rotation in an ‘obesity unit’ is neither a requirement nor of interest to the majority of medical residents. Most doctors’ understanding of obesity, its causes, its complications, and its management is not substantially different from that of a lay person. The well-known bias and discrimination that meets obese patients is also encountered in the commonly held views on the need for and delivery of medical and surgical treatment for this condition.”
“Within weeks of my arrival, referrals for patients began coming in, rapidly growing to over 20 per week. Within a few months, calls were coming in from across the province. One of the first patients I was called to see was a 41-year-old man weighing 436 kg, who had spent the last 9 months in an intensive care unit where he was being treated for intractable lymphedema and cellulitis of his lower extremities. The patient was living in his own ICU suite, while his caregivers were exploring the possibility of having him accepted for obesity surgery. It was already evident that this surgery could not be performed in Canada.”
“Within the first 6 months of my practice, I saw the heaviest people I had ever seen in my life. BMIs >50 kg/m2 were the rule rather than the exception. Most were below the age of 45, virtually none were currently employed, few had drug plans, and none had coverage for antiobesity medication. The majority had a history of childhood-onset obesity, all had significant co-morbidities including diabetes, reflux disease, sleep apnea, and debilitating back and knee pains.
All had significant histories of weight loss attempts, ranging from Weight Watchers and very low- calorie diets to rather questionable ‘medically supervised’ commercial weight loss programs. Many had also failed on pharmacotherapy. None had thus far been offered surgical treatment – the few who had tried to find surgeons in Canada soon discovered that there were only six surgeons performing obesity surgery in the province (population 9,000,000), none of whom were accepting referrals. Some patients were vaguely aware of a process for ‘out-of-province’ referrals, but none knew how to go about it or whom to ask for assistance.
Interestingly, despite the undeniable suffering and disability caused by their excess body weight, a seemingly large proportion of patients would not consider a surgical option because of the perceived risk. They were still hopeful that I would know of some magic bullet that could cure them of their condition (so were some of their referring physicians).”
“Clearly, surgery cannot be a solution for every patient with morbid obesity. Even with 1,000 operations a year, it would take over 200 years to operate on every morbidly obese patient in Ontario. So who should be operated upon, by whom, with what operation, and at what time point in the course of the disorder? Currently, there is little evidence from randomized controlled trials – the ‘gold standard’ of evidence-based medicine – on any of these issues. It appears that the basis for current practice is largely empirical, based on the expertise and judgement of individual surgeons. Yet, an important premise of ‘evidence-based’ medicine is to base care on the best available evidence. If empirical evidence is all we have, then this is what our standard of care should be based on – and no doubt, the empirical data in support of obesity surgery is impressive. It is clearly by far the most, if not the only, successful treatment for morbid obesity currently available.”
“Indeed, without the possibility of referring my patients to an experienced and dedicated obesity surgeon, I feel like I am practising nephrology with no access to dialysis or transplantation. There was only so much I could achieve with diet, blood pressure management, and immunosuppression in my patients with advanced renal failure. In the end, their survival depended on renal replacement therapy.
Similarly, there is only so much I can achieve with diet, exercise, and pharmacotherapy in my morbidly obese patients – ultimately resolution of their medical problems, if not their very survival, will depend on successful obesity surgery. In fact, from all that I have read and seen so far, obesity surgery for morbid (or should we call it malignant?) obesity appears far more successful in terms of improving quality of life, resolving co-morbidities, and promoting physical, mental, and socioeconomic rehabilitation than either hemodialysis or renal transplantation for patients with end-stage renal failure.”
“Surgery remains an important option for numerous ‘medical’ disorders: coronary bypass surgery for coronary artery disease, fundoplication for gastro-esophageal reflux, parathyroidectomy for hyper-parathyroidism, bullectomy for pulmonary bullous emphysema, knee replacements for osteoarthritis, kidney transplantation for renal failure, to name a few. Younger physicians perhaps forget that less than two decades ago, surgery was the treatment of choice for gastric and duodenal ulcers. All of these patients require long-term follow-up and management by internists or family physicians. Recognition of the important role of obesity surgery in the treatment of morbid obesity by internists and family physicians, and their commitment and dedication to the long-term medical management of patients who have undergone bariatric surgery, is long overdue.
For my part, I will undertake all that is necessary to establish bariatric surgery as an important and much needed surgical program at our university medical center.”
A lot has happened since I wrote these words.
Only days after I accepted my current position at the University of Alberta, the Ontario Government did announce funding for a bariatric program at McMaster - too late for me, I had already signed my new contract.
Today, Ontario does have its own Bariatric Network of “Pre-assessment” Clinics and bariatric Centres of Excellence. On the other hand, Ontario has yet to find a model that will appropriately look after the well over 2,000 patients who now receive bariatric surgery each year. There is still no non-surgical program that will treat obese patients early enough to prevent them from reaching a stage where they do need surgery. Nor is there a system in place to manage those who are not good candidates for or do not choose to undergo surgery.
Despite thousands of operations, there is still no real ‘academic’ bariatric program in Ontario - in 2010/11 there was barely a handful of peer-reviewed publications on bariatric care from all of Ontario - not even one paper per medical school - not surprising perhaps, given that there is not even a single chair in bariatric medicine or surgery at any of its five universities.
So, while more patients are now at least getting treatment, the field of bariatric medicine and surgery is still seeking form and structure in Ontario. To be fair, the situation is not that much better in other provinces.
Quebec has seen some improvements in access, but lags well behind Ontario in numbers. Nova Scotia has a fledgling program as does New Brunswick. Saskatchewan and Manitoba now perform a handful of surgeries a year. BC still has no recognizable bariatric strategy.
With about 600 surgeries performed across Alberta together with significant investments into a provincial obesity plan, Alberta, given the size of its population, may be slightly ahead of the pack - at least academically, it ranks number one, if the number of scientific publications on bariatric surgery is any indicator (12 paper in 2011, closely followed by Quebec with 10 articles, easily outranking all of Ontario with a single paper published in 2011).
Thus, eight years after I wrote this editorial, surprisingly little has changed when it comes to the recognition and importance of bariatric care and the need for greater investments and resources into researching the many open questions about the care of these patients.
Across Canada it is still far easier for someone with failing kidneys to receive dialysis than for someone with severe obesity to receive even minimally adequate medical or surgical treatment.
I wonder what the next eight years will bring to the field and to my patients - how much longer are they willing to wait?
AMS
Edmonton, Alberta
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Saturday Stories: Whooping cough and an Olympic Double Shot
Just in time for the Olympics the Atlantic has a slide show primer on performance enhancing drugs.
The Lancet and their Olympic themed editorial on Big Food sponsorship aptly titled, "Chariots of Fries"
Source: http://feedproxy.google.com/~r/blogspot/fLgR/~3/CKrQb5aIFyQ/saturday-stories-whooping-cough-and.html
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