The Diabetes Attitudes, Wishes and Needs (DAWN; DAWN2) Program: Lessons to Advance the PsychoSocial Management Within Obesity

Abstracts / Can J Diabetes 37 (2013) S217eS289

SATURDAY, MAY 4: WORKSHOPS 701-WK Optimizing Care Before and After Bariatric Surgery MARIE-FRANCE LANGLOIS, AURÉLIE BAILLOT, RAJ PADWAL, PRIYA MANJOO, STEPHEN GLAZER Department of Medicine, Division of Endocrinology, Universitéde Sherbrooke, Sherbrooke, Québec, Canada Data on the effectiveness and outcomes of bariatric surgery have prompted many Canadian health-care system decision-makers, including the Alberta, Québec and Ontario Health Ministries to plan an increase in the number of bariatric surgeries by three to seven folds. However, optimal patient trajectories that would effectively select, prepare and manage plan the post-operative care of patients for bariatric surgery remain to be developed. The workshop’s objective is to disseminate results of research and other activities on best practices for the management of patients before and after bariatric surgery. The workshop will consist of 5 presentations by researchers and stakeholders interested in this problematic. We will present different models of care, and detail in addition to discussions on issues like physical activity, follow-up of comorbidities, nutritional evaluation and supplements, and drug absorption in the context of bariatric surgery. This will be relevant to health professionals and decision-makers interested in bariatric care and surgery.

702-WK Bariatric Surgery for Adults: Allied Health Collaboration to Improve Patients’ Health Status & Outcomes Before and After Bariatric Surgery ROBYN EMDE, NOOSHIN ALIZADEH-PASDAR, JONATHAN CHANG Vancouver Coastal Health, Richmond, British Columbia, Canada In recent decades, bariatric surgery rates have risen. Bariatric surgery is an effective intervention in reducing excess weight and resolving obesity-related co-morbidities (e.g. diabetes, hypertension, sleep apnea, hypercholesterolemia, etc.). As the procedure presents minimal risk of complications both pre/post e surgery, use of this treatment strategy is more commonplace. This session will introduce the Richmond Hospital multidisciplinary bariatric surgery team and provide insight into how the needs of patients are addressed in the peri-operative course. This is also a great opportunity for allied health practitioners and interested parties to become familiar with the complex and multifaceted physical and mental health needs of bariatric surgery patients before and after surgery.

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novel psychosocial interventions and education programs for bariatric patients and care providers. Innovative psychosocial interventions including successful use of novel support groups, telephone cognitive behavioural therapy and family therapy to promote weight loss post-surgery will be discussed. The workshop will illustrate multi-site education initiatives for enhancing bariatric psychosocial skills and capacity within hospitals and across Ontario bariatric centres. Case discussions and video case presentations will be used to simulate common psychosocial challenges and to provide participants with an opportunity to develop a psychosocial approach to enhancing bariatric outcomes. 704-WK Are Our Efforts Worthwhile? How to Improve Impact Evaluation of Programs, Policies, Interventions and Strategies Aimed at Promoting Healthy Lifestyles and Preventing Obesity in Canada? HARRY RUTTER, NANCY EDWARDS, JEAN-PIERRE DESPRÉS, IAN JANSSEN, KIM D. RAINE, PHILIPPE DE WALS, MOKTAR LAMARI London School of Hygiene and Tropical Medicine, London, United Kingdom Since WHO identified the worldwide obesity epidemic in 2003*, all kinds of programs, policies, interventions and strategies including whole of government approaches and intersectoral actions have been implemented. Despite this mobilization, it seems that the obesity prevalence is still growing, or at best stabilizing in some groups. A pressing need for the evaluation of the effects and impact of programs, policies, interventions and strategies in the field of obesity prevention calls for coherent, concerted and innovative methodologies and partnerships at all levels. One of the aggravating factors of this problem lies in its intrinsic complexity and system perspective: not only are cause-and-effects relationships difficult to establish and highly context-dependent, but preventative actions also lie outside the health sector. As a consequence, measuring impact relies on close collaborative work. However, there seems to be an important disproportion between the amount of resources and efforts invested in interventions and the documentation of tangible effects. There are many plausible explanations in this regard, but there is no consensus on effective solutions to improve the current situation. The aim of this workshop is to share the experiences of public health professionals and scientists who have risen to the challenges of impact evaluation in different provinces. *World Health Organization, 2003. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation (Technical Report Series 894). 705-WK

703-WK Moving Beyond Assessment: Novel Psychoeducation and Psychosocial Interventions in Bariatric Surgery SANJEEV SOCKALINGAM, STEPHANIE CASSIN, LYNN TREMBLAY, KATIE WARWICK, SANDRA ROBINSON, JAIRO ORTIZ, MONICA CHI Department of Psychiatry, Faculty of Medicine, University of Toronto Bariatric Surgery programs have struggled with the balance between assessment and psychosocial support in a surgical setting. These gaps in psychosocial care following weight loss surgery are accentuated by increasing recognition of psychosocial morbidity post-surgery including de novo eating disorders, addictive behaviours, body image disturbance, mood disorders and in severe cases, suicide. Discussions of effective and patient centred psychosocial interventions post-bariatric surgery have been limited until recently and the emergence of psychosocial trials has offered greater insights into the role of education and psychological support during post-surgery care. This workshop will describe

The Diabetes Attitudes, Wishes and Needs (DAWN; DAWN2) Program: Lessons to Advance the PsychoSocial Management Within Obesity T. MICHAEL VALLIS Dalhousie University and Capital Health, Halifax, Nova Scotia, Canada Recognition and advancement of the mental health aspects of obesity is critical. Yet psychosocial expertise in obesity is lacking across the country. Also lacking are collaborative initiatives, standardized assessment Methods, coherent theoretical models, and adequate follow up. A more organized structure is needed to understand the psychosocial experience of living with obesity and to develop a standardized management model. CON is well-positioned to facilitate this. However, a model for guiding this type of work is lacking. Obesity and Type 2 diabetes overlap substantially, and this includes psychosocial issues. This workshop is intended to stimulate the establishment a national approach to managing psychosocial issues in obesity by drawing from the findings of the

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Abstracts / Can J Diabetes 37 (2013) S217eS289

Diabetes Attitudes, Wishes and Needs (DAWN and DAWN2) program. DAWN and DAWN2 involved multi-national surveys of large samples of individuals with diabetes, family members and healthcare providers. Psychosocial issues were assessed with validated scales within a comprehensive framework. The results and knowledge translation tools of DAWN, which did not include Canada, will be presented to illustrate the value of such an approach. With DAWN/DAWN2 as a model, this workshop will examine the parallels between diabetes and obesity, leading to 3 outcomes: a proposal for a consensus on a psychosocial assessment model for obesity; establishing a country-wide initiative to better integrate psychosocial assessment/management into clinical care for those with obesity; and, the creation of working groups interested building on the knowledge translation accomplishments of the DAWN/DAWN2 for obesity.

706-WK Knowledge Translation: Childhood Obesity Prevention and Treatment Strategic Research Initiative PHILIP SHERMAN, MICHELLE MOTTOLA, NAZEEM MUHAJARIN, WILLIAM H. DIETZ SickKids Hospital, Toronto, Ontario, Canada The Canadian Institutes of Health Research (CIHR) is the Government of Canada’s agency responsible for funding health research in Canada. Obesity and Healthy Body Weight has been a strategic research priority of CIHR Institute of Nutrition, Metabolism and Diabetes (INMD) since its inception in 2001. In 2008, INMD and a number of partners funded three-year Operating Grants to support research targeted at Childhood Obesity Prevention and Treatment. These grants were designed to increase knowledge related to interventions for the prevention and treatment of childhood obesity in clinical settings or at the population level, and to increase the speed at which evidence is transferred into clinical practice, programs or policies. Three of the funded projects will be presented at this workshop: individual and household environmental influences guiding the processes of changing obesogenic behaviours among overweight/obese adolescents and their families - Dr. Louise Masse, Univ. British Columbia; preventing childhood obesity: early intervention during pregnancy and first year postpartum for overweight and obese women using a two pronged family-based Nutrition & Exercise Lifestyle Intervention Program (NELIP) - Dr. Michelle Mottola, Western; working upstream: Effecting healthy children through neighbourhood design - Dr. Nazeem Muhajarine, Univ. of Saskatchewan. This workshop will provide an opportunity for the researchers to discuss the findings of their specific research projects, potential policy and program implications, and identify future research directions. Dr. Philip Sherman, CIHR INMD Scientific Director, will moderate this workshop, and Dr. William Dietz, former Director, Division of Nutrition, Physical Activity and Obesity, U.S. Centers for Disease Control and Prevention, will act as a discussant to place this Canadian research in the context of the international research on childhood obesity prevention and treatment.

707-WK Interventions for the Concurrent Prevention of Eating Disorders and Obesity: Challenges, Opportunities and Implications SHELLY RUSSELL-MAYHEW University of Calgary, Calgary, Alberta, Canada Currently, children and youth are inducted into norms and messages about healthy weights which are at best inconsistent and

confusing, and at worst cause harm. Obesity (OB) and eating disorders (ED) are both major public health concerns. Agreed upon strategies to prevent these issues simultaneously are lacking in part because ED and OB prevention have been seen as working at crosspurposes. Efforts to prevent OB are seen as dangerous in promoting precursors to EDs and efforts to prevent EDs are seen as encouraging complacency about healthy weight. Considering the increase in both OB and EDs and their associated health risks, there is a need to study integrative approaches that potentially prevent a range of unhealthy weight-related issues. This emerging integrative approach to OB and ED prevention involves identifying and intervening around shared risk factors with consistent messages for healthy growth. Prevention interventions designed to prevent both OB and EDs by focusing on shared risk factors potentially optimizes the delivery of the healthy eating/active living messages (OB prevention) without triggering weight and shape preoccupation (ED prevention). The purpose of our study was to determine if ED and OB prevention efforts could be successfully integrated in junior high school settings by providing intervention activities focused on five shared risk factors namely (a) dieting, (b) media, (c) body image, (d) weight-based teasing, and (e) self-esteem.

708-WK Changing Social Norms Associated with Weight and Body Image SHELLY RUSSELL-MAYHEW, MARILYN MANCEAU, DR. SHELLY RUSSELL-MAYHEW, MARIE-CLAUDE PAQUETTE, GINA MORENCY, CHANTAL BAYARD, DR. CONNIE CONIGLIO University of Calgary, Calgary, Alberta, Canada Social norms for body and weight are influenced by many factors: a unique model of beauty, images of edited bodies, weight loss treatment advertising, emphasizing appearance and performance, linking thinness and success, stigma and prejudice towards obesity and medical discourses on obesity. These norms can only be changed by acting at multiple levels. This workshop will present the main factors that shape social norms in regards to weight and body image. Then speakers will demonstrate the necessity of tackling both weight gain prevention and excessive weight preoccupation, which are two sides of the same coin. The workshop wills also presents interventions originating in Quebec and Canada- from government and non-profit organizations which contribute to the transformation of current social norms associated with weight and body image.

709-WK Practical Tools for Engaging "The 6th A: Awareness" COLLEEN CANNON, WENDY SHAH Craving Change Inc., Calgary, Alberta, Canada Physicians and allied health care professionals must engage skillful ‘Awareness’ of the complex range of factors causing and maintaining obesity so as to effectively ‘Assess’ and ‘Advise’. It is also essential for patients to be aware of the relevant root causes of their weight status in order for them to make and sustain behaviour change. Evidence consistently identifies a complex range of factors contributing directly to obesity, including emotional regulation, stimulus control, maladaptive thinking patterns, learned associations, social-cultural factors, sleep, stress management and mental health. However, the practical strategies for detecting and addressing these factors are less available and as a result clinicians and their patients can be overwhelmed. This workshop provides practical tools for the first and pivotal step in assessing these