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Sunday, September 30, 2007

Obesity Sensitivity Training

One of the topics that came up at the retreat and should be part of our strategic plan was sensitivity training to avoid bias and discrimination of obese clients. It is certainly no secret that health professionals (like the general public and obese people themselves) often have negative views on obesity which are either implicit or explicit. I can't recall how often I have heard from patients that sometimes complete strangers come up to them and comment on their weight or throw disapproving looks at them, when they eat in public.

If anyone knows how best to go about providing sensitivity training to our team and to other CH employees, I'd love to know. Any links to resources would be most helpful.

In the meantime if you are wondering if you yourself harbor an implicit bias against obese people (or other popular "targets"), you may consider taking a short test at the Project Implicit Site, a virtual laboratory run by three Harvard Scientists at which visitors can examine their own hidden biases. This site allows web visitors to experience the manner in which human minds display the effects of stereotypic and prejudicial associations acquired from their socio-cultural environment. You may be surprised at the results.


Saturday, September 29, 2007

Obesity and Cancer

As probably all of you know, cancer is one of the leading causes of mortality in obese patients, on the other hand treating obesity (at least with bariatric surgery) is associated with a 40-60% reduction in cancer mortality (see the Sjostrom et al. and Adams et al. studies recently published in the NEJM).

I had several conversations/contacts last week about this:

1) Vickie Baracos UofA's Alberta Cancer Foundation Chair in Palliative Medicine, told me about some fascinating data they were collecting on obesity in their cancer patients, hundreds of MRI and CT images were currently being analysed.

2) I learnt that Dr. Tanis Mihalynuk and colleagues from the Alberta Cancer Board were just embarking on an asset mapping exercise regarding community resources on obesity prevention.

3) I also received an e-mail from Dr. Heather Bryant, Vice President & C.I.O., Alberta Cancer Board, Director Division of Population Health & Information, who would like to meet with me on Oct. 9 to discuss the prevention or reduction of obesity which is seen as central to achieving a reduction in cancer incidence.

All of this is very much in line with my own ideas on linking Weight Wise to the Cancer Board activities.

I think we need to develop and implement collaborations with the Alberta Cancer Board and the relevant CH Cancer Services and Programs to:

- recognize the incidence and prevalence of excess weight in cancer patients

- provide information, education and support to cancer patients at risk for weight gain

- provide weight-management services to cancer patients with excess weight

- coordinate cancer screening and treatment services for patients with excess weight seen in the bariatric clinics

Measures of these activities in the area of cancer can include information on the following:

- No. of cancer patients receiving information, education and support to prevent excess weight gain

- No. of cancer patients receiving services for excess weight

- No. of bariatric patients receiving cancer screening and treatment services

There is no question that obesity is a widely ignored issue in cancer patients, both as a risk factor and as a problem following cancer treatments. The increased weight gain seen in some chemotherapy patients is well described, but poorly understood.

As always, I look forward to thoughts and comments,


Sunday, September 23, 2007

Adult Weight Management Retreat, Sept. 19, 2007

This full-day retreat, held at the new Centre for the Advancement of Minimally Invasive Surgery (CAMIS), was the first opportunty for me to meet many of the staff of the WW Adult Weight Management Clinic (AWMC). There were over 20 people in the room representing a wide range of professions including dietetics, nursing, psychology, physiotherapy, social work, medicine and surgery. There was also a good representation of the administrative staff that is key to running a smooth operation.
A number of topics came up that I believe are highly relevant to the smooth running and expansion of the program:
- Integrating new disciplines: while historically the AWMC (or adult bariatric program, as I prefer to call it) started as a dietetic/surgical service, it has rapidly expanded into a full-fledged multi-disciplinary program that will provide a wide range of tertiary-care bariatric services to the region and beyond. Integrating and taking full advantage of the wide range of expertise now available within the group will be an exciting endeavour.
- Patient Intake: This appears to be a key issue for the effective functioning of the clinic. Currently patients, after 2-3 years on the waiting list, enter the assessment clinic with little to no information on what the program can offer. Given the complexity of individual cases, it may well be that patients are not yet prepared to embark on tertiary-care obesity treatments and/or have other significant problems that do not make them good candidates for intervention. Also, intake staff has to spend considerable time explaining the purpose and treatment opportunties in the program. This results in a rather inefficient overall process that needs to be urgently re-engineered. I presented a possible strategy for triaging patients to community services following an "Orientation Workshop", where patients are given information about the program. This Orientation Workshop would be followed by a series of interactive educational community workshops to provide participants essential skills required for long-term weight management.
- Post Surgical Rehab: The suggestion was made to develop a structured post-surgical bariatric rehab program, not unlike rehab programs in other disciplines (e.g. post-MI). Participants would not only (re-) learn essential skills but would also have the opportunity to (re-) engage in social and physical activities, deal with psychological issues arising post surgery and discuss other aspects related to life after bariatric surgery.
-Space: Currently the clinic is operating out of incredibly cramped offices - this situation is hopefully about to change with the idenfication of new office space.
-Continuing Education: Given that bariatric care is such a rapidly evolving field, it is essential that we continue to review best practices in light of new literature. For this purpose, regular "academic" meetings to discuss latest findings and their implications on our program are essential. Attendees were engouraged to join the Canadian Obesity Nework at and sign up for the literature alert services OBESITY+ (for clinicians) or Pre-OBESITY+ (for clinicians and clinical researchers). I also recommended subscribing to the blog "Weighty Matters"
-Staff: It was widely recognized that we urgently need a data-analyst to help monitor the current data flow in the program. While we have the opportunity to collect a large amount of data that could help us improve and streamline our services (and of course address research questions), analysing these data cannot be done without a dedicated analyst. Another important gap that was identified pertained to occupational therapy, an essential piece of bariatric care.
Overall, the day was a resounding success in that it provided attendees with a good overview of the AWMC and provided an opportunity to share some of the strategic plans for making this a world-class program.
Appreciate any comments,