Monthly Archives: April 2015
How do race and ethnicity influence childhood obesity?

Obesity is a serious public health problem in the US and can affect anyone regardless of age. In particular, childhood obesity prevalence remains high. As well as compromising a child’s immediate health, obesity can also negatively influence long-term health dramatically. Unfortunately, some racial and ethnic groups are affected by obesity much more than others.

Children lying down in a circle smiling.There is a disparity in the prevalence of childhood obesity between different racial and ethnic groups in the US.

For example, the US Department of Health and Human Services Office of Minority Health (OMH) report that African-American women have the highest rates of being overweight or obese, compared with other racial or ethnic groups in the US.

Approximately 4 out of 5 African-African women were found to be overweight or obese and, in 2011, African-American women were 80% more likely to be obese than non-Hispanic white women.

Researchers have identified that disparities in obesity prevalence can be found just as readily among children as among adults. It is alarming that these disparities exist to begin with, but more so that they exist so early in life for so many.

In this Spotlight feature, we take a brief look at the prevalence of childhood obesity in the US and the disparities in childhood obesity prevalence that exist among different racial and ethnic groups. We will examine what factors may contribute to this disparity and what action can be taken to remedy the situation.

A growing problem

“Obesity is the terror within,” states Dr. Richard Carmona, the former Surgeon General. “Unless we do something about it, the magnitude of the dilemma will dwarf 9-11 or any other terrorist attempt.”

These are strong words, but they illustrate the scope of the obesity problem. According to the Centers for Disease Control and Prevention (CDC), in 2009-2010, over a third (35.7%) of adults in the US were obese.

On average, childhood obesity in the US has not changed significantly since 2003-2004, and overall, approximately 17% of all children and adolescents aged 2-19 years are obese – a total of 12.7 million.

There are a number of immediate health problems that childhood obesity can lead to, including:

  • Respiratory problems, such as asthma and sleep apnea
  • High blood pressure and cholesterol
  • Fatty liver disease
  • Increased risk of psychological and social problems, such as discrimination and low self-esteem
  • Joint problems
  • Type 2 diabetes.

In the long term, obese children are much more likely to grow up to be obese as adults than children with healthy weights. Not only that, but the obesity experienced by these children is likely to be more severe, leading to further and more extreme health problems.

Significant disparities exist in obesity prevalence between different racial and ethnic groups. The CDC report the following obesity prevalence percentages among different youth demographics:

  • Hispanic youth – 22.4%
  • Non-Hispanic black youth – 20.2%
  • Non-Hispanic white youth – 14.1%
  • Non-Hispanic Asian youth – 8.6%.

From these figures taken from 2011-2012, we can see that levels of obesity among Hispanic and non-Hispanic black children and adolescents are significantly above average.

When the parameters are extended to include overweight children as well, the disparity persists. Around 38.9% of Hispanic youth and 32.5% of non-Hispanic black youth are either overweight or obese, compared with 28.5% of non-Hispanic white youth.

In 2008, Dr. Sonia Caprio, from the Yale University School of Medicine, CN, and colleagues wrote an article published in Diabetes Care in which they examined the influence of race, ethnicity and culture on childhood obesity, and what their implications were for prevention and treatment.

“Obesity in children is associated with severe impairments in quality of life,” state the authors. “Although differences by race may exist in some domains, the strong negative effect is seen across all racial/ethnic groups and dwarfs any potential racial/ethnic differences.”

However, if there are specific factors contributing to these disparities that can be addressed, the numbers involved suggest that attention should be paid to them. The long-term health of thousands of children in the US is at stake.

Socioeconomic factors

“Rarely is obesity in children caused by a medical condition,” write the National Association for the Advancement of Colored People (NAACP) in their childhood obesity advocacy manual. “It occurs when more calories are eaten than calories burned.”

The NAACP outline a number of factors that contribute to increases in childhood obesity, including:

  • The development of neighborhoods that hinder or prevent outdoor physical activity
  • Failure to adequately educate and influence families about good nutrition
  • Ignored need for access to healthy foods within communities
  • Limited physical activity in schools
  • Promotion of a processed food culture.

The CDC report that childhood obesity among preschoolers is more prevalent in those who come from lower-income families. It is likely that this ties in with the disparity with obesity prevalence among different racial and ethnic groups.

“There are major racial differences in wealth at a given level of income,” write Caprio, et al. “Whereas whites in the bottom quintile of income had some accumulated resources, African-Americans in the same income quintile had 400 times less or essentially none.”

Children's playground.Children living in high-poverty areas may find their access to safe outdoor play areas limited.

Fast food and processed food is widely available, low cost and nutritionally poor. For these reasons, they are often associated with rising obesity prevalence among children. According to Caprio, et al., lower-cost foods comprise a greater proportion of the diet of lower-income individuals.

If adults need to work long hours in order to make enough money to support their families, they may have a limited amount of time in which to prepare meals, leading them to choose fast food and convenient processed food over more healthy home-cooked meals.

Living in high-poverty areas can also mean that children have limited access to suitable outdoor spaces for exercise. If the street is the only option available to children in which to play, they or their parents may prefer them to stay inside in a safer environment.

Hispanic youth and non-Hispanic black youth are more likely to come from lower-income families than non-Hispanic white youth. According to The State of Obesity, white families earn $2 for every $1 earned by Hispanic or non-Hispanic black families.

Over 38% of African-American children aged below 18 and 23% of Latino families live below the poverty line. This statistic suggests that the effects of living with a low income that increase the risk of obesity may be felt much more by African-American and Latino families and their children.

Not only do these socioeconomic factors increase the risk of obesity among these demographic groups but equally obesity can compromise a family’s economic standing.

The NAACP point out that families with obese children spend more money on clothing and medical care. Additionally, as obese and overweight girls frequently start puberty at a younger-than-average age, there is a possibility that their risk of adolescent pregnancy is also higher.

Cultural factors

Alongside these socioeconomic factors, a number of additional factors exist that may be linked to an increased prevalence of childhood obesity among Hispanic and non-Hispanic black youth.

The NAACP give one such example, stating that one component of body image is how a person believes others view them or accept their weight:

“This also poses unique challenges in African-American communities because of cultural norms that accept, uplift and at times reward individuals who are considered ‘big-boned,’ ‘P-H-A-T, fat,’ or thick.'”

Cultural norms such as these may lead to parents remaining satisfied with the weight of their children or even wanting them to be heavier, even if they are at an unhealthy weight. Other sociological studies have also suggested that among Hispanic families, women may prefer a thin figure for themselves but a larger one for their children, according to Caprio, et al.

As well as being influenced by socioeconomic status, the type of foods eaten by children can be influenced by the cultural traditions of their families.

“Food is both an expression of cultural identity and a means of preserving family and community unity,” write Caprio, et al. “While consumption of traditional food with family may lower the risk of obesity in some children (e.g., Asians), it may increase the risk of obesity in other children (e.g., African-Americans).”

As mentioned earlier, the promotion of a processed food culture may be a contributing factor to childhood obesity. As fast food companies target specific audiences, favoring cultural forms associated with a particular race or ethnicity could increase children’s risk of being exposed to aggressive marketing.

Caprio, et al., report that exposure to food-related television advertising – most frequently fast food advertising – was found to be 60% among African-American children.

The amount of television that is watched may contribute as well; one study conducted by the Kaiser Family Foundation observed that African-American children watched television for longer periods than non-Hispanic white children.

A number of these cultural factors are associated with socioeconomic factors. African-American children may be more likely to watch television for longer, for example, if they live in areas where opportunities for playing safely outside are limited.

What can be done?

This subject area is far too detailed to do justice to in an article of this size, but these brief observations suggest that there should be ways in which the disparity in childhood obesity between racial and ethnic groups can be addressed.

Family sitting down for healthy breakfast.Increasing access to healthy food for low-income families is one step that could improve rates of childhood obesity.

Having more safe spaces to walk, exercise and play in low-income areas would give children a better opportunity to get the exercise need to burn the required number of calories each day. Improving the availability of and access to healthy food would give families more options when it came to maintaining a healthy, balanced diet.

The NAACP state that low-income neighborhoods have half as many supermarkets as the wealthiest neighborhoods, suggesting that for many low-income families, accessing healthy food can be a challenge.

These problems are ones that would need to be solved by local government and businesses that have influence over the planning and development of public living spaces.

Caprio, et al. propose that a “socioecological” framework should be adopted to guide the prevention of childhood obesity. Such a framework would involve viewing children “in the context of their families, communities, and cultures, emphasizing the relationships among environmental, biological and behavioral determinants of health.”

This approach would require large-scale collaboration, involving peer support, the establishment of supportive social norms and both the private and public sector working together.

“For health care providers to have a meaningful interaction about energy intake and energy expenditure with children/families, providers should have training in cultural competency in order to understand the specific barriers patients face and the influence of culture and society on health behaviors,” the authors suggest.

In order for this disparity to be adequately addressed, a lot of work will need to be done. Not only might certain cultural norms need to be altered, but most importantly, environments will need to be provided in which children will have the opportunity to live as healthy lives as possible.

Overnight fasting may reduce breast cancer risk in women

A decrease in the amount of time spent eating and an increase in overnight fasting reduces glucose levels and may reduce the risk of breast cancer among women, report University of California, San Diego School of Medicine researchers in the journal Cancer Epidemiology, Biomarkers & Prevention.

The findings were presented at the American Association of Cancer Research’s annual meeting in Philadelphia.

“Increasing the duration of overnight fasting could be a novel strategy to reduce the risk of developing breast cancer,” said Catherine Marinac, UC San Diego doctoral candidate and first author on the paper. “This is a simple dietary change that we believe most women can understand and adopt. It may have a big impact on public health without requiring complicated counting of calories or nutrients.”

Women who fasted for longer periods of time overnight had significantly better control over blood glucose concentrations. The data shows that each three hour increase in nighttime fasting was associated with a 4 percent lower postprandial glucose level, regardless of how much women ate.

“The dietary advice for cancer prevention usually focuses on limiting consumption of red meat, alcohol and refined grains while increasing plant-based foods,” said co-author Ruth Patterson, PhD, UC San Diego Moores Cancer Center associate director for population sciences and program leader of the cancer prevention program. “New evidence suggests that when and how often people eat can also play a role in cancer risk.”

Women in the study reported eating five times per day with a mean nighttime fasting of 12 hours. Those who reported longer fast durations also indicated they consumed fewer calories per day, ate fewer calories after 10 p.m. and had fewer eating episodes.

Researchers recommend large-scale clinical trials to confirm that nighttime fasting results in favorable changes to biomarkers of glycemic control and breast cancer risk.

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‘Sugar and carbs are the obesity culprits, not lack of exercise’

Bad diet is a lifestyle cause of obesity, but a lack of exercise is not, says an editorial reviewing controversial questions about this established health risk. The article published in a journal from The BMJ says the problem “cannot be outrun by exercise.”

woman at gym drinking juice
Commercial messages that say sugar and carbs are OK as long as you exercise are not true, say the authors.

Even the exercise done by athletes cannot counter a bad diet, say the authors, who cite evidence that while obesity has rocketed in the past 30 years, “there has been little change in physical activity levels in the western population.”

Excess sugar and carbohydrates, not physical inactivity, are to blame for the obesity epidemic, says the editorial.

The review, which aims to lead the opinion of sports medicine researchers and clinicians, is written by Dr. Aseem Malhotra, a UK cardiologist and consultant to the Academy of Medical Royal Colleges in London, with Prof. Tim Noakes of the Sports Science Institute of South Africa in Cape Town, and Dr. Stephen Phinney, professor emeritus of medicine at the University of California Davis.

The healthy choice of regular physical activity is not dismissed, however, because while these experts claim it “does not promote weight loss,” evidence shows that it “reduces the risk of developing cardiovascular disease, type 2 diabetes, dementia and some cancers by at least 30%.”

But poor diet is a bigger risk – it “generates more disease than physical inactivity, alcohol and smoking combined.” The authors support this claim with information about the global burden of disease published by The Lancet.

The editorial, published in the British Journal of Sports Medicine, continues by citing a 2013 review of the medical literature for metabolic syndrome, which asks why children are developing this cluster of cardiovascular risk factors.

That article, first-authored by Dr. Ram Weiss, a pediatrician at the Hadassah Hebrew University School of Medicine, Jerusalem, Israel, concludes that while obesity contributes to the syndrome, it is “unlikely” to be an “initiating factor.”

And the present authors cite that “up to 40% of those with a normal body mass index will harbor metabolic abnormalities typically associated with obesity, which include hypertension, dyslipidemia, nonalcoholic fatty liver disease and cardiovascular disease.”

Malhotra, Noakes and Phinney – who are well-known for their opinions on diet, exercise and health, having published widely through popular books and the media – add about the phenomenon in normal-weight people:

“This is little appreciated by scientists, doctors, media writers and policymakers, despite the extensive scientific literature on the vulnerability of all ages and all sizes to lifestyle-related diseases.”

Food and beverage industry ‘lies’

The concluding remark of the editorial reads: “It is time to wind back the harms caused by the junk food industry’s public relations machinery.”

As an industry example of providing “misleading” information, the authors say that Coca-Cola spent 3.3 billion US dollars on advertising in 2013, and that the company “pushes a message that ‘all calories count;’ they associate their products with sport, suggesting it is OK to consume their drinks as long as you exercise.”

“However, science tells us this is misleading and wrong,” says the article, adding:

“It is where the calories come from that is crucial. Sugar calories promote fat storage and hunger. Fat calories induce fullness or ‘satiation.'”

The authors further lambast the food industry by blaming it for creating a public perception that “obesity is entirely due to lack of exercise.”

Malhotra, Noakes and Phinney argue: “This false perception is rooted in the food industry’s public relations machinery, which uses tactics chillingly similar to those of big tobacco.”

In March, we looked at a report that similarly alleged the sugar industry “behaved like tobacco manufacturers” when it came to taking action against tooth decay.

The BMJ, the lead journal of the group publishing the present opinion piece, is positioned against commercial bias in health issues, and in February published its own investigations against the sugar industry, publishing claims that companies have attempted to influence public health policy.

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Frequent use of diet soda may increase waistline

Those who drink diet soda thinking it will help them shed unwanted belly fat may see their waistlines expand instead. New analyses from an observational study of San Antonio men and women age 65 and older seem to indicate this.

The San Antonio Longitudinal Study of Aging (SALSA), led by Helen P. Hazuda, Ph.D., professor of medicine in the School of Medicine at The University of Texas Health Science Center at San Antonio, gathered data on health status and lifestyles of 749 Mexican-American and European-American elders, then tracked the health outcomes in 466 survivors for more than nine years. The number of sodas they consumed – and whether they were diet or regular – was recorded by interviews at the beginning of the study and at each of three follow-up visits, where SALSA personnel measured participants’ waist circumferences and other parameters.


Among SALSA participants who reported that they did not consume any diet sodas, waist circumference increased less than 1 inch on average over the total follow-up period, said Sharon P. Fowler, M.P.H., adjunct faculty in the School of Medicine at the Health Science Center. Among participants who reported occasional use – drinking less than one diet soda a day – waist circumference increased almost 2 inches. And among those who consumed diet sodas every day, or more often than once a day, waist circumference increased over 3 inches. With senior author Dr. Hazuda and co-author Ken Williams, M.S., adjunct faculty in the School of Medicine, Fowler is lead author of a paper describing the data in the April issue of the Journal of the American Geriatrics Society.

These findings raise a red flag for seniors because fat around the waist – the proverbial tire around the middle – includes not only fat just under the skin but also fat that accumulates around internal organs, known as viscera. Many studies have linked visceral fat with increased inflammation and risk of metabolic disease, diabetes, heart attack, stroke, cancer and mortality. When waistlines expand in older age, visceral fat increases disproportionately, and risk rises.

“Because Dr. Hazuda’s study measured waist circumference as well as total weight, we were able to look at what happened to participants’ abdominal obesity,” Fowler said. “The increases in abdominal fat were more than three times as great in daily diet soda users as in non-users, during the very time in life when increasing waist circumference is associated with increased risk of these serious medical conditions, and mortality itself.”

Different from past research

The group’s previous related research, published in 2008, looked at the association between total consumption of artificially sweetened drinks – soda plus coffee plus tea – and long-term weight gain among participants in the San Antonio Heart Study, led by Michael Stern, M.D., emeritus professor in the School of Medicine. That study found that, among more than 3,600 25- to 65-year-old Mexican-Americans and European-Americans followed for seven to eight years, body mass index and risk of obesity rose consistently with increases in artificially sweetened beverage intake.

In the current SALSA report, the researchers adjusted statistically for a large number of variables that might have affected the findings, including initial waist size, exercise level and whether the participant had diabetes or smoked. “Even when you adjust for those things, you have this independent effect of diet soda consumption on waist circumference change over time,” Dr. Hazuda said.

“There is definitely debate about whether the association between diet soda intake and cardiometabolic risk, which has been detected in several large observational studies, is based on an actual causal relationship,” Fowler said. “We are simply reporting the statistical association we found: that, over almost a decade, waist circumference increased significantly, in a dose-response manner, with increasing diet soda intake in this group of older individuals. These results are consistent with findings from a number of other observational studies of increased long-term risk of diabetes, heart attack, stroke and other major medical problems among daily diet soda users.”

Although the study cohort is relatively small, with 466 individuals, the results were based on 3,706 person-years of follow-up. The findings were in people age 65 and older; whether they would apply to younger people is not known. The findings were also most pronounced among those who were already overweight or obese at the outset of SALSA. It is an observational study rather than a randomized, controlled trial design, which is the gold standard in clinical epidemiology.

“In spite of these limitations, however, the evidence, taken together with relevant findings from other studies in both humans and animals, is pretty compelling,” Dr. Hazuda said. “We’re trying to provide the evidence base for meaningful decision-making to improve both the health of individuals, and the public health.”

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Being underweight increases dementia risk, while obesity reduces it
Past research has associated obesity with increased risk of dementia. But a new study – deemed the largest ever to assess the link between body mass index and dementia risk – suggests obesity could actually be a protective factor against the condition, while people who are underweight may be at increased risk.
Study author Prof. Stuart Pocock, of the London School of Hygiene & Tropical Medicine in the UK, and colleagues publish their findings in The Lancet Diabetes & Endocrinology.Dementia is a term used to describe a number of conditions associated with a decline in memory and thinking skills. Alzheimer’s disease is the most common form of dementia, accounting for around 60-80% of cases in the US.

Some risk factors for dementia are well established. It is known that a person’s risk of the condition increases with age, for example, and people with a family history of the condition are more likely to develop it themselves.

Increasingly, researchers are looking at how an individual’s weight influences their risk of dementia, but results have been conflicting. In 2011, for example, a study published in the journal Neurology linked midlife obesity to increased risk of dementia later in life.

In February 2015, however, Medical News Today reported that while obesity may pose a higher dementia risk for young and middle-aged adults, it may protect against the condition for elderly individuals.

In this latest study, Pocock and colleagues assessed the medical records of almost 2 million people in the UK in order to gain a better understanding of how obesity affects dementia risk.

Higher dementia risk for underweight middle-aged adults

Looking at a period of 20 years, the researchers took their data from the Clinical Practice Research Datalink (CPRD) – a large database that holds the medical records of approximately 9% of the UK population.

The adults included in the study were an average age of 55 at baseline and had a median body mass index (BMI) of 26.5 kg/m2, which falls into the overweight category.

Over an average follow-up period of 9 years, 45,507 adults were diagnosed with dementia.

The researchers found that, compared with adults who had a healthy BMI (between 20-25 kg/m2), those who were underweight – defined in this study as a BMI less than 20 kg/m2 – during middle age were 34% more likely to be diagnosed with dementia. This increased risk remained for 15 years after adults’ underweight status was recorded.

The team notes that participants with a BMI of less than 18.5 kg/m2 are usually classed as underweight, but the threshold was raised in this study to allow comparisons with past studies, which have defined a BMI of less than 20 kg/m2 as underweight.

The researchers also found that middle-aged adults’ risk of dementia steadily reduced as their BMI increased. Compared with adults who had a healthy BMI, those who were severely obese (BMI greater than 40 kg/m2) were 29% less likely to develop dementia.

The team says their results remained even after accounting for factors associated with increased dementia risk, including smoking and alcohol consumption. In addition, the results were not affected by adults’ age at dementia diagnosis or the decade in which they were born, according to the researchers.

Findings may lead to new treatments for dementia

Prof. Pocock says the team’s findings suggest that clinicians, public health scientists and policymakers need to reassess the best ways to identify which individuals are at high risk of dementia.

“We also need to pay attention to the causes and public health consequences of the link between underweight and increased dementia risk which our research has established,” he adds.

“However, our results also open up an intriguing new avenue in the search for protective factors for dementia – if we can understand why people with a high BMI have a reduced risk of dementia, it’s possible that further down the line, researchers might be able to use these insights to develop new treatments for dementia.”

Lead study author Dr. Nawab Qizilbash, from OXON Epidemiology in the UK and Spain, says further research is warranted to understand the mechanisms that drive the association between high BMI and reduced dementia risk.

“If increased weight in midlife is protective against dementia, the reasons for this inverse association are unclear at present,” he adds. “Many different issues related to diet, exercise, frailty, genetic factors and weight change could play a part.”

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Five days of eating fatty foods can alter the way your body’s muscle processes food

You might think that you can get away with eating fatty foods for a few days without it making any significant changes to your body.

Think again.

After just five days of eating a high-fat diet, the way in which the body’s muscle processes nutrients changes, which could lead to long-term problems such as weight gain, obesity, and other health issues, a new study has found.

“Most people think they can indulge in high-fat foods for a few days and get away with it,” said Matt Hulver, an associate professor of human nutrition, foods, and exercise in the Virginia Tech College of Agriculture and Life Sciences. “But all it takes is five days for your body’s muscle to start to protest.”

In an article published recently in the online version of the journal Obesity, Hulver and other Virginia Tech researchers found that the manner in which muscle metabolizes nutrients is changed in just five days of high-fat feeding. This is the first study to prove that the change happens so quickly.

“This shows that our bodies can respond dramatically to changes in diet in a shorter time frame than we have previously thought,” said Hulver, who is the head of the department and a Fralin Life Science Institute affiliate. “If you think about it, five days is a very short time. There are plenty of times when we all eat fatty foods for a few days, be it the holidays, vacations, or other celebrations. But this research shows that those high-fat diets can change a person’s normal metabolism in a very short timeframe.”

When food is eaten, the level of glucose in the blood rises. The body’s muscle is a major clearinghouse for this glucose. It may break it down for energy, or it can store it for later use. Since muscle makes up about 30 percent of our body weight and it is such an important site for glucose metabolism, if normal metabolism is altered, it can have dire consequences on the rest of the body and can lead to health issues.

Hulver and his colleagues found that muscles’ ability to oxidize glucose after a meal is disrupted after five days of eating a high-fat diet, which could lead to the body’s inability to respond to insulin, a risk factor for the development of diabetes and other diseases.

To conduct the study, healthy college-age students were fed a fat-laden diet that included sausage biscuits, macaroni and cheese, and food loaded with butter to increase the percentage of their daily fat intake. A normal diet is made up of about 30 percent fat and students in this study had diets that were about 55 percent fat. Their overall caloric intake remained the same as it was prior to the high fat diet. Muscle samples were then collected to see how it metabolized glucose. Although the study showed the manner in which the muscle metabolized glucose was altered, the students did not gain weight or have any signs of insulin resistance.

Hulver and the team are now interested in examining how these short-term changes in the muscle can adversely affect the body in the long run and how quickly these deleterious changes in the muscle can be reversed once someone returns to a low-fat diet.

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Very few commercial weight-loss programs are effective, study finds
Many of us have turned to commercial weight-loss programs in a bid to shed the pounds. But do they really work? According to a comprehensive review of such programs conducted by Johns Hopkins researchers, very fewscales-with-measuring-tape-vitatious-weightloss-islamabad are effective.
Dr. Kimberly Gudzune, an assistant professor of medicine at the Johns Hopkins University School of Medicine, and colleagues publish the findings of their review in the Annals of Internal Medicine.More than a third of adults in the US are obese. According to the US Preventive Services Task Force (USPTF), clinicians should recommend overweight or obese patients to engage in weight-loss interventions, which may include commercial weight-loss programs.But according to Dr. Gudzune and colleagues, clinicians have limited reliable evidence as to which commercial weight-loss programs they should recommend.”Primary care doctors need to know what programs have rigorous trials showing that they work, but they haven’t had much evidence to rely on,” says Dr. Gudzune. “Our review should give clinicians a better idea of what programs they might consider for their patients.”

To reach their findings, the team reviewed more than 4,200 trials of 32 of the major commercial weight-loss programs, data on which was gathered from two popular medical literature databases and the weight-loss programs themselves.

For their final review, the researchers only included randomized controlled trials – in which participants were assigned to either a commercial weight-loss program or a less comprehensive intervention – and studies that lasted for a minimum of 12 weeks.

The team found that they were left with only 39 trials assessing 11 weight-loss programs. Included were three high-intensity programs – Weight Watchers, Jenny Craig and NutriSystem. These programs include self-monitoring, goal setting, nutritional information and counseling.

Five self-directed programs met the gold standard of medical research – Atkins, SlimFast, the Biggest Loser Club, eDiets and Lost It! – as did three low-calorie meal replacement programs, HMR, Medifast and OPTIFAST.

Weight Watchers and Jenny Craig ‘most effective for long-term weight loss’

From analyzing the trials of these programs, the researchers found that Weight Watchers and Jenny Craig were the most effective programs for long-term weight loss.

Studies of these programs lasted at least 12 months, and they showed that participants lost more weight when following the programs than those who dieted alone or who received printed health information or weight-loss counseling.

“Given these findings,” say the researchers, “it may be reasonable for clinicians to refer patients to Weight Watchers or Jenny Craig.”

NutriSystem also demonstrated higher weight loss after 3 months, compared with less intensive interventions. However, the researchers note that no long-term studies on this program could be identified, and knowing the long-term results of a weight-loss program is key for determining its health benefits.

Study co-author Dr. Jeanne Clark, of the Division of Internal Medicine at Johns Hopkins, explains:

“We want people to experience the health benefits of weight loss – lower blood pressure, cholesterol and blood sugar, and lower risk of developing diseases like diabetes.

Those benefits are long-term goals; losing weight for 3 months, then regaining it, has limited health benefits. That’s why it’s important to have studies that look at weight loss at 12 months and beyond.”

Studies of all three low-calorie meal replacement programs showed that participants who followed the programs lost more weight than control participants after 4-6 months. The one long-term study of these programs, however, showed no weight loss benefit at 12 months.

Results from trials assessing the Atkins diet “appear promising,” according to the team, which showed that people who followed this program lost more weight at 6 and 12 months than those who had weight-loss counseling alone.

When it came to SlimFast, the Biggest Loser Club, eDiets and Lost It!, the researchers say they could reach no firm conclusions as to whether these programs are effective for weight loss.

The team cautions that although Weight Watchers and Jenny Craig were found to be the most effective commercial weight-loss programs, the weight loss was still “modest,” with participants losing around 3-5% more than control participants.

In addition, they point out that very few studies they analyzed lasted 12 months or more, so they were unable to accurately determine the long-term benefits of the commercial weight-loss programs.

As a result, Dr. Gudzune and colleagues say more rigorous studies of such programs over longer periods are needed.

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Physical activity benefits lung cancer patients and survivors

Exercise and physical activity should be considered as therapeutic options for lung cancer as they have been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of hospital stay and complications following surgery for lung cancer.

Lung cancer is the leading cause of cancer deaths in the United States with an estimated 160,000 deaths each year and worldwide there are 1.4 million deaths. In the last two decades lung cancer therapy has improved, but the overall 5-year survival rate is still quite low at 17%. Lung cancer patients experience many debilitating symptoms including difficulty breathing, cough, fatigue, anxiety, depression, insomnia, and pain. A third of long term survivors, those >5 years from diagnosis, experience reduced quality of life and report lower physical and health scores compared to healthy patients. Given the incidence of lung cancer and the associated costs An inexpensive and relatively easy cancer therapy to reduce symptoms and improve quality of life, like physical activity, could be beneficial, especially for therapy, but clinicians underutilize exercise as a therapy, in part due to the lack of evidence-based consensus as to how and when to implement increasing physical activity.

Dr. Gerard A. Silvestri, Dr. Brett Bade, and colleagues at Medical University of South Carolina have reviewed the safety, benefits, and application of increasing physical activity and exercise in lung cancer with the goal to summarize the effect on improved lung cancer outcomes. Their results are published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC).

The authors found that most lung cancer patients (regardless of stage) want physical activity advice directly from a physician at a cancer center before cancer treatment and exercise guidance may increase compliance with a dedicated program.

Physical activity reduces risk of cancer development in multiple cancer types including lung. Large trials showed exercise’s association with reduced all-cause mortality and that self-reported moderately vigorous physical activity led to lower risk of all-cause and cancer-specific mortality. Multiple trials have shown that increased activity reduces symptom burden and that exercise interventions may have beneficial effects on quality of life, physical function, social function, and fatigue.

Perioperative exercise in lung cancer patients appears to be safe with improvement in operability, operative risk, post-operative complications, as well as increase exercise capacity. Preoperative interventions may be more beneficial than post. Non-surgical advanced-stage lung cancer patients may benefit from increased physical activity by improving exercise tolerance and symptom burden, though the location, duration, and intensity to be recommended is not clear.

Chronically-ill cancer patients have different exercise limitations than their healthy counterparts and other concurrent diseases and high symptom burden add challenges in how best to study and implement physical activity programs in lung cancer patients. Low-intensity regimens such as daily walking or step-counting may provide a safe mechanism to increase physical activity while identifying an individual patient’s activity limits. Both supervised and self-directed programs have potential benefit, though how to choose one versus the other is not yet clear.

The same benefits of increased activity observed in lung cancer patients, especially improved symptoms and quality of life, appear to apply to lung cancer survivors as well.

The authors conclude “clinicians should (at minimum) consider physical activity early, counsel against inactivity, and encourage physical activity in all stages of lung cancer patients and lung cancer survivors. This review shows uniform recognition that exercise and physical activity are safe for those with lung cancer, patients are requesting increased activity counseling, and multiple studies and reviews show potential clinical benefit in quality of life, exercise tolerance, and post-operative complications. Further, we know that inactivity in cancer patients is associated with worse outcomes.” However, “there are still large gaps in the published literature to be addressed and these could be filled with large definitive prospective trials that evaluate the benefit of exercise in lung cancer patients”.

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Low Testosterone not just in males: Testosterone, atherosclerosis and obesity may be linked in females

New research in The FASEB Journal suggests that the androgen receptor confers protection against diet-induced atherosclerosis, obesity and dyslipidemia in female mice

While testosterone replacement therapies may be controversial in males, new research in The FASEB Journal may extend this controversy to females too. That’s because research involving mice, appearing in the April 2015 issue, suggests that there is an association between low levels of androgens (which includes testosterone), and atherosclerosis and obesity in females.

“We hope that our study will contribute to intensified research efforts on the definition of androgen deficiency in women (e.g. which levels of androgens in the blood should be considered too low?), the consequences androgen deficiency may have for women’s health and ultimately, whether androgen deficient women may need androgen treatment for normalization of their androgen levels in order to maintain long-term cardiovascular and overall health,” said Åsa Tivesten, M.D., Ph.D., a researcher involved in the work from the Wallenberg Laboratory for Cardiovascular and Metabolic Research at Sahlgrenska University Hospital in Göteborg, Sweden.

Tivesten and colleagues discovered this association by comparing female mice with and without the androgen receptor. They found that female mice without the androgen receptor developed obesity, high levels of fat in blood and increased atherosclerosis. They treated these female mice with androgens and body fat and atherosclerosis were reduced.

“The notion that there are ‘male’ and ‘female’ hormones is a bit too simplistic and this research really brings that to light,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “Both men and women have androgen hormones–just at different levels. This report really raises the question of what levels of androgen hormones are optimal for the best health.”

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The rise of the takeaway

The number of takeaway food outlets has risen substantially over the past two decades, with a large increase seen in areas of socioeconomic disadvantage, according to a study carried out across Norfolk by researchers at the University of Cambridge.

In a study published in the journal Health & Place, researchers from the Centre for Diet and Activity Research (CEDAR), at the University of Cambridge, analysed the change in density of takeaway food outlets across Norfolk between 1990 and 2008 and how this related to levels of neighbourhood socioeconomic deprivation.

Takeaway food outlets, such as fish and chip shops, kebab shops, and Indian and Chinese takeaways, primarily offer ready-to-eat, energy-dense foods that are associated with higher total energy and fat intakes. Frequent consumption of takeaway food has been associated with excess weight gain over time.

Previous studies have shown that people of low socioeconomic status and living in deprived areas are more likely to be overweight and consume unhealthy diets than other sectors of the population. One possible explanation could be that more unhealthy food environments – for example, a greater density of takeaway food outlets – could be contributing to unhealthy lifestyle choices. Last year, a team at CEDAR showed that people who lived and worked near a high number of takeaway outlets tended to eat more takeaway food and were more likely to be obese than those less exposed.

Cambridge researchers used Yellow Pages telephone directories to collect data on the number and location of takeaway food outlets across six time points from 1990 to 2008. The researchers then mapped these onto electoral ward boundaries for Norfolk, a large county with a resident population in 2001 of almost 800,000 people.

Over the 18 year period, the number of takeaway food outlets rose by 45%, from 265 to 385 outlets. This equated to an increase from 2.6 outlets to 3.8 outlets per 10,000 residents. The highest absolute increase in density of outlets was in areas of highest deprivation, which saw an increase from 4.6 outlets to 6.5 outlets per 10,000 residents (a 43% increase).

This is in contrast to areas of least deprivation, which saw an increase from 1.6 to 2.1 per 10,000 residents over the time period (a 30% increase).

PhD student Eva Maguire, lead author of the study from CEDAR, University of Cambridge said: “The link we’ve seen between the number of takeaway food outlets and area deprivation is consistent with other reports, but this is the first time the changes over time have been studied in the UK. There were differences in the densities of takeaway outlets as far back as we looked, but these differences also became more extreme.”

Dr Pablo Monsivais, also from CEDAR, added: “The growing concentration of takeaway outlets in poorer areas might be reinforcing inequalities in diet and obesity, with unhealthy neighbourhoods making it more difficult to make healthy food choices. Our findings suggest that it might be time for local authorities to think hard about restrictions on the number and location of outlets in a given area, particularly deprived areas.”

In 2012, the Greater London Authority proposed the idea to limit the percentage of store frontage dedicated to takeaway food outlets on high streets in the Capital. Such initiatives have been endorsed by bodies including Public Health England, the National Institute for Health and Care Excellence (NICE) and the Academy of Medical Royal Colleges.

The researchers also looked at the spread of supermarkets. Although they found an increase in the number of supermarkets over the same time period, from 31 to 40 (an increase of 29%), the proportion of supermarkets in deprived areas did not differ significantly from other types of areas.

Although the study was only carried out in Norfolk, the county shares characteristics with other areas of the UK and so the researchers believe the findings will be generalizable across the country.

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