Archive for July, 2011

AACE Recognizes Obesity as A Disease

July 30th, 2011

The American Association of Clinical Endocrinologists (AACE) has recognized obesity as a disease in its own right. See their statement at AACE Declares Obesity as a Disease State | American Association of Clinical Endocrinologists

AHRQ Seeks Comments on Effectiveness of Childhood Obesity Programs

July 9th, 2011

The Agency for Health Care  Research and Quality is seeking comments on their new paper, Comparative Effectiveness of Childhood Obesity  Intervention Programs. Comments are open until August 5, 2011. Comment Key Questions | AHRQ Effective Health Care Program

New Insight on Gene-Environment Interaction

July 9th, 2011

For many people, understanding obesity is a pretty straightforward proposition. Eat more you gain weight. Eat less you lose weight. The laws of thermodynamics. Energy in v. Energy out. End of story. Alas, we know it is not that simple. For one thing, we know that obesity is highly inheritable. For another, we know that changes in the environment can produce rapid changes in the prevalence of obesity in the population. But, while finding many genes and their variations (called alleles) have been identified, they account for only about 2% of the total genetic variation in BMI. Skeptics doubt a genetic explanation arguing that the gene pool cannot change as quickly as the current changes in obesity. (These folks have tended to see the obesity epidemic as a 75 year phenomenon. But see the book review on The Changing Body, for how long this change has been going on..around 350 years.)  On the other hand, the environmental approach has raised the question, “If the environment is so prone to creating obesity, why isn’t everyone obese?” This line of doubt is reinforced by high variations in obesity in small geographic areas.

So now Danish researchers have use the Danish Twin Registry to try to explain the interaction of genes and the environment. The Danish Twin Registry contains information on virtually all twins born in Denmark since 1870. Two groups were surveyed. What they found was that the environment may modify the genetic expression related to obesity. This environmental effect grows stronger, but only for some individuals and not for others. They estimate that there is a 33.3% increase in the expression of adiposity-related genes associated with a 10% increase in the prevalence of obesity. They conclude that the genetic architecture of obesity should not be considered independent from the environmental context. PLoS ONE: Increased Genetic Variance of BMI with a Higher Prevalence of Obesity

Annual F As In Fat Report Released

July 8th, 2011

The Robert Wood Johnson Foundation has released its annual “F as in Fat” report on obesity. According to its press release, “The obesity epidemic continues to be most dramatic in the South, which includes nine of the 10 states with the highest adult obesity rates. States in the Northeast and West tend to have lower rates. Mississippi maintained the highest adult obesity rate for the seventh year in a row, and Colorado has the lowest obesity rate and is the only state with a rate under 20 percent. This year, for the first time, the report examined how the obesity epidemic has grown over the past two decades. Twenty years ago, no state had an obesity rate above 15 percent. Today, more than two out of three states, 38 total, have obesity rates over 25 percent, and just one has a rate lower than 20 percent. Since 1995, when data was available for every state, obesity rates have doubled in seven states and increased by at least 90 percent in 10 others. Obesity rates have grown fastest in Oklahoma, Alabama, and Tennessee, and slowest in Washington, D.C., Colorado, and Connecticut. “Today, the state with the lowest obesity rate would have had the highest rate in 1995,” said Jeff Levi, Ph.D., executive director of TFAH. “There was a clear tipping point in our national weight gain over the last twenty years, and we can’t afford to ignore the impact obesity has on our health and corresponding health care spending.” Obesity has long been associated with other severe health problems, including diabetes and high blood pressure. New data in the report show how rates of both also have risen dramatically over the last two decades. Since 1995, diabetes rates have doubled in eight states. Then, only four states had diabetes rates above 6 percent. Now, 43 states have diabetes rates over 7 percent, and 32 have rates above 8 percent. Twenty years ago, 37 states had hypertension rates over 20 percent. Now, every state is over 20 percent, with nine over 30 percent.

Racial and ethnic minority adults, and those with less education or who make less money, continue to have the highest overall obesity rates:

Adult obesity rates for Blacks topped 40 percent in 15 states, 35 percent in 35 states, and 30 percent in 42 states and D.C.

 Rates of adult obesity among Latinos were above 35 percent in four states (Mississippi, North Dakota, South Carolina, and Texas) and at least 30 percent in 23 states.

Meanwhile, rates of adult obesity for Whites topped 30 percent in just four states (Kentucky, Mississippi, Tennessee, and West Virginia) and no state had a rate higher than 32.1 percent.

Nearly 33 percent of adults who did not graduate high school are obese, compared with 21.5 percent of those who graduated from college or technical college.

More than 33 percent of adults who earn less than $15,000 per year were obese, compared with 24.6 percent of those who earn at least $50,000 per year.

The full report is available at RWJF, Trust for America’s Health Release F as in Fat 2011 – RWJF.

Diet Trumps Physical Activity for Glycemic Control

July 8th, 2011

A new study published in The Lancet shows little advantage of physical activity over diet for glycemic control in newly diagnosed type 2 diabetics.  The study compared three groups: usual care, diet only and diet and physical activity. Both interventions did better than usual care but physical activity did not confer additional benefit. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial : The Lancet Other studies have shown more benefit from physical activity. Further, usual care involves dietary counseling and the intervention here involved more intensive dietary counseling. So this trial may actually attest to the importance of more intensive behavioral counseling. Diet and exercise for new-onset type 2 diabetes? : The Lancet

Kai Mate

July 7th, 2011

Recognize the phrase? Well, if you did not you are forgiven. It is common in Tonga, an island in the South Pacific (find Hawaii and trace a line due south.) Tonga has a serious obesity problem. It is not alone. Many of the countries of the South Pacific have significant obesity problems which are producing major stress on their health care system. See the video. It may be a picture of life in the United States in the years to come. By the way, “Kai Mate” means “Eat till you die.” Thanks to our friend who is now in Tonga with the Peace Corps (and a former diabetes researcher) for the local insight.

Asian Rates of Diabetes and Obesity Set to Explode

July 7th, 2011

An analysis of over 900,000 individuals in 18 cohorts from 7 Asian nations (Bangladesh, China, India, Japan, Korea, Singapore and Taiwan) show an overall prevalence of diabetes  of 4.3%, ranging from 0.5% TO 8.2%. The positive association between BMI and diabetes prevalence was observed in all cohorts and all subgroups, although the association was stronger for younger individuals. The results were similar no matter whether the standard or ‘Asian” cutoffs are used. The authors note that the fast rising rates of obesity in these countries, For example, in rural China, the prevalence of overweight has increased from 5.3% in men to 13.6% and from 9.8% in women to 14.4%. Rates of obesity increased from 0.5% in men to 1.8% and from 0.7% in women to 3.0%. This, the authors note, “ has profound implications for the expected number of diabetes patients who will be diagnosed in this region in future decades. PLoS ONE: Body Mass Index and Diabetes in Asia: A Cross-Sectional Pooled Analysis of 900,000 Individuals in the Asia Cohort Consortium

Federal Trade Commission Attacks Diet Frauds

July 7th, 2011

The Federal Trade Commission has launched a legal assault against an Internet-based network of affiliates selling acai berries and hCG products. The process starts with a seemingly innocent ad offering “1 Tip for a tiny belly.” You have probably seen it. Consumers are led into a maze of websites, many seeming   to be media “investigations” about their products. They are offered trial products and give up their credit card numbers but continue to be charged for products they did not order or thought they were getting on a trial basis. Consumers may have been bilked out of as much as a billion dollars. Ubiquitous ‘tiny belly’ online ad part of scheme, government says – The Washington Post and Won’t be faux-ed again | BCP Business Center