APRIL 26–28, 2017 Con-Obesitysummit.Ca #COS17

5th Canadian Obesity Summit

FAIRMONT BANFF SPRINGS BANFF, ALBERTA APRIL 26–28, 2017 Pre-conference workshops April 25 con-obesitysummit.ca #COS17

1 | 5th Canadian Obesity Summit | #COS17 REPORT CARD ON ACCESS TO OBESITY TREATMENT FOR ADULTS IN CANADA 2017

Obesity is a chronic disease that impacts the lives of millions of Canadians. But, how well are we doing at treating obesity in Canada? The Canadian Obesity Network has now examined access to publicly provided medical care for adults with obesity, including interventions covered by private health benefit plans.

Full report, methodology and additional findings are available at: www.obesitynetwork.ca/reportcard Table of Contents

Message from the Minister of Health...... 4

Message from the CON Board of Director, Science Chair & Accreditation Statement...... 5

CON-RCO Board of Directors & CON Public Engagement Committee...... 6

CON-RCO Science Committee / Organizing Committee & Abstract Reviewers...... 7

Venue / Hotel Floorplans...... 9

Awards & Grants...... 11

Exhibition...... 12

Conference App...... 13

Social Events...... 14

Group Exercise Opportunities...... 15

General Information...... 16

Schedule at A Glance...... 19

Satellite Meetings...... 23

Workshops...... 24

Lunch Symposium...... 30

Mini-Review Session Details...... 32

Pecha Kucha Session Details...... 53

Concurrent Oral Session Details...... 56

Poster Presentations...... 63

Abstract Details...... 66

Thank you to our Sponsors!...... 111 4 | 5th Canadian Obesity Summit | #COS17 Message from CON Science Chair & Scientific Director

A message from Dr. Gordon A. Zello, Chair, Canadian Obesity Network Science Committee & Dr. Arya M. Gordon A. Zello, Sharma, Scientific Director, Canadian Obesity Network PhD Chair, Science Committee, Canadian Obesity Network Professor, Nutrition and Welcome to the Canadian Obesity Network’s 5th national interdisciplinary Dietetics conference on obesity prevention, management and treatment. College of Pharmacy and Nutrition Representing over 15,000 health professionals, researchers, policy University of Saskatchewan makers, and other obesity stakeholders, as well as 15,000 public support- ers, CON-RCO’s mission is to improve the lives of Canadian affected by obesity through the advancement of anti-discrimination, prevention, and treatment efforts.

The 5th Canadian Obesity Summit will once again welcome Canada’s best researchers and health professionals from across disciplines for three days Arya M. Sharma, of plenary talks, Pecha Kucha sessions, original research and workshops, MD/PhD, FRCPC as well as over 25 hours of CPD accredited programming to help you Scientific Director, support people living with obesity. Canadian Obesity Network Professor, Faculty of Medicine, In our continued efforts to improve access to respectful, compassionate and Chair holder for Obesity evidence-based obesity prevention and treatment in Canada, CON-RCO will Research and Management University of Alberta also present the first Report Card on Access to Obesity Treatment for Adults in Canada. The report card shows that there are significant inequities in access to obesity care in Canada and we have much more work ahead of us.

On behalf of the CON-RCO Scientific Committee it is our pleasure to welcome you to this exciting event.

Accreditation The Canadian Obesity Summit is accredited!

By attending this program, you are eligible for 4.0 SCOPE points. SCOPE is an internationally-acclaimed obesity education program that helps health professionals understand obesity and how to treat, management and prevent it. You can find more information about SCOPE at www.worldobesity.org/scope.

This program is also Continuing Professional Development (CPD) certified This learning activity has reached the required Continuing Professional Devel- opment standards and benchmarks. The learning value has been scrutinised to ensure integrity and quality. The CPD Certification Service provides recognised independent CPD accreditation compatible with global CPD requirements.

5 | 5th Canadian Obesity Summit | #COS17 CON-RCO Board of Directors

Kelly Isfan Mary-Ellen Harper, Chandra Ramasamy Chair, Board of Directors PhD Vice President, President, CEO and Privacy Professor, Mitochrondrial Operations of Graycon Officer, Norfolk General Bioenergetics Laboratory, Group, a division of Ricoh Hospital & West Haldimand Department of Canada Inc., General Hospital Biochemistry, Calgary, AB Simcoe, ON Faculty of Medicine, University of Ottawa, Ottawa, ON

Arya M. Sharma, MD/ Bemal Mehta David Sutherland PhD, FRCPC Vice President, Energy Core Consulting Scientific Director, Intelligence June Capacity Coordinator Professor, Faculty of Medicine Warren-Nickle, Fort Albany First Nations Chair holder Obesity Energy Group Fort Albany, ON Research & Management, Calgary, AB University of Alberta, Edmonton, AB

Feria Bacchus, MHSc Eva Pila, PhD Gordon Zello, PhD, Vice President, Candidate MSc Sales & Marketing NRC Co-Chair CON-SNP Professor, Nutrition Picker Canada National Executive Assistant Dean, Division Toronto, ON University of Toronto, of Nutrition & Dietetics Toronto, ON University of Saskatchewan, Saskatoon, SK

CON Public Engagement Committee

Marty Enokson Ian Patton Adrianna Jodi Krah Ryan Drummond Chair, Vice-Chair, O’Regan Science Committee Edmonton, AB Edmonton, AB Toronto, ON Edmonton, AB Representative, Fonthill, ON

Kelly Moen Alex Schwarzer Katherine Taylor Lisa Schaffer Brenndon Goodman Victoria, BC Edmonton, AB Hamilton, ON Vancouver, BC Toronto, ON

6 | 5th Canadian Obesity Summit | #COS17 CON-RCO Science Committee / Organizing Committee

Dr. Geeta Achyuthan, Regina, SK Dr. Ian Janssen, Kingston, ON Ms. Maxine Myre, Edmonton, AB Ms. Allison Barnett, Dunnville, ON Ms. Thiru Kanagasabai, Montreal, QC Ms. Eva Pila, Toronto, ON Ms. Alexandra Cooke, Montreal, QC Ms. Jodi Krah, Toronto, ON Ms. Amanda Raffoul, Waterloo, ON Dr. Laurent Biertho, Quebec, QC Dr. David Lau, Calgary, AB Dr. Robert Ross, Kingston, ON Ms. Alexa Ferdinands, Edmonton, AB Ms. Allana LeBlanc, Ottawa, ON Ms. Aaryn Secker, Niagara Falls, ON Ms. Melissa Fernandez, Laval, QC Ms. Rebecca Liu, London, ON Dr. Arya Sharma, Edmonton, AB Ms. Maylene Fong, Vancouver, BC Dr. David Macklin, Toronto, ON Ms. Corrie Vincent, Ottawa, ON Dr. Mary Forhan, Edmonton, AB Dr. Priya Manjoo, Vancouver, BC Dr. Shahebina Walji, Calgary, AB Dr. Lise Gauvin, Montreal, QC Ms. Jennifer McConnell-Nzunga, Victoria, BC Dr. Gordon Zello, Saskatoon, SK Dr. Hasan Hutchinson, Toronto, ON Dr. Jonathan McGavock, Winnipeg, MB

Abstract Reviewers

Dr. Geeta Achyuthan, Regina, SK Mr. Steven Glazer, Toronto, ON Ms. Jennifer McConnell-Nzunga, Victoria, BC Dr. Kristi Adamo, Ottawa, ON Dr. Andrea Haqq, Edmonton, AB Dr. Jonathan McGavock, Winnipeg, MN Dr. Angela Alberga, Montreal, QC Ms. Dawn Hatanaka, Mississauga, ON Dr. Kathrine Morrison, Hamilton, ON Dr. Chris Ardern, Toronto, ON Dr. Hasan Hutchinson, Ottawa, ON Ms. Maxine Myre, Edmonton, AB Dr. Stephanie Atkinson, Hamilton, ON Ms. Sarah Hutchison, Victoria, BC Dr. Helena Piccinini-Vallis, Halifax, NS Ms. Allison Barnett, Toronto, ON Dr. Pascal Imbeault, Ottawa, ON Ms. Eva Pila, Toronto, ON Dr. Laurent Biertho, Quebec, QC Dr. Ian Janssen, Kingston, ON Dr. Carla Prado, Edmonton, AB Dr. Daniel Birch, Edmonton, AB Ms. Susan Jelinski, Calgary, AB Dr. Denis Prud’homme, Ottawa, ON Dr. Normand Boulé, Edmonton, AB Dr. Shahzeer Karmali, Edmonton, AB Ms. Amanda Raffoul, Waterloo, ON Dr. Denise Campbell-Scherer, Edmonton, AB Dr. Thirumagal Kanagasabai, Montreal, QC Dr. Sandeep Raha, Hamilton, ON Dr. Tony Chett, Hamilton, ON Ms. Maryam Kebbe, Edmonton, AB Ms. Ximena Ramos Salas, Edmonton, AB Dr. William Colmers, Edmonton, AB Dr. Sara Kirk, Halifax, NS Dr. Laurene Rehman, Halifax, NS Ms. Alexandra Cooke, Montreal, QC Ms. Jodi Krah, Fonthill, ON Dr. Denis Richard, Quebec, QC Dr. Alain Dagher, Montreal, QC Dr. Jennifer Kuk, Toronto, ON Dr. Robert Ross, Kingston, ON Dr. Eric Doucet, Ottawa, ON Dr. Marie-France Langlois, Sherbrooke, QC Ms. Aaryn Secker, St. Catherines, ON Ms. Alexa Ferdinands, Edmonton, AB Dr. David Lau, Calgary, AB Dr. Arya Sharma, Edmonton, AB Ms. Melissa Fernandez, Laval, QC Ms. Allana Leblanc, Ottawa, ON Dr. Sanjeev Sockalingam, Toronto, ON Ms. Maylene Fong, Vancouver, BC Dr. Jian (Jason) Liu, St. Catharines, ON Dr. Guang Sun, St. John’s, NL Dr. Mary Forhan, Edmonton, AB Mr. Michael Lyon, Vancouver, BC Dr. Laurie Twells, St. John’s, NL Dr. Michel Gagner, Montreal, QC Mr. David Macklin, Toronto, ON Dr. Corrie Vincent, Toronto, ON Dr. Lise Gauvin, Montreal, QC Ms. Priya Manjoo, Victoria, BC Dr. Gordon Zello, Saskatoon, SK

7 | 5th Canadian Obesity Summit | #COS17 eocipharma.com

LET’S TALK ABOUT WEIGHT Order your copies of Dairy Farmers of Canada’s latest brochure at dairynutrition.ca/weight2017

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Revised and approved by

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INFO : STÉPHANE N° D’ÉPREUVE : 01 DATE : 06.03.2017 PRODUCTION RELECTURE CRÉATION SERVICE-CONSEIL

Conference Secretariat MCI Group Canada Inc. 200 – 1444 Alberni Street Vancouver, BC V6G 2Z4 CANADA Tel.: +1.604.688.9655 Fax: +1.604.685.3521 Email: [email protected] http://www.con-obesitysummit.ca/

Disclaimer All reasonable endeavors will be made to hold the 5th Canadian Obesity Summit and to present the printed program as scheduled under circumstances which assure the comfort and safety of the Conference Participants. However, the Canadian Obesity Network and its branches, and their respective directors, officers, employees, representatives or agents, shall not be liable in any manner whatever to any person as a result of the cancellation of the Conference or any of the arrangements, programs or events connected therewith; nor shall any of the foregoing entities or persons be liable in any manner whatever for any loss, injury, damage or inconvenience which may be suffered by any person while travelling to or from, or during such person’s presence in, Canada in connection with the Conference. Participants are advised to consider procuring their own insurance against any such occurrences.

18 | 5th Canadian Obesity Summit | #COS17 Venue / Hotel Floorplans

Mezzanine II Mezzanine I

Conservatory McKenzie Room Lacombe Room Champlain First Floor Empress Room To Garden Terrace Room Palliser Cascade Room Ballroom Bowling Centre

Frontenac Theatre Room Retail Oval Retail Room Nester’s Theatre Retail Lobby Foodstore Staircase to New Meeting Rooms Brunswick Room Garden Terrace Riverview Garden Terrace The Banffshire Bow Valley Grill Lounge Club Retail

Alberta Room d o G w r n a

n Data Group t o Lobby Leve l d

S t ai r cas e U p p er Bow V Rundle a

Lounge lley Curio Foyer Rundle Hall T errac e Ivor Mezzanine U p

Petrak

to Second Floor Elevators Room

2 Elevators William Wallace Gra n d

Grapes own Room

Wine Bar d t

S o Lobb y taircas e S Leve l p Preparation Area anish Kitchen Down to Open to Mt. Stephen Mt. Stephen Hall W Heritage Hall Mt. Stephen Hall and Banff Springs al k Hall below Courtyard Shops Van Horne Ballroom

Strathcona Oak C B A Room Foyer Room

Angus Room Norquay Alhambra Room Gues Room Van Horne t Foyer R ooms 150 Baron N.R. Shaughnessy Crump s Courtyard Pres i d Sir Edward ent ’

Beatty s Hal l President’s Hall Ground-Level Entrance Foyer to Conference Centre th 9 | 5 Canadian Obesity Summit | #COS17 D.C. Coleman Venue / Hotel Floorplans

Conference Centre

Conservatory McKenzie Room Follow us on Social Media! Lacombe Room Champlain First Floor Empress Room Room To Garden Terrace  #COS17 Palliser Cascade Room Ballroom Bowling Centre  www.youtube.com/user/

Frontenac Theatre canadianobesity Room Retail Oval Retail Room Nester’s Theatre Retail  Canadian Obesity Network-Réseau Lobby Foodstore Staircase to New Meeting Rooms canadien en obésité (CON-RCO) Brunswick Room Garden Terrace Riverview Garden Terrace The Banffshire Bow Valley Grill Lounge Club Retail

Alberta Room d o G w r n a

n Data Group t o Lobby Leve l d

S t ai r cas e U p p er Bow V Rundle a

Lounge lley Curio Foyer Rundle Hall T errac e Ivor Mezzanine U p

Petrak to Second Floor Elevators Room

2 Elevators William Wallace d Gra n

Grapes own Room

Wine Bar d t o Lobb y S taircas e S Leve l p Preparation Area anish Kitchen Down to Open to Mt. Stephen Mt. Stephen Hall W Heritage Hall Mt. Stephen Hall and Banff Springs al k Hall below Courtyard Shops Van Horne Ballroom

Strathcona Oak C B A Room Foyer Room

Angus Room Norquay Alhambra Room Gues Room Van Horne t Foyer R ooms 150 Baron N.R. Shaughnessy Crump s Courtyard Pres i d Sir Edward ent ’

Beatty s Hal l President’s Hall Ground-Level Entrance Foyer to Conference Centre

D.C. Coleman

10 | 5th Canadian Obesity Summit | #COS17 Awards & Grants

CON-RCO Distinguished Lecturer Award The CON-RCO Distinguished Lecturer Award will be presented in recognition of outstanding contributions to the obesity research community in Canada. The recipient will be announced at the opening ceremonies of the Canadian Obesity Summit, and will deliver a keynote address.

TOPS New Investigator Research Award This award recognizes an individual for a singular achievement or their career contributions to research in the field of obesity. This award is made possible through an annual grant from the Take Off Pounds Sensibly (TOPS). The award recipient will receive a plaque, a $2,500 prize, and a travel grant to attend the Canadian Obesity Summit. The award will be presented during the closing ceremonies at which the recipient will be invited to present the TOPS New Investigator Research Award Lecture. Award recipients must be able to attend the Canadian Obesity Summit.

CON-SNP Rising Star This award recognizes an individual who has promoted the work of CON-SNP through individual work, Chapter initiatives, mentoring SNPs, speaking at CON or CON-SNP events, helping CON-SNP chapters or other similar activities.

CON-SNP Champion Award This award recognizes an active CON-SNP chapter (or individual who belongs to a CON-SNP chapter) who has promoted the work of CON-SNP.

CON-SNP Faculty Supervisor Award This award aims to reward and recognize a faculty member who has demonstrated excellence in their teaching, research and service to the University, community and their trainees (students, clinical or post-doctoral fellows). This award also recognizes a faculty member who has excelled in nurturing trainee research development in his/ her discipline, who has demonstrated outstanding teaching abilities and who exhibits a passion and enthusiasm for teaching and learning.

Student Poster and Oral Awards The best student poster and oral presentations will be awarded cash prizes at the Canadian Obesity Summit. The decision will be made by a board of referees and the awards will be presented at the closing ceremonies on Friday April 28th.

11 | 5th Canadian Obesity Summit | #COS17 EXHIBITION (Riverview Lounge, Cascade Room / Main Hotel Level M2)

Date Time Tuesday, April 25 06:30 – 20:30 (Welcome Reception) Exhibit Area Hours Wednesday, April 26 09:30 – 16:30 Thursday, April 27 09:30 – 16:30 Friday, April 28 09:30 – 16:30

Exhibit Company/Organization Booth # Exhibit Company/Organization Booth # VitalAire 1 SECA 11 Ideal Protein/ Laboratoires COP, Inc. 2 Obesinov 12 Valeant Canada 3 Alberta Health Services SN-OBN 13 Natural Factors – PGX 4 Healthy Together 14 Dairy Farmer of Canada 5 Respiratory Homecare Solutions 15 Nestle – Health Science 6 Take Off Pounds Sensibly – TOPS 16 Novo Nordisk 7/8 Celebrate Vitamins 17 Inbody Canada 9 American Board of Obesity Medicine 18 Weight Watchers Canada 10 Canadian Obesity Network 19/20

The serious solution for weight management.

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√ Latest program updates √ Speaker bio’s √ Schedule and exhibitor info √ Venue map and more

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Available for 5th Canadian Obesity Summit

13 | 5th Canadian Obesity Summit | #COS17 Social Events

Welcome Networking Summit Social – Wild Bill’s Summit Social – Rose & Crown Reception Wednesday, April 26th Thursday, April 27th Tuesday, April 25th  20:30  20:30  18:30 – 20:30  Wild Bill’s Legendary Saloon, Town  Rose & Crown, 202 Banff Ave  Riverview Lounge and Foyer Centre Bldg, 201 Banff Ave | 2nd Floor (optional dinner & social event organized The Canadian Obesity Summit Commit- (optional social event organized by CON by CON-SNP National Executive) Meet in tee invites all delegates to the COS 2017 SNP National Executive) Meet in the Fair- the Fairmont lobby at 8pm to walk togeth- Welcome Reception. Join us for a great mont lobby at 8pm to walk together to the er to the Rose & Crown, a laid-back hang- opportunity to meet colleagues, network Wild Bill’s Legendary Saloon, a lively venue out offering cocktails, brews & pub grub, and visit the exhibitors. offering live entertainment, spacious dance with a rooftop patio & nightly live bands. floor and bars; a perfect evening spot to mingle with friends and have fun! Summit Closing Ceremonies Summit Social – Bowling Alley & Awards Tuesday, April 25th Summit Reception with SNP Friday, April 28th  20:30 Leadership  17:30 – 18:30  Fairmount Thursday, April 27th  Conservatory (optional social event organized by CON-  17:30 – 18:30 SNP National Executive) Participants Find out who is this year’s TOPS New attending the networking reception are  Conservatory Investigator Award winner. All award encouraged to come keep the networking Take a break from scientific sessions to par- winners will be announced and prizes will going and participate in some friendly bowl- ticipate in an interactive networking meet- be delivered. ing. Come meet your hosts, the CON-SNP ing. Meet the CON National Student and National Executive, in the Fairmont Bowling New Professional Executive Committee Summit Social – Hoodoo Alley (optional food and drink available). and discover what our university chapters Lounge have been up to this year. You will have the Summit Reception with PEC opportunity to connect with researchers, Friday, April 28th professionals and students from all over the  20:30 Members country. Come to decompress, socialize  Hoodoo Lounge, 137 Banff Avenue and make new contacts at our “speed-net- Wednesday, April 26th working” event. Don’t forget your business (optional social event organized by CON-  17:30 – 18:30 cards! This event is open to all conference SNP National Executive) Meet in the  Conservatory delegates. Fairmont lobby at 8pm to walk together to downtown Banff to eat then meet for End the day with an opportunity for dancing at the Hoodoo Lounge. Mention informal networking with members of the the “Canadian Obesity Summit” for “no Public Engagement Committee. Open to line, no cover” before 10:30 pm. all conference delegates.

14 | 5th Canadian Obesity Summit | #COS17 Group Exercise Opportunities

No previous experience or special equipment required. Offer on a first come, first served basis.

Pre-conference: Monday Run Club – hosted by lululemon: Every Monday at 7:00 pm, anyone and everyone is welcome to join! Meet at the lululemon store (121 Banff Ave, Banff, AB) for 7pm and run around the town of Banff. The distance is totally personal and people are able to take it at their own pace without feeling stressed or completely out of their comfort zone.

During the conference: Wednesday, April 26, 2017

06:30 – 07:30 Walking Group & Running Group – hosted by CON-SNP: Whether you are an avid runner/walker or just hoping to get some cardio in to start your day please join us in the Fairmont hotel lobby dressed for the weather for a route approximately 60 min in length.

Mindfulness Workshop and Yoga with Trish Huston – hosted by lululemon: Meet in the NR Crump Room dressed to exercise. Trish is a registered yoga and meditation teacher. She is curious about how we can continue to be conscious and aware amidst the distractions we constantly face. Trish can share best practices about how to focus on the end goal while not burning out on a daily basis. For more information on Trish, visit her website at www.trishhuston.com

Thursday, April 27, 2017

06:30 – 07:30 Hatha Yoga – hosted by Gillian Mandich: Meet in NR Crump room dressed to exercise. What a great way to start the day - wake up and join Gillian for an invigorating morning Hatha yoga practice! Sunrise yoga is designed for everyone – from beginners to advanced – and will develop stamina, strength, and balance though its focus on developing proper alignment, breathing techniques, and body awareness. This class will get your blood flowing, improve focus and alertness, as well as energize your mind and body!

18:45 – 19:45 Boxfit Class with Jake Watson – hosted by lululemon: Meet in the NR Crump Room dressed to exercise. Jake is a strength coach, certified exercise physiologist and accredited Kinesiologist. Jake will lead a introductory style class to boxing.

Friday, April 28, 2017

07:00 – 08:00 HHIIT/Abs – hosted by Rebecca Liu: Meet in NR Crump and spend 30 minutes working on your agility, strength, and cardio endurance with a HIIT sports-inspired workout. Whether you are a beginner or a pro, this class is for everyone. Follow-up with 30 minutes of strengthening your core. Improve your technique with body weight exercises like crunches, and hovers; finish off with some hip, butt, and lower back exercises.

13:00 – 14:00 Theraputic Yoga with Kait and Katie – hosted by lululemon: Meet in the NR Crump Room dressed to exercise. Katie and Katie are both 200 hour certified Yoga instructors. Gaining their certificates in Goa, India and in Banff, Alberta, Kait and Katie will lead a therapeutic yoga class focusing on targeting the connective tissues and muscles in the body to help you on the path to a healthier lifestyle. Come learn movements you can take at your own pace and take home with you!

15 | 5th Canadian Obesity Summit | #COS17 General Information

Conference Dates and Venue April 26–28, 2017 Fairmont Banff Springs Hotel 405 Spray Avenue Banff, Alberta T1L 1J4 Tel.: +1. 403.762.2211 Toll Free: +1.800.257.7544 http://www.fairmont.com/banff-springs/

Access/Security Names badges will be provided to all attendees, sponsors and exhibitors and will be available for pick up at the 5th Canadian Obesity Summit Registration Desk, in the Curio Foyer. Please wear your badge at all times as it is your admission to all conference sessions, the exhibit area, and non-ticketed social events. There is a $60 CAD reprint fee for any lost or misplaced name badge.

Conference Language The official language of the 5th Canadian Obesity Summit is English. All sessions will be conducted in English.

Exhibit Area Hours: The Exhibits are located in the Riverview Lounge and will be open at the following times: Wednesday, April 26: 9:30 – 16:30 Thursday, April 27: 9:30 – 16:30 Friday, April 28: 9:30 – 16:30

Lost Property Please report any lost or unattended items immediately to the Registration Desk located in the Curio Foyer. Should you lose anything while at the conference, please enquire at the Registration Desk where any recovered lost property will be held. At the end of the conference, all unclaimed lost and found items will be given to the Fairmont Banff Springs Hotel.

Parking The hotel’s parking is located beside the Convention Center. It is a three-level roofed parkade with 415 parking spaces:

Self-parking: $25 CAD/night, with unlimited access Valet service is also available: $39 CAD/night, with unlimited access

Electric Vehicles - complimentary Fairmont Banff Springs along with Sun Country Highway Ltd, a manufacturer of electric vehicle charging stations has installed Banff’s first electric vehicle charging station, in the hotel’s parkade. Fairmont Banff Springs is pleased to offer complimentary self parking and complimentary charging for all electric vehicles of our guests.

Photographer An official photographer will be present during the conference. By registering for the 5th Canadian Obesity Summit, you agree to have your picture taken. Photography may be used for marketing purposes for future conference events.

16 | 5th Canadian Obesity Summit | #COS17 Health Breaks & Lunch

Tuesday, April 25 10:00 – 10:30 AM Health Break Conservatory 12:00 – 13:00 Lunch Conservatory 14:30 – 15:00 PM Health Break Conservatory

Wednesday, April 26 09:30 – 10:00 AM Health Break Riverview Lounge 11:30 – 13:30 Lunch Symposium – Novo Nordisk Van Horne A&B 11:30 –14:00 Lunch Riverview Lounge 16:00 – 16:30 PM Health Break Riverview Lounge

Thursday, April 27 09:30 – 10:00 AM Health Break Riverview Lounge 11:30 – 13:00 Lunch Symposium – Almased Van Horne A&B 11:30 –13:00 Lunch Symposium – Valeant Van Horne C 11:30 – 14:00 Lunch Riverview Lounge 16:00 – 16:30 PM Health Break Riverview Lounge

Friday, April 28 09:30 – 10:00 AM Health Break Riverview Lounge 11:30 – 13:30 Lunch Symposium – PGX Van Horne A&B 11:30 – 13:30 Lunch Symposium – Dairy Farmers Van Horne C 11:30 – 14:00 Lunch Riverview Lounge 16:00 – 16:30 PM Health Break Riverview Lounge

Registration Desk The Registration Desk is located in the Curio Foyer and will be open during the following times: Monday, April 24...... 07:30 – 18:00 Tuesday, April 25...... 07:30 – 21:00 Wednesday, April 26...... 07:30 – 18:00 Thursday, April 27...... 07:30 – 18:00 Friday, April 28...... 07:30 – 18:00 Registration Desk Phone number: 403 760 6074

Smoking Policy The Fairmont Banff Springs Hotel is a non-smoking venue. Attendees must refrain from smoking or using electronic smoking devices (including electronic vapors) in all Session Rooms and Ballrooms. Smoking is also prohibited within customer service areas of food and/or liquor establishments (indoor or open patios).

WIFI Complimentary wireless internet is included in the conference areas. Network Name: Fairmont Meeting Password: COS2017

17 | 5th Canadian Obesity Summit | #COS17 Conference Secretariat MCI Group Canada Inc. 200 – 1444 Alberni Street Vancouver, BC V6G 2Z4 CANADA Tel.: +1.604.688.9655 Fax: +1.604.685.3521 Email: [email protected] http://www.con-obesitysummit.ca/

18 | 5th Canadian Obesity Summit | #COS17 Schedule-at-a-Glance

Monday, April 24, 2017 MONDA

08:00– Closed meeting Closed meeting Pre-Conference Event: Satellite Meeting (off-site): 17:00 (by invitation only): (by invitation only): Food Addiction Dietitian Learning Retreat (Day 1) Developing International Part- PEC Strategic Planning Meeting in Obesity – Ethical and Policy Van Horne C nerships for Improving Obesity

Frontenac Implications CIHR Retreat Prevention & Management Training Y Ivor Petrak in Primary Care Banff Centre

Tuesday, April 25, 2017 T U ESDA

07:30– Registration Desk Opens 19:00 Curio Foyer Closed meeting Pre-Conference Event: WS.02: WS.04: WS.03: WS.01: 08:30– Y 10:00 (by invitation only): Dietitian Learning The Alberta Pediatric Considering the com- Clinical Updates in Nordic Walking: An PEC Strategic Planning Retreat (Day 2) Obesity Strategy: bined impacts of sleep, Bariatric Surgery: What Ideal Physical Activity Meeting (Day 2) Van Horne C From Inception to sedentary behaviour Every Clinician Needs for Prevention & Frontenac Integration and insufficient phys- to Know from Referral Treatment of Obesity Ivor Petrak ical activity on obesity to Post-Surgery Alhambra and health Follow-up Mt. Stephens Hall Alberta/New Brunswick

10:00– Networking & Health Break 10:30 Conservatory 10:30– WS.05: Culture WS.06: 12:00 and history as Rehabiltating and determinants of eating Assisting Obese Patients behaviours: how does with Medical Devices our ancestry affect our – All About Body Types relationship with food? and Bariatric Aids Ivor Petrak Alhambra 12:00– Lunch 13:00 Conservatory 13:00– Closed meeting Putting LIFE into LIFE- WS.07: WS.04: WS.03: WS.08: 14:30 (by invitation only): style Management Nothing about me, Considering the com- Clinical Updates in Better Together: CON-SNP National Van Horne C without me! bined impacts of sleep, Bariatric Surgery: What Co-Design and Imple- Executive Meeting Patient-centered sedentary behaviour Every Clinician Needs mentation of the Kidfit Frontenac Weight Bias Research! and insufficient phys- to Know from Referral Junior Program with Ivor Petrak ical activity on obesity to Post-Surgery Children, Families and and health Follow-up Community Partners Mt. Stephens Hall Alberta/New Brunswick Alhambra

14:00– Networking & Health Break 14:30 Conservatory

15:00– CON-SNP Career Panel: WS.04: WS.03: WS.09: 16:30 I’ve Got My Degree; Considering the com- Clinical Updates in Designing a Successful Now What? bined impacts of sleep, Bariatric Surgery: What Community Based Ivor Petrak sedentary behaviour Every Clinician Needs Approach to Pre- and insufficient physical to Know from Referral venting Childhood activity on obesity and to Post-Surgery ObesityBariatric Aids health Follow-up Alhambra Mt. Stephens Hall Alberta/New Brunswick

17:00– Opening Ceremony 18:30 Alberta/New Brunswick

18:30– Welcome Reception 20:30 Riverview Lounge/ Cascade Ballroom

19 | 5th Canadian Obesity Summit | #COS17 Schedule-at-a-Glance

Y Wednesday, April 26, 2017

07:30– Registration Desk Opens 16:30 Curio Foyer

08:15– Weight of Living: Personal Perspective Weight of Living: Personal Perspective 09:30

WEDNESDA Mini-Review 1: Mini-Review 2: Reshaping Canada’s Food Policies for Health My Patient has Lost Weight Now What? Alberta/New Brunswick Mt. Stephens Hall

09:30– Networking & Health Break Exhibition & Poster 10:00 Riverview Lounge / Cascade Ballroom Viewing 10:00– Mini-Review 3: Mini-Review 4: Riverview Lounge / Cascade Ballroom 11:00 Government Frameworks for Obesity Prevention Pediatric Obesity & Management Mt. Stephens Hall Alberta/New Brunswick

11:00– Pecha Kucha Presentations 1 Pecha Kucha Presentations 2 11:30 Alberta/New Brunswick Mt. Stephens Hall

11:30– Lunch Symposia: The Growing Weight of Obesity: An update on psychological and pharmacological management 13:30 Van Horne A&B

11:30– Lunch & Exhibits 14:00 Riverview Lounge / Cascade Ballroom

14:00– Concurrent Concurrent Concurrent WS.10: 16:00 Presentations 1: Presentations 2: Presentations 3: Mindful Eating for Obesity Weight Bias, Stigma, and Clinical Management Pregnancy & Maternal/ Alhambra Body Image Adults Fetal Health Alberta/New Brunswick Ivor Petrak Mt. Stephens Hall

16:00– Networking & Health Break 16:30 Riverview Lounge / Cascade Ballroom 16:30– Mini-Review 5: Mini-Review 6: 17:30 Weight bias: Moving beyond Bariatric Surgery I awareness to creating change! Mt. Stephens Hall Alberta/New Brunswick

17:30– Summit Reception with PEC Members 18:30 Conservatory

18:30 Dinner & Explore Banff on own

20:30 Summit Social – Please see page 14

20 | 5th Canadian Obesity Summit | #COS17 Schedule-at-a-Glance

Thursday, April 27, 2017 TH U RSDA

07:30– Registration Desk Opens 16:30 Curio Foyer

08:15– Weight of Living: Personal Perspective Weight of Living: Personal Perspective 09:30 Y Mini-Review 7: Mini-Review 8: Living with Obesity Pregnancy & Maternal Health Alberta/New Brunswick Mt. Stephens Hall

09:30– Networking & Health Break 10:00 Riverview Lounge / Cascade Ballroom Exhibition & Poster Viewing 10:00– Mini-Review 9: Mini-Review 10: Riverview Lounge / 11:00 Family Based Pediatric Care Managing Obesity as a Chronic Disease Cascade Ballroom Alberta/New Brunswick Mt. Stephens Hall

11:00– Pecha Kucha Presentations 3 Pecha Kucha Presentations 4 11:30 Alberta/New Brunswick Mt. Stephens Hall

11:30– Lunch Symposia: Strategies for Personalized Weight Lunch Symposia: Initiating Behavioural Change 13:00 Management in Obesity: The Right Patient, the Right Motivation, Van Horne A&B and the Right Solutions Van Horne C

11:30– Lunch & Exhibits 14:00 Riverview Lounge / Cascade Ballroom 14:00– Concurrent Concurrent Concurrent WS.11: 16:00 Presentations 4: Presentations 5: Presentations 6: Complexity & Obesity 2.0 Nutrition Metabolism: Preclinical Bariatric Surgery I Ivor Petrak Alberta/New Brunswick Insights Mt. Stephens Hall Alhambra

16:00– Networking & Health Break 16:30 Riverview Lounge / Cascade Ballroom 16:30– Mini-Review 11: Mini-Review 12: 17:30 Nutrition Beyond Food Microbiome/CIHR Alberta/New Brunswick Mt. Stephens Hall

17:30– Summit Reception with SNP Leadership 18:30 Conservatory 18:30 Dinner & Explore Banff on own 20:30 Summit Social – Please see page 14

21 | 5th Canadian Obesity Summit | #COS17 Schedule-at-a-Glance

Friday, April 28, 2017

Y 07:30– Registration Desk Opens Curio Foyer

08:15– Weight of Living: Personal Perspective Weight of Living: Personal Perspective FRIDA 09:30 Mini-Review 13: Mini-Review 14: Population Health - Surveillance Energy Metabolism & Body Composition Alberta/New Brunswick Mt. Stephens Hall

09:30– Networking & Health Break 10:00 Riverview Lounge / Alhambra Exhibition & Poster Viewing 10:00– Mini-Review 15: Mini-Review 16: Riverview Lounge / 11:00 Physical Activity Benefits Beyond Weight Loss Bariatric Surgery II Cascade Ballroom Alberta/New Brunswick Mt. Stephens Hall

11:00– Pecha Kucha Presentations 5 Pecha Kucha Presentations 6 11:30 Alberta/New Brunswick Mt. Stephens Hall

11:30– Lunch Symposia: Pharmacological, Dietary and Behavioural Lunch Symposia: Promoting Healthy Living: Moving Beyond 13:00 Strategies for Appetite Reduction and the Promotion of Satiety. Weight and Putting The Person First! Weight Management Outcomes in a High Volume Provincially Van Horne C Funded Program Van Horne AB

11:30– Lunch & Exhibits 14:00 Riverview Lounge / Cascade Ballroom

12:00– Workshop: 13:00 Canadian Obesity Network Local Chapters Mt. Stephens Hall

14:00– Concurrent Concurrent Concurrent WS.12: 16:00 Presentations 7: Presentations 8: Presentations 9: Transforming Primary Care Public Health Children & Adolescents Physical Activity Practice to Improve Obesity Alberta/New Brunswick Ivor Petrak Mt. Stephens Hall Prevention and Management Alhambra 16:00– Networking & Health Break 16:30 Riverview Lounge / Cascade Ballroom

16:30– Summit Closing Ceremony & Awards (Reception to follow) 18:30 Alberta/ New Brunswick/ Conservatory

18:30 Dinner & Explore Banff on own

20:30 Summit Social – Please see page 14

22 | 5th Canadian Obesity Summit | #COS17 Satellite Meetings

SUNDAY, APRIL 23, 2017 – TUESDAY, APRIL 25, 2017

Public Engagement Committee Strategic Planning Meeting (By invitation only) Annual strategic planning meeting for the Canadian Obesity Network’s Public Engagement Committee.

Monday, April 24, 2017

Food Addiction in Obesity – Ethical and Policy Implications CIHR Retreat (By invitation only) A CIHR-funded planning and knowledge initiative to develop provincial, national, and international collaborations to form a food addiction research network for policy development, knowledge translation and exchange. This retreat will bring together diverse research partners and knowledge users to examine the individual, societal, and policy impact of the emerging food addiction concept on obesity treatment in Canada.

Developing International Partnerships for Improving Obesity Prevention & Management Training in Primary Care Off-site meeting being held at the Banff Centre (By invitation only)

The inaugural coalition meeting to improve obesity prevention and management training in primary care.

Saturday, April 28, 2017 Annual General Meeting, Canadian Obesity Network, Board of Directors and Science Committee

Clinical Practice Guidelines Working Group Meeting (By invitation only)

23 | 5th Canadian Obesity Summit | #COS17 Workshops-at-a-Glance

TUESDAY, APRIL 25, 2017

WS.01 Nordic Walking: An Ideal Physical Activity for Prevention & Treatment 08:30 – 10:00 Alhambra of Obesity

WS.02 The Alberta Pediatric Obesity Strategy: From Inception to Integration 08:30 – 10:00 Ivor Petrak

WS.03 Clinical Updates in Bariatric Surgery: What Every Clinician Needs to Know 08:30 – 16:30 Alberta/ New Brunswick from Referral to Post-Surgery Follow-up

WS.04 Considering the Combined Impacts of Sleep, Sedentary Behaviour and 08:30 – 16:30 Mt. Stephens Hall Insufficient Physical Activity on Obesity and Health

WS.05 Culture and History as Determinants of Eating Behaviours: How does our 10:30 – 12:00 Ivor Petrak ancestry affect our relationship with food?

WS.06 Rehabilitating and Assisting Patients Who Have Obesity with Medical 10:30 – 12:00 Alhambra Devices: All About Body Types and Bariatric Aids

WS.07 Nothing About Me, Without Me! People-Centered Weight Bias Research 13:00 – 14:30 Ivor Petrak

WS.08 Better Together: Co-Design and Implementation of the Kidfit Junior 13:00 – 14:30 Alhambra Program with Children, Families and Community Partners

Putting LIFE Into Lifestyle Management 13:00 – 16:30 Van Horne C

CON-SNP Career Panel: I’ve Got My Degree; Now What? 15:00 – 16:30 Ivor Petrak

WS.09 Designing a Successful Community-Based Approach to Preventing 15:00 – 16:30 Alhambra Childhood Obesity

WEDNESDAY, APRIL 26, 2017

WS.10 Mindful Eating for Obesity 14:00 – 17:30 Alhambra

THURSDAY, APRIL 27, 2017

WS.11 Complexity and Obesity 2.0 14:00 – 16:00 Ivor Petrak

FRIDAY, APRIL 28, 2017

Canadian Obesity Network Local Chapters 12:00 – 13:00 Mt. Stephens Hall

WS.12 Transforming Primary Care Practice to Improve Obesity Prevention 14:00 – 16:00 Alhambra and Management

24 | 5th Canadian Obesity Summit | #COS17 Workshops Details

TUESDAY, APRIL 25, 2017

WS.01 Nordic Walking: An Ideal Physical Activity for external to health care including provincial and municipal govern- Prevention & Treatment of Obesity ments, education, indigenous communities and other private and 08:30 – 10:00 public stakeholders. To address the social determinants of health and Workshop Presenters: Mandy Johnson, Urban Poling Inc., unique local needs of families, a special focus will be placed on ensur- Vancouver, BC ing access to vulnerable populations. Highlights of the obesity initia- Workshop Description: This workshop will be 45 minutes of pre- tive to date (including challenges and opportunities), current state and sentation and discussion followed by 45 minutes of outdoor activity. next steps for model integration and optimization will be discussed. Walking is the favourite physical activity of Canadians, with a pleth- Learning Objectives: ora of physical and mental health benefits. Walking is often referred • To discuss the Albert health service obesity initiative. to as a “wonder drug” more potent than medications for treating • To discuss the development and implementation of the multi- a variety of lifestyle conditions. Nordic walking could be viewed as pronged of care. the “extra-strength” dose as it turbo-charges walking by engaging • To understand the multiple factors involve in rolling out a virtually all the muscles of the upper body in addition to the lower pediatric obesity strategy body. On average, Nordic walking increases the caloric expenditure of walking by 20% without any perceived increase in exertion. After WS.03 Clinical Updates in Bariatric Surgery: What Every reviewing current research that supports these claims and discuss- Clinician Needs to Know from Referral to Post-Surgery ing the psycho-social benefits of Nordic walking, participants will Follow-up be outfitted with walking poles and taken outside to experience 08:30 – 16:30 the unique Canadian variation of Nordic walking technique that is Workshop Presenters: David Urbach1, Karyn Mackenzie1, Patti Kasta- growing in popularity across the country with people of all ages nias1, Wynne Lundblad2, Alexis M. Fertig2, Susan Wnuk1, Stephanie and abilities. The activity session will include learning correct Nordic Cassin3, Raed Hawa1, Chau Du1, Rebecca Kirsh1, walking technique and going on a short walk (intensity: easy) with Jennifer Brown4, Sanjeev Sockalingam1 the opportunity to reinforce the learning while experiencing the 1 University Health Network, Toronto, ON joy of outdoor activity in the spectacular environment in the vicinity 2 University of Pittsburgh, Pittsburgh, PA of the Banff Springs Hotel. Participants are required to have sturdy 3 Ryerson University, Toronto, ON outdoor walking shoes and recommended to wear a few layers of 4The Ottawa Hospital Bariatric Centre of Excellence, Ottawa, ON clothing that can be removed as people warm up. Workshop Description: Bariatric surgery is recognized as an effec- Learning Objectives: tive and durable treatment for severe obesity; however, bariatric and • To learn correct Nordic techniques. primary care teams require awareness and skills to manage the myriad • To review current research on benefits of Nordic walking. of pre- and post-operative concerns. Pre-surgery concerns consist of bariatric surgery readiness assessment, surgical risks and psychosocial WS.02 The Alberta Pediatric Obesity Strategy: From stability. Further, patients require additional assessment and inter- Inception to Integration vention after surgery, including early recognition of bariatric surgery 08:30 – 10:00 complications and evidence-informed psychosocial interventions Workshop Presenters: Rena LaFrance, Alison Connors, Alberta to maintain weight loss and health benefits long-term. This full-day Health Services, Edmonton, AB workshop will provide participants with an integrated interprofes- Workshop Description: Obesity is a complex chronic disease that af- sional approach to bariatric surgery assessment and aftercare. Each fects individuals across the lifespan. The Alberta Health Services (AHS) presentation will answer a critical bariatric surgery question pertaining Obesity Initiative aims to reduce the burden of obesity in the province to pre-surgery and post-surgery care. The morning presentations will and spans the age and care continuums. The pediatric component of review the evidence for bariatric surgery, surgical risks, pre-operative the Initiative focuses on children ages 2–17 years and includes a multi- nutritional risks, psychiatric risks and pharmacological concerns. The pronged model of care. Pediatric obesity services include MEND afternoon sessions will respond to common clinical questions pertain- (Mind, Exercise, Nutrition…Do It!), Primary Care services, Outpatient ing to early post-surgery complications, common vitamin deficiencies, Dietitian Counselling, and Pediatric Centres for Weight and Health new onset psychiatric disorders, and the evidence for behavioural and (specialty care). Best treatment option is determined in partnership psychosocial interventions to support weight loss. Case discussions between the child/family and primary care provider with consideration will illustrate approaches to these common clinical challenges. The given to family preference, stage of change, root causes and comor- presenters will summarize new guidelines and share their published bidities of overweight/obesity. The development and implementation protocols and resources with participants. of the model demonstrates the results of collaborative efforts between Learning Objectives: the five AHS zones; Primary Health Care, Nutrition Services; Popu- • Describe the role that clinicians have in pre- and post-bariatric lation, Public and Indigenous Health; physicians, community based surgery care. agencies and many other stakeholders. While there have been numer- • Identify new tools and evidence for assessing and supporting ous successes under the Pediatric Obesity Strategy, the need for scale bariatric surgery patients throughout the bariatric surgery process. and spread of the existing model is needed. In an effort to reach • Apply medical, nutrition and psychosocial protocols and additional families, the initiative now seeks to partner with sectors interventions that improve patient outcomes after bariatric surgery.

25 | 5th Canadian Obesity Summit | #COS17 Workshops

TUESDAY, APRIL 25, 2017

• To enhance participants familiarity with practical implications of WS.04 Considering the Combined Impacts of Sleep, emerging technology Sedentary Behaviour and Insufficient Physical Activity on Obesity and Health WS.05 Culture and History as Determinants of Eating Be- 08:30 – 16:30 haviours: How Does Our Ancestry Affect Our Workshop Presenters: Allana LeBlanc, University of Ottawa Heart Relationship with Food? Institute; Chris Ardern, York University; Jean-Philippe Chaput, CHEO 10:30 – 12:00 Research Institute CHEO Research Institute; Sarah Neil-Sztramko, Workshop Presenters: Wendy Shah and Colleen Cannon, McMaster University; Thirumagal Thirumagal Kanagasabai, McGill Craving Change™ University; McGill University; Jonathan Workshop Description: As experts in the psychology of eating, McGavock, University of Manitoba; Bolette Rafn, University of British registered dietitian Wendy Shah and clinical psychologist Dr. Colleen Columbia; John Spence, University of Alberta. Cannon help people understand “why” they eat the way they do. A Workshop Description: critical step towards fostering this understanding is by increasing both Session 1: Where We Stand – Current State of the Literature the client and the clinician’s awareness of the client’s personal influ- Among the modifiable factors that increase the risk of obesity are ences on their eating behaviours. This includes how culture and his- insufficient sleep, sedentary behaviour and physical inactivity. Until re- tory may have had an impact on their thoughts, assumptions, values, cently, these lifestyle factors were largely researched in isolation, and and expectations. Canada is known for its multicultural composition. without consideration for their interactive effect. It is now apparent As health care providers, prompting clients to reflect on and discuss that sedentary time and purposeful activity, as well as sleep quality their culture and history can be a fascinating and fruitful way to help and duration, may be important in overall health. them begin to understand their relationship with food. Session 2: Information for Researchers Learning Objectives: Obtaining accurate estimates of physical activity, sedentary behaviour • To discuss the remarkable similarities and variations in clients’ and sleep is important for both epidemiologic and applied obesity descriptions of how culture, heritage, and history play a role in research. A wide variety of self-report and objective measurement food choices and eating behaviours. tools exist; each capture different types of information, were de- • To focus on the experience of working directly with indigenous signed for and validated in different populations, and thus are ap- community members who have a distinctly unique history and propriate in different situations. This session will provide an overview face challenging circumstances that can influence their of the most common tools, and the strengths, limitations and most relationship with food. appropriate use of each. Participants will have the opportunity to • An interactive workshop in which attendees will be encouraged to use these tools, and see real-time data scoring and analysis to gain a share their clinical and personal experiences. more thorough understanding of how these tools can be used. Session 3: Information for Practitioners The purpose of this session is to provide solutions for the rising WS.06 Rehabilitating and Assisting Patients Who Have proportion of children and youth who are sitting more and sleeping Obesity with Medical Devices: All About Body Types and and moving less. By reversing this trend, children and youth will be Bariatric Aids at a decreased risk for a range of non-communicable diseases. We 10:30 – 12:00 will pull from lessons learned around the world and provide insights Workshop Presenter: Malene Alexandrowiz, XXL Rehab, Kastrup, on areas where Canada is challenged and where we are succeeding. Denmark We will also give an overview of what a healthy day looks like, and Workshop Description: how health care providers can help parents, teachers, and caregivers One of several requirements to set up the right rehabilitation promote these habits among the children they work with. This ses- approach is to understand how different body shapes move and sion will provide a comprehensive look at healthy active living among behave. Based on XXL-Rehab guidelines, simulation suits, experi- children and youth and provide participants with tools to disseminate ence and existing knowledge, this workshop will provide guidelines this information in practice. and advice on how to handle bariatric patients in a respectable way Session 4: Where We are Going – Future Directions (Master Class) in different situations. We will consider the principles of rehabilita- This will be a Master Class panel discussion with experts from the tion connected to different body types and movements, which are day, along with some special guests, answering your questions and critical to know before choosing programs or designing solutions to engaging in friendly debate on the practical implications of emerging improve, maintain and preserve functional independence. technology. Learning Objectives: Learning Objectives: • To gain insights to barriers in the built and social environment for • To understated the current state of literature for sleep sedentary persons living with obesity. behavior and physical inactivity. • To apply the concepts of ideation and design relevance to their • To gain knowledge on how to use tool for real time data scoring area of practice. and analysis. • To gain experiences on how to handle bariatrics patients in • To explore various tools use for healthy active living among respectful way in various situation. children in use.

26 | 5th Canadian Obesity Summit | #COS17 Workshops

TUESDAY, APRIL 25, 2017

WS.07 Nothing About Me, Without Me! People-Centered process of the KidFit Junior Program, an innovative partnership Weight Bias Research between patients and families, Trillium Health Partners (THP) and 13:00 – 14:30 PM The City of Mississauga. The program is for children in grade 5 Workshop Presenters: Jodi Krah, PEC Members, Ian Patton, York and under living with obesity and their families. In the first year of University, Mary Forhan, University of Alberta development, KidFit embedded focus groups into the first phase Moderators: Sara Kirk, Angela Alberga, Ximena Ramos Salas of the program. Several key themes were identified in the child and Workshop Description: Weight bias and stigma are deeply caregiver feedback: the importance of program implementation ingrained in healthcare settings and lead to many inequities for occurring within the community to promote accessibility, regular people living with obesity. Weight bias exists in various forms in physical activity, food preparation skills, and the importance of the healthcare system, including receiving inappropriate comments including all family members in the program. KidFit and the City of about weight, being treated disrespectfully because of weight and Mississauga staff designed phase 1 and phase 2 of the program to using inaccessible equipment and facilities that do not accommo- include educational sessions for caregivers, while simultaneously date body diversity. Reduced time spent with patients and patient offering physical literacy programming run by Parks and Recreation avoidance of the healthcare system strongly affect the quality of Staff to young patients and their siblings. Through interactive dis- care of patients living with obesity. Weight bias and stigma are also cussion, brainstorming and hands-on group activities participants prevalent in the education sector, which affects health and educa- of the workshop will learn about this innovative program, and how tional outcomes for people with obesity. It can increase vulnerability to build family and community engagement practices into program to anxiety, stress, depression, suicidal thoughts and behaviors, design and implementation. avoidance of physical activity and disordered eating habits. The Learning Objectives: workshop will bring together the Canadian Obesity Network’s • Understand how the KidFit Junior Program created multi-sector Public Engagement Committee (CON-PEC) in collaboration with partnerships to deliver obesity treatment for young Canadian the pan-Canadian EveryBODY Matters Collaborative team of re- children. searchers studying weight bias and people-centered research and • Build family and community engagement practices into your practice. The workshop will begin with a panel of speakers from program design and implementation to ensure sustainability CON-PEC sharing their experience with weight bias and research. and effectiveness. The EveryBODY Matters Collaborative will provide examples of patient-engaged and person-centered research from the field of Putting LIFE Into Lifestyle Management weight bias in health care and education. Participants will then 13:00 – 16:30 engage in an interactive discussion to identify useful practices and Workshop Presenters: Michael Vallis1, David Macklin2, Krista existing mechanisms that can be used to develop meaningful peo- Leck-Merner3, Dayna Lee-Baggley3, ple-centered research in the area of weight bias reduction. 1. Dalhousie University and Nova Scotia Health Authority, Halifax, Learning Objectives: NS, 2. University of Toronto, Toronto, ON, 3. Nova Scotia Health • To hear the voices of people affected by weight bias and their Authority – Central Zone, Halifax, NS vision for people-centered research; Workshop Description: This session presents a model of care that • Acquire practical skills to engage people with obesity in addresses the processes required for lifestyle change (i.e., internal- research and practice and to reduce weight bias in healthcare ly motivated behaviours that a person puts effort into protecting/ and education settings. maintaining). Five core drivers of behaviour are addressed: Obesity bias. This component addresses self-image/self-esteem WS.08 Better Together: Co-Design and Implementation of vis a vis weight and shape. Promoting positive, accepting views the Kidfit Junior Program of oneself and dealing with bias from others is the goal of this 13:00 – 14:30 intervention. Workshop Presenters: Dianne M. Fierheller1, 2, Ian S. Zenlea1, 3, Expectations. This component addresses weight loss expectations, Brenda Callaghan4, Lisa Metzger1, Alexandra Wills1 with the goal to align patient goals with known biology of weight 1. Trillium Health Partners, Mississauga, ON, 2. McMaster University, loss. Hamilton, ON, 3. University of Doing. This component addresses the meaningful/achievable Toronto, Toronto, ON, 4. City of Mississauga, Mississauga, ON behaviours that a person is ready to change using motivational Workshop Description: Developing sustainable and effective communication interventions. The goal is to develop a realistic programs is required in the treatment of obesity with young behavioural plan that can be taken on in a nonjudgmental, children in Canada. Participation in structured weight manage- empowering manner. ment programs is often challenged by systemic barriers such as Wanting. This component addresses one’s relationship with food; accessibility, transportation and childcare. Given the barriers to cravings, pleasure, emotional eating and the functional role of treatment, innovative and collaborative models of care are needed food. The goal is to improve the emotional functioning in light of between hospital-based clinics and community agencies that will the neurobiology regarding the drive to eat. support and engage children and their family members throughout Thinking. This component addresses the cognitive aspects of eat- the treatment process and following transition from the program. ing. Cognitive behavioural interventions highly specific to eating This workshop will highlight the co-design and implementation situations and behaviours are enumerated.

27 | 5th Canadian Obesity Summit | #COS17 Workshops

TUESDAY, APRIL 25, 2017 THURSDAY, APRIL 27, 2017

Learning Objectives: key opportunities and overcome barriers to implementation. The • To address the process require for life style change. format for this workshop will be interactive. Participants will consider • To demonstrate the use of this model in individual care within and discuss in the context of their specific situations strategies such primary care service by a physician. as program evaluation, social marketing, acquiring political support, • To gain understanding of the use of this model in a group of sustainability via PPP, and program organization. Workshop leaders obesity management clinic by a dietitian/psychologist team. Edell and Amed have been involved in program design, training and implementation of community based childhood obesity prevention CON-SNP Career Panel: I’ve Got My Degree; Now What? programs in Canada. 15:00 – 16:30 Learning Objectives: Workshop Moderators: Thirumagal Kanagasbai, Jennifer • To understand the core principal of successful community-based McConnell, CON-SNP National Executives childhood obesity prevention programs. Workshop Panelists: • To understand how to design a program relevant to their setting Academia: Jennifer Kuk, Associate Professor at York University and public health goals for childhood obesity prevention and Industry: Nora Madian, Senior Manager, Stakeholder & Corporate health equity. Relations at Novo Nordisk • To identify the key opportunities and overcome barriers to Government: Hasan Hutchinson, Director General of the Office implementation. of Nutrition Policy and Promotion within the Health Products and Food Branch of Health Canada Clinical: Sean Wharton, Medical Director of the Wharton Medical WEDNESDAY, APRIL 26, 2017 Clinic in Burlington, Ontario NGO: Manuel Arango, Director, Health Policy. Heart and Stroke WS.10 Mindful Eating for Obesity Foundation of Canada – Heart and Stroke Foundation 14:00 – 16:00 Workshop Description: Workshop Presenters: Susan M. Wnuk1,2, Chau Du1,3, Wei Wang1 Do you have questions about your career options but don’t know 1. University Health Network, Toronto, ON, 2. University of Toronto, who to ask? We have a panel of experts from academia, industry, Department of Psychiatry, Toronto, ON, 3. City University of government, non-profit, and the clinical sectors to answer your London, Department of Psychology, London, United Kingdom questions. Come prepared with your questions for this event, and Workshop Description: Long-term weight loss maintenance is get answers from our career panel experts. the goal for bariatric patients and clinicians as it is associated with Learning Objectives: medical, psychological, and quality of life benefits. Weight regain • To gain knowledge on various career options. after weight loss interventions including surgery is concerning, especially when it is associated with problematic psychological and WS.09 Designing a Successful Community-Based Ap- behavioural factors such as emotional eating and loss of control proach to Preventing Childhood Obesity over eating. When these factors are present, both clinicians and 15:00 – 16:30 patients can lose confidence in the patient’s ability to achieve and Workshop Presenters: maintain a healthy weight. Mindfulness approaches have been Dennis Edell1, Shazhan Amed2 used successfully with a variety of presenting problems includ- 1. Epode International Network, Toronto, ON, 2. BC Children’s ing chronic pain, depression, anxiety, and more recently binge Hospital, University of British Columbia, Vancouver, BC eating and emotional eating. Importantly, mindfulness practices Workshop Description: have also been shown to improve gastrointestinal (GI) symptoms. EPODE (Ensemble Prévenons l’Obésité Des Enfants) is a large-scale, Given how closely the gut and brain interact, emotional and centrally coordinated, capacity building approach for communities psychosocial factors can trigger symptoms in the gut. Therefore, to implement effective and sustainable strategies to prevent child- mindfulness can address symptoms in both systems. This work- hood obesity. The EPODE experience suggests that successful child- shop will introduce the principles of mindfulness as it relates to hood obesity prevention requires an integrated community-wide eating, including case conceptualization, mindful eating prac- approach in which both individual and environmental determinants tices, brain-gut health, and other relevant mindfulness exercises are targeted in all settings where children live, learn, and play. for eating problems. The emphasis will be on integrating skills to Collective Impact defines the collaborative nature of this approach cope and understand triggers that can lead to overeating, and calls for multiple organizations or entities from different sectors emotional eating, and loss of control, rather than on restricting. to adopt a common agenda, shared measurement and alignment Learning Objectives: of effort. This workshop is designed for those seeking to implement • Describe the theoretical principles of mindful eating. in their community, a customizable, workable and proven solution • Understand how mindful eating can contribute to a healthier for reducing the prevalence of obese and overweight children. brain-gut connection. Workshop participants will learn: The core principles of successful • Learn how to incorporate mindful eating techniques into daily life, community-based childhood obesity prevention programs; How to and facilitate 1–2 mindful eating exercises with patients/clients. design a program relevant to their setting and public health goals for childhood obesity prevention and health equity; How to Identify

28 | 5th Canadian Obesity Summit | #COS17 Workshops

THURSDAY, APRIL 27, 2017 FRIDAY, APRIL 28, 2017

WS.11 Complexity and Obesity 2.0 WS.12 Transforming Primary Care Practice to Improve 14:00 – 16:00 Obesity Prevention and Management Workshop Presenters: Diane Finegood, Professor, Simon Fraser 14:00 – 16:00 University (Moderator); Harry Rutter, London School of Hygiene Workshop Presenters: Denise L. Campbell-Scherer1,2, Elizabeth and Tropical Medicine; Robyn Tamblyn, CIHR Institute of Health Sturgiss3, Thea Luig4,Katrina Anderson3, Arya M. Sharma2,4 Services and Policy Research; Sonia Wutzke, The Australian 1. Department of Family Medicine, University of Alberta, Edmon- Prevention Partnership Centre, Hasan Hutchison, Health Canada. ton, AB, 2. Alberta Diabetes Institute, University of Alberta, Workshop Description: There’s been a lot of discussion and a Edmonton, AB, 3. Academic Unit of General Practice, Australian growing acceptance of the value of complex systems thinking to National University, Canberra, ACT, Australia, 4. Department of help address obesity and other wicked public health challenges. Medicine, Division of Endocrinology, University of Alberta, But it seems little has changed for public health research which Edmonton, AB is still focused on individuals and on the elements of the system Workshop Description: Obesity is an issue across all healthcare that gives rise to obesity. The focus remains at the individual level systems in the developed world. Connecting ideas and findings because this is where a reductionist approach can be applied. from different international settings give the opportunity to learn Some funders have turned their attention to funding programs about frameworks that might work. This practical workshop will for natural experiments, as well as “evocative” and “systems” allow participants to explore the management of obesity using grant-making methods. Academics are responding to these pro- examples from two different primary healthcare settings, Canada grams but we are far from seeing an impact on the public health and Australia. The workshop will highlight research findings on literature or being able to give decision-makers the evidence they how to support patients and interdisciplinary primary care teams need to support a systems approach. So, what do we need to do to improve obesity prevention and management. Participants to change this state of affairs? We need to start by asking differ- will be introduced to primary care resources: the 5As for Obesity ent questions and then developing the methodology that allows Management™, the 5As Team Tools, and the CHANGE Program. us to answer them. If we want decision-makers to apply solutions Interactive components will allow participants to share their own appropriate to complex problems, we need to provide them the experience, programs and resources with the group. evidence base to support it. Learning Objectives: Learning Objectives: • Compare the primary healthcare setting in international • Build consensus to advance new models of public health action. contexts with a focus on support for obesity management. • Identify the research required to provide a supporting evidence base. • Introduction to practical tools and resources to support provider and team training, and patient intervention to improve • obesity prevention and management. • Learn new skills to be used in a consultation setting from around the world. • Focus on how to spread skills and confidence in your local primary healthcare community.

Canadian Obesity Network Local Chapters 11:30 – 12:30 PM Chair: Arya M Sharma Presenters: Michael Vallis (YHM), Sue Pedersen/Shahebina Walji (YYC), Sean Wharton/Sandra Elia/Priti Chawla (YYZ), JP Chaput (YOW), David Harris/Veronica Kacinik (YVR) If you are part of a local CON chapter or want to find out more about starting one this is your chance. Each established chapter will present what their chapter has done and what they learned. Find out more about local chapters and how CON can support your chapter as we grow. Learning Objectives: • Describe the barriers and limits faced by local chapters • Apply learnings from established CON local chapters

29 | 5th Canadian Obesity Summit | #COS17 Lunch Symposium

Wednesday, April 26, 2017

The Growing Weight of Obesity: An Update on Psychological and Pharmacological Management Lunch: 11:30 – 12:00, Symposium: 12:00 – 13:30 Speakers: Arya Sharma, David Lau, Michael Vallis, David Macklin, Learning Objectives: Sean Wharton • Recall the multifactorial etiology of obesity and the benefits The body of evidence around obesity is rapidly growing, as is our of its management. knowledge of its impact on patients. This fast pace underscores • Describe current approaches to obesity management, with a the need for the healthcare community to remain dedicated to focus on behavioural modifications and pharmacotherapy. continued learning on obesity and approaches to its manage- • Assess the benefits and limitations of approaches to obesity ment. During this program, participants will follow an expert pan- management and strategies for their incorporation into clinical el through an exploration of the neurobiology of obesity, and the practice. importance of behavioural and pharmacologic interventions in (This program was supported in part by an educational grant from managing this chronic disease. Taking a step further, participants Novo Nordisk) will review how these concepts can be integrated into clinical practice to improve patient care.

THURSDAY, April 27, 2017

Initiating Behavioural Change in Obesity: The Right Strategies for Personalized Weight Management Patient, the Right Motivation, and the Right Solutions 11:30 –13:00 11:30 – 13:00 Co-Chairs: Aloys Berg and Arya M. Sharma Chair: David Lau1 Presenters: Arya M. Sharma1,2, Carla Prado1, Jens Walter1 Presenters: Daniel Gagnon2, Sean Wharton3 1. University of Alberta 2. Canadian Obesity Network 1. University of Calgary 2. Université de Montréal 3. University of A large number of studies have analyzed different strategies Toronto aimed at inducing a negative energy balance and, consequently, How do you know if the patient living with obesity is ready for body weight loss. This informative and interactive symposium, change? Stay up to date on the rapidly evolving landscape of co-chaired by Drs. Aloys Berg and Arya Sharma, will review the obesity pharmacotherapy and gain new tools to address obesity, various strategies that can be employed for personalized weight engage patients to change and set up a framework for long-term management. Topics that will be covered include dietary treat- success. ments such as meal replacement strategies, personalized nutri- (This program was supported in part by an educational grant from tion and the influence of gut microbiota. Limited space available. Valeant) (This program was supported in part by an educational grant from Learning Objectives: Almased) • Determine the person living with obesity motivation and Learning Objectives: readiness to change • Describe the options for personalized long-term weight • Engage patients by asking appropriate questions to identify management personal barriers to change • Identify the impacts of personalized nutrition on metabolic • Counsel patients on the role of biological and genetic factors adaptation and body composition that contribute to obesity and • Describe the link between nutrition and obesity as it relates to weight regain gut microbiota • Discuss anti-obesity medications and help choose the proper agent as adjunct to the treatment plan

30 | 5th Canadian Obesity Summit | #COS17 Lunch Symposium

FRIDAY, April 28, 2017

Pharmacological, Dietary and Behavioral Strategies for Promoting Healthy Living: Moving Beyond Weight and Appetite Reduction and the Promotion of Satiety: Weight Putting the Person First! Management Outcomes in a High Volume Provincially 11:30 – 12:30 Funded Program Presenters: Jo-Anne Gilbert1 and Ximena Ramos Salas2 1. 11:30 – 12:30 University of Montreal and Leader of the movement “Imparfait 2. Presenter: Michael R Lyon, Medical Weight Management Centre et en santé”; School of Public Health, University of Alberta and Join Dr. Michael Lyon for lunch and have your questions about Canadian Obesity Network. weight management strategies answered. Dr. Lyon is a Diplomate Health promotion messages and strategies have been criticized of the American Board of Obesity Medicine and the Medical for promoting a simplistic narrative that contribute to weight bias Director of a provincially funded weight management centre in in our society. Often the public health narrative about health pro- British Columbia. moting behaviours is centered on weight. However, weight is not (This program was supported in part by an educational grant from a behaviour and healthy eating, sleep and physical activity have PGX) health benefits that are far beyond weight. The ‘healthy weight’ Learning Objectives: narrative has also lead to individuals being overly concerned • Describe the strategies for appetite reduction about their weight and health. Evidence-based resources on • Identify methods to promote satiety the complex interactions between weight and health are needed to support Canadians who want to improve their health and wellbeing. But how do we talk about weight and healthy lifestyles without causing unintended consequences such as excessive preoccupation with weight? How do we provide evidence-based information about the complexity of weight and health in a way that is useful to Canadian adults? How do health promotion messages align with the realities of people living with obesity? This exciting session will answer these questions and more. (This program was supported in part by an educational grant from Dairy Farmers of Canada) Learning Objectives: • Describe the barriers and limits faced by health professionals working in the weight management field • Apply learnings from a people-centered and evidence- informed process to design an educational resource targeted to Canadian adults who are concerned about their weight and who want to improve their lifestyles

31 | 5th Canadian Obesity Summit | #COS17 Mini-Review Session Details

WEDNESDAY, APRIL 26, 2017 Mini Review 1: Reshaping Canada’s Food Policies for Health 08:15 – 09:30 (Co-Chairs: Neil Neary & Leia Minaker) Alberta/ New Brunswick

The Weight of Living: Personal Perspectives Kelly Moen, PEC member I am a former Bariatric Patient. I have a keen desire to introduce and advocate for a greater focus on mental and emotional well-being of the bariatric patients. The Current landscape of our medical industry lacks in its understanding and teaching regarding obesity treatments. We can no longer believe in the tale of “move more and eat less”. We need to treat today’s obese generations by focusing on our resources for new research and development of treatments and cures. We require a full bio-psychosocial approach when it comes to understanding and treating obesity. Together we can win, apart we will only flounder.

Our 21st Century Diet of Convenience: Why We Need Marketing to Kids (M2Ks) and Sugary Drink Policies Manuel Arango, MA, MHA Manuel Arango is the Director of Health Policy & Advocacy, Canada, for the Heart and Stroke Foundation. Located in Ottawa, he oversees the Foundation’s policy & advocacy efforts. Manuel also acts as a media spokesperson for the Foundation on a variety of policy issues. Manuel has chaired various coalitions and a board of directors. He has a Masters in experimental psychology (Carleton University) and a Masters in health administration (University of Ottawa). Manuel’s policy/advocacy interests focus on cost-effective population-wide interventions that can make it easy for Canadians to be healthy as possible. He was formerly a legislative assistant on Parliament Hill. Since being at the Foundation he has served as Health Policy Analyst; Manager, Government Relations, and; Assistant Director Health Policy. Manuel is passionate about his wife and two hockey & soccer focused children, as well as about ensuring that governments create the healthiest environments possible, so that the healthy choice can always be the easy choice for all Canadians. Learning Objectives: • To learn how the Canadian nutrition environment has changed • To develop an understanding of the need for population level obesity and chronic disease interventions, including marketing to kids restrictions and sugary drink interventions. • To understand how fruit juice as a sugary drink impacts health

Healthy Eating Strategy: Responding to The Senate Report in Obesity Hasan Hutchinson, PhD, ND Hasan Hutchinson is the Director General of the Office of Nutrition Policy and Promotion within the Health Products and Food Branch of Health Canada. As the focal point for public health nutrition within the federal government, the office strives to promote the nutritional health and well-being of Canadians. The Office’s main functions include dietary guidance, food and nutrition surveillance, research and data analysis, health promotion and public health nutrition policy. Hasan is the co-chair of the Federal/Provincial/Territorial Group on Nutrition and of the multi-sectoral Network on Healthy Eating. He serves on a number of nutrition-related committees at the World Health Organization and Pan American Health Organization and has served on a number of health-related committees at the Organization for Economic Co-operation and Development and at the United Nations. He also served as Chair of Canada’s Sodium Working Group. Previous to his current role, Hasan was Associate Director of the Institute of Nutrition, Metabolism and Diabetes at the Canadian Institutes of Health Research (CIHR) and, before that, was Senior Advisor in International Affairs at Health Can- ada. Before working in the public service, Hasan was a faculty member in the Department of Neurology and Neurosurgery at McGill University. His formal education includes a PhD in Quantitative Genetics and an ND in Naturopathic Medicine. Learning Objectives: • To share findings from the 2015 evidence review for dietary guidance • Provide an update on the revision of Canada’s Food Guide • Provide an overview of stakeholder engagement activities

32 | 5th Canadian Obesity Summit | #COS17 Mini-Review Session Details

WEDNESDAY, APRIL 26, 2017 Mini Review 1: Reshaping Canada’s Food Policies for Health 08:15 – 09:30 Alberta/ New Brunswick

The Prospect of Sugar Beverage Taxation in Canada Yann LeBodo, MSc, PhD Since 2012, Yann Le Bodo is a project manager at the Evaluation Platform on Obesity Prevention (EPOP) set- up by Laval University (Université Laval) and the Quebec Heart and Lung Institute-Laval University (Université Laval). He is in charge of projects in the area of healthy eating and physical activity policies. He is also a Ph.D. student in community health at Laval University (Université Laval)’s Faculties of Medicine and Nursing. An important part of his research has focused on sugar-sweetened beverage taxation in Canada. Before joining the EPOP, Yann worked as a project manager in health education at community level in France (2007), and as European and international coordinator of the EPODE childhood obesity prevention network (2008–2011). He holds a Master in food innovation from Angers School of Agriculture (France, 2005) and a M.Sc. in diet-related social sciences from Toulouse II University (France, 2006). He is co-author of several peer-reviewed publications, as well as co-editor and co-author of the books “Preventing childhood obesity: EPODE European Network recommendations” (Lavoisier 2011), “L’Expérience québécoise en promotion des saines habitudes de vie et en prévention de l’obésité: comment faire mieux?” (Presses de l’Université Laval 2016) and “Taxing soda for public health: a Canadian perspective” (Springer 2016). Learning Objectives: • To provide an overview of the evidence about the rationale and potential effects of sugar-sweetened beverage taxation for public health. • To expose the prospects and challenges of such a policy in Canada, including feasibility and acceptability considerations. • The presentation will be partly based on the publication of the book: Taxing soda for public health. A Canadian perspective. Le Bodo, Y, Paquette, MC, De Wals, P. (2016). Springer. Available at: http://www.springer.com/gp/book/9783319336473. A 4-page summary of the book can be downloaded here: http://iucpq.qc.ca/fr/taxing-soda-for-public-health

Mini Review 2: My Patient Has Lost Weight Now What? 08:15 – 09:30 (Co-Chairs: Yoni Freedhoff & Theodore Kyle) Mt. Stephens Hall The Weight of Living: Personal Perspectives Adrianna O’Regan, PEC member A former bariatric surgery patient that has experienced first-hand the stigma that seems to face people living with obesity. She is an Educational Assistant in the Edmonton area and with that she has seen how obesity can affect children and adults alike. Adrianna is an eager participant of CON to help change the typical societal norm that seems to be showcased in regards to excess weight with individuals.

33 | 5th Canadian Obesity Summit | #COS17 Mini-Review Session Details

WEDNESDAY, APRIL 26, 2017 Mini Review 2: My Patient Has Lost Weight Now What? 08:15 – 09:30 (Co-Chairs: Yoni Freedhoff & Theodore Kyle) Mt. Stephens Hall

Lifestyle Intervention Marie-France Langlois, MD, FRCPC, CSPQ Dr Langlois trained in Endocrinology at Université de Sherbrooke (Quebec, Canada) and completed a research fellowship at Harvard University (USA, 1995-1997). She currently practices as an endocrinologist, Director of the Ambulatory Metabolic Unit, which includes diabetes, obesity and lipid disorders clinics, and Medical Manager of the chronic diseases trajectory at the CIUSSS de l’Estrie –CHUS in Sherbrooke. She is also Professor of Medicine and Physiology at Université de Sherbrooke. She received the Young investigator award of the Canadian Society of Endocrinology and Metabolism in 2007 and held a National-Scientist award of the Fonds de la recherche du Québec – Santé (FRQ-S). Her research interests include the regulation of adipogenesis, the treatment and prevention of obesity and diabetes, and health services research in the area of cardio-metabolic chronic disease prevention and management. She is author or co-author of more than 80 articles and 200 abstracts, is an appreciated speaker and regularly sits on per-review Committees. Learning Objectives: • Describe long term changes favoring weight regain after weight loss • Discuss lifestyle intervention strategies that can limit weight regain after weight loss

Meal Replacements Marie-Phillippe Morin Dr. Marie-Philippe Morin completed her Doctorate in Medicine and her residency in General Internal Med- icine at Laval University. She is the recipient of the Governor General’s Academic medal of Canada. Dr. Marie-Philippe Morin works as a General Internal Medicine Specialist at the Quebec Heart and Lung Institute and is an Assistant Professor affiliated to Laval University. She is currently completing a one-year fellowship in bariatric medicine through the University of Ottawa under the supervision of Dr. Judy Shiau and Dr. Robert Dent at the Ottawa Hospital Bariatric Centre of Excellence and LEAF Weight Management Clinic. In 2016, she received grants from the Royal College of Physicians and Surgeons of Canada, the ASMIQ (Association des Spécialistes en Médecine Interne du Québec) and the Quebec Heart and Lung Institute foundation for the purpose of completing her studies in bariatric medicine. Her specialty interests are cardiovascular risk factor management associated with obesity and the management of medical/nutritional complications after bariatric surgery, particularly duodenal switch. Learning Objectives: • To understand what is a Meal Replacement (MR) and the rationale for using MRs. • To understand the difference between a full vs a partial MR strategy. • To review the evidence in the literature supporting the use of MR for weight maintenance. • To evaluate the benefits of using medication after weight loss with a MR strategy

Surgery and Medication Sean Wharton, MD, PharmD, FRCP(C) Dr. Wharton has his doctorate in Pharmacy and Medicine. He is the medical director of the Wharton Medical Clinic, a community based internal medicine weight management and diabetes clinic. He is an adjunct professor at McMaster University in Hamilton and York University in Toronto. He also works as an internist at Toronto East General Hospital, and the Hamilton Health Sciences. Dr. Wharton is a researcher, and is qualified as a diplomat of the American Board of Obesity Medicine. Dr. Wharton’s research focuses on bariatric medicine and type 2 diabetes. He is the lead author of the weight management section of the 2013 and 2018 Canadian Diabetes Guidelines, and co-chair of the 2018 Canadian Obesity Guidelines. Learning Objectives: • To understand the surgical and medical options available • To review the evidence in the literature supporting the use of surgery and/or medication for obesity management. • To evaluate the long-term options after weight loss

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WEDNESDAY, APRIL 26, 2017 Mini Review 3: Government Frameworks for Obesity Prevention & Management 10:00 – 11:00 (Co-Chairs: Jennifer Brown & Shahebina Walji) Alberta / New Brunswick

Developments in European Nutrition, Physical Activity, and Obesity Policies João Breda, PhD MPH MBA Dr Breda works in the Division of Noncommunicable Diseases and Life-course at World Health Organization (WHO)/Europe. He provides support to the 53 Member States in the WHO European Region on the implementation of the European Charter on Counteracting Obesity and evaluates their progress. His team is responsible for the world’s largest and most comprehensive surveillance mechanism for childhood obesity. Before joining WHO he was the Portuguese focal point to WHO/Europe for nutrition and physical activity, and the High Level Group on Nutrition and Physical Activity and the European Platform on Diet, Nutrition and Physical Activity of the European Union (EU). Dr Breda was the first coordinator of the national platform against obesity under the Portuguese Ministry of Health. He worked as a public health nutritionist at the general health directorate in Ministry. He was the Head of the Nutrition Department at Atlantic University in Lisbon and lecturer and researcher at the Escola Superior Agrária de Coimbra (ESAC), the University of the Algarve and the School of Hospitality and Culinary Arts in Coimbra. He has published in scientific journals given presentations at national and international congresses, written several dozen papers and published 17 original books. Learning Objectives: • To review the development of nutrition, physical activity, obesity policy in WHO/Europe member state. • To situate obesity policy action within WHO’s global action plan for the prevention of and control of non-communicable diseases.

Government Response: Senate Obesity Report or Obesity Prevention Policy in Canada David K. Lee Learning Objectives: Photo Not • To review the present senate recommendations Available At • Understand the health minister’s mandate commitments Time Of Print • To review the healthy eating strategy including labelling and claims, nutrition quality standards, protecting vulnerable populations, and improving healthy eating information

Legal Implications of Classifying Obesity as A Chronic Disease Jacob Shelley, LLB, LLM, MTS Jacob is a doctoral candidate in the Doctor of Juridical Science program at the Faculty of Law, Universityof Toronto. His dissertation is exploring the use of product liability law in the prevention of obesity. Jacob has a Bachelor of Laws and Master of Laws, both from the University of Alberta, where he focused on public health law. Jacob’s primary research area concerns the proper use and scope of law in public health, particularly the use of law in the prevention of chronic diseases. He has presented on weight bias and discrimination, and has recently published a paper arguing for reframing how we approach the problem of obesity. Jacob is a Vanier Canada Graduate Scholar and Fellow with the CIHR Training Program in Health Law, Ethics & Policy. Learning Objectives: • To examine Canadian case law classifying obesity as a chronic disease • Contemplate whether obesity falls under the legal definition of disability

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WEDNESDAY, APRIL 26, 2017 Mini Review 4: Pediatric Obesity Care 10:00 – 11:00 (Co-Chairs: Jon McGavock & Stasia Hadjiyannakis) Mt. Stephens Hall

Positive Mental Health as a Starting Point for the Treatment of Child Obesity Laurie Clark, PhD., C.Psych. Laurie Clark is a clinical psychologist and clinical investigator with the Centre for Healthy Active Living (CHAL) at the Children’s Hospital of Eastern Ontario, where she works with an interdisciplinary team to help children, youth and their families achieve their best health. Laurie is part of the Pediatric Research on Eating Disorders and Obesity (PREDO) unit at CHEO, the first collaboration of its kind in Canada, which is interested in prevention, policy, and research of joint risk factors associated with eating disorders and obesity. She also is a clinical professor with the School of Psychology at the University of Ottawa. Her research interests are in the areas of pediatric weight management, using communimetrics to co-ordinate care in weight management, and the interplay between emotional and physical health. Learning Objectives: • To understand the interplay between mental and physical health • To understand the impact of mental health issues on weight management. • To explore ways to integrate mental health promotion into weight management strategies

The Alberta Pediatric Obesity Strategy Rena LaFrance, MD Dr. Rena LaFrance is lead physician of the Pediatric Centre for Weight and Health at the Misericordia Hospital in Edmonton, Alberta, Canada. She is also the Medical Director for Pediatric Chronic Disease ( province wide services) in the Primary Health Care Portfolio for Alberta Health Services. Dr. LaFrance received her first 3 degrees including two bachelors degrees in microbiology and medicine as well as her M.D at the University of Manitoba. She completed her 5 year residency in psychiatry where she spent time studying eating disorders, at the University of Alberta. She then obtained her FRCPC (Fellow of the Royal College of Physicians of Canada). She has been in clinical practice within pediatric bariatric medicine for 10 years. She hopes to prevent future disease in children and their family members by focusing on the biological, psychological and social determinants of weight. Her other related work includes treatment and support for pediatric patients at the Stollery Children’s Hospital in Edmonton Canada since 2006 where she sees children with a variety of conditions including, diabetes, cardiac transplant, cancer, migraine/pain and epilepsy. She is also academically affiliated with the University of Alberta as an assistant clinical professor, department of psychiatry and an adjunct assistant clinical professor, department of pediatrics. Learning Objectives: • Appreciate the challenges and opportunities associated with developing and implementing a provincial pediatric obesity strategy. • Discuss partnering for success with stakeholders external to the health care system. • Engaging and supporting vulnerable populations.

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WEDNESDAY, APRIL 26, 2017 Mini Review 4: Pediatric Obesity Care 10:00 – 11:00 Mt. Stephens Hall The Team to Address Bariatric Care in Canadian Children (Team ABC3): Progress to Date Geoff Ball, PhD, RD Geoff Ball received a BSc in Dietetics from the University of British Columbia (Vancouver, BC), completed a dietetic internship with Capital Health (Edmonton, AB), and obtained a PhD in Nutrition and Metabolism from the University of Alberta (Edmonton, AB). After completing post-doctoral training in Preventive Medicine at the University of Southern California (Los Angeles, CA), Geoff joined the Department of Pediatrics at the University of Alberta. He serves as the Founding Director of the Pediatric Centre for Weight and Health, a multi-disciplinary weight management clinic at the Stollery Children’s Hospital (Edmonton, AB). Geoff’s clinical and health services research includes several methodological approaches (e.g., clinical trials, qualitative inqui- ry, epidemiology, literature reviews) to achieve a primary aim – generate, translate, and apply new knowledge that can optimize obesity management and prevention for children, youth, and families. His research has been supported by the Canadian Institutes of Health Research, Public Health Agency of Canada, Alberta Innovates – Health Solutions, Alberta Centre for Child, Family and Community Research, Women and Children’s Health Research Institute, and Stollery Children’s Hospital Foundation. Learning Objectives: • Appreciate the magnitude and impact of severe obesity in Canadian children and youth • Describe the range of ongoing studies to characterize and manage severe obesity in children and youth

Mini Review 5: Weight Bias: Moving Beyond Awareness to Creating Change! 16:30–17:30 (Co-Chairs: Mary Forhan & Renuca Modi) Alberta / New Brunswick Weight Bias: What can we do about it? Angela Alberga, PhD Born and raised in Montreal, Dr. Alberga completed her BSc (Major Exercise Science, Minor Psychology) at Concordia University. She then completed her MSc and PhD in the School of Human Kinetics, specializing in exercise physiology at the University of Ottawa. She was awarded a Canadian Diabetes Association Doctoral Research Award for her research focused on improving the cardiometabolic health of children and adolescents with obesity through exercise. It is through these experiences that she learned how prevalent and harmful weight-based stigma is and has since been devoted to research, teaching and knowledge translation efforts to reduce weight discrimination in society. Dr. Alberga was awarded a Banting Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship by the Federal Government of Canada at the University of Calgary supporting her research on weight bias reduction in education, healthcare and public policy. She is currently an Assistant Professor in the Department of Exercise Science at Concordia University. Dr. Alberga’s research program focuses on better understanding how (i) societal, and (ii) school and other institutional factors, influence weight-related issues including obesity, eating disorders, physical inactivity and weight bias. Learning Objectives: • To share the results of Weight Bias Summits in Canada aimed to move beyond awareness to create change • To demonstrate research evidence on effective weight bias reduction strategies in healthcare • To recommend practical tips on how to reduce weight bias in day-to-day practices

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WEDNESDAY, APRIL 26, 2017 Mini Review 5: Weight Bias: Moving Beyond Awareness to Creating Change! 16:30 – 17:30 Alberta / New Brunswick

Addressing Weight Bias in Health Care: Inter-professional health education Sara Kirk, PhD Dr. Sara Kirk is a Professor of Health Promotion at Dalhousie University with cross-appointments to the IWK Health Centre and Mount Saint Vincent University, Halifax. She is also the Scientific Director of the Healthy Populations Institute (HPI) at Dalhousie University, a Senate-approved, multi-faculty Institute dedicated to improving population health and promoting health equity by understanding and influencing the complex conditions that impact the health of communities. Dr. Kirk’s own program of research explores how we can create supportive environments for chronic disease prevention. Her research uses a ‘socio-ecological’ approach that considers how individual behaviour is influenced by other broader factors, such as income, education and societal norms. Her work has focused on addressing weight bias within the health system, using drama to highlight the challenges people experience when navigating a healthcare system that is not designed to effectively support chronic disease management. Learning Objectives: • Appreciate how weight bias affects physical and mental health and wellbeing • Understand the ways in which weight bias may be perpetuated within society and culture • Identify practical strategies to reduce weight bias in research, practice, and policy

Addressing Weight Bias in Public Health: Changing the narrative to avoid unintended consequences Ximena Ramos Salas, MSc, PhD (c) Ximena Ramos Salas is a PhD candidate at the University of Alberta’s School of Public Health and the Man- aging Director of the Canadian Obesity Network. As a population health researcher, she is exploring the unintended consequences of obesity prevention policies for people with obesity. Her research goal is to spark solutions that will prevent the perpetuation of weight bias and obesity stigma and create more effective population health approaches. Ximena is also an expert consultant with the World Health Organization Regional Office for Europe where she provides technical and strategic support for the Nutrition, Physical Activity and Obesity Program. Learning Objectives: • To review key weight bias concepts and theories • To apply concepts to public health practice and population health outcomes • To discuss strategies for change

Mini Review 6: Bariatric Surgery I 16:30 – 17:30 (Co-Chairs: Priya Manjoo & Marie-France Langlois) Mt. Stephens Hall An Overview of Bariatric Surgical Procedures Richdeep Gill, MD, PhD Dr. Richdeep Gill joined the Calgary Department of Surgery in August 2015 in the section of General Surgery. He was born and raised in Calgary before shifting to Edmonton, AB to pursue his M.D. a the University of Alberta. He completed his surgical residency & PhD in Edmonton before his Minimally Invasive & Bariatric Surgery Fellowship at the Royal Alexandria Hospital. He currently practices Minimally Invasive Upper Gastro- intestinal & Bariatric Surgery at the Peter Lougheed Hospital and South Health Campus in Calgary, AB. His clinical research interests are focused on Upper GI malignancies & Bariatric surgery outcomes. Learning Objectives: • To review the most commonly performed bariatric procedures, their efficacy, and adverse effects • To provide a perspective on the advantages and disadvantages of each procedure

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WEDNESDAY, APRIL 26, 2017 Mini Review 6: Bariatric Surgery I 16:30 – 17:30 Mt. Stephens Hall

The Evolution of Mental Health Care in Bariatric Surgery Sanjeev Sockalingam, MD Dr. Sanjeev Sockalingam is an Associate Professor of Psychiatry at the University of Toronto and Deputy Psychiatrist-in-Chief at the University Health Network for the Toronto General and Princess Margaret Hospital sites. He is the Director of the Bariatric Surgery Psychosocial Program. He is also the co-lead for the Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health at the Centre for Addiction and Mental and Health and the University of Toronto, which is a provincial hub-and-spoke knowledge-sharing network model building mental health and addiction capacity in rural Ontario. Dr. Sockalingam is the Director of Con- tinuing Practice and Professional Development for the Department of Psychiatry at the University of Toronto. He is also the Director of Curriculum Renewal for the Medical Psychiatry Alliance, a $60-million dollar health systems and education initiative. Dr. Sockalingam has >100 peer-reviewed publications and is the co-editor of the book, “Psychiatric Care in Severe Obesity”, a comprehensive summary of an integrated approach to the assessment and managing psychosocial care in severe obesity. His clinical and research interests include understanding psychiatric morbidity in medical and surgical patients and improving service delivery to improve physical and mental health outcomes. He has a primary research focus on psychosocial outcomes related to bariatric surgery. Learning Objectives: • Describe the role that clinicians have in pre- and post-bariatric surgery care. • Identify new tools and evidence for assessing and supporting bariatric surgery patients throughout the bariatric surgery process. • Apply medical, nutrition and psychosocial protocols and interventions that improve patient outcomes after bariatric surgery

Medical Tourism – It’s a High Stakes Gamble Daniel W Birch, MSc MD FRCSC FACS Dr Birch completed his surgical residency at McMaster University in Hamilton in 1998. He has completed a Fellowship in minimally invasive surgery at the Minimal Access Training Unit (MATTU) in Guildford Surrey, UK and at The University of Kentucky in Lexington, Kentucky. He was appointed assistant professor in the Depart- ment of Surgery, McMaster University in 1999, associate professor in the Department of Surgery, University of Alberta in 2004 and promoted to Professor of Surgery in 2011. He is medical director of CAMIS (The Centre for the Advancement of Minimally Invasive Surgery) at the Royal Alexandra Hospital. He completes advanced minimally invasive procedures for a wide variety of gastrointestinal disease including Bariatric Surgery and is an author on over 100 peer-reviewed publications. Learning Objectives: • Consider the role of the Bariatric Team in Canada when consulted for complications related to medical tourism • Understand the prevalence of medical tourism for Bariatric Surgery in Alberta • Recognize the impact and costs to the healthcare system associated with medical tourism

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THURSDAY, APRIL 27, 2017 Mini Review 7: Living with Obesity 08:15 – 09:30 (Co-Chairs: Sara Kirk & Pascal Imbeault) Alberta / New Brunswick

The Weight of Living: Personal Perspectives Ryan Drummond, PEC member I joined CON after being inspired by its Chair Marty who helped me through my post op surgical complication journey. We have like ideals and I want to help the Public Engagement Committee and CON overall achieve all their goals. I have dealt with obesity all my life and so has my family. Both my wife and I have succeeded in losing a lot of weight post Bariatric Surgery and I want to fight and advocate for this treatment, as well as many others, become more readily available and available to the obese population all across Canada. I want to take this fight to make obesity considered a disease and not such a bias to people so that my children can live in a more informed and embracing world. I am married with 2 growing boys and love playing sports and watching movies. I am Civil Engineering Tech and work for the City of Edmonton.

Health Services Research in Bariatric Care: Living While Losing Mary Forhan, OT Reg (Alberta), PhD Dr. Mary Forhan is an assistant professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta. Dr. Forhan was the first occupational therapist in Canada to work in the area of obesity contributed to the development of the obesity and healthy occupation position statement for the Canadian Association of Occupational Therapists. Dr. Forhan is the lead of the Bariatric Care and Rehabilita- tion Research Group that aims to reduce the disability and promote quality health care for patients living with obesity. Her research focuses on addressing physical, social and environmental barriers to full participation in activities of daily living and life events for persons living with obesity. Dr. Forhan is also an active educator with a focus on inter-professional education to improve access to quality health care for patients with obesity. She is a founding member of the Canadian Obesity Network and continues to be active as a member of the CON- RCO Science Committee and an academic member of the CON-RCO Patient Engagement Committee. Learning Objectives: • Learn about the impact of obesity on access to quality care in hospital settings. • Learn about factors that contribute to quality care and outcomes including length of stay, patient satisfaction and access to care • Learn about strategies that promote health related quality of life for patients living with obesity

Benefits of Obesity and (Un)intended Consequences of Weight Loss: A Devil’s Advocate Position Jennifer Kuk, PhD Dr. Jennifer Kuk is an Associate Professor in the School of Kinesiology and Health Science at York University. She has published over 100 scientific papers and chapters related to obesity, health and lifestyle behaviors. Currently, she is investigating the relationship between obesity and health through clinical human studies and epidemiological approaches. She is researching the metabolically normal obesity phenotype and factors that identify successful weight management in adult and youth. Learning Objectives: • Recognize the variations in the expression of health risk in those with obesity. • Appreciate the potentially negative outcomes associated with weight loss and failed weight loss maintenance (weight cycling). • Understand the sub-populations wherein the risks of weight loss may potentially outweigh the benefits

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THURSDAY, APRIL 27, 2017 Mini Review 7: Living with Obesity 08:15 – 09:30 (Co-Chairs: Martin Binks & Sue Pedersen) Alberta / New Brunswick

Living with Obesity: Before and After Bariatric Surgery Laurie Twells, PhD Dr. Laurie Twells is an Associate Professor with the School of Pharmacy and the Faculty of Medicine at Memo- rial University in Newfoundland and Labrador. Dr. Twells completed a Master’s of Science in Epidemiology and Health Policy at the London School of Hygiene and Tropical Medicine in the UK before completing her PhD in Clinical Epidemiology at Memorial University. Dr. Twells research focuses on: the prevention, management and treatment of adult obesity; infant nutrition and childhood obesity; obesity and its impact on health services utilization. Dr. Twells is the principle investigator of a Translational Program of Research on Bariatric Care that examines the experiences of bariatric surgery patients as they wait for, undergo and adjust to life after surgery, and assesses post-surgical clinical outcomes, health related quality of life and healthcare system use and costs. • To examine weight loss in severely obese patients after surgery. • To understand changes in health-related quality of life, as reported by patients, before and after surgery. • To describe patients’ perceptions of “health, well-being and success” following in the first year after surgery.

Mini Review 8: Pregnancy & Maternal Health 08:15 – 09:30 (Co-Chairs: Martin Binks & Sue Pedersen) Mt. Stephens Hall

The Weight of Living: Personal Perspectives Brenndon Goodman, PEC member Brenndon attends University and is looking forward to a career in politics or law. He has faced the challenges and difficulties of being overweight his entire life. He attended many unsuccessful weight loss programs until he found the Sick Kids Team Obesity Management Program. It was here that he discovered the support and helpful approach to weight loss. In 2012, he underwent bariatric surgery and has lost over 1/3 of his body weight thus far. Brenndon was featured on a CTV W5 program about his weight loss journey. Brenndon is very committed to helping young people understand and cope with the stigma and difficulties they face being overweight and to help curb the growing epidemic of childhood obesity in a modern world.

Prenatal Stress and Obesity: Results from the Stress in Pregnancy International Research Alliance (SPIRAL) Kelsey Needham Dancause, PhD I am a Biological Anthropologist interested in maternal and child health and the developmental origins of health and disease. I study maternal stress and health behaviors during pregnancy and their relationships with child development, particularly obesity and cardiometabolic outcomes. I am a member of the Stress in Pregnancy International Research Alliance (SPIRAL), whose members study prenatal stress and child behavioral, cognitive, motor, and physical development in three studies of prenatal stress due to natural disasters. I have also created two studies of chronic psychosocial stress and health behaviors during pregnancy, and their relationships with child development, in understudied populations. We analyze stress and health behaviors among socially disadvantaged women in Montreal, and in Vanuatu, a lower-middle income country in the South Pacific (the “Healthy Mothers, Healthy Communities” study). Together, these studies help to clarify the role of prenatal stress in child development; highlight health behaviors that might interact with prenatal stress and exacerbate its effects; and might ultimately highlight areas for intervention to improve maternal and child health outcomes. Learning Objectives: • To understand the developmental origins of health and disease • To appreciate the complexity of designing human stress studies

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THURSDAY, APRIL 27, 2017 Mini Review 8: Pregnancy & Maternal Health 08:15 – 09:30 Mt. Stephens Hall

ENRICH: Supporting Healthy Weights in Pregnancy and Postpartum Rhonda Bell, RD, PhD I lead a team of trainees (graduate and undergraduate students and post docs) and research staff in studies that examine the role of nutrition in promoting health and preventing and treating diabetes and its complications. My research program integrates applied and basic research. Much of my work is conducted within the paradigm of the Developmental Origins of Health and Disease, examining the role of nutritional intake during sensitive periods of development on health, specifically diabetes risk, in mothers and their offspring. In the applied setting, I am leading the ENRICH Program (a Collaborative Research and Innovation Opportunity funded by Alberta Innovates Health Solutions) aimed at improving maternal health during pregnancy and postpartum using innovative strategies that meet the needs of diverse groups of women across Alberta. The goals of this Program are to: 1) advance knowledge regarding food and nutrient intake and energy expenditure in pregnancy and postpartum; 2) understand perceptions and experiences of diverse groups of pregnant and postpartum women pertaining to diet, body weight and health; 3) identify needs, gaps and opportunities in health service delivery systems that may be harnessed to promote optimal dietary intake and appropriate weight management strategies; and 4) collaborate with knowledge users, to develop and evaluate strategies aimed at promoting optimal dietary intake and appropriate weight management. Learning Objectives: • To provide an update on the ENRICH studies that are aimed at improving maternal health in pregnancy and postpartum by finding innovative ways to promote healthy weights and healthy eating • To identify innovative strategies that meet the needs of diverse groups of women and care providers

Obesity Management in Women with Infertility Jean Patrice Baillargeon, MD, MSc Jean-Patrice Baillargeon, MD, MSc is board-certified in endocrinology and metabolism and professor of medicine at the Université de Sherbrooke. Dr Baillargeon primary areas of expertise include reproductive endocrinology, polycystic ovary syndrome, obesity, health system improvement and biostatistics/epidemiology. He completed a postdoctoral fellowship on the metabolic aspects of polycystic ovary syndrome (PCOS) under the supervision of Dr Nestler in 2003 and obtained a Master’s in Clinical research and Biostatistics from the Virginia Commonwealth University, Richmond VA. He is director of the Reproductive Endocrinology clinic of the Centre hospitalier universitaire de Sherbrooke (CHUS) and an active member of the Lifestyle Multidis- ciplinary Management Clinic of the CHUS. Dr Baillargeon obtained a CIHR Partnerships for Health System Improvement grant for the evaluation of clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention in obese infertile women. This project is also funded by the Quebec Ministry of Health and the Research Center of Centre hospitalier universitaire de Sherbrooke, and puts together a national network of researchers and decision-makers interested in the implementation and evaluation of a lifestyle modification program integrated to fertility clinics. Dr Baillargeon received a Young Investigator Award from the Canadian Society of Endocrinology and Metabolism (CSEM) and is actually the President Elect of this Society. His has published >65 original peer-reviewed articles, 25 review articles and 6 book chapters. Learning Objectives: • To understand the causes of infertility and the impact of obesity • To evaluate lifestyle benefits and assess impacts on fertility, pregnancy and neonatal outcomes

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THURSDAY, APRIL 27, 2017 Mini Review 9: Family Based Pediatric Care 10:00 – 11:00 (Co-Chairs: Jean-Philippe Chaput & Mark Tremblay) Alberta / New Brunswick

Parenting Stress: Associations with Childhood Obesity, Physical Activity, and TV Viewing Kathryn Walton, MSc, RD PhD Candidate Kathryn Walton is a PhD Candidate in the Department of Family Relations & Applied Nutrition at the Univer- sity of Guelph. Her research interests focus on factors in the general home environment that may increase risk of obesity among young children. Her Masters research focused on the association between parenting stress and obesity risk related behaviours among children including reducing physical activity and increased screen time. The focus of her PhD work has shifted to explore the influence of parent-child interactions during eating on children’s eating behaviours, dietary intake and weight status. This work has been largely informed by my work in the community as a Registered Dietitian. Learning Objectives: • To understand what is parenting stress • To determine the association between parenting stress and child weight outcomes • To evaluate the implications for practice

The Social Determinants of Pediatric Obesity: Time to Let Go of Diet and Exercise Jonathan McGavock, PhD Jonathan McGavock is the Robert Wallace Cameron Chair in Evidence-based Child Health in the Department of Pediatrics and Child Health in Faculty of Medicine at the University of Manitoba. At the Manitoba Institute of Child Health, his research laboratory studies the role of physical activity associated with the prevention and management of type 2 diabetes in youth. Learning Objectives: • To understand the social determinants of pediatric obesity • To identify innovative strategies to improve health

Looking Beyond Nutrition and Obesity Leia Minaker, BSc, MSc, PhD Leia Minaker is an assistant professor in the School of Planning at the University of Waterloo and an Affiliated Scientist at the Propel Centre for Population Health Impact. She received a PhD in public health from the Uni- versity of Alberta in 2013, and currently holds a Canadian Cancer Society Research Institute Career Develop- ment Award in Cancer Prevention. She is interested public health nutrition, especially around retail food environment interventions (like healthy corner stores) and using urban planning practice to create healthy cities. Learning Objectives: • Participants will identify benefits of different dietary patterns beyond nutrition and weight status • Participants will compare public health food recommendations to identify inconsistencies • Participants will recognize different compelling food-health narratives that can influence dietary intake in the population

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THURSDAY, APRIL 27, 2017 Mini Review 10: Managing Obesity as a Chronic Disease 10:00 – 11:00 (Co-Chairs: David Macklin & Andre Tchernof) Mt. Stephens Hall Obesity as a Chronic Disease Arya M. Sharma, MD, PhD In 2002, Arya M. Sharma was recruited from the Humboldt University, Berlin, Germany, to a Canada Research Chair (Tier1) in Cardiovascular Obesity and Management at McMaster University. In 2007 he accepted a position as Professor and Chair in Obesity Research and Management at the University of Alberta, where he is also the Medical Director of the Edmonton Regional Bariatric Program. In 2005, he spearheaded the launch of the Canadi- an Obesity Network, which, with well over 10,000 members, has remarkably transformed the landscape of obesity research and management in Canada. He is also Past-President of the Canadian Association of Bariatric Physicians and Surgeons. His research focuses on an evidence-based approach to managing obese patients and includes the development of the Edmonton Obesity Staging System. Dr. Sharma has authored or coauthored more than 300 publications and has lectured widely on the aetiology and management of hypertension, obesity, and related cardiometabolic disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media including the CBC, CTV, New York Times, and MSNBC. Dr. Sharma maintains a widely-read blog where he regularly posts his ideas and thoughts on obesity prevention and management: http://www.drsharma.ca. Learning Objectives: • Able to discuss the homeostatic mechanisms involved in body weight regulation • Gain insight into the metabolic and weight effects of different dietary approaches to weight management • Understand the role of meal replacement strategies in long-term weight management

Improving Obesity Prevention and Management in Primary Care: The 5As Team Program Denise Campbell-Scherer, MD, PhD, CCFP, FCFP Denise L. Campbell-Scherer is an Associate Professor in the Department of Family Medicine, University of Alberta, and a practicing family physician, researcher and teacher. She is co-Lead with Dr. Arya Sharma for the “Implemen- tation and validation of the 5As framework of obesity in primary care: the 5As Team (5AsT) project.” The goal of the study is to increase the quality and quantity of obesity management in primary care by using the 5AsT intervention to change provider behaviour. Dr. Campbell-Scherer’s research focuses on innovations to transform clinical practice and result in change of benefit to patients, providers and the healthcare system. She has been active in the BETTER, BETTER2, and BETTERWISE projects (www.better-program.ca) that are seeking to transform primary prevention and screening of multiple conditions in diverse regions of Canada. In addition, she is a Co-Investigator and part of the Steering Committee for the ACPLF Innovation Stream on CHANGE. Dr. Campbell-Scherer is also an Associate Editor for the journal Evidence-based medicine, BMJ publishing group (http://ebm.bmj.com). Learning Objectives: • Explore the patient perspective on the role of primary care in obesity management and their experience of existing resources; • Explore successful strategies for improving the confidence and competence of interdisciplinary primary care providers and teams in obesity prevention and management;

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THURSDAY, APRIL 27, 2017 Mini Review 10: Managing Obesity as a Chronic Disease 10:00 – 11:00 Mt. Stephens Hall Treating the Big Picture: Diabetes and Obesity Sue Pedersen, MD, FRCPC Dr. Sue is a Specialist in Endocrinology & Metabolism, having completed her training at the University of Calgary in 2005. She is also a Diplomate of the American Board of Obesity Medicine. Over the last decade, she has worked at the University of Saskatchewan and the University of Copenhagen, Denmark, where she began her work in obesity research. Dr. Sue has a busy endocrinology practice at the C-ENDO Diabetes & Endocrinology Clinic in Calgary, with a focus on type 2 diabetes and obesity. She is a member of the Expert Committee for the 2018 Canadian Diabetes guidelines, and she is a principal investigator for several research studies in diabetes and obesity. She maintains a public information website about weight management and diabetes: www.drsue.ca. Learning Objectives: • Discuss approach to align goals of glycemic control and weight management in patients living with diabetes • Discuss benefits of weight management in people with diabetes • Review treatment options for weight management in the context of diabetes i. Lifestyle management ii. Pharmacotherapy iii.Bariatric surgery

Mini Review 11: Nutrition Beyond Food 16:30 – 17:30 (Co-Chairs: Bohdan Luhovyy & Mary L’Abbe) Alberta / New Brunswick Can We Trust Data on Dietary Intake? Sharon Kirkpatrick, PhD Sharon Kirkpatrick is a registered dietitian and Assistant Professor at the School of Public Health and Health Systems at the University of Waterloo. Her work focuses mainly on methodologic issues associated with measuring what people eat and drink and strategies to mitigate measurement error in dietary assessment. She works with a number of cohort studies to identify feasible and robust approaches to the measurement of diet. Her work also encompasses technology to increase the feasibility of comprehensive capture of intake while reducing respondent burden. She was previously a nutritionist with the Risk Factor Monitoring and Methods Branch of the U.S. National Cancer Institute and received two National Institutes of Health Awards of Merit for her work related to dietary assessment. She holds a PhD in Nutritional Sciences and Master of Health Science in Community Nutrition from the University of Toronto. Dr. Kirkpatrick is currently funded by a Canadian Cancer Society Research Institute Capacity Development Award. Learning Objectives: • Review and discuss recent debates regarding the value of dietary data • Describe strategies to mitigate error and its effects on study findings • Examine circumstances in which self-report dietary data may not be appropriate • Explore emerging directions for advancing dietary assessment • Discover resources to support robust dietary assessment in research

Can Policy Ameliorate Socioeconomic Inequities in Obesity and Obesity-Related Behaviours? Dana Olstad, PhD, RD Dr. Dana Olstad is an Assistant Professor in the Department of Community Health Sciences at the University of Calgary. Her research program aims to inform development and implementation of policies, both inside and outside the health sector, to improve dietary behaviours, body weight, and health, particularly among disadvantaged groups. Learning Objectives: • Understand the role of universal policies in reducing socioeconomic inequities in obesity and obesity- related behaviours • Understand how targeted policies can help to reduce obesity in socioeconomically disadvantaged groups

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THURSDAY, APRIL 27, 2017 Mini Review 11: Nutrition Beyond Food 16:30 – 17:30 Alberta / New Brunswick

Foods That Improve Metabolic Parameters Gordon Zello, PhD Gordon Zello is a Professor of Nutrition in the College of Pharmacy and Nutrition and currently Head of the Division of Nutrition and Dietetics at the University of Saskatchewan He is also an Associate Member of the Col- lege of Kinesiology. He arrived in Saskatoon in 1992 after completing graduate studies determining the dietary amino acid and protein needs of young adults at the University of Toronto and The Hospital for Sick Children. Dr. Zello teaches courses in “Protein, Fat, Carbohydrate and Energy Metabolism”, “Nutritional Assessment” and “Research Methods” and has an active graduate and research program in both basic and applied nutrition. His fields of specialization are intermediary metabolism and nutritional assessment. His research interests include the measurement of body composition, energy expenditure, and nutrient requirements in both healthy and clinical populations, as well as studying the integration and regulation of metabolism in differing nutritional states. Dr. Zello is a member of the University’s Obesity Research Group and the Saskatchewan Natural Products Network. He has published over 70 scientific articles and review papers, and has given over 90 conference presentations. Learning Objectives: • To identify foods that improve metabolic health • Highlight and identify where the evidence is strong

Mini Review 12: Microbiome 16:30 – 17:30 (Chair: Phillip Sherman) Mt. Stephens Hall

The Role of the Gut Microbiome in Obesity: Opportunities for Nutritional Interventions Jens Walter, PhD Jens Walter is an Associate Professor and Campus Alberta Innovation Program Chair for Nutrition, Microbes, and Gastrointestinal Health at the University of Alberta. After receiving his doctoral degree from the University of Hohenheim in Germany, he performed postdoctoral research into genetic and metagenomic approaches to study gut microbial ecology at the University of Otago in New Zealand. His main research interests are the investigation of ecological and evolutionary processes that shape host–microbial symbioses in the vertebrate gut, and specifically the effect of diet on composition and function of the gut microbiome in the context of health. Learning Objectives: • Describe the contribution of the gut microbiota to weight gain and obesity-associated pathologies, and the underlying mechanisms • Discuss challenges and inconsistencies in the field • Provide an overview of the opportunities by which the microbiome could be targeted to prevent obesity and/or its associated pathologies

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THURSDAY, APRIL 27, 2017 Mini Review 12: Microbiome 16:30 – 17:30 Mt. Stephens Hall

Dysbiosis and Non-Alcoholic Fatty Liver Disease: Is There a Relationship? Johanne Allard, MD FRCP Dr. Johane P. Allard is Professor of Medicine at the University of Toronto, Toronto, Canada and is crossed-appointed at the Department of Nutritional Sciences and Institute of Medical Sciences. She is also a Senior Scientist at the Toronto General Research Institute. She trained in gastroenterology at McGill University before completing a research fellowship funded by the National Institute of Nutrition at the University of Toronto. Dr. Allard is a clinician investigator, with a research focus in nutrition and gastrointestinal disorders. She is currently conducting several studies funded by peer-reviewed agencies in patients requiring nutrition support, people with non-alcoholic fatty liver disease (NAFLD) and patients with morbid obesity undergoing bariatric surgery. She is also conducting research on malnutrition in Canadian hospitals and has developed a research program on the intestinal microbiome related to the Metabol- ic-Syndrome. She is the recipient of several CIHR grants looking at the association between the intestinal microbiome and obesity/metabolic syndrome which include assessing the effect of fecal microbiota transplant on the outcomes of these patients. Her publications are primarily in the area of micronutrients, oxidative stress, malnutrition, nutrition support, NAFLD. For NAFLD, she has published on nutrition, gene expression, intestinal microbiota and metabolic syndrome. Dr. Allard is also the Director of the Division of Gastroenterology at the University of Toronto and the Direc- tor of the Nutrition Support Program at the University Health Network (UHN). She works with a multidisciplinary nutrition support team and is the Chair of the Nutrition Review Committee. She is also the past-chair the Royal College of Physician and Surgeon Examining Board in Gastroenterology and co-founder of the Canadian Nutrition Society and member of its Advisory Board. She has been the co-chair of the Canadian Malnutrition Task Force Learning Objectives: • Review what is non-alcoholic fatty liver disease (NAFLD), its association with metabolic syndrome and clinical impact • Review the composition and role of IM in metabolic syndrome and NAFLD • Review the effect of intervention studies on IM, metabolic syndrome and NAFLD I. Diet II. Bariatric surgery III. Fecal transplant IV. Probiotics

Gut Microbiota as a Potential Mediator of the Metabolic Effects of Bariatric Surgery Andre Tchernof, PhD Dr. Andre Tchernof is Professor at Laval University School of Nutrition since 2000. After a Bachelor’s degree in Biochemistry (1991), a Master’s degree (1992) and a Doctoral degree (1996) in Physiology-Endocrinology at Laval University, he underwent two postdoctoral trainings in Molecular Endocrinology (Laval University Medical Center, 1996-97) and in Endocrinology & Metabolism at the University of Vermont (1997-2000). He then obtained salary awards from the Fonds de la recherche en santé du Québec and Canadian Institutes of Health Research (2000- 2012). His research projects have been funded among others by the Canadian Institutes of Health Research, the Canadian Diabetes Association and the National Science and Engineering Research Council. He also co-directed the Research Chair in Bariatric and Metabolic Surgery and is co-director of the Institutionally-approved Obesity Tissue Bank at Institut Universitaire de Cardiologie et Pneumologie de Québec. He is currently the Principal Investigator of a Canadian Institutes of Health Research Team Grant on bariatric care, the REMISSION study. He contributed to more than 150 publications in peer-reviewed journals. His research interests relate to the metabolic complications of obesity and body fat distribution, with a particular emphasis on adipose tissue physiology. Experimental approaches combine cellular biology techniques with biochemistry, genomics, transcriptomics and clinical investigation in humans. Published work has involved collaborations with many surgeons from various surgery services at Laval University-affiliated hospitals, including studies on the impact of bariatric surgery. His research allows clinical observations to be linked with the cellular characteristics or mechanisms underlying pathophysiological conditions such as abdominal obesity and related cardiometabolic complications. The learning objectives: • Describe the surgical procedures currently used for the treatment of severe obesity and their effects • Describe the changes in gut microbiota observed following various bariatric operations • Address some of the putative mechanisms involved in gut microbiota-mediated improvements following bariatric surgery

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FRIDAY, APRIL 28, 2017 Mini Review 13: Population Health – Surveillance 08:15 – 09:30 (Co-Chairs: Ian Janssen & Chris Ardern) Alberta / New Brunswick

The Weight of Living: Personal Perspectives Jodi Krah, PEC member Currently Jodi is a Patient Advocate for people living with Obesity as well as manager for Habitat for Humanity Niagara and has sat on various charitable boards in Ontario. She sits on the Science Committee as the Public Engagement Committee representative for CON. Mrs. Krah has a Bachelor of Fine Arts with Distinction from Brock University and a Diploma in Broadcasting from Niagara College. She has had a long career in senior executive management in the retail industry. Jodi has had obesity throughout her entire life, starting at a very young age. Through 4 decades she gained and lost hundreds of pounds and spent thousands of dollars to reduce her weight. 9 years ago Jodi lost over 100 pounds through non-surgical methods at the Wharton Medical Clinic and struggles to maintain her weight loss.

Assessing Nutritional Intake in Canadian Children and Adolescents Mary R. L’Abbe, PhD Dr. Mary L’Abbé is the Earle W. McHenry Professor and Chair of the Department of Nutritional Sciences, Faculty of Medicine, at the University of Toronto, where she leads a research group on Food and Nutrition Policy for Population Health. Her research examines the nutritional quality of the Canadian food supply, food intake patterns, and consumer research on food choices related to obesity and chronic disease. Dr. L’Abbé a member of several committees of the WHO including the Nutrition Guidance Expert Advisory Group on Diet and Health and the Global Coordinating Mechanism for NCDs. Dr. L’Abbé was co-chair of the Canadian Trans Fat Task Force and Chair/Vice-Chair of the Sodium Working Group. Before joining the University of Toronto, Dr. L’Abbe was Director, Bureau of Nutritional Sciences at Health Canada. Dr. L’Abbé holds a PhD in nutrition from McGill University and has authored over 180 peer-reviewed scientific publications, book chapters and government reports. Learning Objectives: • To understand the quality of the food choices of Canadian children and adolescents, relative to the recommendations in Eating Well with Canada’s Food Guide • To better understand the role that eating location and occasion play in the nutrient intakes of Canadian children and adolescents

Recent Trends in the Prevalence of Overweight and Obesity among Canadian Children Celia Rodd, MD, MSc, FRCPC Dr. Celia Rodd is an Associate Professor in the Department of Pediatrics and Child Health at the University of Manitoba; she recently moved to Winnipeg after working for 20 years at the Montreal Children’s Hospital, McGill University. At McGill University, she had the pleasure of being the Program Director for Pediatric Endo- crinology for 15 years. She trained at the University of Toronto (BSc, MD, Clinical Endocrinology Fellowship), McGill University (Pediatrics Residency), the University of Minnesota (Research Endocrinology Fellowship) and at the London School of Hygiene and Tropical Medicine (Masters of Epidemiology). Celia’s clinical and research interests focus on calcium homeostasis and bone physiology and their associated disorders. She is particularly interested in defining optimal vitamin D intake for healthy Canadian children and ensuring com- pliance with current guidelines. Celia has worked with the Canadian Pediatric Endocrine Group to develop optimized growth charts in Canada based on the 2006-2007 WHO growth charts. She has published over 80 peer-reviewed manuscripts in a wide spectrum of endocrine and diabetes related topics. Additionally, she has been funded by numerous agencies including Canadian Institute of Health Research. Learning Objectives: • Changes in growth charts over the past 2 decades • New charts for monitoring central adiposity (e.g. waist circumference, waist:height ratios) • Recent progress in efforts to contain the North American ‘obesity epidemic’ • The importance of socioeconomic determinants in the development of overweight/ obesity in Canada

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FRIDAY, APRIL 28, 2017 Mini Review 13: Population Health – Surveillance 08:15 – 09:30 Alberta / New Brunswick Canadian 24-Hour Movement Guidelines for Children and Youth Mark Tremblay, PhD Professor Tremblay has a Bachelor of Commerce degree in Sports Administration and a Bachelor of Physical and Health Education degree from Laurentian University. His graduate training was from the University of Toronto where he obtained his M.Sc. and Ph.D. from the Department of Community Health with a specialty in Exercise Science. Dr. Tremblay is the Director of Healthy Active Living and Obesity Research (HALO) at the Children’s Hospital of Eastern Ontario Research Institute and Professor of Pediatrics in the Faculty of Medicine, University of Ottawa. He is a Fellow of the American College of Sports Medicine, Chair of the Active Healthy Kids Global Alliance, Chair of the Canadian Physical Activity Guidelines Committee, Founder of the Sedentary Behaviour Research Network, and former Dean of Kinesiology at the University of Saskatchewan. Dr. Tremblay has published more than 330 scientific papers and book chapters in the areas of childhood obesity, physical activity measurement, exercise physiology, sedentary physiology and health surveillance. His h-index is 50 and his published research has been cited >11,000 times according to Scopus. He has delivered >700 scholarly conference presentations, including >140 invited and keynote addresses, in 20 different countries. Dr. Tremblay received an honorary doctorate from Nipissing University, the Queen Elizabeth II Diamond Jubilee Medal, the Lawson Foundation 60th Anniversary Award and the Canadian Society for Exercise Physi- ology Honour Award for his leadership contributions to healthy active living in Canada. Dr. Tremblay’s most productive work has resulted from his 28-year marriage to his wife Helen, yielding four wonderful children. Learning Objectives: • Understand the rationale for, and procedures used to develop, the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth. • Appreciate the importance of the integrated composition of sleep, sedentary behaviour and physical activities over the 24-hour period on health. • Adjust healthy living counselling practices with school-aged children to promote the new Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth. • Know where to seek further information on the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth.

Mini Review 14: Energy Metabolism & Body Composition 08:15 – 09:30 (Co-Chairs: Mary Ellen Harper & Jennifer Kuk) Mt. Stephens Hall The Weight of Living: Personal Perspectives Ian Patton, PEC member I have been involved in CON for several years as a researcher and trainee. I have also struggled with my weight my entire life and am a recent Bariatric Surgery patient. I have worked as an obesity expert and lived as an obese person. My involvement with the CON Public Engagement Strategy was a natural fit and some- thing I am very passionate about. I am excited to help introduce the public to the deep knowledge base of the network and brilliance of CON members.

Physiological Determinants of Energy Metabolism Eric Doucet, PhD, MSc, BSc Eric Doucet is a Professor at the School of Human Kinetics at the University of Ottawa. He obtained his Ph.D. in Physiology and Endocrinology from Université Laval. His research program focuses specifically on understanding the contribution of physiological and endocrine factors to variations in energy balance and body weight regulation. He has published numerous articles in highly specialized journals in this area. He serves as Editor for the British Journal of Nutrition, the Journal of the Nutrition Society, the Journal of Obesity and Frontiers in Physiology. Learning Objectives: • To understand the relationship that exists between body mass and energy expenditure. • To understand the concept of adaptive thermogenesis (metabolic adaptation) that occurs during weight loss. • To be able to describe the effects of slow vs fast weight loss on energy expenditure.

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FRIDAY, APRIL 28, 2017 Mini Review 14: Energy Metabolism & Body Composition 08:15 – 09:30 Mt. Stephens Hall

Effect of Foods on Appetite and Energy Intake Bohdan Luhovyy, PhD Dr. Bohdan Luhovyy obtained his PhD in physiology in Lviv National University in Ukraine in 2001. From 2002 to 2005, he was a postdoctoral fellow at the University of Pennsylvania. From 2006 until 2011, Dr. Luhovyy was a research associate with Dr. Harvey Anderson at the Department of Nutritional Sciences, University of Toronto. In July 2011, Bohdan joined the Mount Saint Vincent University, and now he is an associate professor in the Department of Applied Human Nutrition and adjunct professor at the Department of Physiology and Biophysics of Dalhousie University in Halifax, Nova Scotia. Learning Objectives: • To overview the homeostatic and hedonic regulations of food intake • To compare the effect of foods and drugs on appetite suppression and review the food-based health claims on satiety proposed in Canada and the regulation around the world • To learn the effect of macronutrients on food intake regulation • To identify whole foods and food ingredients with known effect on food intake regulation in humans.

Defining and Measuring Sarcopenic Obesity Carla Prado, PhD Dr. Carla Prado is an Assistant Professor at the University of Alberta in Canada and a Campus Alberta Inno- vates (CAIP) Chair in Nutrition, Food and Health. She is the Director of the Human Nutrition Research Unit, a state-of-the-art research and training facility. Dr. Prado is an expert in assessing nutritional status through the precise measurement of body composition and energy metabolism. Her research has shown for the first time the prevalence and clinical implications of sarcopenic obesity in cancer, and has provided evidence of the independent effect of body composition on cancer recurrence, treatment and survival. The focus of her current research program is to develop targeted nutrition interventions for the prevention and treatment of sarcopenic obesity in patients with diverse chronic conditions. She is currently the Principal Investigator of two randomized controlled trials investigating the impact of nutrition intervention on body composition and health. Dr. Prado received her Ph.D. from the University of Alberta, Canada, and has completed further training at the Cross Cancer Institute (Canada), the National Institutes of Health (USA) and Newcastle University (UK). She is an Associate Editor of Clinical Nutrition and the Journal of Cachexia, Sarcopenia and Muscle. She serves as a member of the Body Composition Clinical Guidelines group for the American Society for Parenteral and Enteral Nutrition, and the National Cancer Institute Sarcopenia Workshop Planning Committee. Learning Objectives: • To discuss the prevalence and relevance of sarcopenic obesity • To discuss assessment tools for the identification of abnormal body composition phenotypes • To discuss proposed criteria to define sarcopenic obesity

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FRIDAY, APRIL 28, 2017 Mini Review 15: Physical Activity Benefits Beyond Weight Loss 10:00 – 11:00 (Co-Chairs: David Lau & Marc Bomhof) Alberta / New Brunswick

Impact of Hockey Fans in Training Program on Health in Overweight Men Robert Petrella, MD, PhD, FCFP (SEM, COE), FACSM Dr. Robert Petrella is a Professor in the Department of Family Medicine at Western University, with cross-appointments in Kinesiology and Cardiology. Dr. Petrella is the Medical Director of the Canadian Centre for Activity and Aging and is a practising Physician with St. Joseph’s Health Care London. Throughout 2005-2015, Dr. Petrella was the inaugural Beryl and Richard Ivey Research Chair, as well as Program Leader for the former Aging, Rehabilitation, and Geriatric Care Program of Lawson Health Research Institute (now referred to as the Parkwood Institute Research Program). Dr. Petrella’s research is focused on lifestyle interventions for chronic disease prevention and management. His research is dedicated to furthering multi- and inter-disciplinary research on lifestyle management, physical activity, chronic diseases, and innovative technologies to improve the lives of all Canadians, with a specific focus on vulnerable populations (i.e., men, older adults, indigenous, and those living in rural and remote regions). Dr. Petrella’s publications cross disciplines and span topics including lifestyle prescription, healthy aging, real-world rural and remote practice, cardiovascular disease, diabetes, mobility, osteoarthritis, men’s health, and eHealth (totalling 200 peer-reviewed articles with 6754 citations). Dr. Petrella’s research has also led to 2 patents in chronic disease therapy, 6 trademarks, and the development of 2 smartphone apps to extend research reach. Learning Objectives: • To highlight the burden of Men’s Health and challenge in engaging men in making lifestyle changes. • To describe an innovative engagement strategy for overweight and obese men using their love of being a hockey fan. • To describe the main findings of Hockey Fans in Training.

Is One Minute of Exercise Enough? Jonathan Little, PhD Dr. Little is an Assistant Professor and CIHR New Investigator at the University of British Columbia, Okanagan Campus. The aims of research conducted in his lab are to optimize exercise and nutritional interventions for improving cardiometabolic health and reducing inflammation in people with, and at risk for, type 2 diabetes. One major focus is on the efficacy and effectiveness of time-efficient high-intensity interval training (HIIT) as a strategy for the treatment and prevention of type 2 diabetes. Learning Objectives: • To understand the benefits of intense exercise • To share research findings and lessons learned

Exercise Effects on Inflammation and Adipocyte Biology David Wright, PhD Dr. Wright received his PhD in Human Bioenergetics from Ball State University and completed postdoctoral training in the School of Medicine at Washington University in St. Louis. Dr. Wright is currently an Associate Professor and Tier II Canada Research Chair in the Department of Human Health and Nutritional Sciences at the University of Guelph. His research program is focused on studying the interactions between exercise, diet and pharmacological manipulations on adipose tissue and liver metabolism and how this impacts whole body fuel utilization. Learning Objectives: • The anti-inflammatory effects of exercise on adipose tissue • The effects of exercise on modulating adipose tissue metabolism • How adipose tissue can influence whole body fuel metabolism

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FRIDAY, APRIL 28, 2017 Mini Review 16: Bariatric Surgery II 10:00 – 11:00 (Co-Chairs: Priya Manjoo & Michael Lyon) Mt. Stephens Hall Sleeve Gastrectomy: The #1 Performed Bariatric Operation- A Culture Shift or a Fad Dennis Hong, MD, MSc, FRCSC Dr. Dennis Hong is an Associate Professor in the Department of Surgery at McMaster University. He special- izes in Minimally Invasive and Bariatric Surgery. He completed his undergraduate studies in Biology from the University of Western Ontario in 1992. Dr. Hong received his medical degree (M.D.) from the University of To- ronto in 1996. He completed his residency in the Department of Surgery, McMaster University Medical Centre in Hamilton, ON. Then in 2003, he completed a Minimally Invasive Surgery Fellowship at the Legacy Health System in Portland Learning Objectives: • Recognize the growing popularity and variation of sleeve gastrectomy in Canada • Understand major complications of sleeve gastrectomy • Understand major outcome results of sleeve gastrectomy

Reflux Disease and its Impact on Bariatric Surgical Choice Shahzeer Karmali, BSc MD MPH FRCSC FACS FASMBS Dr. Shahzeer Karmali is a minimally invasive gastrointestinal/bariatric surgeon, based at the Royal Alexan- dra Hospital. He is an Associate Professor, Department of Surgery, Faculty of Medicine and Dentistry at the University of Alberta. He completed his surgical residency at the University of Calgary in 2002 and Fellowship training in minimally invasive surgery at Baylor College of Medicine, Houston. Dr. Shahzeer Karmali is appointed to be the Assistant Professor in the Department of Surgery, University of Alberta and is also the General surgery representative, CAMIS Expert Advisory Panel. He is the Executive member of Canadian Association of Bariatric Physicians and Surgeons Member, CAGS Clinical Practice Committee and Committee on Laparos- copy and Endoscopy. He trained at the Methodist Hospital, Houston, Texas, on the DaVinci “S” HD Surgical Robot, at Ohio State University, Columbus, Ohio, on StomaphyX and at Endosastic Solutions, Seattle, Wash- ington on EsophyX.

Bariatric Surgical Outcomes on the National Stage-MBSAQIP and NSQIP Timothy Jackson, BSc, MD, MPH, FRCSC, FACS After receiving a Bachelor of Science degree in Life Science from McMaster University in 1999, Dr. Jackson attended medical school at McMaster. Upon completion, he entered the McMaster post-graduate training program in General Surgery. Dr. Jackson became a Fellow of the Royal College of Physicians and Surgeons of Canada in 2009, and was certified by the American Board of Surgery in 2010. In 2006, he attended Harvard University and received a Master of Public Health degree in Quantitative Methods. Currently, his research interests are in surgical quality improvement and surgical outcomes. In 2010, he completed the Harvard Advanced Laparoscopic Surgery Fellowship at Massachusetts General Hospital in Boston. His clinical focus is in bariatric and gastrointestinal tract surgery. Dr. Jackson is a member of the Division of General Surgery at University Health Network based at Toronto Western Hospital. He is an Assistant Professor of Surgery. Learning Objectives: • To examine the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the associated clinical recommendations • To review the National Surgical Quality Improvement Program (NSQIP) • To understand how Canadian hospitals and programs are working to measurably improve surgical outcomes

52 | 5th Canadian Obesity Summit | #COS17 Pecha Kucha Session Details

Wednesday, April 26, 2017

11:00 – 11:30 (SNP Chair: Rebecca Liu) Alberta / New Brunswick Pecha Kucha Presentations 1 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK1.1 3147 Food, Eating, and Weight: Language, Sarah Nutter & University of Calgary Discourses, and Debates in the Obesity Shelly Russell-Mayhew Calgary, AB Field

PK1.2 3079 Food Insecurity, Diet Quality and Obesity Diana Tarraf University of Ottawa in African and Caribbean Households in Ottawa, ON

PK1.3 3168 Addressing Weight Bias in a Provincial Jenifer Bennett Alberta Health Services Health Services Organization Edmonton, AB

11:00 – 11:30 (SNP Chair: Alexa Ferdinands) Mt. Stephens Hall Pecha Kucha Presentations 2 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK2.1 3127 A Systematic Review and Meta-Analysis Lisa Kakinami Concordia University of Weight Loss Intentions and Strategy Montreal, QC Use Among Youth

PK2.2 3087 Fasting and Postprandial Glucose, Insulin Maha Alsaif University of Alberta and Glucagon-like Peptide 1 (GLP-1) Levels Edmonton, AB in Children with Prader-Willi Syndrome (PWS)

PK2.3 3092 Prevalence of Comorbid Conditions Paola Luca University of Calgary Pre-existing and Diagnosed at a Tertiary Calgary, AB Care Pediatric Weight Management Clinic

PK2.4 3517 The Live 5-2-1-0 Family Physician Toolkit Susan Pinkney & BC Children’s Hospital for Promoting Healthy Childhood Shazhan Amed Research Institute Behaviours in Primary Care – A Pilot Study Vancouver, BC

53 | 5th Canadian Obesity Summit | #COS17 Pecha Kucha Session Details

THURSDAY, April 27, 2017

11:00 – 11:30 (SNP Chair: Allana Leblanc) Alberta / New Brunswick Pecha Kucha Presentations 3 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK3.1 3197 Smoking Does Not Significantly Worsen Brian W. McCrindle The Hospital for Sick Lipid Changes Related to Increasing Children Adiposity in Adolescents: A Heart Niagara Toronto, ON Healthy Heart Schools’ Program Study

PK3.2 3166 Cardiovascular Fitness and not Physical Alisha N. Jamal Hospital for Scik Children, Activity Mediates the Relationship between University of Toronto Dyslipidemia and Higher Adiposity in Toronto, ON Canadian Youth

PK3.3 3191 Body Fat Percentile Curves for Children and Jennifer McConnell University of Victoria Youth of Asian and European Ancestry Victoria, BC

PK3.4 3183 Growing Little Sprouts: Enhancing Tracy McDonough & KFL&A Public Health Supportive Environments in Childcare Mary Jane Gordon Kingston, ON Settings

11:00 – 11:30 (SNP Chair: Melissa Fernandez) Mt. Stephens Hall Pecha Kucha Presentations 4 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK4.1 3195 The Association of Delta-5- and Delta-6- Valérie Lamantia Université de Montréal desaturase Activities with Risk Factors for Montréal, QC Type 2 Diabetes is Dependent on Plasma apoB in Obese Subjects

PK4.2 3118 The Mcmaster Optimal Aging Portal: A tool Sarah Neil-Sztramko McMaster University to provide evidence-based information on Hamilton, ON healthy aging

PK4.3 3052 Trends in Medication Use by BMI and Age Arshdeep K. Randhawa York University over Time in the United States Brampton, ON

PK4.4 3121 Weight Loss, Regression to Normoglycemia, David C. Lau University of Calgary and T2D Development at 3 Years in Early Calgary, AB Weight Loss Responders to Liraglutide 3.0 mg: SCALE Obesity and Prediabetes Trial

54 | 5th Canadian Obesity Summit | #COS17 Pecha Kucha Session Details

FRIday, April 28, 2017

11:00 – 11:30 (SNP Chair: Rebecca Liu) Alberta/New Brunswick Pecha Kucha Presentations 5 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK5.1 3508 Neighbourhood Built Design and Gavin McCormack University of Calgary Socioeconomic Composition and Their Calgary, AB Associations With Weight Status in Canadian Adults

PK5.2 3175 The REFRESH Study Recreation Environment Susan Caswell University of Waterloo and Food Research: Experiences from Hockey Waterloo, ON – Perspectives Revealed Through the Photovoice Method

PK5.3 3158 The Impact of Accelerometer Wear Location Alexandra B. Cooke McGill University on Physical Activity Estimates and the Montreal, QC Relationship with Arterial Health in Adults Treated for Hypertension and Diabetes

PK5.4 3084 The Association Between Functional Skills Andrea Mayo University of New Movements and Obesity-Related Risk Brunswick Factors and Fitness Level Fredericton, NB

11:00 – 13:30 (SNP Chair: Amanda Raffoul) Mt. Stephens Hall Pecha Kucha Presentations 6 Note: Pecha Kucha posters will be on display for viewing from Wednesday April 27 to Friday April 28, inclusive. See below for the Pecha Kucha oral presentation schedule and location of Pecha Kucha poster board.

PK Poster Board # Abstract # Title Speaker Institution

PK6.1 3179 The Economic Impact of Bariatric Surgery: Jillian Vallis Memorial University of A Retrospective Cohort Study Newfoundland St. John’s, NL

PK6.2 3103 Relationship of Weight Loss Expectations Allison A. Holgerson Mayo Clinic to Bariatric Surgery Outcome Rochester, MN

PK6.3 3505 Long-Term Impacts of Adding Supervised Aurélie Baillot Université du Québec en Exercise Training to Interdisciplinary Lifestyle Gatineau, QC Management in Subjects Awaiting Bariatric Outaouais Surgery

PK6.4 3171 Psychosocial Predictors of Cognition in Raed J. Hawa UHN, Toronto Western Bariatric Surgery Candidates Toronto, ON Bariatric Surgery Program

55 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

Wednesday, April 26, 2017

14:00 – 16:00 (Co-Chairs: Sara Kirk & Sonja Wicklum) Alberta/New Brunswick Concurrent Oral Presentations 1: Weight Bias, Stigma and Body Image

Program # Abstract # Title Speaker Institution

O1.1 3139 Dieting and Other Risky Behaviours Among Amanda Raffoul University of Waterloo Adolescent Girls: Implications for Obesity Waterloo, ON Prevention Initiatives

O1.2 3146 What’s in a Name? The Influence of Framing Sarah Nutter & University of Calgary Obesity as a Disease on Weight Bias Angela Alberga Calgary, AB & Concordia University Montreal, QC

O1.3 3091 Association between Weight Discrimination Chris I. Ardern York University and Program Adherence in a Clinical Toronto, ON Weight Management Program

O1.4 3145 Weight-related Attitudes in Children Sarah M. Hutchison University of British Columbia Vancouver, BC

O1.5 3177 “The Weight is Even Worse Than the Eva Pila University of Toronto Cancer”: Exploring Women’s Psychosocial Toronto, ON Experiences with Weight After Treatment for Breast Cancer

O1.6 3506 Impacts and Determinants of Excess Skin Aurélie Baillot Université du Québec en after Bariatric Surgery: a Scoping Literature Outaouais Review

O1.7 3556 Variation in Biases about Obesity and Theodore K. Kyle ConscienHealth People with Obesity in Canada, the U.S., Pittsburgh, PA Mexico, and Brazil

O1.8 3167 “There’s Roots, There’s a Reason Why You’re Denise L. Campbell- Department of Overweight.” – Perspectives of Adults Living Scherer Family Medicine, with Obesity on Barriers to Treatment University of Alberta Edmonton, AB

14:00 – 16:00 (Co-Chairs:David Lau & Danielle Bouchard) Ivor Petrak Concurrent Oral Presentations 2: Clinical Management Adults

Program # Abstract # Title Speaker Institution

O2.1 3101 Improving Obesity Management Education Denise L. Campbell- Department of Family and Training for Family Medicine Residents Scherer Medicine, University of Alberta, Edmonton, AB

O2.2 3122 Characteristics of Individuals Developing Type2 David C. Lau University of Calgary Diabetes in the SCALE Obesity and Prediabetes Calgary, AB Randomized, Double-Blind, Liraglutide vs Placebo Trial

O2.3 3141 Liraglutide: Adjunct Therapy Post-Bariatric Surgery Renuca Modi University of Alberta Edmonton, AB

56 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

Wednesday, April 26, 2017

14:00 – 16:00 Ivor Petrak Concurrent Oral Presentations 2: Clinical Management Adults

Program # Abstract # Title Speaker Institution

O2.4 3174 Competing Visions for Obesity Management Patricia H. Thille The Wilson Centre, in Canadian Primary Care University of Toronto Toronto, ON

O2.5 3100 Weight Loss and Associated Improvements David Macklin University of Toronto in Cardiometabolic Risk Factors with Toronto, ON Liraglutide 3.0 mg in the 3-year part of the SCALE Obesity and Prediabetes Trial

O2.6 3098 Building the Confidence of General Elizabeth A. Sturgiss Australian National Practitioners to Manage Patients with Obesity University – Results from an Australian Pilot Study Canberra, ACT

O2.7 3162 Improved Diagnosis and Follow Up for Obesity Marie-France Langlois CIUSSS de l’Estrie - CHUS with the Implementation of an Integrated and Université de Program in Community Care Sherbrooke, Sherbrooke, QC

O2.8 3113 Associations of Body Mass Index with Coronary Tasuku Terada University of Alberta Revascularization Procedures and Outcomes Edmonton, AB

14:00 – 16:00 (Co-Chairs: Kristi Adamo & Jean-Patrice Baillargeon) Mt. Stephens Hall Concurrent Oral Presentations 3: Pregnancy & Maternal/Fetal Health

Program # Abstract # Title Speaker Institution

O3.1 3109 Exercise in Pregnancy and Children’s Risk Laetitia Guillemette University of Manitoba Factors: a Systematic Review and Meta-Analysis Winnipeg, MB

O3.2 3164 Are Suboptimal in Utero Conditions Associated Soraya Saidj University of Montreal with Obesity and Cardiometabolic Risk Factors Montreal, QC in Offspring Reaching Puberty?

O3.3 3155 Preventing Excessive Gestational Weight Gain: Does Taniya S. Nagpal University of Western Adherence to Prenatal Nutrition and Exercise Ontario Recommendations Improve when You Include London, ON the Family?

O3.4 3202 Is There an Association Between Gestational Jonathan M. Rankin University of Ottawa Weight Gain and Infant Physical Activity? Ottawa, ON

O3.5 3204 Clinician Self-Efficacy Pertaining to Initiating Helena Piccinini-Vallis Dalhousie University Discussions About Gestational Weight Gain Halifax, NS

O3.6 3536 Obesity and Sleep Disturbances During Benjamin C. Guinhouya University of Lille, EA Pregnancy: Does Gestational Weight Gain 2694, Public Health: Matter? Results From the 3 D Cohort Study Epidemiology and Health care quality, Lille O3.7 3570 Impact of Maternal Pre-Pregnancy Overweight Andrea Haqq University of Alberta on Infant Overweight Risk at 1 year of age: Edmonton, AB Sex-Specific Differences 57 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

THURSDAY, April 27, 2017

14:00 – 16:00 (Co-Chairs: Gordon Zello & Michael Vallis) Alberta/New Brunswick Concurrent Oral Presentations 4: Nutrition

Program # Abstract # Title Speaker Institution

O4.1 3153 Prospective Associations of Dietary Intake Andraea Van Hulst McGill University on Insulin Sensitivity and Secretion in Montreal, QC Children with Familial Obesity

O4.2 3160 Histological Improvement of Non-Alcoholic Marc R. Bomhof University of Lethbridge Steatohepatitis with a Prebiotic: a Pilot Clinical Trial Lethbridge, AB

O4.3 3057 The Effects of Partial Sleep Restriction on Olfactory Jessica McNeil Alberta Health Services Performance and 24h Energy Intake in Men and Women Calgary, AB

O4.4 3119 Limited Potential of the Food Craving Chanaka N. Department of Nutritional Inventory and Three-Factor Eating Kahathuduwa Sciences, Texas Tech Questionnaire to Predict Brain Food-cue University, Lubbock Reactivity in Subjects with Obesity Texas, USA.

O4.5 3080 Validation of the Canadian Healthy Eating Jacynthe Lafreniere Institute of Nutrition and Index-2007 Functional Food, Laval University Québec, QC

O4.6 3193 Findings from Alberta’s 2016 Nutrition Report Card Alexa Ferdinands University of Alberta on Food Environments for Children and Youth Edmonton, AB

O4.7 3062 Stop Sugar Coating Children’s Breakfast Monique Potvin Kent School of Epidemiology, Cereals: Child Targeted Cereals in Canada Public Health and Require Reformulation Preventive Medicine, University of Ottawa Ottawa, ON

14:00 – 16:00 (Co-Chairs: Eric Doucet & Carla Prado) Alhambra Concurrent Oral Presentations 5: Metabolism: Preclinical Insights

Program# Abstract # Title Speaker Institution

O5.1 3130 Single Injection of Rapamycin Blocks Post Therese E. Kenny Memorial University of Restriction Hyperphagia and Body Weight Newfoundland Re-gain in Rats St. John’s, NL

O5.2 3161 Maternal Aspartame Consumption May Induce Jodi E. Nettleton University of Calgary Metabolic Derangements and Impact Central Calgary, AB Pathways Involved in Feeding in Mom and Pups in Rats

O5.3 3090 Longitudinal Metabolic Profiling Identifies Differences Heather A. Paul University of Calgary in Maternal Response to Pregnancy and Lactation Calgary, AB Between Lean and Diet-induced Obese Rats

58 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

THURSDAY, April 27, 2017

14:00 – 16:00 Alhambra Concurrent Oral Presentations 5: Metabolism: Preclinical Insights

Program# Abstract # Title Speaker Institution

O5.4 3194 Endogenous Cannabinoid and Nitric Oxide Karen M. Crosby Mount Allison University Interactions in the Rat: Potential Implications Sackville, NB for Appetite Regulation

O5.5 3526 Chondroitin Sulfate Prebiotic Improves GLP-1 Jennifer Pichette Laurentian University Response and Glucose Regulation in Mice Sudbury, ON

O5.6 3537 Effects of Glutathione Redox on Mitochondrial Awa Liaghati University of Ottawa Structure and Energetics in Primary Mouse Myoblasts Ottawa, ON

O5.7 3538 Influence of ACSL5 Genotype on Fatty Acid Abishankari Rajkumar University of Ottawa Oxidation and Mitochondrial Bioenergetics Ottawa, ON – an ex vivo and in vivo Analysis

O5.8 3553 Thermogenic Phenotype Shares a Negative Kanta Chechi Institut Universitaire de Association with Oxidative Stress-Related Cardiologie et de Parameters in Human Epicardial Adipose Tissue. Pneumologie de Quebec, Universite Laval, Quebec, QC

14:00 – 16:00 (Co-Chairs:Rena LaFrance & Andre Tchnerof) Mt. Stephens Hall Concurrent Oral Presentations 6: Bariatric Surgery

Program # Abstract # Title Speaker Institution

O6.1 3176 Health Service Use 12 Months Pre - and 24 Months Jillian Vallis Memorial University of Post-Laparoscopic Sleeve Gastrectomy (LSG) Newfoundland, St. John’s, NL

O6.2 3089 Weight Loss and Quality of Life Outcomes in Laurie K. Twells Faculty of Medicine, Surgically Treated Patients In [Province]: a Memorial University Prospective Cohort Study St. John’s, NL

O6.3 3148 Employment and Quality of Life Outcomes Karin Kantarovich University Health Network 2 Years Following Bariatric Surgery Toronto, ON

O6.4 3116 What Bariatric Surgery Recipients Need Before, Rebecca H. Liu Western University During, and After Surgery for Long-term Health London, ON and Well-being: Recipients’ Perspectives

O6.5 3059 Long-term Psychosocial Predictors of Quality of Life Sanjeev Sockalingam TWH Bariatric Surgery and Weight Loss After Bariatric Surgery: the Program, University Toronto Bari-PSYCH Study Results Health Network, University of Toronto, Toronto ON

O6.6 3205 Revision Bariatric Surgery After Laparoscopic Adjustable Vanessa S. Falk Centre for Advancement Adjustable Gastric Band Removal Has High Post-op- Edmonton, AB erative Complication Rates in Minimally Invasive Surgery

O6.7 3131 Association of Gastrointestinal Symptoms with Caroline Sheppard University of Alberta, Complications After Bariatric Surgery CAMIS, Edmonton, AB

O6.8 3099 Outcome of Gastric Bypass Surgery in Rosamunda Landspitali University Iceland 2001–2015 Thorarinsdottir Hospital, Reykjavik

59 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

FRIDAY, April 28, 2017

14:00 – 16:00 (Co-Chairs: Mary L’Abbe & Hasan Hutchinson) Alberta/New Brunswick Concurrent Oral Presentations 7: Public Health

Program # Abstract # Title Speaker Institution

O7.1 3069 Unhealthy versus Healthy Foods Advertised in Natalie A. Laframboise School of Food and Grocery Store Flyers Nutritional Sciences, Brescia at Western University London, ON

O7.2 3140 Gaps in the Evidence on Interventions to Reduce Amanda Raffoul University of Waterloo Sugar Consumption: a Scoping Review of Waterloo, ON Systematic Reviews

O7.3 3072 Differences in Reach and Effectiveness of a National Melissa A. Fernandez Institution of Nutrition and Healthy Eating Campaign According to Dominant Functional Foods, Université Official Language Laval, Quebec, QC

O7.4 3097 Applying the CAN Approach to School Hot Lunch Cathy Langdon College of Pharmacy and Fundraisers to Promote Healthy Food at School Nutrition, University of Saskatchewan Saskatoon, SK

O7.5 3188 Obesity, Its Associations with the Food Environment, Leia Minaker University of Waterloo and Spatio-temporal Indicators of the Food Waterloo, ON Environment in the Region of Waterloo, Ontario

O7.6 3185 International Interventions on Sugary Drinks and Harsha Kasi Heart and Stroke Best Practices Vishwanathan Foundation Ottawa, ON

O7.7 3154 Examination of Physical Activity and Sedentary Emily Ott Health and Rehabilitation Behaviour Policies in Canadian Childcare Centres Sciences, London, ON

O7.8 3525 The Impact of the Children’s Food and Beverage Monique Potvin Kent University of Ottawa Advertising Initiative’s Uniform Nutrition Criteria Ottawa, ON

14:00 – 16:00 (Co-Chairs: Jean-Philippe Chaput & Mark Tremblay) Alhambra Concurrent Oral Presentations 8: Children & Adolescents

Program # Abstract # Title Speaker Institution

O8.1 3061 Not Just Fun and Games: Toy Advertising Monique Potvin Kent School of Epidemiology, on Television Targeting Children Promotes Public Health and Preventive Sedentary Play Medicine, University of Ottawa, Ottawa, ON

O8.2 3151 Lifestyle Habits and the Development of the Mélanie Henderson Division of Endocrinology, Metabolically Unhealthy Obese Phenotype Department of Pediatrics, in Youth: a Prospective Analysis in the University of Montreal QUALITY Study Montreal, QC

O8.3 3150 Early Life Conditions, Childhood Adiposity Andraea Van Hulst McGill University and Risk Factors for Type 2 Diabetes in Children Montreal, QC Aged 10–12 Years from the QUALITY Study

60 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

FRIDAY, April 28, 2017

14:00 – 16:00 Alhambra Concurrent Oral Presentations 8: Children & Adolescents

Program # Abstract # Title Speaker Institution

O8.4 3060 Neighbourhood Disadvantage During Lisa Kakinami Concordia University Childhood and the Risk of Cardiovascular Montreal, QC Disease Risk Factors and Events from a Prospective Cohort

O8.5 3187 Parents’ Perceptions of the Family- and Shauna M. Burke Western University Community-Based Resources and Support London, ON Required to Enhance Physical Literacy in Children: an Exploratory Study

O8.6 3138 Using Primary Care Electronic Medical Sarah E. Carsley University of Toronto Records to Estimate the Prevalence of Toronto, ON Severe Obesity in Children

O8.7 3107 Maternal and Offspring Intelligence in relation Christina S. Wraw University of Edinburgh to Offspring BMI in Childhood and Edinburgh Adolescence

O8.8 3201 Learning Food Literacy: Educational Emily J. Truman University of Calgary Interventions for Child and Adolescent Health Calgary, AB

14:00 – 16:00 (Co-Chairs: Pascal Imbeault & Eva Pila) Mt. Stephens Hall Concurrent Oral Presentations 9: Physical Activity

Program # Abstract # Title Speaker Institution

O9.1 3189 Evaluation of a Community Driven, Physical Sonja Wicklum University of Calgary Activity Based Wellness Program for Calgary, AB Indigenous Women in Lloydminster, Alberta – the Women Warriors Program

O9.2 3213 Sustained Participation in Running, Sports, Tarun Katapally University of Regina Fitness and Dance Activities Throughout Regina, SK Adolescence and Body Composition in Early Adulthood

O9.3 3081 Impact of Exercise on Olfaction, Gustation Kapria-Jad Josaphat Université de Montréal and Energy Intake in Lean Men – a Montréal, QC Dissociation Profile

O9.4 3210 Neighbourhood Walkability and Its Nicoleta Cutumisu Institute Armand Frappier Association with Child Weight Status in – INRS, Laval, QC Quebec: Findings from the Quality Study

O9.5 3203 Higher Abdominal Fat in Youth and Young Clodagh M. Toomey University of Calgary Adults 3–10 Years Following a Sport-Related Calgary, AB Knee Injury

61 | 5th Canadian Obesity Summit | #COS17 Concurrent Oral Presentations Details

FRIDAY, April 28, 2017

14:00 – 16:00 Mt. Stephens Hall Concurrent Oral Presentations 9: Physical Activity

Program # Abstract # Title Speaker Institution

O9.6 3186 Resistance-Training after Weight Loss has no Luzia J. Hintze University of Ottawa Impact on Body Composition and on Energy Ottawa, ON Expenditure in Overweight and Obese Postmenopausal Women: A MONET Study

O9.7 3132 Active Desks and Excess Body Weight – Marie-Eve Mathieu University of Montreal and A review by the FIT24 Network Sainte-Justine UHC Montreal, QC

O9.8 3546 Association between Physical Activity, Sukhleen Deol York University Obesity, and Cardiometabolic Disease in Toronto, ON South Asians: Canadian Community Health Survey, 2001–2014

62 | 5th Canadian Obesity Summit | #COS17 Poster Presentations WEDNESDAY, April 26, 2017

POSTER # POSTER Poster Title Presenter(s) BOARD #

P1.01 1A Anthropometric, Nutritional, Psychometric, and Biochemical Parameters of Individuals After SG See, Janet and RYGB Bariatric Procedures: A 12-Month Observation P1.02 2A Effects of Vitamin D3 and n-3 Polyunsaturated Fatty Acids on The Development of Metabolic Valle, Marion Syndrome in a Mouse Model of Diet-Induced Obesity P1.03 3A Dysfunction of the Orbitofrontal Cortex in Diet-Induced Obesity Naef, Lindsay P1.04 4A Behavioural Modification for Adolescents with Obesity/overweight: An explanatory conceptual Chahal, Nita framework for Motivational Interviewing P1.05 5A Gaining Expert Consensus on Defining Metabolically Healthy Obesity (MHO) in Pediatrics: Damanhoury, Samah A Delphi Study P1.06 6A Familial Perceptions of Weight and Health: A Qualitative Analysis Among Parents and Children Pila, Eva P1.07 7A Early Childhood Exposure to Antibiotics and the Association with Microbiome Changes, Weight Chau, Kim and Diabetes Later in Life: A Systematic Review P1.08 8A Resting Metabolic Rate and Appetite Sensations Are Not Affected by Different the Degree of Hintze, Luzia J. Caloric Restriction: Preliminary Data P1.09 9A Clinical Correlations of 2-hour and 5-hour Glucose Tolerance Tests in Subjects with Obesity Rodriguez Flores, Marcela P1.10 10A Obesity, Depression and Erysipelas a Clinical Correlation in Workers Ahmed, Sana P1.11 11A Body Mass Index and Risk of Dementia: a Retrospective Cohort Study of 513,775 Korean Adults Ha, Kyoung Hwa P1.12 12A Coffee, but not Its Bioactive Compounds, Alleviates Weight Gain, Insulin Resistance, and Liver Shokouh, Pedram Steatosis in a Model of Diet-Induced Metabolic Syndrome P1.13 13A Discordance of Perceived Weight Status in Canadian University Students Dworatzek, Paula D. P1.14 14A How Does Obesity Affect the Endocrine System? Poddar, Megha P1.15 15A Gestational Weight Gain and Childhood Body Mass Index Trajectories: a Primary Care Nova Scotia Piccinini-Vallis, Helena Cohort Study Using EMR Data P1.16 16A Nova Scotia Women’s Gestational Weight Gain Goals Piccinini-Vallis, Helena P1.17 16B Sustainability of Comprehensive School Health on Body Weight, Healthy Eating and Physical Activity Ofosu, Nicole N. P2.01 15B Formulate, Innovate, Translate: the FIT Solution to Investigating Potential Pathways and Mediators Barnett, Tracie A. in the Environment-Obesity Relation P2.02 14B Minimum Wage and Anthropometric Outcomes in Women: A Longitudinal Study of 24 Conklin, Annalijn I. Low-Income Countries P2.03 13B Toward Equity-Oriented Obesity-Related Health Promotion Darroch, Francine P2.04 12B Diet Quality in Relation to Metabolic Syndrome in Cree (Eeyouch) from James Bay, Northern Lavigne-Robichaud, Mathilde Québec, Canada P2.05 11B Are Dental Caries and Trachoma Associated with Weight Status Among Chinese Children? Liu, Jian P2.06 10B Proportional Responsibility vs Individual Responsibility for Diet and Obesity in the Food System: Savona, Natalie a Complex Systems Analysis P2.07 9B The Effects of Culture on Guideline Discordant Gestational Weight Gain: A Systematic Review Denize, Kathryn M. P2.08 8B Literature Review Obesity Research Pertaining to Sudbury’s Social Determinants of Health Cerilli, Julia/ Weglewski, Christina P2.09 7B Exploring the Effects of Family Characteristics on Indigenous Youth’s Participation in Physical Wilk, Piotr/ Maltby, Alana Activity and Sport P2.10 6B Designing Seating Solutions for Persons with Obesity: An Inter-Professional Collaboration Forhan, Mary P4.26 5B Personalizing Obesity Assessment and Care Planning in Primary Care: Patient Experience and Luig, Thea Self-management Outcomes

63 | 5th Canadian Obesity Summit | #COS17 Poster Presentations THURSDAY, April 27, 2017

POSTER # POSTER Poster Title Presenter(s) BOARD #

P3.01 1A Estimations of Calorie Content of Meals Before and After a Menu Labelling Intervention Vanderlee, Lana P4.01 2A Preoperative Endoscopic Evaluation in Bariatric Surgery Jodeiri, Behzad P4.02 3A Is Depressive Status Associated with Preoperative Weight and Problematic Eating Behaviours Julien, Cassandre A. Among Candidates for Bariatric Surgery? P4.03 4A The NL Bariatric Surgery Cohort Study: Improvement and Remission of Prediabetes and Type 2 Twells, Laurie K. Diabetes Mellitus 2 years after Laparoscopic Sleeve Gastrectomy P4.04 5A A Comparison of Circular – vs. Linear – Stapled Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Miller, Sarah Bypass (LRYGB) in a Tertiary Care Hospital P4.05 6A Association Between Physical Activity Intensity and Physical Capacity Among Individuals Awaiting Rioux, Brittany V. Bariatric Surgery P4.06 7A Impulse Control and Weight-Loss after Bariatric Surgery: The moderating effect of Emotion Williamson, Tamara M. Self-Regulation P4.07 8A Psychotropic Medication Use in Individuals Pursuing Bariatric Surgery Yanofsky, Richard P4.23 9A Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale (BIPASS TM): Thiara, Gurneet S. Phase II – Establishing Convergent Validity P4.08 10A Beyond BMI: NutriSTEP® for the Prevention, and Care and Management of Childhood Obesity Andrade, Lesley/ McDonough, Tracy P4.09 11A Intensive Gestational Glycemic Management and Childhood Obesity: A Systematic Review and Guillemette, Laetitia Meta-Analysis P4.10 12A Effects of a Multidisciplinary Program of Obesity Treatment of Children and Adolescents that Hintze, Luzia J. Performed a Water-Based Intervention: Difference Between Age Groups P4.11 13A Exploring Lifestyle Behaviors of Adolescents with Obesity in Weight Management: A Scoping Kebbe, Maryam Review and Stakeholder Consultation P4.12 14A Maternal Low-Dose Antibiotic Consumption During Pregnancy and Lactation in Rats Increases Klancic, Teja Their Body Weight During Lactation But is Reversed with Prebiotic Diet P4.13 15A The Relationship of Fasting Plasma apoB48 to Cardiometabolic Risk Factors in Adolescents Krysa, Jacqueline P4.14 16A A Telehealth Program for the Treatment of Overweight and Obesity in Children: Baseline Lasinsky, Anne M. Characteristics of Program Evaluation Participants P4.15 16B Obesity Is Associated with Increased Asthma Prevalence and Asthma Related Health Service Use, in Mccomber, Teri D. a Population Based Study of Nova Scotia Children P4.16 15B Listen Up! an Exploration of Families’ Perceptions and Preferences Around Weight-Related McPherson, Amy C. Communication Best Practices in Healthcare Settings P4.17 14B Review of a Family Based Child/Youth Obesity Treatment Program Oates, Constance P4.18 13B Childhood and Adolescent Obesity Treatment: Expanding the Conversation to Include Families Oates, Constance P4.19 12B Do children and adolescents referred to multidisciplinary care for weight management in Alberta Perez, Arnaldo enroll in treatment? A preliminary analysis P4.20 11B Effects of a Multiprofessional Program of Obesity Treatment (MPOT) in Adolescents from the Hintze, Luzia J. Metabolically Healthy Obese (MHO) Phenomenon P4.21 10B The Effect of Peer Support on Knowledge and Self-Efficacy in Weight Management: A Prospective Hibbert, Claire Clinical Trial in a Mental Health Setting P4.22 9B Optimizing Body Composition and Glycemic Control in the Elderly through Creatine Lemos Pinto, Camila Supplementation and Resistance Exercise P4.24 8B Association Between Therapeutic Drug Classes and Weight Change in Patients Attending a Kamran Samani, Elham Medically Supervised Weight Loss Clinic

64 | 5th Canadian Obesity Summit | #COS17 Poster Presentations FRIDAY, April 28, 2017

POSTER # POSTER Poster Title Presenter(s) BOARD #

P4.22 1A Current Weight Management Approaches Used by Primary Care Providers in Multidisciplinary Aboueid, Stephanie Health Care Settings in Ontario P4.23 2A Pediatric Weight Management: Are Dietitian-led Interventions Successful? Bennett, Tesia P4.24 3A Children and Youth Nutrition Survey: Monitoring Dietary Patterns During Weight Management Bennett, Tesia Counselling P4.25 4A Differential Health Burden and Clinical Risks Associated with Types of Obesity in Patients with Obesity and Knee Osteoarthritis Godziuk, Kristine P4.27 6A Effect of Yellow Pea Fiber on Fecal Short-chain Fatty Acids and Bile Acids in Adults with Mayengbam, Shyamchand Overweight/Obesity: a 12-week Randomized Controlled Trial P4.28 7A Impact of Computer-Based Cognitive Training on Outcomes During a Weight Loss Intervention in an Obese Population Stallard, Ryan M. P4.29 8A Benefits of a Multi-Agency Obese Treatment Program Stallard, Ryan M. P4.30 9A Differences in Short and Long-term Mortality Associated with Body Mass Index Following Terada, Tasuku Coronary Revascularization P4.31 10A Non-invasive Brain Stimulation (NIBS) of the Prefrontal Cortex: a Systematic Review of Vincent, Corita M. Multi-session Treatment Studies Examining Eating-related Outcomes P4.32 11A Reasons for Attrition In A Publicly Funded Weight Management Program Wharton, Sean P4.33 12A Effectiveness of a Multidisciplinary Lifestyle-Based Weight Management Program on Improving Zargar, Benyamin the Metabolic Health of Adults with Obesity P4.34 13A Computer Apps to Assist with Weight Loss: Limited Value in the Present and Opportunities for the Future Tanner, Bradley P4.35 14A Health Markers Improvement While Meeting the Physical Activity Guidelines Only doing Bouchard, Danielle R. Resistance Training in People considered Obese P4.36 15A Increasing BMI in Primary Hip and Knee Arthroplasty; Influencing Length of Stay, Complications Gill, Richdeep and Adverse Events. A Retrospective Review P4.37 16A Impacts of Exercise Training on Quality of Life, Body Image, Anxiety, and Depression in Individuals Saunders, Stephanie with Obesity: A Systematic Literature Review P4.38 16B Maternal Antibiotic Consumption Alters Expression of Neurotransmitters Associated with Reward- Cho, Nicole Seeking Behavior in Rats P4.40 14B ENHANCE: A Preliminary Examination of Physiological Outcome Data Following a 12-week Ciszewski, Stefanie Well-being Intervention P4.41 13B Identifying Patient Attributes that Contribute to High Engagement and Long Term Weight Loss Ferguson, Christine P4.42 14B Applying Shared Decision Making Models in Clinical Practice to Increase Exercise Adherence Hanna, Andrew P4.43 13B CHANGE Adventure Camp: Obesity Prevention and Health promotion for Children and Families Klein, Doug P4.44 12B An Online Training System to Improve the Health of University Students: Rationale and Description Mandich, Gillian E. P4.45 11B Standards for a Bariatric Friendly Care Hospital - Translating Research into Practice O’Connell, Petra P4.46 10B The Hockey Fans in Training Weight Loss and Healthy Lifestyle Program Can Attract and Retain Petrella, Robert J. Overweight and Obese Men P4.47 9B Effect of Regular Physical Activity on Cardiovascular Risk Factors in Middle-Aged Active and Ramezani, Alireza Non-active Individuals P4.48 8B Dental Professionals Perceptions of Sugar Consumption and Obesity Advice in the Dental Practice Suvan, Jeanie P4.49 7B Impact of a Bariatric Support Garment to Manage Excess Skin on Activities of Daily Living Teske, Katelyn

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O1.1 O1.3 Dieting and Other Risky Behaviours Among Adolescent Girls: Association Between Weight Discrimination and Program Adherence in a Implications for Obesity Prevention Initiatives Clinical Weight Management Program Amanda Raffoul, Scott T. Leatherdale, Sharon I. Kirkpatrick Neda Yeganeh1, Saaqshi Sharma1, Jennifer L. Kuk1, Sean Wharton2, Chris I. Ardern1 University of Waterloo, Waterloo, ON, Canada 1. York University, Toronto, ON, Canada, 2. Wharton Medical Clinic, Toronto, ON, Canada Objective: A focus on obesity prevention has dominated public health interventions targeted to children and adolescents in recent years. Weight-focused inter- Background: Weight discrimination is a common occurrence for those living ventions have the potential to elicit unanticipated consequences, such as dieting, with obesity. While the detrimental health effects are well known, it is unclear if a which itself is associated with an array of deleterious behaviours that may contribute history of weight discrimination may also impact on adherence to follow-up within a to poorer health overall. This study was conducted to examine whether dieting is medically supervised weight loss setting. associated with clusters of other risky behaviours two years later among Canadian Method: Participants from the Wharton Medical Clinic (Hamilton and Burlington, adolescent girls. ON) completed a battery of weight discrimination questions at their first site visit Methods: We explored associations between dieting to lose weight and engage- (n=120) and were tracked for program adherence. A series of general linear models ment in clusters of health-compromising behaviours at follow-up (2 years later) were subsequently used to assess the relationship between a history of weight among Ontario girls (N=3,386; grades 9–10 at baseline). Multilevel logistic regres- discrimination (yes/no) and program adherence (months and number of program sion models were used to investigate the relationship between dieting and each of visits). Adjustments were made for baseline body mass index, age, sex, and smoking smoking, binge drinking, breakfast-skipping, and clusters of these behaviours. status. Results: Over half of girls reported dieting (54%), as well as heights and weights Results: A majority of the clinic sample (77.5%) reported a history of weight corresponding with a healthy BMI (61%). Four in five girls dieting at baseline discrimination. Overall, no significant difference in treatment time was observed reported dieting 2 years later. Dieting at baseline was positively associated with (no wgt dis: 4.3 months; wgt dis: 2.8 months, p=0.23); however, at the end of one each risky behaviour, as well as combinations of these behaviours at follow-up; the month, significantly more patients with a history of weight discrimination remained highest risk was observed for binge drinking/breakfast-skipping and smoking/binge in the program (no wgt dis: 22.2%; wgt dis: 46.2%), an effect that diminished with drinking/breakfast-skipping (RR=1.6). Baseline dieters were more likely to engage time. There were also no differences in the absolute amount of weight loss or the in a greater number of risky behaviours than non-dieters, regardless of the actual percentage of each group who achieved clinically meaningful weight loss (5% of behaviours. baseline weight) within 3 months of follow-up. Conclusions: Dieting is longitudinally associated with engagement in other Conclusion: In this sample, having a history of weight discrimination was not risky behaviours among adolescent girls. Attention is needed to the potential for associated with differences in program adherence or weight loss outcomes. Further well-meaning obesity prevention initiatives to unintentionally compromise health work is necessary to test the persistence of this finding across clinical settings. through a focus on weight that may drive the uptake of dieting behaviours.

O1.4 O1.2 Weight-related Attitudes in Children What’s in a Name? The Influence of Framing Obesity as a Disease on Sarah M. Hutchison1, 2, 3 Weight Bias Ulrich Mueller 1. University of British Columbia, Vancouver, BC, Canada, 2. BC Children’s Hospital Sarah Nutter1, Angela S. Alberga2, Shelly Russell-Mayhew1, Cara MacInnis1, John Ellard1 Research Institute, Vancouver, BC, Canada, 3. University of Victoria, Victoria, BC, 1. University of Calgary, Calgary, AB, Canada, 2. Concordia University, Montreal, QC, Canada Canada Weight-related attitudes (WA) refer to negative attitudes toward individuals because Background: The declaration of obesity as a chronic disease by the Canadian and they are overweight or obese. These attitudes are widespread among children and American Medical Associations has been met with strong debate, including the adults, and have been proven to be recalcitrant to intervention. To develop more potential impact of this declaration on weight bias. effective interventions it is necessary to understand the origin and development of Objective: The purpose of this research was to experimentally investigate the influ- explicit and implicit WA. Explicit WA tasks require individuals to make evaluations ence of framing obesity a disease on the attitudes of members of the general public. (e.g., self-report) about people who are overweight/ obese, which can be influenced Methods: Canadian and U.S. participants (N= 309, 15-73) recruited through by social desirability. Implicit WA tasks reduce the role of social desirability, such CrowdFlower were assigned to read one of three articles. Two articles presented ac- as the Weight Implicit Association Test (IAT), which compares response speeds curate and identical information about the nature of obesity, with one article stating to fat and thin stimuli. Our goals for the study were to examine the association that obesity has been declared a disease and the other article stating that obesity between two explicit measures of WA to determine if they are tapping into a similar has not been declared a disease. The third article was a control article unrelated to underlying construct and examine age-related differences in explicit and implicit obesity. Participants completed a number of questionnaires, including weight bias WA. We administered the Anti-fat Prejudice task, the Friendship Selection task, relevant outcome measures. and a Weight IAT to eighty-four 4- to 7-year olds. Results showed that: 1) the two Results: Regression analyses revealed that framing obesity as a disease (vs. control measures of explicit WA were associated, 2) children demonstrated both explicit and conditions) was associated with more positive affect towards individuals with implicit WA; and 3) age accounted for 10.6% of the variance in explicit WA, and age obesity, indirectly leading to less negative attitudes toward individuals with obesity. accounted for 11.2% of the variance in the Weight IAT. The association between the Further, for certain individuals framing obesity as a disease (vs. controls) was associ- two explicit tasks is a novel finding as all previous studies have not reported the rela- ated with perceptions that obesity is less personally controllable or higher empathy tions between measures of explicit WA. Taken together, these findings suggest the toward people with obesity, both of which predicted less negative attitudes. importance of early intervention to reduce WA and implications for the developmen- Conclusions: Our results suggest that the declaration of calling obesity a disease tal origins of WA will be discussed. can positively influence attitudes towards people with obesity and can inform future weight bias reduction interventions.

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O1.5 ever follow-up data with subjective and objective measurements of ES are missing. “The Weight is Even Worse Than the Cancer”: Exploring Women’s Psycho- Further studies on the determinants of ES’ quantity and discomfort are needed to social Experiences with Weight After Treatment for Breast Cancer better inform patients and health professionals. Eva Pila1, Catherine M. Sabiston1, Valerie Taylor1, 2, Kelly Arbour-Nicitopoulos1 1. University of Toronto, Toronto, ON, Canada, 2. Women’s College Hospital, Toronto, O1.7 ON, Canada Variation in Biases about Obesity and People with Obesity in Canada, the U.S., Mexico, and Brazil Summary: There is a complex association between obesity and breast cancer, Theodore K. Kyle1, Ximena Ramos Salas2, Bruno Halpern3, Nathalie Dumas4, Joseph whereby excess weight is linked with higher risk of breast cancer development, F. Nadglowski5, Leah D. Whigham6, Diana M. Thomas7, Rebecca M. Puhl8 advanced diagnosis, and increased risk of cancer reoccurrence and mortality. Can- 1. ConscienHealth, Pittsburgh, PA, USA, 2. Canadian Obesity Network, Edmonton, AB, cer-related changes in weight also contribute to worsened mental health, however Canada, 3. Obesity Group, Department of Endocrinology, University of São Paulo, São the psychosocial experiences of weight-concerned women treated for cancer are not Paulo, SP, Brazil, 4. Plateforme d’Evaluation en Prevention de l’Obesite, Université Laval, well understood. As such, the purpose of this qualitative study was to explore wom- Quebec, QC, Canada, 5. Obesity Action Coalition, Tampa, FL, USA, 6. Paso del Norte en’s experiences with weight across the cancer trajectory. A purposeful sample of Institute for Healthy Living, El Paso, TX, USA, 7. US Military Academy, West Point, NY, USA, women selected based on criteria for high weight and body image concern (N=11; 8. Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA Mage = 65.31) participated in a semi-structured interview. Five themes were identified: (i) prevalent history of weight cycling and ongoing quest to manage weight; Introduction: Weight bias (WB) is an impediment to progress toward adoption of (ii) dominant perceptions of failure around goal-oriented weight management evidence-based strategies to address obesity. Key elements of WB include blame di- behaviours; (iii) internalized pressures for weight loss in context of risk reduction, rected at people with obesity (PwO), assumptions of laziness or poor discipline, and and (iv) weight-related concerns notably contributed to psychological distress. Based social rejection. The present research measured beliefs about the causes of obesity, on these novel findings, the pervasiveness of women’s weight concerns spans far and beliefs and attitudes about PwO in English and French-speaking Canada (CAen, beyond cancer diagnosis and treatment In fact, women’s lifetime perceptions of CAfr), US, Mexico (MX), and Brazil (BR). being ‘high risk’ and concerted efforts to lose weight remarkably contributed to Methods: Random samples totaling 47,282 adults completed anonymous, volun- psychological distress. Therefore, improving weight-related psychological distress tary online surveys between Oct 2016 and Dec 2017. Microsurveys required only should be targetted as a clinical priority for women in survivorship. one response per participant to reduce fatigue with multiple questions. Likert scales Learning Objectives: (1) Identify the psychosocial impact of weight in women (5 points) measured agreement with 4 narratives regarding causes of obesity, as treated for breast cancer. (2) Explore how women make meaning of weight cycling well as perceptions of blame, social acceptance, laziness, and self-discipline of PwO. in the context of mitigating risk for breast cancer reoccurance and mortality. Results: Agreement that obesity results from addictive junk food was high in all five populations, highest in BR (mean agreement 3.8±0.1), MX (3.7±0.1) and CAfr O1.6 (3.7±0.1). Respondents in CA, US, and MX agreed that irresponsibility of individuals Impacts and Determinants of Excess Skin after Bariatric Surgery: a Scop- is a cause of obesity, while BR respondents disagreed. Belief that PwO should be ing Literature Review blamed was highest in MX (3.4±0.1), lowest in BR (3.0±0.1). CAfr respondents Elsa Brais-Dussault1, Ahmed J. Romain2, Paquito Bernard3, 4, Caroline Cyr1, Aurélie agreed more than CAen with addictive junk food causing obesity, social acceptance Baillot1, 5 for PwO, and that PwO are undisciplined. 1. Université du Québec en Outaouais, Gatineau, QC, Canada, 2. University of Conclusion: Public beliefs associated with WB vary among these five populations. Montreal Hospital Research Center, Montréal, QC, Canada, 3. Department of Physical Beliefs that addictive junk food plays a causal role in obesity is widespread and Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada, 4. Institut stronger in Brazil, CAfr, and MX. Tracking these patterns may help for developing Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada, 5. Institut de and evaluating future interventions to reduce WB. recherche de l’Hôpital Montfort, Ottawa, ON, Canada O1.8 Objectives: To gather current knowledge on i) the physical and psychosocial conse- “There’s Roots, There’s a Reason Why You’re Overweight.” – Perspectives quences of excess skin (ES) after bariatric surgery (BS), and ii) the physical and psycho- of Adults Living with Obesity on Barriers to Treatment social factors associated with the quantity of ES and the discomfort caused by ES. Jacqueline Torti1, 2, Thea Luig3, Michelle Borowitz4, Arya M. Sharma3, 5, Denise L. Methods: Searches were performed using Pubmed®, Psyarticles and CINAHL. All Campbell-Scherer1, 5 studies recorded were screened by two independent reviewers for inclusion criteria: (1) 1. Department of Family Medicine, University of Alberta, Edmonton, AB, Canada, 2. peer-reviewed empirical studies; (2) adults having realized BS; (3) studies reporting con- School of Public Health, University of Alberta, Edmonton, AB, Canada, 3. Department sequences of ES and/or correlates with the quantity of ES or the discomfort caused by ES. of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Cana- Results: Finally, 24 articles were included in the review, with only one study with da, 4. Department of Anthropology, University of Alberta, Edmonton, AB, Canada, 5. longitudinal data, and 58% with quantitative results. The vast majority were published Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada after 2011 (88%) and only 33% were performed in North America. Only three studies assessed objectively the quantity of ES. Physical (e.g. skin problems) (71%), psychoso- Purpose: Obesity is a complex chronic medical condition. Research shows psychosocial (e.g. low self-esteem) (63%), functional (e.g. mobility limitations) (17%) and daily cial and socioeconomic issues, as well as psychiatric and medical comorbidities affect life (e.g. finding clothes) (75%) consequences were reported in several studies. Eight patients’ health and ability to manage weight. This study aimed to assess the barriers studies explored factors associated with ES’ quantity or discomfort. Women declared to weight management by exploring perspectives of adults living with overweight and more ES’ discomfort compared to men (n=6/6). Regarding other factors (pre-surgical obesity. An expansion of the 4Ms (mechanical, mental, metabolic, monetary) for obe- Body Mass Index (BMI), current BMI, physical activity level, weight loss and age), no sity assessment with patient narratives broadens the discussion on obesity assessment. conclusion can be drawn because of conflicting results. Method: This was a qualitative study. 28 individual semi-structured interviews were Conclusions: Several studies underlined the negative consequences of ES, how- conducted and underwent a thematic analysis.

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Results: Patients discussed mechanical, mental, metabolic, and monetary issues O2.2 as inseparable from their weight trajectory, decisive for weight management efforts, Characteristics of Individuals Developing Type 2 Diabetes in the SCALE and causing feelings of frustration with their ability to reduce weight. Mechanical Obesity and Prediabetes Randomized, Double-Blind, Liraglutide vs conditions included chronic pain, sleep apnea, hernias, asthma, osteoarthritis, Placebo Trial and plantar fasciitis impairing ability to engage in physical activity. Some patients David C. Lau1, Matthias Blüher2, Luc Van Gaal3, Domenica M. Rubino4, German reported weight gain from prescription medication. Patients shared personal stories Guerrero5, John P. Wilding6 linking weight to stressful life events, depression, traumatic childhood experiences, 1. University of Calgary, Calgary, AB, Canada, 2. University of Leipzig, Leipzig, Ger- fatigue, stress, and addictions. Women described struggling with menopause. Fi- many, 3. Antwerp University Hospital, Antwerp, Belgium, 4. Washington Center for nally, patients discussed limited finances and time constraints affecting their ability Weight Management and Research, Arlington, VA, USA, 5. Novo Nordisk, Plainsboro, to maintain weight management programs. Patients emphasized the need for their NJ, USA, 6. University of Liverpool, Liverpool, United Kingdom providers to “put all this together.” Conclusions: Patients’ felt that obesity is a complex phenomenon with multiple Background: This 3-year trial examined the effect of liraglutide 3.0 mg, as adjunct drivers related to their unique story. Our findings highlight the need to assess root to diet+exercise, in delaying onset of T2D in adults with prediabetes and BMI ≥30 causes and drivers of weight gain, comorbidities, and psychosocial barriers to devel- kg/m2, or ≥27 kg/m2 with comorbidities. op a care plan that offers realistic and sustainable strategies according to patients’ Methods: Individuals were randomized 2:1 to liraglutide 3.0 mg (n=1505) or particular constraints and strengths. placebo (n=749), plus 500-kcal/day deficit diet and 150-min/week exercise. Efficacy data are observed means, with LOCF. O2.1 Results: Compared with the entire randomized population, at baseline, individuals Improving Obesity Management Education and Training for Family who developed T2D by week 160 (liraglutide 3.0 mg, n=26; placebo, n=46) were Medicine Residents older (developed T2D: liraglutide 48.4 years, placebo 49.3; vs entire population: Denise L. Campbell-Scherer1, 7, Sonja Wicklum2, Thea Luig3, Erin Cameron6, Shuai liraglutide 47.5, placebo 47.3), had more dyslipidemia (54%, 46%; vs 33%, 33%), Li3, Rena Lafrance4, 5, Alison Connors5, Melanie Heatherington3, Doug Klein1, Karen hypertension (73%, 39%; vs 42%, 42%), higher baseline HbA1c (6.1%, 5.9%; vs Moniz1, Arya M. Sharma3, 7 5.8%, 5.7%), FPG (6.0 mmol/L, 5.9; vs 5.5, 5.5) and BMI (40.2 kg/m2, 40.4; vs 38.8, 1. Department of Family Medicine, University of Alberta, Edmonton, AB, Canada, 39.0). Time to onset of T2D over 160 weeks was 2.7-fold longer with liraglutide com- 2. Department of Family Medicine, Cumming School of Medicine, University of pared with placebo (95%CI 1.9;3.9; p<0.0001) (hazard-ratio=0.2). Mean weight Calgary, Calgary, AB, Canada, 3. Department of Medicine, Division of Endocrinolo- loss (0-160 weeks) for the entire study population was 6.1% with liraglutide 3.0 mg gy, University of Alberta, Edmonton, AB, Canada, 4. Department of Psychiatry and vs 1.9% with placebo (estimated difference ‑4.3% [95%CI -4.9;-3.7], p<0.0001). Pediatrics, University of Alberta, Edmonton, AB, Canada, 5. Primary Health Care, Over 90% of individuals who developed T2D in both groups lost less body-weight Alberta Health Services, Edmonton, AB, Canada, 6. School of Human Kinetics and than the treatment group mean. In those with T2D, one hypoglycemic event was Recreation, Memorial University, St. John’s, NL, Canada, 7. Alberta Diabetes Institute, reported with liraglutide 3.0 mg vs five with placebo, none severe. Liraglutide 3.0 University of Alberta, Edmonton, AB, Canada mg was generally well tolerated. Conclusion: Liraglutide 3.0 mg for 3 years, as an adjunct to diet+exercise, was Purpose: Obesity has risen to epidemic proportions worldwide. Prevention and associated with lower risk of T2D and greater weight loss vs placebo. management requires a lifecycle approach that needs to be embedded in primary care. Yet, research has shown that medical residents and practicing physicians lack O2.3 knowledge and confidence to effectively address weight concerns with patients. Liraglutide: Adjunct Therapy Post-Bariatric Surgery There is a pressing need to create high quality, evidence-based obesity manage- Renuca Modi1, Sarah Cawsey1, Peter Rye2, Arya Sharma1 ment training programs for family medicine residents so they can better support 1. University of Alberta, Edmonton, AB, Canada, 2. University of Calgary, Calgary, AB, Canada patients. We developed a comprehensive educational program for residents based on the 5As of Obesity Management™ (Ask, Assess, Advise, Agree, Assist- 5As), a Background: Patients undergoing bariatric surgery may experience inadequate weight framework and suite of resources to improve residents’ knowledge and confidence loss, weight plateau or weight recidivism. Limited evidence suggests that these patients in weight counselling. may experience additional weight reduction with adjunct anti-obesity pharmacotherapy. Methods: The program, now in its second year, combines lectures with experiential We present our experience with the use of GLP-1 agonist Liraglutide up to 3.0 mg daily learning methods, including content expert presentations, bariatric suit experi- for further weight loss in patients who have undergone bariatric surgery. ence, practice with standardized and in-clinic patients, and narrative reflections. Methods: A retrospective chart review of post- bariatric surgery patients who received We assessed changes in residents’ attitudes and level of self-confidence. Narrative Liraglutide up to 3.0 mg, for at least six months. The primary endpoints were percent reflections were analyzed thematically. total weight loss at three months (four weeks titration plus twelve weeks of therapy) Results: Preliminary findings from the pilot and second year of the program show and six months (four weeks titration plus twenty-four weeks of therapy). Secondary increases of residents’ understanding of the complexity and chronicity of obesity. endpoint was the presence of side effects and need to discontinue medication. Their uptake of the 5As framework and tools improved confidence and perceived Results: Data collection ongoing (10 active patients). Of the three female patients success in their weight management practice. Experiential learning elements of the with three month data mean percent total body weight loss at sixteen weeks was 12.8 program proved crucial in increasing residents’ ability to empathically engage with ± 4.29 % (p = 0.012) with a BMI decrease of 5.5 ± 1.45 kg/m2 (p = 0.022). Of the patients and to critically reflect on implications for their practice. two patients with six month data, mean percent total body weight loss at 24 weeks Conclusion: Results underscore the need for training programs for family was 13.1 ± 6.23 % (p = 0.040) with a BMI decrease of 5.3 ± 0.58 kg/m2 (p = 0.05). medicine. Furthermore, findings reflect the utility of the 5As to improve residents’ Both patients achieved a maximum dose of 3 mg. The most common side effects were confidence and competency in obesity management counselling. nausea and vomiting. No patients stopped Liraglutide due to side effects. Conclusion: In our initial experience, post-bariatric surgery patients show significant additional weight loss with Liraglutide pharmacotherapy.

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O2.4 with liraglutide vs 89.4% with placebo; SAEs 15.1% vs 12.9%. Adjudicated major Competing Visions for Obesity Management in Canadian Primary Care adverse cardiovascular events (non-fatal myocardial infarction, stroke, cardiovascular Patricia H. Thille death) were low overall (0.19 vs 0.20 events/100 patient-years-of-observation for The Wilson Centre, University of Toronto, Toronto, ON, Canada liraglutide vs placebo). Two Canadian knowledge brokers – the Canadian Obesity Network (CON) and the Conclusion: Liraglutide 3.0mg for 3 years, as adjunct to diet+exercise, delayed the Canadian Task Force on Preventative Health Care (CTF) - have developed and dis- onset and reduced the risk of T2D in adults with prediabetes, reduced body weight seminated tools to help primary care clinicians address obesity with patients. What and improved cardiometabolic risk factors. visions of ‘good care’ are embedded in these tools; how consistent are these? O2.6 Objective: compare the CON’s 5As of Obesity Management™ for Adults with the Building the Confidence of General Practitioners to Manage Patients with CTF 2015 guideline for obesity in adults. Obesity – Results from an Australian Pilot Study Methods: discourse and narrative analyses of the core texts of the CON’s 5As and Elizabeth A. Sturgiss1, Emily Haesler2, Nicholas Elmitt1, Chris van Weel3, 1, Kirsty CTF’s guideline. Analysis focused on how each knowledge broker delineates the Douglas1 problem to be addressed, and how that influences recommended care practices. 1. Australian National University, Canberra, ACT, Australia, 2. Curtin University, Perth, Results: The CON 5As develops a discourse of obesity as a chronic condition, one WA, Australia, 3. Radboud University, Nijmegen, Netherlands with many causes - including non-behavioural ones. The 5As embeds an explicit anti-stigma lens for clinical care, warning against assuming obesity is reversible via Background: Patients value dietary advice from their general practitioner (GP) but changes to eating and physical activity. Obesity becomes obesities in the CON’s 5As; international literature confirms that GPs report low confidence when managing the recommended clinical assessments and treatments orient to this multiplicity. In obesity. The Change Program was developed based on Australian guidelines and contrast, the CTF guideline orients to obesity as a behavioural phenomenon. Their provides GPs with a handbook and patient toolkit. This structured program assists recommended solution is singular: offer or refer those diagnosed as overweight or GPs to manage patients with obesity within their own practice setting. obese to behaviour change programs. Objective: To assess the impact of participating in a pilot study of a weight manage- Conclusions: The CON and CTF vary significantly in terms of how they envision the ment program on the confidence and self-efficacy of GPs. problem that weight-related care is to address. The contrast exemplifies controver- Methods: A six month pilot study was undertaken in five Australian general practic- sies in this field about obesity causation and stigma. Making explicit these different es. Each GP was asked to recruit and manage two patients within their practice. GPs visions of ‘good care’ may help spur important conversations about what effects completed a survey and interview at the beginning and end of the pilot to assess clinical practice should aim to create. their confidence and self-efficacy. Bandura’s self-efficacy theory was used to inform the synthesis of data. O2.5 Results: Eleven of the 12 GPs were able to recruit patients and all 11 partici- Weight Loss and Associated Improvements in Cardiometabolic Risk pated in the end of pilot interviews. Most GPs reported an improvement in their Factors with Liraglutide 3.0 mg in the 3-year part of the SCALE Obesity confidence to provide care to patients with obesity, particularly in the “Assist” and and Prediabetes Trial “Arrange” phases of the 5As framework. GPs also reported a change in their usual David Macklin1, Arne Astrup2, Frank Greenway3, Michel Krempf4, Carel W. Le Roux5, clinical practice for obesity and had “Asked” and “Assessed” more patients in their Roberto Vettor6, Soren K. Lilleore7, Ken Fujioka8 day to day work. 1. University of Toronto, Toronto, ON, Canada, 2. University of Copenhagen, Copen- Conclusions: It is possible to improve the confidence and self-efficacy of GPs through hagen, Denmark, 3. Pennington Biomedical Research Center, Baton Rouge, LA, USA, an intensive, structured weight management program. The GPs reported changing 4. Université de Nantes, Nantes, France, 5. Diabetes Complications Research Centre, their clinical practice even in patients who were not participating in the pilot. Dublin, Ireland, 6. University of Padua, Padua, Italy, 7. Novo Nordisk, Copenhagen, Denmark, 8. Scripps Clinic, La Jolla, CA, USA O2.7 Improved Diagnosis and Follow Up for Obesity with the Implementation Aims/Objectives: To investigate the effects of liraglutide 3.0mg, as adjunct to of an Integrated Program in Community Care diet+exercise, on time to onset of T2D, body-weight and cardiometabolic risk factors Christine Brown, Suzanne Gosselin, Raymonde Vaillancourt, Irma Clapperton, over 3 years. Marie-France Langlois Methods: Individuals (BMI ≥30kg/m2, or ≥27kg/m2 with ≥1 comorbidity) were CIUSSS de l’Estrie - CHUS and Université de Sherbrooke, Sherbrooke, QC, Canada randomized 2:1 to once-daily subcutaneous liraglutide 3.0mg (n=1505) or placebo (n=749) and a 500-kcal/day deficit diet and 150-min/week exercise. Efficacy data Objective: Our region has implemented an integrated care framework for the are observed means with LOCF. prevention and management of cardiometabolic chronic diseases, including obesity. Results: With continued treatment over 160 weeks, time to T2D onset was 2.7-fold The aim of this study is to assess the impact of this new Agir sur sa santé program longer with liraglutide than placebo [95%CI 1.9;3.9, p<0.0001] (corresponding to (ASSSE), on the diagnosis and management of patients with obesity. a hazard ratio: 0.2); with 3% vs 11% of patients diagnosed with T2D, respectively Method: Chart review of a random sample of patients who participated in 7 during treatment. More individuals receiving liraglutide (66%) than placebo (36%) Community health centers chronic disease programs before implementation regressed from prediabetes (ADA2010 criteria) to normoglycemia by week 160 (n=1120/2122; 2012-2013) and to the ASSSE program (n=707/2483; 2015) was (OR 3.6 [3.0;4.4], p<0.0001). Individuals receiving liraglutide 3.0 mg lost more performed. weight than with placebo (6.1% vs 1.9%; estimated treatment difference [ETD] -4.3% Results: In both cohorts of patients, 30.5%/33.1% had a BMI ≥ 30 kg/m2, [95%CI ‑4.9;-3.7]), and greater reductions in mean waist circumference (ETD ‑3.5 48.4%/47.1% were females and mean age was 60.9 ± 12.0 and 60.4±12.6 years. [‑4.2;‑2.8] cm), SBP (ETD ‑2.8 [-3.8;-1.8] mmHg), triglycerides (ETD -6%[‑9;-3]) and In patients with obesity, BMI was reported more frequently following implemen- hsCRP (ETD 29% [-34;-23]) (all p<0.001). Mean pulse increased with liraglutide tation of the ASSSE program (84% vs 100%, p<0.001). However, there was no vs placebo (ETD 2.0 [1.2;2.7] beats/min, p<0.0001). AE incidence was 94.7% significant difference in waist circumference reporting (51.8% vs 58.1%, NS).

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Preliminary results show no improvement in the rate of lifestyle counselling or and companion articles of the 10 574 citations initially identified and evaluated laboratory investigation for co-morbidities (A1c, fasting glucose and lipid profile), their internal validity. Data was pooled using random effects models. except blood pressure that was reported more often with the ASSSE program (79.1% Results: We included 12 original observational studies (n=165 230 children) and vs 85.9%, p =0.04). Also, 21.8% of patients with obesity received follow-up specifically 24 original RCTs (n=4930 children). Observational studies were highly heteroge- for weight management compared to only 4.6% before the ASSSE program (p<0.001). nous and had discrepant conclusions. Meta-analyzed RCTs indicated that prenatal Conclusion: Our new integrated care framework recognizing obesity as a separate exercise did not significantly impact birthweight (mean difference [MD]: -45.8g, target chronic disease improves some aspects of the diagnosis and management of 95% confidence interval [CI] -156.1 to 64.5g) or large-for-gestational age status (risk patients with obesity. Further analyses will allow us to determine if this integrated ratio: 1.45, 95%CI 0.97 to 2.17) compared to no exercise. Sensitivity analyses of approach will results in better outcomes for patients. RCTs showed that prenatal exercise reduced birthweight only in women with a body mass index <25 kg/m2 (MD: -238.5g, 95% CI: -475.1, -1.8g). Other outcomes were O2.8 too scarcely reported to be meta-analyzed. Associations of Body Mass Index with Coronary Revascularization Conclusions: Prenatal exercise does not significantly impact birthweight or Procedures and Outcomes large-for-gestational-age status and is not sufficient to reduce birthweight in offspring Tasuku Terada, Jeffrey A. Johnson, Colleen M. Norris, Raj Padwal, Weiyu Qiu, Arya M. of women with overweight. Longer follow up of offspring exposed to prenatal exercise Sharma, Jayan Nagendran, Mary Forhan is needed along with measures of relevant metabolic variables (eg. fat mass). University of Alberta, Edmonton, AB, Canada O3.2 Objective: We explored the associations of obesity with cardiac revascularization Are Suboptimal in Utero Conditions Associated with Obesity and procedures and adverse outcomes following each procedure. Cardiometabolic Risk Factors in Offspring Reaching Puberty? Methods: Data from 56,722 patients in the provincial registry were analyzed. Soraya Saidj1, Stéphanie-May Ruchat2, Mélanie Henderson3, Marie-Ève Mathieu3 Patients were organized into five groups based on body mass index (BMI): normal 1. University of Montreal, Montreal, QC, Canada, 2. Université du Québec à Trois-Riv- (18.5-24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), ières, Trois-Rivières, QC, Canada, 3. University of Montreal, Sainte-Justine University obesity class II (35.0–39.9 kg/m2), and obesity class III (≥ 40.0 kg/m2). Using normal Hospital Center, Montreal, QC, Canada BMI as a reference group, BMI-specific associations of: 1) coronary revascularization procedures (coronary artery bypass grafting [CABG] surgery and percutaneous cor- Objective: This cohort study explores the association between in utero exposure to onary intervention [PCI]); 2) incidences of early adverse outcomes following CABG; suboptimal gestational factors (SGF; gestational diabetes, hypertensive disorders, and 3) longer-term mortality rates following both CABG and PCI were assessed while and maternal smoking), obesity and cardiometabolic risk factors (CMR; low level adjusting for coronary anatomy risks and diabetes status. of high density lipoprotein, hypertriglyceridemia, fasting hyperglycemia, and high Results: Patients with obesity and high-risk coronary anatomy were more likely to waist circumference). be treated with PCI compared to patients in the normal BMI group. Following CABG, Methods: This study used data from the longitudinal “Quebec Adiposity and patients with BMI classified as obese were associated with early infection risks but Lifestyle Investigation in Youth” study (QUALITY), which included 630 Caucasian chil- not with longer-term mortality risks. Following PCI, patients classified as obesity dren enrolled at 8–10 years old at first visit (V1) and 570 children followed at 10-12 class III in the subgroup of high-risk coronary anatomy were associated with a higher years old (V2). Logistic regression was used to investigate the association between risk of long-term mortality compared to patients with normal BMI (adjusted hazard SGF, obesity and CMR. ratio: 1.34, 95%CI 1.00-1.79). Results: A positive association between the number of SGF and obesity was Conclusion: Higher risks of early complications following CABG may explain higher found at V1 (p=0.007). Maternal smoking (p=0.028) and hypertensive disorders rates of PCI in patients with obesity. However, considering the anticipated higher long- (p=0.040) were positively associated with waist circumference in girls at V1. In girls, term mortality risks following PCI, clinical appropriateness of treating patients with maternal smoking was positively associated with the difference between V1 and V2 obesity class III and high-risk coronary anatomy with PCI warrants further investigation. in body mass index (p=0.048) and obesity at V2 (p=0.022). Gestational diabetes tended to be positively associated with the difference between V1 and V2 in fat mass O3.1 (p=0.066) and trunk fat (p=0.061) in boys, and with waist circumference in girls at Exercise in Pregnancy and Children’s Cardiometabolic Risk Factors: a V1 (p=0.099). No association was found between the number of SGF and obesity in Systematic Review and Meta-Analysis V2, as well as between SGF and CMR in V1 and V2 (all p-values >0.05). Laetitia Guillemette1, 2, Scott D. Kehler1, 3, Naomi C. Hamm1, 3, Jonathan M. McGavock1, Conclusion: In utero exposure to SGF impacts girls reaching puberty. In order to 2, Todd A. Duhamel1, 3 implement specific health policies, it is essential to explore whether this impact lasts 1. University of Manitoba, Winnipeg, MB, Canada, 2. Children’s Hospital Research during puberty and young adulthood, and if it appears later in boys. Institute of Manitoba, Winnipeg, MB, Canada, 3. St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada O3.3 Preventing Excessive Gestational Weight Gain: Does Adherence to Prena- Objective: Prenatal exercise might reduce offspring cardiometabolic risk in tal Nutrition and Exercise Recommendations Improve when You Include childhood. We conducted a systematic review and meta-analysis to clarify this the Family? relationship. Taniya S. Nagpal1, Harry Prapavessis1, Christina Campbell2, Michelle F. Mottola1 Methods: We searched Pubmed, MEDLINE, EMBASE, and CENTRAL up to May 1. University of Western Ontario, London, ON, Canada, 2. Iowa State University, 2016. Two reviewers independently identified observational studies and random- Ames, IA, USA ized controlled trials (RCTs) evaluating prenatal exercise and offspring cardiometabolic outcomes and extracted trial-level data with piloted forms. The primary Objective: Nutrition and exercise programs implemented during pregnancy can outcome was birthweight; secondary outcomes included large-for-gestational age prevent excessive gestational weight gain (EGWG), however women with a pre-preg- status, fat and lean mass, dyslipidemia, and blood pressure. We included 47 studies nancy body mass index (BMI) of overweight (BMI≥25.0-29.9kg∙m2) and obese

70 | 5th Canadian Obesity Summit | #COS17 Abstract Details

(BMI≥30.0kg∙m2) may find it difficult to adhere to two behaviour changes. The clinicians to address GWG, such discussions tend to occur infrequently. Clinicians perceive purpose was to identify if adherence to a two behaviour change program increases lack of confidence as a barrier to initiating discussions about GWG. From a theoretical with the addition of a family-based component. perspective, confidence is related to self-efficacy (SE). This study aimed to compare Methods: Retrospectively, women with a pre-pregnancy BMI of overweight and clinicians’ SE in initiating discussions about GWG with pregnant women under a variety obese who participated in the Nutrition and Exercise Lifestyle Intervention Program of conditions and in the context of weight gain in excess of extant guidelines. (NELIP; n=83) and in the Family-based Behavioural Treatment (FBBT) plus NELIP Methods: A theory-based survey consisting of 42 items relating to the known (FBBT+NELIP; n=48) were scored on meeting the goals of each program (3 nutri- barriers and facilitators to having discussions about GWG was created and entered tion and 3 exercise points) for a maximum adherence score of 6. Weight gain on into a web based survey system. The items represented various conditions and were each program was assessed according to the Institution of Medicine (2009) guide- clustered into a number of categories: patient, interpersonal, and clinic factors. For lines. Adherence scores were compared between women who gained excessively or each item, participants were asked to rate their SE in starting a discussion about appropriately stratified by BMI, within and across programs. GWG with a patient who had gained more than the recommended amounts on a Results: Women who gained appropriately had significantly greater overall adher- scale from 0 (“cannot do at all”) to 10 (“highly certain can do”). ence than women who gained excessively in both BMI categories (p<0.05). Women Results: Seventy-one clinicians completed the questionnaire (78% response rate). who attended all FBBT sessions (n=10) had greater adherence to the nutrition SE was overall fairly high. It was highest if the clinician could externalize the reason behaviour change (87%) than those not offered the additional FBBT program (67%) for undertaking the discussion and lowest with system issues. There were significant in the obese category (p<0.05). differences in SE within all three categories depending on condition. Conclusion: Increasing adherence to prenatal nutrition and exercise behaviour changes by adding a family-based component prevents EGWG in women with a O3.6 pre-pregnancy BMI of obese and overweight. Specifically, adding a FBBT plan to NE- Obesity and Sleep Disturbances During Pregnancy: Does Gestational LIP appears to assist in adherence to the nutrition component of behaviour change. Weight Gain Matter? Results from the 3 D Cohort Study Funded by CIHR Benjamin C. Guinhouya1, Frédéric Sériès3, Michèle Bisson2, William D. Fraser4, Isabelle Marc2 O3.4 1. University of Lille, Public Health: Epidemiology and Healthcare Quality, Lille, Is There an Association Between Gestational Weight Gain and Infant France, 2. Department of Pediatrics, Research Centre of CHUQ, Laval University, Physical Activity? Quebec, QC, Canada, 3. Research Unit in Pneumology, Research Centre, Laval Jonathan M. Rankin1, Niko Wasenius1, 2, Alysha L. Harvey1, Kristi B. Adamo1 University, Quebec, QC, Canada, 4. Research Centre of CHU Sherbrooke University of 1. Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada, 2. Folkhäl- Sherbrooke, Sherbrooke, QC, Canada san Research Center, Helsinki, Finland Objective: We examined the effect of pre-pregnancy body mass index (BMI), Introduction: Maternal weight-related factors have been associated with develop- together with gestational weight gain (GWG) on sleep abnormalities over the whole mental programming of offspring PA in animal models. However, more research on pregnancy. human infants is required. The purpose of this study was to investigate the associa- Methods: A sample of 2,366 women was recruited in the 1st trimester (TM) and fol- tion of gestational weight gain (GWG) and change in total daily physical activity (PA) lowed until delivery in the 3D cohort study (Quebec, 2010-2012). Participants were of infants from 3 to 6 and 12 months of age. evaluated each TM for their sleep quality and snoring, using the Pittsburgh Sleep Methods: Eight boys and five girls who participated in the MOM trial were includ- Quality Index (PSQI) score and questions directed to their partner. Age, ethnicity, ed in this study. PA counts were measured over 24 hours using Actiwatch accelerom- and income level were collected as covariates. A mixed linear modeling and a multi- eters. GWG was calculated as the difference between weight measured at delivery nomial logistic regression were applied for PSQI score and snoring, respectively. from antenatal record and self-reported pre-pregnancy weight. Data was analyzed Results: PSQI score was the lowest at TM 2 (β=-1.03; 95%CI: -1.17; -0.89) and using linear mixed models. highest in TM 3 (β=0.27; 95%CI: 0.10; 0.45). Obese (β=0.48; 95%CI: 0.17; 0.78) Results: GWG was not associated with the change in PA counts/min from 3 to and overweight women (β=0.24; 95%CI: 0.00; 0.48) exhibited an overall greater 6 mo (b = -0.6 counts/min, 95% CI = -5.7– 4.5, p=0.831) when adjusted for PSQI than normal-weight women. Differences on PSQI according to BMI were no pre-pregnancy body mass index. However, an association was found between GWG longer significant when either GWG or socio-demographic factors were considered. and the change in PA from 3 to 12 mo (b = -9.6 counts/min, 95% CI = -18.4– -0.8, Snoring was frequently reported in the three TMs (>30%). Obese women almost p=0.033). had up to 4-fold increased risk (OR=3.89; 95%CI: 2.50; 6.06) of being habitual Conclusion: GWG was inversely associated with change in infant’s PA from early to snorer. While GWG did not affect this odds (aOR=3.83; 95%CI: 2.43; 6.03), late infancy. Our findings suggest that maternal weight-related factors may play a socio-demographic factors slightly increased the risk of being habitual snorer role in developmental programming of PA in late infancy. (aOR=4.04; 95%CI: 2.57; 6.35). Conclusion: Unlike GWG, entering pregnancy with a high BMI is the most critical O3.5 for the occurrence of sleep disturbances. Factors such as multiparity, advanced age, Clinician Self-Efficacy Pertaining to Initiating Discussions About non-caucasian ethnicity, and low income warrant attention in the surveillance of Gestational Weight Gain pregnancy-related sleeping disorders. Helena Piccinini-Vallis Dalhousie University, Halifax, NS, Canada

Introduction: Excess gestational weight gain (GWG) is a risk factor for a number of adverse outcomes for mothers and their offspring. In Canada over 50% of women gain weight in excess of the recommended amounts. Advice from a prenatal care provider influences guideline-concordance of GWG. Although patients want their

71 | 5th Canadian Obesity Summit | #COS17 Abstract Details

O3.7 Conclusion: Lowering saturated fat intake and increasing daily portions of fruits Impact of Maternal Pre-pregnancy Overweight on Infant Overweight Risk and vegetables may be beneficial to prevent later development of type 2 diabetes in at 1 Year of Age: Sex-specific Differences youth with familial obesity by improving insulin sensitivity, but not insulin secretion Rose Kalu1, Petya Koleva1, Allan Becker2, Andrea Haqq1, Anita Kozyrskyj1 1. University of Alberta, Edmonton, AB, Canada, 2. University of Manitoba, Winni- O4.2 peg, MB, Canada Histological Improvement of Non-Alcoholic Steatohepatitis with a Prebiotic: a Pilot Clinical Trial Background: Maternal obesity is linked to pregnancy complications such as Marc R. Bomhof1, Jill A. Parnell2, Matt Workentine3, Pam Crotty3, Kevin Rioux3, gestational diabetes, fetal macrosomia, and increased rates of cesarean delivery. It is Saumya Jayakumar3, Maitreyi Raman3, Raylene A. Reimer3 also a strong determinant of overweight in offspring. 1. University of Lethbridge, Lethbridge, AB, Canada, 2. Mount Royal University, Objective: To assess whether maternal pre-pregnancy overweight is associated Calgary, AB, Canada, 3. University of Calgary, Calgary, AB, Canada with infant risk of overweight and to explore possible sex differences. Methods: Weight and height measurements of 976 women were obtained from Background: In obesity and diabetes the liver is highly susceptible to abnormal medical records or maternal report in the Canadian Healthy Infant Longitudinal uptake and storage of fat. In certain individuals hepatic steatosis predisposes to the Development [CHILD] study and infant anthropometrics were measured at age development of non-alcoholic steatohepatitis (NASH), a disease marked by hepatic 1 year. “At risk for overweight” was defined as weight-for-length z-score >85th inflammation and fibrosis. Although the precise pathophysiology of NASH is un- percentile for age and sex according to international reference standards. Mode of known, it is believed that the gut microbiota-liver axis influences the development delivery, breastfeeding status, infant antibiotic exposure and other covariates were of this disease. With few treatment strategies available for NASH, exploration of gut determined from hospital records and maternal report. microbiota-targeted interventions is warranted. Results: Maternal pre-pregnancy overweight increased the risk (OR, 1.48; 95%CI: Methods: We investigated the therapeutic potential of a prebiotic supplement 1.03-2.11) of infant overweight at 1 year, independent of mode of delivery, to improve histological parameters of NASH. In a single-blind, placebo controlled, exclusivity of breastfeeding and exposure to antibiotics. Stratified analyses revealed randomized pilot trial, 14 individuals with liver biopsy confirmed NASH (Non-alco- that boys born to overweight mothers were twice as likely to become at risk of holic fatty liver activity score (NAS) ≥ 5) were randomized to receive oligofructose (8 overweight at 1 year whereas there was no significant effect in girls. Our study also g/day for 12 weeks and 16g/day for 24 weeks) or isocaloric placebo for 9 months. revealed that exclusive breastfeeding until 3 months of age lowered the risk of child The primary outcome measure was the change in liver biopsy NAS score and the overweight at one year by 44% (OR, 0.56 ; 95%CI: 0.39–0.80). secondary outcomes included changes in body weight, body composition, glucose Conclusions: Maternal pre-pregnancy overweight increases the risk of infant tolerance, serum lipids, inflammatory markers, and gut microbiota. overweight, and this association is more evident in males. Results: Independent of weight loss, oligofructose improved liver steatosis relative to placebo and improved overall NAS score (P<0.05). Bifidobacterium was O4.1 enhanced by oligofructose whereas bacteria within Clostridium cluster XI and I Prospective Associations of Dietary Intake on Insulin Sensitivity and were reduced with oligofructose. There were no adverse side-effects that deterred Secretion in Children with Familial Obesity individuals from consuming oligofructose for treatment of this disease. Andraea Van Hulst1, 2, Lucas Leclerc2, Katherine Gray-Donald3, Andrea Benedetti1, Conclusions: Independent of other lifestyle changes, prebiotic supplementation Sanyath Radji2, Mélanie Henderson2, 4 reduced histologically-confirmed steatosis in patients with NASH. Larger follow-up 1. Department of Epidemiology, Biostatistics and Occupational Health, McGill Uni- studies are warranted. versity, Montreal, QC, Canada, 2. Centre de recherche du CHU Ste-Justine, Montreal, QC, Canada, 3. School of Dietetics and Human Nutrition, McGill University, Montreal, O4.3 QC, Canada, 4. Division of Endocrinology, Department of Pediatrics, University of The Effects of Partial Sleep Restriction on Olfactory Performance and 24h Montreal, Montreal, QC, Canada Energy Intake in Men and Women Jessica McNeil1, Geneviève Forest2, Luzia Jaeger Hintze3, Jean-François Brunet2, Éric Objective: To assess how dietary intake predicts insulin sensitivity and secretion Doucet3 over a two-year period in children with a family history of obesity. 1. Alberta Health Services, Calgary, AB, Canada, 2. Université du Québec en Out- Method: Data stem from the QUALITY cohort, consisting of 630 children with at aouais, Gatineau, QC, Canada, 3. University of Ottawa, Ottawa, ON, Canada least one obese parent, recruited at age 8-10 years. Macronutrients (including %car- bohydrates, %fat, %saturated fat, %protein, fibre, sugar-sweetened beverages and Objective: Olfaction can contribute to increasing the drive to eat and may partially portions for fruits and vegetables) were assessed at baseline using 3 non-consecu- explain the consistent increases in energy intake (EI) following sleep restriction. tive 24-hr dietary recalls. Insulin sensitivity was assessed by Matsuda Index, and in- We examined the effects of sleep restriction on olfactory performance. We also sulin secretion by the ratio of the AUC of insulin to glucose at 30min and at 120min evaluated whether changes (∆) in sleep architecture between sessions were related after an oral glucose tolerance test. Physical activity (PA) was evaluated by 7-day to ∆olfactory performance, and whether ∆olfactory performance were associated accelerometry, adiposity (percent fat mass) by DXA. Multivariable linear regression with ∆24h EI. models were minimally adjusted for age, sex, PA, screen time, adiposity, season and Methods: Twelve men and 6 women (age: 23±4 years; BMI: 23±3 kg/m2) com- pubertal stage. Missing data was accounted for using multiple imputation. pleted a habitual sleep and a 50% sleep restriction condition. Sleep was measured Results: Saturated fat intake was deleterious to insulin sensitivity over time: for inside the laboratory (polysomnography). Olfactory performance (“sniffin sticks”) every 1% increase in baseline saturated fat intake, Matsuda Index decreased by and 24h EI (validated food menu) were assessed the next day. 1.6% (95% CI = -3.2, -0.06) 2 years later, in fully adjusted models. Similarly, every Results: Women had decreased, and men increased, olfactory performance follow- additional daily portion of fruits and vegetables was associated with a 2.4% (95% ing sleep restriction vs. control (F (1, 16) = 8.24, P = 0.01; partial η 2 = 0.34). There CI= 0.4, 4.4) improvement in Matsuda Index 2 years later. No dietary component were no significant changes in 24h EI between men and women across conditions predicted insulin secretion in adjusted models. nor were ∆olfactory performance associated with ∆24h EI. Exploratory analysis

72 | 5th Canadian Obesity Summit | #COS17 Abstract Details revealed that decreases in REM sleep duration were associated with increased Results: HEI-C 2007 score calculated with either 1,2, 3 or 4 24HR or FFQ ranged from olfactory performance, but only in women (β=-0.19 minutes, 95% CI for β=-0.34 to 21.5 to 100. With all methods, significant correlations were found between HEI-C 2007 -0.03 minutes; P=0.04). components (4 CFG groups) and all nutrients tested and scores in women were significantly Conclusions: These findings suggest that the impact of sleep restriction on olfacto- higher than in men (P<0.001). Sample menus obtained scores above 99.5. HEI-C 2007 as ry performance differs between sexes; women demonstrating decreased, and men calculated with 2 (Kappa=0.62) or 3 (Kappa=0.78) 24HR showed a substantial agreement increased, olfactory performance following sleep restriction vs. control. Furthermore, with the score obtained with 4 24RH while those calculated with 1 24HR (Kappa=0.35) and reductions in REM sleep duration were associated with increased olfactory perfor- FFQ (Kappa=0.36) demonstrated only fair agreement with 4 24HR. mance, but only in women. Studies are needed to explore factors that may impact Conclusion: These data indicate that assessment of diet quality based on a single sex differences in olfactory performance following sleep restriction. 24HR or a FFQ needs to be interpreted with caution when compared with multiple 24HR.

O4.4 O4.6 Limited Potential of the Food Craving Inventory and Three-Factor Eating Findings from Alberta’s 2016 Nutrition Report Card on Food Environ- Questionnaire to Predict Brain Food-cue Reactivity in Subjects with ments for Children and Youth Obesity Alexa Ferdinands, Laurie Drozdowski, Kayla Atkey, Candace I. Nykiforuk, Kim D. Raine Chanaka N. Kahathuduwa1, 2, Tyler Davis3, Martin Binks1 University of Alberta, Edmonton, AB, Canada 1. Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA, 2. De- partment of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Alberta’s 2016 Nutrition Report Card on Food Environments for Children and Youth is Lanka, 3. Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA the second annual assessment of how Alberta’s current food environments and nutrition policies support or create barriers to improving children’s eating behaviours and Objective: To examine whether Food Craving Inventory (FCI) and Three-Factor body weights. Given that poor nutrition and obesity are major health concerns facing Eating Questionnaire (TFEQ) subscales predict brain food-cue reactivity (functional Canadian children, this assessment aims to increase public, practitioner, and policymaker magnetic resonance imaging; fMRI), in individuals with obesity. awareness of the relevance and status of food environments for children, with a focus on Methods: We extracted baseline data of 32 adults with obesity (BMI 30–39.9kg/m2) health promotion and obesity prevention. The grading system for the Nutrition Report who participated in a larger study. FCI, TFEQ and fMRI scans were administered following Card evaluates four micro-environments (physical, communication, economic, and social) an 8-hour fast. During fMRI scans, subjects rated images of 120 food and 120 color and that each have embedded policies. It also assesses the political macro-environment as a visual complexity-matched objects in an event-related paradigm. We pre-processed and way to understand the factors that support policies within each micro-environment. For analyzed fMRI data using FSL (6.0), extracted the mean food vs. object contrasts (FCR) the 2016 period, Alberta received a D in all five environments, indicating ample room for from pre-specified regions of interest and examined linear correlations between FCR and improvement. Ultimately, the goal is to conduct these assessments across Canadian juris- the subscales of FCI and TFEQ. We further examined correlations between BMI and FCR. dictions to create a national Nutrition Report Card. The Nutrition Report Card Toolkit was Results: Overall food cravings correlated with right anterior cingulate (ACC) FCR developed to help in this process, as it outlines the steps of data collection, grading, and (r=-.353). High-fat food cravings correlated with FCR of left and right ACC; r=-.373 consensus decision-making for individuals interested in conducting their own commu- and r=-.473). All other correlations between FCI and TFEQ subscales and brain nity-based assessments. Overall, the Nutrition Report Card can help to improve children’s regions were not significant. BMI correlated with left and right amygdala (r=.480 well-being by serving as a tool for government and non-government organizations, and r=.409), dorsolateral prefrontal cortex (r=.393 and r=.370), insula (r=.459 researchers, corporations, and foundations to support and develop enhanced program- and r=.527), nucleus accumbens (r=.425, r=.398), precentral gyrus (r=.448 and ming and policies, as well as to identify areas that require further action and work. r=.487), left ACC (r=.402) and right orbitofrontal cortex (r=.400). Conclusion: Negative correlations between ACC FCR and high-fat and overall food O4.7 cravings indicate possible inhibitory role of ACC on food cravings. Subscales of the Stop Sugar Coating Children’s Breakfast Cereals: Child Targeted Cereals FCI and TFEQ do not appear to be reflected in specific brain regions as often implied in Canada Require Reformulation in the literature. Correlations between BMI and FCR substantiate previous findings. Monique Potvin Kent1, Cher Cameron2, Sarah Philippe2 1. School of Epidemiology, Public Health and Preventive Medicine, University of Ot- O4.5 tawa, Ottawa, ON, Canada, 2. Interdisciplinary School of Health Sciences, University Validation of the Canadian Healthy Eating Index-2007 of Ottawa, Ottawa, ON, Canada Jacynthe Lafreniere, Elise Carbonneau, Catherine Laramée, Julie Robitaille, Benoit Lamarche, Simone Lemieux Objective: A significant number of breakfast cereals are targeted at children. The objective Institute of Nutrition and Functional Food, Laval University, Québec, QC, Canada of this study was to analyze the healthfulness of breakfast cereals sold in Canada and to compare the nutritional value and healthfulness of child-targeted and not child-targeted cereals. Objective: To validate the Heathy Eating Index based on the 2007 Canadian Food Methods: The nutritional content of 262 unique breakfast cereals found in the 5 largest Guide (HEI-C 2007) and determine whether assessment with 24h recalls (24HR) (ei- grocery store chains in Ottawa-Gatineau was collected. The first five ingredients and the ther 1,2,3 or 4 days) or a food frequency questionnaire (FFQ) provides reliable results. number of added sugars present in each cereal were noted from the ingredients list. The Methods: Seventy-five women and 75 men filled the R24W a web-based 24HR on various cereal brands were then classified as either “healthier” or “less healthy” using the UK 4 occasions as well as a web-based FFQ. Dispersion as well as association of HEI-C Nutrient Profile Model. Each cereal was assessed by two research assistants to determine if it 2007 and its components with selected nutrients (fiber, vitamin-C, vitamin-D, calci- was child-targeted or not, based on set criteria. Statistical comparisons were made between um, potassium, magnesium and iron) were assessed. The well-known difference in child and not child-targeted cereals. diet quality between men and women was tested. Sample menus derived from the Results: 19.8% of all breakfast cereals were child-targeted and these were significantly Canadian Food Guide provided by Health Canada were analysed to verify whether lower in total and saturated fat. Child-targeted cereals were significantly higher in sodium, they received a perfect score. We performed agreement analyses to determine if and sugar and lower in fibre and protein. A significantly higher percentage (84.6%) were different methods similarly classified participants. categorized as less healthy compared to not child-targeted cereals (64.8%). No child-tar-

73 | 5th Canadian Obesity Summit | #COS17 Abstract Details geted cereals were sugar free, and sugar was the second most common ingredient in 75% Conclusions: Maternal consumption of aspartame and stevia may compromise of cereals. Six breakfast cereal companies had child-targeted product lines that consisted glucose control and insulin sensitivity, and central pathways entirely of less healthy cereals. Conclusion: Breakfast cereal companies in Canada need to offer a greater variety of O5.3 healthier breakfast cereals to children. This could be accomplished by reformulating cereals Longitudinal Metabolic Profiling Identifies Differences in Maternal by reducing the sugar and sodium content, and increasing the fibre content. Response to Pregnancy and Lactation Between Lean and Diet-induced Obese Rats O5.1 Heather A. Paul, Marc R. Bomhof, Hans J. Vogel, Raylene A. Reimer Single Injection of Rapamycin Blocks Post Restriction Hyperphagia and University of Calgary, Calgary, AB, Canada Body Weight Re-gain in Rats Therese E. Kenny, Mark Hebert, Phillip Mac Callum, Jesse Whiteman, Katelyn Fallon, Maternal obesity adversely affects both maternal and offspring health. However, there Katherine Smith, Jacqueline Blundell is little known on how lean versus obese mothers differ in their metabolic response to Memorial University of Newfoundland, St. John’s, NL, Canada pregnancy and lactation. Here, we sought to identify longitudinal metabolic changes that characterize obese versus lean pregnant and lactating dams in order to identify Given the increasing prevalence of and severity of complications associated with key differences in how obese dams respond to pregnancy and lactation. Diet-induced obesity, there is great need for treatments resulting in prolonged weight loss. Losing obese and lean female Sprague-Dawley rats were bred and maintained on their weight is relatively easy, but long-term maintenance of weight loss requires sustained respective diets throughout gestation and lactation. At parturition, litters were culled to changes in food intake and energy expenditure strategies, which are unfortunately 10 pups. The study concluded at weaning. Serum for metabolic profiling was collected often taxing, resulting in a return to pre-dieting weight. Therefore, drug therapies may pre-pregnancy, on gestation d14, and lactation d19, and subjected to 1H NMR facilitate greater adherence to a restricted diet and prolong weight loss. One such metabolomics analysis. Body weight and composition, food intake, and glycaemia drug is rapamycin (RAP), a mechanistic target of rapamycin (mTOR) inhibitor. Here, we was assessed. Obese dams were heavier than lean females throughout the study and show that a single intraperitoneal injection of RAP dampens the hyperphagic response had higher adiposity at weaning (p<0.05). Obese dams consumed more calories only in calorically restricted rats when they were returned to free feed immediately or 10 during gestation (p<0.05). No differences in glycaemia were detected. Metabolic pro- days after injection. Moreover, we demonstrate that a single injection of RAP given to filing indicates that there exists overlap in some, but not all, of the metabolic changes calorically restricted rats prevents body weight re-gain when animals are returned to that occured across pregnancy and lactation in these dams. Notably, pre-pregnancy free feed either immediately or 10 days after injection. Furthermore, we extend our and gestational metabolic profiles of obese dams were more similar to each other previous findings that RAP does not produce malaise or illness, and show that RAP than those of lean dams. In comparison, a larger proportion of the metabolic changes does not produce any behavioural deficits that may inhibit an animal from eating. that occurred from gestation and lactation were similar between groups. Altogether, Thus, we suggest that mTOR may be a useful target in obesity research given that its longitudinal metabolic profiling is expected to identify key differences in maternal inhibition may decrease the hyperphagic response following caloric restriction. We are adaptations to pregnancy and lactation that might improve understanding of how currently investigating neurobiological mechanisms by which RAP may act. maternal obesity adversely affects maternal and offspring health.

O5.2 O5.4 Maternal Aspartame Consumption May Induce Metabolic Derangements Endogenous Cannabinoid and Nitric Oxide Interactions in the Rat: and Impact Central Pathways Involved in Feeding in Mom and Pups in Rats Potential Implications for Appetite Regulation Jodi E. Nettleton1, Nicole A. Cho1, Teja Klancic1, Jane Shearer1, Stephanie L. Borgland1, Tierza Petersen, Jacob McGavin, Jenna Thebeau, Nicholas Cochkanoff, Karen M. Crosby Leah Johnston2, Raylene A. Reimer1 Mount Allison University, Sackville, NB, Canada 1. University of Calgary, Calgary, AB, Canada, 2. Dalhousie University, Halifax, NS, Canada Objective: The dorsomedial nucleus of the hypothalamus (DMH) is an important Objective: Determine the impact of consumption of aspartame or stevia on appetite-regulatory center in the brain. In the DMH, neuronal communication is con- maternal and offspring metabolic health and brain pathways involved in food trolled by two interacting signals: endogenous cannabinoids (eCBs) and nitric oxide consumption behaviour. (NO). It is unknown, however, whether eCBs and NO interact to regulate food intake Methods: Female Sprague-Dawley rats were randomized to one of three groups: 1) in the rat. The main objective of this research is to determine whether eCBs and NO High fat/sugar diet (HFS) + water, 2) HFS + Aspartame (APM), 3) HFS + Stevia (STV). interact to regulate appetite and whether the DMH is involved in these effects. A fourth group was maintained on chow and water as a lean control (CTR). Body Methods: Young male Sprague-Dawley rats were administered a combination of drugs weight, fecal samples, and oral glucose (OGTT) and insulin tolerance tests (ITT) were that either activate or inhibit the eCB and NO signaling pathways. Drugs were adminis- conducted at baseline and during pregnancy and lactation. At weaning (3 weeks), tered into the general circulation or directly into the DMH via surgically-implanted guide dams and 4 offspring from each litter underwent a DXA scan and tissue harvest. cannulas. Following the injections, food intake and body weight were measured over a Remaining offspring were followed until 18 weeks of age. two hour period and brains were subsequently removed for future analysis. Results: Total body weight and body fat% was greater in HFS dams than CTR (p<0.05) Results: When administered into the general circulation, neither eCBs nor NO signifi- at weaning, however there was no difference in gestational weight gain. APM had higher cantly altered food intake or body weight. In contrast, when NO signaling was blocked, glucose levels during gestation ITT compared to CTR and WTR (p<0.025). APM, STV, and eCBs actually decreased food intake compared to control animals. When administered di- WTR had greater levels of Clostridium coccoides compared to CTR (p<0.025) and blunt- rectly into the DMH, eCBs and NO increased food intake when delivered in combination. ed Clostridium leptum (p<0.025) in their fecal samples during pregnancy. Female APM Conclusions: These data suggest that eCBs and NO interact to regulate food intake and STV pups were heavier than CTR and WTR pups at weaning (p<0.05). APM pups had and body weight. These findings also indicate that eCB and NO differentially affect reduced insulin sensitivity and glucose control at age 8 weeks (p<0.05). APM pups had appetite, depending on whether they are administered into the general circulation or greater mu-opioid receptor, dopamine receptor 1 and 2 mRNA expression in nucleus directly into the DMH. Overall, this research will further our understanding of neural accumbens (p<0.05) at weaning compared to CTR. regulation of appetite in rats, with potential implications for obesity in humans.

74 | 5th Canadian Obesity Summit | #COS17 Abstract Details

O5.5 O5.7 Chondroitin Sulfate Prebiotic Improves GLP-1 Response and Glucose Influence of ACSL5 Genotype on Fatty Acid Oxidation and Mitochondrial Regulation in Mice Bioenergetics – an ex vivo and in vivo Analysis Jennifer Pichette, Nancy Fynn-Sackey, Jeffrey Gagnon Abishankari Rajkumar1, Awa Liaghati1, Gilles Lamothe1, Robert Dent2, Ruth McPherson3, Laurentian University, Sudbury, ON, Canada 1, Éric Doucet1, Remi Rabasa-Lhoret6, 5, Denis Prud’homme4, 1, Mary-Ellen Harper1, Frédérique Tesson1 Objective: Incretin hormone therapies are a new and important approach for 1. University of Ottawa, Ottawa, ON, Canada, 2. The Ottawa Hospital, Ottawa, ON, treating obesity and Type 2 diabetes in Canada. The gastrointestinal incretin hor- Canada, 3. University of Ottawa Heart Institute, Ottawa, ON, Canada, 4. Monfort mone glucagon-like peptide-1 (GLP-1) increases insulin secretion, improves insulin Hospital, Ottawa, ON, Canada, 5. Institut De Recherches Cliniques De Montreal, sensitivity, and suppresses appetite. Recently, the gastrointestinal microbiome has Montreal, QC, Canada, 6. Universite de Montreal, Montreal, QC, Canada been implicated in metabolic health. Within the colon, sulfate-reducing bacteria (SRB) produce hydrogen sulfide (H2S). As H2S is implicated in the regulation of The rs2419621 polymorphism in the fatty acid oxidation related protein Acyl-CoA Synthe- metabolic hormones, and GLP-1 producing cells are in the same niche as these SRB, tase Long Chain 5 (ACSL5) gene is associated with i) response to lifestyle intervention in we hypothesize that H2S plays a regulatory role in the secretion of GLP-1. individuals with overweight and obesity, and ii) ACSL5 mRNA levels in skeletal muscle. Methods: We first examined the direct effect of H2S on GLP-1 secretion and signal- The objectives were to study the effect of rs2419621 genotype on fatty acid oxidation ling using the GLUTag cell line. Next, we fed mice a high fat diet with and without and respiration in vivo and ex vivo. Association analysis between ACSL5 genotype and a validated SRB-increasing prebiotic (chondroitin sulfate) for 4 weeks. In these ani- fatty acid oxidation/carbohydrate oxidation levels measured by indirect calorimetry mals we examined the change in SRB using targeted qPCR and H2S measurements, was conducted on 106 individuals with overweight and obesity who participated in the oral glucose tolerance, GLP-1 secretion, and feeding. exercise/diet intervention Montréal-Ottawa New Emerging Team (MONET). In addition, Results: In vitro experiments showed the H2S caused a dose-dependent increase mitochondrial high-resolution respirometry was conducted on vastus lateralis muscle in GLP-1 secretion. This secretion occurred through activation of the p38 MAPK path- biopsies from 8 subjects who participated in the Ottawa Hospital Weight Management way. In the animals, the chondroitin sulfate group had a significant improvement Program (n=4 T-allele carriers and n=4 non-carriers) using the Oxygraph-2k system. in their glucose tolerance and GLP-1 response. These results were paralleled with Compared to non-carriers, rs2419621 [T] allele carriers displayed statistically significant increased levels of fecal H2S and the SRB Desulfovibrio piger. i) greater increase in fatty acid oxidation and greater decrease in carbohydrate oxidation Conclusion: Prebiotics modulating SRB lead to increased H2S, improved glucose following the MONET lifestyle intervention, and ii) greater increase in complex I and II homeostasis, and enhanced GLP-1 levels. This work provides mechanistic evidence respiration in the muscle. These results suggest that rs2419621 [T] allele carriers with of how the microbiome can improve metabolic health and may be a potential new overweight and obesity are more responsive to lifestyle interventions because their high- strategy in the treatment of obesity and diabetes. er levels of skeletal muscle ACSL5 are associated with more effective fatty acid oxidation and respiration in comparison to non-carriers. O5.6 Effects of Glutathione Redox on Mitochondrial Structure and Energetics O5.8 in Primary Mouse Myoblasts Thermogenic Phenotype Shares a Negative Association with Oxidative Awa Liaghati, Pauline Caron, Mary-Ellen Harper Stress-related Parameters in Human Epicardial Adipose Tissue University of Ottawa, Ottawa, ON, Canada Kanta Chechi, Pierre Voisine, Patrick Mathieu, Philippe Joubert, Yves Deshaies, Denis Richard Objective: Glutathione (GSH) plays a pivotal role in cellular redox poise, which is Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Universite Laval, disordered in many metabolic diseases including obesity. Glutaredoxin-2 (Grx2) is a Quebec, Quebec, QC, Canada glutathione transferase in mitochondria and the nucleus. We previously established that Grx2 knockout (Grx2-/-) mice have low GSH:GSSG and mitochondrial dys- Background: Brown fat presence and metabolic activity has been associated with function in isolated mitochondria of muscle and heart. Low GSH:GSSG stimulates better cardiometabolic profile in humans. We, and others, have previously reported mitochondrial fusion. Our goal was to study the impact of Grx2-/- on mitochondrial presence of uncoupling protein 1 (UCP1), a marker of brown adipocytes, in human structure and function in intact cells and of insulin treatment on GSH:GSSG. epicardial adipose tissue (eAT). Experimental Approach: Mitochondrial-targeted Grx1-roGFP and HPLC were used in Objective: To characterize the nature and thermogenic properties of human eAT mouse primary cells, and in C2C12 myoblasts to measure mitochondrial and total and to assess its physiological relevance. cellular glutathione redox, respectively. Mitochondrial energetics was assessed us- Methods: Samples of eAT, mediastinal- (mAT) and subcutaneous- fat (sAT) were ing Seahorse XF technology. Mitochondrial structure and ultrastructure are assessed collected from patients (n=53) undergoing heart surgeries, and were utilized either using confocal and electron microscopy approaches, respectively. for primary culture or direct gene expression analysis. Results: Compared to wild-type (WT), Grx2-/- myoblasts have a decreased Results: UCP1 gene expression exhibited significant variability across individuals GSH:GSSG, with a markedly increase in GSSG levels. Insulin treatment caused a and fat depots with its expression being highest in eAT and lowest in sAT (P ≤ 0.05). decrease in mitochondrial GSH:GSSG, but no overall effect at the total cellular level. Screening for specific markers identified both eAT and mAT to be beige in nature, Mitochondrial ultrastructure is profoundly abnormal, in Grx2-/- compared to WT with eAT exhibiting a much stronger beige phenotype than mAT. eAT derived primary muscle. adipocytes exhibited higher capacity for thermogenesis at the basal level (P ≤ 0.05), and Conclusion: Absence of Grx2 causes marked abnormalities in mitochondrial ultra- an upregulation of UCP1 mRNA as well as downregulation of mitochondrial coupling ef- structure in skeletal muscle and in cellular glutathione redox states. Insulin causes ficiency upon stimulation (P ≤ 0.05). Principal component analyses followed by stepwise a more oxidized mitochondrial GSH:GSSG, an effect that cannot be detected at the regression analyses revealed that thermogenic genes share a negative association with whole cellular level. Analyses of mitochondrial fusion, and energetics are ongoing. oxidative stress-related genes in both eAT and mAT (P ≤ 0.05). In addition, isoproterenol stimulation of eAT resulted in downregulation of secreted proteins included in the GO terms-cell redox homeostasis and protein folding.

75 | 5th Canadian Obesity Summit | #COS17 Abstract Details

Conclusion: Human eAT exhibits a beige phenotype and ability to undergo scores (PCS 51.7 (9.0) and MCS 47.8 (11.8)). All changes were significant, p<.05. thermogenesis under stimulated conditions. Its thermogenic phenotype shares a Conclusions: Bariatric surgery offered in a newly established provincial bariatric surgery negative association with oxidative stress-related parameters in humans. program was clinically effective in terms of weight loss and patient reported HRQoL.

O6.1 O6.3 Health Service Use 12 Months Pre - and 24 Months Post-Laparoscopic Employment and Quality of Life Outcomes 2 Years Following Bariatric Sleeve Gastrectomy (LSG) Surgery Jillian Vallis, Kendra Lester, Deborah Gregory, Laurie Twells Karin Kantarovich1, Susan Wnuk1, 2, Stephanie Cassin3, Raed J. Hawa1, 2, Sanjeev Memorial University of Newfoundland, St John’s, NL, Canada Sockalingam1, 2 1. University Health Network, Toronto, ON, Canada, 2. University of Toronto, Toronto, Objective: Bariatric surgery is an effective treatment for severe obesity. As surgeries ON, Canada, 3. Ryerson University, Toronto, ON, Canada continue to increase in Canada, there is a need for data in order to estimate related health services use (HSU) and to inform health policy. Uncertainties exist about the Objective: Bariatric surgery is the most effective long-term treatment for severe extent to which surgery is associated with reductions in HSU. The objective of this obesity. While the main objective of this procedure is to facilitate significant weight study is to determine the impact of bariatric surgery on short term HSU in patients loss, additional post-operative outcomes include improvements in mental and undergoing LSG. physical health, and consequently, work capacity. The purpose of our study was Methods: A retrospective cohort study examining the effect of bariatric surgery on to evaluate changes to employment impairment (EI) and quality of life (QOL) in HSU (e.g., physician, hospital, ER). Eligible patients recruited through the Provincial patients 2 years following bariatric surgery. Bariatric Surgery Clinic provided self-reported HSU data using standardized case Methods: Prospective data was collected on a cohort of 211 patients who underwent report forms at baseline, 12 months’ pre-surgery and every 6 months for 2 years. bariatric surgery at the Toronto Western Hospital Bariatric Surgery Program. The Lam HSU was compared pre and post-surgery. Employment Absence and Productivity Scale (LEAPS) and the 36 Item Short Form Survey Results: Two hundred one patients were enrolled. Approximately 82% were female, (SF-36) subscales were used to assess pre- and post-operative EI and QOL, respectively. with a mean age and BMI of 44yrs and 48.8 kg/m2, respectively. Compared to the Results: Significant improvements in work performance 2 years following surgery pre-surgical year, the average number of family physician visits and utilization of out- were noted. Specifically, 68% of participants reported decreased overall EI 2 years patient clinic visits, procedures and other healthcare professional visits (e.g., dietician, post-surgery (Z = -6.423, p < 0.001), and 44% participants reported an increase diabetic nurse educator) were significantly reduced at 2 years post-surgery (p<0.05). in work productivity and functioning (Z = -4.671, p < 0.001). Bariatric surgery was ER visits were not significantly reduced after 2 years compared to before surgery. No also associated with improved QOL, with 96% of patients reporting improvements significant differences were reported in hospital admissions pre- and post-surgery. in physical health (t(176) = -21.603, p < 0.001), and 60% of the patients noting Conclusions: Bariatric surgery leads to a significant reduction in the short term use improvements in mental health (Z = -3.231, p = 0.001). of direct health care services in the 2 years following surgery. Conclusions: The results of the current study provide further evidence to support the significant improvements experienced in work capacity and overall well-being in O6.2 patients after undergoing bariatric surgery. Weight Loss and Quality of Life Outcomes in Surgically Treated Patients In [Province]: a Prospective Cohort Study O6.4 Laurie K. Twells1, 2, Deborah Gregory1, Kendra Lester1, Dave Pace1, 3 What Bariatric Surgery Recipients Need Before, During, and After Surgery 1. Faculty of Medicine, Memorial University, St. John’s, NL, Canada, 2. School of for Long-term Health and Well-being: Recipients’ Perspectives Pharmacy, Memorial University, St. John’s, NL, Canada, 3. Eastern Health, St. John’s, Rebecca H. Liu, Jennifer D. Irwin NL, Canada Western University, London, ON, Canada

Objective: [Province] has the highest prevalence of obesity in Canada. In 2011, a Background: Long-term success remains a challenge for many who have undergone publicly funded provincial bariatric surgery program in [Province] began offering bariatric surgery, which suggests there may be important, and as of yet, unmet needs of laparoscopic sleeve gastrectomy (LSG) to eligible patients. A prospective observa- such recipients. The objective of this cross-sectional study was to gain an understanding tional cohort study was implemented to examine weight loss and health related of what bariatric surgery recipients perceive they need to best support their long-term quality of life (HRQoL) over a period of 2 years. health and well-being in the province (Ontario, Canada) and thereafter internationally. Methods: Consecutive eligible and consenting patients were enrolled (n=201). Methods: A questionnaire, taking 30-45 minutes to complete, was designed in The primary outcome was weight change. HRQoL data was collected using the EQ- concert with members of the target audience and distributed via support group ad- 5D, Visual Analogue Scale (VAS, 1-100), SF-12v2 and the IWQOL-lite. ministrators. Descriptive statistics of participants’ demographic/clinical background Results: At baseline, mean (SD) age was 44 (10), mean BMI 48.8 (6.8) kg/m2 and were analyzed for group comparisons using a chi square test and a two-sample t-test 81.6% were female. Patients presented with: sleep apnea (65.5%), back pain (p<.05). Open-ended responses were analyzed using inductive content analysis (50.5%), dyslipidemia (47.9%), hypertension (47.9%), GERD (43.6%), osteoarthritis and reviewed independently by the authors who discussed any discrepancies in (43.3%), and T2DM (41.8%). Almost 78% (n=156) completed 2-year follow up. emerging themes until reaching an agreement. Mean absolute weight loss was 37.4 kg (16.4) and %TWL was 27.3% (9.8). EQ-5D Results: One hundred and nineteen (59 provincial; 60 international) respondents findings indicate almost or more than half reported problems with pain/discom- completed the questionnaire. Themes for what was most useful included encourage- fort, anxiety and depression, usual activities, and mobility with significantly fewer ment from family, friends, bariatric team members, and peers. Access to immediate patients reporting problems after 24 months. Pre-surgery patients reported a VAS of follow-up appointments after surgery for nutrition-specific and general post-surgery 59.7% (18.7) which increased to 79.9% (15.2). Baseline SF-12 physical and mental concerns was reported as needed but not received. Recommendations to address component summary scores (PCS & MCS) were 36.4 (10.6) and 47.8 (10.7), respec- excess skin and creating a mentorship program were proposed. tively. At follow-up the summary scores were at or approaching Canadian normative Conclusions: This study provides an understanding of the needs and experiences

76 | 5th Canadian Obesity Summit | #COS17 Abstract Details of bariatric surgery recipients, which may help clinicians to address gaps in bariatric structive symptoms (43.5%). Median patient age was 48 years (min=29, max=62) programing, provide more effective treatment, and help prevent weight regain and 91% were female. On average, the LAGB was in-situ for 5.0±2.6 years. The among surgery recipients for long-term health and well-being. average time between LAGB removal and revision surgery was 11.8±4.6 months. Overall revision complication rate was 34.8% with no mortalities. O6.5 Conclusion: One third of patients sought revision surgery after LAGB removal. Long-term Psychosocial Predictors of Quality of Life and Weight Loss While immediate complications from primary LAGB may be lower than other After Bariatric Surgery: the Toronto Bari-PSYCH Study Results bariatric procedures, revision surgery has high complication rates. Patients need to Sanjeev Sockalingam1, Raed Hawa1, Susan Wnuk1, Vincent Santiago2, Timothy be aware of these revision risks before opting for LAGB placement. Future research is Jackson1, Allan Okrainec1, Stephanie E. Cassin2 needed to optimize LAGB revision surgery. 1. TWH Bariatric Surgery Program, University Health Network, University of Toronto, Toronto, ON, Canada, 2. Ryerson University, Toronto, ON, Canada O6.7 Association of Gastrointestinal Symptoms with Complications After Background: Studies exploring the impact of pre-surgery psychiatric status as Bariatric Surgery a predictor of health related quality of life (QOL) after bariatric surgery have been Caroline Sheppard1, Daniel C. Sadowski2, Christopher J. de Gara2, Daniel W. Birch1 limited to short-term follow-up and variable use of psychosocial measures. In this 1. University of Alberta, Centre for the Advancement of Minimally Invasive Surgery, prospective cohort study, we examined the effect of pre-operative psychiatric factors Edmonton, AB, Canada, 2. University of Alberta, Edmonton, AB, Canada on QOL and weight loss 2-years after surgery. Methods: 156 patients participated in the Bariatric Psychosocial Cohort Study (Bari- Introduction: Bariatric surgery has been known to cause changes or onset of gas- PSYCH), between 2010 and 2014. Patients were assessed pre-surgery for demo- trointestinal symptoms. Patients may present with symptoms of persistent nausea, graphic factors, weight, psychiatric diagnosis using a structured psychiatric interview reflux, and abdominal pain after bariatric surgery. In many cases, invasive clinical in- and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and vestigations have not been able to determine the etiology of these complaints. This 2 years post-surgery. survey will identify the chief gastrointestinal complaints of postoperative patients Results: At 2-years post-bariatric surgery, patients experienced a significant and identify any trends emerging after surgery. decrease in mean weight (-48.43 kg, 95%[-51.1,-45.76]) and an increase only in Methods: Patients completed the Gastrointestinal Symptom Rating Scale (GSRS) physical QOL (+18.91, 95%[17.01, 20.82]) scores as compared to pre-surgery. Mul- questionnaire before and 6–12 months after bariatric surgery. The GSRS has previ- tivariate regression analysis identified pre-surgery physical QOL score (p<0.001), ously been validated and tested for reliability. younger age (p=0.005), and a history of a mood disorder as significant predictors Results: A total of 100 patients completed the preop questionnaire (40 Laparo- of physical QOL. Only a history of a mood disorder (p=0.032) significantly predicted scopic Sleeve Gastrectomy [LSG], 60 Laparoscopic Roux-en-Y Gastric Bypass [LRYGB]). SF36-MCS (p=0.006). Pre-surgery weight (p<0.001) and a history of a mood disor- The questionnaire response rate was 94%. At follow-up, 2.7% LSG and 10% LRYGB der (p=0.047) were significant predictors of weight loss 2-years post-surgery. had a surgical complication (i.e. late bleed, ulcer). Additionally, 32% of LSG and 18% Conclusions: Bariatric surgery had a sustained impact on physical QOL but not of LRYGB presented with chronic abdominal pain and/or reflux. The average scores mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly for each gastrointestinal syndrome were mild at pre-op (1.3–2.4) and remained increased physical QOL scores and weight loss following surgery. Further research is mild after LSG (1.6–2.5) and LRYGB (1.5–2.3). Only patients with complications after needed to determine if these results are due to bariatric surgery candidate selection, LSG had statistically increased scores for abdominal pain, reflux, and indigestion. models of care, and if these effects change long-term. However, these average scores were still mild (2.3–2.5). Discussion: This study demonstrates the difficulty assessing and diagnosing patients O6.6 with complications based on patient symptoms. Regardless that patients have confirmed Revision Bariatric Surgery After Laparoscopic Adjustable Gastric Band abdominal complications, these appear to only be associated with a small increase in gas- Removal Has High Post-operative Complication Rates trointestinal symptom scores for LSG only. This emphasizes the importance of a bariatric Vanessa S. Falk1, 2, Caroline E. Sheppard1, 2, Kevin A. Whitlock1, Erica L. Lester1, Daniel clinic follow-up with extensive experience to limit unnecessary clinical interventions. W. Birch1, 2, Shahzeer Karmali1, 2, Aliyah Kanji1, Christopher J. de Gara1 1. University of Alberta, Edmonton, AB, Canada, 2. Centre for Advancement in Mini- O6.8 mally Invasive Surgery, Edmonton, AB, Canada Outcome of Gastric Bypass Surgery in Iceland 2001–2015 Rosamunda Thorarinsdottir, Vilhjalmur Palmason, Bjorn G. Leifsson, Hjortur G. Gislason Introduction: While laparoscopic adjustable gastric band (LAGB) has been Landspitali University Hospital, Reykjavik, Iceland associated with fewer complications than both laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), it leads to less weight loss and Introduction: Laparoscopic roux-en-y gastric bypass (LRYGB) has been performed has high failure rates. After LAGB removal, most patients experience weight regain at Landspitali University Hospital (LSH) since 2001. The procedure represents an and seek revision. This study reviewed outcomes of patients that underwent revision important treatment option for morbidly obese patients. The aim of this study is to bariatric surgery after LAGB removal. evaluate the long-term results of these operations in Iceland. Methods: All LAGB removals at one institution were reviewed from January 2014 Methods: All 772 consecutive patients undergoing LRYGB at LSH during 2001- to December 2015. Data was collected for patients who underwent subsequent revi- 2015 were included. Information was collected from a prospective database. sion bariatric surgery. Patient demographics, LAGB placement and removal details, Successful weight loss was defined as body mass index (BMI) less than 33 kg/m2 or time to revision surgery, and postoperative revision complications were analyzed. excess body mass index loss (EBMIL) more than 50%. Statistical analysis was carried out using SPSS 21.0. Results: Mean age of patients was 41 years and 83% were females. Mean pre-operative Results: Five bariatric surgeons carried out 76 LAGB removals. Twenty-three weight was 127 kg (±20) and mean BMI was 44 (±6). Mean %EBMIL was 80% after 1.5 patients (30.2%) went on to have revision surgery in the form of LRYGB (52.2%), LSG year, 70% after 5 years and 64% after 10-13 years. 85% of patients had successful weight (43.5%), and open RYGB (4.3%). The most common reason for band removal was ob- loss with a mean follow-up time of 7.4 years. Pre-operatively patients on average had 2.8

77 | 5th Canadian Obesity Summit | #COS17 Abstract Details obesity related comorbid diseases. 71% of patients with type 2 diabetes were in full remis- Results: A common thread among the reviews is the limited scope of available evi- sion after surgery. One third of patients with hypertension and one third of patients with dence combined with the heterogeneity of methods used in existing studies, including hyperlipidemia achieved full remission after surgery. 37 patients (5%) had an early compli- lack of consensus on definitions and measures used for sugars intake. There is a paucity cation and 174 (25%) had a late complication that frequently needed surgical solution. of data on intervention implementation and interactions with contextual factors. Further, Conclusion: Majority of patients achieved a successful weight loss and most little is known about differential effects of interventions for population subgroups and obesity related comorbidities are still in remission 7.4 years after surgery. Early potential compensatory behaviours on the part of both consumers and the food industry. complications were rare but one fourth of patients had late complications. Life long Conclusions: Given current gaps in the evidence, implementation of interventions follow-up is of utmost importance after gastric bypass surgery. that show promise should be accompanied by careful monitoring to assess intended and unintended consequences, including those related to equity. The application of O7.1 a systems lens might be useful for considering the broad array of factors that impact Unhealthy versus Healthy Foods Advertised in Grocery Store Flyers the planning, implementation, and evaluation of interventions to alter sugars Natalie A. Laframboise1, Jamie A. Seabrook1, 3, 4, June I. Matthews1, Paula D. consumption and associated outcomes, including body weight. Dworatzek1, 2 1. School of Food and Nutritional Sciences, Brescia at Western University, London, O7.3 ON, Canada, 2. Schulich Interfaculty Program in Public Health, Western University, Differences in Reach and Effectiveness of a National Healthy Eating Cam- London, ON, Canada, 3. Dept of Epidemiology & Biostatistics, Western University, paign According to Dominant Official Language London, ON, Canada, 4. Human Environments Analysis Laboratory, Western University, Melissa A. Fernandez1, 2, Sophie Desroches1, 2, Marie Marquis3, Mylène Turcotte1, 2, London, ON, Canada Véronique Provencher1, 2 1. Institution of Nutrition and Functional Foods, Université Laval, Quebec, QC, Cana- Objective: To examine the proportion of unhealthy foods advertised in discount ver- da, 2. School of Nutrition, Univsersité Laval, Quebec, QC, Canada, 3. Département de sus premium grocery store flyers of three major Canadian food distribution companies. nutrition, Université de Montréal, Montreal, QC, Canada Methods: From September 2015 to August 2016, 192 weekly online flyers were collected from 3 discount and 3 premium grocery store chains. Sixty-nine discount Background: The Eat Well Campaign: Food Skills (EWC) was disseminated by and 61 premium flyers have been analyzed. Health Canada’s Surveillance Tool Health Canada to promote family meal planning and preparation to Canadian (2014) was used to score 23,629 food items as unhealthy or healthy based on their parents primarily with public service announcements (PSA), magazine editorials, TV alignment with Canada’s Food Guide. vignettes, spokespeople and the web, in both official languages. The purpose of this Results: The proportions of unhealthy versus healthy foods advertised in discount study was to determine whether there were any differences in campaign exposure (61.0% vs. 39.0%) and premium (60.3% vs. 39.7%) grocery stores were similar and effectiveness according to dominant official language. (p=0.11). There were no significant differences in the mean prices of foods that Methods: A representative sample of 2101 Canadian parents were recruited and were unhealthy ($4.53±3.86) versus healthy ($4.47±4.13) (p=0.22). Foods that invited to respond to an online survey. Questions included demographic variables, did not belong to a food group (Other Foods) were advertised the most (30.4%); exposure to key campaign elements and perceived effectiveness of the EWC. Logistic foods in Milk and Alternatives were advertised the least (10.6%) (p<0.001). By food regression models were used to identify differences in reach and effectiveness, category, the highest proportions of unhealthy foods advertised were in Other Foods controlling for sex, age, region, income, education and religious beliefs. (89.6%), Meat and Alternatives (66.8%), and Milk and Alternatives (61.8%), with the Results: When compared to English-speaking respondents (78%), French-speak- lowest proportions in Vegetables and Fruits (27.0%) and Grains (27.5%) (p<0.001). ing respondents (22%) reported significantly higher odds of total exposure to the The highest proportions of unhealthy foods were found in the middle (61.2%) campaign, PSAs, vignettes and spokespeople, and lower odds of exposure to web versus the front (55.7%) or back (57.1%) pages of the flyers (p<0.001). elements (P < 0.05). Furthermore, French-speaking parents expressed, as a result of Conclusion: Irrespective of the food distribution company or chain, Canadian gro- campaign, greater beliefs in the importance of meal planning and including family cery stores are predominantly advertising unhealthy foods. Policies and programs members, feeling more knowledgeable, and feeling that the campaign was useful to improve the food environment and restrict unhealthy food marketing should not (P < 0.05). There were no differences in exposure to magazine elements, adoption overlook grocery store flyers. of behaviours or relevancy of messages. Conclusion: The campaign was more successful in reaching French-speaking O7.2 Canadians than English speakers and appeared to be more effective for belief, Gaps in the Evidence on Interventions to Reduce Sugar Consumption: a knowledge and usefulness components of meal preparation and planning, but not Scoping Review of Systematic Reviews behavior components. Strategies promoting healthy eating should be tailored to Sharon I. Kirkpatrick, Merryn Maynard, Amanda Raffoul, Jackie Stapleton different populations. University of Waterloo, Waterloo, ON, Canada O7.4 Background: There is currently considerable attention to the role of sugars in obesity Applying the CAN Approach to School Hot Lunch Fundraisers to Promote and the potential for interventions to curb sugars consumption. A rapid scoping Healthy Food at School review of systematic reviews was conducted to identify gaps in the existing evidence Cathy Langdon, Shawna Berenbaum, Susan J. Whiting on the effectiveness of such interventions. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada Methods: The databases Medline, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic review articles related Hot Lunch fundraisers are a popular means by which elementary schools across to interventions to reduce sugars intake, published in English since January 2005. Saskatoon raise extra funds for their students. Despite recommendations to serve Sixteen systematic reviews meeting the inclusion criteria were identified. The inter- healthy foods that meet provincial guidelines, the criteria schools use for choosing a ventions included price changes, interventions to alter specific food environments, lunch vendor is usually focused on profit potential alone. health promotion and education, and initiatives to limit exposure to advertising. Purpose: To highlight observations from a new lunch vendor whose menu meets

78 | 5th Canadian Obesity Summit | #COS17 Abstract Details nutrition guidelines for Saskatchewan schools and aligns with Wansink’s CAN O7.7 approach to positively affect food choice and consumption. Examination of Physical Activity and Sedentary Behaviour Policies in Method: The menu adheres to the CAN approach by being Convenient (pre Canadian Childcare Centres cut fruits and veggies), Attractive (popular and familiar favourites such as Mac Emily Ott1, 2, Leigh Vanderloo1, 2, Patricia Tucker3, 2 and Cheese and Blueberry Pancakes, that are priced competitively) and Normative 1. Health and Rehabilitation Sciences, London, ON, Canada, 2. University of Western (exclusively fruit and veg as ‘sides’ make these choices seem normal).Observations: Ontario, London, ON, Canada, 3. School of Occupational Therapy, London, ON, Canada Preliminary data suggests that the CAN approach may positively affect food choices in this lunch fundraising environment. To date all schools using this vendor are offering Objective: Currently, there is a gap in the research dedicated to the examination the fruit and vegetable sides as part of their lunch (including sides is optional) and of childcare policies aimed at targeting young children’s (under 5 years) physical 87% of families are selecting these healthy sides as part of their child’s lunch. activity and sedentary behaviours. The purpose of this study was to compare the Conclusion: The prevalence of childhood overweight/obesity coupled with the existence and characteristics of physical activity and sedentary behaviour policies in acknowledgement that schools can and should play a role in promoting healthy childcare centres across Canada. food suggests that lunch fundraisers are an ideal opportunity to model healthy Methods: Using a modified version of the Environment and Policy Assessment and eating. Using the CAN approach in a lunch fundraising program has the potential to Observation Self-Report tool (EPAO-SR), an online survey was distributed via email to compete with less nutritious foods available to schools and increase acceptance of the directors/administrators of childcare centres across Canada to elicit information on healthy foods. the characteristics of existing physical activity and sedentary behaviour policies. Fol- lowing aspects of the Dillman technique, two reminder emails were sent to encourage O7.5 survey completion and to secure a strong response rate from across the country. Obesity, Its Associations with the Food Environment, and Spatio-temporal Results: A total of 1,158 childcare representatives accessed the survey, while 514 Indicators of the Food Environment in the Region of Waterloo, Ontario provided complete data. Of these, 295 (44%) centres indicated having a written Jane Law, Leia Minaker, Henry Luan, Matthew Quick physical activity policy for young children, while 178 (29%) reported a written policy University of Waterloo, Waterloo, ON, Canada regarding sedentary behaviours. In addition, when asked about the Canadian Physical Activity and Sedentary Behaviour Guidelines for the Early Years, 102 (19%) This paper reports findings from our study on obesity, its association with the food and 177 (33%) of centres correctly recalled the minimum amount of time that environment, and the creation of spatio-temporal indicators for assessing the food children should be physically active and the amount of screen time children should environment in the Region of Waterloo, Ontario. Previous Canadian research has be limited to each day, respectively. found different aspects of the local food environment to be related to body weight, Conclusions: Physical activity and sedentary behaviour policies in childcare are but the evidence is mixed in terms of the strength of the relationship, and the not common in Canada. These results provide important findings to consider when mechanisms by which the food environment influence dietary and weight-related developing recommendations for physical activity and sedentary behaviour policies outcomes. Cross-sectional study designs dominate this field of research and thus, for childcare centres. little is known about relationships between the food environment and body weight over time. Our study developed local indicators to estimate the probability of an O7.8 area’s accessibility to unhealthy food based on the geographic locations of food The Impact of the Children’s Food and Beverage Advertising Initiative’s outlets in each census area in the Region of Waterloo in more than one time period. Uniform Nutrition Criteria The probability for each area was calculated under a Bayesian spatio-temporal Monique Potvin Kent1, Jennifer Smith1, Elise Pauzé1, Mary L’Abbé2 framework using a binomial distribution that models the count of unhealthy food 1. University of Ottawa, Ottawa, ON, Canada, 2. University of Toronto, Toronto, ON, outlets as a proportion of all food outlets in each area and time period. Our results Canada identified an average increasing trend of accessibility to unhealthy food and varying trends in local areas. Maps showing the geographic variation of the trends of acces- Objective: In 2007, 16 food companies pledged to advertise only “healthier sibility to unhealthy food provide evidence for municipal policymakers to intervene dietary choices” to children under 12 in the Canadian Children’s Food and Beverage at the local level to reduce accessibility to unhealthy food, which may reduce obesity Advertising Initiative (CAI). In 2015, uniform nutritional criteria were implemented by rates in those areas and the study region. participating CAI companies. This study aimed to evaluate these new criteria. Methods: A quasi-experimental pre-post study with a control group was carried out. O7.6 Television ratings data were purchased for 19 food categories from Nielsen Media for International Interventions on Sugary Drinks and Best Practices May 2013 and 2016 for 34 television stations in Toronto. Television programs with a Harsha Kasi Vishwanathan child viewership of ≥35% were determined and 10% of these were randomly selected. Heart and Stroke Foundation, Ottawa, ON, Canada Food ads that appeared in each program were identified and nutritional information was collected on each product. Healthfulness was defined using PAHO and U.K. Nutri- Sugary drinks are the single largest contributor of sugar in the diet, and consump- ent Profile Models (UK NPM). Pre-post statistical comparisons were made. tion is associated with many chronic diseases. This presentation will discuss inter- Results: 100% of all the advertised foods in 2016 were classified as excessive in national interventions on sugary drinks as a strategy to encourage healthy weights at least one nutrient (PAHO) while the U.K. NPM classified 76% of the ads as “less in children, and how these experiences can inform and be applied to the Canadian healthy”. There were no changes in these classifications between 2013 and 2016. In context. The presentation will provide a brief overview of the global landscape of 2016, it was 1.8 times more likely that advertised foods were classified as excessive sugary drink levies and how successful these models have been for revenue gener- in sodium compared to 2013. There were no changes in the healthfulness of adver- ation and decreases in purchasing trends of sugary drinks. It will then present the tised CAI products between 2013 and 2016. revenue potential for Canada based on tax models. It will also reflect on policy and Conclusions: The CAI uniform nutritional criteria have not improved the healthful- programming options for revenue expenditure, and describe how these strategies ness of foods advertised to children on television during their preferred viewing. Govern- can influence health behaviours and outcomes in Canada. ment regulation is needed to restrict unhealthy food marketing viewed by children.

79 | 5th Canadian Obesity Summit | #COS17 Abstract Details

O8.1 O8.3 Not Just Fun and Games: Toy Advertising on Television Targeting Chil- Early Life Conditions, Childhood Adiposity and Risk Factors for Type 2 dren Promotes Sedentary Play Diabetes in Children Aged 10-12 Years from the QUALITY Study Monique Potvin Kent1, Clive Velkers2 Andraea Van Hulst1, 2, Gilles Paradis1, Andrea Benedetti1, Mélanie Henderson2, 3 1. School of Epidemiology, Public Health and Preventive Medicine, University of 1. Department of Epidemiology Biostatistics and Occupational Health, McGill Univer- Ottawa, Ottawa, ON, Canada, 2. Queen’s University, Kingston, ON, Canada sity, Montreal, QC, Canada, 2. Centre de recherche du CHU Ste-Justine, Montreal, QC, Canada, 3. Department of Pediatrics, University of Montreal, Montreal, QC, Canada Objective: Sedentary activities including watching television have been associated with an increased risk of obesity in children. While watching television, children are exposed to a Aim: We examined whether birth weight and postnatal growth during infancy are significant number of advertisements. The purpose of this study was to examine the volume associated with insulin sensitivity in children, and assessed potential mediation of of television toy advertising targeting Canadian children, to determine if it promoted active associations by childhood adiposity. or sedentary play, targeted males or females more frequently, and has changed over time. Methods: Data from a longitudinal cohort of 630 Quebec Caucasian children with a parental Methods: Data for toy/game advertising on twenty-seven television stations in history of obesity (QUALITY) were used. In a sub-sample of children born at term, weight and Toronto for the month of May in 2006 and 2013 was purchased from Nielsen Media length from 0–2 years of age were obtained retrospectively and transformed to sex specific Research. A content analysis was performed on all ads to determine what age group weight-for-length z-scores (n=395). Percentage of body fat was measured by dual-energy x-ray and gender was targeted and whether physical or sedentary activity was being absorptiometry at age 8–10 years. Accelerometry based moderate-to-vigorous physical activity promoted. Comparisons were made between 2006 and 2013. and self-reported daily hours of screen time were measured at age 10–12 years. Insulin sen- Results: There were 3.35 toy ads/hour/children’s specialty station in 2013 (a 15% increase sitivity was measured by the homeostatic model assessment of insulin resistance (HOMA-IR) from 2006). Eighty-eight percent of toy ads promoted sedentary play in 2013, a 27% and an oral glucose tolerance test-based index (Matsuda insulin sensitivity index (ISI)) at age increase from 2006 levels while toy ads promoting active play decreased by 33%. In both 10–12 years. Multiple linear regressions and path analysis were used. 2006 and 2013, a greater number of these ads targeted males, and between 2006–2013, Results: Higher birth weight was associated with improved insulin sensitivity: 1 toy ads promoting sedentary play increased significantly for both males and females. z-score increase in weight-for-length at birth was associated with an 8.2% increase in Conclusion: The current levels of toy advertising promoting sedentary play in Matsuda-ISI (95% CI: 2.9; 13.6) and 6.5% decrease in HOMA-IR (95% CI: -11.9; -1.0). Canada are troubling. Future research should explore whether such advertising These associations were independent of childhood adiposity, lifestyle behaviors, and influences children’s preferences for activities and levels of physical activity. gestational age. Postnatal growth was not directly associated with insulin dynamics, however faster postnatal growth was positively associated with adiposity at 8–10 years O8.2 which in turn predicted decreased Matsuda-ISI and increased HOMA-IR. Lifestyle Habits and the Development of the Metabolically Unhealthy Conclusion: Our results add to the growing body of evidence regarding the impor- Obese Phenotype in Youth: a Prospective Analysis in the QUALITY Study tance of prenatal and postnatal growth for later type 2 diabetes risk factors in children. Andraea Van Hulst2, 3, Jean-Baptiste Roberge2, Marie-Eve Mathieu2, 4, Sanyath Radji2, Tracie A. Barnett5, Mélanie Henderson1, 2 O8.4 1. Division of Endocrinology, Department of Pediatrics, Université de Montréal, Neighbourhood Disadvantage During Childhood and the Risk of Cardio- Montreal, QC, Canada, 2. Centre de recherche du CHU Ste-Justine, Montreal, QC, vascular Disease Risk Factors and Events from a Prospective Cohort Canada, 3. Department of Epidemiology, Biostatistics and Occupational Health, Lisa Kakinami1, Lisa A. Serbin1, Dale M. Stack1, Alex E. Schwartzman1, Jane E. Ledingham2 McGill University, Montreal, QC, Canada, 4. Departments of Kinesiology, Université 1. Concordia University, Montreal, QC, Canada, 2. University of Ottawa, Ottawa, ON, Canada de Montréal, Montréal, Montreal, QC, Canada, 5. Epidemiology and Biostatistic Unit, INRS-Institut Armand-Frappier, Laval, QC, Canada Objectives: To investigate the effect of childhood neighbourhood level SES on the development of CVD risk factors or events during adulthood. Objective: We determined what lifestyle habits predicted the metabolically Methods: Participants were from the XXX cohort (n=3792, Mage=9.0). SES were unhealthy obese (MUO) versus the metabolically healthy obese (MHO) phenotypes measured as the percentage of adults in the neighbourhood (1) with household over a 2-year period in youth. income <$10,000/year, (2) unemployed, (3) single-parent, or (4) with education < Methods: The QUALITY cohort comprises Caucasian youth (n= 630) with at least one high-school from the 1976, 2001, and 2006 census micro data sets. CVD risk factors obese biological parent. Of the 148 obese children at age 10-12 years (BMI ≥ 97th and events were obtained from medical records. Multivariable proportional hazards percentile for age and sex), we defined MHO youth (n=58) as those with none of the regressions with childhood neighbourhood SES as the primary predictor, and cur- following: triglycerides > 1.2 mmol/L, fasting glucose > 6.1 mmol/L, HDL-cholesterol < rent neighbourhood SES as time-varying on the first occurrence of CVD risk factors or 1.04 mmol/L, or blood pressure > 95th percentile for age, sex, and height. In contrast, events were conducted separately for males and females. Analyses adjusted for age, MUO had at least one of these risk factors (n=90). Lifestyle habits were assessed at age frequency of medical visits, and parental history of CVD. 8–10 years, including accelerometry-based physical activity; self-reported hours of screen Results: During 30 years of follow-up, 28% developed a CVD risk factor, and 13% had time; and dietary intake using 3 non-consecutive 24-hour recalls. Sleep duration was de- a CVD event. Nearly 2/3 experienced some upward social mobility since childhood. rived from nightly accelerometer non-wear time. Logistic regression analyses were used Males from disadvantaged neighbourhoods during childhood were 2.70 (95% CI: to determine how baseline lifestyle habits predicted later MUO vs MHO status. Models 1.43-5.10, p=0.002) and 1.77 (95% CI: 1.03-3.05, p=0.04) times more likely to were minimally adjusted for age, sex, pubertal stage and physical activity. develop a CVD risk factor or experience an event, respectively than males not from dis- Results: Children who consumed higher saturated fat (OR = 1.28, p=0.008), more advantaged neighbourhoods. Females from disadvantaged neighbourhoods during sugar-sweetened beverages (OR=1.42, p=0.044) and less fruits and vegetables (OR childhood and adulthood were 1.87 (95% CI: 1.19-2.95, p=0.007) and 1.15 (95% CI: = 0.83, p=0.043) at baseline were more likely to be MUO 2 years later. Other lifestyle 1.03-1.28, p=0.01) times more likely to develop a CVD risk factor. behaviours did not predict MUO or MHO phenotypes. Conclusion: Despite upward social mobility in adulthood, both males and females Conclusions: Specific lifestyle habits, in particular diet, may be important targets to with childhoods in disproportionately disadvantaged neighbourhoods are at an prevent obese children from developing metabolic complications as they enter puberty. increased risk for shorter survival times to CVD risk factors or events.

80 | 5th Canadian Obesity Summit | #COS17 Abstract Details

O8.5 O8.7 Parents’ Perceptions of the Family- and Community-Based Resources and Sup- Maternal and Offspring Intelligence in relation to Offspring BMI in Child- port Required to Enhance Physical Literacy in Children: an Exploratory Study hood and Adolescence Shauna M. Burke, Kristen Reilly Christina S. Wraw1, Ian J. Deary1, Geoff Der2, Catharine R. Gale1, 3 Western University, London, ON, Canada 1. University of Edinburgh, Edinburgh, United Kingdom, 2. University of Glasgow, Glasgow, United Kingdom, 3. University of Southampton, Southampton, United Kingdom Objective: Physical literacy is defined as the knowledge, confidence, motivation, and physical competence to engage in physical activity for life (Whitehead, 2010). Objective: To examine the associations between both maternal and offspring’s intelligence The purpose of this exploratory study was to identify parents’ perceptions of the and offspring’s body mass index (BMI) in childhood and adolescence. resources, tools, and opportunities required at both family and community levels to Method: Participants were members of the National Longitudinal Survey of Youth 1979 improve children’s physical literacy. (NLSY-79) Children and Young Adults cohort (n=11,512) and their biological mothers Methods: Parents of children aged 16 years and younger, living in Ontario, who were also members of the NLSY-79 (n=4,932). Offspring’s IQ was measured with the Canada, were recruited via social media (i.e., Facebook and Twitter) and word-of- Peabody Individual Achievement Test. Maternal IQ was measured with the Armed Forces mouth. Participants completed an online questionnaire containing items related to Qualification Test when they were aged 15–23 years. A series of regression analyses tested what information, resources, and/or support would be needed, both at home and in the association between IQ and offspring’s BMI in middle childhood (age 5–7.99 years), the community, to improve children’s physical literacy. Qualitative data underwent late childhood (age 8–10.99 years), early adolescence (age 11–13.99 years), and middle thematic analysis assisted by QSR NVivo 10. adolescence (age 14–18.99 years) for boys and girls separately, while adjusting for potential Results: Participants (n = 81, MAge= 39.2 years) were predominantly female (93.8%) confounding and mediating factors (including maternal education and pre-pregnancy BMI). and married (79.0%). At the familial level, parents expressed the need for accessible Results: After adjustment for potential confounding factors, a SD increment in girl’s IQ was family-friendly activities, flexible work schedules, and better time management skills in associated with a lower BMI in middle adolescence (beta=-0.12, 95% C.I. -0.17 to -0.07, order to enhance children’s physical literacy. At the community level, parents identified p<0.001). After adjustment for potential mediating factors, maternal IQ was inversely improved quality of physical education, reduced costs of exercise/activity programs, associated with daughter’s BMI across all four age-groups, ranging from (beta=-0.10, 95% increased access to non-competitive physical activity opportunities, and the development C.I. -0.16 to -0.03, p=0.004) in late childhood to (beta=-0.17, 95% C.I. -0.23 to -0.11, of exercise-conducive infrastructure as potential physical literacy-related facilitators. p<0.001) in middle adolescence. Maternal IQ was inversely associated with son’s BMI Conclusions: Preliminary findings provide an overview of the diverse resources in middle childhood (beta=-0.09, 95% C.I. -0.16 to -0.03, p=0.007) after adjustment for and supports that parents perceive as necessary to improve children’s physical liter- potential mediating factors. There was no evidence of a boy’s IQ-BMI association. acy. This research highlights several areas, in both home and community environ- Conclusion: Lower maternal and offspring intelligence may lead to higher offspring BMI, ments, that could be targeted via the development and promotion of interventions particularly in girls. and resources designed to enhance physical literacy in children and families. O8.8 O8.6 Learning Food Literacy: Educational Interventions for Child and Using Primary Care Electronic Medical Records to Estimate the Prevalence Adolescent Health of Severe Obesity in Children Emily J. Truman Sarah E. Carsley1, 3, Karen Tu2, 1, Jacqueline Young2, Patricia Parkin3, 1, Catherine Birken3, 1 University of Calgary, Calgary, AB, Canada 1. University of Toronto, Toronto, ON, Canada, 2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, 3. The Hospital for Sick Children, Toronto, ON, Canada In light of poor eating habits and childhood obesity, food education is needed to enable young Canadians to make informed choices in a complex food landscape. Food Objectives: There are no prevalence estimates of severe obesity (SO) in Canadian literacy—a concept describing proficiency in food related skills and knowledge—has children. Electronic medical records (EMRs) may be a feasible source of height and become a popular way to promote food education in a range of contexts, including weight data. The study objectives were to determine the quality of data collected in promotional and educational campaigns from public health, industry and cultural primary care EMRs and the prevalence of SO in children 0–19 years. institutions. But what is its potential for improving child and adolescent health? This Methods: Height and weight data for children <19 years were extracted from presentation examines existing food literacy studies focusing on educational inter- EMRs through the Electronic Medical Records Administrative Linked Database ventions in order to: 1) identify program objectives and outcomes, and 2) assess their (EMRALD), a network of family practices across Ontario. A complete and accurate set overall success in improving child/adolescent health. of growth measurements was defined as having a non-missing value for height, Method: A scoping review of food literacy research was undertaken which located weight, age, and sex that fell within cut-points for biologically plausible values for 1049 abstracts on the topic, identifying 14 original articles on food literacy interven- BMI-for-age. BMI z-scores were calculated using the World Health Organization tions. From these, data was extracted on study type, objective, population addressed, Growth Standards and Reference. Prevalence was calculated for the time period and outcome. between 2012–2016. SO was defined as a BMI z-score >+3. Results: The majority of studies identified focused on child or adolescent populations Results: Overall, 84% of children had at least 1 complete set of growth measure- (64%), and half of the studies took place in school environments. 59% of the studies ments to calculate a BMI z-score. 34.4% of observations were missing zBMI data. reported improvements in food skills and knowledge, 30% reported changes in A total of 41,963 children less than 19 years of age with complete and accurate food-related attitudes, and 12% reported changes in food-related behaviours. height/length, weight, sex and age were selected from the EMRALD database. The Conclusions: While studies on food literacy interventions for children/adolescents prevalence of SO in children 0–4, 5–9, 10–14, and 15–19 years was 1.33%, 2.61%, are limited, positive improvements in food related skills/knowledge are evident. In 2.93%, and 3.75%, respectively. addition, school-based intervention programs are ideally positioned to improve child/ Conclusions: Severe obesity prevalence in Ontario appears to be increasing with adolescent health beyond improved food skills/knowledge by establishing “positive age. EMRs may be a valid source of data to provide estimates of obesity and SO in food environments” which promote healthy choices and attitudes. School-based food children who attend primary care. literacy programs have the potential to improve child/adolescent health more broadly.

81 | 5th Canadian Obesity Summit | #COS17 Abstract Details

O9.1 independent variables, this effect was insignificant. Evaluation of a Community Driven, Physical Activity Based Wellness Conclusion: With weight status during early adolescence negating the effect of Program for Indigenous Women in Lloydminster, Alberta – the Women consistent participation in running during adolescence on body composition in Warriors Program early adulthood, it is perhaps ideal to address weight status in early childhood years. Sonja Wicklum1, Rita Henderson1, Shelley Wiart2, Lynden (Lindsay) Crowshoe1, Ashlee McGuire3 O9.3 1. Univerity of Calgary, Calgary, AB, Canada, 2. Lloydminster Native Friendship Impact of Exercise on Olfaction, Gustation and Energy Intake in Lean Men Centre, Lloydminster, AB, Canada, 3. Alberta Health Services, Calgary, AB, Canada – a Dissociation Profile Kapria-Jad Josaphat1, Marie-Eve Mathieu1, 2 Objective: Overall, only 14% of Canadian women meet guideline levels of physical 1. Université de Montréal, Montréal, QC, Canada, 2. Sainte-Justine UHC Research activity each week, an issue exacerbated among Indigenous communities facing Center, Montreal, QC, Canada added barriers to activity. The importance of physical activity is demonstrated by its extensive benefits in the domains of physical, psychological, emotional and socio-cul- Objective: This study aims to verify whether physical activity can have an impact on tural health. Goals of the Women Warriors Program are to increase physical activity and olfaction and gustation and thereby influence food choices. develop support systems for participants, creating a safe environment to face the chal- Methods: Ten normal-weight males (18-35y) attended two experimental visits lenge of making sustainable, healthy lifestyle changes. The program seeks to provide a in a counterbalanced fashion. Each visit included a 30-min exercise session on a cost effective, scalable, proactive solution to obesity and diabetes prevention. treadmill at 70% maximal oxygen uptake and a 90-min sedentary period performed Methods: Each Women Warriors program is eight weeks. Weekly sessions include in alternate order (Ex_Sed and Sed_Ex). At 08:30 AM as well as immediately before group exercise, round-circle discussion exploring barriers, and brief nutrition lunch (11:40 AM), participants were submitted to eight visual analogue scales education. The exercise varies each week. Participants use a pedometer to track steps ratings, an olfaction test using Sniffin’ Sticks and a gustation test. An ad libitum weekly. They complete pre/post questionnaires, anthropometric measurements, buffet-style meal was served at 12:00PM. HRQoL surveys and interviews. Results: Desire to eat was reduced by 72% in Sed_Ex and increased by 140% in Results: Preliminary results show increased average weekly step counts (20,249), Ex_Sed (p=0.02). An increase in perceived intensity of 23% for the lemon scent and increased variety in physical activities performed and increased minutes per week of 21% for the clove were measured in Sed_Ex whilet in Ex_Sed, the increase was spent exercising (119). Strong motivators for lifestyle change among participants only 18% for the lemon and 3% for clove (p=0.015; p=0.043). In the Sed_Ex visit, include family and a sense of improved wellbeing, however barriers to participation decreases in gustatory perceptions were observed in saltiness for 2% plain yogurt and making lifestyle changes are overwhelming for many. (37%), and the appreciation for cracker with regular cream cheese (28%), whereas Conclusions and Future Direction: The Women Warriors program has been well the decrease was much greater in the Ex_Sed visit (74% and 30%; p=0.042; received, is achieving the goal of improving physical activity levels for Indigenous women p=0.045). No anorexigenic effects of exercise were measured along with no dif- and is being expanded in length and to a new community - Yellowknife, NWT in 2017. ferences in macronutrient intake between visits. There was no correlation between caloric ingestion and variations in gustative and olfactive perceptions. O9.2 Conclusion: Exercise timing impacts olfactive and gustative responses but there seems Sustained Participation in Running, Sports, Fitness and Dance Activities to be a dissociation between the changes observed and the total caloric ingestion. Throughout Adolescence and Body Composition in Early Adulthood Tarun Katapally1, Mathieu Belanger2, Tracie Barnett3, Erin O’Loughlin3, Catherine O9.4 Sabiston4, Khalid Amin5, Jennifer O’Loughlin3 Neighbourhood Walkability and Its Association with Child Weight Status 1. University of Regina, Regina, SK, Canada, 2. University of Moncton, Moncton, NB, in Quebec: Findings from the Quality Study Canada, 3. University of Montreal, Montreal, QC, Canada, 4. University of Toronto, Nicoleta Cutumisu1, Melanie Henderson2, Marie-Eve Mathieu2, Tracie Barnett1 Toronto, ON, Canada, 5. University of Saskatchewan, Saskatoon, SK, Canada 1. Institute Armand Frappier – INRS, Laval, QC, Canada, 2. University of Montreal & Centre de recherche CHU Ste-Justine, Montreal, QC, Canada Objective: The aim of this study is to investigate whether participation in three types of physical activity (PA)-(sports, running, and fitness and dance) during adoles- Background: Child inactivity is an important public health issue and efforts to pre- cence is a determinant of body composition in early adulthood. vent inactivity are made around the globe. Mounting evidence shows that meeting Methods: Data were drawn from the Natural History of Nicotine Dependence in Teens the physical activity guidelines is a prerequisite for a heathy weight status and that study, a prospective investigation of 1294 students initially aged 12–13 years. Baseline built environment may influence children’s weight status. data (1999) included self-reported PA and objective anthropometric measurements Objective: We aimed to elucidate built environment’s influence on weight status at (height, weight, waist circumference, triceps and subscapular skinfold thickness). the baseline of an ongoing longitudinal study among a cohort of n=630 Canadian Follow-up PA data were collected every 3 months for 5 years (1999–2005). Cycles 21 children aged 8–10 years living in Quebec. and 22 took place in 2007–08 and 2011–12. Follow-up anthropometry was conducted Methods: We employed Geographic Information Systems to generate built in cycles 19 and 22. PA data were grouped into 3 categories using exploratory factor environment measures and to relate individual and built environment data. We analysis: Sports, Running, and Fitness and Dance. Participants were categorized as employed a generalized additive model to check for non-parametric associations having reported involvement in each PA type from 1–5 years during adolescence. Mul- of child’s measured BMI (non-obese vs obese) with area poverty, area disorder, and tivariable regression models were developed to estimate the effect of number of years neighbourhood walkability (calculated for 1000 m network and circular buffers of participation in 3 types of PA during adolescence on body composition measures in around children’s residences), after controlling for individual covariates (age, sex, late adolescence (cycle 19) and early adulthood (cycle 22). parents’ weight status). After establishing the associations’ linearity, we conducted a Results: Although descriptive results showed that consistent participation in run- logistic regression, retaining only children with complete data. ning during adolescence was associated with lower weight status in early adulthood, Results: We found that children living in a higher circular buffer walkability area upon building multivariable models with baseline body composition measures as were less likely (OR=0.86, 95%CI 0.76, 0.97) to be obese compared with their

82 | 5th Canadian Obesity Summit | #COS17 Abstract Details counterparts living in lower circular walkability areas. No associations were found for tissue (CT scan), resting (indirect calorimetry) and total daily energy expenditure (EE) network buffer walkability, suggesting the importance of informal neighbourhood (doubly-labeled water) were measured. pathways. Also, child’s weight status was associated with parental weight status. Results: A significant body weight (+0.90kg, + 1.35 % and +1.33 Kg, +1.63 %) Conclusions: Policy changes are needed to facilitate built environment changes and FM regain (+1.32kg, + 4.80 % and 0.81kg, +2.17 % for controls and resistance that support families to engage in active transport and other physical activity as a training, respectively) was observed. Resting and total daily EE did not change after family, thus contributing to their healthier weights. the 12-month follow up period, and no difference was found between groups. Conclusions: Our results suggest that resistance training over a 12-month weight O9.5 maintenance period does not improve weight loss maintenance, body composition Higher Abdominal Fat in Youth and Young Adults 3-10 Years Following a or energy metabolism in post-menopausal women. Sport-Related Knee Injury Clodagh M. Toomey1, 5, Jackie L. Whittaker2, 3, 1, Raylene A. Reimer1, Alberto O9.7 Nettel-Aguirre4, 5, 1, Carolyn A. Emery1, 4, 5 Active Desks and Excess Body Weight – A review by the FIT24 Network 1. Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada, 2. Department of Marie-Eve Mathieu1, Elise Labonté-Lemoyne2, Mickael Begon1, Sylvain Sénécal2, Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Pierre-Majorique Léger2 Canada, 3. Glen Sather Sport Medicine Clinic, University of Alberta, Edmonton, AB, Can- 1. University of Montreal and Sainte-Justine UHC, Montreal, QC, Canada, 2. HEC ada, 4. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, 5. The Montréal, Montreal, QC, Canada Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada Objective: This project reports the current knowledge about the benefits of active Objective: To examine differences in abdominal fat (AF) between youth with a desks on individuals with excess body weight. 3–10 year history of sport-related knee injury and uninjured controls. A secondary Methods: Five databases (Central, Embase, PubMed, Scopus, Web of Science) were objective was to determine the association between injury and AF, using physical investigated. Search included two concepts in phase 1: Desk (e.g., workstation…); activity (PA) as a covariate. and Active (e.g., standing, stepping, walking…). In phase 2, the keywords ‘over- Methods: 100 young adults (ages 15–26yrs; 55% female) with a sport-related weight’ or ‘obese’ were searched in the titles and/or in the abstracts. intra-articular knee injury sustained 3–10 years previously, and 100 uninjured controls Results: Following the removal of duplicates, 973 manuscripts were retrieved. Of matched on age, sex and sport consented to study participation. Abdominal fat (fat those, 109 were retained after reviewing title, abstract, and manuscript as required mass at L1 to L4 vertebral level; g) was derived using dual-energy x-ray absorptiometry (phase 1). Twenty-one papers met the overweight or obesity criteria (phase 2). Nine (DXA). PA was measured using the Godin Leisure-Time Questionnaire. Descriptive papers only mentioned the effectiveness of active desks in the obesity epidemic statistics (mean within-pair difference; 95%CI) were used to compare participants and (introduction and/or conclusion), and one study is ongoing. The remaining 11 articles multivariable linear regression (clustered by matched-pair) was used to explore the evaluated how active desks can have an impact on obese/overweight individuals association between injury history and AF, using PA and sex as covariates. (treadmill n=6; standing n=3; cycling n=1; multiple n=1). Overall, increased phys- Results: Previously injured youth demonstrated higher AF (461 g; (95% CI: 228, 694)) ical activity, standing and stepping times, and daily steps were observed. In addition, than uninjured controls. In multiple linear regression analysis, previous injury was signifi- reductions in sitting time, body weight, and adiposity following active desk use were cantly (p<0.001, r2=0.82) associated with AF (β=0.11, 95% CI 0.1, 0.2). This association obtained, with greater body weight reductions in obese individuals. The use of active was modified by PA (β=-0.02, 95% CI -0.03, -0.01) and sex (β=-0.42, 95% CI -0.6, -0.2). desks versus traditional desks led to greater energy expenditures, lower fatigue, lower Conclusion: Higher AF may be present in youth with a previous knee injury musculoskeletal discomfort, lower blood pressure, and lower glucose levels. No other compared to matched controls. This is an undesirable feature given the recognition metabolic improvements were noted (e.g., insulin and triglycerides). of regional fat distribution as a risk factor for disease. Efforts to increase PA in youth Conclusion: The use of active desks appears to have a positive effect on individuals with a previous knee injury may be a potential intervention to reduce adiposity and with excess of body weight. Larger studies comparing responses with normal weight thus impede the progression of negative health-related outcomes. individuals but also monitoring productivity outcomes are needed.

O9.6 O9.8 Resistance-Training after Weight Loss has no Impact on Body Composition Association between Physical Activity, Obesity, and Cardiometabolic Disease and on Energy Expenditure in Overweight and Obese Postmenopausal in South Asians: Canadian Community Health Survey, 2001–2014 Women: A MONET Study Sukhleen Deol, Hala Tamim, Chris I. Ardern Luzia J. Hintze1, Eric Doucet1, Virginie Messier2, Martin Brochu3, Remi Rabasa-Lhoret2 School of Kinesiology and Health Science, York University, Toronto, ON, Canada 1. University of Ottawa, Ottawa, ON, Canada, 2. University of Montreal, Montreal, QC, Canada, 3. Université de Sherbrooke, Sherbrooke, QC, Canada Background: Individuals of South Asian (SA) decent have a high prevalence of cardiometabolic risk factors such as type 2 diabetes and visceral adiposity. Objective: This Background: To maintain weight loss benefits, weight-loss maintenance is an study aims to examine the relationship between cardiometabolic health and physical important objective. Resistance training has been shown to be an effective mode activity (PA) among SAs with and without elevated body mass index (BMI: kg/m2). of exercise to decrease fat mass (FM), increase fat-free mass (FFM) and maintain Methods: Data from SA participants of the 2001–2014 Canadian Community Health metabolically active tissue, which can be a useful tool for weight-loss maintenance. Survey were pooled and used in the current analysis (20 y+). PA was defined by Objective: To examine the effect of a 12-month resistance training program on self-report [Inactive: less than 1.5 kcal/kg/day (KKD); Moderately Active (MA): weight loss maintenance following a 6-month dietary weight loss intervention. 1.5-2.9 KKD, and; Active (A): more than 3 KKD)], and Asian-specific BMI thresh- Design: Following a 5.97(4.98)% weight loss, 71 healthy overweight and obese olds for “increased” (23-27.4 kg/m2) or “higher risk” (more than 27.5 kg/m2) of postmenopausal women were randomized to a control group or a resistance-train- obesity-related disease were applied. Multiple logistic regression was subsequently ing group (3 x/week first 6 months; 2 x/last 6 months, 70–80 % of 1 RM). Body used to estimate the odds of 1+ cardiometabolic condition (self-reported diabetes, composition (DXA), visceral adipose tissue and abdominal subcutaneous adipose hypertension, or cardiovascular disease).

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Results: Twenty-three percent of SAs have an “increased” BMI, while 45% are at who were living in Ottawa during the study period. FI was measured using Health “higher risk”. Compared to normal weight (NW) SAs (OR=1.00, ref), those within the Canada’s Household Food Security Survey Module, diet quality was assessed using a “increased” (OR=1.78, 95% CI: 1.77-1.79) or “higher risk” (OR=2.97, 2.96-2.99) 24-hour recall and the Canadian Healthy Eating Index (HEIC-2009) and anthropometric groups had higher odds of 1+ cardiometabolic condition. Within SAs with “higher measurements were done using standardized protocols. Bivariate and logistic regression risk” (over 27.5 kg/m2), these effects were attenuated by PA (inactive: OR=1.00; MA: analyses were used to determine the link between FI, diet quality and weight status. 0.63, 0.63-0.64; A: 0.69, 0.68-0.70). Similar, but less pronounced effects of PA were Preliminary Results: In our sample, total HEIC-2009 score was not associated seen in NW and “increased” risk groups. with FI. However, children living in food insecure households were almost 2.3 times Conclusions: Regular PA was associated with lower odds of obesity-related more likely to having consumed sugar-sweetened beverages than those living in health risk. Further research is necessary to understand the optimal threshold of PA food secure households (OR=2.290, 95% CI=1.35-3.90). FI was linked with recent required for prevention of risk in individuals of SA decent. arrival to Canada and obesity among mothers. Conclusion: In this sample, FI may be associated with certain indicators of poor diet PK1.1 quality among children and higher rates of obesity among mothers. Strategies that aim to Food, Eating, and Weight: Language, Discourses, and Debates in the improve diet quality and reduce overweight in this population should target food security. Obesity Field (Funding: Consortium national de formation en santé and the University of Ottawa.) Sarah Nutter1, Molly Williamson1, Shelly Russell-Mayhew1, Angela S. Alberga2, Cara MacInnis1, John Ellard1 PK1.3 1. University of Calgary, Calgary, AB, Canada, 2. Concordia University, Montreal, QC, Addressing Weight Bias in a Provincial Health Services Organization Canada Mary Forhan1, Kathy Danzinger2, Jenifer Bennett2 1. University of Alberta, Edmonton, AB, Canada, 2. Alberta Health Services, Edmonton, Researchers and professionals in the obesity field can play an important role in exploring AB, Canada larger influences on discourses regarding food and weight. Exploring discourses and debates within the obesity field allows for individuals to better-inform collaborative practice. Purpose: Weight bias is a phenomenon that is known to impact the quality of Objective: Across two studies, this research examined the language, discourses, healthcare persons with obesity receives. The purpose of this study was to determine and debates regarding weight-related topics within the obesity field. In the first to what extent weight bias exists among employees in an urban zone at a large study, we investigated the similarities and differences between weight labels that health services organizations and to identify the types of interventions employees were regarded as common versus socially acceptable. In the second study, we believe would help to address weight bias. examined the ways in which food, eating, and weight are represented in obesity Method: This study was divided into two separate but related phases. Phase one discourses at obesity conferences. used a cross sectional, on-line survey made available to all staff. The survey used the Methods: Study 1: Participants (N=397) reported commonly used and socially Attitudes and Beliefs About Obese Persons Questionnaires (ATOP and BAOP). Phase acceptable weight labels, which we then correlated with weight bias and beliefs two used a cross sectional survey that included a summary of the results from phase about the controllability of weight. Study 2: We used situational analysis to identify one and questions about the types of weight bias interventions staff would find discourses in abstracts from the 2015, 2013, and 2011 CON Summits. most useful and would most likely participate in. Results: We identified tensions in the obesity field surrounding weight labels Results: An equal amount of nursing, allied health and administrative staff and discrepancy between socially acceptable terms and preferred terms, such as responded to the survey (n=423). Mean ATOP score was 77/120 indicating less pos- fat or obese. Situational analysis revealed polarizing positions on themes such as: itive attitudes toward persons with obesity. Mean BAOP score was 17/44 indicating a behaviour modification, obesity as an individual problem, weight as an indicator for stronger belief that obesity is under the control of the individual. Results from phase poor health, and the role of parents in managing childhood obesity. two are still under review however preliminary results show that employees would Conclusion: Tensions regarding preferred terms to describe weight issues suggest the like more education about the causes and consequences of obesity and have oppor- need for increased consideration for weight labels in practice. Further, common discours- tunities to feel more confident in their skills working with patients with obesity. es identified in the obesity field indicate that a more harmonious approach may advance Conclusion: Weight bias exists among employees at a large health services health promotion efforts and result in more coherent messaging to the public organization. Employees appear to be interested in addressing weight bias through education and skill development. PK1.2 Food Insecurity, Diet Quality and Obesity in African and Caribbean PK2.1 Households in Ottawa A Systematic Review and Meta-analysis of Weight Loss Intentions and Diana Tarraf1, Dia Sanou1, Rosanne Blanchet1, 2, Constance P. Nana2, Malek Batal3, Strategy Use Among Youth Isabelle Giroux2 Stephanie Houle-Johnson, Lisa Kakinami 1. Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Can- Concordia University, Montreal, QC, Canada ada, 2. School of Nutrition, University of Ottawa, Ottawa, ON, Canada, 3. Department of Nutrition, University of Montreal, Montreal, QC, Canada Background: Evidence suggests that young females may be more likely to use unhealthy weight loss strategies compared to males, however this has never been Objective: Income-related food insecurity (FI), which refers to insufficient financial systematically assessed. access to food, can contribute to chronic disease such as obesity and type 2 diabetes, Objective: We conducted a systematic review and meta-analysis of the literature and has been linked with higher health care costs in Ontario. The objective of this examining sex differences in weight loss strategies among youth. study was to examine the link between FI, diet quality and weight status among Methods: Relevant articles published after 1990 were identified. Studies black households living in Ottawa. conducted in North America with participants under 18 years old, who measured Methods: We recruited 258 households having at least one school-aged child, weight loss strategy use were selected. Descriptive statistics were extracted from where the mother was born in Sub-Saharan Africa, the Caribbean or Canada, and 19 studies, and weighted Mantel-Haenszel odds ratios with fixed effects were

84 | 5th Canadian Obesity Summit | #COS17 Abstract Details used for the meta-analysis. seen in a weight management clinic at a tertiary care pediatric hospital from May Results: Almost two-thirds of youth report trying to lose weight and the proportion 2012 to May 2014. using unhealthy or extreme strategies is as high as 44% and 13%, respectively. In the Results: 199 patients were included in the review. Comorbidity prevalences were: meta-analysis, compared to males, females were more likely to skip meals (OR: 2.25, hypertension 6 (3%), prediabetes 11 (5.5%), type 2 diabetes 3 (1.5%), dyslipidemia 95% CI: 2.04–2.48), use diet pills (OR: 2.54, 95% CI: 1.80-3.58), diuretics (OR: 1.76, 105 (52.8%), non-alcoholic fatty liver disease 31 (15.6%), asthma 45 (22.6%), 95% CI: 1.30–2.39), vomit (OR: 2.31, 95% CI: 1.92–2.78) and eat smaller portions obstructive sleep apnea 21 (10.6%), and polycystic ovarian syndrome (PCOS) 9 (OR: 1.36, 95% CI: 1.12–1.64) to lose weight. No sex differences were found for the (9.2%). Concerns related to depression and anxiety were present in 20 (10.1%) and likelihood of exercising, fasting, or using laxatives to lose weight. 25 (12.6%) patients respectively. The majority of comorbidities were identified prior Conclusions: Sex differences were noted for some, but not all weight loss strategies to joining the clinic. Conditions requiring more specialized tests, such as diabetes among youth. The extant literature is limited by the lack of reporting the use of mul- and PCOS, were more commonly identified after joining the clinic. tiple weight-loss practices used in tandem, and the lack of reporting other socio-de- Conclusions: These results give further insight into the prevalence of obesity-relat- mographic characteristics such as socioeconomic status. Researchers and practitioners ed comorbidities in overweight and obese children and adolescents, and demon- need to be mindful of these characteristics to better target public health initiatives. strate the importance of screening for these known comorbidities. It is important to have the resources and an experienced multi-disciplinary team to follow children PK2.2 and their families through treatment. Fasting and Postprandial Glucose, Insulin and Glucagon-like Peptide 1 (GLP-1) Levels in Children with Prader-Willi Syndrome (PWS) PK2.4 Maha Alsaif, Michelle Mackenzie, Carla Prado, Andrea Haqq The Live 5-2-1-0 Family Physician Toolkit for Promoting Healthy University of Alberta, Edmonton, AB, Canada Childhood Behaviours in Primary Care – A Pilot Study Shelly Keidar1, 2, Stephanie Shea1, 2, Susan Pinkney1, 2, Katrina Bepple3, Danielle Background: PWS is a unique model of childhood obesity with increased insulin Edwards3, Ilona Hale4, Shazhan Amed1, 2 sensitivity. GLP-1 has potent effects to stimulate insulin secretion; however, it is 1. BC Children’s Hospital Research Institute, Vancouver, BC, Canada, 2. Department unclear if GLP-1 levels are altered in PWS. of Pediatrics, University of British Columbia, Vancouver, BC, Canada, 3. Chilliwack Methods: Ten children with PWS and seven controls completed three visits. Division of Family Practice, Chilliwack, BC, Canada, 4. East Kootaney Division of Fasting and 1h postprandial blood samples (up to 3h) were completed. Participants Family Practice, Cranbrook, BC, Canada consumed one of 3 meals: standard (350kcal, 55%CHO, 30%fat, 15%PRO), higher protein/lower carbohydrate (350kcal, 40%CHO, 30%fat, 30%PRO), higher protein/ Purpose: SCOPE is a community-based multi-sectoral childhood obesity prevention lower fat (350kcal, 55%CHO, 15%fat, 30%PRO). initiative that promotes the Live-5-2-1-0 message: 5+ vegetables/fruits; <2-hours Results: PWS and controls were of similar age and BMI-z score. PWS had lower fast- of screen time; 1+ hour of active play; and 0 sugary drinks, every day. As part of this ing levels of glucose (p=0.033) and a trend for lower insulin and HOMA (p=0.055). initiative, a Live 5-2-1-0 Toolkit (including training) for family physicians (FPs) was Fasting GLP-1 levels in PWS were comparable to controls. Glucose and GLP-1 piloted in 2 BC communities. increased over time in PWS (p=0.031 and p=0.001) but not in controls. However, Objective: To determine whether the Toolkit improves physician capacity to insulin increased over time in both groups (p<0.0005 and p=0.001). Postprandial promote healthy childhood behaviours, and to identify barriers/facilitators to imple- glucose and insulin levels were higher in PWS compared to controls at 3h (p=0.003 mentation of the Toolkit. and p=0.005). PWS had higher glucose at 3h and higher insulin relative to fasting Methods: Implementation occurred sequentially in two communities, involving at 1, 2, and 3h compared to controls. Glucose, insulin and GLP-1 AUC were not 21 FPs in 6 family practice clinics. FPs completed pre/post-implementation surveys different between meals in controls. and participated in semi-structured interviews post-implementation. Descriptive Conclusion: Fasting glucose is lower while insulin and HOMA trend to be lower in statistics and thematic analysis were used for quantitative and qualitative data, PWS, suggesting that PWS are more insulin sensitive than controls. Fasting GLP-1 respectively. levels were comparable in PWS and controls, suggesting that it is not the driver of Results: FPs reported increased knowledge of medical evaluation of obese pediat- insulin sensitivity. The prolonged insulin and glucose response in PWS are sugges- ric patients (14% to 36%); behavioural goal-setting (36% to 93%); and motivational tive of abnormalities in glucose control. interviewing (57% to 79%). FPs’ perceived efficacy improved in addressing weight (43% to 93%). Routine promotion of healthy behaviours increased, facilitated by the PK2.3 use of the Live 5-2-1-0 message. Routine measurement of body mass index (BMI) Prevalence of Comorbid Conditions Pre-existing and Diagnosed at a increased (7% to 29%).Barriers to implementation were increased visit time, family Tertiary Care Pediatric Weight Management Clinic buy-in, and patient/staff capacity to measure BMI; the most-noted facilitator was Griselle Leon1, Elizabeth deKlerk2, Paola Luca1, 3, Michelle Jackman3, Raylene A. ready-to-use Live 5-2-1-0 resources (i.e. handouts/information sheets/goal-trackers/ Reimer1, Kimberly E. Connors4 prescriptions). 1. University of Calgary, Calgary, AB, Canada, 2. University of British Columbia, Van- Conclusions: The Live 5-2-1-0 Toolkit facilitated health promotion by FPs with their couver, BC, Canada, 3. Alberta Children’s Hospital, Calgary, AB, Canada, 4. University pediatric patients. Insufficient clinic staff capacity limited routine BMI measurement. of Alberta, Edmonton, AB, Canada The results will be used to refine the Toolkit and maximize its usability prior to wider dissemination across BC Divisions of Family Practice. Background: Childhood obesity places individuals at risk for a multitude of physical and mental health problems. Objectives: The aim of this study was to assess the prevalence of obesity related comorbidities diagnosed prior to and after attending a tertiary care pediatric weight management clinic. Methods: A cross sectional retrospective chart review of patients 2–17 years old

85 | 5th Canadian Obesity Summit | #COS17 Abstract Details

PK3.1 completely mediated the relationship between higher LDL and higher log-transformed BMI Smoking Does Not Significantly Worsen Lipid Changes Related to Increas- and the relationship between higher triglycerides and all measures of adiposity. Physical ing Adiposity in Adolescents: A Heart Niagara Healthy Heart Schools’ activity level (minutes of moderate to vigorous activity and sedentary time) did not mediate Program Study the relationship between any lipid variable and any adiposity variable. Brian W. McCrindle1, Don Gibson2, Karen Stearne2, Nita Chahal1, Stafford Dobson2, Conclusions: Greater physical fitness but not activity level may be associated with more Myriam Lafreniere-Roula1, Cedric Manlhiot1 favorable lipid values associated with increasing adiposity in youth. 1. The Hospital for Sick Children, Toronto, ON, Canada, 2. Heart Niagara, Inc., Niagara Falls, ON, Canada PK3.3 Body Fat Percentile Curves for Children and Youth of Asian and European Background: In adults, smoking lowers HDL-cholesterol levels and may increase Ancestry non-HDL-cholesterol levels by contributing to insulin resistance. The interaction Jennifer McConnell1, Patti-Jean Naylor2, Heather Macdonald3, 4, Lindsay Nettlefold3, between smoking and adiposity on lipids has not been well-defined for youth. Heather A. McKay3, 4, Ryan E. Rhodes2 Methods: All grade 9 students (ages 14–15 years) in the Niagara Region, Ontario, 1. Social Dimensions of Health, University of Victoria, Victoria, BC, Canada, 2. School of Ex- underwent screening for cardiometabolic risk factors for school years 2009–2016. ercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada, BMI and waist to height ratio (WHtR) were calculated, and fingerstick capillary sam- 3. Centre for Hip Health and Mobility, Vancouver, BC, Canada, 4. Department of Family ples assessed total cholesterol and HDL-cholesterol levels. Any current smoking was Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada assessed by self-report questionnaire. Regression analysis was used to determine interactions between smoking and adiposity. Understanding the trajectory of body fat accrual across maturity in youth is import- Results: Of 17,551 adolescents included (51% males), 16.8% were overweight, ant. Reference data for regionally- and ethnically-diverse Canadian youth do not 13.6% obese, 14.4% had WHtR>0.5-<0.6, 3.5% had WHtR>0.6, and 4.7% were currently exist. We created sex- and ethnic-specific percentile curves for body fat smokers. For non-smokers, HDL-cholesterol levels were 1.05(0.25)mmol/L for obese, percentage (BF%) and BF% velocity for a sample of British Columbian youth of Asian 1.19(0.33) for overweight and 1.32(0.34) for normal weight subjects; for smokers and European Ancestry (reference group). We utilized 4,733 observations from 944 levels were 1.01(0.25) for obese, 1.15(0.31) for overweight and 1.28(0.33) for normal youth (487 girls) aged 9-19 years from the UBC Pediatric Bone and Physical Activity weight subjects. The decrease associated with smoking was not significant (p=0.79), Database. Ethnicity was self-reported and BF% was obtained from whole body dual with no interaction with BMI percentile (p=0.22). For non-smokers, non-HDL-cho- energy X-ray absorptiometry scans. Analyses were centered by chronological and lesterol levels were 3.01(0.79) for obese, 2.69(0.69) for overweight and 2.46(0.63) biological age (years from age at peak height velocity, APHV). We created sex- and for normal weight subjects; for smokers levels were 2.97(0.75) for obese, 2.76(0.77) ethnic-specific BF% percentile and velocity curves using the GAMLSS method in R. for overweight and 2.50(0.69) for normal weight subjects. There was no significant Centile curves were materially different between girls and boys. For girls, centile association with smoking (p=0.66), with no interaction with BMI percentile (p=0.37). curves converged across ages; curves above the 50th centile decreased, curves Findings were similar when WHtR category was used as the measure of adiposity below the 50th increased and all curves increased by age 16. For boys, centile curves Conclusions: The relationship between lower HDL-cholesterol and higher above the 25th increased until approximately age 12 then all curves descended non-HDL-cholesterol with increasing adiposity was not significantly altered by and flattened by age 18. Centile curves for Asian and reference group participants current smoking in this population-based cross-sectional study of adolescents. were similar in shape for girls but not for boys. Velocity curves were also materially different between girls and boys and illustrate how maturity influences BF% accrual. PK3.2 These BF% percentile and velocity curves for a sample of British Columbian youth Cardiovascular Fitness and not Physical Activity Mediates the Relationship illustrate different trajectories of body fat accrual over chronological age and body between Dyslipidemia and Higher Adiposity in Canadian Youth fat velocity over biological age for girls and boys of different ethnic groups. Alisha N. Jamal1, 2, Chun-Po S. Fan3, Brian W. McCrindle1, 2 1. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada, PK3.4 2. Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada, 3. CV Data Growing Little Sprouts: Enhancing Supportive Environments in Childcare Management Centre, The Hospital for Sick Children, Toronto, ON, Canada Settings Tracy McDonough, Mary Jane Gordon, Emma Bassett Objective: We sought to determine if physical activity/fitness mediates the association KFL&A Public Health, Kingston, ON, Canada between adiposity and lipid values in children. Methods: Children <18 years participating in Cycle 1 and 2 of the Canadian Health Mea- Objective: Governments and experts have recommended that healthy environments sures Survey were included. Weighted descriptive and mediation analysis was performed, be established within childcare settings to prevent obesity. The objective of this study adjusted for age, sex, ethnicity, household income and smoking history. Physical fitness was was to pilot test a process for a local public health unit enabling licensed childcare determined from the modified Canadian Aerobic Fitness Test (mCAFT), and physical activity providers to develop or revise their centre’s policies on nutrition and physical activity. from accelerometry. Methods: Participants (“champions”) attended an introductory meeting, completed Results: Data from 4,400 subjects were analyzed. For non-HDL-cholesterol, a higher mCAFT an assessment of their centre’s nutrition and physical activity environment, set goals score (higher fitness) reduced the association between a higher non-HDL cholesterol and a including policy-related goals, and developed an action plan. Process and outcome higher BMI by 37% (p<0.001), 25% for waist to hip ratio (p<0.001), 40% for waist circum- evaluation included: pre- and post-pilot questionnaires for champions; monthly ference (p < 0.001), and 35% for log-transformed BMI (p<0.001), indicating that higher phone call logs; pre- and post-pilot policies; assessment, goal setting and action mCAFT score partially mediates these relationships. Higher mCAFT score partially mediated planning tools; post-pilot interviews with champions and project leads. the relationship between higher total cholesterol/HDL ratio and higher adiposity measures, Results: Thirteen licensed childcare providers participated. At follow up, 8 out of 13 as well as between lower HDL and higher waist-hip ratio. The relationship between higher sites reported having revised or created new policies for nutrition, physical activity adiposity measures and higher total cholesterol was completely explained by mCAFT or both. The largest differences in pre- and post-pilot mean scores was observed for scores indicating complete mediation. For LDL cholesterol and triglycerides, mCAFT score agreement with: “Having written policies and procedure assures children get the

86 | 5th Canadian Obesity Summit | #COS17 Abstract Details same care in each classroom, from day to day, and from week to week” and “Our • Links to full-text systematic reviews centre has staff capacity to revise and implement current or new policies”. Outcomes • Evaluations of online health resources reported by champions included adopting a team approach and collaborating to • Commentaries about scientific research develop policy and an increased ability to compare old and new policies. Champions The Portal is committed to providing accessible, evidence-based resources on topics found the experience to be rewarding and collaborative with public health. of interests to users, and to developing content, applications, promotion strategies Conclusion: This process can be replicated by other public health agencies to en- and research interventions to maximize the value. This presentation will provide an able childcare providers to develop or revise nutrition and physical activity policies. update on these activities specific to obesity and weight management. Participants are encouraged to bring a smart device for a demonstration of site features, and PK4.1 propose strategies for how the Portal could fit within their scope of practice. The Association of Delta-5- and Delta-6-desaturase Activities with Risk Learning Objectives: Factors for Type 2 Diabetes is Dependent on Plasma apoB in Obese • Learn how to access high-quality information about healthy aging via the Subjects McMaster Optimal Aging Portal Valérie Lamantia1, 2, 3, Simon Bissonnette1, 2, 3, Yannick Cyr1, 2, 3, Hanny Wassef2, 3, Rémi • Search for evidence from the latest published research to answer health questions Rabasa-Lhoret1, 2, 3, Christine Des Rosiers1, 4, May Faraj1, 2, 3 • Teach patients, research participants, clients, students, staff, and colleagues how to 1. Université de Montréal, Montréal, QC, Canada, 2. Institut de recherches cliniques find and critically appraise health information they find online de Montréal, Montréal, QC, Canada, 3. Montreal Diabetes Research Center, Mon- tréal, QC, Canada, 4. Montreal Heart Institute, Montréal, QC, Canada PK4.3 Trends in Medication Use by BMI and Age over Time in the United States Objective: Prediabetes is characterized by delayed fat clearance, inflammation, and Arshdeep K. Randhawa, Jennifer L. Kuk high insulin secretion (IS) and resistance (IR). High number of plasma apoB-lipo- York University, Toronto, ON, Canada proteins (apoB) promotes white adipose tissue dysfunction and type 2 diabetes (T2D). Dietary factors, such as omega-3 (n-3) fatty acids (FA) regulate plasma apoB. It is unclear whether the increased in prescription medication use over time differs FA desaturases, delta-5 (D5D) and delta-6 (D6D), convert dietary n-3 and n-6 FA into by age and obesity status. Data from 56,998 adults from the National Health and their bioactive counterparts. They associate with the incidence of T2D positively and Nutrition Examination Survey (NHANES) between 1988 and 2012 was analyzed. negatively, respectively. We hypothesized here that the link between D5D and D6D There was an increase in medication use over time among older individuals of all activities and T2D risk factors is dependent on plasma apoB. body mass index (BMI) groups, but not among younger individuals. In particular, Methods/Results: We examined IS and IR in N=81 (40% men, ≥27kg/m2, 45–74 the increases in medication use over time were most prominent in older individ- yrs, post-menopausal, non-diabetic and not on n-3 therapy) using intravenous-glu- uals with obesity (p<0.001). For example, 60 year old women with obesity took cose-tolerance test and hyperinsulinemic-euglycemic clamp. Plasma clearance of 1.8 more medications in 2012 than 1988 compared to 1.1 more medications for dietary fat was examined following ingestion of 13C-triolein-labeled-high-fat meal normal weight while there were minimal differences in 20 year old women with and (N=30). Plasma FA in phospholipids were measured by gas chromatography-mass without obesity (0.4 versus 0.1 medications). BMI, age and time were independent- spectrometry and used to estimate D5D and D6D activities from the product-to-pre- ly associated with the higher odds of taking antihypertensives, lipid-lowering cursor ratios. Plasma apoB range was 0.3-1.8g/L and average plasma n-6:n-3 FA was medication, antidiabetics and analgesics (p<0.05). Conversely, the odds of taking 12:1. Estimated D5D activity correlated negatively with plasma apoB, IR, 2nd phase IS, antibiotics were lower over time (p<0.05) while BMI and age were inconsistently delayed chylomicron clearance and plasma interleukine-1 receptor antagonist in wom- associated with the use of antibiotics (p>0.05). In conclusion, older individuals of en. Estimated D6D activity correlated positively with plasma apoB, IR and delayed fat all BMI groups had increased cardiometabolic and analgesic medication use over clearance in women. Adjustment for plasma apoB eliminated all associations of D5D time with the increase being most prominent in older individuals with obesity. The and D6D with T2D risk factors, except for that between D5D and chylomicron clearance. rise in medication use in older individuals of all BMI groups may be a function of Conclusion: In obese subjects on habitual diet, the link between D5D and D6D factors such as more medications available in the market, better disease detection, activities and T2D risk factors is dependent on plasma apoB. improved drug insurance coverage and increased drug marketing, but may also reflect differences in how medications are prescribed over time. PK4.2 The McMaster Optimal Aging Portal: a Tool to Provide Evidence-Based PK4.4 Information on Healthy Aging Weight Loss, Regression to Normoglycemia, and T2D Development at Sarah Neil-Sztramko, Maureen Dobbins, Anthony Levinson, John Lavis, Parminder 3 Years in Early Weight Loss Responders to Liraglutide 3.0 mg: SCALE Raina, Brian Haynes Obesity and Prediabetes Trial McMaster University, Hamilton, ON, Canada David C. Lau1, Ken Fujioka2, Frank Greenway3, Patrick O’Neil4, Peter B. Jacobsen6, Trine V. Skjøth6, Sten Madsbad7 Summary: There is an abundance of freely available information on the internet 1. University of Calgary, Calgary, AB, Canada, 2. Scripps Clinic, La Jolla, CA, USA, 3. relevant to health and wellness, but it is difficult for the general public to know Pennington Biomedical Research Center, Baton Rouge, LA, USA, 4. Medical Uni- which sources are trustworthy. The McMaster Optimal Aging Portal was launched versity of South Carolina, Charleston, SC, USA, 5. University of Liverpool, Liverpool, in 2014 as a resource for high quality, evidence-based information about health, United Kingdom, 6. Novo Nordisk, Copenhagen, Denmark, 7. Hvidovre Hospital, aging and common health conditions, including obesity and weight management. Hvidovre, Denmark The Portal is a one-stop shop for high-quality information about how to remain healthy, active and engaged as we grow older. Currently, the Portal contains >3300 Background: SCALE Obesity and Prediabetes (NCT01272219) randomized adults items related to obesity and healthy weights for citizens, clinicians, public health with prediabetes and obesity (BMI ≥30 kg/m2), or overweight (≥27 kg/m2) with professionals, policy-makers and researchers, including: comorbidities to liraglutide 3.0 mg (N=1505) or placebo (N=749) as adjunct to diet • Quality-rated summaries of the best available scientific evidence · and exercise for 3 years.

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Methods: This post-hoc analysis compared liraglutide 3.0 mg early responders PK5.2 (ERs; ≥5% weight loss [WL] at Week [W] 16) and early non-responders (ENRs; <5% The REFRESH Study Recreation Environment and Food Research: WL at W16). Efficacy outcomes are estimated means in ERs (n=580) and ENRs Experiences from Hockey – Perspectives Revealed Through the (n=210) who completed 160 weeks’ treatment. Development of T2D/regression to Photovoice Method normoglycemia were analyzed using LOCF. Susan Caswell1, Rhona Hanning1, Jessica Lieffers2 Results: Of those with W16 data, 68.0% receiving liraglutide 3.0 mg (n=1302) 1. University of Waterloo, Waterloo, ON, Canada, 2. University of Alberta, Edmonton, were ERs, 32.0% ENRs; 22.3% receiving placebo (n=640) were ERs, 77.7% ENRs. At AB, Canada W160, greater WL (–8.6% and –9.1 kg [ER]; –2.9% and –3.1 kg [ENRs]), lower rates of Objectives: Unhealthy dietary behaviours are prevalent among Canadian adoles- T2D development (0.5% ERs, 3.2% ENRs) and greater regression to normoglycemia cents who participate in organized sports. This research aimed to explore, from the (69.8% in ERs, 55.4% in ENRs) were observed in ERs to liraglutide 3.0 mg vs ENRs. perspective of adolescent hockey players, the broad social and physical environ- ERs showed greater clinical (FPG, HbA1c, SBP levels) and patient-reported improve- mental influences of exposure to the recreational food environments on their food ments vs ENRs (SF-36 score +3.68 vs +1.81 and IWQOL-Lite score +13.40 vs +9.53 choices and behaviours using a modified photovoice method. Parent perspectives of [increase in score=improvement]). Adverse events (AEs) and gastrointestinal AEs players’ experiences were also explored. were similar between groups (87.1% and 75.3% for ERs; 95% and 71.6% for ENRs) Methods: Twenty-four hockey players aged 12–15 were recruited within Ontario to while serious AEs and gallbladder disorders were more frequent in ERs (17.7% and take photographs illustrating their experiences with food choices around participa- 6.3% vs 12.7% and 2.2% for ENRs). tion in recreational hockey. Players interpreted illustrated perceptions in individual Conclusions: Among those treated with liraglutide 3.0 mg for 160 weeks, greater interviews. Guided by the SHOWeD method, participant focus groups discussed benefits were seen in ERs vs ENRs; overall AE rates were similar. experiences represented in the photographs. Their experiences were showcased at an exhibit for stakeholders. To gain further insight, five parents were individually PK5.1 interviewed. Interview and focus group transcripts were thematically analyzed. Neighbourhood Built Design and Socioeconomic Composition and Their Results: Both players and parents perceived recreational facility food options as Associations with Weight Status in Canadian Adults unhealthy. Perceptions also overlapped around travel and time constraints. Players Gavin McCormack1, Christine Friedenreich2, 1, Lindsay McLaren1, Melissa Potestio3, reported influences including the importance of nutrition for performance and Ilona Csizmadi1, Beverly Sandalack1 recovery (i.e., protein, chocolate milk), media and branding (i.e., Tim Horton’s), 1. University of Calgary, Calgary, AB, Canada, 2. Department of Cancer Epidemiology tournaments, team meals, and moral values. Parents’ perceived influences included and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, tournament meals, and the “traditional” hockey food environment. AB, Canada, 3. Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Conclusions: Results indicate that recreation facilities are only one in a range Calgary, AB, Canada of environments that influence eating behaviours of adolescent hockey players. Perceptions around brand and product messaging supports how vulnerable Objective: Neighbourhood socioeconomic composition and built design are adolescents are to advertising and promotion. Players embraced healthier choices correlates of weight-related behaviours. We investigated the relations between associated with performance indicating that value associations are essential to neighbourhood design and socioeconomic status (SES) and their interaction, in inform messaging and intervention strategies targeting healthy eating behaviours. relation to waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) in a sample of Canadian adults PK5.3 Methods: Using stratified random sampling, 12 established Calgary neighbour- The Impact of Accelerometer Wear Location on Physical Activity Estimates hoods built prior to 1980 were selected as recruitment sites. The 12 neighbour- and the Relationship with Arterial Health in Adults Treated for Hypertension hoods were defined by their design (grid, warped-grid, or curvilinear block patterns) and Diabetes and socioeconomic status quartiles. In 2014, a random sample of households Alexandra B. Cooke, Stella S. Daskalopoulou, Kaberi Dasgupta (n=10,500) from the 12 neighbourhoods were mailed a survey package. One adult McGill University, Montreal, QC, Canada (aged ≥20 years) per household was invited to participate. The survey package included instructions for completing two online questionnaires capturing physical Objectives: Accelerometer placement may have important methodological impli- activity, health, diet, and demographic characteristics. The survey package also cations for assessing physical activity (PA) levels. Therefore, we aimed to evaluate the included a tape measure and instructions for measuring waist and hip circumfer- impact of wrist and waist accelerometer location on step counts and PA, as well as ence. N=851 provided complete data. Covariate-adjusted linear regression models the relationship between step counts and a responsive clinical outcome, carot- estimated associations between BMI, WC, and WHR in relation to neighbourhood id-femoral pulse wave velocity (cfPWV). design and socioeconomic status and their interaction. Methods: We included a matched sub-group of participants from a larger cohort of Results: WC and BMI were higher among residents of disadvantaged neighbour- 369 adults with HTN and/or T2DM recruited to evaluate the responsiveness of cfPWV to hoods, independent of neighbourhood design and covariates. The association step counts. Accelerometers were worn (Actigraph GT3X+) for the assessment of steps, between neighbourhood-level SES and WC was modified by neighbourhood sedentary time, and moderate-to-vigorous-PA (MVPA). We compared the waist and wrist design – WC was higher in disadvantaged-curvilinear neighbourhoods and lower in location (N=47 per group). Pedometers (Yamax SW-200) were worn simultaneously at advantaged-grid neighbourhoods. the waist in all participants. cfPWV was measured using applanation tonometry. Conclusion: Participants in advantaged neighbourhoods had smaller WC and BMI. Results: Despite comparable pedometer-derived step counts, wrist group participants Neighbourhood design and socioeconomic composition jointly effected WC. Policies had significantly higher accelerometer-derived step counts by 3955 steps/day (95% CI that promote physical activity and healthy diet and that make less obesogenic 2499, 5411), greater MVPA by 132.9 mins (95% CI 108.9, 156.9), and lower sedentary neighbourhoods affordable to low socioeconomic households are necessary. time by 3.8 hours (95% CI -4.5, -3.2) compared to the waist group. In full cohort of 369 participants, a 1000 step/day increment was associated with a 0.1m/s decrement in cfPWV. In our matched analysis, accelerometer-derived step counts measured at the waist also trended with cfPWV; however, we observed no relationship with wrist-derived steps.

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Conclusion: Our findings demonstrate large differences in PA estimates between from others, (15.4% and 8.3% at 1 and 2 years after surgery, compared to 17.3% the wrist and waist location. Furthermore, misclassification of PA levels specifically before surgery, p<0.05). due to the wrist location eliminated any sign of a relationship between step counts Conclusion: For patients living with severe obesity, bariatric surgery is capable and a PA-linked clinical outcome. of helping to reduce indirect costs associated with obesity and consequently the financial burden on these individuals. PK5.4 The Association Between Functional Skills Movements and Obesity-Related PK6.2 Risk Factors and Fitness Level Relationship of Weight Loss Expectations to Bariatric Surgery Outcome Andrea Mayo1, Megan E. Comeau1, Cindy Levesque1, Michel J. Johson2, Danielle Allison A. Holgerson1, Matthew M. Clark1, Gretchen Ames2, Manpreet Mundi1, Todd Bouchard1, Martin Sénéchal1 A. Kellogg1, Karen Grothe1 1. University of New Brunswick, Fredericton, NB, Canada, 2. Universite de Moncton, 1. Mayo Clinic, Rochester, MN, USA, 2. Mayo Clinic, Jacksonville, FL, USA Moncton, NB, Canada While bariatric surgery is highly effective, individuals often have unrealistic expecta- Background: It has been hypothesized that children with better fundamental tions of weight loss following bariatric surgery. It is proposed that these unrealistic movement skills (FMS) do more physical activities, and thus are healthier. expectations might impede outcomes. Expectations for weight loss and relationship Objective: The main objective of this study was to evaluation the association to outcomes following bariatric surgery were examined. Participants were 97 (78% between FMS and body mass index. Secondary objectives include the FMS scores female, mage = 48.24, mBMI = 46.72) patients who underwent bariatric surgery evaluated with two different tools, and to evaluate the association between FMS and (61% gastric bypass, 24% sleeve gastrectomy, 15% biliopancreatic diversion (BPD)). other health indicators. Individuals completed the Goals and Relative Weights Questionnaire identifying how Methods: A total of 145 children were recruited and were tested in schools, after much percentage weight loss they desired (%WLD) to achieve four weight categories: school’s program and summer camps throughout the province of New Brunswick. dream, happy, acceptable, and disappointed. Mean %WLD was: dream (45.74%), Fundamentals skills (e.g., kicking, throwing, jumping) were evaluated using the happy (38.45%), acceptable (32.36%), and disappointed (21.07%). Patients who Passport for life (i.e., lateral bound, plank, circuit, run, kick, throw and catch, and the underwent BPD reported higher than average expectations: dream (55.67%), happy Play Basic (i.e., run, hop, throw, kick and balance walk). Health indicators were body (46.93%), acceptable (40.00%), and disappointed (23.93%). Groupings (high, average, mass index, handgrip strength using a dynamometer, fitness level using the shuttle low) were created within desired weight loss categories using standard deviations. test, waist circumference, and body fat percentage using bioimpedance. Controlling for pre-surgery weight, regression analyses demonstrated that high dream Results: BMI was significantly associated with 67% of FMS using the Passport %WLD predicted greater %WL one year post-surgery [F (2, 93) = 7.92, p = .001, R2 for life (r ranging from -.18 to -0.32; P<.05), 60% of FMS using the Play Basic (r = .15, bdream = 4.43 (p = .023)]. This study is the first (to our knowledge) to include ranging from -.15 to -0.30; P<.05). In both tools, the association was not significant BPD patients, who desire more weight loss than patients seeking other procedures. For for kicking and throwing. Similar results were observed for other health indicators. this sample overall, higher weight loss expectations might have enabled outcomes. Conclusion: BMI and other health indicators in children are associated with FMS. Providers should educate patients about surgical weight loss outcomes to foster realis- Because of the study design, it is unknown if interventions that improve physical lit- tic yet bold goals. Future research should examine psychological (i.e. self-efficacy) and eracy or health indicators may be one means of improving these so children become medical factors (surgery type) that contribute to positive outcomes for those with high or stay active. This needs to be empirically tested. expectations, opposed to those whose expectations might impede efforts.

PK6.1 PK6.3 The Economic Impact of Bariatric Surgery: A Retrospective Cohort Study Long-Term Impacts of Adding Supervised Exercise Training to Interdisci- Jillian Vallis, Kendra Lester, Deborah Gregory, Laurie Twells plinary Lifestyle Management in Subjects Awaiting Bariatric Surgery Memorial University of Newfoundland, ST JOHN’S, NL, Canada Aurélie Baillot1, 2, Warner Mampuya3, 4, Isabelle J. Dionne5, 6, Emilie Comeau7, Marie France Langlois3, 8 Objective: Individuals living with severe obesity report impaired quality of life, 1. Université du Québec en Outaouais, Gatineau, QC, Canada, 2. Institut de recherche increased health services use and costs, and increased indirect costs due to absen- de l’Hôpital Montfort, Ottawa, ON, Canada, 3. Centre Hospitalier Universitaire de teeism, disability, and reduced work place productivity. The objective of this study Sherbrooke Research Center, Sherbrooke, QC, Canada, 4. Department of Medicine, is to determine the impact of bariatric surgery on short term economic outcomes in Division of Cardiology, Université de Sherbrooke, Sherbrooke, QC, Canada, 5. patients undergoing laparoscopic sleeve gastrectomy (LSG). Research Centre on Aging Health and Social Services Centre, Institute of Geriatrics, Methods: A retrospective cohort study was used to examine the effect of LSG on Sherbrooke, QC, Canada, 6. Faculty of Physical Activity Sciences, Université de economic outcomes using standardized case report forms. Bariatric surgery clinic Sherbrooke, Sherbrooke, QC, Canada, 7. Department of Surgery, Division of General patients consented to provide self-reported data on: weight loss interventions and Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada, 8. Department of Medi- mobility aids purchases, workforce productivity, home productivity and employ- cine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC, Canada ment status at baseline and every 6 months for 2 years. Economic outcomes were Background: We have previously reported the beneficial effects of Pre-Surgical Exer- compared pre- and post-surgery. cise Training (PreSET) on physical fitness and social interactions in subjects awaiting Results: Two hundred one patients were enrolled, with 81.6% being female and bariatric surgery (BS). However, post-BS data are required to confirm durable long- 91% Caucasian with an average age and BMI of 44yrs and 48.78 kg/m2, respectively. term effects of PreSET. Approximately 76% of patients had purchased weight loss products pre-surgery, which was significantly reduced to 43.8% and 23.8% at 1 and 2 years post-surgery, Objective: To evaluate the impacts of PreSET on physical activity (PA) level, physical respectively (p<0.05). Similarly, 5.2% and 3.6% of patients required mobility aids fitness and quality of life (QoL) one year after BS. at 1 and 2 years post-surgery, respectively, which was significantly reduced from the Methods: Of the 30 subjects randomized in 2 groups (PreSET -endurance and 13.2% of patients before surgery (p<0.05). Patients also required less assistance strength training before BS-, and control), 27 were re-evaluated one year after BS. All

89 | 5th Canadian Obesity Summit | #COS17 Abstract Details participants received usual care including individual lifestyle counselling before and group had similar demographic and anthropometric profiles, but were pursuing after BS. At baseline and one year after BS, physical fitness was assessed with symp- non-surgical forms of weight management. Anthropometry (weight, BMI), nutrition tom-limited cardiac exercise test, 6-minute walk test (6MWT), sit-to-stand, half-squat (knowledge, motivators), psychometric (depression, anxiety, self-esteem, quality and arm curl tests, and QoL and PA level were obtained with questionnaires. One year of life) and biochemical analyses (glucose levels, lipid profile) were all measured after BS, energy expenditure and step number were estimated using an accelerometer. initially, and at 3 month intervals for 12 months thereafter. Results: The 6MWT distance (+104 vs. +24m) and half-squat test (+30 vs. +4s) Results: Significant differences in anthropometry (weight, BMI), nutrition (knowl- changes were greater in the PreSET group compared to the control group (p≤0.05). edge), psychometric (anxiety, self-esteem, quality of life) were observed between The number of steps (6272 vs. 4268) and level of moderate PA (0.6 vs. 0.2 hour/ test and control groups. No differences were observed in glucose levels between proce- day) were higher in the PreSET group one year after BS (p≤0.04). No significant dures (SG versus RYGB). Both triglyceride levels and cholesterol fractions decreased difference between the 2 groups was observed for the other parameters. after both procedures. Changes in lipid profiles, total cholesterol, and activity of liver Conclusion: The addition of a supervised PreSET to individual lifestyle counselling enzymes were more notable after RYGB than SG – indicative of liver overload. is effective in improving moderate PA and physical fitness one year after BS. Studies Conclusions: Results from this study suggest that bariatric surgery can have signif- with larger cohorts are now required to confirm these findings. icant impact on outcomes in patients – far beyond simple anthropometric measures, and is unquestionably more effective in weight management. Furthermore, potential PK6.4 liver overload and absorption limitations suggest that the SG procedure might be Psychosocial Predictors of Cognition in Bariatric Surgery Candidates considered a primary option when surgical intervention is available. Mario Moscovici1, 2, Susan Wnuk1, 2, Allan Okrainec1, 2, Raed J. Hawa1, 2, Sanjeev Sockalingam1, 2 P1.02 1. UHN, Toronto Western Bariatric Surgery Program, Toronto, ON, Canada, 2. Univer- Effects of Vitamin D3 and N-3 Polyunsaturated Fatty Acids on the sity of Toronto, Faculty of Medicine, Toronto, ON, Canada Development of Metabolic Syndrome in a Mouse Model of Diet-induced Obesity Background: Bariatric surgery is an important treatment option for obesity, Marion Valle1, 2, Geneviève Pilon1, 2, Philippe St-Pierre1, 2, Denis Richard1, Edgar Delvin4, however mental health conditions can have a significant impact on post-operative Claudia Gagnon3, Émile Levy4, André Marette1, 2 morbidity and successful weight loss. This study aims to identify the relationship 1. Quebec Heart and Lung Institute (IUCPQ)- Laval University, Quebec, QC, Canada, between cognition and psychosocial and demographic variables in bariatric surgery 2. Institute of Nutrition and Functional Foods (INAF)- Laval University, Quebec, QC, candidates. The secondary objective was to identify how cognition relates to quality Canada, 3. Endocrinology and Nephrology Unit, CHU de Québec Research Centre, of life and work impairment in this patient population. Quebec, QC, Canada, 4. Sainte Justine Hospital Research Center - University of Methods: In this cross-sectional study, 302 bariatric surgery candidates were assessed Montrea, Montreal, QC, Canada pre-operatively for demographics, cognition (PDQ5), employment impairment (LEAP), depression (PHQ9), anxiety (GAD7), quality of life (SF36) and psychiatric diagnoses (MINI Background: It has been proposed that vitamin D3 (VD3) and n-3 polyunsaturated interview). A multivariate ANOVA was performed to identify significant predictors of cog- fatty acids (n-3 PUFA) improved inflammation and protected from T2D and CVD but nition. A sub-group analysis was performed to identify whether self-reported cognition their combined effects have never been explored. independently predicts work impairment or quality of life while controlling for anxiety Objectives: Determine the long-term independent and combined effects of VD3 and depression. Significance was defined as p<0.05. and n-3 PUFA supplementation on metabolic syndrome in obese mice. Results: Anxiety, depression scores, quality of life predictors and work impairment, Methods: C57BL/J6 mice were fed a high-fat high sucrose (HFHS) diet for 12 but not BMI, were significantly associated with cognition in bariatric surgery candi- weeks. Two groups receive regular 1,400 UI of VD3/kg of food and two groups were dates. Cognitive symptoms significantly predicted work productivity but not quality supplemented with 15,000 IU of VD3 /kg of food. One of each VD3 group was of life after controlling for anxiety and depressive symptoms. additionally fed with 4.35g/kg of fish oil rich in n-3 PUFA. Discussion: Anxiety and depressive symptoms are important predictors of cogni- Results: Food intake was not different between groups. VD3 supplementation tion in bariatric patients independent of BMI and as a result, cognitive testing using significantly increased the plasma levels of 25(OH)D3, specifically the 3-epi-25(OH) the PDQ5 questionnaire, can provide additional information on the psychosocial D3 form representing 30% of the total 25(OH)D3 versus ≤3% in the group fed with burden pre-surgery. Further, this study supports the impact of cognitive symptoms regular VD3. n-3 PUFA increased energy expenditure as shown by indirect calorim- on work productivity independent of anxiety or depressive symptoms or BMI. etry although it did not translate into lower diet-induced weigh gain. Nevertheless, Further studies are needed to explore changes in these relationships post surgery. mice fed diets containing n-3 PUFA showed an improved glucose homeostasis during oral glucose tolerance test and lower triglycerides accumulation in liver. VD3 P1.01 supplementation did not further improve these parameters. Anthropometric, Nutritional, Psychometric, and Biochemical Parameters of Conclusions: These data show that n-3 PUFA treatment can improves features of Individuals After SG and RYGB Bariatric Procedures: A 12-Month Observation the metabolic syndrome in HFHS-fed mice. However, combination with VD3 supple- Keith Z. Brewster, Janet See mentation failed to enhance the beneficial effects of n-3 PUFA. We further plan to University of British Columbia, Vancouver, BC, Canada investigate the impact of these nutrients on gut health, as the VD receptor is known to be expressed in the intestine. Background: Though anthropometry is often the primary measure when assessing bariatric surgery, outcomes from these procedures can extend far beyond; both positively and negatively. The aim of this study was to evaluate the effect of sleeve gastrectomy (SG) and Roux-en-Y-bypass (RYGB) on anthropometric, nutrition, psychometric, and biochemical parameters. Methods: 100 participants (50 test and 50 control) were assessed for this study. The test group comprised of 50 bariatric surgical patients (pre-op) while the control

90 | 5th Canadian Obesity Summit | #COS17 Abstract Details

P1.03 P1.05 Dysfunction of the Orbitofrontal Cortex in Diet-Induced Obesity Gaining Expert Consensus on Defining Metabolically Healthy Obesity Lindsay Naef, Corey Baimel, Stephanie Borgland (MHO) in Pediatrics: A Delphi Study University of Calgary, Calgary, AB, Canada Samah Damanhoury1, Amanda S. Newton2, Geoff D. Ball2 1. Department of Agricultural, Food, and Nutritional Science, Faculty of Agricultural, The orbitofrontal cortex (OFC) is involved in the cognitive control of reward Life, and Environmental Sciences, University of Alberta, Edmonton, AB, Canada, 2. processing. It keeps information online and updates behaviour based on changing Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, reward contingencies. Human studies have demonstrated that obesity is associated Edmonton, AB, Canada with lower behavioural adaptation to reward devaluation. The goal of the present experiments was to test the hypothesis that the OFC is impaired in an animal model Background: The metabolically healthy obesity (MHO) phenotype has been of diet-induced obesity associated with altered reward devaluation. Mice with described since the 1980s; however, no standardized definition has been used to diet-induced obesity display deficits in reward devaluation. Furthermore, obese define MHO in pediatrics. The purpose of this research is to determine a universal mice exhibit decreased inhibitory input onto pyramidal neurons of the lateral OFC MHO definition in pediatrics. measured with whole cell patch clamp electrophysiology. To determine if decreased Methods: We are conducting a Delphi study, a structured communication tech- inhibitory input to pyramidal neurons leads to impairment in reward devaluation in nique to gain consensus from a panel of experts on a universal definition for MHO normal weight animals, we expressed an inhibitory Designer Receptor Exclusively in pediatrics. We will enroll ~25 participants with expertise in pediatric obesity, car- Activated by Designer Drugs (DREADD) in VGAT ires cre mice. Inhibition of GABAer- diometabolic risk, and MHO. We will use an online platform (REDCap®) to conduct gic inputs to the lateral OFC by clozapine N-oxide (CNO) administration impairs multiple survey rounds (at least 3; up to 5). Each survey will include questions relat- reward devaluation. Together, these results demonstrate that obesity induces ed to a number of issues, including MHO risk factors (e.g., triglycerides), risk factor neuroadaptations in the lateral OFC to alter the processing of sucrose rewards, such cut-offs (e.g., triglycerides < 150 mg/dl), and BMI classification systems. After each that obese mice do not accurately update the reward value of rewards. survey round, expert responses will be anonymized, summarized using descriptive statistics, and used to inform experts’ responses in subsequent rounds. Consensus P1.04 on the MHO definition will be defined as having 80% agreement among the experts Behavioural Modification for Adolescents with Obesity/Overweight: an on all questions. Final results will be summarized and shared with participants for Explanatory Conceptual Framework for Motivational Interviewing final approval on the universal MHO definition in pediatrics. This study will start in Nita Chahal1, Janet Rush2, Brian McCrindle1, Katherine Boydell3, Ahlexxi Jelen1 fall, 2016; data will be presented at the Canadian Obesity Summit in 2017. 1. Hospital for Sick Children, Toronto, ON, Canada, 2. Hamilton Health Science, Significance: A universal definition of MHO in pediatric has implications for obesity Hamilton, ON, Canada, 3. Mental Health Black Dog Institute Hospital Road, Sydney, management and health system resource allocation. Applying a consensus-based NSW, Australia definition can help to identify individuals for early interventions, prevent inappropriate interventions for individuals with MHO, and enable comparisons within and Background: Adolescents with overweight/obesity are at greater risk of developing between studies. cardiometabolic disease into adulthood and health promotion strategies are critical in risk reduction. Behavioural management is the preferred first-line intervention P1.06 for adolescents; a unique population where ambivalence to change is typical. Familial Perceptions of Weight and Health: A Qualitative Analysis Among Motivational Interviewing (MI) is considered an effective behavioural strategy for Parents and Children individuals ambivalent to lifestyle change. A comprehensive conceptual framework Anastasia Dikareva2, Eva Pila1, Catherine M. Sabiston1 for MI was sought but not evident in the literature. Theoretical and conceptual 1. University of Toronto, Toronto, BC, Canada, 2. Canadian Obesity Network Students frameworks are valuable reference tools for education, research and standard clinical and New Professionals, Edmonton, AB, Canada practice. To develop a comprehensive theoretical model for MI, various concepts, contexts, and components from the MI literature were consolidated into an explana- Youth are susceptible to the physical and psychosocial consequences related tory, instructive framework. to weight management. The family environment is critical in shaping health Methods: Analysis of the literature revealed overlapping and recurring theorists, behaviours related to weight control. However, little is known about communica- concepts, terms and processes. A descriptive, conceptual framework was developed tion and perceptions of weight and health within a family context. This multiple for MI with application to adolescents experiencing overweight/obesity. Special con- case study explored perceptions and communication related to weight and health sideration for adolescent growth and development was applied to the framework. among parents and children across five families. Through within-case analysis, Results: Exploration of the literature identified the dynamic interplay of four key families identified unique individual and familial perceptions of weight and elements: the problem (ambivalent behaviour); the person (overweight/obese ado- health. A cross-case analysis revealed barriers and facilitators to healthy behaviours; lescents and biopsychosocial factors); the counsellor (specific attributes following MI community weight talk; and parental role modeling in relation to health and weight training); and the process (stages of change). management. These findings demonstrate the complexity of perceived barriers to Conclusion: The MI conceptual framework is a pragmatic, evidence-based tem- health as well as individual and family weight-related perceptions among parents plate, useful for clinical practice, teaching, and research/evaluation. While applied to and children. Thus, health promotion interventions should consider the family con- the adolescent who is obese or overweight, it is also useful for application to other text; communication between parents and children related to weight and health; as clinical situations where lifestyle change is warranted. well as parenting health practices. Parents play a critical role in cultivating positive weight-related attitudes and healthful behaviors for children. Youth is formative period in life where individuals are vulnerable to weight-related pressures in and out of the home environment.

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P1.07 P1.09 Early Childhood Exposure to Antibiotics and the Association with Microbiome Clinical Correlations of 2-Hour and 5-Hour Glucose Tolerance Tests in Changes, Weight and Diabetes Later in Life: A Systematic Review Subjects with Obesity Archita Srivastava2, Kim Chau1, Lyubov Lytvyn1, Henry Kwon3, Bradley C. Johnston1 Marcela Rodriguez Flores, Emma Chavez Manzanera, Carlos A. Aguilar Salinas, 1. The Hospital for Sick Children, Toronto, ON, Canada, 2. McMaster University, Eduardo Garcia Garcia Hamilton, ON, Canada, 3. Wayne State University, Detroit, MI, USA Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, DF, Mexico

Background: The gut microbiota in early childhood is sensitive to modulating factors, such Background: Monophasic and biphasic curves in the oral glucose tolerance test as antibiotic use, which can alter the microbiota and lead to an increased risk of disease later (OGTT) identify different patterns of insulin secretion and sensitivity which could in life. This systematic review aims to evaluate the evidence on the potential impact of early predict feeding responses and progression to type 2 diabetes (T2DM). We assessed and multiple antibiotic exposures on the gut microbiota and health outcomes later in life. the impact of a 6-month obesity program according with the participants’ response Methods: A search of relevant databases was conducted from inception to June 2016. The to a 2-hour and 5-hour OGTT. keywords used included antibiotic, children, microbiome, overweight, obesity, diabetes.Ob- Methods: Five hundred and ninety-nine men and women with obesity (mean BMI servational studies or randomized trials involving children (aged 0 to 18 years) evaluating 44±8 kg/m2) aged 37.7±10 years participated in a six-month medical obesity treat- the potential impact of antibiotics in early life on microbial diversity and the incidence of ment program which included counseling to reduce overeating and hypoglycemia. overweight, obesity and diabetes will be included.Target outcome measures include: micro- Participants underwent a 2-hour OGTT, and 108 patients had an extended 5-hour biota diversity, incidence of overweight (BMI ≥ 25), obesity (BMI ≥ 30), and diabetes (yes/ test in order to confirm hypoglycemia and/or hyperinsulinemia. Levels of weight no). Risk of bias and the quality (certainty) of the estimates using Grading of Recommenda- loss (WL), and remission of comorbidities were determined according with three tions, Assessment, Development and Evaluation (GRADE) guidelines will be assessed. different patterns in the OGTT: Hypoglycemia, monophasic, and biphasic curves. Results: Twenty-nine studies were included; twelve studies examined the impact on Results: Among study participants, 22% had glucose intolerance, 34% had T2DM, microbiota changes, thirteen on overweight and obesity, and four studies addressed and 22% and 31% had biphasic and monophasic patterns, respectively. Men had diabetes. Full results will be presented at the meeting. higher early (basal to 90’) insulin, hypoglycemia and hypertension than women, Conclusions: It is estimated that children by the age of two have received approx- and women were more likely to have a biphasic pattern and higher glucose from imately three courses of antibiotics and approximately ten courses by the age of ten 90’ to 3 hours in the OGTT (p<0.05). The monophasic pattern in the 2-hour OGTT years. Early-life antibiotic exposure may permanently disturb the microbiota. Find- was associated with higher fasting glucose, triglycerides, hypertension, 60’ and 90’ ings will show the potential impact of antibiotics on health outcomes and highlight insulin, and new onset T2DM, and with less hypoglycemia (p<0.05), but not in the the potential importance of judicious use of antibiotics. 5-hour OGTT. WL was only positively associated with presence of hypoglycemia. Conclusion: The monophasic response was associated with worse metabolic P1.08 profile, which was more prevalent in men with obesity, despite achieving higher WL. Resting Metabolic Rate and Appetite Sensations are Not Affected by Different the Degree of Caloric Restriction: Preliminary Data P1.10 Luzia J. Hintze4, 3, 1, Gary Goldfield2, 3, 1, Ryan Seguin4, 3, 1, Aleck Damphousse4, 3, 1, Eric Obesity, Depression and Erysipelas a Clinical Correlation in Workers Doucet4, 3, 1 Sana Ahmed1, Musleh Uddin Kalar2 1. University of Ottawa, Ottawa, ON, Canada, 2. Children’s Hospital of Eastern Ontario 1. ST International, Lahore, Pakistan, 2. Qureshi Clinic of Family Medicine, Karachi, Pakistan Research Institute, Ottawa, ON, Canada, 3. School of Human Kinetics, Ottawa, ON, Objective: To determine the association of obesity with depression and erysipelas. Canada, 4. Behavioral Metabolic Research Unit, Ottawa, ON, Canada Introduction: Population based studies have found associations between obesity and depression and researchers have utilized body mass index (BMI) to establish obesity. Background: Energy restrictions promote metabolic adaptions in energy expenditure Probable intervening factors include deprived physical health associated with depres- (EE) and energy intake (EI) that collectively decrease body weight and fat losses. However, sion. Erysipelas is an infectious disease of the dermis and subcutaneous tissue due to it remains uncertain whether the degree of energy restiction impacts in the magnitude of streptococci. Obesity is a well known risk factor for erysipelas. the decrease in EE and increase in appetite and EI when weight loss is the same. Methods: Sample size was estimated by using the World Health Organization Objective: To investigate the changes in resting EE, appetite and EI in women who (W.H.O) software. BMI was assessed from the National Heart, Lung, and Blood Institute lost the same amount of weight but were engaged in either FAST (-1000kcal, 10- U.S. Department of Health and Human Services website. Depression was assessed week) or SLOW (-500kcal, 20-week) weight loss program. from Patient Health Questionnaire (PHQ-9) scores and Erysipelas was diagnosed by Methods: The data includes 12 women (5 SLOW and 7 FAST). Resting EE was dermatologist. Predictor or independent variable was obesity and response or depen- assessed by indirect calorimetry and appetite ratings (Desire to eat, hunger, fullness dent variables were depression and erysipelas. Binary logistic regression analysis was and prospective food consumption=PFC) were measured using Visual Analogue used to determine the association between dependent and independent variables Scale. EI was measured with a validated food menu. with a threshold for selection of p<0.05 as statistically significant. Results: Resting EE decreased in both groups (SLOW -5.35% FAST -2.81%, p=0.043), Results: Among the sample of 100 workers, 25% were obese and among them similarly to body weight (-6.7% SLOW –5.4% FAST, p<0.001). Fasting PFC increased 15% had depression and 5% had erysipelas. Binary logistic regression analysis after weight loss (p=0.05), while fasting hunger tended to increase (p= 0.09). Post showed depression was (OR 1.77; 95% (CI): 1.57-2.84) and erysipelas was (OR prandial appetite was not changed after the program. EI tended to increase in the first 1.14; 95% (CI): 1.05-2.69), were statistically significant (p<0.001). week and to decrease by the end of the trial. The most important finding of this study Conclusion: This study found an association between obesity, depression and is the absence of differences between the FAST and SLOW for all analyses performed. erysipelas. Obesity was an independent risk factor for depression and erysipelas. Conclusions: The preliminary results suggest that different degrees of caloric restriction Prospective studies should explore obesity as a possible mediator in the relationship promote a similar impact on resting EE, fasting appetite sensations and post prandial between obesity, depression and erysipelas among workers. appetite in women, when final weight losses are similar between groups.

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P1.11 in the concentration of main pyruvate metabolites. Average urine trigonelline level Body Mass Index and Risk of Dementia: a Retrospective Cohort Study of was 0.0002 mmol/L in control, 0.0377 mmol/L in coffee, and 0.0249 mmol/L in 513,775 Korean Adults chemicals group at the endpoint. Kyoung Hwa Ha1, Hyeon Chang Kim2, Dae Jung Kim1 Conclusion: A combination of phenolic acids and trigonelline did not have the same 1. Ajou University School of Medicine, Suwon, Korea, 2. Yonsei University College of level of effectiveness as coffee in improving the components of the MetS. This finding Medicine, Seoul, Korea points to the possible role of other coffee chemicals, and also to the potential synergism between them. More complex combinations need to be evaluated in the future studies. Objective: We investigated the association between body mass index and the risk of Alzheimer’s disease and vascular dementia in a nationwide sample of Korean adults. P1.13 Methods: Study population was randomly sampled 513,775 adults who were Discordance of Perceived Weight Status in Canadian University Students aged 40 years or older and completed health screening tests conducted by the Renita Lam1, June I. Matthews1, Paula D. Dworatzek1 Korea National Health Insurance (NHI) in 2002 or 2003. Body mass index (BMI) 1. School of Food and Nutritional Sciences, Brescia at Western University, London, was classified into five groups: underweight (<18.5 kg/m2), normal (18.5–22.9 ON, Canada, 2. Schulich Interfaculty Program in Public Health, Western University, kg/m2), overweight (23.0–24.9 kg/m2), obese class I (25.0–29.9 kg/m2) and obese London, ON, Canada class II (≥30.0 kg/m2). Diagnoses of Alzheimer’s disease and vascular dementia over 10 years (2004 through 2013) were abstracted from the NHI claim database. Objectives: This study aims to investigate university students’ perceptions of their Cox proportional hazard regression analysis was conducted with adjusting for age, own weight status (underweight, normal, overweight, obese) and the concordance sex, smoking, alcohol consumption, exercise, and preexisting diseases (diabetes, of these perceptions with body mass index (BMI), as well as their weight changes hypertension, and myocardial infarction). during post-secondary education. Results: Adjusted hazard ratio (95% confidence interval) for Alzheimer’s disease was Methods: An online survey was sent to all 30,310 undergraduate students at West- 1.08 (1.00-1.16) for underweight, 0.95 (0.92-0.98) for overweight, 0.92 (0.89-0.96) for ern University inquiring about weight perceptions, self-reported height and weight, obese class I, and 0.92 (0.85-1.00) for obese class II, when compared to normal weight. and weight change during university. Corresponding hazard ratio (95% confidence interval) for vascular dementia was 0.89 Results: The final sample consisted of 6591 respondents. The majority of students (0.80-0.99), 1.03 (0.98-1.08), 1.04 (0.99-1.09) and 1.02 (0.91-1.14), respectively. (73.2%) had concordant weight perceptions. Greater proportions of males (35.4%) than Conclusion: Our findings suggested that lower BMI is associated with higher females (23.6%) had discordant weight perceptions in relation to their BMI category risk of Alzheimer’s disease, but lower risk of vascular dementia. However, obesity (p<0.001). Discordant weight perceptions were least likely to occur in the normal seems not to be associated with dementia risk in the Korean adult population.*This weight category (16.0%), compared to the remaining BMI categories of underweight research was supported by a grant of the Korea Health Technology R&D Project (51.1%), overweight (50.9%), and obese (82.5%) (p<0.001). The majority (83.6%) of through the KHIDI, funded by the Ministry of Health & Welfare, Korea (HI13C0715). normal-weight males with discordant perceptions perceived themselves as underweight, whereas the majority (83.5%) of normal-weight females with discordant perceptions P1.12 perceived themselves to be overweight. High proportions of discordant males and Coffee, but not Its Bioactive Compounds, Alleviates Weight Gain, Insulin females in the overweight BMI category considered themselves normal weight (97.7% Resistance, and Liver Steatosis in a Model of Diet-Induced Metabolic and 91.9%, respectively). Compared to females, males were significantly more likely to Syndrome gain weight intentionally during university (5.3% vs. 50.4%, respectively; p<0.001). Pedram Shokouh1, 2, Per B. Jeppesen1, Kjeld Hermansen3, Christoffer Laustsen4, Conclusion: Although the majority of students had concordant weight perceptions, Mette S. Schmedes5, Hans Stødkilde-Jørgensen4, Søren Gregersen3 over a quarter had discordant perceptions. Discordance differed by sex in nor- 1. Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark, 2. The mal-weight students, but overweight males and females perceived themselves as Danish Diabetes Academy, Odense University Hospital, Odense C, Denmark, 3. normal weight. Students who are overweight, but do not recognize it, are unlikely to Department of Endocrinology and Internal Medicine, Aarhus University Hospital, engage in weight management behaviours. Aarhus C, Denmark, 4. MR Research Centre, Aarhus University Hospital Skejby, Aarhus N, Denmark, 5. Department of Food Science, Faculty of Agricultural Sciences, P1.14 Aarhus University, Årslev, Denmark How Does Obesity Affect the Endocrine System? Megha Poddar, VT Chetty Background: Coffee is indicated to mitigate adiposity and insulin resistance (IR), McMaster University, Hamilton, ON, Canada the main features of the metabolic syndrome (MetS). So far, responsible compounds remain elusive. We aimed to compare in-vivo the effects of unfiltered coffee with its Obesity is a chronic, relapsing, medical condition that results from an imbalance of main bioactive compounds. energy expenditure and consumption. It is a leading cause of preventable illness, Methods: 24 male Sprague-Dawley rats were fed for 14 weeks a high-fat (35%W) disability and premature death. The causes of obesity are multi-factorial and include food plus 20%W fructose in drinking water, and were randomized into three groups: behavioural, socio-economic, genetic, environmental and psychosocial factors. control, coffee, or chemicals (3-O-caffeoylquinic acid, caffeic acid, and trigonelline). Rarely do endocrine diseases for example, hypothyroidism or Cushing’s disease Coffee or chemicals were mixed with drinking water and provided in a dosage equal cause obesity. What is less understood is how the obesogenic environment affects to 4–5 cups/day in an adult. the endocrine system. In this poster review, we will discuss the impact of obesity on Results: Coffee decreased food intake and rate and amount of weight gain. multiple endocrine systems including: the hypothalamic-pituitary axis, changes in Estimated average plasma glucose and surrogate measures of IR (fasting insulin, vitamin D homeostasis, sex steroids and thyroid hormones. We will also examine HOMA-IR, and oral glucose tolerance) were improved only in the coffee group. Liver the renin angiotensin aldosterone system and insulin pathophysiology associated fat content and plasma triglycerides levels were concomitantly reduced in the coffee with obesity. We will provide a general overview of the biochemical changes that group. Coffee augmented RNA expression of Lpl, Pik3ca, Akt2, Cpt1b genes in skel- can be seen in patients with obesity; review possible etiologies of these changes etal muscle. Liver hyperpolarized-pyruvate MRI did not show significant differences and briefly consider current guidelines on their management.

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P1.15 P1.17 Gestational Weight Gain and Childhood Body Mass Index Trajectories: a Sustainability of Comprehensive School Health on Body Weight, Healthy Primary Care Nova Scotia Cohort Study Using EMR Data Eating and Physical Activity Helena Piccinini-Vallis, Emily Burke Nicole N. Ofosu, Kerry A. Bastian, John P. Ekwaru, John C. Spence, Kate Storey, Paul Dalhousie University, Halifax, NS, Canada J. Veugelers University of Alberta, Edmonton, AB, Canada Introduction: A risk factors for the development of childhood obesity is guideline concordance of women’s gestational weight gain. Children whose mothers gained Background: The Comprehensive School Health program, Alberta Project Promoting weight in excess of the guidelines are at higher risk of being obese than children active Living and healthy Eating in Schools (APPLE Schools), has demonstrated bene- whose mothers gained weight within those recommendations. In NS, 58.4 % of wom- ficial effects on diet, physical activity (PA) and body weight among elementary school en gain excess weight during pregnancy. Therefore, a high percentage of our children grade 5 students (10–11 years old). However, the long-term effects remain unknown. are at risk of becoming obese. In NS, most prenatal care for low risk pregnancies Objective: To assess the sustainability of APPLE Schools effects on healthy eating, and routine infant/child care occur in the primary care setting. However, no studies PA and body weight. have linked these primary care data and compared women’s gestational weight gain Methods: In the 2015/2016 school year, junior high and high schools (grades 7–12) concordance with guidelines to the BMI trajectories of their children. The present study with both APPLE Schools and non-APPLE elementary schools graduates completed a was a proof of concept that these samples could be accurately identified and linked to survey including a 24-hour dietary recall, PA - pedometer-measured step count, and one another in a community-based primary care EMR. measured height and weight. Multilevel regression methods were used to analyse the Method: This is a retrospective cohort study using EMR data in the Dalhousie Family changes in diet, steps, and body weights among APPLE Schools and non-APPLE Schools Medicine clinics. Women’s gestational weight gain was categorized as falling below, graduates relative to 2008 and 2009 baseline data. within, or above the 2009 IOM guidelines. Women were matched to their children via Results: APPLE Schools had a positive intervention effect on obesity (OR = 0.39; telephone numbers. Children’s BMI calculations were compared at several time points. p=0.037). PA declined in both groups, between 2009 and 2015/2016, though the decline Results: 111 mother-child dyads were identified. There were no significant differenc- was less pronounced among APPLE Schools graduates (APPLE Schools: -1479 steps/day; p es in children’s BMI by mother’s guideline concordance, although there was a trend for =0.004 and Comparison Schools: -2658 steps/day; p<0.001). Mean servings of vegetables children whose mothers had gained below the guidelines to have a higher BMI. and fruit/day also declined for both groups between 2009 and 2015/2016 (APPLE Schools: 5.98 ± 4.34 to 5.51 ± 4.12 and Comparison Schools: 3.65 ± 2.85 to 3.96 ± 3.53). P1.16 Conclusion: These findings provide evidence for the sustainability of Comprehen- Nova Scotia Women’s Gestational Weight Gain Goals sive School Health effects on children’s body weight. Helena Piccinini-Vallis, Genna Bourget Dalhousie University, Halifax, NS, Canada P2.01 Formulate, Innovate, Translate: the FIT Solution to Investigating Poten- Introduction: Excessive gestational weight gain (GWG) is associated with adverse tial Pathways and Mediators in the Environment-Obesity Relation outcomes for mothers and their offspring. Guidelines for optimal GWG, based on Tracie A. Barnett1, 2 pre-pregnancy body mass index (BMI) categories, include those published in 2009 1. Institut National de Recherche Scientifique, Laval, QC, Canada, 2. CR CHU by the Institute of Medicine (IOM). However, less than one-third of pregnant women Sainte-Justine, Montreal, QC, Canada gain weight within the recommended amounts, in part due to women’s lack of knowledge about the guidelines. My program of research focuses on understanding how built environments and Objective: The objective of this study was to compare women’s GWG goals using social influences contribute to youth’s weight status and how these can best be the Theory of Planned Behaviour as a framework, to their actual GWG. The Theory leveraged to promote healthy weight in youth. Streams include: of Planned Behaviour links beliefs (attitudes toward a behaviour, subjective norms, 1. Investigating potential mediating pathways in the environment-obesity relation and perceived behavioural control) to an individual’s behavioural intentions and 2. Methodological and technological innovation to characterize obesity and lifestyle actual behaviours. behaviours Method: The Department of Family Medicine at Dalhousie University has two com- 3. Translation to clinical applications and population health munity-based, comprehensive primary care teaching clinics that provide prenatal care My lab consolidates socio-environmental measures with clinical data in order to support to approximately 120 women per year. Over a 6-month period, all women registering a range of original methodological, etiological, and applied research endeavours. The at these clinics for their first prenatal visit were asked to complete a questionnaire that physical and social environments of several ongoing pediatric population-based and measured demographic information and explored their beliefs about GWG. clinical studies have been assessed across space and time. Environmental measures Results: Sixty women participated in the study (94% response rate). Data on actual include complete geographic and spatial data from multiple sources including on-site GWG are still being collected as not all women have delivered yet. Final analyses will and desk-based audits using Google Street View, air-quality and noise, among many. occur when all these data are available. Individual-level measures include indicators based on DEXA, accelerometry, GPS, sociometric badges, open-beacons/radio frequency ID and sleep trackers. Applications are used to map activity spaces and to measure social networks. In Stream 1 we test several hypotheses underlying potential (nocturnal and diurnal) pathways linking neighbourhoods to obesity. Steam 2 projects are devising objective indicators of Screen Time and of Social Network Characteristics, which would otherwise rely on self-reports. Stream 3 projects are driven by evidence emerging from the etiologic studies, which inform innovative strategies for the treatment and prevention of pediatric obesity in a clinical setting. Overall, my program bridges research produced from state of the art methods to clinical innovation, and translates both to clinical applications and its public health extensions.

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P2.02 P2.04 Minimum Wage and Anthropometric Outcomes in Women: a Longitudi- Diet Quality in Relation to Metabolic Syndrome in Cree (Eeyouch) from nal Study of 24 Low-Income Countries James Bay, Northern Québec, Canada Annalijn I. Conklin1, 2, Ninez A. Ponce2, Catherine M. Crespi2, John Frank3, Jody Heymann2 Mathilde Lavigne-Robichaud1, 2, Jean-Claude Moubarac3, Stéfanie Lantagne-Lopez1, 2, 1. University of British Columbia, Vancouver, BC, Canada, 2. UCLA Fielding School Louise Johnson-Down4, Malek Batal3, Elhadji A. Laouan Sidi1, Michel Lucas1, 2 of Public Health, Los Angeles, CA, USA, 3. The University of Edinburgh, Edinburgh, 1. Population Health and Optimal Health Practices Research Unit, CHU de Québec United Kingdom Research Centre, Québec, QC, Canada, 2. Department of Social & Preventive Medi- cine, Laval Univeristy, Québec, QC, Canada, 3. TRANSNUT, Department of Nutrition, Objectives: To examine whether an increase in minimum wage contributes to Faculty of Medicine, University of Montreal, Montreal, QC, Canada, 4. Centre for changes in weight status in women in low-income countries. Indigenous Peoples’ Nutrition and Environment, School of Dietetics and Human Methods: Longitudinal study of country-level minimum wage data linked to anthro- Nutrition, McGill University, Montreal, QC, Canada pometric data on 150,796 non-pregnant adult women in 24 low-income countries, using separate multivariable multilevel growth models. Post-estimation analysis Objective: To assess the associations between 3 diet quality indexes and metabolic computed the adjusted mean prevalence difference and the relationship between syndrome (MetS) among James Bay Cree (Eeyouch). minimum wage and predicted mean probabilities of being underweight or obese. Methods: Part of the cross-sectional “Nituuchischaayihititaau Aschii” study, 811 adults Results: We found that a $10 per month increase in minimum wage was Eeyouch (355 men, 476 women) from 7 communities in northern Quebec were surveyed associated with a reduction in underweight in women that accelerated over time study. Three dietary score were calculated from 24-hour food recalls: 1) the alterna- (p-interaction=0.025), becoming significant in 2013 (OR 0.986 [.977, .995]). The tive-Healthy Eating Index (aHEI-2010), 2) the Food Quality Score (FQS) and 3) the dietary adjusted underweight prevalence difference was an average decrease of about 0.14 share of Ultra-Processed Products (UPP) according to the Nova Classification. Presence of percentage points (PD -.0014 [-.0023, -.0005]). Rising minimum wage was also MetS was based on the International Diabetes Federation. Logistic regressions were used associated with greater obesity (OR 1.019 [1.008, 1.030]) but did not alter the pace to assess the relationship between dietary scores quintiles with the presence of MetS. of growth (p-interaction=0.8). A $10 increase in monthly minimum wage resulted Results: MetS prevalence is 56.5% in our sample with 95.4% rates of abdominal in an average increase of about 0.1 percentage points in the adjusted prevalence adiposity, 50.1% of elevated fasting plasma glucose, 43.4% of high blood pressure, difference in obesity (PD .0012 [.0004, .0020]). 38.6% of elevated triglycerides and 44.5% reduced high-density lipoprotein cholester- Conclusion: This is among the first longitudinal studies to assess the impact ol (HDL-C). When comparing highest to lowest quintiles adjusted odds ratio (OR) was of improved wages on weight outcomes in low-income settings. While rising 0.63 [95 % CI: 0.38-1.05; p-trend=0.05] for aHEI-2010 and 1.04 [95 % CI: 0.62-1.74, minimum wage showed a potentially insalubrious effect on obesity, this finding was p-trend=0.87] for FQS. A higher consumption of UPP (NOVA Classification) was signifi- outbalanced by the robust protective effect of rising minimum wage on under- cantly associated with MetS (OR=1.93 [95 % CI: 1.15-3.21; p-trend=0.04]. weight, which strengthened over time. Thus, modest rises in minimum wage may Conclusions: Although poor diet quality has been associated with increased cardiomet- be especially beneficial for addressing the protracted underweight problem in poor abolic risk factors, only the dietary share of UPP from the NOVA classification revealed a countries, particularly south Asia and central and east Africa. significant association with MetS in the context of Eeyouch communities from northern Quebec. Indexes tailored to the environmental food context of northern communities are P2.03 essential to further understand the impact of diet quality in these communities. Toward Equity-Oriented Obesity-Related Health Promotion Francine Darroch, Colleen Varcoe, Annette Browne P2.05 University of British Columbia, Vancouver, BC, Canada Are Dental Caries and Trachoma Associated with Weight Status Among Chinese Children? Pregnant and/or parenting women who are marginalized by poverty, racism, substance Jian Liu use, and trauma are at elevated risk of negative health outcomes in pregnancy and Brock University, St. Catharines, ON, Canada postpartum. Physical activity and prevention of excessive weight gain may be particularly relevant to address, given the high rates of intersecting issues of overweight/obesity, Dental caries and trachoma are two common diseases among developing country children. anxiety, depression, low self-esteem, and physical inactivity. The barriers to healthy To examine if they are associated with children’s weight status we used the data collected pregnancy and postpartum outcomes are often more complex for women experiencing from two screening surveys conducted in Cities of Changsha and Shenzhen, China, in which these kinds of social and health inequities. Obesity interventions during pregnancy and 5,900 were recruited. Weight and height were measured and BMI was calculated as weight postpartum often neglect the lived experiences of women and fail to address the social (kg) divided by height (m2). The information of decayed/filled teeth counts of primary den- determinants that impact women such as poverty, community infrastructure, racism, and tition and trachoma were obtained from school general health examination records (SGER). colonialism. We argue that in order to adequately prevent obesity and address health After excluding those who had missing information on weight, height, and SGER, a total of inequities, there is a need to consider economic, social, cultural and systemic barriers to 4,090 (2,197 boys and 1,893 girls) aged 5–9 yrs old were included in this analysis. BMI was ensure marginalized women’s inclusion in and access to health resources and programs. standardized for age and sex and conversed to a BMI z-score. Using BMI z-score, subjects Despite evidence of the benefits of physical activity for individuals who have experienced were categorized into: underweight (<-2), normal weight (~1.03), overweight (~1.64), trauma, and although culturally safe and trauma-and violence informed care is increas- and obese (>1.64). Overall, approximately 5.5% of children were underweight and 18% ingly integrated in health care, few strategies have focused on adapting these strategies of children were overweight or obese. In comparing to the normal weight, after adjusted obesity prevention programs. Drawing on lessons learned in healthcare where culturally for age, gender, grade, and city surveyed, the odds ratios (OR, [95% CI]) of dental caries for safe and trauma-and violence informed care have had some successful uptake, we assert underweight, overweight, and obese were 1.12 (0.84–1.49), 0.70 (0.56–0.86), and 0.62 that there is a need for a similar approach to obesity interventions. The objective of this (0.48–0.79), respectively (p for trends <.001); while the ORs of trachoma were 1.65 (0.94–- presentation is to identify opportunities for integrating culturally safe and trauma-and 2.89), 0.90 (0.52–1.57), and 1.92 (1.20 –3.06), respectively. This suggests that dental caries violence informed physical activity and wellness programming/resources for women and trachoma are associated with weight status among these Chinese children, but further experiencing marginalization in Canada. study may be needed to explore the underlying mechanism for the observed phenomena.

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P2.06 P2.08 Proportional Responsibility vs Individual Responsibility for Diet and Literature Review Obesity Research Pertaining to Sudbury’s Social Deter- Obesity in the Food System: a Complex Systems Analysis minants of Health Natalie Savona1, Claire Thompson1, Dianna Smith2, Harry Rutter1, Steven Cummins1 Julia Cerilli, Christina Weglewski, Alannah Hawes, Chanelle Landriault, Chelsea 1. London School of Hygiene & Tropical Medicine, London, United Kingdom, 2. Mateev, Kimberly Friesen, Rachel Askett, Camille Smith, Desiree Quenneville, Jaimie University of Southampton, Southampton, United Kingdom Geist, Basem Gohar, Taylor Duhamel, Maggie McDougall Laurentian University, Sudbury, ON, Canada Most interventions to reduce obesity prevalence rely on individuals taking responsibility for their health, for example, by using information to make healthy food choices; A Statistics Canada (statcan) study revealed that Sudbury has the second highest obesity on a population level, many such interventions are ineffectual. This paper reports on rate in Canadian Census Metropolitan Areas (CMAs). Surprisingly, there is a lack of research examining the discourse of ‘responsibility’ for healthy eating, viewed using research in this particular region that could explain such an alarming statistic. A literature a complex systems approach. ‘Responsibility’ provides a framework for examining the review was conducted to identify gaps and supporting articles that could aide in our impact of the food system – as opposed to single variables – on the public’s diet. Qual- understanding of Sudbury’s obesity rates. Using the Social Determinants of Health Model itative analysis of corporate and government documents informed focus groups with to sift through the literature, it was determined that further research is required to gain the public and interviews with representatives from the food industry, government and better understandings of Sudbury’s unique characteristics. These findings have lead to non-governmental organisations in the United Kingdom. The data show that despite the development of a research project to further identify Sudbury specific correlates. claims of collective responsibility for dietary behaviour, government and corporations use rhetoric and measures that instead emphasise individual responsibility. They also P2.09 favour ‘downstream’, individual-level interventions such as food labelling rather than Exploring the Effects of Family Characteristics on Indigenous Youth’s more effective, upstream regulatory or fiscal strategies. Problematising the idea of Participation in Physical Activity and Sport responsibility has highlighted how individuals are allocated most responsibility within Piotr Wilk1, Alana Maltby1, Martin Cooke2 the system for their food choices despite having least power over key determinants 1. Western University, London, ON, Canada, 2. University of Waterloo, Waterloo, ON, Canada of those choices: taste, cost, convenience and promotions. Analysis using a complex systems approach helps explain how the mismatch between power and responsi- Objective: Physical activity contributes to the physical, emotional, intellectual, and bility contributes to a food system in which many people are obese. ‘Proportional social dimensions of health and well-being. Unfortunately, participation in physical responsibility’ offers a counterfactual concept, which challenges the dominant policies activity and sport tends to decrease with age, with youth spending less time being that attribute ‘ultimate’ responsibility to individuals for maintaining a healthy weight, active than children. The purpose of this cross-sectional study is to explore the effect given that they have minimal influence over the determinants of their diets. of family characteristics (i.e., parental residential school attendance, parental education, household income, and parental involvement in education) on participation in P2.07 physical activity and sport among off-reserve Indigenous youth. The Effects of Culture on Guideline Discordant Gestational Weight Gain: A Methods: Employing the 2012 APS data, the analysis was limited to those who Systematic Review were between the age of 12 and 17, who attended elementary or high school Kathryn M. Denize1, Nina Acharya1, Zachary M. Ferraro2, Alysha L. Harvey1, Kristi B. Adamo1 and identified as having single Indigenous identity: First Nations, Métis and Inuit 1. University of Ottawa, Ottawa, ON, Canada, 2. Faculty of Medicine, University of (N=4,910). The analysis was conducted using structural equation modelling tech- Ottawa, Ottawa, ON, Canada niques with observed and latent variables. Results: Parental involvement was found to have a significant effect on participation in Background: Discordant pregnancy weight gain, above or below Institute of Medicine physical activity and sport. Furthermore, residential schooling (for both parents) has a nega- (IOM) guidelines, increases the risk of negative health outcomes for both mom and baby. tive effect on education and mother’s residential schooling has a positive effect on income, Currently, a large portion of women exceed or do not meet the IOM recommendations. Cul- whereas father’s residential schooling has a negative effect on income. Income and father’s ture has been identified as a key determinant in achieving appropriate gestational weight education have a positive effect on parental involvement (mother’s education does not). gain (GWG). However, the effects of culture on GWG have not been greatly explored. Additionally, income has a direct positive effect on participation in physical activity and sport. Objective: To systematically review the effect of culture on discordant GWG as Conclusions: The findings suggest that parental involvement plays an important defined by the 2009 IOM guidelines. role in mediating the effect of family characteristics on physical activity and sport Method: A search was run on the following databases: Ovid MEDLINE, Embase participation among Indigenous youth. Encouraging parental involvement in (Ovid), Cochrane, CINAHL, PsychINFO, LILACS, and CUMED, from 1946- July 2016. youth’s education may be beneficial for promoting increased active behaviours. The search retrieved 1212 abstracts which were then reviewed by two researchers and inclusion/exclusion was assessed by pre-determined criteria. Full articles P2.10 were reviewed for inclusion prior to data extraction. The final review consisted of Designing Seating Solutions for Persons with Obesity: An Inter-Profes- 91 papers. Papers that used the current 2009 IOM guidelines were separated for sional Collaboration quantitative review (35) and the remaining were analyzed qualitatively. Data was Mary Forhan, Robert Lederer, Greig Rasmussen extracted using a standardized form by two independent researchers, with conflicts University of Alberta, Edmonton, AB, Canada resolved by consensus. Risk of Bias will be assessed using a modified Cochrane assessment tool, and quality of evidence through the grading of recommendations, Purpose: Persons living with obesity face many challenges in their everyday lives assessment, development, and evaluations (GRADE) Approach. interacting with objects in the built environment. A considerable problem is finding Results and Conclusions: The findings from this review will synthesize the a suitable place to sit. Most of the chairs that inhabit domestic, work and public current knowledge on how culture influences discordant GWG. We hope to provide spaces are designed with little or no consideration for this user group. insight into culturally appropriate recommendations or feedback that will optimize Method: A team of instructors from industrial design and rehabilitation medicine maternal weight trajectory and downstream child outcomes. offered a course to students enrolled in an industrial design program. The purpose

96 | 5th Canadian Obesity Summit | #COS17 Abstract Details of this course was to design a seating solution for persons with obesity. Students findings The prevalence of endoscopic findings was as follows: gasteroesophageal spent time in the classroom learning about obesity. Then students spent time reflux 26.1%, hiatal hernia 22%, peptic ulcer disease 8.8%, esophageal Barrett’s mu- interviewing persons living with obesity (clients) to gather information to inform cosa 1%.There was significant relationship between BMI (body mass index) and reflux their design. Each student prepared design models and presented them to their disease(p=0.042). Pylori infection was seen in 32.6% of obese patient .The results did clients for feedback. not show relationship between endoscopic finding and patient observation. Results: Several diverse seating options were designed and rendered in small- Conclusion: In our patient, endoscopic findings were relatively common and im- scale models that aim to provide bariatric sensitive and appropriate solutions for use portant that maybe change surgical approach and preoperation planning. Routine in the community, home and work setting. upper endoscopy before bariatric surgery has a high diagnostic yield and may be Conclusion: An inter-professional course in industrial design was effective in reduced postoperative complication. producing a range of viable design solutions aimed to foster opportunities for accessible seating for persons living with obesity. P4.02 Is Depressive Status Associated with Preoperative Weight and Problemat- P3.01 ic Eating Behaviours Among Candidates for Bariatric Surgery? Estimations of Calorie Content of Meals Before and After a Menu Labelling Cassandre A. Julien1, 2, Kim L. Lavoie1, 2, Mélanie Béland1, 5, Henri Atlas4, Ronald Intervention Denis4, Pierre Garneau4, Radu Pescarus4, Simon L. Bacon1, 3 Lana Vanderlee1, 2, Rhona Hanning2, Christian Boudreau2, David Hammond2 1. Montreal Behavioural Medicine Centre (MBMC) at Hôpital du Sacré-Coeur de Montréal 1. University of Toronto, Toronto, ON, Canada, 2. University of Waterloo, Waterloo, (CIUSS-NIM), Montreal, QC, Canada, 2. Department of Psychology, Université du Québec ON, Canada à Montréal, Montréal, QC, Canada, 3. Department of Exercise Science, Concordia Univer- sity, Montreal, QC, Canada, 4. Department of Surgery, Université de Montréal, Montreal, Menu labelling is an intervention intended to inform consumers of the energy content of QC, Canada, 5. Department of Psychology, Concordia University, Montreal, QC, Canada food items in restaurant settings and positively influence eating habits. The current study aimed to examine the influence of menu labelling on consumers’ ability to estimate the Background: Obesity is associated with high levels of psychological stress and calorie content of their meal purchases. Three waves of intercept surveys were conducted problematic eating behaviours, including emotional eating and eating disorders. at an ‘intervention’ cafeteria and a ‘comparison’ cafeteria, before and after menu labelling However, little is known about potential psychological contributors to weight was implemented in the intervention cafeteria, with an additional one-year follow-up. outcomes in bariatric surgery patients. This study sought to: evaluate whether Participants who had purchased food in the cafeteria self-reported food and drink items depression and eating patterns were associated with presurgical weight (absolute purchased, whether they had noticed menu labelling, and estimated the calorie content weight [Kg] and body mass index [BMI]); and whether depression was associated for each food and drink item purchased. 2,084 participants had estimates that could with eating patterns, in patients awaiting bariatric surgery. be matched with objective nutritional information. Of the sample, 55% noticed menu Methods: 116 obese patients seeking bariatric surgery (75% women; M[SD] labelling in the cafeteria, and 13% of the sample were able to accurately estimate the age=46[12] yrs; M[SD] BMI=51[10] kg/m2) were recruited for participation in the calorie content of their meal within 50 kcal of the actual content. Similar proportions over- Canadian REBORN (REsearch on Bariatric care for Obesity tReatmeNt) cohort study. estimated (33%) and underestimated (29%) calorie content. There were no significant All patients underwent an interview, had their weight and height measured, and differences between sites over time in the proportion correctly estimating calorie content; completed the Beck Depression Inventory (BDI-II) and the Dutch Eating Behavior however, those who noticed menu labelling were more likely to correctly estimate the Questionnaire (DEBQ) on the day of their preoperative visit (6-months pre-surgery). calorie content (p=0.03), as were females (p=0.02), those with higher income (p=0.01) Results: Linear regressions, adjusting for age and sex, showed that neither BDI-II nor and those who knew daily estimated energy requirements (p=0.006). This study DEBQ were associated with weight and BMI. However, increased severity of depressive suggests that the impact of the menu labelling intervention was limited to those who symptoms were significantly associated with increased levels of emotional eating (β=4.96, noticed nutrition information and some demographic subgroups, and the overall impact p=.02) and external eating (β=2.44, p=.019), but not restrained eating (β=-0.93, p=.432). on calorie estimation among the general population was limited. Conclusion: These results suggest that depressive status and eating behaviour patterns are not associated with pre-bariatric surgery weight. However, those with P4.01 higher depressive symptoms had a greater tendency to eat in response to negative Preoperative Endoscopic Evaluation in Bariatric Surgery emotions (emotional eating) and food related stimuli (external eating), suggesting Behzad Jodeiri, Alireza Khalaj that depression may increase problematic eating behaviours in bariatric patients. Shahed University, Tehran, Iran This may, in turn, have negative implications for patients’ post-operative outcomes.

Background: In growing of bariatric surgery as a well-known procedure for P4.03 treatment of obesity and metabolic disorder, preoperative evaluation has become The NL Bariatric Surgery Cohort Study: Improvement and Remission really important. The purpose of this study was to evaluate the diagnostic yield and of Prediabetes and Type 2 Diabetes Mellitus 2 years after Laparoscopic incidence of endoscopic finding in large amount of patient in a referral center for Sleeve Gastrectomy bariatric surgery. Kendra K. Lester, Laurie K. Twells, Deborah M. Gregory, Christopher S. Kovacs Methods: During the study period, 522 patients were evaluated by upper Memorial University, St. John’s, NL, Canada endoscopy prior to bariatric surgery in our referral clinic (obesity treatment center of Tehran). The medical records of consecutive obese patients who underwent EGD Objective: To evaluate laparoscopic sleeve gastrectomy (LSG) and its effectiveness on prior to bariatric surgery between September 2013 and Jun 2015 were reviewed. All glycemic control in patients with prediabetes and type 2 diabetes mellitus (T2DM). data from patient including patient observation, history and endoscopic finding was Methods: Patients (n=201) undergoing LSG between May 2011 and May 2014 investigate. Endoscopies were done with two expert endoscopists and experienced were followed prospectively. Pre-surgery, patients were defined as prediabetic endoscopists reviewed all EGD reports. (HbA1c: 6.0 – 6.4% or FPG: 6.1 – 6.9 mmol/L) or diabetic (HbA1c ≥ 6.5% or FPG Results: Endoscopic procedures were shown 58.4% of patients have significant ≥ 7.0 mmol/L, self-reported, or antidiabetic medication use). Glycemic control

97 | 5th Canadian Obesity Summit | #COS17 Abstract Details and medication use were evaluated at 3, 6, 12, 18, and 24 months post-surgery. P4.05 Improvement or remission was based on pre-defined criteria related to glycemic Association Between Physical Activity Intensity and Physical Capacity control and medication use for a duration of 12 months. Among Individuals Awaiting Bariatric Surgery Results: Pre-surgery, 28(13.9%) patients with prediabetes and 84(41.8%) with T2DM Brittany V. Rioux1, Karen Kwok2, Jill Fox1, Dean Gamey3, Neha Bharti3, Ashley Vergis2, were identified. Follow-up data was available for 16(57.1%) prediabetics [A1c 5.9(0.3); Krista Hardy2, Danielle R. Bouchard1, Martin Sénéchal1 FPG 5.8(0.6)] and 54 (64.3%) T2DM individuals [A1c 8.0(1.5); FPG 8.7(3.1)]. 13 1. Faculty of Kinesiology University of New Brunswick, Fredericton, NB, Canada, 2. Faculty (81.3%) prediabetics achieved remission [ΔA1c -0.6(0.3); ΔFPG -0.7(0.7)] on average of Health Sciences University of Manitoba, Winnipeg, MB, Canada, 3. Faculty of Kinesiolo- in 12.9(3.0) months and 3(18.8%) had no change [ΔA1c -0.3(0.2); ΔFPG -0.2(0.5)]. gy and Recreation Management University of Manitoba, Winnipeg, MB, Canada 16(29.6%) T2DM patients achieved complete remission [ΔA1c -1.6(0.9); ΔFPG -2.6(2.3)], 8(14.8%) partial remission [ΔA1c -1.9(1.3); ΔFPG -2.7(2.0)], 7(13.0%) Background: Physical activity is a routine component of lifestyle modification programs improvement [ΔA1c -1.9(1.4); ΔFPG -2.4(1.2)], and 23(42.6%) had no change [ΔA1c implemented prior to bariatric surgery, and one of the goals is to improve patients’ physical -1.7(1.5); ΔFPG -2.5(3.8)]. 24 diabetics achieved remission in an average of 18.4(5.8) capacity. However, the physical activity intensity recommended to meet that goal is unknown. months and median time to remission was 23.8 months. All changes were significant Objective: To assess the association between time spent at different physical activity (p<.05) except for the no change prediabetic group. 22 (52.4%) of 42 diabetics who intensities and physical capacity in patients awaiting bariatric surgery. completed follow-up no longer take antidiabetic medications. Methods: A total of 39 women and 13 men were recruited. The primary outcome was Conclusions: LSG leads to remissions and sustained improvements in glycemic physical capacity, measured using six objective tests: 6-Minute Walk, Chair Stand, Sit control for prediabetes and T2DM. and Reach, Unipodal Balance (eyes open-eyes closed) and Hand Grip Strength Tests. The primary exposure variable was physical activity intensity (i.e. sedentary, light, moderate, and P4.04 vigorous) measured by accelerometers. A Comparison of Circular- vs. Linear-Stapled Gastrojejunostomy in Lapa- Results: The average body mass index (BMI) was 46.3 ± 5.4 kg/m2. Only 6% (percent) roscopic Roux-en-Y Gastric Bypass (LRYGB) in a Tertiary Care Hospital of total time was spent at moderate to vigorous intensity, while 71% was spent sedentary. Sarah Miller1, Erwin Karreman2, Steven Pooler3 When adjusted for BMI, age, and sex, four of the six physical capacity tests were significantly 1. Department of Surgery, College of Medicine, University of Saskatchewan, Saska- associated with moderate intensity physical activity, Beta (SE): 6-minute walk 9.7 (2.7), chair toon, SK, Canada, 2. Research and Health Information Services, Regina Qu’Appelle stand 0.3 (0.1), balance (eyes open) 1.8 (0.7), and hand grip strength 1.2 (0.4), and only the Health Region, Regina, SK, Canada, 3. Department of Surgery, Regina Qu’Appelle 6-minute walk was associated with sedentary activity 1.7 (0.7) (all p< 0.05). Health Region, Regina, SK, Canada Conclusions: These results suggest that physical capacity is associated with time spent at moderate intensity physical activity in individuals awaiting bariatric surgery. The next step is Objectives: Since the introduction of LRYGB, there has been considerable debate to study if an increase in time spent at moderate intensity will translate to improvements in about the preference for circular- versus linear-stapled anastomoses based on physical capacity. surgical outcomes. Long-term follow-up data is lacking and as a result, no conclusion about which technique is superior exists. Our research focuses on the differences P4.06 in success and complication rates between patients undergoing LRYGB procedures Impulse Control and Weight-Loss after Bariatric Surgery: The moderating using either circular or linear staplers. effect of Emotion Self-Regulation Methods: A retrospective chart review of LRYGB procedures between 2009-2014 Tamara M. Williamson1, Joshua A. Rash1, Jo Ann Telfer2, Tavis S. Campbell1 was completed. Average total percent weight loss (TWL) and the incidence of anas- 1. Department of Psychology, University of Calgary, Calgary, AB, Canada, 2. Calgary Adult Bariat- tomotic leak, marginal ulceration, wound infection, and strictures were compared ric Specialty Clinic, Richmond Road Diagnostic and Treatment Centre, Calgary, AB, Canada using a repeated measures ANOVA. Complication rates were compared using the Chi-square test. The study was approved through the Research Ethics Board within Objective: We examined the association between pre-surgical emotion self-regulation our health region and university. (ESR) and impulse control, and weight-loss 12-months following bariatric surgery using a Results: Of 229 charts, procedures with linear and circular staplers totaled 148 and prospective design. 81. Data from 59 charts reached a 24-month follow-up. No statistically significant Method: Treatment-seeking obese adults were recruited from a local clinic specializing in difference in TWL existed between staplers (25.8% circular, 27.9% linear, p>.05). assessment and support for patients undergoing bariatric surgery. Participants completed Linear staplers were associated with statistically significant fewer infections (19.5% the ESR subscale of the Schutte Emotional Intelligence Test (SSEIT) and the Adult Atten- circular, 2.1% linear, p<.001) and strictures (16.0% circular, 1.4% linear, p<.001), tion-Deficit Hyperactivity Disorder (ADHD) Self-Report Scale (ASRS-v1.1) prior to surgery. while no statistically significant difference in incidence of marginal ulceration, Objective measures of body mass index (BMI) were obtained before surgery and 12-months anastomotic leaks, or bleeding existed. following surgery to calculate percent excess weight loss (%EWL). Conclusions: Given success rates, as measured by TWL, are similar between the Results: The sample consisted of 24 adults (80% female; mean age = 46.4 years, SD = two groups, utilizing the linear stapler would be preferred based on complication 8.43; mean BMI = 52.49, SD = 12.72). Using hierarchical regression, there was a margin- rates. Although there was no statistically significant difference in rates of ulceration, ally significant ESR by ADHD interaction on %EWL, F(1, 20) = 2.93, p = .10, accounting for anastomotic leak, or bleeding, the circular stapler was found to be associated with 10% of variance. This interaction was probed using the Johnson-Neyman technique which higher rates of wound infections and strictures. tests the conditional effects of ADHD on %EWL at every value of ESR. There was a significant negative association between ADHD and %EWL among individuals who scored below 29 on ESR (0.76 SD below the mean). Discussion: Emotion self-regulation moderated the association between symptoms of ADHD and %EWL, suggesting that impulse control problems may only be detrimental to weight loss outcomes following bariatric surgery for individuals deficient in ESR. This finding has implications for the mechanism by which symptoms of ADHD influence weight-loss following bariatric surgery.

98 | 5th Canadian Obesity Summit | #COS17 Abstract Details

P4.07 P4.09 Psychotropic Medication Use in Individuals Pursuing Bariatric Surgery Intensive Gestational Glycemic Management and Childhood Obesity: A Richard Yanofsky1, 2, 3, Susan Wnuk1, 3, 5, Azi Zheng3, Rachel Nauruzova3, Raed Hawa3, 4, Systematic Review and Meta-Analysis 5, Sanjeev Sockalingam3, 4, 5 Laetitia Guillemette1, 2, Anita Durksen1, 2, Rasheda Rabbani1, 3, Ryan Zarychanski1, 3, Ahmed M. 1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada, 2. Medical Psychiatry About-Setta1, 3, Todd A. Duhamel1, 4, Jonathan M. McGavock1, 2, Brandy Wicklow1, 2 Program, University Health Network, Toronto, ON, Canada, 3. Toronto Western Hospital Bariatric 1. University of Manitoba, Winnipeg, MB, Canada, 2. Children’s Hospital Research Insti- Surgery Psychosocial Program, Toronto, ON, Canada, 4. Department of Psychiatry, University of tute of Manitoba, Winnipeg, MB, Canada, 3. George & Fay Yee Center for Healthcare Toronto, Toronto, ON, Canada, 5. University Health Network, Toronto, ON, Canada Innovation, Winnipeg, MB, Canada, 4. St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada Objective: The aim of this study was to describe psychiatric medication use in individuals seeking bariatric surgery. We investigated self-reported differences in quality Objective: Treating hyperglycemia in pregnancy reduces macrosomia; however it is of life (QOL) and disability between patients who did and did not use psychotropic unclear if this translates into reduced childhood obesity. We performed a systematic medications and differences in demographic characteristics. review and meta-analysis to evaluate the efficacy and safety of intensive glycemic Methods: Participants were patients enrolled in a bariatric surgery program management in pregnancy in preventing childhood obesity. seeking bariatric surgery. Psychotropic medication use, demographic variables, and Methods: We searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov up to February self-reported quality of life and disability were analyzed. The 36-Item Short Form 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified Health Survey was used to collect mental and physical QOL data, and the Sheehan randomized controlled trials evaluating intensive glycemic management interventions for hy- Disability Scale was used to assess extent to which work/school, social life and perglycemia in pregnancy and included four of the 383 citations initially identified. Two review- home life or family responsibilities were impaired. Descriptive statistics were used ers independently extracted trial-level data with piloted forms and evaluated internal validity to summarize psychotropic medication use and demographics. T-tests were run on of included studies. Data was pooled using random effects models. The primary outcome was continuous variables and chi-square analyses on categorical variables. age- and sex-adjusted offspring obesity measured in childhood. Secondary outcomes included Results: The sample of 1251 participants was 78.6% (percent) female and the offspring waist circumference in childhood and maternal hypoglycemia during the trial. mean age was 44.99. A total of 466 (37.3%) reported taking one or more psychotro- Results: The four eligible trials (n=767 children) similarly used lifestyle and insulin pic medication. The most commonly prescribed medications were antidepressants to manage gestational hyperglycemia. We found no association between intensive (30.4%) followed by benzodiazepines (8.2%). Older individuals were more likely gestational glucose management and childhood obesity at 7-10 years of age (relative to take medications, as were women (85%). Those taking psychotropic medications risk 0.89, 95% CI 0.65 to 1.22; 2 trials; n=568 children). Waist circumference also reported poorer physical and mental QOL and greater disability. did not differ between treatment and control arms (mean difference -2.68 cm; 95% CI Conclusions: Given the high rates of psychiatric medication use amongst bariatric -8.17 to 2.81 cm; 2 trials; n=568 children). surgery candidates and the correlation between psychotropic use and poorer QOL Conclusions: Intensive gestational glycemic management is not associated with reduced and disability scores in this population, it is important for health care practitioners childhood obesity in offspring, but randomized data is scarce. Long-term follow up of trials to be aware of both psychiatric difficulties and work collaboratively with patients to should be prioritized and measures of metabolic risk should be captured in future studies. address medication malabsorption issues post-surgery. P4.10 P4.08 Effects of a Multidisciplinary Program of Obesity Treatment of Children Beyond BMI: NutriSTEP® for the Prevention, and Care and Management and Adolescents that Performed a Water-Based Intervention: Difference of Childhood Obesity Between Age Groups Lesley Andrade1, Tracy McDonough2 Mario M. Castilho1, Carlos A. Lopera1, Ronano P. Oliveira1, Luzia J. Hintze2, Nelson N. Junior1, 1. Sudbury & District Health Unit, Sudbury, ON, Canada, 2. KFLA Public Health, Victor Hugo d. Medes1, João Carlos Locateli1 Kingston, ON, Canada 1. State University of Maringá, Maringá, PR, Brazil, 2. Ottawa of University, Ottawa, ON, Canada

Purpose: To inform the use of nutritional screening for the prevention, and care Introduction: The obesity has been strongly linked with a high index of mortality world- and management of childhood obesity. wide. The multidisciplinary program of obesity treatment (MPOT) focus on the behavioral Objectives: To describe factors influencing the uptake of NutriSTEP® in primary care. and lifestyle change. Aquatic exercise is been considered as efficient to treat obesity in Methods: Semi-structured interviews were completed with primary care providers us- adolescents, but biological differences can interfere the effects of a MPOT. ing an interview guide based on a framework for effective implementation of prevention Objective: To assess the effects of a MPOT on the body composition and health-related innovations. Thematic analysis was completed with NVivo. physical fitness (HRPF) of children and adolescents in different age groups. Results: Ten interviews were completed with primary care providers using NutriSTEP® Methods: Pragmatic clinical trial quasi experimental composed by 67 children and adolescents as a primary prevention program. Factors that affected successful implementation (G1 = 10 to 12 years, G2 = 13 to 15 years, and G3 = 16 to 18 years), assessed both pre and post included: Provider characteristics (e.g. perceived benefit of the innovation, self-efficacy); the intervention period. Were evaluated the anthropometric, body composition and HRPF vari- Characteristics of the innovation (e.g. compatibility, adaptability); Factors related to the ables. Was used descriptive statistic (mean and standard deviation) and inferential (Paired t-tests prevention delivery system (e.g., organizational capacity, processes, staffing); Communi- and Wilcoxon to the comparison among different moments, and Anova with Scheffe’s post-hoc ty-level factors; and Factors related to the prevention support system (e.g. training, tech- and Kruskal Wallis to the comparison among age groups). The significance level was settled in 5%. nical assistance). Primary care providers found using NutriSTEP® feasible and acceptable, Results: Were verified significant differences between the sexes to almost all variables, and were interested in having it integrated into their Electronic Medical Records (EMRs). except lean mass (LM) and manual grip strength. The age groups presented differences Conclusions: Successful implementation of NutriSTEP® requires EMR integration to WC (G2vsG3), body mass and lean mass (G3vsG1/G2) (p≤ 0,05). and the development of an evidence-based reference guide (i.e. key health educa- Conclusion: A 16-week MPOT was seen as efficient on the body composition and HRPF tion messages and local resources for referral) to support primary care providers in of children and adolescents; however, was only found significant differences on the body addressing nutritional screening results. composition comparing age groups.

99 | 5th Canadian Obesity Summit | #COS17 Abstract Details

P4.11 P4.13 Exploring Lifestyle Behaviors of Adolescents with Obesity in Weight The Relationship of Fasting Plasma apoB48 to Cardiometabolic Risk Management: A Scoping Review and Stakeholder Consultation Factors in Adolescents Maryam Kebbe, Samah Damanhoury, Nadia Browne, Michele Dyson, Tara-Leigh Jacqueline Krysa1, 2, Donna F. Vine1, Lawrence J. Beilin2, Trevor A. Mori2, Spencer D. Proctor1 McHugh, Geoff Ball 1. University of Alberta, Edmonton, AB, Canada, 2. University of Western Australia, Perth, WA, University of Alberta, Edmonton, AB, Canada Australia

Objective: To explore the barriers and enablers that adolescents with obesity Introduction: Obesity persists from childhood to adulthood and can increase experience when seeking healthy lifestyle behaviors. cardiometabolic risk in early adulthood. Fat intolerance (the inability to efficiently Methods: Six databases were searched for articles in English and French from 1980 to June metabolize lipids following a high-fat meal) is often observed in obesity and has been 2016 (search update: December 2016). Articles were eligible for inclusion if the study focused shown to be an independent marker of cardiovascular (CVD) risk. An accumulation of on barriers and/or enablers encountered by 13–17-year-olds with obesity enrolled in a weight (intestinal derived) apoB48-remnant cholesterol following a high fat meal is indicative of management clinic, program, or intervention in areas of nutrition, physical activity, sedentary fat intolerance. We have previously demonstrated that fasting plasma apoB48 is elevated behavior, and/or sleep. Retrieved articles were screened for eligibility by two independent two-fold in obese pre-pubertal children. However, it is unclear if impaired apoB48-rem- reviewers; data charting, quality appraisal, and thematic analysis were then completed for nant cholesterol in childhood remains elevated in obese adolescents. included studies. Findings were enhanced by a stakeholder consultation with adolescents with Objectives: To investigate fasting plasma apoB48 as an early biomarker of fat intol- obesity (n=20) and health care professionals (n=20) from Edmonton and Ottawa. erance and its relationship to other cardiometabolic risk factors in a large adolescent Results: We included a total of 17 articles (all English; n=12 qualitative, n=3 mixed population. methods, n=2 quantitative). Barriers and enablers were grouped at the individual, Methods: Fasting plasma apoB48, biochemical and anthropometry indices were mea- interpersonal, and organizational levels for nutrition, physical activity, and sedentary sured in a cross-sectional analysis of participants from the Western Australian Pregnancy behavior; no sleep-related barriers and/or enablers were identified. Limited pleasure Cohort (RAINE) study at age 17yrs (n=1045). Fasting plasma apoB48 was measured in and lack of motivation towards physical activity, together with the availability of using ELISA, and multiple regression analyses examined the relationship between unhealthy foods, were the barriers of highest recurrence; of enablers, support at the apoB48 and cardiometabolic risk factors. family-, social-, and professional-level was the most frequently endorsed factor. Results: Fasting plasma apoB48 was 19% higher in male compared to female adoles- Conclusions: Adolescents with obesity in pediatric weight management reported cents, and was elevated 21% in adolescents at “high risk” of the metabolic syndrome. a range of barriers to and enablers of making and maintaining healthy lifestyle There was a positive association between fasting plasma apoB48 and triglyceride, total behavior changes. These data highlight the value of multi-level interventions (clinic, cholesterol, insulin, HOMA-IR, leptin, waist circumference, skinfold thickness measures. community, home, school) to help overcome barriers and build on enablers. Fasting plasma apoB48 was also inversely associated with HDL-C, and adiponectin. Conclusion: Elevated apoB48-remnant cholesterol may track into adolescence and may P4.12 be a useful biomarker to identify fat intolerance and cardiometabolic risk in youth. Maternal Low-Dose Antibiotic Consumption During Pregnancy and Lacta- tion in Rats Increases Their Body Weight During Lactation But is Reversed P4.14 with Prebiotic Diet A Telehealth Program for the Treatment of Overweight and Obesity in Teja Klancic, Ashley C. Choo, Nicole A. Cho, Heather A. Paul, Raylene A. Reimer Children: Baseline Characteristics of Program Evaluation Participants University of Calgary, Calgary, AB, Canada Anne M. Lasinsky1, Tanis V. Mihalynuk2, Darren E. Warburton1, 3, Danika B. Dickson3, Donna Forsyth-Lukas2, Kiran Kalkat2, Genevieve Larrivee2, Barbara Leslie2, Shannon S. Bredin1, 3 Background: Antibiotics are the most widely prescribed therapeutic agents. Even though 1. University of British Columbia, Vancouver, BC, Canada, 2. Dietitian Services at HealthLink they are life-saving drugs, recent research suggests that early life exposure to antibiotics BC, Burnaby, BC, Canada, 3. The Physical Activity Line, Richmond, BC, Canada may increase infant’s risk of obesity. On the other hand, non-digestible prebiotics improve metabolic health resulting in lower body weight and fat mass. Our goal was to identify the Objective: To describe demographic, anthropometric, and behavioural character- potential of prebiotic supplementation during pregnancy and lactation to reduce antibiot- istics of a sample of children enrolled in a telehealth program for the treatment of ic-associated obesity risk in Sprague-Dawley rats and their offspring. We hypothesized that overweight and obesity. adding prebiotics to the dams diet could mitigate antibiotic-induced obesity risk. Methods: Participant information was obtained through physician referrals and Methods: 10 week old female Sprague-Dawley rats (n=60) were mated and random- questionnaires administered at program intake. ized into 1 of 4 groups: 1)control (water + AIN-93G diet), 2)antibiotic (low doses of Results: Of 203 children referred to the program, 50 (24.6%) participated in the penicillin (LDP) + AIN-93G diet), 3)prebiotic (water + 10% oligofructose (OFS) diet) or program evaluation. Of those children included in the evaluation, 48% (n=24) were 4)antibiotic+prebiotic (LDP+10%OFS diet). Mothers received LDP via drinking water female and the average age was 11.5 yr (SD=3.4). Referral sources included: 14% through the third week of pregnancy and lactation as described previously. Dams under- (n=7) from a partner treatment program, 52% (n=26) from a physician, and 34% went oral glucose tolerance tests (OGTT) and insulin tolerance tests (ITT) at weaning. DXA (n=17) self-referred. The geographic distribution of referrals was 18% (n=9) from was used to determine body composition. rural/remote communities and 82% (n=41) from urban communities. Of those with Results: Increased body weight during lactation was seen in LDP dams when compared a physician-measured BMI (n=42), 71% (n=30) were above the 99th percentile, to control, prebiotic and antibiotic+prebiotic groups (p<0.05). At weaning, no differenc- 19% (n=8) were within the 95th to 99th percentile, and 10% (n=4) were below the es in glucose levels during the ITT and OGTT was observed in LDP dams. Offspring were 95th percentile. Children in the evaluation averaged 9.3 hr (SD = 2.2) of sleep per followed into adulthood and analysis on their body composition and insulin sensitivity is weeknight, although 83% (n=38) of children reported not meeting daily fruit and currently ongoing. vegetable intake recommendations. Conclusion: Adding prebiotics to the dams diet reversed the antibiotic-associated increase Conclusions: While participants generally reported meeting sleep recommenda- in body weight in dams during lactation. Whether this provides protection for tions, they may require specific counselling related to food and nutrition within a offspring obesity risk remains to be determined. comprehensive physical activity and nutrition telehealth program.

100 | 5th Canadian Obesity Summit | #COS17 Abstract Details

P4.15 supported the value of developing trusting and respectful relationships with HCPs as a basis Obesity is Associated with Increased Asthma Prevalence and Asthma to discuss weight management, although few participants achieved this ideal through their Related Health Service Use, in a Population Based Study of Nova Scotia lived experiences. Emerging evidence of using strengths-based approaches and goal-set- Children ting with families around weight management was supported by participants. Teri D. Mccomber1, Crawford W. Revie1, Jennifer P. Taylor1, Paul J. Veugelers2 Conclusions: Families endorsed many of the evidence-based recommendations 1. University of Prince Edward Island, Charlottetown, PE, Canada, 2. University of Alberta, regarding weight-related communication, although empirical evaluations of recom- Edmonton, AB, Canada mended approaches are still required.

Objective: To determine the association between weight status and asthma prevalence, P4.17 and asthma related health service usage among children in Nova Scotia (NS), Canada. Review of a Family Based Child/Youth Obesity Treatment Program Methods: Provincial administrative health records were linked with a province-wide Constance Oates, Lise Leahy, Gina Maloney, Ian Jamieson, Haley Nyboer, Kelly school based survey of grade five NS students (n=5513) and used to identify asthma di- Proulx, Sarah Van Huizen, Erin Brown agnosis and frequency of asthma related health service visits over a six year period (ages Peterborough Regional Health Centre, Peterborough, ON, Canada 6–12y). Body mass index values were calculated from children’s measured height and weight; weight status was then categorized as healthy weight (HW), overweight (OW) or Background: The PHIT Clinic is a hospital based multidisciplinary treatment obese (OB). Logistic regression modeling was used for the asthma diagnosis outcome, program for children/youth and their families living with overweight and obesity while negative binomial modeling was used for the frequency of asthma related health and related complications. The family based approach recognizes that parents/ service use, with weight status as the predictor for both. All models were adjusted by sex, caregivers play a fundamental role in their child’s health and well-being, and parent income, parent education, and geographic region. focuses on helping the whole family to connect to resources within their community. Results: The reference category used was children with HW. There was a significantly Objectives:The goal of the review is to provide a description of a family centred higher risk of asthma diagnosis if the child’s weight was classified as OB (OR=1.37, 95% multidisciplinary program and the characteristics of children/youth and families CI=1.07, 1.77). OW did not have a significant effect. Children who were obese also exhib- referred to this program. The report will also provide preliminary outcome data and ited significantly higher health service use (β=0.46, 95%CI= 0.11, 0.81). patient satisfaction information. Conclusions: Children with obesity had an increased risk of asthma diagnosis and with Method: A review of patients referred to the clinic. BMIz for the individuals were increased asthma related health service use. These findings are important for public health compared at 6 month and 12 month follow up and assessed for a change. Qualita- stakeholders and policy makers, since the promotion of healthy weights may have broader tive patient satisfaction questionnaires were analyzed. impacts on chronic conditions in childhood and reduce the usage of health services. Results: The total referral number of 291 children/youth ranging in age from 0-18 years were reviewed. Of those referred 59% remained active in the program and P4.16 23% had completed the program. BMIz scores at 6 month follow up (total n=65) Listen Up! An Exploration of Families’ Perceptions and Preferences were reviewed. In the 2-5 year old children, 64% had a decreased BMIz, in the 6-12 Around Weight-Related Communication Best Practices in Healthcare year old children, 73% had a decreased BMIz, and in the 13-18 year old youth, 59% Settings showed a decreased BMIz. Results at 12 months (n=23) showed a similar trend. Amy C. McPherson1, 2, Geoff Ball3, Shauna Kingsnorth1, 2, Alissa Steinberg4, Tara Joy Parent and child/youth evaluation forms indicated high rates of satisfaction. Knibbe1, Michelle Peters1, Nadia Browne3, Judy A. Swift5, Lorry Chen6, Kim Krog6, Conclusion: This program review provides important information in understand- John Philpott7, Jill Hamilton4, 2 ing the patient experience and examining the efficacy of a multidisciplinary family 1. Bloorview Research Institute, Toronto, ON, Canada, 2. University of Toronto, Toron- centred program. to, ON, Canada, 3. University of Alberta, Edmonton, AB, Canada, 4. Hospital for Sick Children, Toronto, ON, Canada, 5. University of Nottingham, Nottingham, United P4.18 Kingdom, 6. Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada, 7. Childhood and Adolescent Obesity Treatment: Expanding the Conversa- Toronto East General Hospital, Toronto, ON, Canada tion to Include Families Constance Oates Background: Paediatric obesity prevention and management guidelines state that Peterborough Regional Health Centre, Peterborough, ON, Canada all healthcare professionals (HCPs) should have the skills to communicate with children and parents about weight. There is a need to develop best practices in weight-re- Background: Attrition has been identified as a key challenge in childhood obesity lated communication, drawing upon different sources of information and evidence. treatment. The PHIT Clinic is a hospital based multidisciplinary treatment program Objectives: To explore families’ perceptions and preferences of weight-related for children/youth and their families living with obesity and related complications. communication best practices. Engaging families in the conversations about the development and evaluation of the Methods: This qualitative study used purposive sampling to recruit 7-18 year olds and program recognizes the value of a collaborative approach to health improvement. their parents attending one of two Toronto children’s hospitals. We conducted separate fo- Objectives: The goal of the review is to examine the efficacy of a family centred multi- cus groups and individual interviews with children and parents using an interview guide disciplinary program. The report will include the children/youth and families’ perspectives created with findings from a recent scoping review of weight-related communication best on both the concept of personal health and wellness and their experience of this family practices. Thematic analysis using a phenomenological approach was employed. centred treatment program. Results: Eighteen children (10 boys, 8 girls; age 14yrs ± 2.62) and 21 parents (17 Method: A review of patients referred to the clinic. BMIz for the individuals were com- mothers, 1 father, 3 caregivers) participated. Participants endorsed the recommen- pared at 6 month and 12 month follow up and assessed for a change. Qualitative patient dations to start discussions early in life and to involve all stakeholders, although satisfaction questionnaires and health and wellness surveys were analyzed. Participants there were some concerns about involving younger children. Discussions of growth were invited to provide video recorded comments of their experiences in the program. and health were preferred over focusing solely on weight. Participants demonstrated Results: The total referral number of 291 children/youth ranging in age from 0–18 variable preferences for weight-related terms proposed in the literature. Families years were reviewed. Of those referred 59% remained active in the program and 23%

101 | 5th Canadian Obesity Summit | #COS17 Abstract Details had completed the program. Parent and child/youth group evaluation forms indicated and DBP. Inferential analysis (Mann Whitney test t and U) for comparison between high rates of satisfaction. Survey responses revealed important themes of acceptance, groups (significance of 5%). support, and family fun. Video clips provide an opportunity for patient voices to con- Results: The metabolically unhealthy obese (MUO) presented worse parameters in tribute and highlight learning, multidisciplinary input, and support as primary needs. all baseline variables, with significant differences (p <0.05) for BMI, VO2max, HDL-c, Conclusion: This program review provides evaluation and insight into the experi- TG, SBP and DBP. After 16 weeks of intervention MHO demonstrated improvements ences of children/youth and their families who participated in multidisciplinary family for BM, BMI, RFM and WC, and MUO presented improvements for MC, BMI, RFM, centred program. LM, VO2max and WC (p <0.05). The MUO exposed more expressive improvements than the MHO on all variables, excepted for GLI and WC. P4.19 Conclusion: A 16-week MPOT was effective on body composition and cardiorespi- Do Children and Adolescents Referred to Multidisciplinary Care for Weight ratory fitness of MHO / MUO adolescents. It also promoted discreet improvements in Management in Alberta Enroll in Treatment? A Preliminary Analysis MHO / MUO metabolic variables. Arnaldo Perez1, Maryam Kebbe1, Katerina Maximova1, Maryna Yaskina1, Charlene Nielsen1, Chenhui Peng2, Tanmay Patil3, Nick Holt1, Josephine Ho4, Paola Luca4, P4.21 Alison Connors2, Tesia Bennett2, Kim BrunetWood2, Tim Baron2, Rena LaFrance2, The Effect of Peer Support on Knowledge and Self-Efficacy in Weight Kristine Godziuk2, Geoff Ball1 Management: a Prospective Clinical Trial in a Mental Health Setting 1. University of Alberta, Edmonton, AB, Canada, 2. Alberta Health Services, Edmon- Claire Hibbert1, Margaret Hanh2, Emilie Trottier1, Marlie Boville1 ton, AB, Canada, 3. Alberta Health Services, Calgary, AB, Canada, 4. University of 1. Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada, 2. CAMH, Calgary, Calgary, AB, Canada Toronto, ON, Canada

Objective: To determine the enrollment rate of children (2.0–11.9 years old) and Introduction: Increased body weight is common in people with serious mental adolescents (12.0–17.9 years old) referred for weight management to one of three mul- illness (SMI) due to pharmacological side effects. Strategies for weight management tidisciplinary clinics in Edmonton (Stollery Children’s Hospital; Misericordia Community may include group education, peer support, frequent follow up, and the use of Hospital) and Calgary (Alberta Children’s Hospital, which also offers care at the South ‘Confidence and Conviction’ (C&C) to gage knowledge and self-efficacy. This study Health Campus), Alberta. will evaluate the effects of a group-based weight management program on individ- Methods: Data analysis for this cross-sectional study will end in spring 2017; prelimi- uals’ C&C, body mass index (BMI), health-related quality of life, and diet quality and nary analyses are presented. Data included all referrals received from April 2013 to April determine the relationship between these various factors in people with SMI. 2016. In partnership with Alberta Health Services, participants’ demographic, anthro- Methods: Fourteen participants (aged 51.7 ± 12.2 years; 67% female) who were pometric, and referral data were retrieved from standardized referral forms and clinic unable to successfully achieve and maintain a 5% weight loss were recruited from a enrollment data were obtained from medical records. Metabolic and Weight Management Clinic at a mental health care facility. Weight, Results: In total, 2,014 unique patients were referred during our study period. Of these, C&C, a Dietary Screener Questionnaire and the 36-item Short Form Survey Instru- 1,644 patients (81.6%) booked a pre-clinical orientation session, 1,124 patients (55.8%) ment were collected at baseline (November 2016) and will be collected at 3, 6, and attended this session, 805 patients (40.0%) booked an initial clinic appointment, and 12 months. The 12-month weight management program includes bi-weekly group 660 patients (32.8%) enrolled in treatment, which we defined as attending an initial lifestyle education sessions facilitated by a registered dietitian and a registered clinic appointment. Most patients were referred by physicians (n=1,922; 95.6%), met nurse. Clients also attend monthly individual follow-up throughout the year. the criterion for obesity (BMI ≥95th percentile; n=1,806; 89.7%), and were children Results: At baseline, BMI was 44.1 ± 9.2 kg/m2, conviction was 9.3 ± 1.0, and (n=1,273; 63.5%). Similar proportions of boys (52.2%) and girls (47.8%) were referred. confidence was 6.6 ± 2.1. Three-month data will be collected in February 2017 and Conclusions: Only one-third of children and adolescents referred for multidisciplinary results will be presented. weight management in Alberta enrolled in treatment. Our ongoing analyses will include Discussion: It is expected that weight management programming incorporating examining predictors of enrollment so that future clinical research and quality improve- group peer support will result in clinically meaningful reduction in BMI, improvement strategies can be designed and tested to enhance enrollment in health services for ment in health-related quality of life, and improvement in diet quality via the effect managing pediatric obesity of the program on C&C.

P4.20 P4.22 Effects of a Multiprofessional Program of Obesity Treatment (MPOT) in Optimizing Body Composition and Glycemic Control in the Elderly Adolescents from the Metabolically Healthy Obese (MHO) Phenomenon Through Creatine Supplementation and Resistance Exercise Jane Maria Remor1, Ronano P. Oliveira1, Carlos A. Lopera1, Luzia J. Hintze2, Nelson N. Camila L. Oliveira1, Barbara Antunes2, Fábio Lira2, Aline Gomes3, Gustavo Pimentel3, Junior1, João Carlos Locateli1, Mario M. Castilho1 João Mota3 1. State University of Maringá, Maringá, PR, Brazil, 2. Ottawa of University, Ottawa, 1. University of Alberta, Edmonton, AB, Canada, 2. Sao Paulo State University, Presi- ON, Canada dente Prudente, SP, Brazil, 3. Goias Federal University, Goiania, GO, Brazil Objective: Evaluate the effects of a MPOT on body composition, cardiorespiratory fitness and metabolic profile of adolescents according to the MHO phenomenon Objective: The aim of this study was to examine the efficacy of low-dose creatine sup- defined by the absence of alterations in glycemia (GLI), triglycerides (TG), HDL-cho- plementation associated with resistance training on body composition, metabolic and lesterol, Systolic Blood Pressure (SBP) and Diastolic (DBP). inflammatory blood markers in community dwelling elderly individuals. Methods: Almost experimental pragmatic clinical trial with 55 adolescents (25 Methods: This was a 12-week, parallel-group, double-blind, randomized, placebo-con- MHO and 30 MUO), evaluated before and after 16 weeks of a MPOT focused on trolled trial. Individuals were randomly allocated into one of the following groups: place- lifestyle changes (Physical Education, Nutrition and Psychology). Were analised bo plus resistance training (PL + RT) or creatine supplementation plus resistance training body mass (BM), body mass index (BMI), relative fat mass (RFM), lean mass (LM), (CR + RT). Participants were assessed at baseline and after 12 weeks. Body composition cardiorespiratory fitness (VO2max), waist circumference (WC), GLI, TG, HDL-c , SBP was assessed by dual energy X-ray absorptiometry and blood samples were collected for

102 | 5th Canadian Obesity Summit | #COS17 Abstract Details analysis of glucose, insulin, adiponectin, brain-derived neurotrophic factor, interleukin 6, Methods: Data was derived from a subset of bariatric patients (n=1943) who interleukin 10 and monocyte chemo attractant protein-1. attended WMC for 3+ months. Study exposures included the number and type of Results: Participants (N=27, ~70% with overweight/obesity) were assigned to either medications taken, and number and type of the chronic diseases experienced. The the PL + RT (N=14) or CR + RT (N=13) groups. Compared to the PL+RT group, the primary study outcome was relative weight change. increase in lean mass was higher in the CR + RT group after the 12-week intervention Results: Of the 166 medications listed by WMC patients, 26 have side effects that period (0.6 ± 1.3 kg and 1.8 ± 1.3 kg, respectively; p=0.02) and blood glucose levels include weight gain. Over 3 months of follow-up, average weight loss was 4.65 kg; were lower (104.4 ± 29.3 mg/dL and 91.5 ± 18.9 mg/dL, respectively; p<0.05). No percentage weight change was greatest amongst patients with a history of hyperten- other differences were observed between groups. An inverse correlation between lean sion (4.4%) and least amongst those with a history of stroke (0.6%). mass with insulin (-0.64, p=0.01) and HOMA-IR (-0.69, p<0.01) was observed in the CR Implications: Barriers to weight loss may include pharmacological treatment for + RT group. pre-existing conditions. These findings have implications for setting realistic weight Conclusion: Low-dose creatine supplementation in combination with resistance train- loss goals for long-term obesity management. ing can improve body composition and glycemic control in the elderly. Moreover, lean mass gain was associated with lower insulin resistance in the supplemented group P4.22 Current Weight Management Approaches Used by Primary Care Provid- P4.23 ers in Multidisciplinary Health Care Settings in Ontario Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale Stephanie Aboueid, Ivy L. Bourgeault, Isabelle Giroux (BIPASS TM): Phase II – Establishing Convergent Validity University of Ottawa, Ottawa, ON, Canada Gurneet S. Thiara1, 2, 3, Richard Yanofsky1, 2, 3, Allan Okrainec4, 2, Raed Hawa1, 2, 3, Sanjeev Sockalingam1, 2, 3 To understand how Primary Care Providers (PCPs) assess the most suitable weight 1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada, 2. University management approach for their clients with obesity and elucidate which approach Health Network, Toronto Western Hospital, Toronto, ON, Canada, 3. Bariatric Surgery seems to be most accepted by clients. We conducted 17 interviews with family Psychosocial Program, Toronto, ON, Canada, 4. Department of Surgery, University of physicians and nurse practitioners working in multidisciplinary primary care settings in Toronto, Toronto, ON, Canada Ontario. All interviews were audiotaped, transcribed, and coded using NVivo software. PCPs reported assessing the most suitable weight management approach based on 1) Background: Patients who are referred for possible Bariatric Surgery (BS) intervention client level of readiness, 2) previous weight management attempts, and 3) client pref- undergo a series of assessments conducted by an interdisciplinary health care team to erence. One-on-one nutrition counselling with the registered dietitian was often the determine suitability for surgery. Herein, we report phase II convergent validity findings first approach suggested while on site weight management programs were offered to s of the Bariatric Interprofessional Psychosocial Assessment Suitability Scale (BIPASS) and clients with social isolation. Handing out pamphlets was used by some PCPs but most its relationship to interdisciplinary psychosocial assessment practices for BS. reported that it might be ineffective due to lack of follow up. Medications for weight Methods: This study was conducted at the Toronto Western Hospital, a Level 1A bariatric loss purposes were seldom used since only one PCP reported prescribing them. Most surgery centre of excellence accredited by the American College of Surgeons. Total scores PCPs stressed the importance of lifestyle modification for weight management and ex- for the validated clinical psychosocial scales: GAD-7, PHQ-9, and SF-36 scores were pressed the ineffectiveness of the pharmaceutical approach. Furthermore, according to compared to total BIPASS scores pre bariatric surgery psychosocial assessment. participating PCPs, weight management approaches most accepted by clients were: 1) Results: N=50 including both males and female patients. Total BIPASS rater scores referral to a dietitian for a personalized approach, 2) weight management programs on demonstrated moderate correlations with clinically validated scales of most notably site, 3) weight watchers, and 4) fad diets. The least accepted approach was taking medi- PHQ9 (Pearson correlation =0.510; p<0.01), GAD-7 total scores (Pearson correlation= cation, as many clients fear their side effects. As part of these multidisciplinary clinics, 0.312; p<0.068) and SF-36 (Pearson correlation = -0.156; p<0.41) . PCPs reported evaluating various factors in identifying which approach is most suitable Conclusion: The preliminary study findings show that the BIPASS has promising for clients. Evidence-based weight management approaches (dietitian services, on site convergent validity across psychosocial domains as a clinical tool in the assessment of BS programming) seemed to be most accepted by clients. candidates which will help standardize the evaluation process and systematically identify at-risk patients for negative outcomes after BS. P4.23 Pediatric Weight Management: Are Dietitian-led Interventions Successful? Tesia Bennett, Rena LaFrance, Kim Brunet Wood P4.24 Alberta Health Services, Edmonton, AB, Canada Association Between Therapeutic Drug Classes and Weight Change in Patients Attending a Medically Supervised Weight Loss Clinic Purpose: Outpatient Dietitian Counseling (ODC) is a dietitian-led intervention accessed Elham Kamran Samani1, Jennifer Kuk1, Sean Wharton2, Christpher Ardern1 by referral from a primary healthcare provider. Families meet regularly with a dietitian 1. York University, Toronto, ON, Canada, 2. Wharton Medical Clinic, Toronto, ON, Canada trained in Pediatric Weight Management. The program is multi-component and includes nutrition, physical activity, sedentary time and sleep. The dietitian and the family’s Introduction: Obesity is a leading public health problem in the developed and healthcare provider work together to ensure the family is supported in achieving their developing world. As the prevalence of obesity and its associated comorbidities increases, health goals. To determine the ODC program success, a Program Evaluation is underway. the number of the medications used by individuals living with obesity is also on the rise. The primary objective is to determine success at achieving lifestyle behaviour changes Beyond the utility of these drugs for the treatment of obesity-related chronic diseases, in children and adolescents 2-17 years with overweight or obesity. Secondary objectives many have unwanted side effects, including weight gain. include changes in anthropometrics and self-reported quality of life. Objectives: To characterize the number and type of medications used by patients of Methods: This prospective, longitudinal, observational study commenced Decem- the Wharton Medical Clinic (WMC), a medically supervised weight management ber 1, 2015 and will continue until 243 participants have been recruited. All families center, and; to determine whether the amount of weight change differs according to who attend an initial appointment are invited to participate. Written informed con- therapeutic drug classes or chronic condition. sent is received from the caregiver(s) before entry. Data collection occurs at baseline,

103 | 5th Canadian Obesity Summit | #COS17 Abstract Details

6, 12, 18 and 24 months. Data elements include food frequency using the Child and non-sarcopenic types of obesity in OA, and examine the relationship between body com- Youth Nutrition Survey (CYNS) , physical activity, sedentary time and sleep using the position, physical function, quality of life, and surgical outcomes in this population. A two Physical Activity and Sedentary Time questionnaire (PAST), health-related quality of phase prospective study protocol was developed based on a systematic literature review life using thePedsQLTM and anthropometry (BMI z-score). The data will be extracted and focused meetings with stakeholder organizations. Research results will expand and stored in the online REDCapTM database. knowledge on the impact and identification of sarcopenic obesity in knee osteoarthritis. Relevance: This evaluation will assist with understanding the success of dietitian-led interventions in achieving lifestyle behaviour change for children referred P4.26 for pediatric weight management, and identify areas for future improvement. Personalizing Obesity Assessment and Care Planning in Primary Care: Patient Experience and Self-management Outcomes P4.24 Thea Luig1, Robin Anderson2, Arya M. Sharma4, Denise L. Campbell-Scherer1, 3 Children and Youth Nutrition Survey: Monitoring Dietary Patterns During 1. University of Alberta, Edmonton, AB, Canada, 2. Edmonton Southside Primary Weight Management Counselling Care Network, Edmonton, AB, Canada, 3. Grey Nuns Family Medicine Centre, Tesia Bennett, Lorian Taylor, Susan Buhler, Kim Brunet Wood Edmonton, AB, Canada, 4. Alberta Diabetes Institute, Edmonton, AB, Canada Alberta Health Services, Edmonton, AB, Canada Purpose: This project aims to improve primary care obesity management by Purpose: Accurate methods for collecting food intake and eating behaviors are examining how personalized root cause assessments and action plans can support needed for children participating in weight management interventions. The primary patients in improving their health. Root causes include comorbid diseases and aim of this study was to develop, pilot and evaluate the Children and Youth Nutrition psychosocial factors. Personalized strategies are crucial to helping patients navigate Survey (CYNS). their set of drivers and barriers to self-management. Despite available resources, Methods: The CYNS is adapted from three previously published surveys with clinicians feel ill-equipped to counsel on weight and patients’ needs are not acceptable psychometric properties. The CYNS includes foods and eating behaviors adequately addressed. There is a pressing need for an effective intervention that de- both recommended and discouraged for a healthy lifestyle. The survey contains four livers personalized obesity care. We integrated the 5As of obesity management with sections: fruit and vegetables, beverages (sugar-sweetened and healthier choices), the collaborative deliberation model for patient-centred communication to develop fat, and eating behaviors. To ensure relevance to Canadian children, the survey was an intervention. We examined how patients experience the intervention and make developed with expert review, and piloted to assess internal consistency and identify changes to improve health as a result. evaluation cut-points. Participants were parents of children aged 3-17, who were Methods: Purposeful sampling of 20 patients to record consultations, conduct attending dietitian counselling sessions for weight management. semi-structured patient and provider interviews, and document patients’ self-man- Results: A convenience sample of 48 surveys was completed. The fruit and vege- agement through diaries and two follow-up interviews. Inductive, thematic analysis tables questions demonstrated acceptable internal consistency (Cronbach’s alpha in NVIVO11. = 0.83). The beverages, fat and eating behavior questions showed low internal Results: Preliminary results reveal interpersonal processes that prove decisive for consistency when examining them as subscales (Cronbach’s alpha = 0.51, 0.48, supporting patients’ everyday self-management: (1) validating patients - listening to and 0.46 respectively). Upon examination of the beverage and eating behavior stories of weight gain and exploring root causes; (2) supporting self-efficacy - labeling questions, it was identified tracking individual items over time and using cut-points patients’ strengths and exploring preferences; (3) optimizing care - prioritizing root was preferable to using a total subscale score. More items were added to the fat causes and directing patients to interdisciplinary clinicians. questions to improve internal consistency. Conclusion: Personalized consultations using the 5As and collaborative deliberation Conclusions: The CYNS shows promise for assessing food intake and eating appear to support patient self-efficacy and coordinate clinical care and self-management to behaviors in children receiving weight management interventions. Further research addressing root causes of weight gain and improving health. Results will be used to refine is underway to retest the adaptation identified in this pilot study. an intervention and identify outcome measures for testing in a future trial.

P4.25 P4.27 Differential Health Burden and Clinical Risks Associated with Types of Effect of Yellow Pea Fiber on Fecal Short-chain Fatty Acids and Bile Acids in Obesity in Patients with Obesity and Knee Osteoarthritis Adults with Overweight/Obesity: a 12-week Randomized Controlled Trial Kristine Godziuk, Carla Prado, Linda Woodhouse, Mary Forhan Shyamchand Mayengbam1, Jennifer E. Lambert1, Jill A. Parnell2, Jasmine M. Tunni- University of Alberta, Edmonton, AB, Canada cliffe1, Jay Han3, Troy Sturzenegger3, Hans J. Vogel4, 5, Jane Shearer1, Raylene Reimer1, 5 1. Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada, 2. Physical Edu- Knee osteoarthritis (OA) can lead to severe pain and disability that necessitates surgical cation and Recreation Studies, Mount Royal University, Calgary, AB, Canada, 3. Food joint replacement. The demand for total knee arthroplasty (TKA) in Canada has risen Processing Development Centre, Alberta Agriculture and Rural Development, Leduc, along with rates of obesity, resulting in long wait times for surgery. Screening for TKA AB, Canada, 4. Department of Biological Sciences, University of Calgary, Calgary, AB, eligibility is routinely based on clinical evaluation and obesity classification using body Canada, 5. Department of Biochemistry & Molecular Biology,Cumming School of mass index (BMI). Individuals with moderate to severe obesity (BMI ≥35 kg/m2) are often Medicine, University of Calgary, Calgary, AB, Canada considered ineligible for surgery unless they lose weight, without clear evidence that weight loss improves surgical outcomes. Long term results after TKA appear similar for Obesity is a major risk factor for several metabolic diseases. It is also associated with individuals with and without obesity, although post-surgical infection rates and recovery dysbiosis of gut microbiota and alteration in microbial metabolites, especially short times are elevated in those with obesity. Reliance on BMI to screen for TKA discounts the chain fatty acids (SCFAs) and bile acids (BAs) in humans. The role of dietary fiber in influence of body composition on outcomes. Sarcopenic obesity (SO), a condition of high regulating SCFAs and BAs metabolism as one the mechanisms in the prevention adiposity and low skeletal mass and function, has been linked to increased infection rates of metabolic disease is well recognized. The current study aimed to investigate the after cardiac surgery. SO could be influencing TKA outcomes, and further investigation effect of yellow pea fiber on SCFAs and BAs metabolism in adults with overweight/ is essential. Our research program aims to identify the prevalence of sarcopenic and obesity. A total of 53 adults (BMI>25.0) were randomly assigned to either a pea

104 | 5th Canadian Obesity Summit | #COS17 Abstract Details fiber (PF, n=29) or placebo (PL, n=24) group for 12 weeks. The PF group received wa- Methods: 15 patient charts will be retrospectively reviewed from a multi-agency obesity fers containing 5g/serving of yellow pea fiber thrice a day, while the PL group received program. Classes take place at the Queen’s Family Health team with excursions to the local an isocaloric amount of control wafers with no fiber. Fecal samples were collected at grocery store for grocery shopping education and cooking classes. At each weekly visit baseline and at the end of the study. Fecal SCFAs and BAs were analysed by the use of participants are seen by a registered nurse for blood pressure and review of health status, GC-MS and HPLC-DAD methods respectively. There was no significant change in fecal and a registered dietitian for weight measurement and lifestyle assessment. At treatment SCFAs or BAs in the PL group. However, we found a significant increase in fecal acetate completion participants will be provided additional resources for ongoing support. (P=0.039) and significant decrease in fecal isovalerate (P=0.015) concentrations in PF group compared to baseline. In case of BAs, cholic acid (P=0.011), deoxycholic P4.30 acid (P=0.014) and total BAs (P=0.042) content were significantly reduced. Thus, the Differences in Short and Long-term Mortality Associated with Body Mass current study provides important data on the effect of yellow pea fiber on fecal SCFAs Index Following Coronary Revascularization and BAs metabolism in adults with overweight/obesity. Tasuku Terada, Jeffrey A. Johnson, Colleen M. Norris, Weiyu Qiu, Raj Padwal, Arya M. Sharma, Jayan Nagendran, Mary Forhan P4.28 University of Alberta, Edmonton, AB, Canada Impact of Computer-Based Cognitive Training on Outcomes During a Weight Loss Intervention in an Obese Population Background: Few studies have investigated the mortality associated with obesity Ryan M. Stallard2, Vic Sahai1, Duncan Day2 following cardiac revascularization while accounting for coronary anatomy risks and 1. Hotel Dieu Research Institute, Kingston, ON, Canada, 2. Hotel Dieu Hospital, diabetes status. Kingston, ON, Canada Objective: This study examined the associations of body mass index (BMI: kg/m2) with short-, intermediate-, and long-term mortality following coronary artery bypass Objective: Elucidate the impact of computer-based cognitive training on eating graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with behaviours and weight loss in an obese population. different coronary anatomy risks and diabetes status. Methodology: We will recruit treatment seeking obese adults to participate in a Methods: Data from the Alberta Provincial Project for Outcomes Assessment in Coro- double-blind, randomized, controlled trial. This trial will include 3 phases; a weight nary Heart Disease (APPROACH) registry were analyzed. Using normal BMI (18.5–24.9) loss intervention phase, a weight maintenance phase, and a no-contact phase. Eligible as a reference, multivariable-adjusted hazard ratios (HRs) for all-cause mortality participants will be randomized to 1 of 2 groups: standard care or computer-based within six months, one year, five years, and 10 years were individually calculated for cognitive training. All participants will attend a 12 week lifestyle-based weight loss in- CABG and PCI with a Cox proportional hazards regression model for four prespecified tervention. Weekly sessions are designed to educate participants on evidenced-based BMI categories: overweight (25.0–29.9), obesity class I (30.0-34.9), obesity class II lifestyle change strategies that support weight management. Participants in both (35.0–39.9), and obesity class III (≥ 40.0). The analyses were repeated after stratifying groups will complete online cognitive training tasks; the control group will be provid- for coronary risks and diabetes status. ed tasks that have no known impact on ingestive behaviours while the experimental Results: The cohorts included 7560 and 30258 patients for CABG and PCI, respective- group will receive tasks shown to improve response inhibition and emotion regulation. ly. Following PCI, overall mortality was lower in overweight and obese class I compared They will be asked to complete these tasks on 5 separate days each week during the to normal BMI, irrespective of follow-up duration; however, five-year (adjusted HR 1.38 course of the treatment phase and 1 time per week during the maintenance phase. 95%CI 1.01–1.88) and 10-year (adjusted HR 1.34 95%CI 1.00–1.79) mortality rates Relevance to practice: An ability to detect an effect of computer-based cognitive were significantly higher in obesity class III with high-risk coronary anatomy. Following training on eating behaviours and weight loss will expand our current understanding of the CABG, obesity was not associated with higher mortality compared to normal BMI. role that known neural networks play on the management of ingestive behaviours that has Conclusion: Obesity was not associated with elevated mortality following CABG. not been accomplished by existing laboratory studies. Improving our understanding in this Greater long-term mortality in patients with obese class III and high-risk coronary field can provide new insights into novel therapeutic strategies for this complex disease anatomy warrants further investigation.

P4.29 P4.31 Benefits of a Multi-Agency Obese Treatment Program Non-invasive Brain Stimulation (NIBS) of the Prefrontal Cortex: a System- Ryan M. Stallard1, Allison Little2, Kaitlyn Bresee3 atic Review of Multi-session Treatment Studies Examining Eating-related 1. Hotel Dieu Hospital, Kingston, ON, Canada, 2. Queen’s Family Health Team, Kingston, ON, Outcomes Canada, 3. Kingston General Hospital, Kingston, ON, Canada Corita M. Vincent1, Peter A. Hall2 Goal: Assess the benefits of a multi-agency community-Bariatric Centre of Excellence collab- 1. University of Toronto, Toronto, ON, Canada, 2. University of Waterloo, Waterloo, orative obesity program on weight and quality of life in obese adults living in the Kingston, ON, Canada Ontario region. Objective: Previous studies have demonstrated that single session NIBS of the Background: Obesity is a primary risk factor for multiple chronic diseases including type 2 PFC results in significant reduction of food cravings that may extend to changes in diabetes, heart disease, sleep apnea, and several cancers. Sustained weight loss, while chal- food consumption. However, findings from multi-session treatment studies have lenging, is possible and is related to significant improvements in patient health and quality been mixed. The current systematic review summarizes multi-session and long-term of life. While barriers to successful treatment are multifactorial one common challenge that follow up studies of NIBS on food behaviours and suggests possible explanations faces many people living with obesity is access to appropriate resources. Health care systems for disparities in findings. are also challenged by obesity given limitations in budget and difficulty creating expertise Methods: PubMed, Scopus, Web of Science, PsychoInfo and EMBASE databases in all relevant domains. These challenges may be overcome by offering inter-connected pro- were used to identify studies examining multi-session effects of NIBS of the PFC on grams that are shared between agencies alleviating the barriers faced by both patients and food behaviour. Studies with more than 1 session of NIBS, sham comparison group, health care teams. The Kingston region has a collection of obesity programs, however there and outcome measures related to food behaviours (consumption, craving, binge/ appears to be little or no collaboration between agencies resulting in duplication of efforts. purge) were included.

105 | 5th Canadian Obesity Summit | #COS17 Abstract Details

Results: Eight articles were included in the systematic review: two studies involved Results: Out of 473 patients, 81.4% (N=385) who were metabolically abnormal at healthy adults, 3 studies involved individuals with obesity, and 3 studies involved baseline 67.8% (N=321) reduced their weight by ≥ 5%, while 41.8% (N= 198) at- individuals with bulimia nervosa. Of studies involving healthy or obese populations tained a weight loss of ≥ 10%. The mean (SD) initial waist circumference was 125.3 2 of 2 studies demonstrated significantly reduced food cravings in participants (18.3) cm and average initial BMI was 44.3 (8.85). At baseline, 146 patients (30.8%) randomized to NIBS compared to sham, 1 of 2 studies observed significant weight were diagnosed with type 2 diabetes (41.1%) with A1c >7%. After a minimum of six loss, 1 of 2 studies observed decreased caloric intake. Among studies examining months participation in the program, 51.6% (N=31) of patients had an A1c <7%, individuals with bulimia nervosa 2 of 3 studies observed no effect on binges and and 40.0% (N=24) achieved an A1C <6.5%. purges and 1 study observed a decrease in the number of purges. Conclusion: Gathered data supports the effectiveness of this publicly funded Conclusion: The findings of this systematic review indicate a potential role for weight management program. NIBS in altering food behaviours in the longer term among healthy populations and those with obesity; however further research is needed to clarify the long-term P4.34 effects on food consumption and weight loss. Computer Apps to Assist with Weight Loss: Limited Value in the Present and Opportunities for the Future P4.32 Bradley Tanner1, 2, Mary Metcalf1, 2, Brian C. Tanner2 Reasons for Attrition in a Publicly Funded Weight Management Program 1. Clinical Tools Inc, Chapel Hill, NC, USA, 2. University of North Carolina, Chapel Hill, Sean Wharton1, 2, Rebecca A. Christensen1, Dishay Jiandani2, Kristin J. Serodio1, Chapel Hill, NC, USA Jennifer L. Kuk2 1. The Wharton Medical Clinic, Toronto, ON, Canada, 2. Department of Kinesiology Computer apps and wearable enabled devices tied to apps are common and and Health Science, York University, Toronto, ON, Canada ubiquitous; yet there is little evidence they offer much value to a health community interested in the prevention or treatment of obesity. Even the cardiovascular benefits Objective: To explore why patients stop attending clinical weight management are doubtful. The talk reviews existing app and device based solutions by first and to determine whether these attrition factors relate to weight loss (WL) attained. categorizing them and then summarizing research findings related to their success Methods: The Wharton Medical Clinics (WMC) are weight and diabetes man- and failure. Example lessons that can learned from work include the value of social agement clinics with locations across Southern Ontario. Semi-structured phone connectedness. Going forward software and solutions will evolve. The talk reviews interviews were conducted with 52 former patients to determine why they stopped the potential role of Virtual Reality especially VR delivered with state of the art attending WMC. Reasons cited by patients were categorized as personal, or relating head mounted displays such as Facebook Oculus, Google Daydream, HTC Vive, and to the program, facility or staff. Playstation VR. Strengths and weakness for each solution vary because of complexi- Results: Personal issues (55.8%) were the most common reason for attrition, ty, computer hardware requirements, and the availability or lack of support for hand followed by issues related to the program (40.4%), facility (28.9%), and staff (26.9%). controllers which are essential to manipulate objects in the VR environment. Further Regardless of the reason(s) given for attrition, there were no differences in WL at options also include entertainment quality role playing games to practice lifestyle their last visit (P>0.05) or at follow-up (P>0.05). Individuals reporting issue(s) with change as seen in so called “first-person thinker” games, mystery games, find-and- staff had greater personal WL goals (36.0±16.4% versus 24.3±13.5%, P<0.05) and seek (e.g., Pokeman Go) games, and exploratory simulations. In such games players attended for significantly less time (P<0.05), but were not different in their intentions make choices, healthy or unhealthy, and receive feedback on the outcome. Elements to return to WMC as compared to those reporting no issues with staff (P>0.05). of the typical game challenge players to maximize metrics such a health, strength, Conclusion: As longer treatment time is one of the strongest correlates of greater and mobility, develop and test skills, advance to higher levels, and work with other WL, determining factors that contribute to attrition is crucial. Greater patient WL goals players in the game. The collaboration potential of games allows them to offer peer may be associated with greater likelihood of perceived issues with weight manage- support and coaching, further enhancing motivation for lifestyle change. ment staff and shorter treatment time. While the program, staff, and facilities may influence patient attrition, personal factors outside of the clinic appear to be the most P4.35 common contributing factor. However, the reasons for attrition do not appear to result Health Markers Improvement While Meeting the Physical Activity Guide- in differences in weight loss achieved during the program or after leaving. lines Only doing Resistance Training in People considered Obese Danielle R. Bouchard, Andrea Mayo, Martin Sénéchal P4.33 University of New Brunswick, Fredericton, NB, Canada Effectiveness of a Multidisciplinary Lifestyle-Based Weight Management Program on Improving the Metabolic Health of Adults with Obesity Background: Very few people considered obese in Canada reaches the national Benyamin Hakakzargar physical activity guideline (PAG) including a minimum of 150 minutes of aerobic exer- Simon Fraser University, Burnaby, BC, Canada cises and a minimum of two sessions of resistance training every week. The objective of this study was to explore a new way of encouraging people living with obesity to Objective: Assessing the effectiveness of a publicly funded medical weight man- reach the PAG by targeting a major barrier to regular exercise; lack of time. agement program Methods: A total of people with a minimum body mass index (BMI) of 30 kg/m2, Methods: Medical records of 1418 patients who had attended the multidisci- considered inactive were recruited for a 12-week exercise program. One group did plinary weight management program at Medical Weight Management Centre the traditional PAG while the other group did only 150 minutes of resistance train- (Coquitlam, BC) between Jan 2011 – Oct 2016 were checked. Patients between 18 ing at moderate to vigorous intensity reducing considerably in the weekly required – 90 years of age who had attended the clinic for at least 6 months were included. time. Health outcomes included anthropometric measures, body composition, Patients with missing data or bariatric surgery before their initial visit were excluded. cardiorespiratory fitness, blood pressure, fasting glucose, and lipids profiles. Data collected were waist circumference, BMI, blood glucose, cholesterol and blood Results: At baseline, the average age and BMI were of the sample were 46.4 ± pressure. Smokers and past smokers were put in the smokers’ category for sample 11.3 years old and 35.7 ± 4.9 kg/m2 respectively. The proportion of men participat- size purposes. The data was compared at the initial versus latest visit. ing in the study was 36.7 %. The traditional group increased cardiorespiratory fitness

106 | 5th Canadian Obesity Summit | #COS17 Abstract Details compared to the non-traditional group median (25-75th) [6.1% (4.3-15.0) vs. + (n=12, 60%). Ten studies were with samples mostly comprised of women (75% 3.5% (2.9-4.7); p=.02], while no such difference was observed on health markers of the sample) and 13 studies were with adults who had type-2-diabetes, arthritis, were observed between the groups when analyzing pre-post values. hypertension, and/or cardiovascular diseases. Interventions averaged 23±19 weeks, Conclusion: This pilot study suggests that a person considered obese could 55±17 minutes/session, and were mostly aerobic (n=13). Significant changes in replace some aerobic time for resistance training activities and still achieve health global QoL (n=6/8), depression (n=4/5), and BI (n=1/1) were reported post-EX. No outcomes. A study with an appropriate sample size of longer duration is needed to significant changes were found for anxiety (n=0/2). confirm these findings. Conclusion: EX appears to improve QoL and BI, and reduce depression in adults with obesity. Due to heterogeneity across studies and poor rigorous reporting in the P4.36 studies reviewed, additional studies are needed to strengthen evidence regarding Increasing BMI in Primary Hip and Knee Arthroplasty; Influencing the effects of EX on psychosocial outcomes in adults with obesity. Length of Stay, Complications and Adverse Events. A Retrospective Review P4.38 Richdeep Gill, Irfan Abdulla, Rajrishi Sharma Maternal Antibiotic Consumption Alters Expression of Neurotransmitters University of Calgary, Calgary, AB, Canada Associated with Reward-Seeking Behavior in Rats Nicole Cho, Teja Klancic, Raylene Reimer Purpose: Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are reliable University of Calgary, Calgary, AB, Canada surgical options to treat pain and disability secondary to degenerative arthritis. The purpose of this study is to retrospectively compare length of stay, complications and Background: Healthy gut microbiota is essential for the maturation and adverse events in patients undergoing joint arthroplasty with increased BMI to those with maintenance of the immune and nervous system. Gut microbiota are especially normal BMI. important in early life (during pregnancy and/or in the first years of life). Since the Methods: We retrospectively reviewed the data in the ABJHI (Alberta Bone and Joint gut communicates with the brain via the gut-brain axis, antibiotics may indirectly Health Institute) between March 2010 and July 2016. 10, 902 THA patients and 16,485 perturb neurotransmitters and inflammatory markers in the brain. Therefore, early TKA patients were included in the study. life antibiotic exposure could have detrimental effects later in life. Our objective was Results: In THA, Class II and III obesity were more likely to have 2 or more surgical risk to alter microbiota through low dose penicillin (LDP) in pregnant Sprague-Dawley factors, while in TKA only Class III had similar findings. In THA patients, class II and III rats and examine changes in the hippocampus of the dams and their offspring. had higher 30-day re-admission rates while there was no difference in the TKA group. All Methods: Pregnant 10 week old female Sprague-Dawley rats (n=10) were classes in TKA had increased post-operative medical events. No association was found randomized to: 1)control (water+AIN-93G diet) or 2)antibiotic (LDP+AIN-93G diet). in the THA cohort. In THA, all classes were more likely to have a deep infection while in Mothers received LDP via drinking water through the third week of pregnancy and TKA, patients with Class III Obesity had similar results. In THA, Class II and III obesity had lactation. Offspring were kept until 10 days post-weaning. The expression of various longer length of acute hospital stay while BMI did not affect TKA length of stay. In both neurotransmitters and inflammatory markers was measured using real-time PCR. THA and TKA, class II and III obesity patients were less likely to be discharged home. Results: LDP increased mRNA levels of dopamine receptors Drd1 (p=0.033) and Conclusion: We offer insight on the effects of BMI on THA and TKA patients. The current Drd2 (p=0.025) compared to control. Expression of μ-opioid receptor was also in- data can be used to better detail the risks associated with this particular patient population. creased in LDP dams (p=0.01) as well as TLR4 (p=0.021). Female offspring showed a trend towards higher levels of TNF-α in LDP groups. There were no significant P4.37 changes in gene expression of Drd1, Drd2, or μ-opioid receptors in the offspring. Impacts of Exercise Training on Quality of Life, Body Image, Anxiety, and Conclusion: Administration of LDP during pregnancy and lactation increases Depression in Individuals with Obesity: A Systematic Literature Review expression of neurotransmitters associated with reward-motivated behavior such as Stephanie Saunders1, Jennifer Brunet1, 2, Ahmed J. Romain3, Paquito Bernard4, 5, seeking out palatable food in dams. Implications for behavior, obesity, and neuro- Aurélie Baillot2, 6 psychiatric disorders in offspring warrant further investigation. 1. University of Ottawa, Ottawa, ON, Canada, 2. Institut de recherche de l’Hôpital Montfort, Ottawa, ON, Canada, 3. University of Montreal Hospital Research Centre, P4.40 Montreal, QC, Canada, 4. Université du Québec à Montréal, Montreal, QC, Canada, ENHANCE: A Preliminary Examination of Physiological Outcome Data 5. Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada, 6. Following a 12-week Well-being Intervention Université du Québec en Outaouais, Gatineau, QC, Canada Stefanie Ciszewski1, Lesley Lutes1, Kostadin Kushlev2, Samantha J. Heintzelman2, Jaque- line May Kanippayoor1, Damian Leitner1, Derrick Wirtz1, Shigehiro Oishi2, Ed Diener2 Objective: The negative health consequences of obesity are multi-faceted and 1. University of British Columbia - Okanagan, Kelowna, BC, Canada, 2. University of complex. Reviews show that exercise (EX) reduces many obesity-related physical health Virginia, Charlottesville, VA, USA problems. However, it is unclear whether those benefits extend to psychosocial outcomes. We undertook a systematic review of the literature to evaluate the effects of EX Subjective well-being (SWB), which refers to an individual’s evaluation of their life on quality of life (QoL), body image (BI), anxiety, and depression in adults with obesity. and emotional experiences, is associated with health and longevity. It has been sug- Methods: Searches were performed in 7 databases (Pubmed, Cochrane, EMBASE, gested that individuals who report higher levels of SWB are more likely to engage Proquest, CINAHL, Psycharticle, SportDiscus). Two reviewers screened records using in healthy behaviours (e.g., exercise). However little is known about physiological the following selection criteria: 1) peer-reviewed empirical study, 2) sample of adaptations following an intervention targeted at improving SWB. ENHANCE obese adults (BMI ≥30kg/m2), 3) randomized controlled trial (RCT), experimental, (Enduring Happiness and Continued Self-Enhancement) is 12-week intervention or quasi-experimental studies with isolated EX, and 4) assessment(s) of QoL, BI, with the primary aim of improving SWB. The purpose of the present poster is to examine anxiety, and/or depression. the physiological outcomes following completion of the ENHANCE program. Participants Results: Of the 1,084 studies identified during the search, 20 met inclusion included men and women community members who were randomly assigned to criteria. Studies were published recently (≥2010; n=17, 85%) and most were RCTs either the ENHANCE intervention condition (n = 27, Mweight = 179.38) or a wait-list

107 | 5th Canadian Obesity Summit | #COS17 Abstract Details control condition (n = 26, Mweight = 159.78). Participants assigned to the intervention assess patient acceptance, satisfaction and feedback. condition participated in a 3-month group-based intervention program. Weight, height, Anticipated Implications of Study Results and Conclusion: the findings blood pressure, and resting heart rate were recorded at baseline and immediately will increase collaboration in clinical practice by empowering patients and following the intervention. Participants in the intervention condition lost a mean weight physicians alike to participate actively in shared decision making when treating of -4.87(t = -.530, NS) and participants in the control group lost a mean weight of -2.73(t obesity. The findings will help make patients aware of the interventions that exist = -.530, NS). Furthermore, systolic, diastolic, and resting heart rate was not found to and highlight the benefits of exercise as a first treatment method over traditional be significantly different following the completion of the program for either condition. pharmacotherapy. While non-significant, the theoretical potential for a well-being intervention to produce beneficial physiological changes remains. Implications and recommendations for future P4.43 studies, particularly integrating health components into treatment, will be discussed. CHANGE Adventure Camp: Obesity Prevention and Health promotion for Children and Families P4.41 Doug Klein, Serena Humphries Identifying Patient Attributes that Contribute to High Engagement and University of Alberta, Edmonton, AB, Canada Long Term Weight Loss Christine Ferguson, Jeanette May Objective: The CHANGE Adventure Camp is a new program to prevent and mange Leverage Global, Jamestown, RI, USA obesity by targeting the family unit. The camp aims to reconnect families and children with healthy, active lifestyles through a series of educational programs. The Obesity rates are on the rise in the US and globally with over 641 million individuals camp facilitates the exploration of nature and teaches participants key principles of with obesity, a major risk factor for many chronic diseases. The American Board of physical activity, land use, growing food and meal preparation. Obesity Medicine has certified 1,590 Diplomats, but there continues to be a lack of Methods: The physician led camp content was developed in collaboration with obesity specialists available to patients causing most patients to turn to their primary community stakeholders, with each activity having specific educational messages care provider for help. Unfortunately, due to new information and treatment options relating to physical activity, nutrition and/or nature. The camp was piloted through constantly being developed, primary care physicians have difficulty understanding all two weeklong nature experiences for children aged 9–12 focusing on discovery, of the obesity treatment options available and the role a patient’s individual attributes exploration and health. The CHANGE Adventure Camps were evaluated using a and weight loss history plays in successful treatment. There is a need for solutions that multi-method approach, including participant observation, facilitator reflections, bridge the knowledge gap for both patients and providers as well as enabling patient and surveys of participants, parents and facilitators. engagement and driving outcomes in obesity care. H20- Health to Outcomes, a Results: The weeklong camp included experiential activities related to 1) encourag- Patient-Provider Solution for Obesity, is being developed by a team of cross-sector pro- ing physical activity without a gym; 2) improving nutritional awareness and cooking fessionals that includes obesity specialists, doctors, clinicians, consumer groups, data skills; and 3) connecting with nature. Participants scored the meals on a 5-point scientists, information experts and technology specialists. The core of the solution is a scale with average scores ranging from 3.15-5.0. Participants also reported whether predictive engine that utilizes retrospective patient information and current evidence meals included first-time foods with some meals introducing new foods to 100% of to predict potential obesity treatment options that are individualized to each patient. the participants. Feedback from parents and participants was positive. The goal of H20 is to provide each patient with an individual plan using insights about Conclusion: The CHANGE Adventure Camp promotes healthy lifestyles in children individual patients and a comprehensive set of treatment approaches from lifestyle and families by building life skills while engaging with nature. Future programing is and behavior to surgical interventions. It will match patients with the treatment planned to include family camps and children expanded age ranges. options most likely to be effective given their health status, cultural context, insurance coverage, demographics, lifestyle attributes and treatment intricacies. P4.44 An Online Training System to Improve the Health of University Students: P4.42 Rationale and Description Applying Shared Decision Making Models in Clinical Practice to Increase Gillian E. Mandich, Linda Miller Exercise Adherence Western University, London, ON, Canada Andrew Hanna, Kenneth Kirkwood The University of Western Ontario, London, ON, Canada Background: It has been suggested that obesity may have a negative effect on the subjective well-being and happiness of individuals. Research has shown that hap- Background: The benefits of incorporating exercise as a method to treat obesity piness skills can be taught, and that these skills can have positive implications for has been well documented; however, clinical practice fails to utilize both the emotional, physical and spiritual well-being. Given that physical and mental health preventative and treatment benefits of exercise on various chronic diseases. Shared are becoming an increasing concern on university campuses, innovative and flexible decision models between physicians and patients have been gaining recognition solutions such as online learning offer promising opportunities for this population. recently as a method to increase exercise adherence when prescribed in practice. To Methods: This study includes a descriptive research design involving pre/post date, no shared decision-making model exists that incorporates both pharmaceuti- self-report questionnaires used to assess happiness, physical well-being, and mental cals and exercise interventions to treat chronic diseases. health. Data will be collected via questionnaires at baseline and post-intervention. Objective: The aim of this study is to develop and pilot a shared decision-making tool target- Participants will be full-time, undergraduate student aged 17–24. The intervention ing the treatment of obesity, with an emphasis on exercise prescription as first-line treatment. is a series of 10-30-minute online video modules that teach happiness skills and Methods: a search of the literature will be executed to identify shared deci- are available to participants (1 per week for 4 weeks). The impact of the module on sion-making tools that have been implemented successfully in other areas of clinical outcomes such as subjective well-being, happiness literacy, expressions of gratitude, practice. The findings of this search will be used to inform the development of a and life satisfaction will be evaluated. The main outcome measure is self-reported similar tool targeting the treatment of obesity. This tool will be piloted among 30 happiness, and secondary outcomes include lifestyle information (body image physician-patient pairs and a mixed methods paper survey will be administered to and goal setting), health behaviours (exercise habits, stress, tobacco use, drug use,

108 | 5th Canadian Obesity Summit | #COS17 Abstract Details alcohol use), social information (social issues and friendships), and gratitude. (25%) of men in the intervention group were ‘program non-completers’. Of ‘program Discussion: Given that physical and mental health are becoming an increasing completers’, the mean (SD) percentage of sessions attended was 81.7 (13.7)%. concern on university campuses, this project explores a fresh approach to enhance Conclusions: It was feasible to recruit and retain overweight/obese men to Hockey happiness; improve quality of life, well-being and health; and motivate health FIT. Recruitment methods were easy to implement and had no added costs. The behaviour change. majority of men were ‘program completers’ with high average attendance over Conclusion: It is anticipated that the modules will have a positive effect on health 12 weeks; nonetheless, program optimization is warranted to further improve indicators among university students. retention.

P4.45 P4.47 Standards for a Bariatric Friendly Care Hospital - Translating Research Effect of Regular Physical Activity on Cardiovascular Risk Factors in Mid- into Practice dle-aged Active and Non-active Individuals Petra O’Connell1, Linda Iwasiw1, Vince DiNinno1, Mary Forhan2, Arya Sharma1, 2 Alireza Ramezani1, Morad Hosaini2 1. Alberta Health Services, Calgary, AB, Canada, 2. University of Alberta, Calgary, AB, 1. Department of Exercise Physiology, Shahid Rajaee Teacher Training University, Canada Tehran, Iran, 2. Sport Cardiovascular and Respiratory Physiology, Shahid Rajaee Teacher Training University, Tehran, Iran Thirty-five percent of patients admitted to an acute care setting in Canada had a body mass index classified as obesity and that obesity was associated with a two-fold Objective: lifestyles of Iranians can affect their susceptibility to cardiovascular increase in the length of time a person spent in hospital. Factors within the hospital diseases. This study is aimed at surveying the Effect of Regular Physical Activity on care environment were found to contribute to costly increased time spent in hospital Cardiovascular Risk Factors in Middle-Aged Active and Non-Active Individuals. due to issues associated with respectful and responsive care that meets the needs Methods: Subjects included 26 Teaching Staff and 55 administrative staff. The age of patients with obesity, access to appropriate and timely care, a lack of evidence for range of test subjects was 26–58 years. Fasting blood glucose was measured by test guiding practice in acute settings for patients with obesity, a lack of knowledge of strips of code free made in Pars Azmoon Co, Iran, serum TC, TG, LDL and HDL choles- health care practitioners about obesity and it’s impact on acute care and issues re- terol levels were measured by test strips SD Lipid care made in Biosensor Co, South garding patient and provider safety. In response to this evidence, a university based Korea. To determine Peripheral Arterial Disease (PAD) used Ankle-Brachial Index research group, in collaboration with a provincial health authority, practitioners (ABI). Individuals had physical activity three sessions per week at least included as and patients at a regional hospital are leading a project to be the first hospital in active persons. To assess variables was used one sample t-test, Pearson Correlation Canada to methodically and strategically develop standards that contribute to the test, and independent t-test by use SPSS software, version 20. development of an acute care setting that sustains safe, high quality healthcare for Results: Results showed that total measured variables located in normal range patients with obesity who require acute care services. This presentation will describe except administrative staff serum TG level that place in risk area (P=0.05). Total the process and strategies used to change practice environments and behaviours in variables were not significantly different between faculty and administrative staff a hospital setting that will improve quality care and reduce time spent in acute care groups (P=0.05). There was a significant positive correlation between TC (r=0.204, settings for patients living with obesity. P=0.031) and TG (r=0.277, P<0.012) levels with age. TC, LDL-C, and TG significantly correlated with BMI. P4.46 Conclusions: Authors concluded that Faculty and not- the academic staff of The Hockey Fans in Training Weight Loss and Healthy Lifestyle Program University have health lifestyles, of course, it needs to encourage performing regular Can Attract and Retain Overweight and Obese Men exercise training and health nutrition regime. Dawn P. Gill1, Wendy Blunt1, Ashleigh De Cruz1, Brendan Riggin1, Kate Hunt2, Sally Wyke2, Cindy M. Gray2, Christopher Bunn2, Roseanne Pulford1, Cassandra Bartol1, P4.48 Karen Danylchuk1, Robert J. Petrella1 Dental Professionals Perceptions of Sugar Consumption and Obesity 1. Western University, London, ON, Canada, 2. University of Glasgow, Glasgow, Advice in the Dental Practice United Kingdom Jeanie Suvan, Petya Karadobreva, Bob Blizard, Albert Leung UCL Eastman Dental Institute, London, United Kingdom Objective: To examine the feasibility of recruiting and retaining overweight/obese men into a gender-sensitized weight loss and healthy lifestyle program using the Objectives: The WHO has challenged all health care providers to contribute to power of sport affiliation. efforts targeting increased awareness of healthy weight dietary choices amongst Methods: Hockey Fans in Training (Hockey FIT) includes a 12-week active (group patients. The study aim was to explore dental professionals’ perceptions of extend- coaching) phase and a 40-week maintenance (self-directed) phase. We conducted a ing advice to patients on sugar consumption and oral health to include overweight/ pilot pragmatic randomized controlled trial with an integrated process evaluation. obesity information. Male hockey fans (aged 35-65 years; BMI ≥28 kg/m2) of 2 Ontario Hockey League Methods: This study was a cross-sectional international questionnaire survey of teams were recruited. Eligible and consenting men were randomized to interven- dental professionals working in practice. The questionnaire covered the following tion (Hockey FIT) or comparator (Wait-list Control). Coaches monitored attendance domains: willingness and confidence, knowledge of the association between weekly; men allocated to intervention, who attended <50% of sessions (including obesity/sugar consumption and oral health, self-evaluated abilities on screening none in the final 6 weeks), were classified as ‘program non-completers’. and giving advice in regards to sugar consumption, obesity, and potential barriers to Results: Email blasts from hockey teams (35%) and word of mouth (25%) were the providing advice. most successful methods for recruiting participants. In <6 weeks, 105 men heard Results: 245 dental professionals consisting of 79.6% females and 20.4% males about the study; 24 men were excluded [did not meet eligibility criteria (n=17); completed the survey. Results showed the majority of dental professionals (75.3%) unavailable on scheduled day/time slot for program (n=7)] and 1 eligible individual would be willing to give advice on obesity/overweight if a relationship between did not enroll. The remaining 80 men were randomized and enrolled. In total, 10/40 obesity /overweight and oral health was found. Significant misconceptions in their

109 | 5th Canadian Obesity Summit | #COS17 Abstract Details knowledge about obesity as a disease and its relationships to oral health were evident. Although 88.3 % of dental professionals are already providing counselling over other oral and/or general health matters, only less than 30% would start a conversation with their patients addressing sugar consumption and obesity. The lack of training and understanding of obesity as a disease was highlighted as a potential barrier to providing advice. Conclusions: Although dental professionals showed willingness to expand sugar consumption counseling beyond oralhealth messages, confidence is lacking. Fur- ther training is indicated to understand the association between sugarconsumption, overweight/obesity and/or their association with oral or general health.

P4.49 Impact of a Bariatric Support Garment to Manage Excess Skin on Activi- ties of Daily Living Katelyn Teske, Chelsea Wong, Seyoung Kim, Mary Forhan University of Alberta, Edmonton, AB, Canada

Objective: The purpose of this study was to investigate the impact of custom made bariatric support garments on patient engagement and participation in activities of daily living (ADL) (i.e. functional mobility, self-care, work and leisure). Method: Participants in treatment for obesity and who had lost significant amounts of weight were included in the study and were fit with a custom-made support garment. While wearing the garment for a minimum of seven days, participants completed a garment wearing log and participated in individual interviews. Partic- ipants were asked to describe their experiences participating in ADL while wearing their garment. Data was analyzed using thematic analysis. Results: Participants reported that they found it easier and more comfortable to move around as they participated in ADL including walking indoors and out, sitting, standing and running. These activities were completed in the context of work, self- care, recreation and physical activity. Participants also perceived improvements in their posture, ability to bend over, sit and stand with ease and bodily control during movements with less strain on their lower back. A second theme identified in the study, was increased self-confidence when participating in activities of daily living. Conclusion: Wearing the bariatric support garment provided participants the feeling of postural stability and control while mobilizing that translated into feeling more confident while engaging in ADL at home and in public places. Participation in life events provide opportunities for skill development, physical activity and social support that contribute to health and well-being.

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