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Concurrent Session: Diet resistant obesity - Biological causes and clinical implications

Friday, May 6, 2016
10:45am - 12:00pm


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Diet resistance (DR) in obesity has complex origins. Research of Drs. Dent, McPherson and Harper examines DR in the Ottawa Hospital Weight Management Program. They have identified genetic & metabolic factors, as described in ~25 publications. It is hoped that such research will lead to personalized strategies (patient-specific diet, exercise or surgical treatments).

Genomics of Diet Resistant Obesity
Dr. Ruth McPherson

Dr. McPherson will discuss evidence for a genetic basis for differences in the capacity for weight loss.

Why don't we all lose weight equally on calorie restriction?
Dr. Robert Dent

This is an overview of the factors affecting rate of weight loss in patients on the Core Program at the Ottawa Hospital weight Management Clinic.  The core program is a yearlong course in lifestyle modification that uses a total meal replacement (Optifast 900®) of 900 KCal for the first 6 -12 weeks to bring about weight loss in a timely and safe manner. Our studies examine rate of rate loss in the first 6 weeks of Optifast on 4000 patients who did the program from 1992 to 2012. There will be a description of the usual barriers known to decrease rate of weight loss as well as an inherent resistance to weight loss with dietary restriction that some patients have.  This inherent resistance to weight loss with dietary restriction has been newly discovered with these studies.What does this Diet Resistance State look like clinically?  What are the implications of this state with respect to triaging patients to the optimum treatment for their individual needs?  How can this be used to help obese patients improve self-esteem and empowerment? This is clinical part of three related presentations.  The other two presentations deal with the muscle energy balance of this Diet Resistant Sate, and the genetics of it.

Biological causes and clinical implications
James Butcher (Abstract Presentation)

Exclusive breast milk feeding confers health benefits to infants. Many of those benefits are attributed to breast milk promoting a gut microbiome that is composed of beneficial bacteria. Breast milk is critical for very low birth weight (VLBW, <1500 g) infant health. Exclusive breast milk feeding by VLBW infants is associated with improved feeding tolerance, fewer severe infections and a reduced risk of necrotizing enterocolitis. Few VLBW infants are exclusively fed mothers' own milk (MOM) as many VLBW mothers are unable to express enough milk to feed their children. Little is known about VLBW infant microbiomes and previous studies have been unable to study the effect of MOM for practical and ethical reasons. Thus, while it is clear that exclusively MOM-fed VLBW infants have better health-outcomes, we remain ignorant of MOM's effect on VLBW microbiome composition/development. To address this gap in knowledge, we profiled the microbiota composition of stools collected from exclusively MOM-fed VLBW infants admitted to Mount Sinai Hospital in Toronto and enrolled in the DoMINO trial (ISRCTN35317141). We found that the VLBW microbiota is primarily composed of Firmicutes and Proteobacteria with transient contributions by Acintobacteria. Moreover, the microbiota of individual infants is subject to dramatic shifts in microbial composition that appear to be associated with clinical antibiotic use. These results will allow us to define a reference or "gold standard" VLBW taxonomic profile from infants fed mother's own milk, the optimal source of nutrition for these infants. (Funding by the PSI Foundation, CIHR and Genome Canada)



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