May 3rd, 2012
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What does the US have in common with Kenya, Turkey, Thailand, East Timor and Honduras? Answer: high rates – around 12% – of preterm births, according to a new study from the World Health Organization. Most European countries and Canada have rates around 7% to9%. The report notes, “Underlying maternal conditions (e.g. renal, disease, hypertension, obesity and diabetes) increase the risk of maternal complications (e.g., pre-eclampsia) and medically-indicated preterm birth. The worldwide epidemic of obesity and diabetes is, thus, likely to become an increasingly important contributor to global preterm birth. In one region in the United Kingdom, 17% of all babies born to diabetic mother were preterm, more than double the rate in the general population.
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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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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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
March 14th, 2012
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A study just published in the International Journal of Obesity looks at disability rates 
of men and women who have had bariatric surgery compared to non-surgical controls. The study, from the Swedish Obesity Study, followed subjects for 19 years and found a significant decline in days lost due to disability in men but not in women. International Journal of Obesity – Abstract of article: Effects of bariatric surgery on disability pension in Swedish obese subjects
March 4th, 2012
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DVT or Deep Vein Thrombosis is a very preventable cause of death and persons who are obese/sedentary are at risk for DVTs or its cousin, pulmonary embolism.
For many years, I have had the honor of being on the steering committee of the Prevent DVT Coalition, which has collected a great deal of information for patients and health professionals on this condition. Their website, Prevent DVT | Coalition to Prevent Deep-Vein Thrombosis, includes information for patients to assess their risks and for health care professionals who can implement preventive steps, especially in hospitals.
Melanie Bloom is the spokesperson for the Coalition. She lost her husband, David, an NBC correspondent, to a DVT as an imbed in covering the Iraq war. David Bloom – Wikipedia, the free encyclopedia She is not what you think of as a celebrity; she is a modest, somewhat shy person, but very compassionate, relating to people who have avoided a bad outcome from a DVT or who, like her, have suffered a loss of a loved one.
There are a number of conditions around obesity we cannot control very well. DVT is not one of them. Know the symptoms. Do not take “come and see me in the morning” as an answer. Get to an emergency room. Save a life. March may be Prevent DVT Month but Preventing DVT is a 12 month, 24/7 effort.
February 23rd, 2012
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Two scientists from the National Institutes of Health (NIH) have presented a new mathematical model to calculate reductions in caloric intake needed to lose weight. The old formula of a reduction of 500 calories/day resulting in a pound a week weight loss is wrong, according the researchers. The reason for the error is that, as weight is lost, metabolism slows down. Therefore, ever greater intake reductions are needed. This is why so many dieters feel like failures. Bottom line: It’s not their fault. The researchers presented at AAAS in Vancouver. Battling obesity with better mathematical models They have an on-line tool (which is not that easy to use) http://bwsimulator.niddk.nih.gov/favicon.ico . Their work was published in Lancet. Quantification of the effect of energy imbalance on bodyweight : The Lancet.
