Mood & Food

This weekend (June 8) I was part of a lunch symposium on the Complex Depressed Patient at the 30th Annual Meeting of the Canadian College of Neuropsychopharmacology (CCNP), held in Toronto.

Other members of the panel were Claudio Soares (McMaster), Pierre Blier (Ottawa) and Valerie Taylor (McMaster).

While Soares and Blier focused their discussion on a case of peri-menopausal depression, Taylor and I discussed a patient who was non-compliant with her antidepressant medication due to weight gain.

As blogged previously, weight gain is a common complication of neuropsychiatric medications and there are few proven strategies to treat or prevent it. While there is some data to support co-prescription of metformin or sibutramine with some of the psychotropic medications, this is clearly not current medical practice.

As always, prevention of weight gain may be easier than treating obesity. Thus it may perhaps be advisable to start patients on weight-gain prevention strategies (which may include both behavioural interventions and antiobesity medications) right off the bat rather than trying to treat the excess weight gain or risk non-compliance resulting from the weight gain.

As pointed out by Taylor, based on her own (unpublished) observations and other studies, weight gain with psychotropic medications is by no means benign, resulting in all of the usual complications of weight gain.

We know that simply telling people to eat less and move more is as effective for treating obesity as simply telling people to cheer up is for depression.

Both are complex multifactorial conditions that need to be addressed by behavioural, psychological and often medical interventions - not uncommonly for life!

AMS
Edmonton, Alberta

Hat tip to Bryan Ashuk for suggesting the title for this post

Fracture Non-Union in Obesity

On Saturday (June 7), I presented at a session on How Obesity Affects Orthopaedic Care at the 2nd joint meeting of the American and Canadian Orthopaedic Associatons in Quebec City.

Despite being on the last day of this meeting, the session was surprisingly well attended, probably a reflection of the increasing awareness of issues around orthopaedic care for patients with severe obesity.

While I presented my usual take on how obesity is now a widespread chronic disease, I did take away some interesting aspects related to orthopaedic care of patients with obesity that I was unaware of.

For example, George Russell (Jackson, Mississippi) in his talk mentioned the issue that in severely obese patients immobilization of fractures with a plaster cast poses a significant problem due to the "cushioning" effect of the surrounding adipose tissue. This results in an increased risk of "non-union", often requiring additional internal or external fixation to ensure healing.

Russell also presented an interesting view of how differences in body fat distribution pose specific problems in orthopedic surgery on hips and knees. Thus, in patients with the "large belly - thin limb" phenotype, the operation on the limbs is relatively easy, but, given the association between large bellies and cardiometabolic risk, these patients are at greater risk for poor wound healing and cardiovascular problems. In contrast, patients with "large limbs - thin bellies" present problems related to the size of the limbs resulting in a greater risk for bleeding and wound infections. Obviously, patients with "large bellies - large limbs" are at increased risk for both types of complications.

In a talk on orthopaedic problems in childhood obesity, Benjamin Alman (Sick Kids, Toronto) mentioned the issue of "relatively" (i.e. in relationship to their body mass) lower bone density in children with overweight and obesity, an issue that may increase the likelihood of traumatic fractures in these kids - again, something I had not previously thought much about.

Bassam Masri (UBC, Vancouver) confirmed that despite slightly greater risk and less functionality following joint replacement in patients with severe obesity, their satisfaction is no smaller than that or non-obese patients - clear indication that obese patients should not be denied surgery simply because of their size. But don't expect to see spontaneous weight loss after surgery - in fact weight sometimes even goes up in overweight patients following surgery (I have blogged on this before).

I was particularly happy to note that all three surgeons called upon their colleagues to show compassion and deliver care with the same professional attitudes with which they approach their non-obese patients.

Overall, a most interesting session. I am delighted to see the orthopaedic surgeons taking this great interest in these (unfortunately) increasingly important issue.

AMS
Edmonton, Alberta

Cell Biology to City Building

Yesterday I spent all day listening to student presentations at the 1st Canadian Obesity Student Meeting in Quebec City.

The topics literally ranged from cell biology to city building. All presentations were by students from across Canada, selected and moderated by students. Because there are so few "old" folks like me in the audience, the students actually have the guts to stand up and ask questions - something they may not do at "regular" conferences.

And the quality of the data (all original) is as good as at any "regular" meeting I've ever been to. This of course is not surprising since it is exactly the same data being presented at other meetings, except that at those meetings it is often the supervisor presenting rather than the young students, who actually did most of the work.

You can sense the excitement and enthusiasm in the room. The nervousness, the pride, the sincerity of the presenters.

For many, it is the first time they expierence themselves as organizers, moderators, chairs, jurors, and even interviewees in front of a camera.

I am not going to mention any of the actual findings - all I will say is that anyone interested in obesity can look forward to a whole slew of great papers coming out of Canada in the near future.

I cannot but feel proud that this meeting would not have happened without the strong partnership between the Canadian Obesity Network and the Merck-Frosst/CIHR Obesity Chair, Laval University.

I am also grateful to all the supervisors and senior researchers for sending their students to this meeting and allowing them to present their data at such a "minor" forum.

I sincerely hope that this will only be the first in a whole series of student meetings and already look forward to the next one.

AMS
Quebec City, Quebec

Obesity Network Students

Last night I presented a talk on Developing Research Careers in Obesity to the over 150 attendees of the 1st National Obesity Student, Meeting held at Laval University, Quebec. This meeting is co-organized by the CIHR/Merck-Frosst Chair for Obesity at Laval University, Ste.-Foy, Quebec and the Canadian Obesity Network. The students who come from universities across Canada are currently working on their Masters or PhDs in areas ranging from cell biology to city building.

The meeting is not only intended for students but is also entirely organized by CON students and new professionals (CON-SNPs): they chose the abstracts, chair the sessions, decide on the awards and everything else that goes into running a meeting.

Not only is this an opportunity for the next generation of obesity researchers in Canada to present their data but also an opportunity for them to gain first-hand experience in chairing and moderating sessions and interacting with their peers.

As I emphasized in my talk, developing a career in any field not only depends on doing good original work but also often depends on who you know and (sometimes more importantly) who knows you. The student meeting provides ample opportunity for students to practice their social skills in getting to know their peers but also to build relationships that will serve them in the future.

Needless to say, the senior faculty present at this event are happy to take a back seat and watch the future generation of Canadian obesity researchers and practitioners take the stage and run this event.

I, for my part, am happy to be part of this and to meet all these young attendees and watch them do their thing.

By the looks of it, obesity research in Canada is alive and kicking.

AMS,
Quebec City, Quebec

Pharmacists in Obesity Management

Tuesday I spoke on obesity treatment to around 100 pharmacists from the Capital Health Region. For many of the attendees, this was the first time they heard a formal "CME" on obesity. This is unfortunate.

Pharmacists are the frontline health professionals who are probably most often asked about weight management. They are accessible, well versed in practice guidelines and of course dispense and sell both prescriptions and non-prescription remedies for weight management.

Pharmacists also regularly dispense the host of medications that can promote weight gain and they could therefore also play an important role in preventing iatrogenic obesity by warning their clients about potential weight gain and recommending preventive strategies- after all preventing weight gain is always easier than trying to lose those extra pounds once they're there.

The idea of engaging pharmacists in weight management is very much in line with the role for Pharmacists promoted by Alberta Health and Wellness, which in its recent Action Plan on Health 2008-2009 calls for immediate actions in expanding the role of pharmacists in preventing and managing chronic diseases.

The notion of engaging pharmacists in obesity management is also the goal of the National Obesity Certification Program for Pharmacists offered by the Ontario Pharmacist Association in collaboration with the Canadian Obesity Network.

Given the magnitude of the obesity epidemic - there is a role for ALL health professionals in promoting evidence-based obesity prevention and treatments.

AMS,
Edmonton, Alberta

June is Bike Month

I've always liked biking. Back in med school, I biked straight across Berlin (Neukoelln to Dahlem) and back every day and on certain days all the way from Neukoelln to Dahlem to Wedding and back to Neukoelln (probably around 70 Km or so). The funny thing was, I thought nothing about it - it was simply the easiest and quickest way to get around.

That's the kind of "exercise" I like - physical activity that you have to do to actually do something - very different from "non-utilitarian/recreational-type" stuff that most people seem to be into (honestly, I can think of a million things I'd rather do in the little free time I have than to exercise simply for the sake of exercising).

So of course, now that Summer is almost here (yes, there actually is a Summer in Edmonton), I've gone out and bought a bike and ride it to work everyday (at least I did all of last week - so far, so good). It's only 25 mins one way - faster than ETS and not much slower than by car at rush hour (hey and parking's free!).

All of this just in time for Bike Month in Edmonton. As the "City of Festivals", it should be no surprise that there actually is a Bikeology Festival here. Tons of cool events like ride to work challenges, bikey breakfasts, ride-in outdoor movies, bike salons, guided tours and even a "make your own jewelry out of bicycle trash" class.

Not sure I'll be taking part in all of this but I sure will be out there riding my bike to work and back.

Living within walking distance to work - luxury!

Living within biking distance to work - bliss!

AMS
Edmonton, Alberta

Image by Paul Turnbull

Little Big Run 2008

I am not a runner - I prefer walking. So yesterday, I participated in the 5 K walk at this year's Little Big Run.

The hardest part was getting up at 6.30 on a Sunday to actually get to the start. In fact, I had to first ride 7 K on my bike to get to the "run" and of course I rode my bike back after that (more on the bike stuff in tomorrow's post).

The Little Big Run was founded by The University of Alberta, Capital Health and the City of Edmonton and the idea is to get people moving. This year, there was even a 1 K walk, especially for those folks for whom even that is a challenge - some of my patients actually did this one - pretty much a "miracle" for some.

Of course there were all the usual "fitness types" out on the course, but more importantly, I was happy to see how many "normal" folks showed up, kids, walkers, pets and all. I am sure, for some, this was the first time they'd ever actually walked downtown.

Congrats everyone for showing up! Thanks to the organizers for pulling this off! Thanks to all the sponsors for their great support!

AMS
Edmonton, Alberta