Liraglutide and Weight Loss

July 31st, 2015 No comments »

MedPage of July 8, 2015 contains an interesting  opinion piece on liraglutide SCALE study by Dr. F. Perry Wilson of the Yale School of Medicine. Dr. Wilson makes some fair points about the study regarding weight loss but seems a bit shocked that, when the drug is discontinued, the weight returns. He also notes that bariatric surgery is probably a better option than taking a drug for life. Perhaps. But there is a group of patients who would rather avoid surgery at all costs, even if more effective. As to seeing the weight return after discontinuation of the drug, we should not be surprised. Most conditions only respond during intervention and return when the intervention stops. It may be more remarkable that the drug continues to be effective against the phenomenon of adaptive thermogenesis.


FDA Approves New Device for Treating Obesity

July 30th, 2015 No comments »

The Food and Drug Administration (FDA) has approved a new medical device for the treatment of obesity. This device, a minimally invasive dual balloon delivered via an endoscope , is designed to make the stomach feel full and, thus, reduce consumption. While hailed by some groups like the American Society for Bariatric and Metabolic  Surgery, the importance of this approval may lie not so much in the specific device but in the greater willingness of the FDA medical device regulators to be open to more devices meant to assist in weight management. See here for more information.

The Food and Drug Administration (FDA) has approved a new medical device for the treatment of obesity. This device, a minimally invasive delivered via endoscope , is designed to make the stomach feel full and, thus, reduce consumption. While hailed by some groups like the American Society for Bariatric and Metabolic  Surgery, the importance of this approval may lie not so much in the specific device but in the greater willingness of the FDA medical device regulators to be open to more devices meant to assist in weight management. See here for more information.

FDA Spikes Concerns Over Dangerous Dietary Supplements

April 8th, 2015 No comments »

Anahad O’Connor, writing in the New York Times, discloses an upsetting picture of the Food and Drug Administration inaction on policing an amphetamine-like substance in dietary supplements. The article describes how the leadership of the FDA division responsible for policing dietary supplements has been and is led by highlevel executives from the Natural Products Association, the trade association representing dietary supplement makers.


Bases for obesity public policies basically worthless

January 30th, 2015 No comments »

Policy-makers, employer wellness programs, many physicians, the First Lady and most of the public health establishment espouse lifestyle changes, especially increased physical activity as the way (with or without caloric restriction) to prevent and reduce obesity and its related cardiovascular diseases. Millions of dollars have been spent to get Americans to increase their physical activity levels. For such programs to succeed they must have accurate information on levels of physical activity in the general population.

Virtually all of the studies on which these leaders rely come from self-reported answers to questionnaires, especially the National Health and Nutrition Examination  Survey (NHANES). Richard S. Cooper and colleagues who have compared NHANES results to objective data from accelerometers in 3,370 adults. The results are pretty shocking. They found:

“The estimates of both vigorous and moderate activity were extremely low, and contrast dramatically with those obtained by self-report. Vigorous activity lasting even 1 minute was only observed in 2% of any of  gender-race/ethnic groups and a 10 minute episode of moderate activity- the intensity obtained by walking up stairs was recorded in only one-third of the participants on any day of monitoring. ..

The major finding from these analyses is the demonstration that the population that population estimates of activity levels from surveys by questionnaire are markedly at variance with those obtained by objective managements. As the only source available from past surveys, questionnaires have been used in analytic research and have informed public policy for the last 50 years. If the data presented here are correct, a re-evaluation of the conclusions from much of this literature would be required. For example, based on national survey data it was assumed in Healthy People 2010 that 23 percent of adults engaged in vigorous activity of more than 20 minutes per episode at least 3 times a week at the beginning of this decade. However, in the NHANES data presented here, <1% of the population achieved this level of expenditure. Likewise, current guidelines recommend 150 minutes of moderate or 75 minutes of vigorous activity per week for adults. Only 0.3%, or 10 of the 3,370 individuals in this sample achieved that level.

Despite the widely held perception that low levels of energy expenditure in activity is an important risk factor for obesity, prospective data do not support this view. Randomized trials, where activity levels are rigorously measured and no attempt is made to restrict calories, likewise show that even substantial increases in energy expenditure in exercise do not result in weight loss because of compensatory increases in intake. We conclude, therefore, that the associations observed in the NHANES data presented here between activity and relative weight are spurious – i.e. the direction of the causality is most likely from obesity to lower activity.”

Things are not any better on the energy-intake side. Self-reported energy intake values are far inferior to objectively measured double-labelled water method, rendering energy intake information virtually useless according to a letter from 15 distinguished obesity researchers in 2013. A similar group of distinguished made the observation that “this extreme lack of validation of self-reported energy intake can be credibly drawn about energy intake derived from self-reported energy intake measures.”

So, the ground of almost all obesity pubic policies regarding energy intake and expenditure is at least questionable and maybe misleading. A similar group of research leaders has concluded that, ” We argue here that it is time to move from the common view that self-reports of (energy intake) EI and  physical activity energy expenditure (PAEE) are imperfect, but nevertheless deserving of use to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE…it is unacceptable to use decidedly inaccurate instruments which may misguide health-care policies, future research and clinical judgment…Researchers and sponsors should develop objective measures of energy balance.”

The Obama Administration and the First Lady have shown their commitment to addressing obesity. Now is their time to get serious and direct the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Prevention to combine efforts to develop more accurate and reliable measures.

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.


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


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!


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.