The U.S. Food and Drug Administration today approved Kybella (deoxycholic acid), a treatment for adults with moderate-to-severe fat below the chin, known as submental fat. Using Kybella for the treatment of fat outside of the submental area is not approved and is not recommended. [Read more…]
The number of states with an obesity prevalence of 30 percent or more has tripled in two years to nine states in 2009, according to a CDC Vital Signs report. In 2000, no state had an obesity prevalence of 30 percent or more. The report, “State-Specific Obesity Prevalence Among Adults – United States, 2009,” also finds no state met the nation’s Healthy People 2010 goal to lower obesity prevalence to 15 percent.
The data show a 1.1 percentage point increase—an additional 2.4 million people—in the self-reported prevalence of obesity between 2007 and 2009 among adults aged 18 and over. The report also notes the medical costs associated with obesity are high. In 2008 dollars, medical costs associated with obesity were estimated at $147 billion. People who are obese had medical costs that were $1,429 higher than those of normal weight, the report said.
“Obesity continues to be a major public health problem,” said CDC Director Thomas Frieden, M.D., M.P.H. “We need intensive, comprehensive and ongoing efforts to address obesity. If we don’t more people will get sick and die from obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of death.”
The August Vital Signs report is based on new data from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS contains state-level public health data and provides a way for states to monitor progress toward Healthy People goals. To assess obesity prevalence, approximately 400,000 phone survey respondents were asked to provide their height and weight, which was used to calculate their body mass index (BMI). An adult is considered obese if he or she has a BMI of 30 or above. For example, a 5-foot-4 woman who weighs 174 pounds or more, or a 5-foot-10 man who weighs 209 pounds or more has a BMI of 30, and so is considered obese.
The BRFSS obesity data are underestimates of true obesity prevalence. Research has found that both men and women often say they are taller than they actually are and women often say they weigh less than they do in telephone surveys. As a result, according to William Dietz, M.D., Ph.D., director of CDC’s Division of Nutrition, Physical Activity and Obesity, the overall BRFSS obesity prevalence estimate of 26.7 percent is 7.2 percentage points lower than the national 2007-2008 estimate of 33.9 percent (nearly 73 million people) from the National Health and Nutrition Examination Survey, for which individuals’ height and weight were measured rather than self-reported.
The BRFSS data highlight how obesity affects some populations more than others. The highest prevalence was found among non-Hispanic blacks overall, whose rate was 36.8 percent, and non-Hispanic black women, whose rate was 41.9 percent. The rate for Hispanics was 30.7 percent. The rate among all non-high school graduates was 32.9 percent. Obesity prevalence was also higher in some regions than others. The South had an obesity prevalence of 28.4 percent while the Midwest had a prevalence of 28.2 percent.
“Obesity is a complex problem that requires both personal and community action,” said Dr. Dietz. “People in all communities should be able to make healthy choices, but in order to make those choices there must be healthy choices to make. We need to change our communities into places where healthy eating and active living are the easiest path.”
The typical dose of a medication considered pivotal in treating tuberculosis effectively is much too low to account for modern-day physiques, UT Southwestern Medical Center researchers said.
The finding, reported online and in the August edition of Antimicrobial Agents and Chemotherapy, is particularly important for those living in societies plagued by obesity, said Dr. Tawanda Gumbo, associate professor of internal medicine at UT Southwestern and the study’s lead author.
“What really drives the variability of this particular drug is patient weight and gender, so in our simulations we took that into account,” Dr. Gumbo said. “What we found is that we’re really using doses for very skinny people – 105 to 110 pounds. I haven’t met many adults who are at that weight.”
About one-third of the world’s population is infected with Mycobacterium tuberculosis, the bacterium that causes TB, and as many as 2 million people die from the disease each year. TB, which is the leading cause of death among people infected with HIV/AIDS, kills more people than any other disease caused by a single infectious agent, according to the National Institutes of Health. Treatment usually lasts six to 12 months and includes a combination of antibiotics such as Pyrazinamide, the drug examined in this study.
Because treatment typically includes multiple drugs, introducing new ones to existing regimens has made it harder to identify which, if any, of the drugs are working at the current dosage levels. Researchers also have struggled to identify the needed dosage as well as exactly where in the body these drugs work to combat the bacterium.
The new model developed at UT Southwestern uses cultured cells to gauge the effectiveness and proper dosage of anti-tuberculosis drugs.
“With this model, we can directly test molecules that have the potential to shorten therapy and go straight to coming up with the doses that you would use in patients,” Dr. Gumbo said. “What that means is that if you have a molecule that could cure TB in one month in this model, it stands a good chance that it would do the same in patients.”
For this study, the researchers gave patients Pyrazinamide – an older drug generally used in combination with other drugs – daily for one month. The researchers then used the data collected to calculate how much bacteria the drug killed before resistance emerged. They opted to focus on Pyrazinamide because physicians once used it alone to treat the disease, so there are many studies documenting precisely how the drug behaves in patients – something that is unclear for some newer drugs.
When the UT Southwestern researchers began testing Pyrazinamide in the lab, they found that the concentration of the drug declined at a rate that matches the rate seen in patients.
“In patients, unlike in test tubes, it’s not a constant concentration. A patient given multiple drugs degrades each of them at different rates,” he said. “Using this model, we can actually copy this concentration profile of the drugs to human-like exposures.”
Dr. Gumbo said his team’s finding that the doses traditionally given to tuberculosis patients are much too low suggests that different doses are probably needed in different countries. “Most of the patients we see here in Dallas are not 110 pounds unless they have some other severe disease,” he added.
The next step, Dr. Gumbo said, is to continue researching drug combinations in order to devise the optimum treatment regimen for tuberculosis patients.
“We’ve rationally and scientifically come up with a dose that depends not just on the kinetics or the concentration time profile of patients, but also how the bug itself responds to that particular drug,” he said. “So, instead of using the average patient or a mean patient, we can now project how a drug combination will fare in actual patients. With this model, researchers can use these simulations to determine the duration of therapy, which could shorten from years to months.”
Source: Antimicrobial Agents and Chemotherapy, August, 2009.
Fen-phen was once regarded as a miracle weight-loss drug, but when it induced heart valve lesions and mother life-threatening side effects, it was taken off the market. UT Southwestern Medical Center scientists are exploring Fen-phen’s behavior in the brain so that safer anti-obesity drugs with less side effects can be developed.
In a recent study, the researchers define a circuit in the brain that explains the ways fenfluramine, a component of Fen-phen, suppresses appetite.
“Our findings provide evidence that the neural circuit we’ve proposed is sufficient for the neurotransmitter serotonin to regulate food intake and body weight, ” said Dr. Joel Elmquist, professor of internal medicine and pharmacology at UT Southwestern and senior author of the study. “Fen-phen works directly on this pathway. Unfortunately, that drug also adversely affects peripheral tissue such as the heart.”
Mice were engineered for the current study, in which the expression of a serotonin receptor called 5-hydroxytryptamine 2C was blocked throughout the entire body. Previously, this produced obese mice resistant to the anorexic actions of fenfluramine. When activated by serotonin, however, this receptor is also known to suppress appetite. Using this mouse model, the authors engineered another set of mice in which the same serotonin receptor was blocked everywhere in the body except within a group of brain cells called pro-opiomelanocortin, or POMC, neurons. The POMC neurons, which are found in the hypothalamus, are also known to play an important role in suppressing appetite and inducing weight loss.
The scientists noted that the animals with no serotonin 2c receptors expectedly developed obesity as well as other metabolism disorders such as increased food intake, hyperactivity and leptin insensitivity. They also were prone to spontaneous seizures, said Dr. Elmquist. The mice in which the serotonin receptor was fre-expressed and functioning only in the POMC neurons stayed slim and responded to fenfluramine.
“The POMC-specific reactivation of the receptor only in POMC neurons normalizes the abnormal metabolism in these mice,” Dr. Elmquist said. “The animals don’t eat excessively. Their hyperactivity is also gone.”
Previous work from the UT Southwestern group led to the hypothesis that Fen-phen worked by activating the serotonin 2c receptor in the POMC neurons in the hypothalamus. The current work provides genetic proof supporting this model.
“Conventional wisdom is that fenfluramine increases serotonin release that then activates serotonin receptors in the brain to regulate food intake and body weight, but unfortunately, this drug also causes lesions in heart valves,” he said. “If you could develop a drug that would travel to both the brain and the peripheral tissues, and then give a blocker to protect the heart, it’s possible that you could prevent the harmful side effects and still aid weight loss. Admittedly, that’s a bit farfetched, but this mouse model could be used to test that theory.”
The team’s next step is to determine whether they’ve identified the sole circuit required to suppress appetite and induce weight loss.
The American Academy of Pediatrics has issued new cholesterol screening and treatment recommendations for children that suggest cholesterol screening, and possible use of statins for certain children.
The policy statement, “Lipid Screening and Cardiovascular Health in Childhood,” recommends cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. It also recommends screening patients whose family history is unknown or those who have other factors for heart disease including obesity, high blood pressure or diabetes.
The AAP suggests that screening should take place after age two, but no later than age 10. The best method for testing, according to the organization’s policy statement, is a fasting lipid profile. If a child has values within the normal range, testing should be repeated in three to five years.
The American Academy of Pedatrics suggests that for children who are more than eight years old and who have high LDL concentrations, cholesterol-reducing medications should be considered. Younger patients with elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling.
The policy statement also recommends the use of reduced-fat dairy products, such as two percent milk, for children as young as one year of age for whom overweight or obesity is a concern.
Source: American Academy of Pediatrics, July 7, 2008
The results of a new study show that the overall health of obese teenagers improved after they underwent laparoscopic gastric banding surgery.
The study’s lead author, Ilene Fennoy, MD, a pediatric endocrinologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and clinical professor of pediatrics at Columbia University College of Physicians and Surgeons, said that this type of surgery – called the Lap Band procedure – is a safe and effective way for morbidly obese teens to lose weight. The procedure has been approved for use in adults by the FDA, but not yet for teenagers.
Dr. Fennoy observed that obesity-related health problems, such as diabetes and high blood pressure, are common in extremely obese teenagers, who have had to rely on non-surgical methods or high-risk surgeries to lose weight; and to date few treatments have been effective in helping adolescents. “Laparoscopic gastric banding offers the possibility of a new therapy for morbidly obese adolescents who have medical complications,” Dr. Fennoy said.
The study involved 14 morbidly obese adolescents, 6 boys and 8 girls, aged between 14 and 17 years, with the objective of documenting the impact of Lap-Band on the medical complications of obesity or their risk factors.
In order to shrink the stomach without using staples, a band goes round the upper part of the stomach, to create a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible.
Dr. Fennoy stated that patients lost an average of 20 pounds within 6 months of the operation. While blood pressure remained virtually unchanged, major improvements were noted, including levels of fat in the blood, average blood sugar, liver function and a measure of immune response.
“Laparoscopic gastric banding provides a reasonable solution for obese young people who need to lose a large amount of weight,” Fennoy said.
Source: Endocrine Society, 9th Annual Meeting, June, 2008
The results of the Multiethnic Study of Atherosclerosis (MESA) identifies "the biological effects of obesity on the heart" as a serious reason for 72 million overweight Americans to worry about their health.
Senior study investigator Joao Lima, M.D., says "Even if obese people feel otherwise healthy, there are measurable and early chemical signs of damage to their heart, beyond the well-known implications for diabetes and high blood pressure. Now there is even more reason for them to lose weight, increase their physical activity and improve their eating habits."
The development of heart failure of some 7,000 mean and women, aged 45 to 84 was followed by researchers conducting the MESA study, which started in 2000. To date, of the 79 participants who developed congestive heart failure 44% were obese with a body mass index (BMI) of 30 or more. They were also found to have higher blood levels of interleukin 6, C-reactive protein and fibrinogen, key immune system proteins involved in inflammation, than non-obese adults. An 84% greater risk of developing heart failure was accounted for by a near doubling of average interleukin 6 levels.
The links between inflammation and the combination of risk factors known as the metabolic syndrome alarmed the researchers from 5 U.S. universities.
The researchers from five universities across the United States also found alarming links between inflammation and the dangerous mix of heart disease risk factors known as the metabolic syndrome. Its combined risk factors for heart disease and diabetes—high blood pressure, elevated blood glucose levels, excess abdominal fat and abnormal cholesterol levels, and particularly obesity—double a person’s chances of developing heart failure.
"More practically, physicians need to monitor their obese patients for early signs of inflammation in the heart and to use this information in determining how aggressively to treat the condition," says Lima, a professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart Institute. "Our results showed that when the effects of other known disease risk factors—including race, age, sex, diabetes, high blood pressure, smoking, family history and blood cholesterol levels—were statistically removed from the analysis, inflammatory chemicals in the blood of obese participants stood out as key predictors of who got heart failure," says Lima.
The study found that higher levels of interleukin 6 and a tripling of average levels of C-reactive protein in study subjects increased the possibility of heart failure by 36%.
What this tells us is that both obesity and the inflammatory markers are closely tied to each other and to heart failure," says lead researcher Hossein Bahrami, M.D., M.P.H. Bahrami, a senior cardiology research fellow at Hopkins, says "the basic evidence is building the case that inflammation may be the chemical route by which obesity targets the heart, and that inflammation may play an important role in the increased risk of heart failure in obese people, especially those with the metabolic syndrome."
Each year, nearly 300,000 Americans die from heart failure.
Source: Journal of the American College of Cardiology, May 6, 2008
Obese women with breast cancer have lower rates of survival, and suffer a more intense form of the disease, according to recently-published research.
"The more obese a patient is, the more aggressive the disease," said Massimo Cristofanilli, MD, associate professor of medicine in the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center. "We are learning that the fat tissue may increase inflammation that leads to more aggressive disease."
606 women with breast cancer were observed by Cristofanilli and colleagues, and classified by body mass index into three groups—normal/underweight (24.9 or below), overweight (at least 25 but less than 30), or obese (more than 30). At five years, overall survival was 56.8 percent among obese women, 56.3 percent among overweight women and 67.4 percent among normal weight women. The 10-year survival rate was 42.7 percent among obese women, 41.8 percent among overweight women and 56.5 percent among normal weight women. Researchers found that the rate of inflammatory breast cancer was 45% among obese women, compared with 30% in overweight women, and 15% in women with normal weight.
Obese or overweight women also displayed a higher risk of breast cancer recurrence. Obese women (50.8%) reported a recurrence after 5 years, compared with normal weight women (38.5%). After 10 years, the rate of recurrence was 58% in obese women and 45.4% in women with normal weight.
"Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight. Particular attention should be paid to our overweight patients," Cristofanilli said.
Drugs commonly used to treat cancer patients, such as tamoxifen, said Dr. Cristofanilli tend to increase weight gain during treatment – an effect physicians should note carefully. "We have actually become quite good at managing acute side effects such as nausea in our chemotherapy patients and it goes away within a couple of days," Cristofanilli said. "Following the nausea, our patients tend to overeat, which further increases their risk of weight gain. We need to implement lifestyle modifications interventions and develop better methods to follow these patients closely."
Clinical Cancer Research, March 15, 2008
After total knee replacement surgery, obesity limits a patient’s range of motion, makes the recovery period longer and calls for extended physical therapy, according to a recent study. A patient’s body mass index (BMI)—a correlation between height and weight—has a direct relationship on the knee’s range of motion and need for manipulation under anesthesia.
Close to 20% of patients with a BMI of 25 to 30 needed manipulation for improved flexibility and to break up scar tissue, while patients with a BMI of less than 25 needed the manipulation. Said Geoffrey Westrich, MD, lead author of the study and an associate professor of orthopaedic surgery at Hospital for Special Surgery in New York City, "For anyone considering knee replacement surgery, recovery time is always an important consideration". Heavy patients, he continued, need to be advised that their weight will probably slow their recovery.
Data from 309 patients (400 knee replacements) who underwent the procedure at Hospital for Special Surgery was evaluated for the effect of BMI on range of motion and the need for manipulation under anesthesia. Patients with BMI from less than 25 to more than 29.9 were divided into groups: major findings from the study were as follows:
- The greater a patient’s BMI, the less range of motion they can expect after knee surgery
- Age was not a predictor for range of motion
- Gender was a predictor for range of motion and the need for manipulation
- Regardless of BMI: – Men had a 4.6-degree higher range of motion than women – Less than 10 percent of men needed manipulation six weeks after surgery compared to 18.5 percent for women
"Our study reinforces the drain that obesity is having on the health-care system," Dr. Westrich said. "The obesity epidemic is causing health-care expenditures to grow at a rapid rate. Insurance companies, Medicare, hospital administrators, and patients need to understand that obesity will likely cause different patient outcomes, including more complications that may require further surgical interventions."
Dr. Westrich concludes that "setting realistic expectations prior to surgery is paramount to patient care.". Surgeons performed more than 533,000 knee replacements in 2005.
The study was presented at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in March, 2008.
The rising obesity epidemic among Latino youth may be traceable to the sheer volume of Spanish-language fast-food television commercials, according to a study in the Journal of Pediatrics. The research was conducted by pediatricians from the Johns Hopkins Children’s Center.
"While we cannot blame overweight and obesity solely on TV commercials, there is solid evidence that children exposed to such messages tend to have unhealthy diets and to be overweight," says study lead investigator Darcy Thompson, M.D., M.P.H., a pediatrician at Hopkins Children’s. Past research among English-speaking children has shown that TV ads influence food preferences, particularly among the more impressionable young viewers.
Programming during the heaviest childrens’ viewing hours on Univision and Telemundo, the two leading Spanish-language channels in the US, was monitored. (These channels reach 99% and 93% of US Latino households). The two or three food commercials aired each hour specifically targeted children, with nearly 50% of commercials advertising fast food, soda and other high sugar content drinks.
The researchers recommend limiting young children’s TV viewing to two hours a day or less, with parental guidance on healthy diet and food choices. Children under 2 should not be allowed to watch any TV at all, advise pediatricians.
Other recommendations include advising Latino childrens’ pediatricians of their parents’ heavy exposure to food advertising; and following the lead of many European countries in urging public health authorities to appeal to policy makers to limit food advertising to children.
The Journal of Pediatrics, DOI: 10.1016/j.jpeds.2007.09.011.