Fat Bullying Can Kill

November 13th, 2014 No comments »

Want an example? The November 13, 2014 edition of the Washington Post carries a sad story of a talented young man who put on weight, was bullied at school and turned to marijuana to ease the pain of the taunting. The marijuana use brought him into contact with violent drug dealers who are suspected in his shooting. This case will no doubt be listed as a drug-related crime and the shooter or shooters will probably be found and prosecuted. But the bullies at his school, his teachers and administrators, and his classmates who did nothing…they will not shoulder any responsibility but their guilt will be just as great.

The Memory of Starvation

November 13th, 2014 No comments »

Movie buffs may remember the 1999 movie A Bridge Too Far and the book by Cornelius Ryan of the same title on which it was based. The book and movie told the tale of an Allied operation to liberate Holland and achieve a bridgehead over the Rhine and into Germany. It failed. The book and movie only dealt with the military aspects of Operation Market-Garden, as it was called. Left out was what happened afterward.

The Nazi regime was going to punish the Dutch for their support to the combined English-American invasion of Holland. So they cut off food supplies to Holland in the winter of 1944-5. Thousands starved. Subsequently, researchers found that women who were pregnant during this period had offspring who were more prone to obesity, diabetes and cardiovascular disease and who were also smaller than those who were not exposed to the “Hunger Winter.” But, they also found that the grandchildren of those women had similar health problems. This helped establish the field of epi-genetics, i.e., that there were inheritance factors other than genes which might respond to early environmental stimulus, or the lack thereof. Now, in perhaps a groundbreaking paper, Dr. Oded Rechavi and colleagues may have found the mechanism. By studying worms exposed to starvation conditions, they observed a mechanism they call, ‘small RNA inheritance’ that enables worms to pass on the memory of starvation to at least three generations, perhaps more. At the very least, the study demonstrates that we still have a lot to learn about the gene-environment interaction as it affects the development of obesity and that those who say obesity is not genetic  only show they don’t know much about genetics or obesity.

 

Problems With Defining Diabetes

November 13th, 2014 No comments »

Folks familiar with obesity conversations know that the Body Mass Index (BMI) has many problems as a reliable indicator of excess adipose tissue (which is the definition of obesity). However, many may be somewhat surprised that the use of glycosylated hemoglogin (HbA1c) test with a cutoff value of >6.5% also has several problems. In a recent paper,  Juarez, Demaris, Goo et al reviewed 47 studies looking at HbA1c as a diagnostic tool. They concluded that HbA1c is useful for its convenience and effectiveness, especially in community-based and acute-care settings where tests requiring fasting are not practical. However, HbA1c may underestimate the prevalence of diabetes among whites, children, women with gestational diabetes, patients with HIV and those with pre-diabetes.  While these findings are pretty significant on their own, it is sobering to consider that the familiar Obesity-Diabetes axis or BMI- HbA1c Axis has so much, what to say, “flexibility” in interpreting results of studies, such as the Diabetes Prevention Program or Look AHEAD. As many of these studies, (consider the SCOUT trial of sibutramine, see Sept 20, 2010 statement to the FDA), draw large conclusions from relatively small differences, the “flexibility” or error-room of mistakes by relying on BMI- HbA1c has serious implications for personal and public health.

 

USPSTF Seeks Comments Due Nov. 19

November 13th, 2014 No comments »

The United States Preventive Services Task Force (USPSTF) is seeking public comments on its draft research plan for Screening for Obesity and Interventions for Weight Management in Children and Adolescents. The final research plan will guide a systematic review of the evidence by researchers at an Evidence-based Practice Centerwhich will form the basis of USPSTF Recommendations on this topic. Other USPSTF recommendations, such as on intensive behavioral counseling for adults with obesity, have been included in Medicare coverage and under provisions of the Affordable Care Act.

The proposed key questions to be reviewed are:

Do screening programs for obesity in children and adolescents reduce weight or age-associated weight gain, improve health outcomes during childhood, or reduce incidence of obesity in adulthood?

Does screening for obesity in children and adolescents have adverse effects?

Do weight management interventions (defined as behavioral counseling, pharmacotherapy and health-care system level approaches) for children and adolescents that are primary care feasible or referable from primary care health outcomes during childhood or reduce the incidence of obesity in adulthood?

Do weight management interventions for children and adolescents that are primary care feasible or referable from primary care reduce weight or age-associated weight gain?

Do weight management interventions for children and adolescents have adverse effects?

The draft also proposes four contextual questions:

What is the accuracy of age and sex specific body mass index percentile in identifying children and adolescents with high body fat compared with appropriate reference standards.

What is the likelihood that childhood obesity persists into adulthood?

Are improvements in child weight outcomes associated with reduced likelihood of adult obesity, If so, how much improvement is necessary?

Is the medication bupropion being used for weight management in children or adolescents? If so, is there evidence supporting is use in children and adolescents?

The comment period is open until November 19, 2014.

 

Fast Food Giants Target Obese-Prone Children

November 13th, 2014 No comments »

The Washington Post Wonkblog carries an article on research from Arizona State University’s Punam Ohri-Vachaspati which found that fast-food chains are targeting children already at high risk for obesity, including African-Americans, poor and those in rural areas.

 

DNC Resolution on Dotty

September 16th, 2014 No comments »

After my last post about Dotty, I received this resolution of the Democratic National Committee and a lovely note from its Chair, Debbie Wasserman Schultz.

A most fitting tribute.

 

 

A Tribute to My Wife, Dotty

September 2nd, 2014 No comments »

Faithful readers may observe a certain lack of activity for the last couple of months. I have an excuse. My wife, Dotty, had a major engagement with a very aggressive melanoma, starting at the end of May and ending with her death on August 10th. While this is a very private matter, I wanted to share with my readers how important Dotty was to Downey Obesity Report. She provided constant and major support for this endeavor, spotted good stories and edited many pieces to their betterment.  She understood completely what I wanted to do with this site and was a source of many imaginative ways to addresses various stories.

Even more, while I ran the American Obesity Association and, later, The Obesity Society, she used her extensive political and journalistic contacts to make our first forays into conferences on obesity and public policy the successes they were. She constantly worked the phones (of Blackberry, in her case) to get the representatives of presidential campaigns to participate in our conferences. We collaborated thoroughly on the program to get the platforms of both the Democratic and Republican National Conventions to recognize obesity for the first time.

She was a true partner in creating and sustaining our efforts to have policy makers take obesity seriously as a matter of public policy. She also tempered my reaction to various news items, calming me down, making me explain my objections, being more temperate and a better observer of our current dilemma.

Any ‘success’ of the Downey Obesity Report is due to her wise and loving guidance.

She always was a teacher, bringing along interns at CBS News or students at American University. She loved politicians and journalists, but could discriminate the authentic from the phony. She always sought to promote and encourage her students and friends.

She received many wonderful tributes including Scott Pelley of the CBS Evening News and from Bob Scheiffer of Face the Nation. Here are links to obituaries in the New York Times, Washington Post, Politico, and Real Clear Politics. Here are some of my favorite pics.

 

Was Dr.Oz truthful before the US Senate?

June 27th, 2014 No comments »

When Dr. Mehmet Oz testified before a Senate subcommittee on June 17, 2014, he was challenged by Senator Claire McCatskill on a study he had conducted on green coffee bean extract, “ Green Coffee Bean Extract “The Fat Burner That Works!” which aired on September 12, 2012.

Senator McCatskill questioned the quality of the science in this show saying it would “not pass scientific muster”. Dr. Oz replied that it would not meet what the Food and Drug Administration required to approve a drug. (No foolin!). Dr. Oz continued that he would not publish the study because it was not conducted under the appropriate IRB (Institutional Review Board) guidance. He explained that is was not under IRB guidance because “ the purpose was for me to get a thumbnail sketch: was this something worth talking about.” See clip at 2:50 minutes.

Dr. Oz Testifying Before US Senate

The show described in detail the hypothesis Dr. Oz was testing; the protocol was described by two members of his Medical Advisory Board; the use of placebo was described vis a vis the intervention group. The necessity of using a food journal was described as well as the inclusion and exclusion selection criteria. The terms “experiment,” “study,” “clinical trial” “placebo,” “intervention group,” “duration,” “food log (or journal),”study design,” “who (green coffee bean extract) is good for and who it is not right for,” “outcome,  and “results” were used 36 times. The recommendation from this study presented by Dr. Oz was that the extract  probably should not be used by pregnant women and children under 18. For all others, they could expect to lose twice as much weight as using a food journal alone, about a pound a week. Some thumbnail sketch!

It is interesting too that Dr. Oz said the study was not done “under appropriate IRB guidance.” The IRB process is intended to protect human subjects of medical treatments. The Columbia University College of Physicians and Surgeons where Dr. Oz is on the faculty has comprehensive IRB procedures, as required by New York State Law and Federal Law. It would appear that any research conducted on human subjects by a faculty member of the College of Physicians and Surgeons must be submitted for approval by the IRB. Under limited circumstances a study can receive an exemption from the IRB requirements but the exemption is  given by the IRB. Assuming that Dr. Oz received an exemption from the IRB, I’ve asked the director of the IRB program for an explanation of what the reasons for exemption were. They responded and said they are looking into it. Stay tuned.