Tag Archives: overweight

More Docs Are Asking Patients to Exercise

Physicians are getting better at advising adults to exercise.

Photo courtesy National Cancer Institute/Bill Branson

In 2010, 32.4% of adults in the United States who had seen a physician or other health care professional in the past year had received a recommendation to begin or continue to do exercise or physical activity, up from 22.6% in 2000. At each time point, women were more likely than men to have been advised to exercise.

The findings, published this month as a National Center for Health Statistics Data Brief, come from the National Health Interview Surveys conducted in 2000, 2005, and 2010.

Between 2000 and 2010 the percentage of patients aged 85 and older who received a “get fit” recommendation from a physician nearly doubled from 15.3% to 28.9%. The percentage of patients aged 18-24 years receiving such a recommendation also increased during the same time period, but to a lesser extent (from 10.4% to 16.1%).

The report also found that the percentage of adults with hypertension, cardiovascular disease, cancer, and diabetes who received exercise advice from a physician increased between 2000 and 2010.

“Trends over the past 10 years suggest that the medical community is increasing its efforts to recommend participation in exercise and other physical activity that research has shown to be associated with substantial health benefits,” the report states. “Still, the prevalence of receiving this advice remains well below one-half of U.S. adults and varies substantially across population subgroups.” 

 — Doug Brunk (on Twitter@dougbrunk)

Photo courtesy National Cancer Institute Visuals Online

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Attacking Obesity

The diversity of disciplines represented at the annual meeting of The Obesity Society parallels the reach of the obesity epidemic itself.

Primary care physicians, endocrinologists, pharmacologists, bariatric surgeons, psychiatrists, psychologists, social workers, educators, nutritionists, and food service workers have spent the past five days in Orlando, Fla., wrestling the obesity beast, trying to shed light on why it is so intractable and discussing interventions that may tame it. Following are a few observations from the meeting:

Courtesy of the Rudd Center for Food Policy & Obesity

1. Although obesity in the United States is being attacked full-force from all sides with drugs, surgery, and psychosocial and behavioral interventions, its prevalence is expected to continue to climb as those born in the 1980s (when the obesity epidemic began) age into their “prime years of obesity incidence,” according to data presented by Whitney Robinson, Ph.D. of the University of North Carolina at Chapel Hill. Dr. Robinson and colleagues used height and weight data measured from 1971-2008 in the National Health and Nutrition Examination Survey (NHANES) to quantify cohort effects as a way to estimate obesity trends. They determined that cohorts born in the 1980s had significantly increased obesity risk versus those born in the late 1960s. The cohort effects, which are those not attributable to the additive effects of age and period, for the 1979-1983 and the 1984-1988 birth cohorts relative to the late 1960s cohort were 1.18 and 1.21, respectively.

Although it is well understood that period effects representing widespread environmental influences have driven increases in obesity prevalence, Dr. Robinson reported, “obesity in adults born in the 1980s shows positive cohort effects as well.”  This finding suggests that even if the obesigenic environment stabilizes, obesity prevalence could continue to increase, particularly in the absence of widespread environmental change.

2. Technology is becoming an ubiquitous weapon in the obesity armamentarium, as evidenced by the many presentations focusing on computer-, Internet- and even smart phone-based strategies. For example, in one late-breaking presentation, Kelly H. Webber, Ph.D. and Dr. Stephanie A. Rose of the University of Kentucky, Lexington, described a pilot study comparing the impact of an Internet behavioral weight loss program alone and in combination with portion-controlled food provision. The study demonstrated that the short-term effect of the combination approach was particularly beneficial.

Similarly, Melissa A. Napolitano, Ph.D. of Temple University in Philadelphia presented a pilot trial of a virtual reality-based psycho-educational intervention for modeling weight loss skills. The findings demonstrated short-term success, with outcomes approximating those found in conventional behavioral weight loss programs.

Finally, a comprehensive evaluation of available iPhone apps for weight loss, presented by Penny Deck, a Ph.D. student at Simon Fraser University, demonstrated the considerable variation in the degree to which the applications follow evidence-based recommendations for weight loss. In particular, she noted, “most of the apps demonstrated poor adherence to such recommendations as basing goals on behaviors vs. weight and advocating small sustainable changes.”

All of the technology interventions are still too young to have long-term outcomes data. It is therefore too early to determine whether their short-term efficacy is a function of the interventions themselves or their novelty. In a presentation describing the apparent benefits of a church-based telemedicine weight loss intervention, Gary Foster, Ph.D., of Temple University observed that most behavioral weight loss interventions are effective in the short term, “but what we really need are long-term studies to evaluate their continued efficacy over time.”

3. Anti-obesity prejudice is pervasive in all sectors of society, including among individuals and organizations in positions of influence. In response to a query from an attendee about the FDA’s reluctance to approve amphetamines for weight loss but not for attention deficit disorder, Dr. George Bray, chief of the division of Clinical Obesity and Metabolism at Pennington Biomedical Research Center in Baton Rouge, La., attributed the double standard to the cultural perception that obesity is an aesthetic problem. “ADHD is viewed as a disease, while obesity is perceived to be a moral deficit,” he said.

The cultural stigma is perpetuated by the news media and even by medical professionals through the photographic and video portrayal of overweight people using headless body shots, primarily focusing on unflattering views of the abdomen or lower body, often in sloppy attire and eating unhealthfully, according to Dr. Arya Sharma, chair in obesity research and management at the University of Alberta in Edmonton, Canada.

To counter the prejudice, the Rudd Center for Food Policy and Obesity at Yale University and The Obesity Society have developed a document called Guidelines for the Portrayal of Obese Persons in the Media, which was available in the meeting press room. The Rudd Center also offers a gallery of more positive images that it makes available to the press.

–By Diana Mahoney

 

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Street Food May Contribute to Obesity. Surprise.

What about the guys selling food on the street? That was the primary research question posed by Dr. Sean Lucan of Albert Einstein College of Medicine in New York and colleagues as part of a study evaluating whether the fare offered by mobile food vendors in New York contributes to an “obesigenic” food environment. Hmm. Did we really need a study to give us the answer?

Courtesy Wikimedia Commons/Totya/Creative Commons License

The team scoured the Bronx looking for mobile food stalls during the summer and fall of 2010, querying the vendors about what they sold, then assessing the health value of the items. “Only 10% of vendors selling prepared food sold any produce,” Dr. Lucan reported in a poster presentation at the annual meeting of the Obesity Society in Orlando.

In addition, low-fat milk and whole grains were “essentially absent” among the 372 food vendors surveyed, he said. Items high in fat, calories, salt, and/or added sugar were plentiful while fruits and vegetables were limited. Of the 28% of vendors offering any fruit or vegetable, one offered a single whole grain item, while all offered multiple prepared and processed foods. The investigators concluded that the overall contribution of street food vendors “may be unhealthy and obesigenic on balance.” Go figure.

A more enlightening study might consider whether consumers would bite if more healthful street food options were available.  

–Diana Mahoney

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Does Adenovirus 36 Infection Cause Childhood Obesity?

Findings from new a study of Southern California children support the idea that a viral infection may play a role in causing or contributing to obesity. 

Reported in the Sept. 20, 2010 online edition of Pediatrics, researchers led by Dr. Jeffrey B. Schwimmer, associate professor of clinical pediatrics at University of California, San Diego, studied 124 children aged 8-18 years in primary clinics in San Diego for the presence of antibodies specific to adenovirus 36 (AD36), which is the only human adenovirus currently linked to human obesity. 

Of the 124 children 67 (54%) were defined as obese based on a body mass index in the 95th percentile or greater (Pediatrics Sept. 20, 1010 [Epub doi:10.1542/peds.2009-3362]). Of these 124 children 19 (15%) had neutralizing antibodies specific to AD36. A whopping 78% of these AD36-positive children were obese. 

On average, children who were AD36-positive weighed almost 50 pounds more than their peers who were AD36-negative. In addition, obese children who were AD36-positive infection weighed an average of 35 pounds more than obese children who were AD36-negative. 

“Many people believe that obesity is one’s own fault or the fault of one’s parents or family,” Dr. Schwimmer commented in a prepared statement about the study (a downloadable video of Dr. Schwimmer highlighting the findings is also available). “This work helps point out that body weight is more complicated than it’s made out to be. And it is time that we move away from assigning blame in favor of developing a level of understanding that will better support efforts at both prevention and treatment.” 

— Doug Brunk (on Twitter@dougbrunk)

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Unhealthy Insurance

It might be an unfair overgeneralization to say that insurance companies make people sick, but a study presented at the annual meeting of the American Society for Metabolic & Bariatric Surgery looking into the consequences of morbidly obese patients who were denied coverage for bariatric surgery confirms that, in this population, insurers often stand in the way of helping people get well.

Image via Flickr user Leoncillo Sabino by Creative Commons License

Dr. Ayman B. Al Harakeh and colleagues at Gundersen Lutheran Medical Foundation in LaCrosse, Wis., compared the natural history and metabolic consequences of morbid obesity for patients who were denied bariatric surgery (despite satisfying NIH criteria and being deemed appropriate candidates) to that of patients who underwent laparoscopic Roux-en-Y Gastric Bypass at their institution from 2001-2007. Compared with the 587 patients in the LRYGB cohort, the 189 patients in the denials cohort were significantly more likely to develop new comorbidities, including diabetes, hypertension, obstructive sleep apnea, lipid disorders, and gastroesophageal reflux disease within a 3-year follow-up period, despite no change in BMI.

Because the data for the study were collected retrospectively through a medical record review, the specific reasons for the insurance denials were not available, according to Dr. Al Harakeh, who nonetheless lamented insurance companies’ apparent ability to deny bariatric surgery arbitrarily:  “Often, they just don’t want patients to have the surgery because of the high economic impact. We see that happen all the time.”

The findings indicate “a clear and present danger to at-risk obese patients,” according to discussant Dr. John Morton, director of bariatric surgery and surgical quality at Stanford Hospital and Clinics in Palo Alto, Cal., who stressed the need to investigate and, when appropriate, fight the insurance denials.

Dr. Al Harakeh and Dr. Morton disclosed no financial conflicts of interest.

—Diana Mahoney (Twitter @DMPM1)

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Getting Kids HEALTHY

Thank God – or school administrators, or Dr. Gary Foster, or kids who just want to have fun – thank anyone you want… but there’s finally some good news about childhood obesity. It came on June 27, at the annual meeting of the American Diabetes Association

The Move It Kids demonstrate fun fitness. By Flickr user nutrition educator.

 The results of the three-year HEALTHY Study are in, and while they might not be exactly what researchers hoped for, they’re plenty good. A three-pronged middle school program that improved food in schools, jacked up gym classes, and made it “cool” to be healthy, helped husky 6th-graders slim down by the time they were headed off to high school.  

Technically, the study didn’t succeed – that is, it did not meet the primary endpoint of decreasing the prevalence of a combination of overweight and obesity at target schools more than control schools. But by the end of the intervention, HEALTHY schools did have fewer kids with extremely high waist circumference, and fewer with a body mass index above the 95th percentile.  

The program seemed to work best in the kids who were already overweight or obese as 6th-graders. They were 21% less likely to be overweight or obese in 8th grade than students at the control schools. And they had a trend – though not a significant difference toward a greater reduction in the BMI z-score  by grade eight.  

Perhaps the best news in the study was its “failed” primary endpoint: By the end of the study both intervention and control schools saw significant decreases of 4% in the prevalence of kids who were overweight or obese. It’s not entirely clear why, but at a press briefing, Dr. Foster, a Temple University endocrinologist, suggested a few possibilities.  

The control schools had the same enrollment procedure as the intervention schools: All the 6th-graders had a health screening that included weight, blood pressure, a lipid panel, and insulin and fasting glucose levels. All the parents got a “health report card” describing their child’s status and suggesting a doctor visit if indicated. That might have been enough to stimulate some family changes that helped children shed pounds.  

Just as likely, he suggested, are societal trends. Maybe word of the looming avalanche of obesity-related diabetes, cancers, and cardiovascular disasters has finally penetrated the cacophony of advertisements suggesting that kids can live off the “Children’s Menu” diet – chicken fingers, french fries, and a soda.  

Whatever the reason, I’m thrilled: Last year, my son wanted to celebrate  his 13th birthday by taking some buddies to a theme park . Two of them — one “husky” and one frankly huge —  couldn’t take the strain of walking around a slightly hilly park on a warm late-April day. The bigger one ended up in the nurse’s station for 4 hours with a splitting headache and an upset stomach.  

It was a lesson learned for my son, though. He has moderated his own diet noticeably since then, referring several times to how sad it was that his lifelong, overweight friend couldn’t keep up, even in the race to have fun. 

— Michele G. Sullivan (on Twitter @MGsullivan)

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Fightin’ Words

The battle against adolescent obesity has been elevated to the status of war. “The incidence of adolescent obesity is rising meteorically and represents the largest healthcare crisis in young adults since Vietnam,” Dr. Robert Cywes said at the annual meeting of the American Society for Metabolic & Bariatric Surgery

Via Flickr Creative Commons user enviziondotnet

 

That being the case, he wondered, where is the outrage? Why — in the face of mounting evidence that procedures such as adjustable gastric banding are not only safe and effective, but may represent the most realistic option for achieving significant weight loss and improving multiple metabolic risk factors in adolescents — has the FDA not yet approved these procedures for use in adolescents? 

Dr. Cywes of Jacksonville Surgical Associates in Florida — who does have a financial relationship with gastric band maker Allergan — presented data from a retrospective study looking at the outcomes of 402 obese adolescents (mean BMI 43) who underwent “off-label” adjustable gastric banding from 2005-2009 following extensive pre-operative psychological, nutritional, and lifestyle assessment and counseling, and showed that patients’ mean BMI declined to 35.7 and 31.9, respectively, at six months and one year. Additionally, of the 38 patients who had complete follow-up data at 4 years, the mean BMI was 27.8. 

In a separate study looking at the outcomes of 17 morbidly obese adolescents who underwent gastric banding surgery as part of an FDA investigational device exemption study, Dr. Kirk Reichard of Nemours, A. I. Dupont Hospital for Children in Wilmington, Del., and his colleagues observed significant improvements in weight, waist circumference, systolic blood pressure, and HDL cholesterol—all “clinically significant changes given the difficulty of achieving these results in an otherwise treatment-resistant population,” he said. 

While the sustainability of these observed changes  still need to be evaluated over time, the findings suggest that the “the FDA should accelerate the lifting of barriers to banding in this population,” said Dr. Cywes. “The question is no longer whether laparoscopic adjustable gastric banding is safe or effective [in adolescents]. The question is whether it is negligent not to offer it as an option for the treatment of severely obese children.” 

— Diana Mahoney 

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