Which is more important for weight loss: diet or exercise? While science has one answer, soda manufacturers have another
For years the message from medical experts to the increasingly hefty American population has been the same—watch what you eat, and exercise. But since everybody eats, but not every person is physically active, the focus has really been more on the former rather than the latter. Diet is an easier target, too, because the biggest culprits are simple to spot: fried favorites, calorie-dense fast food, sugar-sweetened beverages and processed foods that pack a lot of fat-building carbohydrates and sugar. Eat less of these, the white-coat brigade keeps telling us, plus more fruits, vegetables and whole grains, and it’ll be easier to control weight, avoid putting on extra pounds and bypass serious diseases like heart problems and diabetes. The problem is, the messaging hasn’t worked. Obesity rates have continued to climb in recent decades. (While they’ve started to level off, there still aren’t many signs that they are beginning to drop.) So some people are now changing the mantra: instead of focusing on what you put into your body, turn your attention to what you do with the energy, stored up in the form of fat, that you’ve packed away. Worry less about your diet, and get active so you can burn off the unwanted calories you consume to keep your weight in check.
The sugar-sweetened beverage industry has hungrily adopted the message. Facing mounting pressure to improve their products, both when it comes to calories and overall nutrition, they’re eagerly shifting the attention—or blame—from their fare to the American public. It’s not us, they seem to be saying, but you. You’re just not moving enough to burn off all the calories you’re taking in. First, the makers of Coca-Cola, Dr. Pepper, and Pepsi, along with the American Beverage Association, launched Mixify, a campaign that encourages young soda drinkers to “mixify” their balance of sugared drinks and exercise, giving license to indulge more if they’re more active. But the latest soda-backed program is the Global Energy Balance Network, a collaboration of leading medical experts with a mission to urge Americans to focus on finding a better balance between what they eat and what they burn off (which, for the mainly sedentary American population, is about getting more active.) The network is supported by Coca-Cola, though initial invitations to scientists failed to mention that.
What’s particularly insidious about this new spotlight on exercise and energy balance is that it’s good medical advice that’s being promoted in a misleading and potentially harmful way. There simply isn’t strong evidence to show that exercise alone, at least at the level that anyone other than a marathoner maintains, can actually help people to shed pounds. “The notion that we can exercise away a bad diet is absolutely unfounded,” says Dr. David Ludwig, director of the New Balance Foundation Obesity Prevention Center and professor of pediatrics and nutrition at Harvard, “and contradicted by many research studies.” Dr. Yoni Freedhoff, assistant professor of family medicine at University of Ottawa, agrees. “The average person who sees me is definitely under the impression that the ticket to the weight loss express is exercise,” he says. “These are well-intentioned people who want to change their weight or health status predominantly through exercise without paying much attention to their intake, because they don’t believe their intake is an important or valuable contributor to their weight.” No doctor or public health official would argue with the soundness of getting more exercise. Loads of studies show the benefits of being physically active on the mind, heart, metabolism and more. But in these new campaigns, this scientifically solid advice is being tweaked to encourage the less scientifically valid idea that extra calories from processed foods or sugared drinks can be so easily worked off. “By grabbing onto causes that are beyond reproach and tough to argue with, like ‘exercise is good for you,’ Coca-Cola is getting involved in a way that isn’t in the best interest of public health,” says Freedhoff. The campaigns want us to believe that we can figure out how many calories we’re taking in, then exercise the appropriate amount to work off that additional input. But people are notoriously bad at measuring how many calories they consume and work off–and, even more significantly, our bodies don’t work that way. Calories that come in don’t simply turn into fat and sit inertly as a back-up source of energy if it’s not used. A body that gets exposed to a lot of excess sugar, such as from sodas or carbohydrate-rich processed foods, isn’t the same as one that only sees a smaller amount. Consistently high levels of sugar can change the way the body breaks it down. Like a car that’s repeatedly driven at high speeds and needs to rely on the brakes more often in order to stop, the biological metabolic brake system—in this case the insulin that processes sugar—starts to wear down and become less efficient. That’s the first step toward weight gain and diabetes.
If weight were as simple as burning off the calories that come in, then foods that are high in calories, such as nuts, would be a “nightmare,” says Ludwig. Instead, study after study shows that people who eat more nuts, which are also brimming with protein, healthy unsaturated fats and fiber, tend to lose weight and weigh less than those who don’t consume them. The key, he says, is insulin. The more processed and refined a food is, such as baked goods and carb-heavy snacks like chips, the quicker the body digests it, and the more insulin the body pumps out to break down the food. The more insulin that circulates around, the more fat is sequestered away, since the excess calories far exceed what the body needs so it stores the fat away for future use. That’s why the idea of just working off the calories you eat doesn’t quite capture all the hormonal and metabolic changes that occur in the body when food comes in. “If you’re a toaster oven, then the calorie balance model is for you,” says Ludwig. “If you’re a human, it’s not helpful. By the calorie balance theory, we should cut back on everything. There should be no difference in cutting back on fruits and vegetables than from cutting back on soda. Instead, we all intuitively know that’s not the case. Eating too much fruit is not the road to obesity.” But there is a certain appeal to the notion of being able to compensate for that can of soda with a jog around the block. And the beverage makers know that, which explains why they’re backing the exercise message, similar to the way that the tobacco industry supported and ultimately biased results of studies claiming that light or low tar cigarettes were less harmful. In response to a recent New York Times article about Coke’s involvement in the network, the company released a statement: “At Coke, we believe that a balanced diet and regular exercise are two key ingredients for a healthy lifestyle and that is reflected in both our long-term and short-term business actions,” the company wrote. But the soda makers’ strategy of shifting responsibility onto consumers and making it their choice to work off what they eat or drink misses the point. Consumers do have choices to make, but Dr. David Katz, co-founder and director of the Yale-Griffin Prevention Research Center, likens the American public to flood victims, caught in a dangerous current of sugar-sweetened beverages, fast food, calorie-dense but nutritionally barren options and forced to “swim” by adopting a healthier diet or becoming more physically active. But, notes Freedhoff, “Without a levy, even the best swimmers get tired.” Until the food environment in which Americans find themselves changes dramatically — such as with taxes on sugared sodas, bans on advertising sugared foods to children and stricter vetting of health claims, like the energy balance message being promoted now, Americans will continue to be carried along with the unhealthy tide toward obesity, diabetes, and heart disease. “If you want to live a healthful life and maintain a healthy body weight, you need to go out of your way to live abnormally in an environment where normal isn’t healthy,” says Freedhoff. “It should really be the other way around.”
Is overeating more addictive than crack cocaine? It’s hard to compare addiction rates, or to produce a clear definition that holds true across all substances and behaviours. But consider this crude contrast: of people who use crack cocaine,10%-20% become addicted to it; across a nine-year study of 176,000 obese people, 98.3% of the men and 97.8% of the women failed to return to a healthy weight. Once extreme overeating begins, it appears to be almost impossible to stop.
A paper published in the journal Neuroscience & Bio behavioral Reviews proposed that “food addiction” is a less accurate description of this condition than “eating addiction”. There is little evidence that people who are driven to overeat become dependent on a single ingredient; instead they tend to seek out a range of highly palatable, energy-dense foods, of the kind with which we are now surrounded.
The activation of reward systems in the brain and the loss of impulse control are similar to those involved in dependency on drugs. But eating addiction appears to be more powerful. As the paper notes, in laboratory experiments most rats “will prefer a sweet reward over a cocaine reward”.
Once you become obese, an article in the Lancet this year explains, biological changes lock you into that condition. Fat cells proliferate. The brain becomes habituated to dopamine signalling (the reward pathway), driving you to compensate by increasing your consumption.
If you try to lose weight, the body perceives that it is being starved, and powerful adaptations (such as an increase in metabolic efficiency) try to bounce you back to your previous state. People who manage, against great odds, to return to a normal weight must consume 300 fewer calories per day than those who have never been obese, if they are not to put the weight back on. “Once obesity is established … bodyweight seems to become biologically stamped in”. The more weight you lose, the stronger the biological pressure to get back to your former, excessive size.
The researchers find that “these biological adaptations often persist indefinitely”: in other words, if you have once been obese, staying slim means sticking to a strict diet for life. The best you can hope for is not a dietary cure, but “obesity in remission”. The only effective, long-term treatment for obesity currently available, the paper says, is bariatric surgery. This can cause a number of grim complications.
I know this statement will be unwelcome. I too hate the idea that people cannot change their circumstances. But the terrible truth is that, except through surgery, for the great majority of sufferers obesity is an incurable disease. In one respect it resembles cancer: the changes in lifestyle that might have prevented it are unlikely to be of use in curing it.
Fat-shaming is worse than useless. Another paper found that the more weight-conscious people are, the more likely they are to overeat: the stress it induces is a trigger for comfort eating. As the Guardian journalist Sarah Boseley points out in her book The Shape We’re In, “the diet industry … is one of the biggest frauds of our time”. For the obese, temporary reductions in weight will almost inevitably be reversed.
People who are merely overweight, rather than obese (in other words who have abody mass index of 25 to 30) appear not to suffer from the same biochemical adaptations: their size is not “stamped in”. For them, changes of diet and exercise are likely to be effective. But urging obese people to buck up produces nothing but misery.
The crucial task is to reach children before they succumb to this addiction. As well as help and advice for parents, this surely requires a major change in what scientists call “the obesogenic environment” (high-energy food and drinks and the advertising and packaging that reinforces their attraction). Unless children aresteered away from overeating from the beginning, they are likely to be trapped for life.
You might have expected this knowledge to lead to acceptance, empathy and an end to stigmatisation. Fat chance. A fortnight ago, just after the figures mentioned at the top of this article were published, David Cameron announced a review that could lead to obese people being deprived of social security paymentsif they fail to accept “treatment” for their condition.
This review, conducted by Dame Carol Black, has already pre-empted its conclusions: eight times it describes obesity as “treatable”. Really? How? It will consider the case “for linking benefit entitlements to take up of appropriate treatment”. Are Cameron and Black proposing that benefit claimants will be forced to undergo surgery? Or will they be pressed into a useless and punitive dietary regime? These proposals look to me like a transfer of blame for the disease away from food manufacturers and advertisers, and on to those afflicted.
Why do we have an obesity epidemic? Has the composition of the human species changed? Have we suffered a general collapse in willpower? No. Theevidence points to high-fat, high-sugar foods that overwhelm the impulse control of children and young adults, packaged and promoted to create the impression that they are fun, cool and life-enhancing. Many are placed in the shops where children are bound to encounter them: around the tills, at grasping height.
The disease will keep ravaging the population (and slowly overwhelm the health service) until these circumstances change. But the government’s sole contribution has been to tear down mandatory controls, replacing them with a voluntary – and therefore useless – “responsibility deal” with manufacturers and retailers.
It allows them to choose whether or not to use the traffic-light system, which is the most effective way of informing people about the likely impact of what they eat. And many corporations, unsurprisingly, choose not to. As far as nutritional content is concerned, food manufacturing is in effect unregulated.
Industry and government will resist the obvious solutions until they can be resisted no longer. Eventually the change will have to happen, with similar restrictions on advertising, sponsorship, display and accessibility to those imposed on the tobacco pedlars. One day, though not before many thousands have needlessly died, it will become illegal to advertise any food or drink that merits a red traffic-light warning. They will be sold only in plain packaging, with health warnings, on high shelves.
Does this seem draconian to you? If so, remember that obesity afflicts a quarter of the adult population, and is rising rapidly. It causes a range of hideous conditions, just one of which – diabetes – accounts for one sixth of NHS admissions and 10% of its budget. In what looking-glass world is this acceptable? If smoking demands fierce intervention, why not overeating?
This is the choice we face: to recognise that the only humane and effective means of addressing the obesity epidemic is to prevent more people from being hooked, by restricting the pushers – or to continue a programme of fat-shaming, bullying and compulsory treatment, whose only likely outcome is unhappin
I am a 20-year-old man. My current weight is 243 lbs at a height of 5 ft 9″. I have been down to 203 lbs before, but I suffered a psychological barrier due to the fact that I couldn’t go below 200 lbs. I have resumed my weight loss journey. What are some healthy snacks that I could use to replace unhealthy ones? I walk in the mornings. Is that sufficient cardio exercise?
I am very sorry to hear that you have regained all the weight that you lost. Getting some professional help would have been useful when you realised that you were putting on back the weight. But that aside, the good thing is that you have decided to restart your weight loss programme. Also, you have shown that you have the ability to reach 203 lbs which is good. You should try at least to get back there.
I figure you understand how to achieve weight loss since you have lost weight before. As you know, you will have to reduce your calorie intake and at the same time, as much as possible, increase your calorie output.
I wish you had given me an idea of what your current eating habits are. In simple terms, weight loss occurs from eating less food/fewer calories and also increasing your activity/exercise.
In the process of your weight loss programme it is also important to eat healthy — reducing processed carbohydrates, fats and oils. It is also very important that as much as possible, more fruits, vegetables and vegetable juices should be added to your diet.
A weight loss programme should not only be about losing weight, but also becoming healthier. A major cause of weight gain is snacking. Unfortunately, we sometimes eat too many snacks on a daily basis. Having the wrong snacks can also reduce the rate at which we lose weight on a programme. Therefore, snacking on the right foods is key to a good weight loss programme.
Some healthy snacks include fruits, vegetables, coconut water, yoghurt, vegetable juices (green juice and carrot juice). As much as possible, ensure that your snacks are nutritious, but low in calories.
With reference to your exercise programme, walking is a good route to take, but how long do these walks last? Going forward, something will have to be different about your walking if that is the only exercise you want to do. You will have to increase the duration and intensity of your walking. Also, you could increase the number of days you walk and also walk up a hill versus on the flat.
In a nutshell, as far as your weight loss programme goes, you will have to try and reach back to 203 lbs. At this point you will still need to adjust your nutrition and exercise programme further. This is the secret to going below 200 lbs. However, you may need professional help to break the 200-lb barrier. Good luck.
We will answer your weight- related questions
Are you struggling to lose weight or just need some advice on living a healthier life? Tell us about your health issues and we’ll have nutritionist and wellness coach Donovan Grant answer them for you. Grant has over 12 years’ experience in the fitness industry and is the owner of DG’s Nutrition and Wellness Centre, Suite 16, 39 Lady Musgrave Road, Kingston 5.
Obesity is just not a cosmetic issue. It is more a chronic health disorder contributing to, among other ailments, diabetes, hypertension, cholesterol and heart-attack and reduces life expectancy by 10 years, according to laparoscopic and bariatric surgeon G. Ramesh.
Thanks to increased awareness on obesity, more and more people are coming forward to undergo laparoscopic obesity surgery in the State to improve their quality of life, he said at an awareness programme held at Sri Venkatramana multi-specialty hospital here on Sunday. on the dangers of morbid obesity The number of people opting for the weight-loss surgery a couple of years was hardly 15 in the State.
But over 100 surgeries are now performed in different hospitals in the State, according to Dr.Ramesh, who has been trained in bariatric diabetic surgeries at Michigan University, USA.
There had been an increased realisation among people who had tried commercial weight loss programme that it was just not enough to manage obesity. “Internal modification like removal of hunger-producing harmones and gastric bypass surgery were needed to reduce fat absorption by the body,” he said.
While 80 to 90 per cent of obese people had diabetes, 60 to 80 per cent had hypertension and over 80 per cent were prone to suffer a heart attack.
Sedentary lifestyle and unhealthy food habits were the major causes for morbid obesity, he said while counselling people on a healthy lifestyle.
Laparoscopic surgery was suited for patients with over 35 body mass index (BMI) and those with 30 BMI but suffering from diabetes, cholesterol and hypertension, added Dr.Ramesh who has 12 years of experience in advanced laparoscopic surgeries.
Explaining that 1600 calorie diet was enough for women and 1800 calorie diet for men, he said fast food and high calorie food comprising more refined carbohydrates had taken a toll on the health of present generation of people.
The patients after surgery would get satisfied with lesser quantity of food and would be able to lead a better life, he added.
Dr Ramesh says sedentary lifestyle and unhealthy food habits are the major causes for morbid obesity
People who think they are overweight or obese are more likely to pile on the pounds than those who are unaware that they may be heavier than doctors would advise, according to research.
The findings of the study raise a difficult issue for public health experts involved in the fight against obesity. It is well-known that many people who are overweight do not realise it because so many others around them look the same size and shape. But it has been thought, until now, that people with a weight problem need to recognise the fact in order to do something about it.
Eric Robinson of the Institute of Psychology at Liverpool University and colleagues in California and Stirling who carried out the research says feelings of stigmatisation may be causing overweight people to stress-eat, leading their weight rising further.
“There is quite a substantial body of research showing it is not really very much fun being an overweight person in this climate,” said Robinson. “It is a stigmatised condition. Realising you are an overweight individual is in itself likely to be quite stressful and make making healthy choices in your lifestyle more difficult.
“It is a tricky finding for public health intervention work. You would hope that making a person aware they are overweight would result in them being more likely to change and lose some weight.”
The paper, published in the International Journal of Obesity, looks at the lives of 14,000 adults in the US and the UK through data captured in three studies: the US National Longitudinal Study of Adolescent to Adult Health, the UK National Child Development Study and Midlife in the United States.
The researchers investigated the data from time periods after the children had reached adulthood to find out their perception of their own weight – whether or not it was correct – and their subsequent weight gain over time. The UK study followed participants from 23 until 45, but the other two studies had shorter followup periods, of seven years and nine to 10 years.
The paper says all three studies “found consistent evidence that perceiving oneself as being overweight was associated with increased weight gain”. Evidence that feeling overweight – whether or not it is true – can cause people to comfort-eat to relieve stress came from the third study.
“Individuals who identified themselves as being ‘overweight’ were more likely to report overeating in response to stress and this predicted subsequent weight gain,” the authors write. “These findings are in line with recent suggestions that the stress associated with being part of a stigmatised group may be detrimental to health.”
Robinson said he and the fellow researchers could not know exactly what people were doing – whether habitually overeating or embarking on crash diets which lead to rapid weight loss followed by even greater weight gain. “The widely accepted finding is that these types of diets don’t work in the long run and the debate is over how much of a harmful effect they have,” he said. “Weight regain is going to happen.”
What is important is to tackle stigma in society, he said. “People with a heavier body weight have body image challenges. That is not surprising given the way we talk about weight and fat and obesity as a society.
“But the way we talk about body weight and the way we portray overweight and obesity in society is something we can think about and reconsider. There are ways of talking about it and encouraging people to make healthy changes to their lifestyle that don’t portray adiposity as a terribly deviant thing.”
Angelina Sutin, assistant professor at the department of behavioural sciences and social medicine at Florida State University College of Medicine, said it was “a really impressive study” for several reasons. It had previously been shown that adolescents who are weight-conscious tend to gain more weight but “this paper shows this is a life course phenomenon that has consequences across the life span”, she said. “The effect are there over a very long period of time.”
It followed that experts should be promoting healthy behaviours like eating well and getting more physical activity, rather than focusing on the weight and body mass index numbers, she said. “We should not be classifying people as overweight and giving them a label that has a stigma attached to it, but enabling people to make healthier choices.”
Traci Mann, a psychologist at the University of Minnesota who has been studying eating habits and diets for decades, pointed out that it didn’t matter whether those who thought they were overweight were correct or not. “It’s about people who perceive they are overweight. What that says to me that I find interesting is that there is some psychological thing going on here.
“It certainly goes against all the common wisdom that you must find all the overweight people and tell them. This suggests that is not a good strategy.”
Weight-loss surgeries for obesity have gained popularity in recent years, often producing dramatic weight loss and a decrease in obesity-related health problems in the short term.
But the results may not last over the long haul. A new study, published Wednesday in JAMA Surgery, analyzed patient records at one hospital between one and five years after laparoscopic sleeve gastrectomy (LSG), an increasingly common form of bariatric surgery. It found many patients who had that type of surgery experienced significant weight regain and a return of type 2 diabetes several years later.
“The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitus and other obesity-related co-morbidities,” lead author Dr. Andrei Keidar of Beilinson Hospital in Petah Tikva Israel, said in a statement.
“These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient.”
Few studies exist on long-term results for this specific, newer type of weight-loss surgery — or comparisons to long-term results of other surgical options, like the often-used gastric bypass surgery.
This study collected and reviewed the checkup information for 443 patients at Rabin Medical Center at Beilinson Hospital in Peta Tikvah, Israel, who had LSG between 2006 and 2013. LSG surgery involves removing a large portion of the stomach, leaving behind a narrow “sleeve” to limit its size and reduce the natural stomach’s hunger signals.
The patients maintained weight loss soon after the surgery, but gradually regained more of the weight. The weight loss success of bariatric surgeries is defined as losing at least half of the amount of weight that is above normal. The study showed that these LSG patients had excess weight loss of 77 percent after the first year, 70 percent after three years, and a much lower 56 percent at the five-year exam.
The battle against type 2 diabetes proved even more challenging over time for these LSG patients. Remission rates for the patients who completed follow-up exams were 51 percent after the first year, 38 percent after 3 years, and only 20 percent after five years.
High blood pressure, or hypertension, was reduced to normal levels for a little less than half the patients at each checkup.
The study is relatively small and includes information from only one hospital. The study was also limited by the fluctuation in patient follow-up. Patients in the hospital were scheduled for follow-up exams at 1, 3, 6 and 12 months and every year after, but many did not follow the schedule, especially as time went on. This limited the amount of data and could have added bias since patients with some conditions may be more likely to pursue follow-up care than others.
But these results do lead to more questions about comparing the long-term results of different forms of weight-loss surgery.
“The study is retrospective and it’s certainly interesting because it sheds some light on long-term results for sleeve at five years,” Dr. Namir Katkhouda, professor of surgery at the Keck School of Medicine of the University of Southern California and director of the bariatric surgery program, told CBS News.
“There are numerous studies that seems to hint that the sleeve is maybe less effective than the gastric bypass on long-term efficacy in the treatment of diabetes,” said Katkhouda, who has worked with lead author Keidar previously. This results of this study, he added, “begs the ultimate question of comparing prospectively, in a randomized fashion, the sleeve to the bypass. And then we’ll see who emerges as the winner.”
Long-term benefits are an important measurement because the average age of people having bariatric surgeries is 40 to 50 years old, so they are expected to live for quite some time. Morbid obesity, defined as a body mass index of 40 or more, puts people at the highest risk for heart disease, stroke, type 2 diabetes and certain types of cancer, according to the CDC.
Bariatric surgery options still have the most positive outcomes for the treatment of morbid obesity, according to several recent studies. The condition has proven extremely hard to combat through non-surgical methods.
“Weight loss surgery, if you are morbidly obese and you have tried and failed other conservative methods,” said Katkhouda, “[is] a very safe and effective operation for weight loss and for treatment of other co-morbidities, such as hypertension and especially type 2 diabetes. That remark includes the laparoscopic Roux-en-Y gastric bypass, and the sleeve. I find both very effective and safe.”
The diabetes drug liraglutide can help obese people who don’t have diabetes lose weight and keep it off, new findings confirm.
Researchers found that 63 percent of study participants given liraglutide for 56 weeks lost at least 5 percent of their body weight — the amount experts agree is needed to make a difference in obesity-related health problems — whereas just 27 percent of the placebo group lost that much.
“It is a very effective drug. It seems to be as good as any of the others on the market, so it adds another possibility for doctors to treat patients who are having trouble either losing weight or maintaining weight loss once they get the weight off,” said Dr. Xavier Pi-Sunyer, a professor of medicine at Columbia University Medical Center in New York City, and first author of the new study published today (July 1) in the New England Journal of Medicine. The company Novo Nordisk, the maker of liraglutide, funded the research.
Liraglutide has been available in the United States for treating people with diabetes since 2010. The drug mimics a naturally occurring hormone called glucagon-like peptide-1, which is released in the human intestine and reduces hunger, increases satiety and slows the rate at which the stomach empties its contents into the small intestine. The Food and Drug Administration approved liraglutide (at a higher dose than is used for diabetes) for treating obesity in December 2014.
In the new study, Pi-Sunyer and his colleagues randomly assigned 3,731 men and women with a body mass index of at least 30, or a BMI of at least 27 if they also had high cholesterol or high blood pressure, to receive a 3.0-milligram dose of liraglutide daily, or a placebo shot. Study participants also received counseling on ways to change their lifestyle to promote weight loss. About 2,500 patients in the study were given liraglutide, and about 1,200 were given the placebo injections.
After 56 weeks, the participants on liraglutide lost an average of 18.5 pounds, compared with 6.4 pounds for the people on the placebo. Among the patients on liraglutide, 33 percent lost at least 10 percent of their body weight, whereas just 11 percent of the placebo group lost that much.
The most common side effects of the drug were nausea and diarrhea. Patients on the medication were also at increased risk of gallbladder-related problems, which, the authors noted, could have been due to their above-average weight loss.
Starting patients at a lower dose and then increasing it gradually helps reduce gastrointestinal side effects, Pi-Sunyer said. For most patients, the nausea went away after they had been on the drug for four to six weeks, he added.
Drawbacks to the medication include its high cost — about $1,000 for a month of treatment — and the fact that it must be given by injection. Currently, most insurers don’t cover liraglutide for treating obesity. Also, Pi-Sunyer said, patients will probably have to be on the drug indefinitely to maintain weight loss.
Nevertheless, “every tool we discover for obesity is good news,” said Dr. Elias Siraj, a professor of medicine at Temple University School of Medicine in Philadelphia, who was not involved in the new study but co-authored an editorial accompanying it in the journal. “The reason is, we are in the midst of a huge global obesity epidemic, and there’s no question it has not been easy to manage obesity.”
Many of the people in the study who lost weight on liraglutide remained obese, Siraj said, although this doesn’t mean they didn’t benefit from losing weight. “Previous studies have shown if you lose more than 5 percent of your body weight, it may not make a difference in how you look from outside, but it does make a difference in terms of metabolic parameters and cardiovascular risk factors,” he said.
The patients who will likely benefit the most from liraglutide are those with diabetes, high blood pressure, cholesterol and other obesity-related problems, he added. “You can’t make a blanket recommendation that everyone should be on it,” he said. “Cost is going to be an issue initially, but hopefully down the road the cost will get better.”
The increased risk of gallstones and other problems associated with liraglutide should be investigated further, Siraj said. “There is always room for caution until we have long-term data.”
“While there’s room for options, we also have to note that this is not a cure,” he told Live Science. “Fundamentally, obesity is a disease of lifestyle — diet and exercise — and therefore lifestyle modification has to be the core, no matter what you do. Medications alone are not going to do it.”
The device comprises two balloons that are inserted into the stomach and inflated without the need for surgery. The device is meant to be a temporary measure and should be removed after 6 months. Removal is also via a non-surgical procedure.
The US Food and Drug Administration (FDA) note that the ReShape Integrated Dual Balloon System:
“… likely works by occupying space in the stomach, which may trigger feelings of fullness, or by other mechanisms that are not yet understood.”
The Dual Balloon does not alter the anatomy of the stomach.
To help achieve and maintain weight loss, patients implanted with the Dual Balloon are advised to follow a medically supervised diet and exercise plan both while the device is in place and then for 6 months after it is removed.
The device is inserted during an outpatient visit. The procedure lasts no more than half an hour and is performed while the patient is under mild sedation.
A trained physician inserts the deflated balloons using an endoscope. This is a tube with a camera on the end that goes into the mouth, down the throat and into the stomach. The camera allows the physician to guide the placement of the deflated balloons.
Once in the stomach, the physician inflates the balloons by filling them with a sterile salt solution and then releases them and removes the endoscope.
The device is for obese adults whose body mass index (BMI) lies in the range 30-40 kg/m2. It is intended for patients who have not been able to lose weight through diet and exercise alone and is limited to those with one or more obesity-related conditions such as high blood pressure, high cholesterol and diabetes.
Trial participants lost 14 lbs on average
For the approval, the FDA reviewed a clinical trial of 326 obese patients aged from 22 to 60 whose BMI was in the range 30-40 kg/m2 and who had at least one obesity-related condition.
The trial randomly assigned the patients to either have the Dual Balloon inserted, or to undergo an identical “dummy” endoscopic procedure but where the device was not fitted.
The results showed that at the end of 6 months, when the device was removed, the 187 patients who were fitted with the Dual Balloon on average lost 14.3 lbs (6.5 kg), equivalent to 6.8% of their body weight.
In contrast, the control group on average lost 7.2 lbs (3.3 kg, 3.3% of their body weight).
And 6 months after the device was removed, the group that had it fitted managed to keep off an average of 9.9 lbs (4.5 kg) of the 14.3 lbs they lost.
The insertion procedure may have side effects. These include muscle pain, nausea and headache. In rare instances, this may also lead to severe allergic reaction, tearing of the esophagus, infection, breathing problems and heart attack. Once the Dual Balloon is inserted, patients may also experience nausea, vomiting, feelings of indigestion, abdominal pain and stomach ulcers.
Patients who have had bariatric or other kinds of gastrointestinal surgery should not be fitted with the device, and neither should patients diagnosed with inflammatory intestinal or bowel disease, who have symptoms of delayed gastric emptying or active H. pylori infection, or who have a large hiatal hernia. Pregnant women and patients taking aspirin every day should also avoid it, the FDA advises.
Device ‘fills a significant gap’
“Many Americans have struggled with a lack of effective weight loss options when their BMI is in the 30-40 range,” states Dr. John Morton, President of the American Society for Metabolic and Bariatric Surgery.
He says options like the ReShape Dual Balloon address a significant gap that exists between diet and exercise on the one hand and weight loss medications and surgery on the other.
The following video shows an animation of the insertion and removal of the ReShape Dual Balloon, which is made by ReShape Medical Inc., in San Clemente, CA.
(Reuters Health) – The odds are against obese men and women trying to get to a healthy weight, particularly if they are severely obese, a U.K. study suggests.
Researchers followed 76,704 obese men and 99,791 obese women for up to nine years. In any given year during the study, the probability that a patient might achieve a normal body weight was 1 in 210 for men and 1 in 124 for women.
For those who were severely obese, the annual odds stretched to 1 in 1,290 for men and 1 in 677 for women.
“The findings are not entirely unexpected as the weight trajectory for most is a gradual increase until late middle age,” said senior study author Martin Gulliford, a primary care and public health researcher at King’s College London. “Large reductions in body weight tend to be unusual.”
Globally, 1.9 billion adults are overweight or obese, according to the World Health Organization. Obesity increases the risk of heart disease, diabetes, joint disorders and certain cancers.
Previous research has found obese people often struggle to shed excess pounds or keep weight off when they do lose it. Lifestyle changes such as following a healthy diet and getting regular exercise can often help in the short-term but fail to produce lasting results, particularly among people who have more than 100 pounds to lose before reaching a healthy weight.
For the current study, Gulliford and colleagues focused on whether obese people who didn’t get weight loss surgery could reach a healthy weight, as well as whether they could successfully shed just 5 percent of their weight.
“Reductions of body weight of 5 percent or more are very valuable as this will reduce the harmful metabolic effects of excess weight,” Gulliford said by email.
Researchers analyzed data on obese people aged 20 years and older from a national database in the U.K. from 2004 to 2014.
To be included in the study, participants had to have at least three records of their body mass index (BMI), a measure of weight relative to height, in the database so researchers could estimate changes over time.
A BMI between 18.5 and 24.9 is considered a healthy weight, 25 to 29.9 is overweight, 30 or above is obese and 40 or higher is what’s known as morbidly obese.
An adult who is 5’ 9” tall and weighs from 125 to 168 pounds would have a healthy weight and a BMI of 18.5 to 24.9, according to the U.S. Centers for Disease Control and Prevention. An obese adult at that height would weigh at least 203 pounds and have a BMI of 30 or more.
At the start of the study, the men were 55 years old on average and the women were 49.
After a maximum of nine years, just 1,283 men and 2,245 women achieved a normal weight.
Overall, the annual likelihood of losing 5 percent of body weight was 1 in 12 for men and 1 in 10 for women, the researchers estimated. For people who were morbidly obese at the start of the study, the odds of achieving this milestone improved – narrowing to 1 in 8 for men and 1 in 7 for women.
It’s possible that these estimates might be thrown off by inaccurate data on height or weight for the study participants, the researchers acknowledge in the American Journal of Public Health.
Even so, the findings highlight the benefit of focusing on diet and exercise changes that may be needed to achieve that first 5 percent weight loss, which can often be achieved within six months, said Marion J Franz, of Nutrition Concepts by Franz in Minneapolis.
“Research has shown important health benefits from a weight loss of about 5 percent – prevention or delay of type 2 diabetes, decreases in blood pressure, decreases in circulating inflammatory markers, and potential improvements in lipids,” Franz, who wasn’t involved in the study, said by email.
“Therefore, weight loss interventions should promote health benefits not achieving an ideal body weight,” she said.