Posts Tagged ‘sleep apnea’

Primum Non Nocere*

November 28th, 2011

Many media outlets are reporting on the removal of a 200 lb. 8 year old from his family in Cleveland. Cleveland is, of course, the home of Toby Cosgrove, MD, head of the Cleveland Clinic, who proclaimed his desire to not hire workers who were obese. This came a year or so after the American Medical Association took the official position that persons who are obese are not entitled to compensation for being disabled for being unable to work. 

The intellectual justification for the forced removal of the child from his family is that provided by Dr. David Ludwig of Harvard Medical School.  State Intervention in Life-Threatening Childhood Obesity, July 13, 2011, Murtagh and Ludwig 306 (2): 206 — JAMA In the Commentary in July in the Dr. Ludwig had indicated that the forced removal by the state of children who were obese was justified. 

On what basis, you might ask? Well, there were several and they were all, in my opinion, intellectually bankrupt.

First, Dr. Ludwig and his co-author Lindsey Murtagh, J.D., assume “even mild parenting deficiencies such as having excessive junk food in the home or failing to model a physically active lifestyle, may contribute to a child’s weight problem.”

Excuse me? Before you go calling these “parental deficiencies,” how about defining: “excessive”, “junk food” or “failing to model a physically active lifestyle? Well, forget about it. They don’t define their terms.

What do they mean by “may contribute” to a child’s weight problem? If you are arguing that these “mild parental deficiencies” cause life-threatening conditions, is “may” good enough? What is the degree of evidence? If you are arguing that these conditions merit breaking up a family should not the evidence be like, beyond a reasonable doubt or a preponderance of the evidence? Is “may” good enough?

Second, they posit that severe obesity (a BMI at or beyond the 99th percentile) represents a fundamentally different situation than most overweight and obese children who have “the opportunity to ameliorate these risks through behavior change and weight loss as adults.” So, they say that severe obesity is fundamentally different “suggesting profoundly dysfunctional eating and activity habits”. Obesity of this magnitude can cause immediate and potentially irreversible consequences, most notably type 2 diabetes”.

Excuse me? Where is it written that persons with severe obesity as a child have a much smaller likelihood of reversing it as an adult than those with a lower level of obesity?

And what makes the BMI, which we know is a limited measure of body adiposity, at the 99th percentile different from the 97th percentile or the 95th percentile or the 92nd  percentile for that matter?

They argue that  severe obesity ‘suggests’ profoundly dysfuncitional eating and physical activity habits? ‘Suggests?’ They aren’t sure? If they are proposing breaking up a family maybe something more than ‘suggests’ is warranted. More importantly, could it not be that we are confusing cause and effect.  If there is anything to the increases in height and weight over the past 350 years, if there is anything to the contribution of genetic inheritance to obesity, if there is anything to the contribution of epigenetic factors to obesity, then, we must at least allow the suggestion that some children are born programmed to be overweight or obese. Upon achieving that status, one would assume they would overeat and underexercise compared to their normal weight peers. Would these be acquired ‘habits’ or the adaptions to their body habitus?

When they say that obesity of this magnitude can cause immediate and potentially irreversible consequences, most notably type 2 diabetes, what do they mean? Only a subset will develop type 2 diabetes immediately and for many, it will be manageable by lifestyle, drugs or surgery. Others, at a BMI lower than the 99th percentile and some who are merely overweight or normal weight will develop diabetes as well.

Third, (here’s the rub) the authors point with alarm that these patients may have to have bariatric surgery, whose long-term safety and effectiveness is not established. Therefore, they propose an alternative “therapeutic approach” i.e., placement of the severely obese child under state protective custody. The authors state, “Indeed, it may be unethical to subject such children to an invasive and irreversible procedure without first considering foster care.”

Doh? Did I get this right? Because at some point in the future, a child has continued to suffer with obesity and decides to have bariatric surgery, Ludwig and Murtagh propose the state comes in when the child is a juvenile and break up the only family the child has ever known?

Friends, I have worked for years with the professional jealousy of surgeons and internists and non-physician health care professionals. For the most part, they keep these often bitter inter-professional competitions to themselves. But this approach of Ludwig and Murtagh is nothing more than saying that breaking up a family, taking an obese child away from their mother and father and siblings, making them a ward of the state, having them raised by strangers who are paid for their care is better than even the potential that someday that person may want/be eligible for/can pay for bariatric surgery. 

The bias is demonstrated by the additional point raised by the authors that, “Although removal of the child from the home can cause families great emotional pain, this option lacks the physical risks of bariatric surgery. Moreover, family reunification can occur when conditions warrant, whereas the most common bariatric procedure (Roux-en-Y anastomosis [gastric bypass]) is generally irreversible.” Well, this is factually wrong. Roux-en-Y is not the most common bariatric procedure. The reversible laproscopic gastric banding is. Metabolic/bariatric surgery Worldwide 2008. [Obes Surg. 2009] – PubMed – NCBI  And  emotional pain may play a  particularly important role on the development of obesity. See this recent post.

And what does family reunion “when conditions warrant” mean? There are several options here which are starkly different and completely unaddressed by the authors. One option is that the obese child has returned to normal weight. The second option is that the obese child is still obese or has lost some weight but has improved eating or physical activity behaviors. The third option is that one parent or both have improved their ‘deficiencies’ by (a) removing only ‘excessive’ junk food in the home and/or (b) modeling a physically active lifestyle, independent of any change in the child. (Did I mention that the NIH guidelines for pediatricians on weight management did not find much support for physical activity?)

The fourth option is that that the foster care parents are both removing excessive junk food and modeling a physically active lifestyle and the child is continuing to gain weight. In some cases, there may be no “family reunification” but a succession of foster homes, all equally unable to affect the child’s excess adiposity. 

At the very end of their Commentary, Ludwig and Murtagh do a bit of a CYA, stating, “Nevertheless, state intervention would clearly not be desirable or practical, and probably not be legally justifiable, for most of the approximately 2 million children in the United States with a BMI at or beyond the 99th percentile. Moreover, the quality of foster care varies greatly; removal from the home does not guarantee improved physical health, and substantial psychosocial morbidity may ensure. Thus, the decision to pursue this option must be guided by carefully defined criteria such as those proposed by Varness et al with less intrusive methods used whenever possible.”

Now, dear reader, when one comes upon a statement like this, one assumes that Varness, et al, is in at least broad agreement with Ludwig and Murtagh. So it came as some surprise to actually read the cited Varness articles. See Childhood obesity and medical neglect. [Pediatrics. 2009] – PubMed – NCBI 

What Varness says is that, for a child to be removed from their home, all 3 of the following criteria have to be met: (1) a high likelihood that serious imminent harm will occur; (2) a reasonable likelihood that coercive state intervention will result in effective treatment and (3) the absence of alternative options for addressing the problem.

Regarding #1, a high likelihood that serious imminent harm will occur, Varness states, “The mere presence of childhood obesity does not predict serious imminent harm…Although childhood obesity is a risk factor for the development of multiple diseases as an adult, increased risk for adult diseases does not constitute serious imminent harm.” At the other end of the spectrum are current risks, such as severe obstructive sleep apena with cardiorespiratory compromise, uncontrolled type 2 diabetes and advanced fatty liver disease with chirrhosis. In some cases, like advanced hepatic fibrosis, the harm cannot be reversed in adulthood. Varness et al state, contrary to Ludwig and Murtagh, “There is no clear threshold level of childhood obesity (overweight, obese, or severely obese) that automatically predicts serious imminent harm….Although it is true that childhood obesity can lead to adult obesity, childhood obesity itself does not seem to lead to irreversible changes that are significant enough to mandate coercive state intervention.”

Regarding #2, a reasonable likelihood that coercive state intervention will result in effective treatment, Varness states, “In other words, is it truly reasonable to demand that families be able to achieve effective weight loss for their children? In addition, if it has been impossible for a family to reduce weight, what evidence is there to suggest that removal from the home would be more successful?” 

Regarding #3, the absence of alternative options for addressing the problem, Varness clearly does not share Ludwig and Murtagh’s antipathy for bariatric surgery. He states, “In summary, medications and surgery hold some promise but still have a questionable risk/benefit ratio, in both the short term and the long term. Although these may seem to be attractive options for some motivated adolescents with severe obesity, they are not options that are likely to be mandated for a child over the family’s objections. In contrast to the Ludwig-Murtagh paradigm of “mild parenting deficiencies,” Varness observes, “ In most cases of obesity, families make a good-faith effort to address the problem when they are made aware of the condition and the potential adverse health consequences. The development of a serious comorbidity can serve as a “wake-up call” for families, prompting full cooperation with intensified medical services.”

In sum, Varness makes the case that state intervention for obese children with no comorbidity is not justified; for those with a serious imminent harm, e.g. obstructive sleep apnea with cardiorespiratory compromise, intervention is probably justified. In between, only those risks known to be irreversible as an adult, such as hepatic fibrosis resulting from nonalcoholic fatty liver disease as opposed to cardiovascular disease, seems to be justified.

Finally, contrary to the misinformation about bariatric surgery, Varness notes that, “If a medical or surgical intervention that has a very high probability of decreasing weight with minimal adverse events is developed, then the availability of this effective treatment might result in a stronger intervention on behalf of children. For instance, gastric banding is a reversible procedure that involves the laparoscopic placement of an adjustable band around the proximal stomach. This procedure is not approved by the Food and Drug Administration for adolescents, and long-term data on its efficacy and complications are lacking. However, this procedure may hold some promise for extremely obese children, particularly as it is reversible.” In other words, coercive state action may be justified for bariatric surgery, rather than as an alternative to bariatric surgery, as desired by Ludwig and Murtagh. Not to belabor the point, but it seems Varness contradicts every major point Ludwig and Murtagh make. Curious, no?

My problem with the Ludwig-Murtagh commentary is not just on its intellectually bankruptcy and the harm it is bringing on persons who have enough pain it their lives. It is the question of what is Organized Medicine doing? So the position of Organized Medicine is this: Persons with obesity should be denied jobs (and, presumably, employer-provided health care), denied disability compensation when they cannot work, empathetic treatment by their physician and now the support of their own families in favor of unknown, paid-to-be-parents in foster care? Shouldn’t medicine be looking for better treatments? Maybe diagnosing their own patients? Maybe making appropriate referrals? Why don’t Dr. Ludwig and Attorney Murtagh call on pediatricians to develop better treatment protocols for children and adolescents with obesity? Why don’t they call on the American Academy of Pediatrics to lobby for dedicated funding for research on new treatments? Why don’ they criticize their fellow pediatricians who neglect to advise their patients on weight loss, in my opinion, unethically so. Pediatricians, in particular, have spent decades telling parents their children will ‘grow out of’ their weight problems. Now that obesity has become epidemic, they have done next to nothing to actually treat the disease, instead pointing to food companies’ marketing, television viewing, computers, vending machines, and parents as the culprits. Is it too much to ask them to develop treatments for their patients and quit blaming everyone else?

This blaming is only driving parents away from consulting with primary care providers, as discussed in Dr. Arya Sharma’s blog today. www.drsharma.ca.



If medicine, and especially, pediatrics, cannot help, at least stop making matters worse. 

See County places obese Cleveland Heights child in foster care | cleveland.com

Associated Press, MSNBC News: U.S. News – Ohio puts 200-pound third-grader in foster care

ABC News: Health » Obese Third Grader Taken From Mom, Placed in Foster Care Comments Feed

Background: Should parents lose custody of super obese kids? – Washington Times 

* Latin for “First, Do No Harm”

Latest News

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Read Morgan Downey’s Testimony

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lock.pdf

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Health Effects

September 26th, 2009

Obesity is now recognized as one of America’s most serious and growing epidemics. As expected, the prevalence of numerous, adverse health conditions flowing from obesity has also increased. For some of these conditions, obesity appears to be a strong causal factor, others are mentioned in the literature as associations or as causing additional complications: asthma, birth defects, certain cancers (such as breast, esophagus, gastric cardia, colorectal, endometrial, kidney, ovarian, pancreatic, prostate and renal cell), chronic venous insufficiency, congestive heart failure, coronary artery disease, deep vein thrombosis, end-stage renal disease, erectile dysfunction, gallbladder disease, gastroesophageal reflux disease (GERD), gout, fatty liver disease also called NASH, heat disorders, hypertension, hypercholesteremia, impaired respiratory function, infections following wounds, infertility, kidney disease, low back pain, macular degeneration, metabolic syndrome, migraine, gynecological complications, osteoarthritis, pancreatitis, polycystic ovary syndrome, pseudotumor cerebri or benign intracranial hypertension, psoriasis, sleep apnea, stroke and urinary stress incontinence and urinary tract infections. Obesity is often accompanied by psychosocial problems and outright stigmatization and discrimination. Low self-esteem and disability are obesity’s handmaidens.

The health effects of morbid obesity may be understated. A recent study found that employees with morbid obesity have a significantly higher prevalence of more than 100 diseases and conditions compared with other employees, and that those who had bariatric surgery had reduced the prevalence of one quarter of them. According to the lead author, “Morbid obesity appears to be a common link between a wide variety of conditions. This study suggests employers who implement effective prevention and treatment strategies for morbid obesity itself could have a major impact on the overall health of their employees.” New Study Shows Morbidly Obese Workforce Has Higher Prevalence of 100+ Diseases and Conditions

The following are numerous health effects associated with obesity. This is not intended as an exhaustive listing of conditions. Some may be inadvertently omitted. In some cases, the relationship between obesity and the condition are well established. Conditions also vary in how powerful a factor obesity might be. Type 2 diabetes, dislipidemia, obstructive sleep apnea, breathlessness, the obesity hypoventilation syndrome, indiopathic intercranial hypertension and nonalcoholic steatohepatitis have the strongest association with obesity. The effect of obesity on health outcomes. [Mol Cell Endocrinol. 2009] – PubMed Result

Several conditions are in very early stages of research and the connection with obesity may be disproved. Some of the associations with obesity or overweight are quite strong, less so in others. The incidence of co-morbidities related to obesity…[BMC Public Health. 2009] – PubMed Result The links are principally to peer-reviewed, published articles. Where possible, the first link is to a newspaper or magazine article on the subject. The articles are not meant to be comprehensive on the topic but merely to enable the reader who is interested in getting started. Where possible, the links are to review articles which summarize the available studies. Governmental statements are included where available as well as professional consensus statements or treatment guidelines. Whenever available, the links go to free, full-text articles. Otherwise, they are merely the most recent articles concerning the presence or absence of a link between obesity and the named condition. MD

Acute Pancreatitis

Diagnosis and treatment Acute Pancreatitis: Pancreatitis: Merck Manual Home Edition

Acute pancreatitis: a literature review. [Med Sci Monit. 2009] – PubMed Result

Allergic Diseases

Possible link between allergies and childhood obesity Possible Link Between Childhood Obesity And Allergies

Obesity and allergic diseases. [Acta Dermatovenerol Croat. 2008] – PubMed Result

Alzheimer’s Disease

Relationship of Alzheimer’s disease and obesity Obesity Today, Alzheimer’s Disease Tomorrow?

Adiposity, type 2 diabetes, and Alzheimer’s diseas…[J Alzheimers Dis. 2009] – PubMed Result

Adiposity and Alzheimer’s disease. [Curr Alzheimer Res. 2007] – PubMed Result

The epidemiology of adiposity and dementia. [Curr Alzheimer Res. 2007] – PubMed Result

Body mass index in midlife and risk of Alzheimer d…[Curr Alzheimer Res. 2007] – PubMed Result

Central obesity and increased risk of dementia mor…[Neurology. 2008] – PubMed Result

Asthma

Understanding the asthma-obesity connection Wider Waist Boosts Asthma Risk – US News and World Report

Researchers have been trying for years to sort out the relationship between asthma and obesity. Some have found no relationship Does higher body mass index contribute to worse as…[J Allergy Clin Immunol. 2009] – PubMed Result while others have.

Fitness and body weight in asthma Fitness, daily activity and body composition in ch…[Allergy. 2009] – PubMed Result

Asthma and obesity in 4-5 year olds Association between asthma symptoms and obesity in…[J Asthma. 2009] – PubMed Result

Asthma, the metabolic syndrome and obesity Asthma-like symptoms are increased in the metaboli…[J Asthma. 2009] – PubMed Result

Overweight, obesity, and incident asthma: a meta-a…[Am J Respir Crit Care Med. 2007] – PubMed Result

A meta-analysis of the effect of high weight on as…[Arch Dis Child. 2006] – PubMed Result

Obesity and the lung: 1. Epidemiology. [Thorax. 2008] – PubMed Result

On-line self tests for children and adults Nationwide Asthma Screening Program — Self Tests – ACAAI

Atrial Fibrillation

AHRQ: Management of new atrial fibrillation New Report Available on Management of New Onset Atrial Fibrillation

Meta-analysis shows increasing BMI increases AF risk Atrial fibrillation and obesity–results of a meta…[Am Heart J. 2008] – PubMed Result

Epidemiology of atrial fibrillation. [Swiss Med Wkly. 2009] – PubMed Result

Obesity and the risk of new-onset atrial fibrillat…[JAMA. 2004] – PubMed Result

Risk of new-onset atrial fibrillation in relation …[Arch Intern Med. 2006] – PubMed Result

Effect of coffee and obesity on AF Effect of coffee consumption, lifestyle and acute …[J Cardiovasc Med (Hagerstown). 2008] – PubMed Result

Obesity associated with increased left atrial size Body mass index is an independent determinant of l…[Heart Lung Circ. 2008] – PubMed Result

Tests for Atrial Fibrillation Atrial Fibrillation Diagnosis – Mayo Clinic

Attention Deficit Disorder-Hyperactivity

What is the relationship between attention deficit/hyperactivity disorder and obesity? International Journal of Obesity – Abstract of article: Overweight//obesity and attention deficit and hyperactivity disorder tendency among adolescents in China

Association Between Adult Attention Deficit/Hypera…[Obesity (Silver Spring). 2009] – PubMed Result

ADHD associated with long term weight loss Treatment of refractory obesity in severely obese …[Int J Obes (Lond). 2009] – PubMed Result

Attention-deficit/hyperactivity disorder (ADHD) an…[Crit Rev Food Sci Nutr. 2008] – PubMed Result

Symptoms of attention-deficit/hyperactivity disord…[Eat Behav. 2008] – PubMed Result

Barrett’s Esophagus

Exploring the association between elevated body ma…[Ann Thorac Surg. 2009] – PubMed Result

Birth Defects

Overview: http://www.reuters.com/article/scienceNews/idUSTRE51979K20090210

See: JAMA — Maternal Overweight and Obesity and the Risk of Congenital Anomalies: A Systematic Review and Meta-analysis, February 11, 2009, Stothard et al. 301 (6): 636

USPSTS Recommendations on Folic Acid Consumption

Folic acid for the prevention of neural tube defects: U.S. Preventive Services Task Force recommendation statement.

Blood Pressure, Hypertension

How Do I Know If I Have High Blood Pressure?

Visceral obesity associated with lack of success in hypertension treatment Blood pressure control and components of the metab…[Cardiovasc Diabetol. 2009] – PubMed Result

High blood pressure (HBP), blood pressure readings

Questions on long term improvements in blood pressure with weight loss. Long-term weight loss from lifestyle intervention …[Hypertension. 2009] – PubMed Result

Blount Disease

Association with obesity Blount disease. [J Bone Joint Surg Am. 2009] – PubMed Result

Body mass index as a prognostic factor in developm…[J Pediatr Orthop. 2007] – PubMed Result

Relationship to Childhood Obesity Blount disease. [J Bone Joint Surg Am. 2009] – PubMed Result

Breast Cancer

Combined effects of obesity and type 2 diabetes co…[Cardiovasc Diabetol. 2009] – PubMed Result

Adipocytokines and breast cancer risk. [Chin Med J (Engl). 2007] – PubMed Result

Obesity and mammography: a systematic review and m…[J Gen Intern Med. 2009] – PubMed Result

Cancer, General

See Breast Cancer, Endometrial, Esophageal, Ovarian, Pancreatic

Body-mass index and incidence of cancer: a systema…[Lancet. 2008] – PubMed Result

Cancer incidence and mortality in relation to body…[BMJ. 2007] – PubMed Result

Cancer is a preventable disease that requires majo…[Pharm Res. 2008] – PubMed Result

Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General Populations and Cancer Patients and Survivors: Summary, Evidence Report/Technology Assessment No 102

Energy balance, physical activity, and cancer risk. [Methods Mol Biol. 2009] – PubMed Result

Cardiovascular Disease, see also Heart Disease

Fitness and abdominal obesity are independently as…[J Intern Med. 2009] – PubMed Result

Disease Risk Obesity and cardiovascular disease: pathophysiolog…[Circulation. 2006] – PubMed Result

Surgery: Is extreme obesity a risk factor for cardiac surge…[Eur J Cardiothorac Surg. 2006] – PubMed Result

Effect of obesity on early morbidity and mortality…[Heart Lung Circ. 2007] – PubMed Result

Findings from Project HeartBeat! Their importance …[Am J Prev Med. 2009] – PubMed Result

Youth with obesity and type 2 diabetes have heart abnormalities Youth with obesity and obesity-related type 2 diab…[Circulation. 2009] – PubMed Result

Use of BMI or other indicators Waist-height ratio as a predictor of coronary hear…[Epidemiology. 2009] – PubMed Result

Cataracts

Central Obesity and the metabolic syndrome appear to raise the risks of cataracts Relation between cataract and metabolic syndrome a…[Eur J Ophthalmol. 2007 Jul-Aug] – PubMed Result

Cholesterol, Hypercholesterolemia

NHLBI, High Blood Cholesterol: What You Need to Know

Increased body mass and depressive symptomatology …[Lipids Health Dis. 2009] – PubMed Result

Chronic Diseases

Best Practices for reducing obesity and chronic disease

Reducing obesity and related chronic disease risk …[Obes Rev. 2006] – PubMed Result

Colorectal Cancer

Obesity and colon and rectal cancer risk: a meta-a…[Am J Clin Nutr. 2007] – PubMed Result

Obesity and risk of colorectal cancer: a meta-anal…[Cancer Epidemiol Biomarkers Prev. 2007] – PubMed Result

Obesity and colorectal cancer risk: a meta-analysi…[World J Gastroenterol. 2007] – PubMed Result

Obesity and risk of colorectal cancer: a meta-anal…[Cancer Epidemiol Biomarkers Prev. 2007] – PubMed Result

Deep Vein Thrombosis

The Coalition to Prevent DVT has a risk assessment tool at Assess Your DVT Bloood Clot Risks

[Influence of body mass index and age on deep vein…[Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006] – PubMed Result

Cardiovascular evaluation and management of severe…[Circulation. 2009] – PubMed Result

Metabolic syndrome and risk of venous thromboembol…[J Thromb Haemost. 2009] – PubMed Result

Greater fish, fruit, and vegetable intakes are rel…[Circulation. 2007] – PubMed Result

Depression

The relationship between abdominal fat, obesity, a…[J Psychosom Res. 2009] – PubMed Result

Altered executive function in obesity. Exploration…[Appetite. 2009] – PubMed Result

A prospective study of the role of depression in t…[Pediatrics. 2002] – PubMed Result

Depression and body mass index, a u-shaped associa…[BMC Public Health. 2009] – PubMed Result

Psychosocial aspects of obesity. [Adv Psychosom Med. 2006] – PubMed Result

Diverticulitis

AHRQ: Research Activities, July 2009: Chronic Disease: Obesity boosts risk of diverticulitis and diverticular bleeding

Research Activities, July 2009: Chronic Disease: Obesity boosts risk of diverticulitis and diverticular bleeding

Obesity increases the risks of diverticulitis and …[Gastroenterology. 2009] – PubMed Result

Drug Induced Weight Gain

Epidemiology, implications and mechanisms underlyi…[J Psychiatr Res. 2003 May-Jun] – PubMed Result

[Psychotropic drugs induced weight gain: a review …[Encephale. 2005 Jul-Aug] – PubMed Result

Preventive treatment of migraine: effect on weight. [Curr Pain Headache Rep. 2008] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

Weight issues for people with epilepsy–a review. [Epilepsia. 2007] – PubMed Result

Weight gain in the treatment of mood disorders. [J Clin Psychiatry. 2003] – PubMed Result

Weight gain in bipolar disorder: pharmacological t…[Acta Psychiatr Scand. 2008] – PubMed Result

Bipolar disorder, obesity, and pharmacotherapy-ass…[J Clin Psychiatry. 2003] – PubMed Result

Endometrial Cancer

Endometrial Cancer Risk Among Younger, Overweight …[Obstet Gynecol. 2009] – PubMed Result

New review on obesity and endometrial cancer Body size, adult BMI gain and endometrial cancer r…[Int J Cancer. 2009] – PubMed Result

Epilepsy

Obesity related to undiagnosed epilepsy in children Obesity is a common comorbidity for pediatric pati…[Neurology. 2009] – PubMed Result

Erectile Dysfunction

The triad of erectile dysfunction, hypogonadism and the metabolic syndrome

Beneficial impact of exercise and obesity interven…[J Sex Med. 2009] – PubMed Result

Effect of lifestyle changes on erectile dysfunctio…[JAMA. 2004] – PubMed Result

Esophageal Cancer

Body mass index and adenocarcinomas of the esophag…[Cancer Epidemiol Biomarkers Prev. 2006] – PubMed Result

Abdominal Obesity Abdominal obesity and the risk of esophageal and g…[Cancer Epidemiol Biomarkers Prev. 2008] – PubMed Result

Fecal Incontinence

Fecal incontinence in obese women with urinary inc…[Am J Obstet Gynecol. 2009] – PubMed Result

Gallstone Disease

[Gallbladder disease and obesity] [Gac Med Mex. 2004 Jul-Aug] – PubMed Result

Gallstone disease: Primary and secondary preventio…[Best Pract Res Clin Gastroenterol. 2006] – PubMed Result

GERD (Gastroesophageal reflux disease)

Relationship of BMI to GERD in the US Body mass index and gastroesophageal reflux diseas…[Am J Gastroenterol. 2006] – PubMed Result

Meta-analysis: obesity and the risk for gastroesop…[Ann Intern Med. 2005] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

New Guidelines American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease

Gestational Diabetes

Intrauterine exposure to gestational diabetes, chi…[Am J Hypertens. 2009] – PubMed Result

Obese Mothers at risk for Gestational Diabetes. See: Maternal obesity and risk of gestational diabetes mellitus: A meta-analysis — Chu et al., 10.2337/dc06-2559a — Diabetes Care

Maternal obesity and risk of gestational diabetes …[Diabetes Care. 2007] – PubMed Result

AHRQ Clinician’s Guide http://effectivehealthcare.ahrq.gov/repFiles/2009_0804GDM_Clinician_final.pdf

Gum Disease

Obesity is associated with gum disease with inflammation being a common possible method of action Obesity Boosts Gum Disease Risk – Forbes.com

Heart Disease

The obesity paradox: body mass index and outcomes …[Arch Intern Med. 2005] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Childhood obesity, CVD risk Childhood obesity and adult cardiovascular disease…[Int J Obes (Lond). 2009] – PubMed Result

Different degrees of overweight: anthropometric in…[Acta Cardiol. 2009] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Impact of obesity on cardiovascular disease. [Endocrinol Metab Clin North Am. 2008] – PubMed Result

Obesity and cardiovascular disease: risk factor, p…[J Am Coll Cardiol. 2009] – PubMed Result

The joint effects of physical activity and body ma…[Arch Intern Med. 2008] – PubMed Result

Body mass index and vigorous physical activity and…[Circulation. 2009] – PubMed Result

Association of overweight with increased risk of c…[Arch Intern Med. 2007] – PubMed Result

Obesity and disease management: effects of weight …[Obes Res. 2001] – PubMed Result

Inflammation

Small study: Anti-inflammatory treatments (aspirin, statins) may help with weight loss in patients with type 2 diabetes. The effect of anti-inflammatory (aspirin and/or st…[Diabet Med. 2009] – PubMed Result

Obesity and the role of adipose tissue in inflammation and metabolism — Greenberg and Obin 83 (2): 461S — American Journal of Clinical Nutrition

Obesity, innate immunity and gut inflammation. [Curr Opin Gastroenterol. 2007] – PubMed Result

The evolving role of inflammation in obesity and t…[Curr Diab Rep. 2005] – PubMed Result

Epidemic inflammation: pondering obesity. [Mol Med. 2008 Jul-Aug] – PubMed Result

Relationship between inflammation, insulin resista…[Curr Diabetes Rev. 2006] – PubMed Result

Insulin Resistance

From chronic overnutrition to insulin resistance: …[Nutr Metab Cardiovasc Dis. 2009] – PubMed Result

Permanent impairment of insulin resistance from pr…[Med Hypotheses. 2009] – PubMed Result

Kidney Disease

Should prevention of chronic kidney disease start …[Int Urol Nephrol. 2008] – PubMed Result

Overweight, obesity and chronic kidney disease. [Nephron Clin Pract. 2009] – PubMed Result

Waist-to-hip ratio, body mass index, and subsequen…[Am J Kidney Dis. 2008] – PubMed Result

Overweight, obesity, and the development of stage …[Am J Kidney Dis. 2008] – PubMed Result

Association between obesity and kidney disease: a …[Kidney Int. 2008] – PubMed Result

Lipids, Hyperlipidemia

Bridging science and health policy in cardiovascul…[Atheroscler Suppl. 2009] – PubMed Result

Genetic influence of lipids HDL subspecies in young adult twins: heritability …[Obesity (Silver Spring). 2009] – PubMed Result

Macrosomia

The influence of obesity and diabetes on the preva…[Am J Obstet Gynecol. 2004] – PubMed Result

Macular Degeneration

Changes in waist-hip and macular degeneration Changes in abdominal obesity and age-related macul…[Arch Ophthalmol. 2008] – PubMed Result

Obesity and eye diseases. [Surv Ophthalmol. 2007 Mar-Apr] – PubMed Result

Melonoma Cancer

Cutaneous melanoma and obesity in the Agricultural…[Ann Epidemiol. 2008] – PubMed Result

Metabolic Syndrome

Abdominal obesity and the metabolic syndrome: cont…[Arterioscler Thromb Vasc Biol. 2008] – PubMed Result

The concept of cardiometabolic risk: Bridging the …[Ann Med. 2008] – PubMed Result

Is visceral obesity the cause of the metabolic syn…[Ann Med. 2006] – PubMed Result

Maternal obesity, gestational diabetes and large for gestational age factors Metabolic syndrome in childhood: association with …[Pediatrics. 2005] – PubMed Result

Lifestyle intervention in obese children with non-…[Arch Dis Child. 2009] – PubMed Result

Migraines

Obesity may raise migraine risk, U.S. study finds | Science & Health | Reuters

Obesity, migraine, and chronic migraine: possible …[Neurology. 2007] – PubMed Result

Body mass index and headaches: findings from a nat…[Cephalalgia. 2008] – PubMed Result

Migraines and the metabolic syndrome Migraine in metabolic syndrome. [Neurologist. 2009] – PubMed Result

Mobility Problems in the Elderly

Metabolic syndrome and physical decline in older p…[J Gerontol A Biol Sci Med Sci. 2009] – PubMed Result

Lifestyle factors and incident mobility limitation…[Obesity (Silver Spring). 2007] – PubMed Result

Musculoskeletal Disorders

Musculoskeletal disorders associated with obesity:…[Obes Rev. 2006] – PubMed Result

Musculoskeletal effects of obesity. [Curr Opin Pediatr. 2009] – PubMed Result

Musculoskeletal findings in obese subjects before …[Int J Obes (Lond). 2007] – PubMed Result

Nonalcoholic Fatty Liver Disease

NAFLD strongly affects Hispanic population through obesity and insulin resistance Correlates and heritability of nonalcoholic fatty …[Obesity (Silver Spring). 2009] – PubMed Result

Metabolic liver disease of obesity and role of adi…[World J Gastroenterol. 2007] – PubMed Result

Metabolic syndrome and non-alcoholic fatty liver d…[Ann Hepatol. 2009] – PubMed Result

NASH

Nonalcoholic Steatohepatitis

Role of inflammation in nonalcoholic steatohepatit…[Curr Opin Gastroenterol. 2005] – PubMed Result

Obesity Genetic Syndromes

Genetic obesity syndromes. [Front Horm Res. 2008] – PubMed Result

Genetic and hereditary aspects of childhood obesit…[Best Pract Res Clin Endocrinol Metab. 2005] – PubMed Result

OB/GYN Issues; see also Birth Defects

Greater cesarean deliveries in overweight/obese women Maternal obesity and risk of cesarean delivery: a …[Obes Rev. 2007] – PubMed Result

Higher risk of stillbirths Maternal obesity and risk of stillbirth: a metaana…[Am J Obstet Gynecol. 2007] – PubMed Result

The impact of maternal obesity on maternal and fet…[Rev Obstet Gynecol. 2008] – PubMed Result

Higher risks of neural tube defects Maternal obesity and risk of neural tube defects: …[Am J Obstet Gynecol. 2008] – PubMed Result

Greater maternal weight and the ongoing risk of ne…[Obstet Gynecol. 2005] – PubMed Result

Reproductive results after bariatric surgery Reproductive outcome after bariatric surgery: a cr…[Hum Reprod Update. 2009 Mar-Apr] – PubMed Result

Pregnancy and fertility following bariatric surger…[JAMA. 2008] – PubMed Result

Obstetric outcome following laparoscopic adjustabl…[Int J Gynaecol Obstet. 2007] – PubMed Result

Osteoarthritis

Osteoarthritis of the knee and hip and activity: a…[Joint Bone Spine. 2006] – PubMed Result

Obesity and osteoarthritis in knee, hip and/or han…[BMC Musculoskelet Disord. 2008] – PubMed Result

Obesity increases the likelihood of total joint re…[Int Orthop. 2007] – PubMed Result

The relationship between obesity and the age at wh…[J Bone Joint Surg Br. 2008] – PubMed Result

Ovarian Cancer

Height, body mass index, and ovarian cancer: a poo…[Cancer Epidemiol Biomarkers Prev. 2008] – PubMed Result

Body mass index, height, and the risk of ovarian c…[Cancer Epidemiol Biomarkers Prev. 2002] – PubMed Result

Pain

Health-related quality of life in obese persons se…[J Fam Pract. 1996] – PubMed Result

Overview of the relationship between pain and obes…[J Rehabil Res Dev. 2007] – PubMed Result

low back pain and obesity – PubMed Results

Pancreatic Cancer

Body mass index and risk, age of onset, and surviv…[JAMA. 2009] – PubMed Result

Pelvic Floor Disorders

Obesity is associated with increased prevalence an…[Surg Obes Relat Dis. 2008] – PubMed Result

Obesity and pelvic floor disorders: a systematic r…[Obstet Gynecol. 2008] – PubMed Result

PCOS (Polycystic Ovarian Syndrome)

Effect of body weight on PCOS Effect of body mass index on clinical manifestatio…[Int J Gynaecol Obstet. 2009] – PubMed Result

Polycystic ovary syndrome: a major unrecognized ca…[Rev Cardiovasc Med. 2009] – PubMed Result

Pregnancy Outcomes

Obesity as an independent risk factor for elective…[Obes Rev. 2009] – PubMed Result

Effect of Body Mass Index on pregnancy outcomes in…[BMC Public Health. 2007] – PubMed Result

Prostate Cancer

Obese men have larger tumors Obese men have higher-grade and larger tumors: an …[Prostate Cancer Prostatic Dis. 2009] – PubMed Result

Psoriasis

Psoriasis and the metabolic syndrome. [J Drugs Dermatol. 2008] – PubMed Result

Pseudo Tumor cerebri (idiopathic intercranial hypertension)

Profiles of obesity, weight gain, and quality of l…[Am J Ophthalmol. 2007] – PubMed Result

Gastric surgery for pseudotumor cerebri associated…[Ann Surg. 1999] – PubMed Result

Idiopathic intracranial hypertension: the associat…[BMC Ophthalmol. 2007] – PubMed Result

Renal Transplantation

Severe obesity affects success of renal transplantation Effect of degree of obesity on renal transplant ou…[Transplant Proc. 2008] – PubMed Result

Morbid Obesity not a contraindication to transplant Morbid obesity is not a contraindication to kidney…[Am J Surg. 2004] – PubMed Result

Severe Mental Illness

Obesity in patients with severe mental illness Overview of managing medical comorbidities in pati…[J Clin Psychiatry. 2009] – PubMed Result

Sexual Dysfunction

International Journal of Impotence Research – Abstract of article: Obesity and sexual dysfunction, male and female

Male obesity and alteration in sperm parameters. [Fertil Steril. 2008] – PubMed Result

Sleep Apnea

Is there a connection with obesity? Is there a clear link between overweight/obesity a…[Sleep Med Rev. 2008] – PubMed Result

Sleep Apnea Medicare announces new coverage MEDICARE ANNOUNCES FINAL COVERAGE POLICY FOR SLEEP TESTING FOR THE DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA

Stroke

Contribution of obesity and abdominal fat mass to …[Stroke. 2008] – PubMed Result

The Impact of Body Mass Index on Mortality After S…[Stroke. 2009] – PubMed Result

AHRQ Stroke Prevention Recommendations

Healthy lifestyle and the risk of stroke in women. [Arch Intern Med. 2006] – PubMed Result

Lifestyle and stroke risk: a review. [Curr Opin Neurol. 2009] – PubMed Result

Obesity: effects on cardiovascular disease and its…[J Am Board Fam Med. 2008 Nov-Dec] – PubMed Result

Swine Flu

Swine Flu may be especially virulent in persons with morbid obesity Intensive-care patients with severe novel influenz…[MMWR Morb Mortal Wkly Rep. 2009] – PubMed Result

Type 1 Diabetes

Children with type 1 diabetes likely to be overweight Atlanta health, diet and fitness news | ajc.com

Childhood BMI, breastfeeding and risk of type 1 diabetes Childhood body mass index (BMI), breastfeeding and…[Diabet Med. 2008] – PubMed Result

Type 2 Diabetes

Obesity and Type 2 diabetes: global phenomenon IDF Diabetes Atlas – Obesity and type 2 diabetes

CDC Data & Statistics | Feature: Diabetes is Common, Disabling, Deadly, and On the Rise

CDC’s Diabetes Program – Publications & Products – National Diabetes Fact Sheet 2005

Primer on Diabetes San Fernando Valley Sun – A Diabetes Primer

Prevalence of diabetes among children, adolescents Prevalence of overweight and obesity in youth with…[Pediatr Diabetes. 2009] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

Effect of weight loss on diabetes Influences of weight loss on long-term diabetes ou…[Proc Nutr Soc. 2008] – PubMed Result

Benefits of weight loss for type 2 diabetics Impact of a weight management program on health-re…[Arch Intern Med. 2009] – PubMed Result

No definitive studies of best dietary practices Dietary advice for the prevention of type 2 diabet…[Cochrane Database Syst Rev. 2008] – PubMed Result

Not much evidence that physical activity and dietary interventions prevent type 2 diabetes Exercise or exercise and diet for preventing type …[Cochrane Database Syst Rev. 2008] – PubMed Result

United Kingdom’s National Institute for Clinical Evidence (NICE) issues new guidelines for treating type 2 diabetes. Type 2 Diabetes – newer agents (partial update of CG66)

Studies confirm effectiveness of bariatric surgery in resolving diabetes Data confirm long-term effects of bariatric surgery on type 2 diabetes

UK Diabetes drug may also cause weight loss Diabetes Drug: New Treatment Helps Lower Blood Pressure And Weight Loss | Health | Sky News

FDA to review once a week diabetes drug US FDA To Review Once-A-Week Diabetes Drug Exenatide – WSJ.com

Stopping type 2 diabetes in children Experts: Most type 2 diabetes can be stopped in childhood – USATODAY.com

Urinary Incontinence

Weight loss helps women with urinary incontinence Weight Loss in Overweight and Obese Women Reduces Urinary Incontinence, January 28, 2009 News Release – National Institutes of Health (NIH)

A systematic review of overweight and obesity as r…[Neurourol Urodyn. 2008] – PubMed Result

Weight loss to treat urinary incontinence in overw…[N Engl J Med. 2009] – PubMed Result

Uterine Cancer

Obesity positively associated with uterine cancer The impact of BMI on subgroups of uterine cancer. [Br J Cancer. 2009] – PubMed Result