Category: Weight Loss & Obesity News
Piceatannol aids weight management, helps prevent obesity, found in red grapes and wine

Obesity is threatening the health and lives of nearly 70 percent of the U.S. population, and indicators of this epidemic are continuing to affect even more men, women and children and place a significant burden on an already failing health care system. Most health-minded individuals understand the importance of eliminating refined and processed foods while maintaining constant blood glucose and insulin levels to achieve individual weight management goals.

Researchers from Purdue University have published the result of a study in the Journal of Biological Chemistry that demonstrates the potent nature of natural compounds found in red wine and many fruits to block cellular processes that allow fat cells to develop. Scientists found that the compound piceatannol, found naturally in the skin of grapes and other fruits blocks an immature fat cell’s ability to develop and grow, opening a door to a potential method to control obesity.

Piceatannol inhibits the formation of mature fat cells to achieve weight management goals

The lead study author Dr. Kee-Hong Kim found that piceatannol, an analog of resveratrol found in grapes and other fruit, is converted to piceatannol in humans following its consumption. The team tested piceatannol in cultured immature fat cells called preadipocytes to determine if the compound inhibited the maturity process that results in fully developed fat cells, capable of storing body fat and contributing to obesity.

Dr. Kim commented “We consider that adipogenesis is an important molecular target to delay or prevent fat cell accumulation and, hopefully, body fat mass gain.” The team found that piceatannol bound to the insulin receptor on the immature fat cells, effectively blocking insulin’s ability to control normal cellular cycling resulting in mature adipocytes. The grape-derived compound stimulated the activation of special genes necessary for the fat cell maturation process.

The study authors concluded “Piceatannol actually alters the timing of gene expressions, gene functions and insulin action during adipogenesis, the process in which early stage fat cells become mature fat cells… in the presence of piceatannol, you can see delay or complete inhibition of adipogenesis.” Similar in structure to resveratrol, scientists believe piceatannol may also exert some of the same properties to help combat cancer, heart disease and neurodegenerative conditions.

Piceatannol is yet another natural compound that has demonstrated the ability to influence genetic expression to inhibit the formation of adipocytes or alter metabolism to help achieve weight management goals alongside resveratrol, green tea catechins (EGCG) and irvingia gabonensis. When used to compliment a natural food diet void of wheat and refined carbohydrates, piceatannol may be an important component to achieve natural weight management goals.

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Learn how to heal the adrenals, balance hormones and lose weight naturally

Sitting on top of each kidney, the adrenals are responsible for producing four main hormones – catecholamines, aldosterone, cortisol and androgens – which help to deal with everything from stressful situations, digestion, gender traits to blood pressure regulation. Gaining weight usually involves overactive adrenals but, this can be avoided, even reversed, without the need for surgery or extreme diets.

Don’t become a victim of adrenal stress. Most people, living in the ‘modern’ world, are being hurt by nutritional deficiencies and too many environmental toxins. But, the fact remains, you CAN naturally restore hormonal function, lose weight and avoid years of suffering. Want to learn more? Don’t miss the next NaturalNews Talk Hour – this Sunday.

The costs associated with obesity are staggering

In January 2012, according to a study published in the Journal of Health Economics, the estimated annual healthcare costs of obesity-related illnesses were calculated to be $190.2 billion or nearly 21% of annual medical spending in the United States. By the way, childhood obesity alone is responsible for $14 billion in direct medical costs.

Lead author John Cawley, a Professor in the Department of Policy Analysis and Management, and the Department of Economics, at Cornell University, said:

“Obesity raises the risk of cancer, stroke, heart attack and diabetes. For any type of surgery, there are complications with anesthesia, with healing [for the obese]. … Obesity raises the costs of treating almost any medical condition. It adds up very quickly.”

The problem here is that economists are great at calculating numbers and conventional medicine is great at ‘identifying’ or ‘treating’ disease – but the obesity epidemic remains unresolved. Even if you’re NOT obese – this is a problem that affects all of us because obesity raises costs in Medicaid – which results in higher taxes for society.

On the next Natural News Talk Hour, Dr. Christianson and Jonathan Landsman take a closer look at how to solve the obesity epidemic by improving hormone function and, specifically, adrenal health.

The 3 BIGGEST myths associated with adrenal health

Myth #1: Your adrenals are “fatigued.” More accurately, we need to understand that emotional and physical stress can cause insomnia, anxiety, weight gain, heart disease and adrenal stress – not fatigue. In truth, the adrenal glands work with several other glands, in what’s called the HPA (Hypothalamic Pituitary Adrenal) axis – which helps to regulate our energy levels and metabolism.

When our hormones are in balance – we feel great. But, hormonal imbalances usually occur due to work-related issues; eating too many processed foods, EMF pollution and poor sleeping habits – which lead to chronic inflammation, weight gain and disease.

Myth #2: Your adrenal glands need a drug. If that were true, then adrenal ‘fatigue’ – often diagnosed due to low cortisol levels – would simply be fixed by taking some herbs and cortisol pills. But, in most cases, health-related problems are NOT resolved this way.

Besides a more natural diet, one of the best ways to restore adrenal function is to get 30 to 60 minutes of sunlight exposure – every day. Limit your exposure to artificial lights (i.e. computers or T.V.) – especially 1 – 2 hours before bedtime.

Myth #3: Adrenal stress is just part of life. Put nicely, that’s a bunch of baloney! A healthy diet is one of the best ways to effectively restore hormonal balance and eliminate the threat of stress-related disorders.

Oddly enough, just the simple act of thoroughly chewing your food can have a tremendous ability to calm the nervous system. And, on the next Natural News Talk Hour, Jonathan Landsman and Dr. Christianson will reveal how to achieve optimal hormonal function.

This week’s guest: Dr. Alan Christianson, an expert in thyroid and adrenal disorders

Learn how to achieve optimal body weight and dramatically improve your health – Sun. Nov. 30

Dr. Alan Christianson is a naturopathic medical doctor, specializing in natural endocrinology with a focus on thyroid and adrenal disorders. He is the author of the soon to be released “Adrenal Reset Diet”, the bestselling “Complete Idiot’s Guide to Thyroid Disease”, and “Healing Hashimoto’s – a Savvy Patient’s Guide.”

As a child, Dr. Christianson was an avid reader of his family’s encyclopedias and medical textbooks, but his body was a source of struggle. Cerebral palsy left him with seizures, poor coordination, and eventual obesity. But, with acquired knowledge and persistence, he complete reversed his condition and, now, trains doctors internationally on the treatment of obesity and hormone-related issues.

Lose weight naturally! Don’t fall into the trap of believing that optimal weight is impossible to achieve. With improved eating habits and stress management techniques – you CAN quickly see results. On the next Natural News Talk Hour, Jonathan Landsman and Dr. Alan Christianson will talk about how to naturally balance hormones and achieve optimal weight.

Join our weight loss program and lose upto 16-20 pounds in just 26 days. Call us at +92 345 8580969 to speak to our weight loss expert or email us at wecare@vitatious.com.

 

 

 


Mediterranean diet can reverse metabolic disorder, lower risk of diabetes, obesity, heart disease

The Mediterranean diet doesn’t just protect against heart disease: It may actually reverse metabolic syndrome, a cluster of symptoms linked to heart disease and diabetes.

The findings came from a study conducted by researchers from the Universitat Rovira i Virgili and the Hospital Universitari de Sant Joan de Reus in Reus, Spain.

“In this large, multicentre, randomized clinical trial involving people with high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil was associated with a smaller increase in the prevalence of metabolic syndrome compared with advice on following a low-fat diet,” the researchers wrote.

“Because there were no between-group differences in weight loss or energy expenditure, the change is likely attributable to the difference in dietary patterns.”

A heart-healthy diet

Metabolic syndrome refers to a cluster of symptoms that is associated with a higher risk of diabetes, cardiovascular disease and premature death, and affects about 25 percent of all adults globally. The condition can be diagnosed in anyone who has three or more symptoms. Symptoms include high blood sugar, high triglycerides, low HDL (“good”) cholesterol, high blood pressure and central obesity (a large waist circumference).

The researchers wondered how the Mediterranean diet could affect metabolic syndrome, because the diet has previously been shown to reduce the risk of cardiovascular disease and type 2 diabetes, as well as lead to better health, longer life and less age-related cognitive decline. For example, a 2013 study published in the New England Journal of Medicine found that people who ate a Mediterranean diet were about 30 percent less likely to develop cardiovascular disease than people who ate a low-fat diet.

The Mediterranean diet has high quantities of olive oil, seeds and nuts, whole grains and beans; moderate to high quantities of dairy, primarily in the form of yogurt and cheese; moderate quantities of fish and poultry; low to moderate consumption of red wine; and low consumption of red meat.

Metabolic syndrome decreased 30 percent

In the new study, researchers randomly assigned 5,801 adults between the ages of 55 and 80 who were considered at high risk of developing heart disease to follow one of three diets: a low-fat diet (control group), a Mediterranean diet plus extra olive oil or a Mediterranean diet plus extra nuts. Participants were followed for an average of 4.8 years.

By the end of the study, there was no difference between the three groups in the numbers who had developed new cases of metabolic syndrome. This showed that, despite being higher in fat, the Mediterranean diet did not worsen metabolic outcomes.

The more surprising outcome came among patients who already had metabolic syndrome at the beginning of the study. Among the groups on one of the two Mediterranean diets, the incidence of metabolic syndrome actually fell by 28.2 percent. Participants receiving extra olive oil were more likely to see decreases in central obesity and blood sugar, whereas participants receiving extra nuts were more likely to see a decrease in central obesity alone.

“Mediterranean diets supplemented with olive oil or nuts were not associated with a reduced incidence of metabolic syndrome compared with a low-fat diet; however, both diets were associated with a significant rate of reversion of metabolic syndrome,” the researchers wrote.

Increasingly, research is suggesting that the benefits of the Mediterranean diet also extend far beyond metabolic health. In a 2010 study conducted by researchers from the University of Navarra in Pamplona, Spain, and published in the Journal of the American Medical Association, the Mediterranean diet was found to lower the risk of developing depression by 30 percent — even after researchers controlled for risk factors including anxiety, personality, lifestyle habits and family status.

Join our weight loss program and lose upto 16-20 pounds in just 26 days. Call us at +92 345 8580969 to speak to our weight loss expert or email us at wecare@vitatious.com.

 

 


Doctors should advise overweight moms considering another pregnancy to take off extra weight first because they are at greater risk of having big babies, a new Saint Louis University study finds.

Researchers found that moms who don’t lose the weight they gained during the first pregnancy and continue to gain after their first child is born are at risk of having bigger babies than mothers who do not gain weight between pregnancies. A patient’s prepregnancy weight remained the strongest predictor for the birth of a large infant in the next pregnancy.

“Our advice to moms is to take off the weight they gained during one pregnancy and not to gain weight between pregnancies,” said Robert Blaskiewicz, M.D., professor of obstetrics, gynecology and women’s health at Saint Louis University.

Large babies can be more difficult and take longer to deliver than normal weight babies because they are too big to fit easily through the birth canal. Large birth weight also might lead to a cesarean delivery.

“The ideal is to have their weight as close to normal as possible. Weight gain between pregnancies doubles the risk of having a ‘large for gestational age’ baby.”

Dr. Blaskiewicz presented the research, which was conducted in conjunction with the Saint Louis University School of Public Health, at the May meeting of the American College of Obstetricians and Gynecologists.

Dr. Blaskiewicz compared 38,086 women who were of normal weight at their first and second pregnancies with 10,585 women who were of normal weight for their first pregnancy but overweight for their second.

A baby who is “large for gestational age” typically weighs about eight pounds, 13 ounces. Most babies weight about seven pounds.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others. The School of Medicine trains physicians and biomedical scientists, conducts medical research, and provides health services on a local, national and international level.

Join our weight loss program and lose upto 16-20 pounds in just 26 days. Call us at +92 345 8580969 to speak to our weight loss expert or email us at wecare@vitatious.com.

 


A weight loss plan

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.


Benefits of some weight-loss surgeries diminish over time

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.”


Drug Helps Obese People Drop Weight and Keep It Off

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.”


UK proposals to strip obese claimants of benefits ‘flawed and unethical’

UK government proposals to strip obese or drug-addicted welfare claimants of benefits if they refuse treatment may violate medical ethics, the president of the British Psychological Society has said.

Prof Jamie Hacker Hughes, whose organisation represents psychologists in the UK, said people should not be coerced into accepting psychological treatment and, if they were, evidence shows it would not work.

He said: “There is a major issue around consent, because as psychologists we offer interventions but everybody has got a right to accept or refuse treatment. So we have got a big concern about coercion.”

Hacker Hughes lent his voice to a chorus of criticism following the announcement of an official review to consider how best to get people suffering from obesity, drug addiction or alcoholism back into work.

A consultation paper launched on Wednesday admitted strong ethical issues were at stake, but it also questioned whether people should continue to receive benefits if they refused government-provided treatment.

In an interview with the Guardian, Hacker Hughes said claimants with obesity and addiction problems often faced complex mental health issues. But he warned the government against using sanctions to force people to accept interventions.

“It’s a problem firstly because we don’t believe people should be coerced into accepting any treatment, and secondly there is a problem because the evidence shows that if you are trying to change people’s behaviour, coercion doesn’t work,” he said.

Hacker Hughes said there was a well-documented link between joblessness and psychological problems, but said the government’s plan risked confusing the symptoms with the cause.

“It’s not just a correlational relationship, but research that’s going on at the moment shows that for every so many people who are unemployed there’s an increase in psychological problems,” he said. “Unemployment gives rise to psychological problems, so is the way to look at that to look at psychological problems or to look at causal factors?”

Commenting on the potential impact of sanctions, he added: “If you take the argument that people’s psychological problems are caused by sociological factors, and then you end up in a situation where people are worse off, it’s not going to help.”

Simon Antrobus, the chief executive of Addaction, also said he doubted that threats to remove benefits were an answer to helping people overcome their addictions.

“For people with drug and alcohol problems who are receiving welfare, benefits can provide the building blocks of recovery from addiction: regular income and access to secure accommodation,” he said.

“At Addaction we know that the people we support are more likely to recover if there is stability in their lives. This isn’t easy to achieve, so I’m not surprised that when we discussed this with our service users recently they said that a threat to remove their benefits wouldn’t be an incentive and could make their addiction worse and not better.”

Officials estimate that in August last year about 280,000 working-age benefit claimants were suffering from addiction to opiates, and 170,000 from alcohol dependency.

In addition, in May 2014, there were 7,440 working-age disability living allowance claimants whose main condition was obesity. There were also 240 claiming incapacity benefit and severe disablement allowance, and 1,540 claiming employment and support allowance.

The consultation paper published this week gave no indication of the kinds of support that would be on offer, but psychological treatment seems likely. An editorial on the issue in the British Medical Journal pointed out that the only treatment consistently successful for obesity is bariatric surgery, a major surgical procedure.

“Requiring people to undergo a major surgical procedure as a condition of receiving benefits seems far from ethical,” it said.

Jill Tipping, the director of Helping Overcome Obesity Problems, an obesity support group, welcomed any promise of help. But she said there simply wasn’t a wide enough range of services available for people with serious weight problems.

“When you have got an 18-year-old who is five stone overweight, who’s completely messed up head-wise, and needs help for food addiction, the child really needs psychological support and counselling,” she said.

“We can’t see that there is adequate treatment out there. Look at the amount of money spent on obesity, it’s a tenth of the money spent on drug and alcohol addiction. It’s a pitiful amount.”

Paul Atkinson, a London-based psychotherapist and member of the Alliance for Counselling and Psychotherapy, called the government’s proposals an outrage. “It’s the same psychology from the government of punishing rather than working with people. Under a regime like welfare and jobcentres at the moment it is going to be felt as abuse, punitive and moralistic.”

 


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.

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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!