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Health of Obese Teens Better After Laparoscopic Surgery

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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

Study Shows Obesity Is a Major Risk for Heart Failure

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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

Not Enough Doctors to Treat Increasing Number of Obese and Diabetic Children

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The number of diabetic and obese children is growing so rapidly that there aren’t enough doctors to treat the kids. According to a recent study by University of Michigan’s C.S. Mott Hospital, there is only one board-certified pediatric endocrinologist per 290 children with diabetes. The ratio of obese children to board-certified endocrinologists is 17,000 to 1. The rate if childhood obesity in the United States meanwhile has more than doubled in the past 20 years, with a corresponding increase in the number of children at risk for type 1and type 2 diabetes.

"Although the American Diabetes Association recommends that all children with diabetes be cared for by a pediatric endocrinologist as part of a diabetes team, there is a current shortage of pediatric endocrinologists in this country," says study lead author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics. "This problem will likely only worsen due to the recent epidemic of childhood obesity."

The 16.5% of American children aged 6 to 19 who are obese are at risk for ‘adult’ diseases such as type 2 diabetes, elevated blood pressure and high cholesterol. As a result more children than ever are being referred to pediatric endocrinologists for screening, evaluation and management. "But even if just a small fraction of obese children are referred to a pediatric endocrinologist for evaluation", says Lee, " the overall ratio of one pediatric endocrinologist to 17,000 obese children makes providing the necessary care extremely challenging." Dr. Lee is assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.

Available pediatric endocrinologists are so few in relation to the number of children at risk that they cannot see even a fraction of the children with diabetes or at risk for the disease. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Pediatric endocrinologists currently do not have the capabilities to see even a fraction of the large number of children with diabetes or at risk for diabetes. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Using data from the American Board of Pediatrics and the National Survey of Children’s Health, Lee and her colleagues compared the number of board certified pediatric endocrinologists by region to obese children and children with diabetes in those same areas.

Their research revealed that there are an estimated 229,249 children with diabetes, and only 790 board-certified pediatric endocrinologists in the country. And, in two states—Montana and Wyoming—there are no board-certified pediatric endocrinologists.

The study was published in the March, 2008 issue of The Journal of Pediatrics.

The Desperate Housewives Result: First Scientific Study Reveals Growing Population Suffer From Eating Disorders in Midlife

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The Eating Disorder Center of Denver has announced the results of a two-year study on the growing, but often overlooked population of "middle-aged" women with eating disorders. The study is the first to scientifically establish that there is an increase in the number of women in midlife seeking treatment for eating disorders. It has been a common misconception that the profile of someone with an eating disorder is an upper-class teenage girl. However it is often a woman between the ages of 30 and 65.

"Women with eating disorders who are age 30 and above fly under the radar in terms of getting noticed and treated," said Dr. Tamara Pryor, Clinical Director of the Eating Disorder Center of Denver and the author of this landmark study. "Over the past four years or so, we’ve been seeing more midlife women with eating disorders in our center and according to my research; these women don’t just wake up at age 30 and develop an eating disorder. 94% of the participants had an eating disorder when they were younger and either relapsed or their condition worsened later in life."

"Since such a study has never before been conducted, the results and conclusions drawn from it will have profound effects on how eating disorder treatment is conducted on women in midlife," said Carolyn Ross, MD MPH, medical director of the Eating Disorder Center of Denver. "I am one of the 6 percent for whom the behaviors started later in life. I got a divorce and it started with a diet," said former Eating Disorder Center of Denver patient, Toni Saiber. In a way, I believe I had the temperament traits of someone at risk for an eating disorder [since adolescence], it just hadn’t manifested until I was 32.

"Mid-life eating disorder survivor, Ellen Hart Peña’s illness recurred after the stressor of a divorce. She personally identified with the genetic component of the study’s findings, as her daughter also struggled with the illness. Psychologists refer to personality traits that one has since birth as one’s "temperament." This study is the first to compare the temperament and character profiles of eating disorder patients in adolescence and midlife.

In the study, teen and middle-aged study participants were compared with each other and their profiles were surprisingly similar. Both the midlife eating disorder patients and the young adult eating disorder patients shared genetically-determined traits that resulted in them being highly anxious, worrisome individuals with low self-esteem. "This is about prevention and about intercepting the illness early on. When parents are armed with knowledge about the temperament profile of someone at risk for an eating disorder, they can take steps to prevent it–like never encouraging those children to go on a diet," said Saiber.

"We can change a lot about ourselves, but temperament sticks with you throughout your life. You have to learn what your temperament is in order to make healthy behavior changes that are appropriate for you."

Pryor accounts for the increase in middle-aged eating disorder patients with several explanations:

  • More awareness and better treatment methods have allowed eating disorder patients to survive into middle-age;
  • A baby boom of more middle-aged Americans has likewise yielded a boom of more middle-aged eating disorder sufferers;
  • A society that places such a high premium on a young, very thin physical appearance has caused women to develop eating disorders in adolescence and either relapse or continue their eating disorders well into middle-age

"We call this phenomenon the ‘Desperate Housewives Result’ because of how thin and young the middle-aged women on the popular television show appear. The timely name puts some responsibility on a culture that supports and encourages fountain of youth fixes" said Pryor. "It is just not statistically ‘normal’ for women over 30 to have the same bodies they did at 18 or 20."

Both groups of study participants (regardless of age) shared early dieting as the gateway behavior triggering their illness. Other contributing causes the study identified were: abuse, trauma, grief and loss.

The study found that psychological issues for midlife patients with eating disorders are similar to those in younger women: low self-esteem or self-worth, body loathing and, perhaps, a co-existing psychiatric condition. In fact, women with eating disorders in both age groups were found to have such similar temperaments, coping mechanisms and maturity levels that it does not make sense to separate them from one another in a treatment setting.

"I learned a lot from those young women," Saiber said of her former adolescent therapy group mates. Saiber added that she considers them sisters, sharing the same obstacles in life. "Midlife eating disorder patients may be 46 years old, but this study indicates that they are actually 16 years old, developmentally. Eating disorders actually stunt people’s emotional development," Pryor said. "Both age groups can benefit from one another in treatment."

Fifty more participants have recently been added to this continuing scientific study.

Heart Disease Appears Early in Obese Children

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A new study published in the Winter 2007 issue of the Journal of Cardiometabolic Syndrome finds that early signs of heart disease  appear in obese children or in children at risk for obesity.

"Based on this study, these subtle markers can help us predict who could be at risk for heart disease and heart attacks," said Angela Sharkey, M.D., associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children’s Hospital.

Nationally, 19% of children in the 6 to 11 age group and 17% of children aged 12 to 19 are overweight, which amounts to an epidemic says the Centers for Disease Control (CDC). Being overweight during childhood means a higher risk of adult obesity, with the possibility of diabetes, elevated blood pressure and heart disease.

Dr. Sharkey and Dr. Steven M. Lorch of the University of Texas Health Science Center at Houston reviewed data from 168 children aged 10 to 18 who suffer from heart murmur, chest pain, acid reflux or hiogh blood cholesterol. CDC guidelines for BMIA indicated that 33 patients were obese, 20 had a BMIA putting them at risk for obesity, and 115 were considered normal.

The obese children’s hearts were evaluated by Drs. Sharkey and Lorch using a new tissue Doppler imaging technique called vector velocity imaging. This tracks the movement of the heart’s muscular wall: changes in the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion.

"In the patients who are obese, the rate of motion of heart muscle changed," Sharkey said. "As a child’s BMIA increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were assumed to be from long-standing obesity, but it may be that these changes start much earlier in life than we thought."

The results of the study, said Dr. Sharkey, help physicians in counseling patients and parents about the risks of obesity and the importance of achieving a normal weight.

"Even in teenagers, obesity leads to decreased myocardial performance and abnormal diastolic function," she said.

Source: Washington University in St. Louis

Gastric Inhibitory Polypeptide (GIP) Can Reverse Diabetes and Promote Weight Loss

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A new study was designed to find whether prolonged receptor antagonism using daily injections of GIP was capable of reversing diet-induced obesity and related metabolic abnormalities in an animal model.

The 8-week old mice selected for the study were given access to drinking water and a high fat diet—20% protein and 35% protein, percent of total energy 26.15kg/g. Control mice were fed a standard rodent maintenance diet—10% fat, 30% protein, 60% carbohydrate, percent of total energy of 12.99.

Before the study, mice were fed a high-fat diet for 160 days. Another set of mice were given a high-fat diet for 112 days before measuring circulating GIP and GLP-1 levels. For both samples, obesity and diabetes were unmistakably evident.

Among the key findings were that consumption of the high-fat diet produced progressive weight gain and elevations of plasma and gyrated hemoglobin, resulting in impaired insulin sensitivity and glucose intolerance within 10 days. (Pro3)GIP countered many of the detrimental effects of high fat diet on body weight and indices of glucose and lipid metabolism.

This study showed that blocking GIP activity using (Pro3)GIP in mice with established, high fat diet-induced obesity and diabetes results in significant weight loss, improvement of insulin resistance and amelioration of diabetes. These findings represent an interesting new approach to the treatment of obesity and metabolic disturbances.

Nigel Irwin, PH.D., of the research team said that possible parallels exist with the benefits of gastric bypass surgery in treating gross obesity and diabetes in people. In this procedure nutrients surgically bypass the area of the small intestine, resulting in a deficiency of circulating GIP.

Source: American Physiological Society (APS)

Physical Activity Plus A Mediterranean Diet Can Lower Death Rate Over 5 Years

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Eating a Mediterranean diet and following nationally recommended physical activity are associated with a reduced risk of death over 5 years, according to two reports in Archives of Internal Medicine . Data provided by the National Institutes of Health-AARP Diet and Health Study was used in both studies, when 566,407 AARP members aged 50 to 71 returned questionnaires between 1995 and 1996.

A nine-point scale to measure conformity with the Mediterranean diet was used by Panagiota N. Mitrou, Ph.D and colleagues in 380,296 of the participants (214,284 men and 166,012 women) with no history of chronic disease. The diet included vegetables, legumes, fruits, nuts, whole grains, fish, ratio of monounsaturated fats, alcohol and meat. In the 5 years following, 12,105 sample members died, with 5,985 dying of cancer and 3,451 dying of cardiovascular disease. People with higher Mediterranean diet scores were less likely to die of any cause, or of cancer or heart disease.

The second study, supervised by Michael F. Leitzmann, M.D. Dr.P.H., of the National Cancer Institute, analyzed data provided by two questionnaires on physical activity from 252,925 participants (142,828 men and 110,097 women). 7,900 people died. The people who performed physical activity at least 30 minutes most days of the week (the amount of physical activity recommended in national guidelines) were 27% less likely to die. Those who performed vigorous physical activity recommended under the same guidelines (at least 20 minutes three times weekly) were 32% less likely to die. Lesser amounts of physical activity were associated with a 19% reduced risk of death.

Source: Arch Intern Med. 2007;167(22):2461-2468 and 2453-2460.

What You Don’t Want for Christmas: Weight Gain and Back Pain

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In a recent survey conducted by SpineUniverse, 69%
of people estimated that they typically gain up to 8 pounds during the
holiday season. Another 9% put their weight gain at over 8 pounds.

 Those extra pounds from sugar cookies and big family dinners don’t come
off easily, either: it takes 60% of the people surveyed up to 10 months
to lose their holiday weight. 11% said that they never lose the weight.
A study published in the New England Journal of Medicine agrees: most
people can’t shake their holiday weight until the next fall–just in
time for the Halloween candy.

 So year after year, people add on weight during the holidays, and in
the long-term, that holiday weight gain can add up–to back pain. Dr.
Steven Richeimer, a member of the SpineUniverse Editorial Board and
Chief of Pain Medicine at the University of Southern California, Keck
School of Medicine, explains, "If you’re overweight, your spine may be
overworked as it tries to carry that extra weight. This can produce
injury and back pain."

He continues, "When you’re overweight, you’re more likely to injure
your back, and it is more difficult to recover–the result can be
chronic back pain. Additionally, being overweight can exacerbate or
even lead to symptoms of degenerative disc disease, compression
fracture, osteoporosis, osteoarthritis, spinal stenosis, and
spondylolisthesis."

Thinking about back pain isn’t exactly full of holiday cheer. But
suffering excruciating back pain is even less cheerful. For some simple
steps to follow this holiday season to prevent the typical holiday
weight gain, visit Spine Universe.

Insufficient Sleep Could Lead to Overweight Kids

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Research findings from the University of Michigan C.S. Mott Children’s Hospital indicate that kids who don’t get enough sleep may be at increased risk of being overweight.

A study researching the connection between length of sleep and weigh for third and sixth grade children showed that kids who got less than 9 hours sleep per day were at greater risk of being overweight—regardless of their gender, race, socioeconomic status, or home environment quality.

The study showed that sixth graders short on sleep were more likely to be overweight. Third graders who got fewer hours of sleep—regardless of their BMI—were more likely to become overweight in sixth grade. The findings of this study appear in the November issue of the journal Pediatrics.

"Many children aren’t getting enough sleep, and that lack of sleep may not only be making them moody or preventing them from being alert and ready to learn at school, it may also be leading to a higher risk of being overweight," says study lead author Julie C. Lumeng, M.D., assistant research scientist at the U-M Center for Human Growth and Development. "This study suggests that an increased risk for overweight is yet another potential consequence of short sleep duration, providing an additional reason to ensure that children are receiving adequate sleep, primarily through enforcing an age-appropriate bed time."

Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development on reported sleep problems, sleep duration and BMI for 785 elementary school children, aged 9 to 12, was reviewed . 50% were male, 81% were white, 18% were overeight in the sixth grade. The overweight sixth grade lids slept fewer hours than those were not overweight, with boys in the majority of overweight sixth grade children.

"Even more important," Lumeng says, "is emerging research that shows a connection between sleep disruption and the hormones that regulate fat storage, appetite and glucose metabolism. Short sleep duration alters carbohydrate metabolism, and leads to impaired glucose tolerance, which can affect a person’s weight. Circadian rhythms, too, affect the body’s leptin, glucose and insulin levels."

So weight gain may not be a result of sleep’s effect on behavior, notes Dr. Lumeng, but rather sleep’s effect on hormone secretion in the body, specifically leptin and grehlin.

The National Sleep Foundation recommends these basic daily sleep requirements for children, adolescents, pre-teens and teens:

  • Preschoolers: 11-13 hours
  • Elementary school students: 10-12 hours
  • Pre-teens: 9 – 11 hours
  • Teens: 8 ½ – 9 hours

In addition to Lumeng, co-authors from the U-M Center for Human Growth and Development are Deepak Somashekar, B.S., and Niko Kaciroti, Ph.D.; Danielle Appugliese, MPH, with the Data Coordinating Center, Boston University; and Robert F. Corwyn, Ph.D., and Robert H. Bradley, Ph.D., with the Center for Applied Studies in Education, University of Arkansas.

The study was supported by the American Heart Association Fellow-to-Faculty Transition Award, and the American Heart Association Midwest Affiliate Grant-in-Aid.

Reference: Pediatrics, November 2007, Vol. 120, Issue 5.

Researchers ID Brain Circuits Responsible for Hunger

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A team of researchers has identified the brain circuits controlling hunger that are influenced by a hormone called leptin. The research, published in Proceedings of the National Academy of Science, found that leptin reduced activation in regions of the brain linked to hunger, while enhancing activation in regions linked to inhibition and satiety. The study suggests possible new targets for the treatment of obesity.

Three Turkish adults who lacked the leptin (ob) hormone were used in the study, and magnetic resonance imaging (MRI) was used to measure brain activity before and after leptin supplementation in them. The subjects were shown images of food before and after leptin treatment, while MRI imaging was in progress.

After leptin replacement, the subjects had feelings of hunger induced by the images, and activity in brain regions associated with hunger—the insula, parietal and temporal cortex—were reduced, while brain activity increased in the prefrontal cortex, previously associated with feeling full.

Despite the limitations in having only three subjects with the ob mutation, Prof. London says, "We think knowing the mechanisms by which leptin alters brain function in congential leptin deficiency can provide understanding of normal leptin physiology. Ultimately, that may help identify new targets for the treatment of obesity and related metabolic disorders."

The research was conducted by Edythe London, a professor of psychiatry in the UCLA Semel Institute for Neuroscience & Human Behavior, and Kate Baicy, a graduate student in Professor London’s lab. Other authors involved with the study were ohn Monteroso, Tuncay Delibasi, and Anil Sharma from the Semel Institute and the UCLA David Geffen School of Medicine, and Ma-Li Wong and Julio Licinio of the University of Miami Miller School of Medicine. The research was supported in part by the National Institutes of Health and the UCLA General Clinical Research Center. During the course of this study Amgen, Inc. provided leptin; Amylin, Inc. now provides leptin to these patients. Neither Amgen, Inc., nor Amylin, Inc., contributed to the design, analysis, or writing of this study.

Source: Proceedings of the National Academy of Science,October 29, 2007