May 1st, 2012
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The British newspaper, The Guardian, has reported that a majority of physicians in the National Health Service (NHS) (54%) believe persons with obesity and smokers should not be treated except in emergency situations. This would include in-vitro fertilization and liver transplants. Already, in some parts of England, smokers and patients with obesity are being denied breast reconstructions and knee and hip replacements. A spokesman for the National Obesity Forum said doctors who support such “lifestyle rationing” are “totally out of order.” The Royal College of Physicians, the British Medical Association and the Department of Health expressed opposition to such bans. Guardian: Brit MDs approve denying treatment to obese
Nevertheless, we will probably hear more of this type of thing. Already we see Toby Cosgrove M.D, head of the Cleveland Clinic, wish he could refuse to hire obese workers, the American Medical Association support denying disability payments to persons with obesity and Dr. David Ludwig support taking obese children away from their parents. A hospital in Texas recently tried to ban hiring employees with obesity. victoria-hospital-wont-hire-very-obese-workers
Under pressure from the Obesity Action Coalition, they backed off. Texas Medical Center Backs Off
May 1st, 2012
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Reuters has published a devastating report on how the food industry has won numerous fights in Washington over childhood obesity. Its victories include stopping the Federal Trade Commission’s development of voluntary industry guidelines on marketing food and beverages to children, weakening the USDA proposals, strongly backed by First Lady Michele Obama, to improve the nutritional quality of school lunches. Reuters: How Washington Went Soft on Childhood Obesity
While noting that the food and beverage industry has defeated state and local taxes on sugar-sweetened beverages, the article did not address how the industry has had state legislatures ban municipalities from enacting local legislation to require caloric labeling on menus or bans on trans-fats. NYT: Local Laws Under Siege
May 1st, 2012
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That may seem like a silly question but, then again, most of the important ones are. So researchers at the University of Arizona looked at the levels of endocannabinoid in the blood of ferrets (who don’t do much of anything) human and dogs (who love to run). Endocannaboinoids provide the “runners high” and were the target of the drug, rimonabant.They found that humans and dogs had higher levels of endocannabinoid after running but not walking. Ferrets did not have higher levels after running or walking. Author David Raichlen thinks that running probably helped early humans run down animals for food and run away from hungry predators. So, it appears that this represents an evolutionary drive to run. The study leaves open the question why so few of us do not run today. The answer (I’m just guessing here) is that we don’t have to run down our food anymore nor escape being someone else’s dinner. Is this why we say, “Honey, I’ll run to the store” when actually we mean “drive?” NYT: Evolution of Runners High Article: PubMed: Wired to Run
May 1st, 2012
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An article by Denise Grady in the New York Times reports on a study that type 2 diabetes in children is harder to treat and more virulent that in adults. The article recounts story of Sara Chernov who learned she had type 2 diabetes when she was 16. “ Her grandfather had had both legs amputated as a result of the disease and one of the first questions she asked was when she would lose her legs and her eyesight. A doctor scolded her for being fat and told her she had to lose weight and could never eat sugar again. She left the office in tears and did not go back.” NYT: Obesity type 2 diabetes worse in children See the article at NEJM: Clinical Trial Glycemic Control in Youth
This is one of those “really bad news” papers. Patients were 10 to 17 years old and treated with metformin to reach a HbA1c level below 8% They were randomized to metformin alone or metformin with rosiglitazone or lifestyle-intervention focusing on weight loss through eating and activity behaviors. Of the 699 participants, only 45.6% reached the primary outcome over an average of 3.86 years of follow-up. Rates of failure were 51% for metformin alone, 38.6% for metformin plus rosiglitazone and 46.6% for metformin plus lifestyle. Metformin alone was least effective in non-Hispanic black participants and metformin plus rosiglitazone was most effective in girls.
Serious adverse events were reported in 19.2% of participants; including 18.1% in the metformin group, 14.6% in the metformin-rosiglitazone group and 24.8% in the metformin plus lifestyle group.
Differences in outcomes were not attributable to adherence or changes in BMI.
May 1st, 2012
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In a new study just out, Imayama et al examined the effects of diet and exercise on inflammatory biomarkers in 439 postmenopausal women. The women were randomized to 1 year of caloric restriction diet, aerobic exercise or combined diet and exercise. Women in the diet and diet + exercise group with a 5% or more weight loss reduced inflammatory biomarkers compared with controls. The diet only and diet plus exercise groups showed reductions. This is an important finding as inflammation has been hypothesized to be a mechanism for cancer in obese patients. Cancer Research : Effect of Caloric Restriction
Last year, the same research team found that a combined diet and exercise intervention had positive effects on health related quality of life (HRQOL) in overweigh/obese postmenopausal women. Weight loss predicted improvements in physical functioning, vitality and mental health. Improved HRQOL led to positive changes in depression, stress and social support. PubMed: Dietary weight loss and exercise effect on HRQOL
A study published last November showed that a high body mass index BMI) at the time of diagnosis of breast cancer is associated with higher mortality, as is weight gain at later times. A low-fat diet rich in fruit, vegetables and fiber seems to be weakly associated with a better prognosis. There was no evidence of any benefit from micronutrients, supplements or antioxidant foods. Alcohol consumption did not affect outcomes in breast cancer. PubMed: Effect of overweight on breast cancer prognosis
April 19th, 2012
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Forbes Magazine has just published an article from Melanie Haiken on the 5 deadliest diet drugs. Included in her list were “Qnexa and Successors” (which doesn’t even make sense.) I jotted off a quick comment and encourage readers to do so as well. http://www.forbes.com/sites/melaniehaiken/2012/04/19/5-deadliest-diet-trends/
April 19th, 2012
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Childhood obesity has now been linked to liver cancer in adulthood. Obesity has been linked to non-alcoholic fatty liver disease (NALDF). Data presented today at the International Liver Congress 2012. Danish researchers have now shown that childhood is positively linked with developing hepatocellular carcinoma…the most common form of liver cancer in adulthood. http://medicalxpress.com/news/2012-04-childhood-obesity-linked-hepatocellular-carcinoma.html
April 19th, 2012
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Researchers at the Mayo Clinic have found significantly higher costs associated with obesity, especially morbid obesity, than smoking. Smokers had average health costs $1,275 higher than non-smokers but the added costs for persons with morbid obesity were $5,500 per year. http://insurancenewsnet.com/article.aspx?id=338975&type=newswires
