Mind the Gaps
New CIHR Team Grants to enhance knowledge about the treatment of severe obesity where we need it most

A New Focus on Unmet Needs

The Canadian Obesity Network (CON-RCO) works to bridge key knowledge gaps so that parents, educators, policy makers and health professionals can make decisions based on scientifically rigorous evidence, and not unsubstantiated beliefs.

To do this, more high-quality obesity research urgently needs to be done in Canada. Lessons learned from current and future research also need to get in the hands of the people who need it most.

The Fund for Obesity Collaboration and Unified Strategies (FOCUS) initiative was launched in 2015 to leverage resources and expertise from Canadian leaders in research, business and the public sector. The goal is to raise a minimum of $1.5 million each year toward funding meaningful research, education and outreach initiatives to fill in these knowledge gaps.

Find out more at the Canadian Obesity Network.

Reprinted from CONDUIT Magazine Spring 2015 © 2015 The Canadian Obesity Network
By Lisa Willemse

The World Health Organization recognizes the epidemic of obesity as one of today's most blatant yet neglected public health problems. In Canada, as elsewhere, research and clinical practice has made gains in understanding the complexity of the issue, but a great deal of work remains, particularly in the area of obesity treatment – most notably, for individuals with severe obesity.

Last April, the Canadian Obesity Network (CON-RCO) through its newly established FOCUS Fund, along with the Canadian Institutes of Health Research (CIHR) launched a strategic research initiative aimed at filling key knowledge gaps in our understanding of severe obesity.

"Obesity is a complex chronic disease that requires action from multiple sectors in society to prevent and treat," says Dr. Philip Sherman, scientific director of CIHR's Institute of Nutrition, Metabolism and Diabetes. "This new research funding will support the development of effective new treatments for obesity both in adults and children and is a result of an exciting partnership between the Canadian Institutes of Health Research, Alberta Innovates - Health Solutions (AIHS), Alberta Health Services Obesity, Diabetes and Nutrition Strategic Clinical Network (SCN), Ontario Ministry of Health and Long-Term Care, Fonds de recherche du Québec–Santé (FRQS), and CON-RCO."  

Following an extensive CIHR peer review process, three team grants were awarded. Each project – one in pediatric obesity and two which explore bariatric surgery and the microbiome in adults – will share a total investment of $4.5 million over five years.

Defining the scope of severe obesity in Canadian children

On school playgrounds across the country, one can see children with significant physical and emotional health challenges caused by severe obesity. "They're easy to pick out," says Dr. Geoff Ball, associate professor at the University of Alberta and lead researcher on the FOCUS Team ABC3 (Addressing Bariatric Care in Canadian Children). "And yet, we don't know how common severe obesity is, what kinds of subpopulations exist within this group, or what kinds of treatments are effective."

Team ABC3 is comprised of a large, coordinated group of researchers and clinicians from across the country who will contribute to several projects in Vancouver, Edmonton, Toronto and Hamilton. Collectively, the team aims to gather data from children with severe obesity, including their health risks, eating behaviours and predictors of treatment initiation. In recognition that rural and remote children have fewer opportunities to access services, and that those living in urban centres may not feel comfortable accessing health services in person, one study includes testing an online lifestyle and behavioural intervention for managing severe pediatric obesity.

Helping children with severe obesity and their families in weight management is challenging, but the challenge increases when severe obesity is coupled with a physical disability. "The expectation is that specialized pediatric clinics for obesity management should be equipped to offer comprehensive treatment for these individuals and families," says Dr. Ball. "We need to do the best work possible and not just be another place that throws up our hands and says 'sorry, we can't help you'." Born out of this need, the team has included a qualitative study to learn from families about their health services needs in addressing severe obesity among children with a physical disability.

Bariatric surgery procedures and their effects on type 2 diabetes

The prevalence of bariatric surgery performed across Canada varies dramatically from province to province. In Ontario and Quebec, nearly 5,000 surgeries were performed in 2012-13, compared with 178 in British Columbia. Further, the remission rate for type 2 diabetes following bariatric surgery can vary between 20% and 90%, according to the type of surgery and the severity of the disease. Such disparities demand greater understanding, which is the central aim of the CIHR team grant led by Drs. André Tchernof, Laurent Biertho, and Denis Richard at Laval University.

Dr. Tchernof explains, "We need more information about the clinical effects of each surgery and the basic mechanisms that underlie these effects so that we can make better decisions about what type of treatment is best for each patient."

"More specifically," adds Dr. Biertho, "we want to look at long-term remission of type 2 diabetes, one of the critical secondary health concerns for individuals with severe obesity. Right now, data on long-term outcomes – five to 10 years – is almost non-existent."

To remedy this, the team will look at the long-term pre- and post-operative effects of three types of bariatric surgery to assess quality of life and remission of obesity related diseases. In addition, a complementary study will investigate metabolic, neurobiological and gut microbial changes, both in humans and rodent models. The first patients in the clinical study were enrolled in April 2015.

The fecal microbiome as a therapeutic approach to bariatric care

Bariatric surgery is the current standard treatment for about half of individuals living with severe obesity. Recent research tells us that one of the outcomes of bariatric surgery is a disruption in the intestinal microbiome – the bacteria and other microorganisms that aid in digestion. This disruption, however, may be an opportunity. At least that's how Dr. Johane Allard, professor at the University of Toronto, sees it. Dr. Allard is leading a CIHR team grant that will explore the fecal microbiome through all stages of bariatric surgery and look at the correlation between the microbiome and insulin sensitivity.

"People with obesity have a different type of intestinal microbiome. Additionally, it's been shown that if you lose weight, you improve your intestinal microbiome," says Dr. Allard. "One of our aims is to identify interactions between colonic bacteria and metabolic improvements associated with bariatric surgery, and see if specific bacteria are associated with the release of hormones that affect appetite and insulin sensitivity."

Outcomes of this portion of the study will inform a secondary aim, which is to perform and study the outcomes of fecal transplant in patients. This builds on other research suggesting that fecal transplants from lean, healthy subjects into subjects with metabolic syndrome may improve insulin sensitivity.

Given that not all patients can have bariatric surgery as a weight management strategy, results from this project may show fecal transplant to be a viable alternative.

"We are thrilled with the outcome of the first activity funded though the FOCUS initiative, which strives to leverage the support of public and private sector partners to make a tangible improvement in obesity prevention and treatment in Canada," says Dr. Arya M. Sharma, CON-RCO's scientific director. "We have big things planned and look forward to bringing more partners on board."

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