Health-Medical-Fitness-Diet-zk: Obesity

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duminică, 5 august 2012

Obesity: Are Americans Ready To Solve The Weight Of The Nation?

In a Perspective article appearing in this week's New England Journal of Medicine, public health researchers examine how recommendations in a new report from the Institute of Medicine (IOM) - "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation" - square with American's opinions about the obesity epidemic.

Over the last 30 years, rates of obesity have doubled among adults and tripled among children. The new IOM report summarizes growing evidence that these increases have been driven by a complex interaction of changes in the environments in which we live - our schools, our workplaces, our communities, in the media and in our food and beverage systems.

While praising the IOM report's scope and vision, Colleen L. Barry, PhD, MPP, associate professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and lead author of "Are Americans Ready to Solve the Weight of the Nation?" says that it is critical to understand how the public thinks about the problem of obesity. Barry notes that one recent poll found that 64 percent of Americans believe personal decisions - overeating, lack of exercise, watching too much television - are the biggest contributors to obesity. However, only 18 percent of Americans attribute environmental factors, such as safe places for children to play, access and availability of healthy foods and exposure to junk food, as major contributors.

"If people think obesity is all about individuals and parents making bad choices, they will be much less likely to embrace changes in schools, communities and food marketing practices aimed at creating healthier environments," said Barry.

Jeff Niederdeppe, PhD, assistant professor of communication at Cornell University and a co-author of the article, emphasized the need for "a research-driven communication strategy to encourage a better understanding of the environmental determinants of obesity among the public, and to emphasize the importance of waging a collective response to the epidemic." The IOM report was accompanied by a four-part HBO documentary series, "The Weight of the Nation," which Niederdeppe described as a great example of the kind of communication partnerships that are needed.

However, communications efforts on obesity should include careful attention to "the potential to increase already high levels of stigma toward obese adults and children, which can have lifelong psychological, social and health consequences," according to Sarah E. Gollust, PhD, assistant professor at the University of Minnesota School of Public Health and a co-author of the Perspective article. Gollust noted that the IOM recognized this concern and explicitly included as a guiding principle the notion that obesity prevention should not be achieved at the expense of overweight or obese individuals' well-being.

The authors concluded that while widespread awareness of obesity's causes and consequences will be necessary, increased awareness alone will not be sufficient to put in place the extensive actions that the IOM report stipulated will be necessary. A favorable political environment as well as leadership in multiple sectors and grassroots advocacy will be needed to support the efforts of the public health community to reduce obesity.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject. Public opinion data reported in article was collected by the authors through a grant from the Robert Wood Johnson Foundation Healthy Eating Research program.
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Study Identifies Discrepancies Between National Surveys Tracking Obesity

Despite the increasing awareness of the problem of obesity in the United States, most Americans don't know whether they are gaining or losing weight, according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Obesity increased in the US between 2008 and 2009, but in response to the questions about year-to-year changes in weight that were included in the most widespread public health survey in the country, on average, people said that they lost weight. Men did a worse job estimating their own weight changes than women. And older adults were less attuned to their weight changes than young adults. The findings are being published in the article "In denial: misperceptions of weight change among adults in the United States" * in the August edition of Preventive Medicine.

"If people aren't in touch with their weight and changes in their weight over time, they might not be motivated to lose weight," said Dr. Catherine Wetmore, the lead author on the paper. "Misreporting of weight gains and losses also has policy implications. If we had relied on the reported data about weight change between 2008 and 2009, we would have undercounted approximately 4.4 million obese adults in the US."

A range of public health campaigns in recent years have urged Americans to lose weight to lower their chances of developing heart disease, diabetes, and other chronic conditions. To understand whether people in the US are heeding this advice, Dr. Wetmore, a former Post-Graduate Fellow at IHME and now a biostatistician at Children's National Medical Center, and IHME Professor Dr. Ali Mokdad compared self-reported changes in body weight between 2008 and 2009.

They used data from the Behavioral Risk Factor Surveillance System (BRFSS), a yearly cross-sectional survey of adults in the US designed to monitor leading risk factors for morbidity and mortality nationwide. More than 775,000 people were surveyed in the years analyzed, and they were asked multiple questions about their weight, including how much they weighed on the day of their interview and how much they weighed one year prior to their interview.

The researchers found that, on average, American adults gained weight over the study period - because the reported weights increased between the 2008 and 2009 surveys - but the 2009 study participants told surveyors that they had lost weight during the previous year. Based on the weights they reported, the prevalence of obesity in the US would have declined from 2008 to 2009. Instead, the prevalence of obesity inched upward from 26% to 26.5%, and average weight increased by about one pound per person between 2008 and 2009.

"We all know on some level that people can be dishonest about their weight," Dr. Mokdad said. "But now we know that they can be misreporting annual changes in their weight, to the extent of more than two pounds per year among adults over the age of 50, or more than four pounds per year among those with diabetes. On average, American adults were off by about a pound, which, over time, can really add up and have a significant health impact."

Not everyone reported losing weight. The researchers found that reports of unintentional weight gain were more common in specific groups: men and women under the age of 40 those identifying as black, Native American, or Hispanic current and former smokers those consuming less than five servings of fruits and vegetables per day those reporting no physical activity those with diagnosed chronic diseases, frequent poor mental health, and insufficient sleep those lacking health care coverage "It's very popular right now to talk about the underlying environmental causes of obesity, whether it's too much fast food or not enough parks," Dr. Wetmore said. "While we know that the environment definitely plays a role, these results show that we need to do a better job helping people to be aware of what's going on with their own bodies." Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Gut Microbe Changes That Usually Promote Obesity And Diabetes Are Beneficial During Pregnancy

The composition of microbes in the gut changes dramatically during pregnancy, according to a study published by Cell Press in the August 3rd issue of the journal Cell. Although these changes are associated with metabolic disease under most circumstances, they could be beneficial in pregnant women.

"This is the first in-depth characterization of the gut microbiota associated with pregnancy," says senior study author Ruth Ley of Cornell University. "The findings suggest that our bodies have coevolved with the microbiota and may actually be using them as a tool - to help alter the mother's metabolism to support the growth of the fetus."

In nonpregnant animals, changes to gut microbe composition can cause symptoms of metabolic syndrome, including weight gain, abnormal glucose metabolism, and inflammation - an immune response that normally protects the body but can cause health problems. These symptoms also appear during pregnancy, but the underlying causes have been unclear, and few studies have examined the potential link to gut microbiota during pregnancy.

To address this question, Ley and her team obtained stool samples from 91 pregnant women. They found that gut microbes changed in composition from the first trimester to the third trimester, becoming less "normal" and less diverse over time. Health-boosting bacteria decreased in abundance, while disease-related bacteria increased in number. In addition, signs of inflammation increased over the course of the pregnancy. "The changes in gut microbes were not related to diet, so we think the immune system or hormones play a role," Ley says.

When gut microbes from pregnant women were transferred to healthy germ-free mice, animals that received microbes from the third trimester became fatter and had higher levels of inflammation markers and worse glucose metabolism than mice that received microbes from the first trimester.

"By the third trimester, the microbiota can induce changes in metabolism," Ley says. "In the context of pregnancy, these metabolic changes in the mother are healthy, because they promote energy storage in fat tissue and help support the fetus. Outside of pregnancy, however, these changes can lead to the development of type 2 diabetes and other health problems."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. Koren et al.: "Remodeling of the gut microbiome and metabolic changes during pregnancy."
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Hope For New Obesity And Diabetes Treatments From Mechanism That Turns White Fat Into Energy-Burning Brown Fat

Columbia University Medical Center (CUMC) researchers have identified a mechanism that can give energy-storing white fat some of the beneficial characteristics of energy-burning brown fat. The findings, based on studies of mice and of human fat tissue, could lead to new strategies for treating obesity and type 2 diabetes. The study was published in the online edition of the journal Cell.

Humans have two types of fat tissue: white fat, which stores excess energy in the form of triglycerides, and brown fat, which is highly efficient at dissipating stored energy as heat. Newborns have a relative abundance of brown fat, as protection against exposure to cold temperatures. In adults, however, almost all excess energy is stored as white fat.

"Turning white fat into brown fat is an appealing therapeutic approach to staunching the obesity epidemic, but it has been difficult to do so in a safe and effective way," said study leader Domenico Accili, MD, professor of Medicine and the Russell Berrie Foundation Professor at CUMC.

White fat can be "browned" with a class of drugs called thiazolidazines (TZDs), which increase the body's sensitivity to insulin. However, TZDs have many adverse effects - including liver toxicity, bone loss, and, ironically, weight gain - which have limited the use of these drugs.

The current study was undertaken to learn more about the function of TZDs, with the ultimate goal of developing better ways to promote the browning of white fat.

Scientists have known that TZDs promote the browning of white fat by activating a cell receptor called peroxisome proliferator-activated receptor-gamma (ppar-gamma), but the exact mechanism was not clear. To learn more, Dr. Accili and his colleagues studied a group of enzymes called sirtuins, which are thought to affect various biological processes, including metabolism.

The researchers had previously shown in mice that when sirtuin activity increases, so does metabolic activity. In the present study, they found that sirtuins boost metabolism by promoting the browning of white fat. "When we sought to identify how sirtuins promote browning, we observed many similarities between the effect of sirtuins and that of TZDs," said lead author Li Qiang, PhD, associate research scientist in Medicine at CUMC.

Sirtuins work by severing the chemical bonds between acetyl groups and proteins, a process known as deacetylation. "So the next question was whether sirtuins remove acetyl groups from ppar-gamma and, indeed, that was what we found," said Dr. Qiang.

To confirm that the deacetylation of ppar-gamma is crucial to the browning of fat, the researchers created a mutant version of ppar-gamma, in effect mimicking the actions of sirtuins. The mutation promoted the development of brown fat - like qualities in white fat.

"Our findings have two important implications," said Dr. Accili. "First, they suggest that TZDs may not be so bad - if you can find a way to tweak their activity. Second, one way to tweak their activity is by using sirtuin agonists - that is, drugs that promote sirtuin activity."

"The truth is, making sirtuin agonists has proved to be a real bear - more promise than fact," he continued. "But now, for the first time, we have a biomarker for good sirtuin activity: the deacetylation of ppar-gamma. In other words, any substance that deacetylates ppar-gamma should in turn promote the browning of white fat and have a beneficial metabolic effect."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject. Dr. Accili's paper is titled, "Brown Remodeling of White Adipose Tissue by SirT1-Dependent Deacetylation of Ppar-gamma." The other contributors are Ning Kon (CUMC), Wenhui Zhao (CUMC), Sangkyu Lee (University of Chicago, Chicago, Illinois), Yiying Zhang (CUMC), Michael Rosenbaum (CUMC), Yingming Zhao (University of Chicago), Wei Gu (CUMC), and Stephen R. Farmer (Boston University School of Medicine, Boston, Mass.)
This research was supported by grants from the National Institutes of Health (HL087123, DK58282, DK64773, DK063608, and RR024156).
The authors declare no financial or other conflicts of interest.
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The Impact Of Obesity On Donor Acceptability In Pediatric Liver Transplant Recipients

Children undergoing liver transplantation are at greater risk of graft loss and death from adult organ donors who are severely obese according to research published in the August issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases. The study, funded in part by a grant from the National Institutes of Health (NIH), found that pediatric donor body mass index (BMI) did not increase mortality risk in this pediatric population.

Obesity is a global health concern. A 2008 report from the World Health Organization (WHO) estimates that 1.4 billion adults were overweight, and of these 200 million men and 300 million women were classified as obese. WHO also reports that more than 40 million children under the age of five were overweight in 2010. In the U.S., rates of being overweight or obese have risen in children and now exceed 30% say experts.

Prior research shows the prevalence of overweight and obese donors to adult liver transplant recipients has increased during the last two decades. "Donor BMI is associated with post-transplant obesity, but not survival rates of adult liver recipients," explains lead author Dr. Philip Rosenthal, from the University of California, San Francisco's Benioff Children's Hospital. "Our study is the first to evaluate the impact of donor BMI on pediatric liver transplant recipients."

Using data from the United Network for Organ Sharing (UNOS), researchers identified 3788 pediatric liver transplants between 2004 and 2010. Analysis indicates that adult donor BMI 25-35 kg/m2 was not associated with graft loss or mortality in pediatric liver recipients. However, adult donors with a BMI greater than 35 kg/m2 increased the risk of graft loss and death in children receiving livers, after adjusting for other recipient, donor, and transplant risk factors. The authors found that pediatric donor BMI was not associated with graft or patient survival.

"While we found it common for adult donors to be overweight or obese, our analysis suggests that BMI in the 25 to 35 range should not deter liver donation," concludes Dr. Rosenthal. The authors note that causes of graft loss, death, and donor steatosis could not be determined due to lack of donor biopsies. Rosenthal added, "Further research is needed to understand the impact of obesity on donor acceptability and how this affects pediatric liver transplant patients."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our transplants / organ donations section for the latest news on this subject. Full citation: "An Evaluation of the Impact of Donor BMI on Survival and Post-Transplant Obesity in Pediatric Liver Transplant Recipients." Emily Rothbaum Perito, Sue Rhee, Dave Glidden, John Paul Roberts, Philip Rosenthal. Liver Transplantation; Published Online: July 24, 2012 (DOI: 10.1002/lt.23438) Print Issue Date: August, 2012. URL: http://onlinelibrary.wiley.com/doi/10.1002/lt.23438/abstract
About the Author: Dr. Philip Rosenthal is with the University of California, San Francisco's Benioff Children's Hospital.
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joi, 15 decembrie 2011

Orangutans That Have Survived Extreme Food Scarcity May Provide Better Understand Of Obesity And Eating Disorders In Humans

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Eating Disorders; Veterinary
Article Date: 15 Dec 2011 - 0:00 PST

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Rutgers Evolutionary Anthropologist Erin Vogel thinks new research published in Biology Letters, a Journal of the Royal Society, examining how endangered Indonesian orangutans - considered a close relative to humans - survive during times of extreme food scarcity might help scientists better understand eating disorders and obesity in humans.

"There is such a large obesity epidemic today and yet we don't really understand the basis of the obesity condition or how these high-protein or low-protein diets work," said Vogel, whose research, Bornean orangutans on the brink of protein bankruptcy, represents the first time scientists have looked at how these long-haired, orange-colored apes - that depend on low-protein fruit to survive - endure protein cycling, or period bouts of protein deprivation. "I think studying the diets of some of our closest living relatives, the great apes; may help us understand issues with our own modern day diets," she said.

According to Vogel, an assistant professor of anthropology in Department of Anthropology and Center for Human Evolutionary Studies, in the School of Arts and Sciences, the research shows that it is only during high periods of high caloric and protein intake that orangutans put on fat, a scientific fact that is sometimes ignored by those who believe that high protein, low carbohydrate diets are the best way to lose weight. She said it is only when caloric intake is restricted that orangutans use these fat reserves for energy and eventually dip into their protein (muscle) reserves - a condition that is seen with eating disorders like anorexia.

Orangutans in particular are interesting to study, Vogel said, because they are the only documented species of non-human ape to store fat when food is abundant in the wild and use these fat reserves when preferred fruits become scarce, presumably something done by our early hominin ancestors.

Vogel and her research team, analyzed samples collected over a five-year period to study the effects of protein recycling, which included examining urinary metabolites and nitrogen stable isotopes - compounds and byproducts in Orangutan urine. What they determined is that these primates are able to endure prolonged protein deficits without starving to death by consuming higher protein leaves and inner bark and obtaining energy from their stored body fat and even muscles for an extended period of time when low-protein fruit is unavailable.

"We discovered through this research that the daily amount of protein the orangutans take in when fruit is not available is inadequate for humans and one-tenth of the intake of mountain gorillas. But it is sufficient to avert a severe protein deficit," said Vogel. The Bornean orangutan population has fallen drastically in the last 50 years in Indonesia to less than 55,000 and on the island of Sumatra to less than 5,000 due to a massive amount of illegal logging and further clearing of the land to develop palm oil plantations in their now impoverished rainforest habitat. Vogel says that although some palm oil companies argue that clearing partially logged areas of the rainforest for palm oil plantations is not detrimental to the existence of the orangutan because their natural habitat has already been taken away, this research on protein cycling indicates that even areas that have been partially stripped of trees are better for orangutan survival than no forest area at all.

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joi, 8 decembrie 2011

Obesity And Diabetes Undermining America's Overall Health

Editor's Choice
Main Category: Public Health
Also Included In: Obesity / Weight Loss / Fitness; Diabetes
Article Date: 08 Dec 2011 - 6:00 PST

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America's overall health is being undermined by obesity and diabetes, other chronic diseases, and child poverty; these detriments have been deemed greater than the benefits from improvements in cardiovascular deaths, preventable hospitalizations and smoking cessation, says a new report titled 2011 America's Health Rankings.

The Rankings is a collaboration between United Health Foundation, the America Public Health Association, and Partnership for Prevention.

No improvement in overall health - while the country's overall health improved by an average of 0.5% from 2000 to 2010 and 1.6% since the 1990s, the rate was unchanged from 2010 to 2011, the authors wrote.

Vermont is still the healthiest state in the USA, and has been so for the last five years. New York and New Jersey moved up six places and are the most improved states - mainly due to the impressive numbers of people who gave up smoking. Idaho has slipped from ninth to nineteenth place, while Alaska went down five places.

Below are the five healthiest and five unhealthiest states, according to the report:

United Health Foundation board member and executive vice president and chief of medical affairs, UnitedHealth Group, Reed Tuckson, M.D., said:

"Where people live matters. Every state can make improvements to ensure healthier quality of lives for their residents. In the history of the Rankings, we have seen many examples of stakeholders coming together to improve their standing.
States such as Tennessee and Maine - which made explicit efforts to improve their rankings - have shown us that improved public health is achievable but must be tackled in a concerted and aggressive way."

Jud Richland, M.P.H., president and CEO of Partnership for Prevention, said:

"The Rankings provides comprehensive data states can use to develop prevention solutions and health-improvement plans - empowering their residents to live long, healthy and productive lives."

The authors explain that their latest Rankings give a snapshot of each state, and is based on 23 measures that include several promising trends: Smoking - there are 25.4% fewer smokers in the USA today than in 2001. In 2011, 17.3% of US adults smoked, compared to 17.9% a year before.Preventable hospitalizations - there were 68.2 preventable hospitalizations per 1,000 Medicare beneficiaries in 2011, compared to 70.6 a year before - 17.3% less than in 2001.Cardiovascular deaths - in 2011, there were 270.4 cardiovascular deaths per 100,000 people, compared to 278.2 a year before - a 22.2% drop since 2001.The following undesirable trends more than offset improvements: Childhood poverty - 21.5% of US children lived in poverty in 2011, compared to 20.7% a year before - 33.5% more than in 2001.Diabetes - 8.7% of US adults were diagnosed with diabetes in 2011, compared to 8.3% a year before - 42.6% higher than in 2001.Obesity - the national adult obesity rate reached 27.5% in 2011, compared to 26.9% a year before - up 37.5% compared to 2001. This year is the first in which not one US state has an obesity rate below 20%.The authors remarked on how good and bad trends erased each other out - for every person who gave up smoking in 2011, another became obese.

Dr. Tuckson said:

"While this year's Rankings shows some important improvements, we also see some very alarming trends - particularly diabetes and obesity - that, left unchecked, will put further strain on our country's already strained health care resources.
At a time when the nation, states and individual families are grappling with tightening budgets and growing health care expenses, this year's Rankings sends a loud wakeup call that the burden of preventable chronic disease will continue to get worse unless we take urgent action.
Broad collaboration is the only path to health and financial progress. Government, the private sector, philanthropy and community-based organizations all need to join in a data-driven process to determine and address priorities."

Georges C. Benjamin, M.D., executive director of the American Public Health Association, said:

"Addressing the leading causes of these largely preventable diseases is essential if we are going to improve the nation's health. America's Health Rankings gives us a tool to gauge where we are and where we need to go, and the numbers should drive us to action."

Even though smoking prevalence has dropped from 29.5% in 1990 to 17.3% this year, it is still the cause of 1 in every 5 premature deaths per year (443,000). In 1990, only 11.6% of US adults were obese, compared to 27.5% this year, an increase of 137%. More than 1 in every 4 adults are obese today; approximately 65 million people. Obesity prevalence continues to increase and is costing the nation $147 billion just in direct health care expenditure. Experts say the main reason for the obesity explosion is bad eating habits and lack of physical activity. There are over 20 million adults in the USA today who have been diagnosed with diabetes, i.e. 8.7% of all adults. In 1996, the figure was 4.4%. Studies have indicated that within the next four decades between 1 in every 3 to 5 adults will have been diagnosed with diabetes. The authors say this means there are millions of people today who are either at risk of developing diabetes, or already have it but do not know (have not yet been diagnosed).

By the end of this decade, about 10% of all health care spending will be channeled towards treating diabetes and prediabetes - an annual total of nearly $500 billion (compared to $208 billion today).

Written by Christian Nordqvist
Copyright: Medical News Today
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Obesity Linked To Worse Outcomes In Early Breast Cancer Treatment

Main Category: Breast Cancer
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 08 Dec 2011 - 3:00 PST

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Obesity is associated with worse outcomes overall in early-stage breast cancer, researchers reported at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

Obesity was linked to shorter time to recurrence (TTR), disease-free survival (DFS) and overall survival (OS). The exception was treatment with endocrine therapy (mainly tamoxifen), in which obesity was associated with a protective effect.

"The findings add to the body of evidence indicating that obesity, in general, increases a patient's chance for having a worse prognosis," said lead researcher Sao Jiralerspong, M.D., Ph.D., an assistant professor of medicine at Baylor College of Medicine.

"Obesity is a probable risk factor for worse breast cancer outcomes, and ours is the latest study to suggest it has an effect on treatment outcome as well," Jiralerspong said.

Using data from the Lester and Sue Smith Breast Center at Baylor, Jiralerspong and colleagues examined the link between weight and treatment modality in 4,368 patients treated between 1970 and 1995.

For the group as a whole, data revealed that overweight patients had similar outcomes to normal-weight patients, but obese patients had an increased risk for worse TTR, DFS and OS.

Among patients who received no adjuvant chemotherapy or endocrine therapy, there was a trend for worse survival outcomes in obese patients compared with normal-weight patients.

Obese patients who received chemotherapy fared significantly worse compared with normal-weight patients, "with the magnitude of this effect approaching that of the degree of benefit expected from chemotherapy," Jiralerspong said.

In contrast, overweight patients who received endocrine therapy, predominantly tamoxifen, fared significantly better compared with normal-weight patients.

"Finding that overweight patients have a better outcome than normal-weight patients after tamoxifen treatment is surprising. We are examining the possible reasons for this," Jiralerspong said.

He said that obesity could contribute to worse outcomes because of biological factors associated with excess weight, such as higher blood insulin and estrogen levels, inflammation and growth factors secreted by fat cells. But Jiralerspong also added that more research is needed to understand the effect of body mass on adjuvant treatment because of the unexpected findings and because additional agents are in use today compared with the time period studied.

The study was funded by the Lester and Sue Smith Breast Center at Baylor College of Medicine.

Article adapted by Medical News Today from original press release. Source: American Association for Cancer Research
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