Doctor's Review: Medicine on the Move

August 18, 2017
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Obesity’s heavy topics

The Canadian Obesity Network held its second national Summit on Obesity last month in Montreal. It was heartening to see as many researchers as practitioners present. Probably the most interesting presentations for practitioners were those focussed on the diagnosis and treatment of obesity in a primary-care setting, the role of pain management and how cancer outcomes differ among the obese.

In the primary-care sessions, discussions centred around the belief that obesity is a chromic disease best treated by an interdisciplinary team.(1) To help physicians improve their knowledge of therapies and their successes, one session offered a review of some of the current practices in obesity management: pharmacology, behavioural approaches, meal replacement, surgery as well as lifestyle-management programs.

Another topic was the role of musculoskeletal pain. Overweight individuals experience changes in how the body responds to physical activity. An article published in the Journal of Obesity in 2011 reviewed the biomechanical and physiological aspect of physical activity and obesity.(2) This study highlighted the reality that health-care practitioners must be aware of these changes when they recommend increasing physical activity to their patients, including walking.

When making these recommendations we rarely consider the potential for injury. Obese and overweight individuals are more likely to feel pressure on different parts of the foot. In children, this effects foot structure which could lead to discomfort during weight-bearing activities. So it’s possible that by asking people to be more active, we’re putting them in a position to injure themselves and thereby do less activity, and ultimately gain weight. Many individuals with chronic pain also suffer from depression,(3) which can impact food choices and activity. Medications that manage pain and depression may also contribute to weight gain.

Research has demonstrated that patients who have obesity surgery significantly decrease their chances of developing cancer — even more than one might anticipate. A study published in 2009 demonstrated that when weight-loss surgery patients were compared to severely obese patients, the risk of developing cancer was significantly lower in the patients who had had gastric bypasses.(4) The gastric bypass surgery group had a 46-percent decrease in cancer mortality versus the control group.

New research suggests that there are several mechanisms that take place on a cellular level that can be linked to the development of cancer in the obese person.(5) On top of that, body composition in cancer patients is a predictor of chemotherapy-related toxicity, poor outcomes and ultimately reduced survival in patients who had cancer.(6)

For more details on these and other issues related to the treatment and management of overweight and obese patients, the Canadian Obesity Network has published Best Weight: A Practical Guide to Office Based Obesity Management, available at obesitynetwork.ca.

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