Monthly Archives: July 2015
Jules Hirsch, Pioneer in Obesity Studies, Is Dead at 88

Jules Hirsch, whose clinical investigations into body weight regulation helped establish the biological underpinnings of obesity — including that a person’s weight is in part determined by the body’s own predisposition — died on July 23 in Englewood, N.J. He was 88.

His death was confirmed by a nephew, Norman Silber.

Dr. Hirsch had a long career at the Rockefeller University in New York, including as physician in chief at Rockefeller University Hospital from 1992 to 1996. An advocate of patient-oriented research — in which a doctor investigates the mechanism of disease by studying his own patients — he specialized in studies of metabolism, focusing in particular on why some people get fat and others don’t.

That research was crucial to a shift in approach in obesity studies. Through the middle of the 20th century, fat cells, known as adipose tissue, were considered to be inert storage units for fat that the body burned for energy.

That view reinforced the popular perception that obese people were to blame for their own condition — that they must be lazy or gluttonous or lacking in will power.

Over the years, Dr. Hirsch and others showed that to the contrary, many people are biologically predisposed to be heavy, and that even when they manage to lose weight, biological processes work against their being able to keep it off.

Dr. Hirsch demonstrated that fat cells came in different sizes, and that weight loss reduced the size but not the number of such cells.

The discovery provided evidence that fat cells, far from being inert depots, communicate with the brain, and that the brain keeps track of how much fat is in the body and to some extent regulates it.

In 1994, researchers at Rockefeller isolated the communicating agent, a hormone called leptin, which, when secreted from fat cells, tells the brain how big those cells are.

The scientists also determined that the brain used leptin to maintain a base level of body fat.

“Dr. Hirsch’s work was seminal in demonstrating that there is this flexibility of fat cell size, which provided an anatomic basis for a signal between the body’s adipose tissue and the brain,” Dr. Rudolph L. Leibel, a research partner of Dr. Hirsch’s, said in an interview.

Dr. Leibel was among those responsible for the discovery of leptin.

For 10 years, beginning in the mid-1980s, he and Dr. Hirsch studied 41 volunteers — some obese, some lean — while regulating their weights with liquid formulas.

The study’s findings, released to acclaim in 1995, showed that the body worked against attempts to lose — or gain — weight: When the body slims down, its metabolism slows down and its muscles burn fewer calories with the same effort; when the body beefs up, it burns calories more briskly.



The benefits of weight loss in obese gravidas

The obesity epidemic now affects a third of US adults including pregnant women. Adverse pregnancy outcomes attendant obesity include increased rates of congenital anomalies, stillbirth, preeclampsia, preterm birth, gestational diabetes, as well as both fetal growth restriction and macrosomia. Macrosomia is, in turn, linked to increased risks of both shoulder dystocia, which can lead to permanent brachial plexus injuries, and cesarean delivery, which in obese patients is accompanied by elevated rates of venous thromboembolism and wound complications. Moreover, obesity in pregnancy has serious long-term health consequences for both mother and offspring.4

Conversely, it has also been long-appreciated that underweight mothers, and/or those with low gestational weight gain, are at increased risk for spontaneous preterm birth and low-birth-weight (LBW) infants. In 2009, a committee of the Institute of Medicine (IOM) attempted to thread the needle between these risks with a revised set of guidelines for gestational weight gain among obese gravidas. The IOM recommended that obese women (body mass index [BMI] > 30) gain 11 to 20 lb (5–9 kg).5 Their recommendation came under immediate fire, with some (including me) opining that lesser weight gain strategies might be beneficial in select obese patients.6 A number of experts have gone further and endorsed weight loss during pregnancy among such patients. Recent studies of weight loss among severely obese patients either during or before pregnancy, due to diet or bariatric surgery, respectively, demonstrate clear benefits but some potential risks.

The effects of diet-induced weight loss in obese gravidas

Bogaerts and colleagues assessed pregnancy outcomes in a cohort of more than 18,000 obese Flemish women with live-born singleton gestations according to degree of obesity and extent of gestational weight gain or loss.7 Obesity was broken into 3 classes: class I (BMI 30 to 34.9), class 2 (35 to 39.9) and class III (≥ 40). Weight change categories were:

1. greater weight loss (≥5 kg);

2. lesser weight loss (between 0 and 5 kg);

3. low weight gain (0 to 5 kg);

4. adequate weight gain (≥5 to ≤9 kg); and

5. excessive weight gain (>9 kg).

Birth outcomes included gestational hypertension, LBW infants (≤ 2500 g), small-for-gestational age (SGA; birthweight < 10th percentile), macrosomia (≥ 4000 g at birth), large-for-gestational age infants (LGA; >90th percentile), emergency cesarean delivery, and neonatal intensive care unit (NICU) admission. Among this cohort, only 4.7% reported any degree of weight loss, 13.8% had low weight gain, 28.3% had adequate weight gain, and an astonishing 53.1% had excessive weight gain. Weight loss occurred among only 3.2% of class I, 7% of class II, and 13.4% of class III patients. In univariate analysis, the prevalence of adverse outcomes, except SGA, significantly increased with increasing obesity class. Conversely, gestational hypertension, macrosomia, LGA, and emergency cesarean delivery all decreased with decreasing categories of gestational weight gain. However, the prevalence of LBW and SGA decreased with increasing categories of weight gain.

When Bogaerts et al performed an adjusted multivariate analysis, they found that among class I gravidas, weight loss and low gestational weight gain were associated with a decreased odds ratio (OR) for gestational hypertension of 0.31 (95% CI: 0.11–0.84) for those with greater weight loss, 0.46 (95% CI: 0.21–0.99) for those with lesser weight loss, and 0.71 (95% CI: 0.54–0.93) for those with low weight gain, compared with those achieving “adequate” weight gain. Similar beneficial trends were observed in class II and III patients achieving greater weight loss but these did not reach statistical significance, likely due to the low numbers of affected patients achieving that degree of weight loss. The occurrence of emergency cesarean delivery was reduced among class II patients with an OR of 0.24 (95% CI: 0.07–0.78) for greater weight loss patients, 0.5 (95% CI: 0.26–0.97) for lesser weight loss patients and 0.55 (95% CI: 0.38–0.79) for those with low weight gain.

Macrosomia was also reduced in all 3 obesity classes when there was weight loss ≥ 5 kg with an OR of 0.47 (95% CI: 0.24–0.9) for class I, 0.32 (95% CI: 0.12–0.9) for class II and 0.15 (95% CI: 0.05–0.49) for class III patients. Macrosomia was also reduced in each class among those in the lesser weight loss and low weight gain categories but with variable degrees of statistical significance. Similar findings were noted for LGA. Importantly, weight loss had no statistically significant effect on LBW, SGA, or NICU admissions in any class of obesity. Conversely, excessive weight gain significantly lowered the risk of SGA only among class II patients (OR of 0.62; 95%CI: 0.53–0.72) and significantly increased rates of gestational hypertension in class I and II patients. Thus, the authors concluded that weight gain lower than IOM recommendations among obese gravidas with singleton gestations resulted in reduced risks of gestational hypertension, emergency cesarean delivery, macrosomia, and LGA infants. Moreover, among those who lost weight, all these adverse outcomes were reduced without an increase in SGA and LBW.

In contrast, Catalano and associates conducted a prospective cohort study of 1053 overweight and obese patients with singleton term pregnancies and observed that weight loss or weight gain ≤5 kg was associated with SGA (adj OR of 2.6; 95% CI: 1.4–4.7).While neonates of women who lost or gained ≤5 kg had lower birth weight and fat mass, they also had less lean mass and a smaller length and head circumference. However, a growing number of recent studies suggests greater benefits and lesser risks for weight gain lower than than what is recommended in the IOM guidelines. Swank and colleagues studied the effects of gestational weight gain compared with IOM guidelines in a retrospective cohort using California birth certificate and patient discharge data. Among 1034 obese women studied, those with weight gain below IOM guidelines had fewer macrosomic infants (OR of 0.50, 95% CI 0.32–0.77) without an increase in preterm births or LBW. In contrast, excessive weight gain increased rates of gestational hypertension (OR 1.96, 95% CI 1.26–3.03) and cesarean delivery (OR 1.40, 95% CI 1.00–1.97).

Turong et al conducted a US population-based retrospective cohort study of obese nulliparous women with term singleton vertex births and observed that weight gain in excess of IOM guidelines, particularly when ≥20 lb, increased the risk of preeclampsia, eclampsia, cesarean delivery, and various adverse neonatal outcomes including low Apgar scores, seizures, and the need for ventilation.10 Conversely, obese gravidas who gained less than IOM guidelines had fewer hypertensive disorders of pregnancy and obstetric interventions but were more likely to have SGA neonates (aOR of 1.55; 95% CI: 1.52–1.59).

There is also evidence that excessive weight gain may have different long-term effects on offspring, depending on the trimester in which weight gain takes place. Karachaliou and colleagues observed that excess weight gain in the first trimester was associated with increased risk of overweight/obese and hypertensive children at age 4 years whereas excess weight gain during the second and third trimesters was associated with LGA infants but not childhood obesity.11

Pregnancy outcomes after bariatric surgery

While Bogaerts and colleagues found weight loss or at least lesser weight gain in obese gravidas to be clearly beneficial, fewer than 20% of such patients achieved such dietary discipline, while more than half had excessive weight gain.7 This finding underscores the difficulty of treating obesity in pregnancy. The use of preconceptional bariatric surgery in patients with severe obesity or obese patients with related comorbidities has now gained favor. However, the effects of these procedures on subsequent pregnancies have been poorly studied. A recent large Swedish study sheds light on the benefits and potential risks of bariatric surgery in subsequent pregnancy.12 Johansson and associates mined 2 large registries—the Scandinavian Obesity Surgery and Swedish Medical Birth registries—to identify 670 pregnancies occurring in women with prior bariatric surgery for whom pre-surgery weights were available. They conducted a nested case-control study matching these patients with up to 5 controls for presurgical BMI and potential confounders and then compared outcomes including gestational diabetes, LGA, SGA, preterm birth, stillbirth, neonatal death, and congenital anomalies. Compared to controls, bariatric surgery patients had lower risks of gestational diabetes (6.8% vs 1.9%; OR 0.25; 95% CI: 0.13–0.47), and LGA infants (22.4% vs 8.6%; OR 033; 95% CI: 0.24–0.44). There were no differences between the groups in preterm delivery rates.

However, compared with controls, bariatric surgery patients had higher rates of SGA infants (7.6% vs 15.6%; OR of 2.20; 95% CI: 1.64–2.95) and, more ominously, a trend toward higher rates of perinatal mortality, ie, stillbirth plus neonatal deaths (0.7% vs 1.7%; OR of 2.39; 95% CI: 0.98–5.85). Interestingly, gestational weight gain had no effect on these associations. Several confounders may explain the higher rate of SGA and trend toward a higher perinatal mortality rate among the bariatric surgery patients. For example, they had more preoperative medical comorbidities than controls and 98% had metabolically challenging gastric bypass rather than more-benign gastric banding procedures. Interestingly, the longer the surgery-to-delivery date interval, the higher the rate of SGA, and the greater the surgically induced reduction in BMI, the lower the risk of LGA.

Take-home message

Where does all this leave us? First, most obese gravidas gain substantially more weight than recommended under IOM guidelines, and the combination of obesity and excessive weight gain results in substantially excess maternal and perinatal morbidity and likely mortality. Second, gestational weight gain less than IOM recommendations, and possibly moderate (< 5 kg) weight loss, confer clear maternal and neonatal health benefits but the degree of optimal weight loss is unknown and excess weight loss may increase the risk of SGA, possibly smaller head circumferences and, if extreme, potentially perinatal mortality. Third, it is unlikely that current counseling and lifestyle modification techniques are adequate to achieving these gestational weight goals.

Thus, extensive studies are needed to determine:

1. how to enhance diet adherence in obese gravidas;

2. the optimal weight gain or weight loss targets that confer maximum perinatal and long-term health benefits with minimal risks; and

3. how such targets vary with maternal obesity class.

Until such studies are completed, it seems reasonable to encourage obese gravidas to at least follow current IOM guidelines and perhaps attempt to gain only 0 to 5 kg. Such counseling is best done in concert with a nutritionist who maintains regular and frequent contact with the patient, and should be accompanied by a tailored exercise regimen. However, it is far from certain whether such an approach will prove practical, successful, or cost-effective in real-world applications. For bariatric surgery patients, surveillance for fetal growth restriction and oligohydramnios seems reasonable after 28 weeks and weight gain within but not above IOM recommendations seems in order. Of course, the best strategy by far is for obese women to achieve a BMI < 28 prior to pregnancy by exercise and dieting, but we all know how hard that is!

Smoking, drinking and obesity increase the risk of dementia, research reveals

Smoking, binge drinking and obesity raise the risk of dementia by shrinking your brain, researchers have found.

More than 850,000 Britons suffer from the disease, with someone being diagnosed every three minutes.

There is currently no cure, so discovering ways to prevent its onset is vital.

Now US scientists have shed light on how the three risk factors can raise the chances of developing dementia, of which Alzheimer’s is the most common form.

Their findings add weight to previous suggestions that stopping smoking, curbing alcohol intake and maintaining a regular weight may keep the condition at bay.

Smoking, binge drinking and obesity raise the risk of dementia by shrinking your brain, researchers have found.

More than 850,000 Britons suffer from the disease, with someone being diagnosed every three minutes.

There is currently no cure, so discovering ways to prevent its onset is vital.

Now US scientists have shed light on how the three risk factors can raise the chances of developing dementia, of which Alzheimer’s is the most common form.

Their findings add weight to previous suggestions that stopping smoking, curbing alcohol intake and maintaining a regular weight may keep the condition at bay.

The study, published online in journal Radiology Today, analysed 1,629 Americans involved in the Dallas Heart Study.

They were followed up for seven years and given brain scans and cognitive tests to identify problems with thinking, knowing and remembering. Patients were also tested for early stages of the illness.

Analysis revealed binge drinking was linked to smaller total brain volume, while smoking and obesity appeared to go hand in hand with shrinkage of parts of the brain associated with memory.

Scientists focused on the hippocampus, precuneus and ­posterior cingulate cortex areas.

Professor Dr Kevin King, of Keck School of Medicine at the University of Southern California, Los Angeles, whose team carried out the research, said: “We currently do not have ­effective treatments for Alzheimer’s disease, so the focus is on prevention.”

Dr King said he believed the findings could lead to patients being shown MRI scans of their brains so they can see just how the three risk factors could be increasing their risk of developing dementia.

While prevention is key, researchers are also continuing to search for a cure for the disease – which one million people in the UK are predicted to be living with in the next decade.

Last week initial results of a trial of solanezumab, a new drug which can slow the decline of brain cells by a third, were unveiled at the Alzheimer’s Association International Conference in Washington.

It cannot cure dementia but is the first to slow its pace. Existing ­medication only alleviates symptoms.

However, it could be several years before ­solanezumab was available on the NHS even if it did prove reliable.

Although the exact cause of Alzheimer’s disease is still unknown, and there is no definitive way to prevent the condition, doctors say there are steps you can take to help to delay its onset.

These include stopping smoking, keeping within alcohol guidelines, eating healthily, exercising for at least 150 minutes a week and controlling blood pressure.

Only One in 210 Obese Men Reach Healthy Weight

An obese man has a one in 210 chance of achieving a normal body weight, and a woman a one in 124 chance, according to a large population-based cohort study of obese adults in the United Kingdom.

The study, published online July 16 in the American Journal of Public Health, is one of the first to quantify the chance of an obese person attaining a normal body weight or even a 5% reduction in body weight.

“The findings show just how difficult it is for people with obesity to lose weight and keep it off,” first author Alison Fildes, PhD, from University College London, United Kingdom, told Medscape Medical News. (Dr Fildes conducted the research while at King’s College London, United Kingdom.)

The study findings make clear that current strategies to tackle obesity are not effective and do not help the majority of obese patients lose weight and maintain that weight loss. “Most important, there is a need for effective public-health policies aimed at obesity prevention,” Dr Fildes added.

Obesity is a growing global health concern and, in the United Kingdom, if not elsewhere, the main treatment option available for obese patients is to follow a weight-management program accessed through primary care. Against this background, Dr Fildes explained their motivation for the study: “This framework envisages that patients may transition from obesity to a healthier body weight. We therefore saw a need to understand and quantify the frequency with which weight loss and weight-loss maintenance occurs in a large population.”

Large, Population-Based Study

Dr Fildes and colleagues calculated the probability of an obese individual attaining a normal or 5% reduction in body weight using data from the UK Clinical Practice Research Datalink, which includes information from electronic primary-care health records. The authors tracked the weight of 278,982 participants aged 20 years or older from 2004 to 2014. Weight changes were estimated using a minimum of three records of body mass index (BMI) per patient. Patients who had received bariatric surgery were excluded.

Over 9 years of follow-up data, the annual probability of obese patients achieving 5% weight loss was one in 12 for men and one in 10 for women with simple obesity (BMI 30–35 kg/m2), but the probability increased for people in higher categories of obesity. In patients with morbid obesity (BMI 40.0–44.9 kg/m2), the probability was one in 8 for men and one in 7 for women.

However, many fewer individuals were able to achieve a normal body weight. Overall, only 1283 of 27,966 men and 2245 of 27,251 women with a BMI of 30 to 35 kg/m2 reached their normal body weight, equating to an annual probability of attaining normal weight of one in 210 for men and one in 124 for women. Among those with morbid obesity at baseline, the frequency increased to one in 1290 for men and one in 677 for women.

In addition, maintaining weight loss also proved difficult for these patients. “For those who achieved 5% weight loss, 53% regained at least some of this weight within 2 years, and 78% had regained weight within 5 years,” Dr Fildes remarked.

“For people with a BMI above 35 kg/m2, the probability of achieving a normal BMI was even lower,” reported Dr Fildes. “Weight cycling, with both increases and decreases in body weight, was also observed in more than a third of patients.”

Reflecting on the results, she added that although previous research indicated the difficulty of achieving and maintaining weight loss for people with obesity, “I was still surprised by how low the numbers actually were.”

Effectiveness of Weight-Management Programs

The authors write that, “These findings raise questions concerning whether current obesity treatment frameworks, grounded in weight-management programs accessed through primary care, may be expected to achieve clinically relevant and sustained reductions in BMI for the vast majority of obese patients and whether they could be expected to do so in the future.”

A target of 5% to 10% body weight loss is often recommended for obese patients receiving weight-management interventions. “It may be unrealistic to expect people with severe obesity to achieve a normal BMI,” Dr Fildes pointed out, “but as our findings suggest, a target of 5% weight loss is more achievable, and even this small reduction in weight has been shown to have important benefits for health.”

The research did not explore the efficacy of current weight-management programs or measure how many participants were pursuing weight-management interventions. However, previous work has found that weight-management interventions may be difficult to access with small and poorly maintained effects on body weight, acknowledged Dr Fildes. “When people lose weight, they often regain this weight quite quickly, and this study highlights how difficult it is for people to maintain even small amounts of weight loss.”

She noted that obesity treatment programs should prioritize preventing further weight gain and support maintenance of weight loss.

“It is also important to remember that there are small and achievable lifestyle changes, in terms of increasing physical activity, reducing sedentary behavior, and making adjustments to diet, which can have a beneficial impact on health regardless of weight.”

Body talk: ‘Every fourth person in Pakistan is obese’

KARACHI: As consumption of oily foods and lack of exercise prevail in Pakistan, every fourth person in the country is obese, said Aga Khan University (AKU) gastroenterology associate professor Dr Rustam Khan.

He was speaking at a session on nutrition awareness at the varsity. According to him, obesity is on the rise in Pakistan as consumption of oily foods and lack of exercise are the norm.

Talking about the body mass index (BMI) cut-off for Asians, he said a BMI greater than 27 indicates obesity while one less than 18.5 hints at malnourishment. He added that BMI between 18.5 and 22.9 is the healthy range for individuals in Asian countries.

According to AKU medicine associate professor Dr Romaina Iqbal, one should be concerned about weight as it is often the root cause of vascular and arthritis diseases. Explaining the relationship of age and weight, she said that the common perception in society is that it is acceptable for an elderly person to be overweight. “Weight has nothing to do with age,” she said, adding that it is never appropriate to transgress your ideal BMI range. According to her, one should make it a habit to weigh herself/himself at least once a month.

Iqbal also shared her findings of 2010 on Karachi. “Up to 58 per cent of the men in urban settings in Karachi are obese,” she said. “Likewise, the strength of women in the same category is 66 per cent.”

Talking about child obesity, AKU Hospital clinical dietician Sidra Raza shared some studies on obese children. “More than 155 million children worldwide are overweight and obese,” she said. She stressed the importance of controlling obesity in children as it has a direct impact on their achievement in school. “Children who are obese lack self-esteem and confidence as society tends to reject them,” she said.

Nutritionist Dr Mozamila Mughal was of the view that a good diet is essential for good health. According to Mughal, the best diet is one that accommodates all food groups such as bread, fruits, meat, milk and vegetables. “The largest portion of your plate should be vegetables and fruits for maximum vitamins and minerals intake,” she said. “The other two small portions should be of meat and carbohydrates which can be taken in the form of rice, grains and lentils.” She further said that seasonal fruits should always be taken as their composition of nutrients is such that they are best suited to a particular season.

It’s no secret that Americans’ waistlines are getting bigger. But a new study from Cornell University’s Food and Brand Lab shows that we can actually predict future obesity levels simply by opening the newspaper and looking at news coverage of food trends.

The study, published by general BMC public Health, analyzed 50 years of common “healthy” and “unhealthy” food words mentioned in articles in the New York Times (as well as the London Times, to ensure the findings held true outside the U.S.) and statistically correlated them with the country’s annual BMI, the most basic method of calculating obesity.

Mentions of sweet snacks (like cookies, chocolate, ice cream) were related to higher obesity levels three years later, and the number of vegetable and fruit mentions were related to lower levels of obesity, the researchers found. (We recommend these 20 Sweet and Salty Snacks Under 200 Calories)

“The more sweet snacks are mentioned and the fewer fruits and vegetables that are mentioned in your newspaper, the fatter your country’s population is going to be in three years,” lead study author, Brennan Davis, Ph.D., said in an interview. “But the less often they’re mentioned and the more vegetables are mentioned, the skinnier the public will be.”

Interestingly, while people may expect media coverage to follow health risk trends and changes in obesity, the researchers actually found that changes in obesity came after media coverage of food consumption trends. In other words: “Newspapers are basically crystal balls for obesity,” said study co-author Brian Wansink, Ph.D., director of the Cornell Food and Brand Lab. “This is consistent with earlier research showing that positive messages—’Eat more vegetables and you’ll lose weight’—resonate better with the general public than negative messages, such as ‘eat fewer cookies.’”

The study authors concluded that the findings may help public health officials anticipate future obesity levels and more quickly assess the effectiveness of current obesity interventions.

It’s also a powerful reminder that the national media has a huge responsibility to continue to report on healthy food trends.

Paper Clip: Slim chance that obese will return to normal weight

The chance of an obese person attaining normal body weight is 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with severe obesity, according to a study of UK health records led by King’s College, London. The findings suggest that current weight management programmes focused on dieting and exercise are not effective in tackling obesity at the population level. The research, funded by the UK’s National Institute for Health Research (NIHR), tracked the weight of 278,982 participants (129,194 men and 149,788) women using electronic health records from 2004 to 2014. The study looked at the probability of obese patients attaining normal weight or a 5% reduction in body weight. Patients who received bariatric surgery were excluded from the study. A minimum of three body mass index records per patient was used to estimate weight changes. The annual chance of obese patients achieving 5% weight loss was 1 in 12 for men and 1 in 10 for women. For those people who achieved 5% weight loss, 53% regained this weight within 2 years and 78% within 5 years. Overall, only 1,283 men and 2,245 women with a BMI of 30-35 reached their normal body weight — equivalent to an annual probability of 1 in 210 for men and 1 in 124 for women. For those with a BMI above 40, the odds increased to 1 in 1,290 for men and 1 in 677 for women. Weight cycling, with both increases and decreases in body weight, was also observed in more than a third of patients. The study concludes that current obesity treatments are failing to achieve sustained weight loss for the majority of obese patients. Dr Alison Fildes, first author, said: “Losing 5 to 10% of your body weight has been shown to have meaningful health benefits and is often recommended as a weight loss target. These findings highlight how difficult it is for people with obesity to achieve and maintain even small amounts of weight loss. “Once an adult becomes obese, it is very unlikely that they will return to a healthy body weight. Obesity treatments should focus on preventing overweight and obese patients gaining further weight, while also helping those that do lose weight to keep it off. Priority needs to be placed on preventing weight gain in the first place.” – See more at:

Too much TV, low physical activity may worsen cognitive function

Study co-author Tina Hoang, of the Northern California Institute of Research and Education (NCIRE) in San Francisco, and colleagues recently presented their findings at the 2015 Alzheimer’s Association International Conference (AAIC) in Washington, DC.

The 2008 Physical Activity Guidelines for Americans state that adults aged 18-64 should engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week. According to the Centers for Disease Control and Prevention (CDC), however, only around 1 in 5 adults meet these recommendations.

It is well established that lack of physical activity and sedentary behavior can have negative implications for health, such as overweight and obesity, greater risk of type 2 diabetes and increased risk of cardiovascular disease. Increasingly, research has suggested such behavior may also adversely affect brain function.

Previous studies have shown physical activity in later life may protect against cognitive decline and dementia. However, Hoang and colleagues note that little is known about the role physical activity in early adulthood plays in later-life brain function.

“Understanding this relationship in early adulthood may be particularly important because global data suggests that levels of physical inactivity and sedentary behavior are increasing,” says Hoang.

Physical activity in early, mid-adulthood important for healthy cognitive aging

The team’s study included more than 3,200 adults aged 18-30 who were part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Over 25 years, the researchers recorded participants’ television viewing time and physical activity levels via a minimum of three assessments.

In the study, high television viewing was defined as more than 4 hours daily, while low physical activity was defined as activity below 300 Kcal per 50-minute session, three times weekly. If participants met these definitions in more than two thirds of assessments, they were deemed as having a long-term pattern of high television viewing and low physical activity.

At the end of the 25-year study period, participants took part in tests that assessed their cognitive function, including memory, executive function and processing speed.

Seventeen percent of participants had a long-term pattern of low physical activity over the 25 years, 11% had a long-term pattern of high television viewing and 3% had a long-term pattern of both.

The researchers found that high television viewing and low physical activity among participants were independently associated with significantly poorer cognitive function in mid-life, while subjects with both factors were nearly two times more likely to have worse cognitive function in mid-life.

How Are Overweight and Obesity Treated?

Successful weight-loss treatments include setting goals and making lifestyle changes, such as eating fewer calories and being physically active. Medicines and weight-loss surgery also are options for some people if lifestyle changes aren’t enough.

Set Realistic Goals

Setting realistic weight-loss goals is an important first step to losing weight.

For Adults

  • Try to lose 5 to 10 percent of your current weight over 6 months. This will lower your risk for coronary heart disease (CHD) and other conditions.
  • The best way to lose weight is slowly. A weight loss of 1 to 2 pounds a week is do-able, safe, and will help you keep off the weight. It also will give you the time to make new, healthy lifestyle changes.
  • If you’ve lost 10 percent of your body weight, have kept it off for 6 months, and are still overweight or obese, you may want to consider further weight loss.

For Children and Teens

  • If your child is overweight or at risk for overweight or obesity, the goal is to maintain his or her current weight and to focus on eating healthy and being physically active. This should be part of a family effort to make lifestyle changes.
  • If your child is overweight or obese and has a health condition related to overweight or obesity, your doctor may refer you to a pediatric obesity treatment center.

Lifestyle Changes

Lifestyle changes can help you and your family achieve long-term weight-loss success. Example of lifestyle changes include:

  • Focusing on balancing energy IN (calories from food and drinks) with energy OUT (physical activity)
  • Following a healthy eating plan
  • Learning how to adopt healthy lifestyle habits

Over time, these changes will become part of your everyday life.


Cutting back on calories (energy IN) will help you lose weight. To lose 1 to 2 pounds a week, adults should cut back their calorie intake by 500 to 1,000 calories a day.

  • In general, having 1,000 to 1,200 calories a day will help most women lose weight safely.
  • In general, having 1,200 to 1,600 calories a day will help most men lose weight safely. This calorie range also is suitable for women who weigh 165 pounds or more or who exercise routinely.

These calorie levels are a guide and may need to be adjusted. If you eat 1,600 calories a day but don’t lose weight, then you may want to cut back to 1,200 calories. If you’re hungry on either diet, then you may want to add 100 to 200 calories a day.

Very low-calorie diets with fewer than 800 calories a day shouldn’t be used unless your doctor is monitoring you.

For overweight children and teens, it’s important to slow the rate of weight gain. However, reduced-calorie diets aren’t advised unless you talk with a health care provider.

Healthy Eating Plan

A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight.

A healthy eating plan is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. Following a healthy eating plan will lower your risk for heart disease and other conditions.

Healthy foods include:

  • Fat-free and low-fat dairy products, such as low-fat yogurt, cheese, and milk.
  • Protein foods, such as lean meat, fish, poultry without skin, beans, and peas.
  • Whole-grain foods, such as whole-wheat bread, oatmeal, and brown rice. Other grain foods include pasta, cereal, bagels, bread, tortillas, couscous, and crackers.
  • Fruits, which can be fresh, canned, frozen, or dried.
  • Vegetables, which can be fresh, canned (without salt), frozen, or dried.

Canola and olive oils, and soft margarines made from these oils, are heart healthy. However, you should use them in small amounts because they’re high in calories.

You also can include unsalted nuts, like walnuts and almonds, in your diet as long as you limit the amount you eat (nuts also are high in calories).

The National Heart, Lung, and Blood Institute’s “Aim for a Healthy Weight” patient booklet provides more information about following a healthy eating plan.

Foods to limit. Foods that are high in saturated and trans fats and cholesterol raise blood cholesterol levels and also might be high in calories. Fats and cholesterol raise your risk for heart disease, so they should be limited.

Saturated fat is found mainly in:

  • Fatty cuts of meat, such as ground beef, sausage, and processed meats (for example, bologna, hot dogs, and deli meats)
  • Poultry with the skin
  • High-fat dairy products like whole-milk cheeses, whole milk, cream, butter, and ice cream
  • Lard, coconut, and palm oils, which are found in many processed foods

Trans fat is found mainly in:

  • Foods with partially hydrogenated oils, such as many hard margarines and shortening
  • Baked products and snack foods, such as crackers, cookies, doughnuts, and breads
  • Foods fried in hydrogenated shortening, such as french fries and chicken

Cholesterol mainly is found in:

  • Egg yolks
  • Organ meats, such as liver
  • Shrimp
  • Whole milk or whole-milk products, such as butter, cream, and cheese

Limiting foods and drinks with added sugars, like high-fructose corn syrup, is important. Added sugars will give you extra calories without nutrients like vitamins and minerals. Added sugars are found in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet drinks.

Check the list of ingredients on food packages for added sugars like high-fructose corn syrup. Drinks that contain alcohol also will add calories, so it’s a good idea to limit your alcohol intake.

Portion size. A portion is the amount of food that you choose to eat for a meal or snack. It’s different from a serving, which is a measured amount of food and is noted on the Nutrition Facts label on food packages.

Anyone who has eaten out lately is likely to notice how big the portions are. In fact, over the past 40 years, portion sizes have grown significantly. These growing portion sizes have changed what we think of as a normal portion.

Cutting back on portion size is a good way to eat fewer calories and balance your energy IN. Learn how today’s portions compare with those from 20 years ago at the National Heart, Lung, and Blood Institute’s Portion Distortion Web pages

Food weight. Studies have shown that we all tend to eat a constant “weight” of food. Ounce for ounce, our food intake is fairly consistent. Knowing this, you can lose weight if you eat foods that are lower in calories and fat for a given amount of food.

For example, replacing a full-fat food product that weighs 2 ounces with a low-fat product that weighs the same helps you cut back on calories. Another helpful practice is to eat foods that contain a lot of water, such as vegetables, fruits, and soups.

Physical Activity

Being physically active and eating fewer calories will help you lose weight and keep weight off over time. Physical activity also will benefit you in other ways. It will:

  • Lower your risk for heart disease, heart attack, diabetes, and cancers (such as breast, uterine, and colon cancers)
  • Strengthen your heart and help your lungs work better
  • Strengthen your muscles and keep your joints in good condition
  • Slow bone loss
  • Give you more energy
  • Help you relax and better cope with stress
  • Allow you to fall asleep more quickly and sleep more soundly
  • Give you an enjoyable way to share time with friends and family

The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching. You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity.

People vary in the amount of physical activity they need to control their weight. Many people can maintain their weight by doing 150 to 300 minutes (2 hours and 30 minutes to 5 hours) of moderate-intensity activity per week, such as brisk walking.

People who want to lose a large amount of weight (more than 5 percent of their body weight) may need to do more than 300 minutes of moderate-intensity activity per week. This also may be true for people who want to keep off weight that they’ve lost.

You don’t have to do the activity all at once. You can break it up into short periods of at least 10 minutes each.

If you have a heart problem or chronic disease, such as heart disease, diabetes, or high blood pressure, talk with your doctor about what types of physical activity are safe for you. You also should talk with your doctor about safe physical activities if you have symptoms such as chest pain or dizziness.

Children should get at least 60 minutes or more of physical activity every day. Most physical activity should be moderate-intensity aerobic activity. Activity should vary and be a good fit for the child’s age and physical development.

Many people lead inactive lives and might not be motivated to do more physical activity. When starting a physical activity program, some people may need help and supervision to avoid injury.

If you’re obese, or if you haven’t been active in the past, start physical activity slowly and build up the intensity a little at a time.

When starting out, one way to be active is to do more everyday activities, such as taking the stairs instead of the elevator and doing household chores and yard work. The next step is to start walking, biking, or swimming at a slow pace, and then build up the amount of time you exercise or the intensity level of the activity.

To lose weight and gain better health, it’s important to get moderate-intensity physical activity. Choose activities that you enjoy and that fit into your daily life.

A daily, brisk walk is an easy way to be more active and improve your health. Use a pedometer to count your daily steps and keep track of how much you’re walking. Try to increase the number of steps you take each day. Other examples of moderate-intensity physical activity include dancing, gardening, and water aerobics.

For greater health benefits, try to step up your level of activity or the length of time you’re active. For example, start walking for 10 to 15 minutes three times a week, and then build up to brisk walking for 60 minutes, 5 days a week.

For more information about physical activity, go to the Department of Health and Human Services “2008 Physical Activity Guidelines for Americans” and the Health Topics Physical Activity and Your Heart article.

Behavioral Changes

Changing your behaviors or habits related to food and physical activity is important for losing weight. The first step is to understand which habits lead you to overeat or have an inactive lifestyle. The next step is to change these habits.

Below are some simple tips to help you adopt healthier habits.

Change your surroundings. You might be more likely to overeat when watching TV, when treats are available at work, or when you’re with a certain friend. You also might find it hard to motivate yourself to be physically active. However, you can change these habits.

  • Instead of watching TV, dance to music in your living room or go for a walk.
  • Leave the office break room right after you get a cup of coffee.
  • Bring a change of clothes to work. Head straight to an exercise class on the way home from work.
  • Put a note on your calendar to remind yourself to take a walk or go to your exercise class.

Keep a record. A record of your food intake and the amount of physical activity that you do each day will help inspire you. You also can keep track of your weight. For example, when the record shows that you’ve been meeting your physical activity goals, you’ll want to keep it up. A record also is an easy way to track how you’re doing, especially if you’re working with a registered dietitian or nutritionist.

Seek support. Ask for help or encouragement from your friends, family, and health care provider. You can get support in person, through e-mail, or by talking on the phone. You also can join a support group.

Reward success. Reward your success for meeting your weight-loss goals or other achievements with something you would like to do, not with food. Choose rewards that you’ll enjoy, such as a movie, music CD, an afternoon off from work, a massage, or personal time.

Weight-Loss Medicines

Weight-loss medicines approved by the Food and Drug Administration (FDA) might be an option for some people.

If you’re not successful at losing 1 pound a week after 6 months of using lifestyle changes, medicines may help. You should only use medicines as part of a program that includes diet, physical activity, and behavioral changes.

Weight-loss medicines might be suitable for adults who are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater, and who are at risk for heart disease and other health conditions, also may benefit from weight-loss medicines.

Sibutramine (Meridia®)

As of October 2010, the weight-loss medicine sibutramine (Meridia®) was taken off the market in the United States. Research showed that the medicine may raise the risk of heart attack and stroke.

Orlistat (Xenical® and Alli®)

Orlistat (Xenical®) causes a weight loss between 5 and 10 pounds, although some people lose more weight. Most of the weight loss occurs within the first 6 months of taking the medicine.

People taking Xenical need regular checkups with their doctors, especially during the first year of taking the medicine. During checkups, your doctor will check your weight, blood pressure, and pulse and may recommend other tests. He or she also will talk with you about any medicine side effects and answer your questions.

The FDA also has approved Alli®, an over-the-counter (OTC) weight-loss aid for adults. Alli is the lower dose form of orlistat. Alli is meant to be used along with a reduced-calorie, low-fat diet and physical activity. In studies, most people taking Alli lost 5 to 10 pounds over 6 months.

Both Xenical and Alli reduce the absorption of fats, fat calories, and vitamins A, D, E, and K to promote weight loss. Both medicines also can cause mild side effects, such as oily and loose stools.

Although rare, some reports of liver disease have occurred with the use of orlistat. More research is needed to find out whether the medicine plays a role in causing liver disease. Talk with your doctor if you’re considering using Xenical or Alli to lose weight. He or she can discuss the risks and benefits with you.

You also should talk with your doctor before starting orlistat if you’re taking blood-thinning medicines or being treated for diabetes or thyroid disease. Also, ask your doctor whether you should take a multivitamin due to the possible loss of some vitamins.

Lorcaserin Hydrochloride (Belviq®) and Qsymia™

In July 2012, the FDA approved two new medicines for chronic (ongoing) weight management. Lorcaserin hydrochloride (Belviq®) and Qsymia™ are approved for adults who have a BMI of 30 or greater. (Qsymia is a combination of two FDA-approved medicines: phentermine and topiramate.)

These medicines also are approved for adults with a BMI of 27 or greater who have at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high blood cholesterol.

Both medicines are meant to be used along with a reduced-calorie diet and physical activity.

Other Medicines

Some prescription medicines are used for weight loss, but aren’t FDA-approved for treating obesity. They include:

  • Medicines to treat depression. Some medicines for depression cause an initial weight loss and then a regain of weight while taking the medicine.
  • Medicines to treat seizures. Two medicines used for seizures, topiramate and zonisamide, have been shown to cause weight loss. These medicines are being studied to see whether they will be useful in treating obesity.
  • Medicines to treat diabetes. Metformin may cause small amounts of weight loss in people who have obesity and diabetes. It’s not known how this medicine causes weight loss, but it has been shown to reduce hunger and food intake.

Over-the-Counter Products

Some OTC products claim to promote weight loss. The FDA doesn’t regulate these products because they’re considered dietary supplements, not medicines.

However, many of these products have serious side effects and generally aren’t recommended. Some of these OTC products include:

  • Ephedra (also called ma huang). Ephedra comes from plants and has been sold as a dietary supplement. The active ingredient in the plant is called ephedrine. Ephedra can cause short-term weight loss, but it also has serious side effects. It causes high blood pressure and stresses the heart. In 2004, the FDA banned the sale of dietary supplements containing ephedra in the United States.
  • Chromium. This is a mineral that’s sold as a dietary supplement to reduce body fat. While studies haven’t found any weight-loss benefit from chromium, there are few serious side effects from taking it.
  • Diuretics and herbal laxatives. These products cause you to lose water weight, not fat. They also can lower your body’s potassium levels, which may cause heart and muscle problems.
  • Hoodia. Hoodia is a cactus that’s native to Africa. It’s sold in pill form as an appetite suppressant. However, no firm evidence shows that hoodia works. No large-scale research has been done on humans to show whether hoodia is effective or safe.

Weight-Loss Surgery

Weight-loss surgery might be an option for people who have extreme obesity (BMI of 40 or more) when other treatments have failed.

Weight-loss surgery also is an option for people who have a BMI of 35 or more and life-threatening conditions, such as:

  • Severe sleep apnea (a condition in which you have one or more pauses in breathing or shallow breaths while you sleep)
  • Obesity-related cardiomyopathy (KAR-de-o-mi-OP-ah-thee; diseases of the heart muscle)
  • Severe type 2 diabetes

Types of Weight-Loss Surgery

Two common weight-loss surgeries include banded gastroplasty and Roux-en-Y gastric bypass. For gastroplasty, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold.

For gastric bypass, a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed. This surgery limits food intake and reduces the calories your body absorbs.

Weight-loss surgery can improve your health and weight. However, the surgery can be risky, depending on your overall health. Gastroplasty has few long-term side effects, but you must limit your food intake dramatically.

Gastric bypass has more side effects. They include nausea (feeling sick to your stomach), bloating, diarrhea, and faintness. These side effects are all part of a condition called dumping syndrome. After gastric bypass, you may need multivitamins and minerals to prevent nutrient deficiencies.

Lifelong medical followup is needed after both surgeries. Your doctor also may recommend a program both before and after surgery to help you with diet, physical activity, and coping skills.

If you think you would benefit from weight-loss surgery, talk with your doctor. Ask whether you’re a candidate for the surgery and discuss the risks, benefits, and what to expect.

Weight-Loss Maintenance

Maintaining your weight loss over time can be a challenge. For adults, weight loss is a success if you lose at least 10 percent of your initial weight and you don’t regain more than 6 or 7 pounds in 2 years. You also must keep a lower waist circumference (at least 2 inches lower than your waist circumference before you lost weight).

After 6 months of keeping off the weight, you can think about losing more if:

  • You’ve already lost 5 to 10 percent of your body weight
  • You’re still overweight or obese

The key to losing more weight or maintaining your weight loss is to continue with lifestyle changes. Adopt these changes as a new way of life.

If you want to lose more weight, you may need to eat fewer calories and increase your activity level. For example, if you eat 1,600 calories a day but don’t lose weight, you may want to cut back to 1,200 calories. It’s also important to make physical activity part of your normal daily routine.


Mum-of-three Kelly Collis tells LIAM BARNES how she dropped from a size 14 to a healthy size 10 just 14 weeks after joining a Weight Watchers class…

DETERMINED Kelly Collis took issues with her weight into her own hands – with spectacular results in just a matter of months.

The mother-of-three, from Lyme Road, Meir, had seen her weight steadily increase over the past six years. Bit by bit it became more of an issue.

After finally feeling fed up when she went up another dress size, she resolved to tackle the problem once and for all.

“It was one of those things where I decided enough was enough and I needed to do something about it,” she said.

“Over the years I ended up gaining two stone, so I’d try to lose some weight, but every time I did it would come back after a while.

“It got to the point where none of my old clothes were fitting me any more, and as I went up another dress size, I realized I couldn’t keep on this way.”

To help her lose the crucial pounds, Kelly joined her local Weight Watchers group, based at St Mary and St Chad’s on Anchor Road in Longton, and immediately began reaping the benefits.

Despite only being a member of the group for the last 14 weeks, the slimming group has already had tremendous results, seeing Kelly drop 19 lbs and go from a size 14 to a 10.

“It’s been absolutely brilliant since I joined,” she said.

“The support from the team and the leaders here has been fantastic, and it’s really helpful being able to talk to other slimmers at the meetings.

“The results have been amazing – I didn’t expect to lose so much weight so quickly.”

As well as bringing her back to a weight where she feels more comfortable, the group has also provided a new lease of life for Kelly.

As well as losing weight together, the class members have become good friends, and frequently go out for walks together to help encourage them to do more exercise and keep up the good work.

Last weekend a group of slimmers even took part in the MINI Moonlight walk to raise money for the Douglas Macmillan Hospice, and Kelly said she was delighted with the camaraderie in the class.

The 38-year-old said: “As a group, we do a lot to support each other.

“We’ve all started going out as a group walking together to lose some weight, and doing the MINI Moonlight walk was really good.

“There was a fantastic atmosphere that night, and it was nice to raise some money for charity while helping us to lose weight.

“It’s amazing how quickly the group has helped me lose weight.

“It’s not been that difficult sticking to the plan, it’s all come naturally, and it’s great how we all help each other.

“I’m definitely going to carry on coming to the group – it’s become a big part of my life now. I’ve met some lovely people and we all help each other, it’s a very social thing.”

Rachael Smith, team leader for Weight Watchers, said she was proud of the way Kelly had taken to the plan and thrown herself into the social side of the group.

She said: “She’s been absolutely fabulous. I’ve known her a long time anyway, she’s a fantastic lady, and it’s great for everyone to see how well she’s done.

“Kelly really enjoys coming, and she’s such a bubbly personality.

“She really helps the group and encourages them to lose weight.”