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OBESITY

Neurological and Psychiatric Approaches to the Obesity Epidemic

SUMMER 2011


1 | IMS MAGAZINE SUMMER 2011 OBESITY


TABLE OF CONTENTS

IN THIS ISSUE...

Space photo courtesy of Dr. Dave Williams, Ghana photo courtesy of Dr. Mojgan Hodaie

Letter from the Editor ......................04 News at a Glance ...........................05 Director’s Message .........................08 IMS Scientific Day Overview ..........09 Special Tribute.................................11 Feature ............................................13 Research Highlight ..........................24 Spotlight ..........................................26 Close Up ..........................................31 Research Controversy .....................33 Behind the Scenes ..........................35 Future Directions .............................37 Funding ............................................39 Ask the Experts ...............................40 Past Events ......................................41 Diversions .......................................42

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FEATURE

Obesity

Neurobiological and Psychiatric Approaches to the Obesity Epidemic

MAGAZINE STAFF Editor-in-Chief Natalie Venier Managing Editors Nina Bahl Avi Vandersluis Assistant Managing Editors Allison Rosen Meghna Rajaprakash Departmental Advisor Kamila Lear Copy Editors Adam Santoro S. Amanda Ali Tetyana Pekar Content Committee Anthony Grieco Zeynep Yilmaz Minji Kim Wenjun Xu Atiqa Malik Aaron Kucyi Design Editors Tobi Lam Natalia Burachynsky Minyan Wang Merry Wang Andreea Margineanu Photography Paulina Rzeczkowska Connie Sun Mohammed Sabri Yekta Dowlati Acknowledgements Diego Accorsi, Joyce Hui, Senior Design Editors Beatrice Lau, Julie Man Copyright Š 2011 by Institute of Medical Science, University of Toronto. All rights reserved. Reproduction without permission is prohibited.

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Sleep in Space Dr. Dave Williams reflects on some of the complexities with sleeping in space.

29

International Research Program

A look into how Dr. Hodaie and her former student Udi Blankstein are working to facilitate the translation of neurosurgical skills to residents in Ghana.

Cover Art By IMS Magazine Senior Design Editors The cover has been designed to illustrate the vast interplay of variables that contribute to the obesity epidemic. The measuring tape has been drawn in the shape of a DNA double helix to reflect the relationship between scientific facts and societal pressures. IMS MAGAZINE SUMMER 2011 OBESITY | 02


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LETTER FROM THE EDITOR

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Letter from the Editor

s I was preparing for my PhD transfer exam, I had a sudden realization. In the midst of all my literature searches, textbook readings and discussions, I discovered something that every scientist goes through at some point in his or her career. Amazingly, the more information I read, the less I realized that I actually knew. The world of research is immense. All around the world people are studying every aspect of medicine and science, while also looking for ways to improve upon the existing methods and approaches by which they are currently studied. This inquisitiveness and scientific exploration is quite evident here at the IMS. Our scientists are examining everything from genetics to quality of life assessment in patients suffering from Alzheimer’s to the differences between various methods of knee surgery and much, much more. In this issue, we have decided to focus our attention on an aspect of obesity that is often overlooked in the media: the neurobiological and psychiatric aspects of obesity. This comes at a timely manner as a new federal report has recently been released suggesting that there are currently more than 1 million cases of obesity in Canada, many of which could be avoided with lifestyle modifications. With the help of Dr. Robert Levitan, Dr. Allan Kaplan, Dr. Roger McIntyre and Dr. Minna Woo, we hope to provide you with a better insight into the different approaches to the obesity epidemic. Further, we will give you a historical perspective on one of the most commonly used measures of obesity, the Body Mass Index (BMI). I would also like to take this opportunity to acknowledge Dr. Ori Rotstein. When I first began the IMS Magazine initiative, Dr. Rotstein fully supported and encouraged the project. Despite the lack of evidence as to what was to come, he completely threw his weight behind the magazine with full confidence in both the IMS Magazine team and in me. He was an outstanding director and will be remembered for his enthusiasm, kind-natured personality and his dedication to the IMS students. You will be able to read about Dr. Rostein in a special tribute article written by Nina Bahl.

Natalie Venier

Editor-In-Chief Natalie Venier is a second year PhD Candidate at the Institute of Medical Science. She is currently studying prostate cancer chemoprevention at Sunnybrook Health Sciences Centre.

It is my great honour to extend a warm welcome to Dr. Allan Kaplan, the new director of the IMS. I recently had the privilege to meet with Dr. Kaplan to discuss the IMS Magazine. Even in our brief meeting, I could clearly see how dedicated he is to our students and how enthusiastic he is about our wonderful department. I would like to thank him for his support for the IMS Magazine and wish him the best of luck as the new director. As always, I must mention the IMS Magazine staff for their tremendous efforts for this issue. It could not be done without all of you.

Photo by Paulina Rzeczkowska

Enjoy!

Natalie Venier Editor-In-Chief, IMS Magazine IMS MAGAZINE SUMMER 2011 OBESITY | 04


NEWS AT A GLANCE

NEWS&VIEWS at a glance...

JULY

13 16 20 28

Interdepartmental Boat Cruise IMS T-shirt sales (MSB, Stone Lobby) IMSSA Sporting Event Toronto FC game Summer Pub Night

AUGUST

4

Summer Undergraduate Research Program: Research Day

19

Annual IMSSA Fundraiser Talent Show

SEPTEMBER

15 TBA TBA

Student Orientation Frosh Event IMSSA Elections

For more information on IMSSA/IMSSA-related events, please visit: http://imssa.sa.utoronto.ca For information on IMS news and events, please see: http://www.ims.utoronto.ca Please send your comments and suggestions to: theimsmagazine@gmail.com

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IMS STAFF ANNOUNCEMENTS We are delighted to announce that Professor Allan S. Kaplan was appointed as Director of the Institute of Medical Science for a 5-year term effective July 1, 2011. Professor Kaplan received his medical, residency, and graduate school training from the University of Toronto and the Faculty of Medicine’s Institute of Medical Science. He is currently the Director of the Clinician Scientist Program, Vice Chairman for Research, and a Professor in the Department of Psychiatry. He is also a Senior Scientist, the Chief of Clinical Research, and Director of Research Training at the Centre for Addiction and Mental Health (CAMH), and a Senior Scientist in the Toronto General Hospital Research Institute. He has been a full faculty member of the Institute of Medical Science since 1996. He recently completed his term as the inaugural Loretta Anne Rogers Chair in Eating Disorders at the University Health Network/Toronto General Hospital, one of three endowed chairs in eating disorders in the world. He has also served as Director of Postgraduate Education and Acting Vice-Chair of Education in the Department of Psychiatry. Professor Kaplan has worked in the field of eating disorders for 30 years, has lectured widely on various topics in the field, and has published 140 peer-reviewed articles, two books, 50 chapters, and over 200 abstracts. He is the past President of both the Academy for Eating Disorders—the largest organization of eating disorder professionals in the world—and the International Eating Disorder Research Society. Congratulations to Professor Kaplan on his appointment! We extend our sincere thanks and gratitude to Professor Ori Rotstein for his leadership during his two terms as Director of the IMS. We are pleased to announce that Kaki Narh has joined the IMS as our new Program Assistant. Kaki has many years of administrative experience in academic institutions such as Edinburgh Napier University and Nottingham Trent University. More recently, she held a position as PhD Program Coordinator at Rotman School of Management, University of Toronto. Kaki will be responsible for setting up student defense examinations and monitor student progress. She can be reached at pa.medscience@utoronto.ca and by telephone at 416-978-6696. Effective July 14, Marika Galadza will be joining the IMS as our new Departmental Assistant. Marika will be responsible for room bookings, reception, general inquiries, and the Summer Undergraduate Research Program (SURP). She can be reached at dir. medscience@utoronto.ca and by telephone at 416-946-8286. Prior to joining the IMS, Marika was the Administrative Assistant at the Department of Family and Community Medicine. Please join us in welcoming Marika to the IMS!


NEWS AT A GLANCE

IMS ANNOUNCEMENTS On Saturday, July 23, the IMS will be moving to its new location: Room 2352 in the Medical Sciences Building, 1 King’s College Circle. Thesis defenses scheduled shortly before or after July 23 will proceed as usual. There may be some room changes, in which case, the IMS office will advise. On Monday, July 25, it will be business as usual in our new premises. We look forward to seeing you at our new location! SURP Research Day Attention Summer Students! All Summer students are expected to attend Research Day on Thursday, August 4, 2011. If you cannot attend, your supervisor must submit a note to the IMS office explaining your absence.

STUDENT HONOURS & AWARDS

NEW FACULTY MEMBERS Najma Ahmed

Associate Professor of Surgery St. Michael’s Hospital

Michelle McFarlene wins the Harry Jerome Award offered by the Black Business Professional Association (BBPA). For more information, visit: http://www.thestar.com/news/article/954607--harry-jerome-awards-celebrateordinary-people-doing-extraordinary-things?asid=cb3a71e8

Zeynep Yilmaz and Wigdan Al-Sukhini were selected to participate in the Canadian Student Health Research Forum 2011 in Winnipeg.

S. Fatima Lakha was awarded the 2011 Trainee Travel Award at the Canadian Pain Society Conference.

2011/2012 Vanier Canada Graduate Scholarship CIHR

Mohammed Sabri, Gregory Costain, Hwa-Lin Hsiang, Siba Haykal

2011/2012 Ontario Graduate Scholarships (OGS)

Joanne Goldman, Yunee Kim, Zeynep Yilmaz, Alanna Adleman, Nadine Akbar, Salvador Alcaire, Katherine Allan, Seham Chaker, Li-Hao Chen, Yekta Dowlati, Matthew Florczynski, Kota Hatta, Tina Hu, Salima Jiwani, Boyko Kabakchiev, Aaron Kucyi, Katarina Lakovic, Rachel Leeder, Bozhena Livak, Cynthia Luk, Chloe Macdonald, Ann Montgomery, Olena Puzyeyeva, Rachel Rabin, Linda Rothman, Paulina Rzeczkowska, Mohammed Sabri, Bahar Salavati, Adam Santoro, Sally Yu Shi, Vanessa Sinopoli, David Spillane, Megha Suri, Christopher Tran

FACULTY AWARDS

Muhammad Mamdani named as one of the Globe & Mails’ Top 40 under 40. http://www.news.utoronto.ca/campus-news/u-of-t-celebrates-several-top-40under-40.html Molly Shoichet and Tom Waddell, IMS faculty members, were two of seven UofT faculty members who received the collaborative health research projects program (CHRP) grants. In total, UofT faculty members won $3.2 million. http://www.news.utoronto.ca/health-and-medicine/u-of-t-researchers-win-32million-to-tackle-cancer-other-health-challenges.html

Tiffany Chow

Assistant Professor of Medicine University of Toronto affiliate

Michael Corrin

Lecturer of Biology UTM University of Toronto affiliate

Vincenzo De Luca

Assistant Professor of Psychiatry Centre for Addiction and Mental Health

Jonathan Downar

Assistant Professor of Psychiatry Toronto Western Hospital

Binita Kamath

Associate Professor of Paediatrics Hospital for Sick Children

Monika Krzyzanowska

Associate Professor of Medicine Princess Margaret Hospital

Dzung Anh Le

Professor of Pharmacology & Toxicology Centre for Addiction and Mental Health

Kirk Cheung-Lun Lo

Associate Professor of Surgery Mount Sinai Hospital

Helen McNeill

Professor of Molecular Genetics Mount Sinai Hospital

Sandra Moses

Assistant Professor of Medical Imaging Hospital for Sick Children

Daniel Josef Mueller

Associate Professor of Psychiatry Centre for Addiction and Mental Health

Benjamin Neel

Professor of Medical Biophysics Princess Margaret Hospital

Tarek Rajji

Assistant Professor of Psychiatry Centre for Addiction and Mental Health

Jurgen Rehm

Professor of Public Health Sciences Centre for Addiction and Mental Health

Aristotle Voineskos

Associate Professor of Psychiatry Centre for Addiction and Mental Health

Valerie Johanna Waters

Assistant Professor of Paediatrics Hospital for Sick Children

Camilla Zimmermann

Associate Professor of Medicine Princess Margaret Hospital Find out more about faculty on the IMS faculty database: http://www.ims.utoronto.ca/ faculty/directory.htm

IMS MAGAZINE SUMMER 2011 OBESITY | 06


Poster design by Merry Wang

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DIRECTOR’S MESSAGE

Director’s Message It is a privilege to be writing to you as the new Director of the IMS, a role I officially began as of July 1. The IMS Magazine is just one of the many wonderful student initiated projects that make the IMS such a very special institute. I fully support the ongoing publication of the IMS Magazine and look forward to the many opportunities the magazine can afford us for recruitment and for publicizing the outstanding research that is being conducted by our faculty and our trainees. This third issue of the magazine focuses on an area of clinical importance that I have focused on in my own research career: the relationship between disturbed eating, weight regulation and psychiatric/medical illness. Kudos to Natalie Venier and her team for their continued hard work and collective creative energies in producing this wonderful publication. Thanks as well to Kamila Lear for her assistance in this project. The IMS has gone through significant change in the past several years, especially in terms of expansion in student enrolment. I believe it is time to take stock of where we are at this point in time and where we want to go. Towards that end, I believe it is timely for the IMS to go through a comprehensive strategic planning process, something the IMS has never been previously. This process is important, for it gives us the integrity to make decisions related to agreed-upon priorities for the IMS over the next 5 years. Over the next several months, along with others in the IMS leadership, I hope to engage strategic planners who can take us through an extensive strategic planning process through the fall months. As part of this process, I hope to be able to involve as many of you, both faculty members and students, in this process as possible. Your input will be critical to the success of this process to produce an exciting inspirational vision for our future.

Allan S Kaplan, MSc, MD, FRCP(C) Director, IMS

Dr. Allan Kaplan became the IMS Director in July 2011. He is the Chief of Clinical Research and Director of Research Training at the Centre for Addiction and Mental Health (CAMH), and a Senior Clinician-Scientist in CAMH’s Mood and Anxiety Program. He is also the Vice Chair of Research, Director of the Clinician Scientist Program and Professor of Psychiatry at the University of Toronto.

I look forward to working with all of you in my new role.

Photo by Mohammed Sabri

Sincerely,

Allan S Kaplan MD FRCP(C) Director Institute of Medical Science

IMS MAGAZINE SUMMER 2011 OBESITY | 08


SCIENTIFIC DAY OVERVIEW

IMS Scientific Day AWARD WINNERS Dr. Aristotle Voineskos As the winner of the Siminovitch-Salter Award – conferred annually to a graduating Doctoral student for his/her outstanding scholarly contributions – Dr. Aristotle Voineskos is grateful for the great honour bestowed upon him. He is extremely appreciative to be a part of the legacy of remarkable research achievement at the IMS. Specifically, his experience as a doctoral student has been an unforgettable one as his supervisor and 09 | IMS MAGAZINE SUMMER 2011 OBESITY

PhD committee have provided outstanding mentorship and advice. Voineskos hopes to continue working with them for the remainder of his career.

Whiteside Award

Dr. Karen Lim Awarded to a graduating IMS Master’s student with outstanding scholarly contributions, this year’s Whiteside Award went to Dr. Karen Lim. Her academic contributions were highly regarded by her supervisor, the

IMS graduate coordinators, associate director and director. She currently lives in Australia, so it was not possible for her to receive the award personally; however, her video message showed how appreciative she is to be this year’s recipient.

Mel Silverman Award

Dr. John Flanagan This year’s Mel Silverman Award was awarded to Dr. John Flanagan, a senior scientist with research interests in glaucoma and dia-

Artwork by Minyan Wang after Carly Vanderlee

Siminovitch-Salter Award

By Minji Kim


SCIENTIFIC DAY OVERVIEW betic eye disease. His exceptional mentorship ability was recognized by the numerous IMS graduate students who nominated him for the award. As both a teacher and role model, he has contributed greatly to the success of the IMS graduate students.

Roncari Book Prize

Zeynep Yilmaz Being awarded the prestigious Roncari Book Prize this year is an honour for Doctoral student Zeynep Yilmaz. As the current president of the IMS Students’ Association (IMSSA) this is the third year that she has been involved with the student group. She is also a member of the IMS Executive and Curriculum Committee, and these involvements exemplify her passion to improve the graduate student experience. She is very proud to be a part of the IMS as she believes the department truly cares about its students.

leagues at IMS Scientific Day. Although she has had many opportunities to present her work at many conferences, she describes her participation in the Laidlaw Manuscript Competition as truly amazing. Haas remarks that her experience throughout the day was very rewarding, and likens winning the award to “the icing on [her] cake”.

Alan Wu Poster Competition & Academic Development Award

Basic Science – Mohammed Sabri Mohammed Sabri recalls feeling disbelief and gratitude when his name was announced as the basic science winner of the Alan Wu Poster Competition Award. The competition

gave the Master’s student an opportunity to showcase his passion for translational research and discuss the intricacies of his project. He notes that winning the award was an unexpected but rewarding way to close out his graduate journey. Clinical Science – Crystal Chan Crystal Chan, current Master’s student and clinical science winner of the Alan Wu Poster Competition Award, describes her experience at this year’s IMS Scientific Day as wonderful. She was especially impressed by the calibre of the biomedical research being conducted by trainees in IMS. She is very grateful for the research prize, and is happy to see that women’s health research is well supported by the department.

IMS Graduate Course Lecturer Award

Dr. Jeff Daskalakis Dr. Jeff Daskalakis was awarded this year’s IMS Graduate Course Lecturer Award for his involvement in the MSC1081H Studies in Schizophrenia. As an expert on the neurophysiology of psychiatric disorders, his research focuses on examining the role of cortical inhibition and plasticity as potential pathophysiological mechanisms in schizophrenia. His expertise in and enthusiasm for the field have enhanced the academic experience and success of IMS students.

Photos by Paulina Rzeczkowska

Laidlaw Manuscript Competition Awards

Basic Science – Brent Williams Brent Williams, this year’s basic science winner for the Laidlaw Manuscript Competition Award, is honoured to have his research recognized among the numerous, high quality projects conducted at the IMS. His presentation at this year’s competition was an extension of scientific interests that he has pursued for more than five years. The flexibility offered by the IMS has helped him to focus on his academic endeavours, and he is proud to be part of such a successful graduate department as he completes his doctoral degree. Clinical Science – Barbara Haas As a doctoral student, Barbara Haas enjoyed sharing her research with friends and col-

Dr. Jeff Daskalakis accepts the IMS Graduate Course Lecturer Award from graduate co-ordinator Dr. Mary Seeman.

IMS MAGAZINE SUMMER 2011 OBESITY | 10


SPECIAL TRIBUTE

The End of an Era

By Nina Bahl

Looking back on Dr. Ori Rotstein’s decade-long directorship and 25-year involvement with the IMS

Dr. Rotstein was accepted as an IMS faculty member in 1986, a year after he joined the University of Toronto’s Faculty of Medicine as a surgeon. In 1991, Dr. Rotstein was appointed Associate Director under Mel Silverman’s leadership and was subsequently selected as Director in 2001, a position he held until this past June. After two decades of directorial involvement with the IMS, the impact of Dr. Rotstein’s leadership is extensive: we take a look at some of the most transformative initiatives throughout his directorship.

Then and Now: 2001 to 2011

A snapshot of how the IMS has evolved throughout Dr.Rotstein’s tenure as director. Students enrolled

349 550

IMS faculty members

455 617

Undergraduates participating in SURP

2001

62

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150

2011

Improved sense of community

Despite the smaller numbers of students and faculty, Dr. Rotstein felt a level of disjointedness within the department when he first came aboard. “It was clear to me that we didn’t have very much cohesion among our students. There was a lot of geographical dispersion across the university centres, and I don’t think our students really felt any sense of community,” he explains. “I made it one of my major objectives to improve on that; specifically, I wanted to help students identify with the IMS as their home department. From that standpoint, I think we did pretty well.” Indeed, Dr. Rotstein has managed to help IMS students feel part of the greater whole in a number of ways: by involving students in executive committees and curriculum development, by closely aligning with the Institute of Medical Science Students’ Association (IMSSA) and its objectives, and by encouraging a number of student initiatives. The most fulfilling of these experiences for Dr. Rotstein has been his Breakfast with the Director endeavour, in which he regularly met with groups of IMS students in a casual setting to discuss issues of science, offer advice and opinions when necessary, and overall, establish a personal connection with the student body. “What I actually like most about graduate training is the excitement students have for their own projects, for research, for science, and the relevance of those things to society. I got a whole lot of personal satisfaction out of the [Breakfast with the Director] events because it’s been great to connect with these students – you can feel their enthusiasm.”

Translational research focus

Over the last decade especially, the IMS has identified the need for translational research and incorporated its emphasis in the depart-

Photo by Paulina Rzeczkowska

I

f you’ve ever had the opportunity to chat with Dr. Ori Rotstein, it quickly becomes easy to understand why those who have worked alongside the former IMS Director are able to unanimously declare his enthusiasm. His is a kind of infectious eagerness that seems to permeate all of his tasks – from executive duties within the department to discussing his journey as director with the IMS Magazine. His unique passion also helps us understand his remarkable dedication to the Institute of Medical Science for the past 25 years.


SPECIAL TRIBUTE years. “I have had the opportunity to work with some phenomenal people, indeed.” As he moves on from the IMS and assumes his new role as Associate Chair of the Department of Surgery, Dr. Rotstein’s appreciation for meaningful mentorship and teaching remains. “I’m going to take a lot of the lessons I’ve learned in the IMS with me. Mentoring is something you do in graduate training all the time, and I think we need to extend that to the clinical side in our mentoring of junior faculty.” If his last 25 years with the IMS have been any indication, Dr. Rotstein’s enthusiasm will ensure this next venture is filled with success.

Breakfast with the Director ment’s mandate. “It became clear many years ago that this was where things in research were headed. It also became clear that [translational science] was already a particular strength of our own department,” comments Dr. Karen Davis, IMS’ Associate Director. “We have both basic and clinical faculty and resources, so we wanted to try and push that link.”

Photo courtesy of IMSSA

One of the main implementation strategies has involved restructuring the core IMS Student Seminar course (MSC1010Y/ MSC1011Y) to provide students with a general understanding of translational research and its opportunities. Part and parcel of this course reform has been the introduction of elective course modules, which have significantly broadened academic opportunities for students. “It was a brilliant idea to use the course we already had to really implement our translational focus. Ori [Rotstein], Tom Waddell, and Howard Mount were all critical in realizing this,” remarks Dr. Davis. While Dr. Rotstein acknowledges the department’s achievements, he suggests there is work yet to be done. “I think we’ve made some really good progress with the redesign of our curriculum, but I would like to see even more effort moving forward.” Notably, he advocates for increasing the number of collaborative programs to promote translational research. “The idea is that this would bring together people who have common themes of research, and who would also complement each other with their differences.”

Increased IMS visibility

Special thanks to Dr. Davis and Kamila Lear for their help with this article.

Dr. Rotstein and his team have also enhanced the visibility of the department within U of T and beyond by forging relationships with both national and international departments and institutions. “Our Summer Undergraduate Research Program (SURP) is a very good example of how we have tried to bring students in from a variety of places – all across the country, of course, but international students as well. That’s been a huge accomplishment,” encourages Dr. Rotstein. “I think some of these processes are a bit slow, but we shouldn’t be discouraged by that. It may take a while to reap the benefit of our efforts, but we are already starting to see interest from students all over the world.” Over the years, Dr. Rotstein has also had the self-proclaimed pleasure of working with a number of talented and equally dedicated individuals, and he is quick to acknowledge their efforts. “Everyone in the office, past and present, has been absolutely unbelievable. I can’t say anything but fabulous things about all of them.” Specifically, Dr. Rotstein acknowledges the work of his current administrative team – “Hazel [Pollard] is a legend,” he quips – and commends former graduate co-ordinator Dr. Mingyao Liu, as well as Dr. Mary Seeman and Dr. Davis for their outstanding work over the

What Others Have to Say: “Ori is such a great people-person; that really is one of his strengths. People genuinely want to work with him and please him. I think individuals also tend to work better and harder when their leader is somebody they admire and trust, and you don’t always find that sort of respect for the person at the top.” – Dr. Karen Davis, IMS Associate Director “Dr. Rotstein’s immediate approval and support of [the IMS Magazine] illustrates his style. The Graduate Oath is another example…Dr. Rotstein was quick to support it and ensure that it happened. When something good comes along, he doesn’t hesitate – he embraces the opportunity.” – Dr. Mary Seeman, IMS Graduate Coordinator “Dr. Rotstein gives IMS students tremendous opportunity to engage themselves in the department and really make their voices heard.” – Dr. David Kideckel, PhD graduate (‘09) and former IMSSA president (‘08-‘09)

IMS MAGAZINE SUMMER 2011 OBESITY | 12


FEATURE

Information Visualization by Andreea Margineanu

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FEATURE

Neurobiological and Psychiatric Approaches to the Obesity Epidemic: An Emerging Priority for Obesity Research Despite significant efforts, the prevention and treatment of obesity across the lifespan has fallen well short of established goals. It may be that current treatments are simply unable to override the basic evolutionary processes that have protected humans from starvation over millions of years by making high caloric foods a rich source of pleasure and reward (Mietus-Snyder and Lustig, 2008). Indeed, some forms of overeating and obesity are likely driven by an excessive motivational drive for food, similar to what occurs for addictive behaviours in general (Volkow and O`Brien, 2007; Davis, 2010).

By Dr. Robert D. Levitan MD, FRCPC Dr. Robert D. Levitan is a Senior Scientist and Research Section Head at the Center for Addiciton and Mental Health, a Professor of Psychiatry, and a Full Member in the Institute of Medical Sciences at the University of Toronto.

A

s a group, psychiatric patients may be particularly vulnerable to the addictive properties of food. Several different aspects of food addiction may be of relevance in this regard. For example, emotional eating describes nonhomeostatic food intake usually triggered by negative moods, such as sadness, anxiety, and boredom, as opposed to food intake triggered by normal hunger. The foods consumed in this context – often referred to as “comfort foods” – are usually high in calories. Given that a majority of psychiatric patients have at least some problems

Photo by Mohammed Sabri

Emotional eating describes non-homeostatic food intake usually triggered by negative moods, such as sadness, anxiety, and boredom, as opposed to food intake triggered by normal hunger. with mood regulation, these individuals are at high risk for emotional eating overall. Not surprisingly, this is particularly true for mood disorders such as atypical depression, seasonal affective disorder, dysthymia and

bipolar disorder, which are often complicated by obesity. The most extreme example of emotional eating occurs in binge eating disorder (BED), whereby patients consume large amounts of food in a short period of time, usually in response to negative emotional triggers and/or minor daily stressors. As might be expected, BED is often complicated by particularly morbid obesity, and is over-represented in bariatric surgery patients. Another key aspect of food addiction that is highly pertinent to psychiatric patients is heightened reward sensitivity. The major brain system implicated in reward is the mesocorticolimbic pathway, which includes dopamine cell bodies in the ventral tegmental area (VTA) with projections to both the striatum (nucleus accumbens [NAc]) and neocortex (including the pre-frontal cortex [PFC]). Neuroimaging studies strongly support a role for central dopamine both in many psychiatric disorders and in food reward processes per se. Regarding the latter, food-related cues significantly activate dopamine-rich areas of the brain associated with the processing of pleasurable stimuli IMS MAGAZINE SUMMER 2011 OBESITY | 14


FEATURE

such as the VTA, substantia nigra, amygdala and orbitoprefrontal cortex (Killgore et al., 2003; Rothemund et al., 2007). Furthermore, activity in the amygdala and orbitoprefrontal cortex is proportional to the subjective pleasure associated with a given food (Beaver et al., 2006). Ghrelin, a hormone known to stimulate food intake, increases the response of these brain regions to food-related stimuli (Malik et al.., 2008), while leptin, an adiposederived hormone which produces satiation at higher levels, is associated with a decrease in the response of the NAc to food cues (Farooqi et al.., 2007).

Brain dopamine activity is primarily determined by the density and sensitivity of dopamine receptors, the amount of dopamine transporter, and the activity of key monoaminergic enzymes such as catechol-omethyl transferase (COMT) and monoamine oxidase-A (MAOA). “Reward deficiency syndrome� refers to one particular model of reward sensitivity in which addictive behaviours are based on a hypo-functioning central dopamine system (Blum et al., 1995). The basic notion is that vulnerable individuals will often consume food (or other substances) to temporarily boost an otherwise sluggish dopamine system, which is experienced subjectively as improved energy and/ or mood. Consistent with this model, several associations between hypo-functional dopamine genetic variants and various aspects of overeating and obesity have been reported, including several studies in psychiatric populations. The dopamine-4 receptor (D4) and its corresponding gene (DRD4) may be

15 | IMS MAGAZINE SUMMER 2011 OBESITY

of particular interest in this regard. The D4 receptor is expressed in various brain regions that comprise the natural reward pathway (Civelli, 1995; Meador-Woodruff et al., 1996). Treatment with the dopamine antagonist clozapine, which has high affinity for the D4 receptor (Van Tol et al., 1991), is often complicated by increased food consumption and weight gain. The DRD4 gene 7-repeat (7R) allele is associated with decreased affinity for dopamine and impaired intracellular signaling in comparison to other DRD4 exon III alleles (Asghari et al., 1995), and carriers of this allele have an increased risk for neurolepticinduced weight gain (Popp et al., 2008). In women with seasonal affective disorder who experience both carbohydrate craving and weight gain during winter depressive episodes, the 7-repeat allele of DRD4 has been associated with dysphoria, binge eating, and obesity (Levitan et al., 2004a; Levitan et al., 2004b; Levitan et al., 2006). Furthermore, this link between obesity and the 7R allele has been replicated in a separate cohort of

women with bulimia nervosa (Kaplan et al., 2008). The dopamine-2 (D2) receptor has also been a key focus of overeating and obesity work. Individuals carrying the TaqI A1 allele of the ANKK1 gene, proximal to the dopamine-2 receptor gene (DRD2), have a 30-40% reduction in striatal D2 receptor density (Jonsson et al., 1999). Food reinforcement is greater in obese than non-obese individuals if they also bear the A1 allele (Epstein et al., 2007). This suggests that the DRD2 genotype may interact with food reinforcement to influence energy intake. Subjects with either binge eating disorder or obesity report higher reward sensitivity than do normal weight controls, but only if they carry the TaqI A1 allele (Davis et al., 2008). A recent fMRI study further suggests that decreased activity in the dorsal striatum, moderated by the TaqI A1 allele, leads to compensatory increases in food intake with resultant increases in body mass index (Stice et al., 2008).

Photo Courtesy of smokedsalmon / FreeDigitalPhotos.net

Vulnerable individuals will often consume food to temporarily boost an otherwise sluggish dopamine system, which is experienced subjectively as improved energy and/ or mood.


FEATURE

Dysfunction in the brain’s meso-cortico-limbic system, the notion of a reward deficiency syndrome, and the hypofunctional 7R allele of DRD4 have each been associated with attention deficit hyperactivity disorder (ADHD). This being the case, ADHD may have particular relevance for psychiatric models of food addiction, reward processes, and obesity. In support of this hypothesis, various studies have found either high rates of ADHD symptoms in adult obese populations (Altfas, 2002; Fleming et al., 2005), or high rates of obesity in adults with ADHD. Regarding the latter, Pagoto et al. (2009) found an odds ratios for obesity of 1.81 in ADHD subjects relative to controls in a population sample of 6735 U.S. adults. This association was independent of demographic characteristics and depression, and was partially mediated by binge eating disorder. High rates of ADHDobesity co-morbidity have also been reported in children – in both boys and girls – suggesting that the link between ADHD pathology and obesity begins early in life (Holtkamp et al., 2004; Agranat-Meged et al., 2005). In a large representative sample of U.S. children and adolescents (the National Survey of Children’s Health, N=62,887), Waring and Lapane (2008) found that non-medicated children with ADHD had an odds ratio for overweight of 1.5 relative to controls. In addition to those described above, many other potential mechanisms to explain ADHD-obesity co-morbidity have been proposed, many of which are of primary importance to obesity work in general. Impulsivity is a key component of both overeating and ADHD, and is likely to play a major role in their co-morbidity. In support of this, Davis et al. (2006) have reported a strong correlation between ADHD symptoms, including impulsivity and overeating behaviour, which in turn associates with higher body mass index (BMI). Deficits in planning and an inability to delay reward – the normal processes of which are largely mediated by the

prefrontal cortex – may also lead individuals with ADHD to over-consume highly palatable, fattening foods. High-risk health behaviours may also contribute to obesity in various psychiatric populations. While this has frequently been described in the context of mood disorders, Kim et al. (2011) examined this issue as it relates to ADHD. In a large U.S. population sample of children 6-17 years old, Kim et al. found that children with ADHD engaged in less physical activity and organized sports than did their peers. Unmedicated girls with ADHD also had more media time than their peers, which was associated with higher obesity rates. It is important to note that children with ADHD have low gross motor performance, poor physical fitness, delayed motor development and more negative feelings about physical activity than do their peers (Harvey et al., 2007; 2009). Thus, the link between ADHD and obesity is likely to be driven by both reward sensitivity/overeating and decreased physical activity, similar to what has been described for obesity overall. This further establishes ADHD as an important focus for future psychiatric obesity work.

Children with ADHD have low gross motor performance, poor physical fitness, delayed motor development and more negative feelings about physical activity than do their peers. In sum, there is significant support for the notion that the current obesity epidemic is largely driven by brain mechanisms tied to emotion regulation, reward sensitivity, and addiction. These same neural mechanisms play a critical role in various psychiatric disorders, including mood disorders, binge eating disorders and ADHD, and are likely to account for the particularly high rates of obe-

sity in these vulnerable populations. Obesity in psychiatric patients has great direct clinical relevance, and is likely to reflect more extreme manifestations of the same emotional and behavioural processes that underlie the obesity epidemic overall. Further integration of metabolic and emotional-behavioural research in both psychiatric and non-psychiatric obese populations offers great promise in this regard.

References Mietus-Snyder ML and Lustig RH. Annu Rev Med 2008;59:147-162. Volkow ND and O’Brien CP. Am J Psychiatry 2007;164:708-710. Davis C. Curr Psychiatry Rep 2010;12:389-395. Killgore WD et al. Neuroimage 2003;19:1381-1394. Rothemund Y et al. Neuroimage 2007;37:410-421. Beaver JD et al. J Neursci 2006;26:5160-5166. Malik S et al. Cell Metabolism 2008;7:400-409. Farooqi IS et al. Science 2007;317:1355. Blum K et al. Pharmacogenetics 1995;5:121-141. Civelli O. Psychopharmacology, the fourth generation of progress (Raven Press)1995: 155-161. Meador-Woodruff JH et al. Neuropsychopharmacology 1996;15:17-29. Van Tol HH et al. Nature 1991;350:610-614. Asghari V et al. J Neurochem 1995;65:1157-1165. Popp J et al. Pharmacogenomics J 2008;9:71-77. Levitan RD et al. Neuropsychopharmacology 2004a;29:179-186. Levitan RD et al. Biol Psychiatry 2004b;56:665-669. Levitan RD et al. Neuropsychopharmacology 2006;31:2498-2503. Kaplan AS et al. Int J Eat Disord 2008;41:22-28. Jönsson EG et al. Mol Psychiatry 1999;4:290-296. Epstein LH et al. Behav Neurosci 2007;121:877-886. Davis C et al. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:620-628. Stice E et al. Science 2008;322:449-452. Altfas JR et al. BMC Psychiatry 2002;13:2-9. Fleming JP et al. Eat Weight Disord 2005;10:e10-13. Pagoto SL et al. Obesity 2009;17:539-544. Holtkamp K et al. Int J Obes Relat Metab Disord 2004;28:685-689. Agranat-Meged AN et al. Int J Eat Disord 2005;37:357359. Waring ME and Lapane KL. Pediatrics 2008;122:e1-6. Davis C et al. Eat Behav 2006;7:266-274. Kim J et al. Prev Med 2011;52:218-222. Harvey WJ et al. J Abnorm Child Psychol 2007;35:871882. Harvey WJ et al. Adapt Phys Act Q 2009;26:131-150.

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FEATURE

Binge Eating Disorder

E

ating, food choices, and weight are often associated with the morality of an individual in our culture. Cultural values, prejudices, and attitudes toward food are closely tied to those related to weight loss and obesity, shaping an individual’s views on their body image and appearance-related self-esteem. Studies have revealed that body fat is seen as the cornerstone of physical unattractiveness by many people and is associated with negative traits such as untrustworthiness, sloppiness, gluttony, and laziness. Weight loss programs are sometimes likened to religious rituals that are designed to redeem people from their ‘sin’ of being fat. Eating behaviour is routinely associated with traits such as attractiveness, intelligence, and even morality. And although being overweight or obese is often (and wrongfully) attributed to intrinsic qualities such as being lazy and lacking selfcontrol, many people are unaware that up to 30-40% of obese individuals suffer from an eating disorder called binge eating disorder. Individuals with binge eating disorder regularly engage in binge eating – episodes defined by the consumption of a very large amount of food in a short period of time, which are also accompanied by a sense of loss of control over eating. Binge eating be-

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Zeynep Yilmaz, PhD Candidate

haviour is relatively common in the general population, especially in social situations and during holiday meals. However, binge eating at a regular frequency – accompanied by a sense of loss of control and characteristic psychopathology – is less common and requires psychiatric attention. Furthermore, these episodes of pathological binge eating are often triggered by stressful events and serve the purpose of regulating negative affect by self-medicating with food. Binge eating disorder affects up to 5% of the general population. Currently categorized as a mental health disorder in need of additional research and validation, the number of affected individuals is likely to increase with its 2013 inclusion in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Unlike the pattern observed in anorexia nervosa and bulimia nervosa where 90% of the afflicted individuals are female, the sex distribution is roughly equal in the case of binge eating disorder. Binge eating disorder also differs from bulimia in other ways. Individuals with bulimia nervosa compensate for binge eating episodes by self-induced vomiting, diuretic and laxative abuse, and other dysfunctional behaviours. Individuals with

binge eating disorder, in contrast, do not compensate for the binge eating episodes, thus gaining a significant amount of weight. Similar to those with other eating-disorder diagnoses, individuals with binge eating disorder often present with other psychological problems, including depression, anxiety, substance abuse/dependence, impulsivity, attention-deficit/hyperactivity disorder, and low self-esteem. Binge eating disorder is also highly prevalent among people seeking help for obesity. In line with other eating disorders, binge eating has a biological basis and is highly heritable. The heritability index obtained from identical twin studies is 0.29-0.43 for binge eating disorder, meaning that 29-43% of phenotypic variation can be explained by genetic factors. Overall, however, eating disorders are complex traits with biological, psychological, and sociocultural factors contributing to their development, which presents challenges to genetic researchers attempting to pinpoint the exact function of genetics in these disorders. Furthermore, although these illnesses have a complex etiology, this does not discredit the role that genetic factors may play in an individual’s predisposition to developing them. Like most other psychiatric illnesses, the heritability of binge eating disorder follows a non-Mendelian pattern, with many genes making a small contribution to its development. Thus far, genes regulating the dopaminergic system and endogenous opioids have been associated with binge eating disorder, although more research is necessary to gain a better understanding of its underlying causes. In a culture that ruthlessly stigmatizes being overweight, individuals suffering from binge eating disorder often blame themselves and

Photo by Mohammed Sabri

By Allan S. Kaplan, MD FRCP(C)


FEATURE their ‘gluttonous ways’ for their weights and eating disorders. As a result of this, many of these individuals seek treatment from weight loss programs, which fail to address the underlying psychological issues associated with binge eating disorder. Thus, patients go through multiple phases of yo-yo dieting, which often leads to great frustration. Instead, binge eating disorder should be viewed as a psychological problem that must be addressed within a therapeutic context with a clinician experienced in the treatment of disordered eating. Evidence-based treatments for binge eating disorder include cognitive behavioural therapy, interpersonal therapy, and selective serotonin reuptake inhibitors (SSRIs), as well as treatments that co-target weight loss in order to reduce the risk of medical complications associated with obesity. These treatments offer hope for tackling the hidden psychological mechanisms that drive binge eating disorder, and more importantly, the often-misunderstood condition that is obesity.

References American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). 2000. Davis C, Levitan RD, Kaplan AS, Carter J, Reid C, Cur-

tis C, Patte K, Hwang R, Kennedy JL. Reward sensitivity and the D2 dopamine receptor gene: A case-control study of binge eating disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:620-8. Davis CA, Levitan RD, Reid C, Carter JC, Kaplan AS, Patte KA, King N, Curtis C, Kennedy JL. Dopamine for “wanting” and opioids for “liking”: a comparison of obese adults with and without binge eating. Obesity (Silver Spring). 2009;17:1220-5. DSM-V Development. Arlington (VA): American Psychiatric Association; c2010. Available from: http://www.dsm5. org. Harrison K. The body electric: thin-ideal media and eating disorders in adolescents. J Commun. 2000;50:119-43. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry. 2007;61(3):348-58. Kaplan AS, Howlett AL, Yilmaz Z, Levitan R. Attention deficit hyperactivity disorder and binge eating: Shared phenomenology, genetics and response to treatment. Int J Child Adolesc Health. 2009;2:165-74. Latner JD, Clyne C. The diagnostic validity of the criteria for binge eating disorder. Int J Eat Disord. 2008;41(1):114. Martins Y, Pliner P, Lee C. The effects of meal size and body size on individuals’ impressions of males and females. Eat Behav. 2004 May;5(2):117-32. Mitchell KS, Neale MC, Bulik CM, Aggen SH, Kendler KS, Mazzeo SE. Binge eating disorder: a symptom-level investigation of genetic and environmental influences on liability. Psychol Med. 2010;40(11):1899-906. Mooney KM, DeTore J, Maloy KA. Perceptions of women related to food choices. Sex Roles. 1994;31:433-42. Shinohara M, Mizushima H, Hirano M, Shioe K, Nakazawa M, Hiejima Y, Ono Y, Kanba S. Eating disorders with binge-eating behaviour are associated with the s allele of the 3’-UTR VNTR polymorphism of the dopamine transporter gene. J Psychiatry Neurosci. 2004;29(2):134-7. Stein RI, Nemeroff CJ. Moral overtones of food: Judgments of others based on what they eat. Pers Soc Psychol Bull. 1995;21:480-90. Vartanian LR, Herman CP, Polivy J. Consumption stereotypes and impression management: how you are what you eat. Appetite. 2007 May;48(3):265-77. Wonderlich SA, Gordon KH, Mitchell JE, Crosby RD, Engel SG. The validity and clinical utility of binge eating disorder. Int J Eat Disord. 2009;42(8):687-705.

Pick Your Brain... Physical features define obesity, but psychological and cognitive factors are important determinants of coping strategy and motivation for weight-loss. Although much is known about brain networks that control eating behaviour, an interesting yet underexplored possibility is that obesity affects brain circuitry. German researchers recently studied the brains of obese versus non-obese individuals. Participants received structural and functional MRI scans, during which the subjects were asked to lie still and not think of anything in particular as their brain activity was being measured -- a protocol known as “resting state fMRI.” This procedure has previously been used to gain insight into “functional connectivity,” which measures correlations in fluctuations of activity between different brain regions when an individual is not performing a particular task and sensory input is minimized. No differences were found between groups in volume of the brain’s gray matter, but extensive differences were found in functional connectivity. Specifically, obese individuals exhibited altered connectivity

in networks comprised of regions that are involved in food intake and reward processing. Decreased connectivity within a temporal lobe network was associated with greater body mass index, whereas connectivity in two other networks was associated with insulin sensitivity. The findings indicate that obesity is associated with alterations in neural properties that could easily be overlooked in a conventional analysis of brain structure. Important questions for future research are whether functional connectivity can be used to disentangle the psychological/ cognitive effects of obesity, and whether connectivity returns to normal after recovery. SOURCE: Kullmann S, Heni M, Veit R, Ketterer C, Schick F, Haring HU, Fritsche A, Preissl H (2011) The obese brain: Association of body mass index and insulin sensitivity with resting state network functional connectivity. Hum Brain Mapp.

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Brain illustration by Andreea Margineanu

Brain illustration by Andreea Margineanu

A column by Aaron Kucyi


FEATURE

Mood Disorders and Obesity Results from multi-national epidemiological studies indicate that mood disorders are highly prevalent and are associated with high rates of recurrence and substantial intra-and inter-episodic dysfunction. In developed and developing nations, mood disorders account for more illness-associated morbidity and mortality than any other chronic health condition in young adults. For example, in Canada, mood disorders are the most frequently cited reason individuals underperform in the workforce (i.e. either due to absenteeism or presenteeism).

Associate Professor of Psychiatry and Pharmacology, Head of Mood Disorders Psychopharmacology Unit, University of Toronto.

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I

warranted. Towards this aim, a transdisciplinary approach holds promise to better understand the underlying patho-etiology.

A consensus in the field is that before a saltatory leap forward can be made in therapeutics for mood disorders, refinement of disease models with sufficient construct, face, pathological, and interventional validity are

The implications of phenotypic and neurobiological overlap of obesity/metabolic syndrome with mood disorders has tremendous implications for clinicians and researchers. For example, work from our group suggests

The majority of individuals with mood disorders are either overweight/obese/abdominally obese and/or have metabolic abnormalities that are components of, or threshold for, the metabolic syndrome. For example, results from population-based and clinical studies indicate that between 50-75% of individuals with mood disorders are overweight/ obese and/or have adverse fat distribution (i.e. abdominal distribution). Historically, excess weight and metabolic abnormalities in individuals with mood disorders were conceptualized as secondary to abnormal health behaviours and iatrogenic artefact. It has subsequently emerged that the neurobiology of depression (e.g. glucocorticoid dysregulation, insulin resistance, pro-inflammation) also is contributory. A working hypothesis by our group, and several others, has been that obesity/metabolic syndrome shares a pathophysiological nexus with mood disorders which we have referred to as “Metabolic Syndrome Type II.� Photo by Mohammed Sabri

Dr. Roger S. McIntyre MD, FRCPC

t has been established that the course of mood disorders is progressive, likely reflecting an underlying neuroprogression of illness. For example, population-based surveys, as well as postmortem studies, indicate that mood disorders in young adults are associated with dementia in old age at a much higher rate than the general population. This concatenation of observations introduces a portrait of mood disorders as a highly chronic condition that endangers human capital. It is disquieting that despite the foregoing portrait of mood disorders, contemporary treatments for these syndromes remain very disappointing. Most individuals receiving conventional pharmacotherapy either fail to achieve or sustain remission and/or discontinue treatment due to adverse events and safety concerns. Moreover, conventional pharmacotherapy has never been demonstrated to modify the underlying disease process. In part, this latter observation stems directly from the fact that researchers in mood disorders do not have a clear consensus neuropathology as a basis for disease modeling and novel treatment discovery.


FEATURE that age/height inappropriate weight is associated with decreased cognitive function. Cognitive deficits in the mood disorder population are believed to be a principal causative and perpetuating factor of psychosocial impairment. Moreover, longitudinal studies, as well as post-mortem investigations, indicate that both mood disorders and obesity are associated with mild cognitive impairment, vascular and Alzheimer’s dementia. Excess weight has also been associated with decreased treatment response, higher rates of recurrence and chronicity as well as suicidality in mood disorder populations. Taken together, the complex mood disorder presentation associated with obesity invites the need for prioritizing excess weight prevention, treatment, and management.

In partnership with Health Canada, we will be exploring the effect of a ketogenic diet on mood symptoms, cognitive functioning, and quality of life in mood disorder populations. Available evidence supports the use of a ketogenic diet in medication-resistant children with epilepsy syndromes. Moreover, we are also exploring the impact of bariatric surgery on brain structure and function in individuals with mood disorders and morbid obesity. The basis for this latter project is the observation of inverse relationships between body mass index (BMI [kg/m2]) and regional grey matter volume (e.g., hippocampus) in nonpsychiatric populations. Taken together, obesity differentially affects mood populations invoking the hypothesis that although discrete conditions, there is overlapping neurobiology. It is hoped that delineation of this pathophysiological nexus may help unravel the complex patho-etiology of mood disorders. The neuronal (and glial) endangering effects of mood disorders and obesity are established, indicating that a bidirectional relationship between the central nervous system and obesity exists. Characterization and refinement of these frequently co-occurring phenotypes has promise to provide the field with genuinely novel, disease modifying, therapeutic avenues for mood disorders. In the interim, clinicians are increasingly being asked to treat patients with the “body in mind.�

Photo courtesy of http://www.sxc.hu/photo/420296

For the research community, there are a host of questions and research vistas that are created by this hypothesis. For example, what are the effectors that mediate/moderate cognitive decline in overweight/obese individuals? It has been recently reported that mutations at the FTO obesity gene may be a common susceptibility factor for both obesity and mood disorders. Our group is attempting to identify genomic, proteomic, metabolomic, and exposomic factors that bridge these foregoing phenotypes. Interventional research from our group has also established that the administration of intranasal insulin improves measures of executive function in individuals with mood disorders. This proof of concept work provides evidence supporting the critical role of insulin under both physiological

and pathophysiological conditions.

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FEATURE

Body Mass Index By Tetyana Pekar

History and Purpose of the Body Mass Index The body mass index (BMI) is a simple, safe, non-invasive, and cheap way of estimating body fat percentage and assessing a person’s health and nutritional status. The BMI is one of many anthropometric indices, but it is by far the most popular. Indeed, it is an internationally accepted index for defining obesity (Jequier, 1987). The concept of the BMI dates back to the Belgian Adolphe Quatelet, who, in 1832, observed that an individual’s weight is approximately proportional to the square of their height (kg/m2) (Eknoyan, 2007). However, it was only in the 1970’s, when the American scientist Ancel Keys published several papers showing that the BMI is both highly correlated with adiposity and largely uncorrelated with height, that the Index began to gain popularity for assessing the level of obesity, optimal weight, and overall nutritional health (Keys et al., 1972).

The History and Concept of an “Ideal Weight” Since an individual’s weight increases as a function of the square of their height, the BMI provides a rough guideline for evaluating when an individual deviates from the mean. The Index on its own, however, does not provide one with a guideline for appropriate cutoff values associated with an “ideal weight”. Modern attempts to establish “ideal weight” standards, defined as the weight associated with the lowest mortality, date back to Louis Dublin, a statistician and vice-president of the Metropolitan Life Insurance Company (Met Life) (Jarrett, 1986). Met Life first issued height-forweight tables based on longevity statistics in the early 1940’s, and then again in 1959, compiling information from 4.9 million policies issued to adults between the ages of 25-59 by 26 life insurance companies in the United States and Canada (Jarrett, 1986). The Met Life tables were reproduced and appraised in a report on obesity by the Royal College of Physicians (RCP), and in 1973, the Fogarty Center conference also used the Met Life tables to establish guidelines for body weight (Jarrett, 1986). The conference recommended “ideal” BMI ranges of 20.1-25 for men, and 18.7-23.8, for women. Later, the NIH utilized the Met Life tables in its recommendation of “ideal weight”, although the values were higher than those recommended by the RCP and Fogarty Center. In 1995, the World Health Organization also adopted it as a tool to evaluate obesity (WHO, 1995).

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“Ideal Weight”: Biases in evaluating weight-associated mortality Given that the Met Life data played a key role in establishing the current BMI cut-off points, it is important to consider the biases and limitations of the results. The data is biased and likely not wholly representative of the population for many reasons: (1) insurance policies do not necessarily reflect individual people (one may have several), (2) policies may be terminated for reasons other than death (skewing mortality data) and (3) non-random sampling, which involves collecting data only from those wealthy enough to have life insurance. Methods of data collection were also inconsistent. Approximately 20% of the weights were self-reported, while the others were weighed in indoor clothing with shoes on (to correct for this, 7lbs and 4lbs were subtracted from the men and women, respectively) (Shah et al, 2006). Individuals with coronary heart diseases were excluded from subsequent analyses, and important covariates such as smoking (which can lead to reduced weight) were not considered (Jarrett, 1986).

Since an individual’s weight increases as a function of the square of their height, the BMI provides a rough guideline for evaluating when an individual deviates from the mean. To make matters more complex, frame build was arbitrarily assigned based on Dublin’s observation that there was a large distribution in weight for a given height, which led him to divide the distribution into thirds, for “small”, “medium” and “heavy” frames. He defined the “ideal” weights to be the average weight for each third. In the subsequent table, issued in 1983, body frame was determined more precisely by measuring elbow breadth. This was based on the assumption that the measure was independent of body fat mass, but even this assumption has not been supported by evidence (Himes and Bouchard, 1985). Perhaps most importantly, the WHO’s BMI recommendation cutoffs are the same for both genders and all ethnic backgrounds, but Met Life data was collected from a largely Caucasian sample, and thus, may be inappropriate for for non-Caucasians.

Limitations of the BMI In recent years, the BMI has become a tool for evaluating health and disease risk on an individual basis,


FEATURE

despite the fact that according to Keys, it was meant to assess populations in epidemiological studies only (Eknoyan, 2008). The BMI, which assumes that the average person is relatively sedentary and of “average” body composition, is also not appropriate for athletes or extremely sedentary but slim individuals. In addition, the BMI can be misleading when evaluating the elderly, as many age-related diseases result in weight loss, and tends to miscategorise very short or tall individuals into the obese category (Freeman et al, 1995). Nonetheless, the BMI still serves as a proxy for body adiposity, which is associated with an increased risk of many diseases, such as type 2 diabetes, cardiovascular diseases, and several cancers. However, in recent years, it has become apparent that the BMI is often not the best tool for predicting the risk of many of these diseases (Huxley et al, 2010). This is because the BMI does not take into account fat distribution, which is known to be an important predictor in cardiovascular diseases (Jarrett, 1986; WHO, 2000). There is also increasing evidence that even when it has predictive value, the cut-off points for evaluating clinically significant risk vary for different ethnic populations (WHO, 2000). In particular, studies have shown that the proportion of the Asian population with type 2 diabetes and cardiovascular diseases is substantial in the “normal” range, and that for a particular BMI, body fat mass can vary substantially among Asians, when compared to a Caucasian population (Huxley et al, 2010; WHO, 2000). For this reason, the WHO has recommended that for these populations, cut-off for the normal range be changed to 22, which is associated with the lowest mortality risk in these groups (WHO, 2000).

Beyond the BMI It is well-established that increased adiposity correlates with an increased risk for the development of certain diseases and mortality, but the exact cut-off points at which this risk becomes significant is often not clear. Indeed, it is likely to depend on age, ethnic background, fat distribution, level of activity, diet, frame size, disease and family history and other behaviours (such as smoking). And while the BMI is a useful tool for epidemiological research and as a rough estimate for body fat, when it comes to predicting disease risk, many alternatives fare much better (Jarrett, 1986; Huxley et al, 2010; WHO, 2000). Hydrodensitrometry

In recent years, the BMI has become a tool for evaluating health and disease risk on an individual basis, despite the fact that according to Keys, it was meant to assess populations in epidemiological studies only. (underwater weighing) and DXA (dual-energy x-ray absortiometry) are the most accurate measures of adiposity, but they are not readily available for clinical or epidemiological studies. Thus, better alternatives to the BMI include the waist-to-hip ratio, waist circumference and waist-to height ratio, all of which are more reflective measures of central or visceral adiposity (Jarrett, 1986; Huxley et al, 2010).

BMI Values ■Underweight (less than 18.5) ■Normal weight (between 18.5 and 24.9) ■Overweight (between 25 and 29.9) ■Obese (30 and over)

References Eknoyan, G. Adolphe Quetelet (1796–1874)—the average man and indices of obesity. Nephrol Dial Transplant 2008; 23: 47-5. Freeman J, Power C, Rodgers B. Weight for height indices of adiposity in childhood and early adult life. Int J Epidemio 1995; 24: 970-6. Himes JJ and Bouchard C. Do the new Metropolitan Life Insurance weight-height tables correctly assess body frame and body fat distribution relationships? Am J Public Health 1985; 85: 1076-9. Huxley R, Mendis S, Zheleznyakov E, Reddy S and Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk – a review of the literature. Eur J Clin Nutr 2010; 64:16-22. Jarrett RJ. Is there an ideal body weight? Br Med J 1986; 293:493-5. Jequier E. Energy, obesity, and body weight standards. Am J Clin Nutr 1987; 45:1035–1047. Keys A, FIdanza F, Karvonen MJ, et al. Indices of relative weight and obesity. J Chron Dis 1972; 25:329-43. Shah B, Sucher, K and Hollenbeck CB. Comparison of Ideal Body Weight Equations and Published Height-Weight Tables with Body Mass Index Tables for Healthy Adults in the United States. Nutr Clin Pract. 2006; 21:312-19. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne, 2000.

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FEATURE

Obesity and Type 2 Diabetes A Global Health Burden

Dr. Minna Woo MD, FRCPC, PhD Associate Professor, Dept of Medicine, Institute of Medical Sciences and Medical Biophysics.

O

besity once reflected a state of physical and general affluence. However, the obesity epidemic has now outstripped its predictions and obesityrelated problems are now a significant global burden to the health care. In Canada alone, approximately 24% of Canadians were obese between 2007 and 2009, and the incidence continues to rise1. Faithfully following the obesity trend is the diabetes epidemic, which in Ontario has surpassed the WHO’s predictions for 20302. It is estimated that 400 million individuals worldwide will be afflicted with diabetes by then3. Particularly alarming are the growth rates of obesity and diabetes in children, and in developing countries. Obesity predisposes individuals to developing insulin resistance, which is the underlying defect in type 2 diabetes mellitus. Diabetes mellitus, as manifested by chronic hyperglycemia, is divided broadly into two types – type 1 and type 2. Type 1 diabetes is an autoimmune disease, where insulin-producing cells in the pancreas are selectively destroyed by the autoimmune process, Type 2 is the more common form, which comprises over 90 percent of all diabetes. Incidence

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The underlying defect in type 2 diabetes is insulin resistance, also referred to as metabolic syndrome or pre-diabetes. Recent studies have highlighted the multi-organ involvement of this syndrome. Initially, classic metabolic organs such as the liver, muscle and adipose tissue were investigated extensively as sites of insulin resistance. However, it has become increasingly evident that all tissues are subject to developing insulin resistance since insulin receptors are ubiquitous. Recent studies show that other tissues are implicated in insulin resistance, including the ovaries, the lungs and even the pancreatic cells themselves, which not only produce insulin, but also are targets of insulin action. Clinically, insulin resistance or metabolic syndrome can manifest in a wide range of presentations, including obesity, hypertension, fatty liver, polycystic ovarian syndrome, asthma, obstructive sleep apnea, and even some cancers. Importantly, over time, chronic hyperglycemia leads to multi-organ failure due to damage of small and large vessels referred to as micro- and macro-vascular complications of diabetes, respectively. The importance of pancreatic cells in the pathogenesis of type 2 diabetes has become more clear with the recent genome-wide association studies showing that nearly all susceptibility genes for type 2 diabetes are related to pancreatic cells4. This evidence also supports the notion that insulin resistance can be compensated by increased production of insulin from pancreatic cells, thereby preventing the emergence of type 2 diabetes. However, in the event of a defect in pancreatic cells, either due to genetic predisposition or due to metabolic or other forms of cellular toxicities, diabetes will develop. This compelling evidence has directed diabetes research towards enhancing pancreatic cell mass and function in hopes of diabetes prevention and cure. The underlying defect of insulin resistance in type 2 diabetes is still not well understood.

Animal studies and supportive clinical evidence point to many possible mechanisms, which can lead to whole body insulin resistance5. New findings in diabetes research include over-nutrition of many cell types, which can lead to cellular stress, thereby causing cell death or inflammation. Indeed, chronic inflammation is a predominant defect that can instigate and/or exacerbate disease processes. However, the particular cell types or organs that instigate this process are under debate. Many new organ systems are now in the limelight for diabetes research. These include all immune cell types, the central nervous system, and the pancreatic cells, in addition to the usual suspects including the adipose tissue, liver and muscle, which all contribute to the disease process. More research on therapies is needed given the relentless progression of disease despite implementation of currently available therapy. Physical activity and balanced nutrition are cornerstone therapy in the prevention of diabetes and obesity, but difficult to implement. We are proud of being part of University of Toronto where scientists have made landmark discoveries on molecular-based treatments, including the discovery of insulin6 and GLP-1-related therapies7. Such research provides us with the tools to combat the obesity and diabetes epidemics, which currently devastate the world.

References

1. http://www.statcan.gc.ca 2. Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995-2005: a populationbased study. Lipscombe LL, Hux JE. Lancet. 2007 Mar 3;369(9563):750-6. 3. Obesity and diabetes in the developing world--a growing challenge. Hossain P, Kawar B, El Nahas M. N Engl J Med. 2007 Jan 18;356(3):213-5. 4. The emerging genetic architecture of type 2 diabetes. Doria A, Patti ME, Kahn CR. Cell Metab. 2008 Sep;8(3):186-200. Review. 5. From mice to men: insights into the insulin resistance syndromes. Biddinger SB, Kahn CR. Annu Rev Physiol. 2006;68:123-58. Review. 6. “The Nobel Prize in Physiology or Medicine 1923”. The Nobel Foundation. 7. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Drucker DJ, Nauck MA. The Lancet. 2006. Nov 11;368(9548):1696 - 1705

Photo by Mohammed Sabri

of type 2 diabetes is rising rapidly in parallel to the obesity epidemic.


RESEARCH HIGHLIGHT

The Final Frontier

Getting a Good Night’s Sleep in Space

By Allison Rosen

Dr. Dave Williams earned his medical degree from McGill University and joined the Canadian Space Agency in 1992. He first traveled to space with the Neurolab mission to conduct neuroscience research, and later, as part of a space station construction team. Beyond his role as a physician and astronaut, Williams is also an avid pilot and aquanaut. Wholly, Williams’ career reflects his passion for emergency and remote care medicine. He recently sat down with the IMS Magazine to discuss some of the complexities involved with sleeping in space.

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stronauts face enormous pressure to perform while in space: the years they spend training culminate in a mission during which they are expected to complete numerous assignments, from mechanical operations to biomedical experimentation, all while dealing with the effects of microgravity. Adequate sleep is crucial for good performance, but getting quality sleep in space is a difficult task. How is sleep different in space than on Earth, and what can be done to improve the sleep of astronauts?

Photo used with permission from Dr. Dave Williams

Current Studies on Sleep in Space A study conducted on astronauts during space missions reported decreased subjective sleep quality and decreased feelings of being physically rested on awakening. This account was corroborated by polysomnography and actigraphy findings, which record measures such as body movement, temperature, breathing rate, light levels, and pulse oximetry. Heart rhythm information was also collected via electrocardiogram recordings. Overall, these data revealed highly variable light-dark cycles in the

spacecraft and reduced body temperature fluctuation, which normally changes during sleep and wake. While wake time was fairly constant, the time at which astronauts fell asleep varied significantly. Circadian rhythm, as measured through urine content of cortisol, appeared misaligned relative to the imposed sleep/wake schedule. A battery of additional tests – including reaction time and memory recall – were used to determine neurobehavioural functioning. Almost all results revealed decrements in astronaut performance correlated with decreased sleep quality and quantity. The effect of melatonin on sleep/wake cycles in space was also investigated in one particular study, whereby astronauts were administered melatonin just prior to sleep. This naturally occurring substance is crucial in the entrainment of circadian rhythm, but actigraph and polysomnographic measurements did not reveal significant changes in sleep quality upon pre-sleep administration of melatonin. This shows that melatonin may not be a useful treatment for astronauts’ sleep problems, and furthermore, that sleep disturbances are not likely due to abnormal melatonin levels while in space.

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RESEARCH HIGHLIGHT What’s it Like to Sleep in Space? Dr. Williams describes the importance of getting enough sleep as critical. “Fatigue as a result of sleep debt or chronic sleep deprivation may impair our ability to perform, which may have critical mission impact,” he explains. Before launch, astronauts are exposed to a light-dark schedule that is designed to shift circadian rhythms to the required 24-hour sleep cycle while in space.

Dave Williams: A Chat with the Canadian Astronaut/ Doctor about his Prolific Career

For astronauts in space, Williams points to eight hours of sleep as the intended goal. “But do we achieve the target all the time? The answer is probably no. Sometimes we do, and sometimes we don’t for operational reasons. If [a situation] arises like a leak, you do what you need to do, but that can impact the sleep schedule of crewmembers on orbit,” he explains.

A: Arguably, that was the thing that led to me being selected

Williams describes his own experience with decreased sleep as detrimental. “You feel the fatigue beginning to build during a mission anyway because you’re working really hard, but then when you add [on] a short sleep period, it [can become] problematic.” A unique aspect of sleep while in space is the reduced gravity. Williams gives us a glimpse into this experience. “Your arms float out in front of you, your hips and knees flex because you have no gravity to pull your limbs into a certain position, and you don’t have to worry about snoring as much.” There are two sleep environments in spacecrafts: the Sleep Station, which is sound-proof, light proof and equipped with its own ventilation. “It works out really well, [but] we only generally fly those on research missions.” The rest of the time, astronauts use the less comfortable Sleep Restraint System. “It basically looks like a sleeping bag that you can attach to the wall or ceiling,” explains Williams.

What Can We Learn? Williams believes that research regarding sleep in space has a high level of translatability. He lists one important finding as the strong correlation between performance and rest or fatigue. “You can think about undergraduate students studying for their final exams. Many students cram for exams and yet, if you look at the research, data suggests that cramming and decreasing the amount of sleep you’re getting during an exam period will actually decrease your performance, not enhance it.” Practically, sleep studies in space also enable astronauts to bring new technology back to Earth. “We’ve had to develop miniaturized technology in order to record all the different parameters associated with sleep physiology.” By having this technology available for use on Earth, Williams suggests that 24-hour portable sleep studies can be done at home in the patient’s environment, as opposed to a special facility. Future studies regarding sleep in space will undoubtedly add to the body of knowledge about sleep in general. Williams postulates that the next step is “to answer the life sciences questions needed to send humans farther into space and keep them there longer.”

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Q: You are an accomplished pilot, scuba diver, astronaut, researcher, and clinician. How do you think engaging in such diverse activities has impacted your career?

as an astronaut. If I had applied to be an astronaut as a physician without the other things that I did, I doubt that I would have been selected. I really enjoy exploring the final frontiers here on Earth and in space, but doing it from a scientific and clinical perspective.

Q: What advice do you have for graduate students? A: Know what you’re passionate about. If you’re able to align your passions with what you do from a career perspective, then suddenly it’s not work anymore. You will devote all sorts of time and effort, and as a result you’ll become really good at it. If you’re forcing yourself to do something that you really don’t want to do, you might be successful, but you’re never going to be happy doing it.

It’s also important to believe in your capabilities and be really, really persistent. My marks weren’t stellar. I didn’t get into medical school the first time I applied. If I had given up when I had received negative feedback, I never would have achieved the things that I’ve been able to achieve.

Q: What’s next for you? A: I want to be able to share all the knowledge and experience

that I’ve accumulated participating in the space program – and my experience as a clinician and a researcher – with students at various stages in their career. I hope to help them see what it is that they’re passionate about.

References Dijk, D., Neri, D., Wyatt, J., Ronda, J., Riel, E., Ritz-De Cecco, A., Hughes, R., Elliott, A., Prisk, G., West, J., and Czeisler, R. Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights. American Journal of Physiology Regulatory Integrative Comparison of Physiology. 2001; 280:R1647-R1664.


SPOTLIGHT

Janice Joo

STREAM MSc Biomedical Communications SUPERVISOR Nicholas Woolridge

Visualizing a New Approach to Data Analysis

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lthough Janice Joo studied health sciences at McMaster University during her undergraduate years, she was always fascinated by visual design. Joo’s decision to pursue a Master’s degree in Biomedical Communications (BMC) at the University of Toronto stemmed from her desire to combine these two passions. Current-

ly in her second and final year, Joo is working with a health geographer to develop a userfriendly data analysis tool for use in health research that improves upon existing programs such as SPSS and ArcMap. As the first in her department to work with a health geographer, she feels that her project pushes the research boundaries in the BMC program.

Since her Master’s project is programmingintensive, Joo spends the majority of her day developing and honing her skills as a computer programmer. It is not uncommon for her to spend several hours a day debugging code and designing an intuitive and userfriendly interface for her program. Joo feels that her work as a graduate student is akin to scientific research in that the problems that arise in her work are solved not by reading through textbooks or journal articles, but by constantly troubleshooting. Joo believes that the current method of displaying and analyzing data, particularly within the field of health geography, is insufficient. She feels that raw data remains difficult to understand when accessed via drop down menus that disregard the values found in the table of data itself. “It creates a sense of disconnect between the user and the data,” Joo remarks. Moreover, she feels that the researcher could better discover new trends through easier data exploration. Joo intends to aid researchers in data analysis by providing them with a spatial playground in which they can more easily view, organize, analyze, and display data. Realizing that to be a successful teacher and communicator, one must understand the learner and his or her context, Joo attains a learner’s perspective by developing new skills and hobbies such as music and songwriting. Apart from her studies, Joo considers religion and faith to be of utmost importance in her life, and enjoys studying biblical scriptures and playing piano at church.

Photo by Paulina Rzeczkowska

After graduation, Joo plans to gain experience in industry as an interactive media developer, where she hopes to develop mobile applications for educational purposes. She also has a desire to continue her education by pursuing a PhD and investigating educational tools and technologies. Joo aspires to work in a team of researchers and instructors who are interested in developing new ways to present educational material to students. Interview by Anthony Grieco

WEBSITE http://www.janicejoo.com

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SPOTLIGHT

Binu Jacob

STREAM PhD SUPERVISOR Dr. David R. Urbach

Successful Researcher Hopes to Teach Others

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inu Jacob began her academic career in her country of origin, India, at the prestigious Christian Medical College, University of Madras. There she completed a Master’s degree in biostatistics and engaged in cancer research before moving to Canada with her family. Eager to continue her academic journey in Canada, she spent two years conducting research at St. Michael’s Hospital, prior to enrolling in a PhD program “to pursue a graduate education with a focus on cancer research.”

In her search for a PhD program, Jacob decided that the program at the IMS stood apart from the rest, due to its flexible program structure, reasonable coursework requirements, and broad research scope. She felt that the IMS would provide her with the perfect environment to concentrate on her research, while continuing to develop her skills as a scientist. She also felt that the PhD program at the IMS was appropriate because it is highly multidisciplinary.

For her PhD research, Jacob is examining the effectiveness of colonoscopy for prevention of colon cancer. She conducts observational studies using administrative health data at the Institute of Clinical and Evaluative Sciences (ICES) at Sunnybrook Hospital. During the first year of her PhD, Jacob won a training award from CIHR, as well as an Ashley Scholarship. Jacob has also been awarded a three-year CIHR award and has won several U of T Open Scholarships. Jacob’s PhD research continues to be successful, and she currently has papers under review in JAMA and BMC. Enthusiastically claiming that the IMS was a very welcoming program regardless of the applicant’s academic background, Jacob speaks highly of the IMS PhD program. She is impressed by the broad scope of researchers who are studying at the IMS, from biostatisticians to clinical researchers to basic science researchers. She further states that the program’s administrative branch is truly exceptional and that they are continually in touch with students, and appreciates the ongoing information regarding upcoming scholarship and award opportunities and job postings. She has found this frequent communication to be very helpful, and feels it is one of the advantages of being an IMS student.

Jacob was recently employed as a teaching assistant for two biostatistics courses, MSC1090, Introduction to Clinical Biostatistics and MSC1060, Biostatistics for Health Scientists, positions she greatly enjoyed. She received a lot of praise and encouraging feedback from her students, providing her with ample confidence that in the future, she will be an effective lecturer and mentor. With her thesis defense coming up, Jacob wishes to pursue an academic teaching career. She is excited for her future, and hopes that her success will continue as she pursues her goals.

Interview by Atiqa Malik

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Photo by Paulina Rzeczkowska

“I am impressed by the broad scope of researchers who are studying at the IMS, from biostatisticians to clinical researchers to basic science researchers.”


SPOTLIGHT

FACULTY VIEW

Dr. John Vincent PhD

need to know what the genes do, so there will be a greater need for animal and functional/ cellular studies. Also, for complex disorders, we need more genetically relevant clinical measures to help define clinical subgroups. What is the most rewarding part of your job? Discovering something new, clear and definitive, like a nonsense mutation in a gene. Tell us something you would like people to know about you that they do not already know. I’m a big football (soccer) fan and have supported West Ham United all my life. I’ve seen many legends play – the 1966 World Cup heroes, Bobby Moore, Geoff Hurst, Martin Peters – and I even witnessed George Best score against us. I still play regularly, but few people realize that I only really started playing when I came to Toronto, which explains my lack of skill (or at least that’s my story, and I’m sticking to it).

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r. John Vincent sat down to talk with the IMS Magazine about his journey into neurogenic research, his own studies of autism and other developmental disorders, and life beyond the lab.

Photo by Paulina Rzeczkowska

How did you get started in science? After high school, I spent a year working as a hospital porter in Guildford (England). During that period, I applied to study biochemistry at Manchester University. Manchester was a fantastic place for me; all the coolest bands of the day (like Stone Roses, The Smiths, and New Order) played there. In my third year, I spent several terms working at Withington Hospital, and I loved the bench work. After graduation, I got a research technician job looking at genetic markers for atherosclerosis. After two years, I started my PhD at the University College and Middlesex Hospital Medical School, where I also started working on the genetics of autism and the newly discovered trinucleotide repeat expansions causing fragile X mental retardation. After my PhD, a fellow student – who was then in Toronto – informed me that Jim Ken-

nedy at CAMH was looking for a postdoc to work on trinucleotide repeat expansion in psychosis, and a few months later I moved to Toronto. Three years later, I moved to the Hospital for Sick Children and Steve Scherer’s lab to work on the genetics of autism, and in 2002 I started my own lab at CAMH. Tell us about your research. My research is on the identification and characterization of genes involved in autism and other pervasive developmental disorders. One line of research involves using consanguineous (related) families from Pakistan for gene mapping. What would you consider your most significant research accomplishment? Initiating the study on familes from Pakistan was a great experience, as was finding our first disease gene (CC2D2A) and the identification of PTCHD1 as a gene for autism by studying copy number variants on the X chromosome. What do you think is the future of neurogenetic research? The advent of SNP microarrays and next generation sequencing will speed up disease gene identification. However, we will still

What do you like to do in your free time? Travelling has always been a great love. I spent several months travelling in Central Asia after my PhD and before coming to Toronto. My work fortunately allows the occasional trip to far off places. Interview by Zeynep Yilmaz

What advice would you give to students? 1. Stay focused on your chosen field. It’s good to have breadth of knowledge, but you don’t need to know everything about everything, which may distract you from your research goal. 2. It is beneficial to develop a network of friends and collaborators in research. Getting help from others can make up for shortcomings in your portfolio of techniques. 3. Don’t start a PhD merely because you can’t think of an alternative after finishing a Masters- you’ll need to have enough passion for the subject to carry you through. 4. Get out of the lab once in a while! Go for a walk, play some sports, read a book… Do something non-work-related.

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SPOTLIGHT

Tackling international disparity in

NEUROLOGICAL EDUCATION Dr. Mojgan Hodaie on international neurosurgical training and awareness of disparities in educational resources. By Aaron Kucyi

J

ust outside, next to the Neurosurgical Block of Korle Bu Hospital in Ghana, is a large lawn primarily composed of dirt. Well after sunset, a man carries a mat out of the hospital and makes his way toward the lawn. After suffering from headaches for years, his family has finally gathered enough money to pay for the cost of a brain scan, and he had spent the day waiting to see a neurosurgeon. Now at night, hours away from his hometown and with buses no longer running, there is no prospect of leaving Korle Bu. He sets his mat on the dirt and lies down to sleep.

Together with Udi Blankstein, a recent MSc graduate at the IMS (’09), Hodaie has developed an innovative program that attempts to abolish some of those limitations. Using structured online courses with highly active discussion forums as well as local visits that facilitate the translation of neurosurgical skills to residents in Ghana, the program has so far produced impressive results. The aims 29 | IMS MAGAZINE SUMMER 2011 OBESITY

Photo by Connie Sun

This man is one of the very few fortunate patients to receive medical attention despite the paucity of physicians and resources in Ghana. However, Dr. Mojgan Hodaie, IMS faculty member and neurosurgeon at Toronto Western Hospital, believes that there is hope for patient care in under-serviced countries. “Throughout the developing world, there are a bunch of people who are extremely dedicated to providing neurosurgical care,” she says. Based on extensive correspondence with neurosurgical practitioners at Korle Bu Hospital and two personal visits, Hodaie shares that “these people are willing to overlook all of the limitations associated with practicing under very pressed circumstances and a lack of resources.”


SPOTLIGHT

In Ghana, for instance, it is estimated that there are 8 neurosurgeons among a population of nearly 24 million citizens. These surgeons may also need to look after patients in neighbouring countries that have no neurosurgeons. of the program are to move toward an international standard of neurosurgical training and to ultimately eliminate disparities in the level of care between countries in the developed and developing worlds. Currently, the most well-known outreach efforts to the developing world focus on improvement of hygienic conditions and elimination of large-scale threats such as HIV/ AIDS. Although neurosurgical care may seem to be less of a priority than such critical global issues, the importance becomes salient when considering the abundance of patients requiring neurosurgical care in contrast to the number of available physicians. In Ghana, for instance, it is estimated that there are 8 neurosurgeons among a population of nearly 24 million citizens. These surgeons may also need to look after patients in neighbouring countries that have no neurosurgeons, such as Togo (population ~7 million) and Benin (population ~9 million). It is crucial that neurosurgeons in the developing world receive highly effective training to prepare them to treat these huge numbers of patients who present with extremely diverse and critical conditions. The World Federation of Neurological Surgeons (WFNS) is the main organization that facilitates improved training in the developing world through activities such as international conferences and visits. Individual surgeons also visit select sites in the developing world and are the main source of current international education efforts. Rather than mirroring the activities of these existing programs, Hodaie and her colleagues sought to create a platform that takes international education a stride further. The idea is simple: introduce online modules with consistent interaction and communication, similar to courses that already exist in many universities and colleges. Using this strategy, course participants do not have to rely on sparse visits from experts that are often interleaved with periods of closed or

non-structured communication. Unlike other online systems that exist, these structured courses strongly rely on the human element, since each course has a faculty member who mentors, guides and assists the course participants in their learning. To date, two structured online courses have been piloted in Ghana with support from the WFNS. The first course, starting in April 2010, was 12 weeks long and included lectures in neuroanatomy and clinical case scenarios. Throughout the course an active online discussion ensued, with residents receiving timely feedback about specific cases at their hospital. Hodaie followed the course with a visit to Korle Bu, where she trained residents to use techniques such as deep brain target localization and biopsy collection. Some of these techniques could significantly increase the efficiency of surgical practice; for example, part of a deep tumor may be biopsied within less than two hours in an awake patient rather than many hours in an anesthetized patient.

keenly cooperative. The particular feature that impressed students was the consistency of dialogue between faculty in Canada and participants in Ghana. When asked about the program, one participating resident commented “there really is a great future in its open forum nature, and the fact that we can take part in the course wherever we are is a big plus.” Hodaie proposes that the biggest advantages of having these types of courses for residents in the developing world are “the fact that it removes them from their scientific and academic isolation” and that it allows them “to know that there is a bigger connection to people they can easily contact.” Future plans for the program include the introduction of online modules for weekendlong conferences hosted by the WFNS in the developing world and efforts to introduce online courses to African countries beyond Ghana. Blankstein, who has taken an interest in the technical aspects of expanding the program, suggests that with increasing internet access in the developing world, online international courses have tremendous potential beyond just neurosurgery and even beyond medicine. “With the disparity of resources that exists throughout the world, this is a really amazing tool. Maybe medicine will be a beacon for other areas.”

The second course, starting in September 2010, was entitled “Introduction to Scientific Writing.” Residents learned skills that are essential for effective interaction with the international neurosurgical community, such as preparing meeting abstracts and clinical publications. Participation in this course was particularly high, with residents eager to acquire skills that promote the end-goal of selfsustenance.

Along with financial support and increased international awareness of disparities in educational resources, advances in communication technology will continue to be an invaluable tool in bringing the neurosurgical state of the art to the developing world. A patient who has no choice but to sleep on a mat outside after their clinic visit certainly deserves this much.

The courses were well-received by the faculty and neurosurgical residents in Ghana, who made significant contributions and were

References

“There really is a great future in its open forum nature, and the fact that we can take part in the course wherever we are is a big plus.”

Blankstein, U., Dakurah, T., Bagan, M., Hodaie M. (in press). Structured online neurosurgical education as a novel method of education delivery in the developing world. World Neurosurgery.

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CLOSE UP

Up Close and Personal Professor Emerita Dr. Mary Seeman reflects on her career, her research, and offers advice for new professors. By S. Amanda Ali

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r. Mary Seeman is a Professor Emerita in the Department of Psychiatry at the University of Toronto. Her research on biopsychosocial gender differences in psychotic disorders has resulted in over 260 scientific publications and an Honorary Doctor of Science degree from the University of Toronto. Her roles have included Psychiatrist-in-Chief at Mount Sinai Hospital, Vice Chair of the Department of Psychiatry at the University of Toronto, and Graduate Co-ordinator for the Institute of Medical Science.

Photo by Paulina Rzeczkowska

with Dr. Mary Seeman


CLOSE UP Dr. Seeman was honoured at the 2011 IMS Scientific Day for her leadership, compassion, patience, dedication, insight, and generosity. Together with IMS Associate Director Dr. Karen Davis, it was Dr. Seeman’s initiative and exceptional writing skills that led to the inception of the IMS Graduate Student Oath. Although her term as Graduate Co-ordinator has come to an end, Dr. Seeman will always be recognized for her significant contributions to the Institute of Medical Science, to the University of Toronto, and to the scientific and medical communities at large.

“Some of our patients stayed with us a long time and I became very attached to them. When I left the city, I kept writing to them and continued to do so until very recently. “

Q

How did you become involved in the field of psychiatry, and schizophrenia in particular?

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I read a lot of fiction growing up and I was always intrigued by the motivation behind the characters’ behaviours; this helped me decide early on to be a psychiatrist. I spent my psychiatry residency in New York City working at a research ward where all the patients were women with schizophrenia. There was a basic laboratory attached to the ward where my lab mates did biochemical experiments (except for me – I wasn’t allowed near a pipette due to my clumsiness!). Our research team was one of the first groups in North America to run clinical trials on the effects of haloperidol, an antipsychotic. We also gave our patients LSD and mescaline to see if these drugs improved their symptoms, but unfortunately, the drugs made them much worse – as did many of our treatments at the time. Some of our patients stayed with us a long time and I became very attached to them. When I left the city, I kept writing to them and continued to do so until very recently. Needless to say, I became very interested in schizophrenia: its causes, treatments, and outcomes.

Q

How have your research interests evolved from those early days?

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I started working at the Centre for Addiction and Mental Health (CAMH, Toronto) in 1975 in a schizophrenia outpatient setting. It was there I realized the stark differences between male and female schizophrenia patients: the men were grubbier, harder to talk to, more dependent on their families, and very prone to suicide. I found the suicides very hard to handle emotionally, so after 10 years, I moved to Mount Sinai Hospital and joined the IMS. When I returned to CAMH several years later, to my surprise, the men I had left behind seemed to be doing very well. They looked better, smiled and chatted, made jokes, and lived independently. The women who had previously been doing well, however, were in and out of hospital, looked bedraggled and suicidal. This observation led to a series of studies to try to sort out the reason why. Specifically, why do women (who get ill with schizophrenia later in life than men) seem more ill with time, whereas the men improve? There are no easy answers to this question, and individual differences are usually more important than whether one is a man or a woman. But over the years, it has been fascinating to trace the role of hormones, family entanglements, drug side effects, and therapeutic relationships in the course of schizophrenia.

“But over the years, it has been fascinating to trace the role of hormones, family entanglements, drug side effects, and therapeutic relationships in the course of schizophrenia.“

Q Since your research examines differences between men and women, what are your thoughts on the research controversy of male mice being used to study diseases that affect women? (See pages 33-34 for an in-depth discussion of female mice in scientific research.)

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Research has traditionally used males because of the changes involved in female reproductive cycles. In humans, there is the

additional fear of harming a potential fetus (who does not have the opportunity to consent). In the end, it is not so important that men and women differ with respect to schizophrenia, but that we are all unique. Guidelines developed for a population are not necessarily apt for an individual.

Q

How do you think societal perceptions of psychotic disorders have changed over recent decades?

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It has become permissible to publicly declare depression, bipolar disorder, or psychosis secondary to drug abuse. I am not so sure that the public perception of schizophrenia has changed very much. It has always been considered the worst form of madness and this attitude may remain until causes and cures are found.

Q

Given your career success, what advice would you give to an Assistant Professor just starting out in his/her field?

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Times change and it is very presumptuous for one generation to advise another. Working on one’s own was more or less acceptable in my day, but now this is not the case. Collaboration is important and, of course, doing what you most enjoy. If I could go back in time and change something, I would probably be more collaborative and work in teams.

In addition to her prolific career, Dr. Seeman enjoys interacting with her grandchildren: Ahron, who is a volleyball pro; Geoff, a Latin dancer; Ciara, a star of Sound and Music; Davey, a budding mathematician; Ronan, an inventor, and Dori, a pastry chef. Her husband, Dr. Phil Seeman – whom she met on the first day of medical school at McGill University – is a renowned neuroscientist. They are both Officers of the Order of Canada, an outstanding honour reserved for Canadian citizens who have made an exceptional difference to this country.

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RESEARCH CONTROVERSY

Sexism in Biomedical Research By S. Amanda Ali

The Bias

A recent article in the Toronto Star proclaimed that “a battle of the sexes is incubating in North America medical research labs over the role of the lowly rodent.� (Pigg 2011) There is a predominant use of male rodents in biomedical research, despite the fact that disease pathogenesis often differs between the sexes.

The Justification

Females are not considered to be a homogenous population because they undergo estrous cycles. The recurring physiologic changes induced by reproductive hormones may be un-

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RESEARCH CONTROVERSY synchronized within a female population and may confound a study. Some advise that females require protection from experimental variables to avoid adverse effects on existing or future fetuses. It has also been suggested that male rodents are cheaper, less time-consuming, and easier to work with (Wald and Wu 2010).

The Data

Existing data does not support the belief that non-human female mammals are intrinsically more variable than males (Mogil and Chanda 2005). Although anxiety disorders and stroke events are more common in females, male animals are being used as models for this research. A study published in Neuroscience and Biobehavioral Reviews examined sex bias in research on mammals in ten biological fields for 2009 (Beery and Zucker 2011). In eight of the ten fields the majority of studies used only males, representing a striking bias. This bias was found to be most prominent in neuroscience, with male-only studies outnumbering female-only studies 5.5 to 1. Studies which did include both sexes rarely analyzed and reported results by sex.

The Law

In 1993, the United States passed the National Institute of Health Revitalization Act, which included legislation for the inclusion of women and minorities in human clinical

The IMS Community Given the existing controversy, do you think female animals should be used in research? “Sex difference should be taken into consideration when interpreting experimental results for proper use of current research data. Depending on the field of study, controlling for sex difference when designing experiments may not be necessary. However, studies on diseases that are known to be more prevalent in either sex should include sex as a variable, and use of the more disease-affected sex should be encouraged.” - Shu-hsuan C. Hsu 5th year PhD student

research, but did not address non-human research. As of December 2010, the Canadian Institutes of Health Research (CIHR) requires all grant applications to answer mandatory questions about whether the research designs include gender and sex. This is an effort to comply with the federal government’s 2009 revision of the Health Portfolio Sex and Gender-Based Analysis Policy (SGBA), the purpose of which is “to promote rigorous sex/ gender-sensitive health research, which expands understanding of health determinants in both sexes, in order to provide knowledge which can result in improvements in health and health care.”

The Controversy

Requiring experiments to be conducted and results to be analyzed with sex as an independent variable would add time to study completion, increase complexity of data analysis, and necessitate supplementary funding. Overarching principles for effective integration of sex-based research are lacking. While the SGBA policy offers definitions for sex and gender, the CIHR recognizes that there are no single widespread definitions of sex or gender. Moreover, how these definitions would be applied to animal research is unclear. The SGBA policy strongly maintains that “gender-blind science fails to account for disparate life trajectories that are influenced by genetic endowment, environmental expo-

“From an ethical point of view, I think female animals should be included to eliminate bias. However, from a practical point of view, I think one should stick to conducting research in one sex to eliminate unnecessary complexity of study design and resource spending. In the field of immunology, there are sex differences in immune responses, but they are not so drastic as to necessitate controlling for sex differences. However, some thought should be given as to whether to use females or males, depending on the prevalence and severity of the investigated phenomenon in either sex. Ultimately, we are trying to translate the findings to humans, and the gap between species is much larger than the gap between sexes.” - Anastassia Mikhailova 2nd year MSc student

sures and social and political environments,” while the CIHR reasons that “there is no simple ‘recipe’ for integrating gender and sex in health research.” This is currently a hot topic with opposing views being published in high impact journals; for example, Zucker and Beery (2011) state that “males still dominate animal studies,” while Bolon, Barthold et al. (2010) report that “male mice [are] not alone in research.”

The Recommendations

Beery and Zucker (2011) offer recommendations to promote the inclusion of female nonhuman animals in clinical research which can be summarized as follows: 1. If sex differences are unknown or suspected, the study design must answer the question for each sex. 2. If sex differences have been disproven, the study design is not required, but still encouraged, to include both sexes. 3. Study of mechanisms underlying sex differences should be a high priority. 4. Outreach training activities should be made available by funding sources to help investigators design studies that fully incorporate female animals. 5. The review process for extramural funding should treat inclusion of female animals as a matter of scientific merit that affects funding.

References Beery, A. K. and I. Zucker (2011). “Sex bias in neuroscience and biomedical research.” Neurosci Biobehav Rev 35(3): 565-72. Bolon, B., S. W. Barthold, et al. (2010). “Male mice not alone in research.” Science 328(5982): 1103. Mogil, J. S. and M. L. Chanda (2005). “The case for the inclusion of female subjects in basic science studies of pain.” Pain 117(1-2): 1-5. Pigg, S. (2011). Research controversy: Male mice used to study diseases that affect women. The Toronto Star. Toronto. Wald, C. and C. Wu (2010). “Biomedical research. Of mice and women: the bias in animal models.” Science 327(5973): 1571-2. Zucker, I. and A. K. Beery (2010). “Males still dominate animal studies.” Nature 465(7299): 690.

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BEHIND THE SCENES

Diego Accorsi

Julie Man Joyce Hui Hometown: Markham, Ontario Undergraduate Studies: Queen’s University, Honours BSc. (Biology) Why BMC? It was a way to use my passion for both art and science to educate and inspire various audiences Career Aspirations: Design of conceptual art in scientific and medical visualization

Hometown: Edmonton, Alberta Undergraduate Studies: University of Alberta, Honours BSc. (Molecular Genetics) Why BMC? I wanted to increase the accessibility of scientific content to a wider audience through visual media Career Aspirations: Communication of health content through popular media

Beatrice Lau Hometown: Basel, Switzerland Undergraduate Studies: Queen’s University, Honours BSc. (Life Sciences) Why BMC? I wanted to expand my knowledge and further my skills in both science and visual communication Career Aspirations: 3-D visualization of scientific concepts

Hometown: Caracas, Venezuela Undergraduate Studies: University of Toronto, Honours BSC. (Health and Disease Specialist) Why BMC? It was an interesting combination of my two passions Career Aspirations: Medicine

Leaving their The original Design Editors of the IMS Magazine are saying goodbye By Avi Vandersluis 35 | IMS MAGAZINE SUMMER 2011 OBESITY

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t was a quiet afternoon in midsummer 2010 when four bright students from the Master of Science in Biomedical Communications (MScBMC) program walked into the IMS Conference Room to meet with the newly-formed IMS Magazine Executive Committee. Until that point, there had been little, if any, interaction between the members of the Department of Biomedi-

cal Communications, a professional program affiliated with the IMS, and those in the IMS’ main stream. But despite this fact, and the unclear nature of the tasks they were about to undertake, Diego Accorsi, Julie Man, Beatrice Lau, and Joyce Hui – now known as the original IMS Magazine Design Editors – had no hesitations in joining forces with the IMS Magazine Executive to not only create what


BEHIND THE SCENES is now well-known as the IMS Magazine, but also to help form a new collaborative bond between the two departments that continues to strengthen. One year and three issues of the magazine later, the “Design Team” is hanging up their hats, having recruited a new team of eager and talented BMC students to fill their shoes. I recently had a chance to sit down with the team to reminisce about old times, to look forward to new times, and to share a whole bunch of laughs. How did the four of you meet? All: BMC! (laughing) BL: We met on Google Docs. (laughing) DA: We actually didn’t have a chance to work together until the magazine though. JM: Yeah, most of our projects in BMC are individual. JH: I agree. From all of the BMC students who were presented with the opportunity to be a part of the IMS Magazine upon its creation, the four of you decided to take the plunge. What attracted you to the idea of designing a magazine? JH: I’ve done a lot of design in the past, including working on magazines. The magazine was a good opportunity to get back into it. BL: I wanted to do a project that was outside of the normal BMC environment. And it was an opportunity to do something as part of a team. DA: I agree. I also really liked the idea of creating something that would attract and inspire other people towards the sciences.

Photos by Connie Sun

What were your expectations when you signed on as the design team? JM: Interesting question! I didn’t really know what to expect – I just thought it would be a lot of fun! DA: I actually thought it would be tons of work and would require a lot of communication. JH: I think we didn’t really know what to expect, so we came into it with a clean slate. It has kind of blossomed from there. With three issues now under your belts, would you say those expectations have been met? JH: I actually think the magazine has exceeded our expectations. I initially thought it was only going to be online, but now it’s even in

print! BL: It’s really cool to be able to see all of our work published for everyone to see. JM: Yeah, it has been a great opportunity to showcase people’s other talents – those not usually used in everyday work. DA: We’ve really been able to further strengthen our existing skills, far more than we would have been able to do otherwise. Also, I think we were able to develop many new skills, such as communication and collaboration. Each of you has your own style of design and your own area of expertise. Has it been difficult to bring everything together to create a magazine with a cohesive look? JH: In short, yes. (all laughing) My design is more conservative, whereas the others are more experimental. JM: Agreed. I have a very functional style of design – I don’t play around until I get the content in. BL: I really enjoy playing around with typography. DA: Initially, we started off doing our own sections individually, but as we went on, we started to work all together as a team. In the end, it was really just about keeping lines open with each other. BL: Yeah, you definitely have to be flexible. JM: So yes, it was hard, but we worked through it. We know where each other stand, and have been able to come together really well. Is there a ringleader among the four of you? JH: There actually isn’t. I found that pretty surprising to be honest. In my past experience, it functions better when someone takes charge, but for us, working together was best. DA: We always consulted each other for our respective areas of expertise. For example, I would always ask Bea about fonts and Joyce about layout. JM: We’re not afraid of receiving criticism, and we trust each other’s designs. BL: Julie did tie a lot of things together, though. (laughing) No, to be honest, we all had our roles, and we all took the initiative to complete our sections. Describe the process of designing the magazine. What goes into each edition? BL: Sweat, blood, and tears. (all laughing) JH: Where do we begin? DA: The first thing we did was determine

what the vision was. JM: We weren’t sure if the idea was to do something playful or professional. Once we figured out that we were going for something that could be sustainable, we started to develop the consistent elements of the magazine, such as the header and footer. JH: Now that everything has been created, we are able to take more liberties in terms of designing new layouts. BL: There was a lot of discussion between both the design team and the executive about how we wanted everything to look. Once we all figured that out, we have worked from there as the magazine expands. What would you say was the most challenging aspect of the process? JH: Probably coordination. DA: Before we established a Google Docs conversation (an online discussion that can be accessed and edited by multiple people), it was really hard to coordinate with everyone. We were initially using email and face-toface meetings. BL: I think that balancing the content and the design is probably the most challenging thing. I can tell you for sure that my favourite moment was waiting for the first print copy to come out. JH: Yeah, we definitely had a “WOW!” moment when we compiled all of our individual designs to create a single file for the first issue. JM: Yup, that was awesome. Have we seen the last of you? DA: Hopefully not. If we stay true to our desires of communicating science, the scientific community has definitely not seen the last of us. JM: You’ll probably see our work, but you might not always realize it’s our work. BL: I hope that all of the scientific artwork we have been able to show will really gain awareness for BMC and what we do. It will hopefully also promote more cross collaboration between BMC and the rest of the scientific community. JH: You’ll never see the end of us! JM: I’ll be spamming your emails once this is an alumni magazine. (all laughing)

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Photo by Paulina Rzeczkowska

FUTURE DIRECTIONS

A Blended Career Social Work, Healthcare, and Bioethics By Atiqa Malik

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“The keys to a successful career are creativity and the ability to balance different passions in a distinctive way, as this is what leads to professional diversity and a richer environment for collaboration.”


FUTURE DIRECTIONS

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ike many others, Dr. Kerry Bowman completed a PhD with the IMS, but what set him apart from most of his classmates was his non-traditional field of interest: bioethics. After completing a Bachelor of Arts in Psychology at York University, Dr. Bowman obtained a bachelor’s degree in social work at the University of British Columbia. Following this exposure to the social sciences, he joined the University of Toronto to earn a Master of Social Work degree, and ultimately decided to pursue his PhD in bioethics. At the time he began his degree in 1992, research in this field was a rarity as most IMS students were immersed in basic, and to a lesser degree, clinical science investigations. Nonetheless, Bowman was determined to explore some of the complex interconnections between social and medical science. Bowman extensively searched different graduate faculties to determine where his endeavours in bioethics could best be supported, and found that the IMS was the most welcoming and encouraging environment. He notes how appreciative he was of the great flexibility within the program, as well as the departmental support he received regarding his interdisciplinary interests and non-traditional social science background. He decided to pursue the collaborative program offered by the IMS in partnership with the Joint Centre for Bioethics at the University of Toronto. Bowman’s PhD research focused on the interplay between culture and health; specifically, he studied how culture influences health care from a psychiatric point of view. His work looked at the intercultural differences in bioethical deliberation, and more pointedly, how healthcare professionals must consider these differences during critical decision-making for patients from diverse backgrounds. To expand his knowledge and to gain further exposure within the field, Bowman also completed a fellowship in Cultural Psychiatry with the Department of Psychiatry at the University of Toronto during his graduate training. After completion of his PhD in 1996, Bowman embarked on a project in which he studied the differences in end-of-life decision-making at different teaching hospitals within Toronto. This work allowed him to

gain further clinical exposure within the hospital environment and, in 1999, he became a Clinical Ethicist at Mount Sinai Hospital – a full-time position he still holds. Bowman’s official affiliations within the University of Toronto include memberships at the IMS and the Joint Centre of Bioethics, as well as a faculty position within the Department of Family and Community Medicine. As a clinical ethicist, Bowman is responsible for providing consultation services to patients and families facing specific ethical challenges in patient care or health care delivery, such as decisions regarding genetic testing, pre-term babies, end-of-life decision making, and patient ability to consent to treatment. Patients and families often face moral challenges when making decisions regarding genetic diseases or life-support, and as a clinical ethicist, Bowman is able to help such patients and their families with their tough decisions. Bowman’s duties also involve more general ethical issues such as policy review and development. Beyond his work in the clinical setting, Bowman maintains an active academic career as an Assistant Professor; he teaches at the University of Toronto and Mount Sinai Hospital within multiple programs, including large undergraduate level ethics classes. Bowman has been an invited speaker at many scientific and medical conferences where he has spoken about bioethical issues in healthcare. Bowman is passionate about his continued research efforts, and was recently awarded the prestigious Genome Canada Grant as a co-investigator for his work examining ethical models of reduced treatment costs for cancer patients. He regularly mentors many bioethics fellows, research assistants, and graduate students, and holds a special appreciation for diverse academic backgrounds among his trainees. Thinking back to his time as a PhD student at the IMS, Bowman believes it prepared him very well for his multiple career roles – a mixture of clinical duties, education and research. He notes that his PhD training taught him how to approach scientific challenges with exacting methodology, and how to work in scientific and medical environments, both of which are crucial skills that were once un-

familiar given his initial educational background in social work. His experiences as a PhD student also helped prepare him for his career as a clinical ethicist and a researcher. As we progress through the 21st century, Bowman foresees greater diversity within the medical science field and an enhanced blurring of career boundaries. He encourages any students looking to develop a collaborative career to first gain experience in the fields in which they are interested, and then approach an academic institution that is able to combine the fields, such as the IMS.

Bioethicist or Activist?

Bowman’s originality does not end with his unique approach toward his education and academic career. His other passion is conservation work, a field in which he is also considered a leader. Bowman is enthusiastic about this aspect of his career, and stated that since healthy environments lead to healthy people, he insists on focusing on this work in addition to his academic duties. Bowman has an appointment with the Centre of Environment at the University of Toronto, is a consultant with the United Nations Environmental Programme (UNEP) and is currently co-authoring the Environment for Development’s Fifth Global Environmental Outlook Report. Not only has he set up his own non-government organization (NGO) and opened a school in Africa, but he also has humanitarian and conservation projects running in the Democratic Republic of Congo, and ongoing environmental projects in Africa, Brazil and North Korea. Additionally, after conducting primatology research with orangutans prior to joining the IMS, he has continued to work with great apes and other non-human primates in the wild for over 23 years.

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FUNDING

Talking Science with Canadian Politicians By Aaron Kucyi

Yet during the Leader’s Debate leading up to Canada’s federal election in May 2011, not a single mention of scientific funding was made. In the campaign as a whole, funding issues for research were scarcely addressed, with party leaders predominantly focusing on the economy and fiscal policy. Those keen enough to inspect each party’s proposed platform would have been disappointed to discover that plans for scientific funding were vague and incomplete at best, if not absent entirely. For example, the Conservative and Liberal parties both proposed increased spending in brain science initiatives but did not mention any other specific areas of medical science. The NDP and Green party platforms contained plans for environmental science, but there was no acknowledgment of the federal government’s major role in medical science and Tri-council (NSERC, CIHR, SSHRC) funding. The air of political indifference toward science in Canada should motivate us to address a key predicament: How can we persuade Canadian politicians and voters to care about funding for science?

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Adrian Ebsary, a graduate student studying biochemistry at the University of Ottawa and founder of PeerReviewRadio, invited several political candidates in his local riding to discuss scientific funding in Canada on his popular radio show and podcast during the election campaign. “I assumed from the outset that a twenty minute interview during a campaign would be a relatively small investment in time for candidates, but this assumption was proven quite false,” Ebsary recalls.

the 2011 federal election campaign. The interviews were shared extensively via social media and received nation-wide attention. However, drastic further steps must be taken before scientific funding-related issues reach attention-worthy status in national-level political conversations. A good place to start, according to Ebsary, might be improving public science education and communication.

“My sense is that since scientific funding wasn’t one of the major national issues being discussed, individual candidates felt unprepared to discuss science policy.”

“Any investment that the average voter [can not] see clearly affecting their personal lives in the immediate [future] becomes more difficult to justify. I believe the best route to raising the public profile of science and scientists is prioritizing science literacy at a national level.”

Two candidates agreed to be interviewed on the radio program – Scott Bradley, a Liberal MP with a background in developing science education programs, and Emma Hogbin, the “Science Shadow” member of the Green Party. Both candidates engaged in fruitful conversations about science policy matters that affect all Canadians as well as issues directly facing public sector researchers at all stages of their careers. Candidates were asked about the recently re-introduced taxation of postdoctoral fellowships, the funding cuts to the Tri-council, graduate student scholarships, and plans for public science education and outreach. Ebsary’s program represents one of the few efforts in the country to engage politicians in discussions of scientific funding during

“Science is an investment in our future.”

Current and recent events convey a clear message: to invest in science is to invest in the future. With 2011 national surveys placing scientists well above most other occupations in terms of public trust, persuading Canada to care about scientific funding today is both a reasonable and realistic pursuit. And that is a scientific fact.

References E-mail/Twitter correspondence with Adrian Ebsary http://peerreviewradio.com/ http://www.theglobeandmail.com/news/politics/canadians-surprisingly-divided-over-education-religion-indepth-poll-reveals/article1950897/ http://dontleavecanadabehind.wordpress. com/2011/04/11/research-in-the-election-platforms/

Photo by Tobi Lam

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cience is invaluable to society, perhaps more so today than ever before. The recent nuclear crisis in Japan, environment and climate issues, and medical science matters such as viral pandemics as well as the “obesity epidemic” discussed in-depth in this issue of the IMS Magazine are a few among countless examples that underscore the dire need for governments to invest in scientific research.


Experts

Ask the

Dear Experts, I am interested in supervising a summer student in my lab. Who can I contact for more information? - Looking to Expand Dear L.E., Supervising summer students is an excellent opportunity to gain supervisory skills and experience. The IMS generally accepts numerous students each summer. You can contact the IMS office or the Summer Undergraduate Research Program (SURP) Director, Dr. Vasundara Venkateswaran, for more details. Dear Experts, I am in the second year of my PhD degree; I would like to apply for a teaching assistant (TA) position for an undergraduate course. Where can I look? - Aspiring Prof Dear A.P., To become a T.A., you should look into positions available in the various undergraduate departments at the University of Toronto (e.g. Human Biology, Physiology, etc.). The IMS also has some T.A. positions, which are usually available prior to the fall session. These can be found through the IMS website. Additionally, U of T has a program called the Teaching Assistants’ Training Program (http://www.teaching.utoronto.ca/gsta/ training/tatp.htm) which is designed to train students to become teaching assistants. IMSSA may also be a helpful resource for steering you in the right direction. Dear Experts, I am moving into the second year of my Master’s program, and I am a little confused about the deadlines for completing my degree. Is there a general guideline or format that I can follow? - Nearing Graduation

Dear N.G., It usually takes about 3 months to write up your thesis once your experiments are complete. As your program advisory committee (PAC) needs to approve the writing of your thesis, you should organize your final PAC meeting early enough to allow for plenty of writing time. Once you have completed the final draft of your thesis, you should send it to your PAC for review and suggestions. Once your committee approves your thesis, it is sent to the IMS office. It takes 6 weeks to arrange a defense. Alternatively, if you are interested in transferring to a PhD, plan to do so about 18 months after you start your MSc program. Prepare a 12 page proposal that includes what you have completed and what you are planning to do for your PhD. Show it to your PAC. As with a Master’s defense, once your proposal is approved, it takes 6 weeks to set up a transfer exam. More information is available on the IMS website. Dear Experts, I have heard that some students bring refreshments to their PAC meetings, defenses, or transfer exams. Is this a requirement? - Mandatory Munchies Dear M.M., No. The decision to offer refreshments at PAC meetings, defenses, or transfer exams rests with the student and supervisor. The IMS neither encouraged nor discourages students from catering, and does not cover the expense of doing so. If you and your supervisor choose to offer refreshments, you need to organize this on your end.

Dear Experts, I have just been accepted to the IMS for a Master’s program. How can I go about finding a supervisor? - Need a Lab Dear N.L., Firstly, decide what area of research you are interested in studying for your MSc. One way to find a supervisor is to use the list of potential supervisors who are currently looking for graduate students that is provided on the IMS website. This list is only updated on a yearly basis. You should search on the faculty database to see who is doing the kind of work you are interested in. Do not be afraid to contact potential supervisors to ask if they are interviewing and accepting students. Other good options are to talk to currently enrolled IMS graduate students, check out the IMS Magazine for information on the research going on at the IMS, and talk to the Graduate Coordinators.

EXPERT TIP Be sure to give yourself plenty of time to write up your thesis or proposals. Do you have a question for the experts? Please send it to theimsmagazine@gmail.com (ATTN: Experts)

IMS MAGAZINE SUMMER 2011 OBESITY | 40


PAST EVENTS

This event is held annually and gives IMS students an opportunity to become familiar with the city’s hotspots.

Scavenger Hunt & Site Specific Event photos provided by IMSSA

IMS students enjoy IMSSA’s Scavenger Hunt by exploring the streets of Toronto.

IMS Symposium (left), IMS Scientific Day (right) photos by Paulina Rzeczkowska

PAST EVENTS

IMS students from Mount Sinai, Samuel Lunenfeld Research Institute, Princess Margaret Hospital, Sick Kids Site take time out of their busy research day to revel in their site specific event. Dr. Andy Feinberg gives his stellar presentation for the IMS students and faculty at the IMS’ state of the art Mini-Symposium in Cancer Research honouring Dr. Ernest (Bun) McCulloch. (left) Highlights from this year’s IMS Scientific Day. (right)

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DIVERSIONS

SUDOKU 2

1

7

4

This is a

6 6

9

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1 2

MAGNIFIED PHOTO of...

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1

9

8

9 3

3 9

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6

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Movember

5

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1. A neural stem cell 2. A red blood cell 3. A macrophage phagocytosing a pathogen 4. A drop of ketchup 5. A stain on Dr. Rostein’s suit jacket **Please find the answer in next issue of the IMS Magazine.

competition

Movember (the month formerly known as November) is a moustache-growing charity event held during November of each year to raise funds and awareness for men’s health. If you have ever grown a moustache worthy of publication, please send your past photos to theimsmagazine@gmail.com (ATTN: Movember Competition) by August 31. If you are voted to have the best ‘stash, we will publish a photo of you and your moustache in the fall issue of the IMS Magazine! Solution to Sudoku from Spring 2011 issue of the IMS Magazine

“Piled Higher and Deeper” by Jorge Cham http://www.phdcomics.com

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IMS Magazine Summer 2011