Airline travel is not just a continuing challenge for most of my patients, but being stuck in the middle seat is no fun for anyone (and yes, I’ve been there often enough).  So, I guess, someone had to write a song about it! In fact, as part of my new musical adventures, I have just recorded my first blues single, which should be out on Spotify, Apple Music, Amazon, and everywhere else in a couple of weeks.  If you want to learn more about Dr. Sharma, the blues musician, please follow me on facebook or instagram. You can also sign up on my Music Page for an exclusive preview of my s ..read more

On January 20, 2000, Salim Yusuf and colleagues published the seminal Heart Outcomes Prevention Evaluation (HOPE) Study in the New England Journal of Medicine.  The HOPE Study included over 9,000 high-risk patients (55 years of age or older) who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low ejection fraction or heart failure, who were randomly assigned to receive ramipril (10 mg once per day orally) or matching placebo for a mean of five years.  A total of 651 participants who were assigned to receive ramip ..read more

Followers of social and other media will have by now heard the term “Ozempic-” or “Wegovy-face”, which refers to the facial changes associated with the use of the anti-obesity medication semaglutide. These facial changes have been said to deepen facial folds, increase wrinkles, and often make people look older and, in extreme cases, rather unhealthy.  Nothing about this is in anyway directly attributable to the specific action of semaglutide. In fact, these are the very facial changes that we routinely see in anyone losing a significant amount of weight, irrespective of the reason.  ..read more

A few weeks ago, I attended Obesity Week, the annual scientific meeting of The Obesity Society, in Dallas.  As expected, there was a palpable buzz and excitement about the ever-expanding pipelines of nutrient-stimulated hormone (NuSH)-based treatments that bear the promise of dramatically changing the future clinical management of obesity. Given this promise, I noticed based on the many random conversations that I had with participants and looking around the well-filled plenary sessions, that there is a substantial increase in the number of physicians attending this meeting.  Judging ..read more

Last week at Obesity Week, Ildiko Lingvay (UT Southwestern Medical Center, Dallas) presented a plenary talk in which she discussed weight-centric vs. gluco-centric approaches to managing patients with type 2 diabetes mellitus (T2DM).  Despite the fact that we have long seen the strong association between body fat and the development of T2DM, the recommendation of weight loss in all T2DM guidelines, and ample data showing that weight loss can markedly reduce the risk for T2DM, improve glucose control, and even lead to diabetes “remission”, Lingvay noted that we have so far lacked the tools ..read more

Last week at EASD 2023 in Hamburg, the greatest buzz was clearly around incretin-based weight loss treatments and their potential metabolic benefits.  In the many sessions on incretin mimetics, data were presented with the promise of weight loss of 25% and beyond, results that are only rivalled by surgical treatments.  There were also several sessions that focussed on the increasingly complex biology of adipose tissue and the various obesity phenotypes that may be defined according to metabolic parameters.  Does this mean that diabetes is now poised to take over the fast evolvin ..read more

While we eagerly await the final publication of the results of the SELECT Trial of semaglutide in participants with overweight or obesity with established cardiovascular disease (but without diabetes), it may be of interest to speculate on the mechanisms by which treatment may have resulted in the reported 20% reduction in major adverse cardiovascular events (MACE). After smoking, elevated blood pressure is the single most important risk factor for macrovascular atherosclerotic disease (even in people with type 2 diabetes!). Previous studies with semaglutide have shown a consistent lowering of ..read more

This week Novo Nordisk released the topline results of the SELECT trial, apparently showing that once-weekly treatment with 2.4 mg semaglutide s.c. results in a 20% reduction in the composite endpoint of CV death, nonfatal MI or nonfatal stroke (three-component MACE) compared to placebo. This is no doubt a landmark achievement, given that enrolment into the SELECT Trial  was limited to individuals with overweight or obesity and established cardiovascular disease (CVD) but WITHOUT  diabetes (the reduction of CV outcomes with semaglutide in people with high CV risk and diabetes has alr ..read more

This week’s blog is a joint post written by myself and my good friend and colleague, Dr Sue Pedersen. Standard lifestyle advice from any doctor will include being active.  General health guidelines recommend being active at least 150 minutes to achieve health benefits and prolong life.  The Canadian Obesity Guidelines recommend 30-60 minutes of moderate to vigorous intensity aerobic activity most days of the week to improve cardiovascular health, mobility, metabolic health, mental health, and quality of life, even if no weight is lost with this strategy. Most people are familiar with ..read more

Back in the mid-eighties, when I was still training in nephrology, it seemed not a week would go by without being called upon to attend to a patient with malignant hypertension.  These patients, with blood pressures well over 200/120 mmHg, would often show up with no prior anti-hypertensive medication or, in some cases, not even a known diagnosis of hypertension. Without immediate attention, these patients were in acute danger of progressing to kidney or heart failure or experiencing strokes.  Today, 40 years later, malignant hypertension is a comparatively rare occurrence and can ge ..read more