Sanjeev Sockalingam

• MD, FRCPC
• University of Toronto at University of Toronto

Background: Body-contouring surgery can be a solution to excess skin folds following bariatric surgery. Many patients desire body-contouring surgery, but the cost of the procedure may be a limiting factor. This study aims to examine barriers to access and to compare socioeconomic variables and psychological variables between bariatric surgery pati...

Background There are increasing efforts to include equity in all quality improvement (QI) initiatives. A comprehensive framework to embed equity in QI has been lacking, which acts as a barrier to the QI community from taking action to reduce healthcare inequities. Objectives The objectives of this scoping review were to: (1) map and summarise avai...

Background Obesity prevalence continues to rise in Canada, highlighting a growing public health concern. This study updates estimates of the societal cost of inaction in treating obesity, emphasizing the significant economic burden stemming from both direct healthcare costs and indirect productivity losses. Methods We combined data from national s...

Introduction Open-ended feedback from learners offers valuable insights for adapting continuing health education to their needs; however, this feedback is burdensome to analyze with qualitative methods. Natural language processing offers a potential solution, but it is unclear which methods provide useful insights. We evaluated natural language pro...

Purpose This study explores uses of artificial intelligence (AI) in health professions education for non–psychomotor skills training at undergraduate, postgraduate, and continuing health professions education levels for education program development, delivery, and evaluation. Method This scoping review was conducted in 5 stages: (1) planning and r...

Purpose of Review To highlight recent research on antidepressant use and weight change and explore best clinical practices for reducing weight gain and obesity risk in individuals with depression. Recent Findings Research on antidepressant use and weight gain suggests that genetic and biological factors including metabolizer phenotypes and inflamm...

Introduction People with lived and living experience (PWLLE) and family members (F) can engage in mental health and substance use health research beyond participant roles, as advisors, co‐researchers, equal partners and research leads. However, implementing meaningful and effective engagement is complex. Methods This article profiles five research...

Background Older adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked a resuscitation status order (RSO) incorporating distinct do-not-resuscitate l...

Introduction COVID-19 led to rapid innovations in continuing professional development (CPD). We surveyed Canadian Psychiatry CPD directors to understand the pandemic’s impact and to identify effective practices. Methods In fall 2021, an online 31-item survey was created iteratively based on discussions among CPD educators and disseminated to CPD p...

BACKGROUND Healthcare continues to advance digital innovation, and technology-enabled processes and interventions are increasingly introduced to deliver and expand access to care. In this evolving digital health ecosystem, healthcare professionals, learners and organizations may not be prepared or equipped with the knowledge, skills, and behaviours...

Background Obesity prevalence continues to rise in Canada, highlighting a growing public health concern. This study updates estimates of the societal cost of inaction in treating obesity, emphasizing the significant economic burden stemming from both direct healthcare costs and indirect productivity losses. Methods We combined data from national s...

BACKGROUND Lightening the EHR burden through the five year analysis of a physician engagement strategy in a Canadian Mental Health Organization focused on the use of electronic health records and the impact of digital health. OBJECTIVE This study focuses on evaluating physician burnout related to electronic health record (EHR) usage, and the impac...

Background The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes. Aim The aim of this paper is to describe the educa...

Background The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social dista...

Purpose Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-s...

With the increasing application of Natural Language Processing (NLP) in Medicine at large, medical educators are urged to gain an understanding and implement NLP techniques within their own education programs to improve the workflow and make significant and rapid improvements in their programs. This paper aims to provide twelve essential tips inclu...

COVID-19 unleashed a maelstrom of distress on health care professionals. The pandemic contributed to a host of stressors for workers because of the need for rapid acquisition of new knowledge and skills to provide best treatment while simultaneously dealing with personal safety, limited resources, staffing shortages, and access to care issues. Conc...

Background Transitional-aged youth (16–29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are not yet thoroughly characterised. Objectives This study aimed to answer the following research question: What...

Introduction Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic. Method...

Introduction Structured feedback is important to support learner progression in competency-based medical education (CBME). R2C2 is an evidence-based four-phased feedback model that has been studied in a range of learner contexts; however, data on factors influencing implementation of this model are lacking. This pilot study describes implementation...

Efforts to optimize continuing professional development (CPD) are ongoing and include advocacy for the use of clinician performance data. Several educational and quality-based frameworks support the use of performance data to achieve intended improvement outcomes. Although intuitively appealing, the role of performance data for CPD has been uncerta...

Background With ongoing gaps in obesity education delivery for health professions in Canada and around the world, a transformative shift is needed to address and mitigate weight bias and stigma, and foster evidence-based approaches to obesity assessment and care in the clinical setting. Obesity Canada has created evidence-based obesity competencies...

Introduction The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid...

Background Approximately 15% of Canadian adults live with two or more chronic diseases, many of which are obesity related. The degree to which Canadian obesity treatment guidelines are integrated into chronic disease management is unknown. Methods We conducted a 12-min online survey among a non-probability sample of 2506 adult Canadians who met at...

Objective: To examine how Project ECHO Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients with complex needs. Methods: An exploratory qualitative approach was undertaken using semi-structured interviews conducted between August 2020 and March...

Importance: Weight regain after bariatric surgery is associated with recurrence of obesity-related medical comorbidities and deterioration in quality of life. Developing efficacious psychosocial interventions that target risk factors, prevent weight regain, and improve mental health is imperative. Objective: To determine the efficacy of a teleph...

Background Obesity is a prevalent chronic disease in Canada. Individuals living with obesity frequently interact with medical professionals who must be prepared to provide evidence-based and person-centred care options. The purpose of this scoping review was to summarize existing educational interventions on obesity in Canada for current and prospe...

Introduction: Quality improvement (QI) programming attempts to bridge the gap between patient care and standards of care. Mentorship could be a means through which QI is fostered, developed, and incorporated into continuing professional development (CPD) programs. The current study examined (1) models of implementation for mentorship within the De...

Background Mental health conditions are common among people living with complex chronic conditions (PLWCCC), yet recognition and treatment are low in medical settings. Methods To design appropriate mental health services for this population, a qualitative study was conducted to identify the factors affecting access to mental health care for PLWCCC...

Psychosis spectrum disorders (PSDs), as well as other severe mental illnesses where psychotic features may be present, like bipolar disorder, are associated with intrinsic metabolic abnormalities. Antipsychotics (APs), the cornerstone of treatment for PSDs, incur additional metabolic adversities including weight gain. Currently, major gaps exist in...

As Canadians with severe mental illness remain underserved and experience a high burden of physical health challenges and premature mortality, there is an unprecedented need to provide better physical healthcare to this population. Ways of addressing this gap include the delivery of physical healthcare in mental health settings ("reverse integratio...

Introduction: Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big...

Objective: To determine whether depression and anxiety symptoms differ between revisional bariatric surgery patients and primary bariatric surgery patients, as such mental health outcomes can have long-lasting impacts on weight loss and the overall success of bariatric surgery. Methods: An exploratory matched case control study was performed wit...

Objective: To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. Design: Systematic review. Data sources: Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints. Eligibility criteria for selecting studies:...

Background: The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use o...

Background OpenNotes is the concept of patients having access to their health records and clinical notes in a digital form. In psychiatric settings, clinicians often feel uncomfortable with this concept, and require support during implementation. Objective This study utilizes an implementation science lens to explore clinicians’ perceptions about...

Introduction Health and social service providers have limited expertise with regard to assessing and treating psychiatric disorders in adults with intellectual and developmental disabilities. The aim of this study was to describe the development and pilot evaluation of a virtual capacity-building program (Project ECHO) focused on supporting the men...

Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health an...

Introduction: Improving effective user engagement with digital mental health tools has become a priority in enabling the value of digital health. With increased interest from the mental health community in embedding digital health tools as part of care delivery, there is a need to examine and identify the essential factors in influencing user enga...

Introduction Bariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have a history of mental health disorder. The COVID-19 pandemic has made it difficult for people living with obesity to manage their weight even after undergoing...

Women and gender-diverse individuals have faced disproportionate socioeconomic burden during COVID-19. There have been reports of greater negative mental health changes compared to men based on cross-sectional research that has not accounted for pre-COVID-19 differences. We compared mental health changes from pre-COVID-19 to during COVID-19 by sex...

Background The success of continuing professional development (CPD) programs that foster skills in lifelong learning (LLL) has been well established. However, healthcare professionals often report barriers such as access to CPD and cost which limit uptake. Further research is required to assess how accessible CPD programs, such as those delivered v...

Background Patients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if...

Introduction: Despite the support for and benefits of data-driven learning, physician engagement is variable. This study explores systemic influences of physician use of data for performance improvement in continuing professional development (CPD) by analyzing and interpreting data sources from organizational and institutional documents. Methods:...

Introduction: The use of data to inform lifelong learning has become increasingly important in continuing professional development (CPD) practice. Despite the potential benefits of data-driven learning, our understanding of how physicians engage in data-informed learning activities, particularly for CPD, remains unclear and warrants further study....

Introduction: Recovery colleges (RCs) are mental health centres aimed at equipping people with skills to live a meaningful life despite the presence of mental distress. Unique to them is the aspect of cocreation; RCs are designed collaboratively with people of lived experiences of mental health and addictions and care providers. Despite establishe...

Food addiction (FA) is an increasingly popular concept that certain highly processed foods are implicated in addictive-like eating, which may contribute to obesity. The prevalence of FA is estimated to be around 10–15% among adults and children, with elevated rates among those with underweight or obesity and/or binge eating problems. In this chapte...

Background Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemen...

Internationally, transitions from prison to the community are often precarious experiences for people who are living with substance use and mental health concerns. In Canada, a continuing opioid overdose crisis and overlapping challenges related to the COVID-19 pandemic have generated urgency for scaling up community-based services that can meet th...

Purpose of Review We review evidence for assessing and monitoring psychotropic medications in metabolic and bariatric surgery (MBS) patients. We describe weight gain side effects, potential perioperative risks, pharmacokinetic changes that occur after MBS, and conclude with clinical recommendations. Recent Findings Research on psychiatric medicati...

Objective Bariatric surgery is associated with reduced atherosclerotic cardiovascular disease (CVD) and heart failure hospitalization in people with type 2 diabetes (T2D) and those with prior CVD. Most patients undergoing bariatric surgery do not have T2D or CVD. Many otherwise eligible patients do not have surgery because of self-exclusion. Clinic...

BACKGROUND Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention a...

Background: Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention...

Introduction: Project Extension for Community Healthcare Outcomes (Project ECHO®) is a global-guided practice initiative aimed at building primary care capacity and improving health care quality for underserved populations. This tele-education model brings together primary care providers and subject-matter specialists in online communities of pract...

Objective The use of virtual learning in psychiatric education has been required to address COVID-19-related challenges. Research regarding the implementation of virtual teaching environments and standardized patients for simulation remains limited. Here, educators’ outcomes were evaluated following a transition from in-person teaching with “real”...

Absenteeism rates among nurses have increased across Canada over the last several years, with work environment challenges and staffing shortages being possible contributors. With the onset of the COVID-19 pandemic, nurses have worked under increasingly stressful conditions. Unsurprisingly, many nurses are facing mental health challenges. Digital to...

Objectives The limited access to addiction services pre-COVID-19 and the increase in substance use disorder support required during COVID has led to a heightened need for virtual addictions care capacity building interventions. We describe the evaluation of Project Extension for Community Healthcare Outcomes™-Ontario Addiction Medicine and Psychoso...

Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health‐related quality of life (HRQoL) in the short‐term, there is wide variability in weight and long‐term HRQoL outcomes. The role of bariatric patients' self‐management style in explaining variability in long‐term outcomes is unclear. Th...

Introduction: With the proliferation of virtual learning programs during the COVID-19 pandemic, there is increased need to understand learner experiences and impact on developing expertise. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established hub-and-spoke tele-education model aimed at building capacity and experti...

BACKGROUND People with intellectual and developmental disabilities are at increased health related risks due to the COVID-19 pandemic. Virtual training programs that support providers in caring for the physical and mental health needs of this population, as well provide psychological support to the providers themselves are favourable during the pan...

Background People with intellectual and developmental disabilities are at increased health-related risk due to the COVID-19 pandemic. Virtual training programs that support providers in caring for the physical and mental health needs of this population, as well provide psychological support to the providers themselves, are needed during the pandemi...

The body of research examining the validity of food addiction and eating addiction far exceeds the research examining their clinical utility [...]

Background The coronavirus disease 2019 (COVID-19) pandemic has had far reaching consequences on the health and well-being of the general public. Evidence from previous pandemics suggest that bariatric patients may experience increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery. Objective We aimed to exami...

Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be...

In 2019, the American Psychiatric Association Council on Consultation-Liaison Psychiatry convened a Work Group to develop a Resource Document on Proactive Consultation-Liaison Psychiatry. A draft of this document was reviewed by the Council in July 2020, and a revised version was approved by this Council in September 2020. The accepted version was...

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physicia...

Objective Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review w...

Disturbed eating behaviours have been widely reported in psychotic disorders since the early 19th century. There is also evidence that antipsychotic (AP) treatment may induce binge eating or other related compulsive eating behaviours. It is therefore possible that abnormal eating patterns may contribute to the significant weight gain and other meta...

BACKGROUND The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December, 2020 national survey. Given the need to physically distance during the pandemic, and the increase in dema...

Background The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in deman...

Background COVID-19 causes significant morbidity and mortality. Despite the high prevalence of delirium and delirium-related symptoms in COVID-19 patients, data and evidence-based recommendations on the pathophysiology and management of delirium are limited. Objective We conducted a rapid review of COVID-19-related delirium literature to provide a...

The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioura...

Presurgical psychosocial evaluations are an important component of bariatric care; yet, bariatric programs vary widely in their assessment and interpretation of psychosocial risk. There is a need for validated clinical tools that help to standardize and streamline the assessment of variables relevant to surgical outcomes. The present study contribu...

The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those...

The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale. These measures have significantly affected the training environment and the mental health of health care providers and learners. Design thinking offers creative and innovative solutions to emergent comple...

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physicia...

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physici...

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physicia...

Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index. This guideline update reflects su...

KEY POINTS • Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health. • People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index. • This guideline upd...

Background Novel coronavirus pneumonia (COVID-19) is a global reminder of the need to attend to the mental health of patients and health professionals who are suddenly facing this public health crisis. In the last two decades, a number of medical pandemics have yielded insights on the mental health impact of these events. Based on these experiences...