Coffee With Dr. Sharma

A few weeks ago, I wrote a post entitled "Good-bye Dr. Sharma" where I expressed my disappointment in a medical professional whom I had felt, up until then, could be considered--dare I say--an ally of those of us who don't believe that overweight is an automatic ticket to an early, ugly death. He had made a few posts, in the immediate wake of an important conference on obesity, that led me to believe that I had been totally wrong in thinking that he was more than just another weight-loss proselytizer with an MD after his name. I was really sad to see someone whom I greatly respected go down the same old road of "lose weight, fat is always bad", etc. etc.

Well, after having the pleasure of meeting Dr. Sharma on Friday afternoon over an iced latte and spending a good hour and a half chatting with him, I've got to say, he's going back on my blogroll.

I did not go on a mission to interview Dr. Sharma. His blog post that morning had mentioned that he was doing a "meet and greet" for anyone who was in Toronto that day and all were welcome. I leapt at the chance, of course. But what follows are merely my impressions as well as some of the topics we discussed.

I arrived at the café to find Dr. Sharma busy chatting with three young people, probably in their early to mid-twenties, whom he introduced as being participants in the Canadian Obesity Network (Student and New Professionals). He was wearing a jaunty straw hat and looked the picture of a relaxed fellow, out with a few friends. Soon after my arrival, we were joined by his daughter--a wonderful, accomplished young woman--and a friend of hers.

I admit that as I entered the café I actually felt a bit nervous, but the feeling disappeared within oh, about a half-second, max.

Dr. Sharma is a charming man, incredibly approachable, ready to listen, to give his point of view and to dialogue. He also struck me as someone who is very sure of himself and the work he does. He's a doctor and doctors need that assurance. He's got it in spades. But throughout the conversation I was struck by not only his unwavering commitment to his work but also by the deep, real compassion he shows when talking about people living with obesity.

In the course of our discussion, we touched on a number of topics:

• With respect to the people who gravitate towards nutrition and exercise physiology, we agreed that these fields attract people who don't look anything like the overweight patients they treat. At one point, Dr. S. had an interesting little side discussion with one of the students (a slim young women herself) about the importance of developing empathy and understanding and being able to reach your patients on a truly human level.

• He talked about understanding the causes of obesity rather than assuming--as most people do--that people are overweight because they are lazy and eat too much. He mentioned that many overweight people feel this about themselves, a view that I pointed out to him is rampant in the weight-loss blogosphere.
  

• Interestingly--but in fact not surprisingly--he does not read the lay bloggers. His blogging mission is first and foremost directed at colleagues. In fact, his blog, "Obesity Notes", originally started as way to communicate with his immediate colleagues. He had no intention of reaching the large, varied audience he reaches today. He is also an incredibly busy man, so reading blogs written by ordinary shlubs like me just doesn't fit into his blog time. He did, however, make some comments that gave me the impression that does respect his lay readers. He also said he likes a good argument, though, like most people, he doesn't agree with personal attacks.
  

• Dr. Sharma is definitely not out to right all the wrongs of the world. He does his work in his clinic and as a roving bariatric specialist, but he feels that if you're too far out ahead, no one's going to listen. I would say he's an incrementalist, rather than a warrior.

• On a couple of occasions, he actually laughed derisively at that old saw "eat less - move more". He really does know that it's reductionist rot (OK, that's my term, not his).

• I was thrilled to hear him forcefully speak out in favour of decoupling the notion that thin always equals healthy and that fat always equals sick, although he did talk at length about the issues that the patients in his clinic (average BMI 50) have to deal with. He referred to the scale that he developed with Dr. Freedhoff (I believe). I'm really sorry that I can't remember the name of the scale, but essentially it covers the whole range of health/health problems starting with a rating for overweight people who have NO health problems whatsoever. I believe that Dr. Sharma does not advocate losing weight just for the sake of losing weight. If you're healthy but overweight, that's what counts, not the number on the scale.

• We were very much on the same wavelength regarding reality TV weight loss shows. His disgust was palpable. He says he just can't watch such shows.

• I asked him a specific question regarding his series on bariatric surgery. I wanted to know why he said so little about its many side effects (dumping, band erosion, etc.). His response was that everyone (i.e. the medical community) knows about these side effects. He, on the other hand, wanted to talk about some of the things that are often not mentioned (psychological issues, marital break-ups, excess skin), though he did say he might consider dealing with my question in a future post. (We'll see...). I also asked him why he was still in favour of WLS, given the high rate of problems. His response: sometimes the alternative (no WLS surgery) is even worse. He's certainly not someone who wants to foist WLS surgery on all overweight people, and certainly not on those whose health is just fine as it is.

• One topic we did not directly discuss was "Health at Every Size". Maybe the next time...
  

• Dr. Sharma is optimistic. He thinks that some doctors as well as some journalists are finally "getting it"--that ELMM is not the answer, that overweight people are not uniformly the authors of their own misfortune, etc. I hope he's right, but personally, I think the zeitgeist (the spirit of the times) is going to get a lot worse before it gets better...

I hope that I haven't put any words in Dr. Sharma's mouth. I have certainly tried here to relate what I heard as faithfully as possible. If I was mistaken or misinterpreted what I heard, my apologies in advance to the good doctor. It was a real pleasure meeting him and I certainly hope that I will have the opportunity to do so again one day.

Dr. Sharma is back on my blogroll. I'm not saying I'm never going to disagree with him again, but I have a much more well-rounded (oh, please, please pardon the pun) picture of someone who does play an important role in the world o' weight.