Dr. Arya Sharma • MSVU Seton Auditorium, Halifax NS • Fri Apr 4th 2014 7:00 PM
(article length = 1,500 words)
Successful long-term weight-losers in the National Weight Control Registry typically eat about 1,400 calories per day and burn about 400 calories per day in regular physical activity. Dr. Sharma’s conclusion: these people didn’t just change a few bad habits, they changed their entire lives.
Dr. Arya Sharma is an Edmonton-based General Internist who has long cultivated a special interest in treating obesity. He holds the Chair of Obesity Research and Management at the University of Alberta, and he founded the Canadian Obesity Network, which comprises 6,000 health professionals in various disciplines. He has authored or co-authored over 300 scientific articles on the causes and treatment of obesity, and he developed the Edmonton Obesity Staging System, a new classification system for health risks associated with obesity that does not rely so extensively on BMI measurements alone. Born in Berlin and raised in India, Dr. Sharma completed most of his medical training in Germany before settling in Edmonton 8 years ago to begin his research into obesity in earnest.
For this talk, Dr. Sharma launched his lecture on the topic of weight loss by looking at the overall effectiveness of dieting. He got our attention in the first few minutes by informing us of the stark, sad statistic that the number of people who manage to keep weight off for the long term with a diet is about 1 in 20. Of course, this is an abysmal success rate that would never be recommended as an effective treatment standard for any other medical condition. He also took care to dispel several commonly-held myths about the obese, such as that fat people just need to eat less and move more (the so-called “calories-in/calories-out model”), that they have no will power, that they are lazy, or that all fat people are unhealthy. “Put a 300-pound fat suit on me and I’ll barely be able to raise myself from a chair and walk across the room,” he said. “In my opinion, most of my obese patients are athletes just for moving around that much body weight successfully all day.”
The foundation for his own approach to obesity treatment appears to be rooted in his analysis of the National Weight Control Registry, which is run by researchers of his acquaintance in Texas. Subjects in the NWCR have successfully maintained a significant weight loss over several years, and when you investigate their behaviours, you can quickly reveal what are the most important life habits that these successful, long-time weight-losers share. When he considered that these subjects generally eat about 1,400 calories per day and also burn about 400 calories per day in regular physical activity, he could only draw one conclusion: if you want to lose a significant amount of weight and keep it off, you will have to change nearly all of your habits to do it. The subjects in the NWCR didn’t just change a few habits, they changed their entire lives.
To recover from addiction, you only need to change one thing: everything.
— U.S. addiction treatment specialist Bob Forrest
In this respect, Dr. Sharma might draw a similar conclusion to Mr. Forrest. Another variation on that theme comes from the Ottawa-based obesity specialist Dr. Yoni Freedhoff, who has noted that the more weight you want to permanently lose, the more of your life must permanently change. When that reality sunk in with Dr. Sharma, he realized that anyone who can successfully maintain long-term weight loss deserves his sincere respect. His approach recognizes from the outset that this is an incredibly hard thing to do, as is evidenced by the sheer proportion of those who attempt to do it, but fail. That deep-seated empathy on his part is also behind his strong drive to abolish the shaming and blaming of fat people who have not successfully lost weight or maintained weight loss. If it was easy, he took care to point out, we wouldn’t have such widespread prevalence of obesity today.
To my initial disappointment, Dr. Sharma’s talk was somewhat short on specifics about how his own clinic treats obesity and on what he thinks is the best approach. He stressed several times how difficult it is to treat obesity effectively, but he did not point to any specific pathway to permanent weight loss, touching instead on the myriad causes for the condition that must necessarily spawn a variety of treatment options. He is optimistic by nature, however, and described how much the field of obesity research and treatment has bloomed in recent years. He indicated that 6 obesity treatment centres have been established in Alberta, and he also referenced the number of bariatric surgeries being performed in Alberta and Ontario, with the latter province having completed 6 thousand last year. (Note: A Nova Scotia-based health researcher spoke up later in the evening to indicate that almost no such resources were on offer anywhere in our province.)
I’ve already implied that Dr. Sharma was rather equivocal on what treatment modalities were the most effective for long-term weight loss. Perhaps that makes it noteworthy that the only specific treatment he mentioned at all—aside from bariatric surgery or very-low-calorie, liquid diet protocols—was in the form of professionally-facilitated support groups that teach their subjects Cognitive Behavioural Therapy techniques to change their habits. Dr. Sharma indicated that participants in that type of support group have been noted to experience an 80% success rate at long-term weight loss.
After a brief intermission, Dr. Sharma opened his second half of the evening talk by nudging closer to specific advice about how to lose weight effectively and for the long term. My notes record him telling us to let go of three things:
1) Habits. You have to permanently exchange most of your current habits (a.k.a. the unhealthy/maladaptive ones that brought you here) for completely new ones.
2) Thoughts. The persistent, negative self-talk that so commonly sabotages your best efforts must be banished, or at least transformed into something more positive and constructive.
3) People (and by extension, obesogenic aspects to your environment). If there are people in your life (even close friends or family members) who are actively sabotaging your efforts, you will be better served by excising them (even if only temporarily) from your day-to-day life. The same goes for potential pitfalls on your driving route home, overly-sought-after comfort foods, foods you have little to no self-control over consuming, and so on.
Other specific points he mentioned that defy quick categorization are as follows:
Accept the reality that this is hard and find your truest personal motivation to do this. You’re striving to be the 1 in 20 for whom your new, healthier habits will permanently stick. By definition, this will involve a lot of hard work on your part to achieve, and it may also involve several relapses before it really “takes.”
Correctly identify the problem. By enlisting the help of a professional counsellor or support group as needed, identify what are your true underlying issues and obstacles towards developing new, leaner eating habits. These might involve some extensive psychological research, self-reflection and assessment. But this step must be accomplished at some point in the recovery process.
Avoid gaining any more weight, to whatever possible extent you are able to. The “setpoint” is indeed a neurophysiological state in our bodies, and sadly it is permanent. Micro-scarring of certain brain tissues prevent your body’s ability to reset its highest weight setpoint to a lower level. There’s a sensible biological reason for this, of course: from an evolutionary standpoint, we’ve never needed to decrease the amount of weight our bodies try to maintain; until recently, for survival purposes we’ve always needed to preserve every pound we gained for as long as possible.
Never wait until you are hungry to eat. The body’s hunger hormone, ghrelin, is a powerful motivator to eat voraciously when you’ve let yourself become famished. “You can do a lot of damage [by eating] in the 20 minutes it takes for your brain to register the presence of food in your digestive system,” he pointed out.
Sleep, glorious sleep. Few significant improvements can be fully realized without adequate sleep. Dr. Sharma indicated that numerous studies back up the premise that without adequate sleep, your efforts at significant life changes like these will be undermined. He advocated placing a much higher emphasis on getting enough sleep than many of us do. He also pointed out a high prevalence of sleep apnea amongst obese subjects, which if left untreated results in very poor quality sleep, no matter how many clock hours of sleep you happen to log each night.