Statin Use on the Rise

January 6th, 2015 No comments »

CDC reports statin usage for the control of cholesterol has increased  by one-third over the past decade. In 2012, 28% of people over age 40 reported using a cholesterol-lowering medication, up from 2003 rate of 20%. Most of the increase was in statins. 71% of adults with cardiovascular disease and 54% of adults with high cholesterol reported medication usage to control their cholesterol, according to an article in the Washington Post by Tanya Lewis.

The high use of statins has several implications for persons with obesity. Obviously, this trend improves the health of many persons with obesity and  are at greater risk of cardiovascular disease. However, it can also be a confounding factor in research studies. Looking for changes in cardiovascular disease through weight loss (by any method) can be more difficult to find because of the effectiveness of statins. High use of statins was referenced as one of the reasons by the Look Ahead trial was terminated early.

 

Opportunity to Expand Coverage of Bariatric Surgery and Anti-obesity Drugs

January 6th, 2015 No comments »

Kaiser Health News reports today on the poor coverage of drugs for obesity by Medicare and private insurance plans. Health plans which are part of the health exchanges established by the Affordable Care Act also have poor coverage. However, there is a strategy to deal with the health exchange ( or marketplace) plans.

As reported here in a paper (see p.8)  Christopher Still and I wrote on the Affordable Care Act’s impact on persons with obesity, the law has a unique provision allowing for review of plans for ‘discriminatory benefit design.’ Robert Pear of the New York Times reports that the Center for Medicare and Medicaid Services is looking at plans to see if their benefit are structured to discriminate against persons with H.I.V./AIDs, autism, diabetes, bipolar, schizophrenia and other diseases. The article reports that the Obama Administration has said it would challenge restrictions on benefits if they were “not based on clinically indicated, reasonable medical management practices.”

This is a huge opportunity for the obesity community to persuade CMS to look at the lack of coverage of anti-obesity drugs and bariatric surgery in plans on the health marketplaces. It is also an opportunity to have CMS look at whether health plans are adequately including behavioral counseling for adult obesity as they are required to do.

 

Causes of Obesity: It isn’t Physical Activity

January 5th, 2015 No comments »

So, our popular culture, as well as many physicians, believe that increased physical activity can either prevent obesity or bring about weight loss. The Today Show is an example of this popular, if wrong, view.

Lost in all this panting-cries for more steps are the actual research results. So it was interesting to find this interview at the University of Delaware annual Foltyn Family Health Sciences Seminar with Dr. Amy Luke of Loyola University Chicago. Dr.Luke has a distinguished career and a host of peer-reviewed publications.

Dr. Luke has been at the epicenter of the debate over whether it is energy intake or energy expenditure (i.e. physical activity) that is the cause of the obesity epidemic. Her research has taken her to rural Ghana, the Seychelles, urban South Africa, Jamaica, and the U.S.  Using objectively measured criteria (stable isotope techniques and accelerometers in five cohorts) Luke found that in developing countries, residents were not expending significantly more energy than those in developed nations like the U.S.

She told the U.Delaware audience, “Physical activity is important for a whole host of health benefits, but it may not be as important as we thought in the prevention of obesity. This points to the need for strong objective measures of the factors on which we are basing public policy.” (Michelle Obama: are you listening?) Dr. Luke has concluded that it is diet, not physical activity, which is responsible for the obesity epidemic

 

ADA Urges Lower BMI Cutoff for Asian-Americans

January 5th, 2015 No comments »

The American Diabetes Association (ADA) is lowering the Body Mass Index (BMI) cutpoint for screening Asian-Americans for type 2 diabetes to a BMI of >23kg/m2. In the new article, the evidence for a lower BMI cutpoint is discussed.  The authors note the presence of Asian-Americans and the projections for their increasing population, especially in 10 states, including California, New York, Texas, New Jersey, Hawaii, Illinois, Washington, Florida, West Virginia, and Pennsylvania.  The authors also note the limitations of current measurement techniques, observing that  BMI does not into account the relative proportions of fat and lean tissue and cannot distinguish the location of fat distribution. There is a propensity for Asians to develop visceral versus peripheral adiposity which is more closely associated with insulin resistance and type 2 diabetes. The new standard is not a measure of increased mortality or morbidity but a guide how to use BMI to screen for the presence of type 2 diabetes, with a focus on reacting to BMI cut-offs for eligibility of weight-reduction services or treatment reimbursable by payers.

There a couple of points. First, it is unfortunate that the ADA is not taking on the use of BMI for criteria for products (such as anti-obesity drugs) or services. Changing the BMI cut-offs to accommodate a poor public policy only adds to the distortion of our understanding of excess adipose tissue. The paper understates the fact that the BMI is such a poor standard for use in clinical settings. Third, aside from the literature about cut-offs, the problem is “Who is an Asian-American?” In addition to covering a number of various ethnic groups, determining whether one is “Asian-American” has a host of problems, including the issue of inter-marriage. Demographers are having a hard time determining just what “Asian-American” means. The problem originates with the Census Bureau criteria, as well as the problem of inter-marriage and self-identification as Asian-American versus White. Historically, the Census Bureau has combined Asians, Native Hawaiians and other Pacific Islanders, even though there are significant differences in physiology and body composition between Asians and the other two groups. Listen to this interesting discussion on the Diane Rehm Show on NPR on January 5, 2015 on this very topic.

 

Weight Gains Among Normal Weight Adolescents Cause Adverse Metabolic Effects

January 5th, 2015 No comments »

Researchers in Finland have made an important finding that weight gain in normal weight adolescents carries adverse metabolic effects. The cardiometabolic effect was highly responsive to weight changes over time.

 

FDA Warns Public about Weight Loss Scams

January 5th, 2015 No comments »

The FDA has issued a timely reminder to consumers that many heavily marketed weight loss products are ineffective and possibly unsafe. The advice, while not new, is useful to remind consumers that weight loss frauds are rampant.

We tend to think of these scams as petty, fringe marketing programs. Not so. Watch this episode from the Today Show on NBC on January 5, 2015.  Easy to lose weight? No effort required? The Today segment carries forward a common fallacy: that cutting out X number of calories lost over 365 days will lead to amazing weight loss. No consideration of how many people can sustain such patterns? No consideration of the phenomenon known as Adaptive Thermogenesis. Oh yeah, permanent weight loss is so easy!

 

How Obesity is Changing the Environment

January 5th, 2015 No comments »

The association of overweight and obesity with type 2 diabetes is one of the strongest in the scientific literature. Well known to many is that the drug, metformin, is a front-line treatment for type 2 diabetes. But now come researchers with something unexpected: high levels of metformin in the Great Lakes is affecting the fish population and may be changing the expression of genes in some fish. According to a report in MedScape Today, researchers at the School of Freshwater Sciences at the University of Wiscon-Milwaukee found such high levels of metformin in the waters of Lake Michigan. There are some 180 million prescriptions written for diabetes drugs in 2013, a $213 billion market. Metformin has about 70 million prescriptions written in 2013.

The level of metformin, measured in fathead minnows in the lab, were enough to disrupt gene expression in the endocrine system of male fish but not females. The males were producing biochemical that are associated with female minnows. It has been assumed that the volume of water in the Great Lakes would dilute such a drug. The new study casts doubt on that assumption.

 

New Insight on the Effect of Time on Genetic Expression

January 5th, 2015 No comments »

A New Year’s Eve story in the New York Times reported on a new study about a well-studied gene, FTO, which is strongly correlated with the development of obesity.  Previous research had established that, on average, one copy of a variant of FTO tended to have an extra 3.5 pounds. Persons with two copies of the gene have an extra 7 pounds, significantly increasing the risk of becoming obese.

The new study, published in the Proceedings of the National Academy of Sciences, indicates that this effect did not exist before World War II. Using the longitudinal data from the Framingham Heart Study the researchers led by James Niels Rosenquist of Massachusetts General Hospital found a “robust” relationship between birth cohort and the genotype-phenotype correlation between the FTO risk allele and Body Mass Index (BMI) with an observed inflection point for those born after 1942. The authors observe that “genetic influences on complex traits like obesity can vary over time, presumably because of global environmental changes that modify allelic penetrance.”