Evidence-Based Nutrition Guidelines Needed For Cancer Survivors

Cancer survivors die of non-cancer-related causes at much higher rates than the general public. In 2008, the U.S. economic burden of cancer totaled over $228 billion but only 41% of these costs involved direct cancer care. The majority of expenses were attributed to increased morbidity, lost productivity, and premature mortality. A commentary published in the March 2011 issue of the Journal of the American Dietetic Association examines the current evidence supporting nutrition recommendations for preventing cancer recurrence and managing chronic conditions prevalent in cancer survivors, as well as improving quality of life and decreasing health care costs. The commentary also describes knowledge gaps and suggests future nutrition research directions.

"As the number of cancer survivors continues to increase, opportunities to conduct longer-term research are expanding," commented lead author Kim Robien, PhD, RD, Assistant Professor, Division of Epidemiology and Community Health; and Member, Cancer Outcomes and Survivorship Program, Masonic Cancer Center, University of Minnesota, Minneapolis. "With over 12 million American cancer survivors (about 4% of the population), it is time to concentrate on guidelines to help patients avoid the other complications that lead to death. Data support the hypothesis that nutrition interventions are not only likely to help with cancer outcomes, but can also be important in preventing and managing some of the chronic health conditions that can occur after cancer treatment, such as cardiovascular complications, weight gain, diabetes and other endocrine disorders, functional impairment, osteopenia and osteoporosis."

The authors discuss current recommendations for cancer survivors, which emphasize achieving and maintaining a healthy weight; encouraging regular physical activity (for adults at least 30 minutes of moderate to vigorous physical activity every day); eating a diet rich in vegetables, fruits, and whole grains; and limiting red and processed meats and alcohol consumption. Further, the current recommendations are that cancer survivors try and obtain their nutrients from foods, rather than supplements since there have been several studies that have linked supplement intake with higher cancer-specific and all-cause mortality among cancer survivors.

Important knowledge gaps that call for further research are identified. Because most cancer patients have one or more comorbid conditions, management of these comorbidities by nutritional interventions may improve quality of life for these individuals. Another area of investigation is whether specific cancers require specific nutritional guidelines.

Finally, the authors recognize that any nutritional intervention must work with the individual patient. Despite efforts by the American Cancer Society and the World Cancer Research Fund/American Institute for Cancer Research to encourage cancer survivors to follow diet and lifestyle recommendations for cancer prevention, evidence suggests that few cancer survivors are doing so. Further research is needed to determine the optimal method and timing of interventions to promote healthy lifestyle behaviors among cancer survivors.

Body Weight Influences Risk Of Death Among Asians

A study of more than 1 million Asians found that those who were a normal weight were far less likely to die from any cause than individuals whose body-mass index (BMI) was too high or low. A similar association was seen between BMI and the risk of death from cancer, cardiovascular disease or other causes.

The study, led by Wei Zheng, M.D., Ph.D., M.P.H., Ingram Professor of Cancer Research at Vanderbilt-Ingram Cancer Center, Nashville, Tenn., Paolo Boffetta, M.D., M.P.H., professor, Mount Sinai School of Medicine, New York, N.Y., and John D. Potter, M.D., Ph.D., member and senior adviser, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Wash., was published in this week's issue of The New England Journal of Medicine.

"Previous studies that evaluated the association between BMI and the risk of death have been conducted primarily in populations of European descent, and the current definition of overweight and obesity is based essentially on criteria derived from those studies," said Zheng, director of the Vanderbilt Epidemiology Center. "The validity of these criteria in Asian populations has yet to be determined. A large proportion of Asians are very thin and the impact of a severely low BMI on the risk of death has not been well evaluated until now."

The World Health Organization estimates that more than 1 billion adults worldwide are overweight and at least 300 million are obese. Fat tissue has been recognized as an active endocrine organ, capable of releasing a number of biologically active factors that may contribute to obesity-related diseases, including type 2 diabetes, hypertension, coronary artery disease, stroke and several types of cancer.

The research, conducted as part of the Asia Cohort Consortium, included health status and mortality information on more than 1.1 million individuals from East and South Asia. In the cohorts of East Asians, including Chinese, Japanese and Koreans, the lowest risk of death was seen among individuals with a BMI in the range of 22.6 to 27.5, which is considered normal to slightly overweight (BMI is defined as weight in kilograms divided by the square of height in meters).

Chinese, Japanese and Korean populations were much like groups in other parts of the world. These East Asians with a raised BMI of 35.0 or higher had a 50 percent higher risk of death. The same was not true for Indians and Bangladeshis, indicating that a high BMI did not affect all ethnic groups in a similar way.

Being severely underweight was even more dangerous among all of the Asian populations studied. The risk of death was increased by a factor of 2.8 among those whose BMI was very low, that is, 15.0 or less.

"The most unexpected finding was that obesity among sub-continent Indians was not associated with excess mortality," said Potter. "This may be because many obese people in sub-continent India have a higher socioeconomic status and so have better access to health care."

"Our findings capture two different aspects of a rapidly evolving pattern; severe underweight was highly prevalent in Asia in the past, and we can still observe its important impact on mortality," explained Boffetta. "Looking into the future, however, prevention of overweight and obesity deserves the highest priority."

The authors conclude that this study provides strong evidence supporting the biologic plausibility that excess weight contributes to a higher risk of death.

"This confirms that most people are at a higher risk for dying early if they are obese and is a clear message not to gain weight as we age," said Potter.

Nearly 50 researchers from seven countries contributed to this study. Data analysis for the project was conducted by the Asia Cohort Consortium Coordinating Center, which is supported, in part, by Fred Hutchinson Cancer Research Center and the National Cancer Institute.

 

Millions Of Overweight People Unaware Of Cardiometabolic Dangers

Experts meeting at the 2nd International Congress on Abdominal Obesity (ICAO) issued a warning that millions of individuals around the globe are at risk from the cardiometabolic consequences of being overweight. Worryingly, the experts suggest that these people are not being identified by their doctors.

The International Chair on Cardiometabolic Risk (ICCR) released the statement from the ICAO, at a symposium sponsored by GlaxoSmithKline. The statement suggests that the media tends to focus on extremes when discussing obesity: either skinny celebrities who gain or lose a few pounds or the morbidly obese who need the help of fire-fighters to leave their homes. As the proportion of the general population which is overweight or obese increases, so the perception of what is the norm of a healthy weight is being reset. In the minds of society as a whole, including healthcare practitioners, the mental picture of an overweight or obese person has been reset inaccurately to a far heavier model.

Yet it is the millions across the world with BMIs above 25 who may already be suffering the early stages of high blood pressure, dyslipidemia and diabetes, who could benefit most from early intervention, say ICCR.

"Many primary care doctors may be treating obese patients with BMIs of 30 and above for the symptoms related to increased cardiometabolic risk, like pre-diabetes, dyslipidemia and hypertension, but not treating them for the underlying cause, their excess visceral adiposity," commented Professor Jean-Pierre Després, Scientific Director of ICCR and Professor, Faculty of Medicine, University Laval, Québec, Canada. Visceral adiposity is fat stored in the abdomen and around the vital organs. Excess visceral fat increases the risk of serious diseases, such as type 2 diabetes, stroke and heart disease.

"A patient with a BMI of 29 or 31 is the norm today yet when we think of an obese person, we tend to visualise someone with a much higher BMI of 40 plus. Patients with lower BMIs but higher levels of hidden, visceral fat are more difficult to identify yet can be at as much cardiometabolic risk as more obviously obese individuals", continued Professor Després. ICCR emphasised the need for urgent action to target these at-risk patients in order to slow the increasing rate of obesity across the world and stem the rising levels of diabetes and cardiovascular disease.

New research released at the Congress from the INternational Study of Prediction of Intra-abdominal adiposity and its RElationships with cardioMEtabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA) supports the ICCR's position. INSPIRE ME IAA recruited 4,504 patients from 29 countries and showed harmful cardiometabolic risk profiles among non-diabetic, study participants, even among sub-groups of moderately overweight patients with an excess of visceral adipose tissue.

ICCR called for a renewed focus on what actually constitutes a healthy weight and how healthcare professionals support people in attaining and maintaining it. "In addition to patients who are clearly obese, we need to pay attention to overweight patients with visceral obesity who do not realise the potential dangers of the fat within their abdomen. Their doctor may not make this connection either. Yet a modest weight loss of just five or ten percent could result in a substantial loss of visceral adipose tissue and make all the difference to these people" stated Professor Després.

Modest gradual weight loss is recognised by most experts as the best way to lose and keep off weight, yet the diet industry and media fuel unrealistic expectations by promoting 'crash diets' and extreme dieters who slim to a fraction of their previous size. A lack of information and guidance on realistic approaches to and interventions which support modest weight loss is also considered by ICCR as a factor in the failure to reverse the tide of obesity.

As an organisation which strongly advocates a multidisciplinary approach to treating cardiometabolic risk factors, ICCR believes it is in a strong position to drive a renewed effort to overcome the multi-factorial barriers preventing healthcare professionals from turning the tide in the battle against obesity. ICCR also told the Congress it will seek to encourage and broaden the conversation around the concept of healthy weight in the hope of resetting the conversation around abdominal obesity, realistic weight loss and health.

Breastfeeding Babies Exposed To Diabetes In Utero Protects Against Childhood Obesity

Breastfeeding a baby exposed to diabetes in utero may help protect that infant from becoming obese during childhood, according to a study published in the February issue of Diabetes Care and an accompanying editorial, which noted that population-wide detection and treatment of gestational diabetes takes on even greater importance due to these findings.

Babies that were breastfed for six months or more, after exposure to maternal diabetes in utero, were no more likely to put on extra weight as children (ages 6-13) than those who were not exposed to diabetes, the study found. This effect was not realized, however, for babies breastfed less than six months. The results were consistent across ethnicities.

"Our data suggest that breastfeeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in offspring of mothers with diabetes during pregnancy," said Dr. Dana Dabelea, Associate Professor in the Department of Epidemiology, Colorado School of Public Health, and lead researcher on the study. "Since childhood obesity and in utero exposure to maternal diabetes have both been associated with later development of type 2 diabetes, it follows that breastfeeding these children may also help reduce their future risk for developing type 2. However, further research would be needed to confirm that added protection."

The study also suggests that the early postnatal period may be a critical period for determining future obesity and diabetes risk, the researchers concluded. "The macronutrient composition of breastmilk (i.e. protein, fat, carbohydrate) and bioactive substances not present in formula may influence metabolic programming and regulation of body fatness and growth rate," they wrote.

Previous research has shown that children born to mothers who had diabetes during pregnancy are more prone to childhood obesity than those who are not, perhaps because they are "programmed" to put on extra weight due to exposure to their mother's excessive glucose levels during these critical stages of prenatal development.

In an editorial accompanying this study, Dr. Andreas Plagemann, of the Clinic of Obstetrics, Division of Experimental Obstetrics, Charite-University Medicine Berlin, wrote that the study reinforced the importance of breastfeeding and of testing and treating pregnant women for diabetes "to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."

"Beyond its important role for mother-child binding, breastfeeding as compared to formula has a considerable number of positive short and long term effects on human development, such as a decreased incidence of high respiratory infections, a lower risk of asthma and atopy, and a decreased risk of high blood pressure, type 2 diabetes as well as type 1 diabetes," he wrote. "Moreover, profound evidence exists that breastfeeding has the potential to permanently decrease the long-term risk of developing obesity, as shown by the results of at least for meta-analyses on this issue."

 

Six Easy, Fun Steps To Better Health

CIGNA and Healthy Kids Challenge, working together since 2004 to fight obesity, announced the launch of their latest initiative - an online CIGNA Mix Six for Healthy Balance Toolkit offering real-life ways for individuals, families and employers to incorporate better health into their daily routines.

Despite all of the dialogue about obesity, some 86 percent of Americans are expected to be overweight or obese by 2030.1 Businesses, individuals and families pay the price not only in higher health care costs but in human terms as well: loss of productivity, a shorter life expectancy due to conditions caused by obesity and poor health in general. The CIGNA and Healthy Kids Challenge collaboration is designed to help reverse the obesity trend through online coaching and interactive programs.

"It is critical that we continue to get the message out about the effects that everyday choices have on our health and on overall costs to the health care system," said Patty Caballero, director of sponsorships, CIGNA. "This toolkit is a great resource to reinforce this message in a fun and engaging - and hopefully habit-forming - way."

Drawing on CIGNA's experience with wellness in the workplace and Healthy Kids Challenge's expertise on children's health, the new collaborative toolkit offers simple, actionable solutions at a variety of levels. The goal is to enable everyone to eat healthier and exercise more both at home and at work. The educational and interactive materials can be adapted in any chronological order, therefore, Mix Six for Healthy Balance:

- Colorful Plates: Diets rich in fruits and vegetables not only keep weight in check but can lower the risk for stroke, cardiovascular disease, diabetes and even some cancers. Yet fewer than two in 10 adults - and fewer than one in 10 kids - eat the daily recommended amount of fruits and vegetables. Colorful Plates helps users add fruits and vegetables to their diets simply by adding color to their plates.

- Minutes in Motion: Regular physical activity lowers risk for stroke, heart attack, diabetes, and bone fractures and can help people stay mentally sharp as they age. Experts recommend 30 minutes of daily physical activity and agree that most adults are not meeting that goal. Minutes in Motion offers fun activities to help people of all ages get moving.

- Power Breakfast: Parents were right: breakfast is the most important meal of the day. Eating breakfast improves concentration, problem-solving ability, mental performance, memory and mood and helps people maintain a healthy weight. Power Breakfast offers easy tips and meal ideas to begin any day the right way.

- Snack Attack: It's estimated that in the U.S., one-quarter of daily calorie intake comes from snacks. An extra 100 sugary calories daily can add up to more than 10 pounds in a year. Snack Attack helps people learn how to make healthy snack choices by planning ahead and understanding which snacks are both nutritionally worthy and tasty.

- Smart Servings: Super-sized meals are not a value when you consider your waistline. Smart Servings helps users recognize eating distractions so that they can better watch what they eat and also shows how to better estimate serving sizes.

- Drink Think: Coffee used to cost a quarter - and came with a quarter of the calories when compared to today's café mochas. Drinks are often an overlooked culprit when it comes to weight control. Drink Think challenges users to assess calories in a particular drink to help them downsize or choose an alternate beverage.

"The new CIGNA Mix Six for Healthy Balance Toolkit features up-to-date, relevant and fun information and activities for a variety of ages, in a variety of settings," said Vickie James, RD, LD, executive director, Healthy Kids Challenge. "This latest initiative has been another great opportunity to partner with CIGNA to work towards our shared goal of improving health."

1 According to researchers at the Johns Hopkins Bloomberg School of Public Health, the Agency for Healthcare Research and Quality and the University of Pennsylvania School of Medicine.

FDA Decision Endorsed By Leading Texas LAP-BAND Team True Results

The True Results team of gastric band surgeons and medical weight loss experts is pleased the U.S. Food and Drug Administration (FDA) has recognized the long-standing safety and effectiveness record of the LAP-BAND® System. This ruling will now allow millions of additional Americans to qualify for earlier weight-loss intervention. Additionally, the LAP-BAND is now the first and only FDA-approved device for bariatric surgery in patients with a body mass index (BMI) of 30-35 and one or more obesity related comorbid condition such as type 2 diabetes, heart disease, hypertension or sleep apnea.

With this ruling, the LAP-BAND device is now approved for use on patients that are generally more than 50 pounds overweight (classified as obese), which is approximately 30 percent of the U.S. adult population. For example, a person 5-feet, 2-inches tall, weighing 165 pounds with one comorbid condition, that has not been successful on diet and exercise programs, is now eligible for the LAP-BAND procedure. Previously, this person needed to weigh at least 192 pounds with one medical condition or 220 pounds without any medical conditions.

"The FDA endorsement of the LAP-BAND as a safe and effective treatment for the mild to moderately obese is very gratifying. It is the culmination of a process that began with a major clinical trial we performed in Australia five years ago," said Dr. Paul O'Brien, True Results National Medical Director and world-renowned surgeon that played a key role in the development of the LAP-BAND. "It is pleasing to see obesity acknowledged as a disease that deserves treatment and have the LAP-BAND recognized as the most appropriate surgical weight loss option for this group. Nearly 26 million more Americans can now benefit from this safe, gentle and effective treatment to reach and maintain a healthy weight."

Medical research has found that, if left untreated, those individuals who are currently obese (BMI of 30-40) will likely remain obese without intervention. Obesity is the second-leading cause of preventable death in the United States, second only to smoking, and given the correlation between obesity and life-threatening conditions, such as heart disease, Type 2 diabetes and high blood pressure, it is a disease that requires medical treatment.

Texas Survey Findings Support National Medical Data

The lowering of BMI requirements for the LAP-BAND procedure has become necessary to combat the U.S. obesity epidemic. For overweight people, the problem is not personal weakness or lack of willpower - often times it's hereditary or diet programs themselves. Fifty years of research shows that dieting fails at providing significant long-term weight-loss. Many times dieters stop one diet program and move onto the next, gaining weight in the process.

In fact, a recent True Results survey found that nearly a quarter of Texans have tried 10 or more diets in their lifetime. The rate of frequent dieting (10+ diets) increased to 37 percent for obese respondents (BMI = 30-40) and 45 percent for morbidly obese respondents (BMI = 40+).

"The LAP-BAND is not a quick fix, it is a tool to help patients achieve the long-term weight loss they have not been able to sustain with other methods," said Jessica Diaz, nutritionist and exercise physiologist for True Results. "The patient must still undergo a complete lifestyle change in order to achieve long-lasting results. That's why True Results provides complete aftercare including nutrition and exercise support throughout the patient's weight loss journey."

The poll also showed that 71 percent of Texans feel the LAP-BAND procedure is the safest medical weight loss procedure as compared to gastric bypass or gastric sleeve. Half of Texans feel LAP-BAND is the most effective weight loss procedure.

True Results LAP-BAND Experts

True Results specializes in the gastric band procedure due to its safety record and long-term effectiveness. The LAP-BAND has been proven in studies to significantly reduce weight and body mass steadily and consistently with patients maintaining their weight-loss over time. The LAP-BAND is 10 times safer than gastric bypass and gastric sleeve and achieves nearly identical long-term weight loss. Because the LAP-BAND is a restrictive device and requires no cutting, stapling, or removal of any part of the stomach, it is completely reversible and adjustable, unlike gastric bypass or gastric sleeve.

About the Survey

The statewide survey was conducted by Promark Research Corporation, a public opinion research firm, from January 6 to 13, on behalf of True Results. A total of 802 residents of Texas were surveyed online. Results are considered accurate to +/- 3.46% 19 times out of 20.

 

Knee Pain From Common Arthritic Condition Eased By Weight Loss

Knee pain related to osteoarthritis (OA) is a common complaint among obese individuals and retired professional athletes, especially former NFL players, but researchers presenting their work at the American Orthopaedic Society for Sports Medicine's Specialty Day program said they have a simple solution: lose weight.

"Our research on patients who were obese with early-onset knee osteoarthritis showed that those individuals who underwent isolated weight loss via bariatric surgery and lost an average of 57 pounds within the first six months significantly improved their knee pain, stiffness and physical function. Quality of life, activities of daily living and sports activity also improved; all of this without other arthritic treatments," said lead researcher Christopher Edwards of the Penn State College of Medicine.

OA of the knee is one of the five leading causes of disability among elderly men and women in the U.S., and costs $185 billion in out-of-pocket expenditures each year. Obesity is one of the leading risk factors for the disease.

The study followed 24 adult patients who ranged in age from 30-67 and were diagnosed as obese with clinical and radiographic evidence of knee OA. The Western Ontario and McMaster (WOMAC) Index of Osteoarthritis and Knee and Osteoarthritis Outcome Score (KOOS) surveys were administered at a pre-bariatric surgery baseline and at six and 12 months post surgery.

"Each individual had some kind of improvement in their pain from losing weight, some more than others. There are few studies that have investigated the role of isolated weight loss in the absence of additional arthritis treatment on those individuals with radiographically confirmed OA. Further research still needs to be performed to investigate whether knee arthritis symptom improvement continues over time and are applicable to those individuals who are simply overweight, but our research suggests a strong possibility of improvement," said Edwards.

Obesity And Knee Osteoarthritis Shorten Healthy Years Of Life

An estimated 10 million Americans suffer from knee osteoarthritis (OA), making it one of the most common causes of disability in the US. Due to obesity and symptomatic knee OA, Americans over the age of 50 will together lose the equivalent of 86 million healthy years of life, concluded researchers at Brigham and Women's Hospital (BWH), who investigated the potential gains in quality and quantity of life that could be achieved averting losses due to obesity and knee OA. These findings are published in theAnnals of Internal Medicine.

"Reducing obesity to levels observed in 2000 would prevent 172,792 cases of coronary heart disease, 710,942 cases of diabetes, and 269,934 total knee replacements," said Elena Losina, PhD lead author of the study and co-director of Orthopedics and Arthritis Center for Outcomes Research in the Dept of Orthopedic Surgery at BWH. "All told, it would save roughly 19.5 million years of life among US adults aged 50-84."

Experts have long known that knee osteoarthritis is on the rise among Americans, due in part to the growing obesity epidemic and longer life expectancy. Obesity and knee OA are among the most frequent chronic conditions in older Americans. However, how that translates into years of healthy life lost has not been accurately estimated. Dr. Losina and colleagues used a mathematical simulation model to assemble national data on the occurrence of knee OA, obesity and other important conditions such as coronary heart disease, diabetes, cancer and chronic lung disease. Their analysis examines the contribution of both obesity and knee OA to losses in quantity and quality of life. It also evaluates how those losses are distributed among racial and ethnic subpopulations in the United States.

"There are 86 million healthy years of life at stake, a disproportionate number of them being lost by Black and Hispanic women," said Jeffrey N. Katz, MD, Director of the Orthopedics and Arthritis Center for Outcomes Research at the BWH and a senior author of the study. "These staggering numbers may help patients and physicians to better grasp the scale of the problem and the potential benefits of behavior change."

This study was funded by grants from National Institute of Arthritis, Musculoskeletal and Skin Disease and the Arthritis Foundation. Contributing authors include Rochelle P. Walensky, MD, MPH, Massachusetts General Hospital, William M. Reichmann, MA, Holly L. Holt, Hanna Gerlovin, Daniel H. Solomon, MD, MPH and Jeffrey N. Katz, from Brigham and Women's Hospital, David Hunter MD from University of Sydney, Australia, Joanne M. Jordan, MD from University of North Carolina, Chapel Hill, Drs. Lisa Suter and A. David Paltiel, from Yale University School of Medicine.

FDA Approves Gastric Band For Obese Americans

Losing weight is extremely difficult for some. So difficult in fact, that a new stomach band has been approved by the FDA for those persons with a body mass index (BMI) of between 30 and 40, amounting to approximately 37 million Americans in fact that can now use this new product put out by Allergan Incorporated.

A frequent use of the BMI is to assess how much an individual's body weight departs from what is normal or desirable for a person of his or her height. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI significantly (see discussion below and overweight). The World Health Organization regards a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is considered obese. These ranges of BMI values are valid only as statistical categories when applied to adults, and do not predict health.

Frederick Beddingfield, M.D., Allergan's Vice President of Clinical Research and Development states:

"Given the proven and significant health ramifications of obesity, we are pleased with the FDA's decision to expand the use of the LAP-BAND System. Although this label expansion represents a significant advancement in obesity treatment, the LAP-BAND System is not intended for everyone. The LAP-BAND System does represent a potential treatment option for those patients with obesity and a related health condition, who have failed more conservative weight-loss therapies, such as diet and exercise and pharmacotherapy, and under consultation with their physician, have determined that weight-loss surgery is the next best treatment option."

Smoking is America's number one killer, but obesity is the second-leading cause of preventable death in the United States. Given its known correlation to life-threatening comorbid conditions, such as heart disease, stroke, Type 2 diabetes, high blood pressure, sleep apnea and even premature death, obesity is a disease that requires medical treatment. Medical research has found that, if left untreated, those individuals who are currently obese will likely remain obese.

Robert Michaelson, M.D., Ph.D., Northwest Surgical Weight Loss Surgery, Everett, Washington, and Clinical Trial Investigator continues:

"As a surgeon, I see patients every day who have been obese for years and have tried several diet and exercise programs without success. These patients frequently feel judged by their weight, as obesity is often viewed as a lack of will power, which it is not. Obesity is a disease, which requires medical treatment, but unfortunately diet and exercise alone do not work for everyone. The LAP-BAND System meets an unmet clinical need, as it provides an effective treatment option, which is used in combination with diet and exercise, to enable sustained weight loss."

The LAP-BAND System was originally approved by the FDA in 2001 for use in severely obese adults, individuals with a BMI of 35 with at least one severe comorbid condition or a BMI of 40, or those who are at least 100 pounds or more overweight. In addition, the LAP-BAND System has been approved internationally since 1993. The System is now the first and only FDA-approved device for bariatric surgery in patients with a BMI of 30-35.

Over the past 18 years, more than 650,000 procedures have been performed, leading to over two million patient years of exposure for the device.

 

Link Between Obesity, High-Fat Meals And Heart Disease Reinforced By Study

The effect of a high-fat meal on blood vessel walls can vary among individuals depending on factors such as their waist size and triglyceride levels, suggests new research at UC Davis.

The new research reinforces the link between belly fat, inflammation and thickening of the arterial linings that can lead to heart disease and strokes.

Triglycerides are types of fat molecules, commonly associated with "bad cholesterol," known to increase risk of inflammation of the endothelium, the layer of cells that lines arteries.

"The new study shows that eating a common fast food meal can affect inflammatory responses in the blood vessels," said Anthony Passerini, assistant professor of biomedical engineering at UC Davis, who led the project.

"Our techniques allowed us to measure the inflammatory potential of an individual's lipids outside of the body and to correlate that with easily measured characteristics that could be used to help better understand a person's risk for vascular disease," Passerini said.

Passerini collaborated with Scott Simon, professor of biomedical engineering at UC Davis, to develop cell culture models to mimic the properties of blood vessels. They wanted to learn how triglyceride levels can cause endothelial inflammation, and find a way to assess an individual's inflammatory potential.

They recruited 61 volunteers with high and normal fasting triglyceride levels and a range of waist sizes, then measured levels of triglyceride particles in their blood after they ate a typical fast food breakfast from a major fast food franchise: two breakfast sandwiches, hash browns and orange juice.

Passerini's team found that after eating the high-fat meal, the size of a type of a particle called triglyceride-rich lipoprotein (TGRL) varied directly with the individual's waist size and preexisting blood triglyceride level. These particles can bind to the endothelium, triggering inflammation and an immune response that brings white blood cells to repair the damage. Over time, this leads to atherosclerosis.

The researchers tested whether TGRL particles from the volunteers' blood could cause cultured endothelial cells in the laboratory to express markers for inflammation.

There was a mixed response: individuals with both a waist size over 32 inches (not terribly large by most standards) and high triglyceride levels had large lipoprotein particles that bound easily to the endothelial cells and caused inflammation in response to an immune chemical "trigger."

The TGRLs only caused inflammation when exposed to this immune molecule, which suggests that people with existing low-grade inflammation may be more susceptible to endothelial dysfunction related to triglyceride "spikes" that occur after eating high-fat meals, Passerini said.

In people who are predisposed, repeated episodes of inflammation could lead to atherosclerosis. Passerini's lab is continuing to investigate how abdominal obesity, high triglyceride levels and inflammation can lead to atherosclerosis.

New Mothers' Postpartum Lifestyle And Parenting Stress

Post-pregnancy excess weight is likely caused by the impact of new parenthood stress on physical activity, Georgia Health Sciences University researchers say.

In a study of 60 first-time mothers, researchers linked higher post-pregnancy body mass index - weight in relation to height - to a combination of a high BMI before pregnancy, excessive weight gain during pregnancy, parenting stress and a sedentary lifestyle, according to a study published in Women & Health.

The study gauged parental stress by asking participants to rate statements such as "I feel like I have less time to myself" and "I enjoy being a parent." They were also asked to recall their physical activity over the previous 24 hours, categorizing that activity from light to vigorous.

"Sedentary lifestyle, or a low amount of physical activity, was most influenced by the type of parenting stress the mothers reported," says Dr. Deborah Young-Hyman, behavioral psychologist with the Georgia Prevention Institute. "More parenting stress, especially depression, was associated with less physical activity and a higher postpartum BMI."

Interestingly, social interaction, generally considered a measure of well-being, correlated with a higher body mass index, she noted.

"We think women are socializing with their friends, not isolating themselves, but they are doing sedentary things like talking on the phone, watching television or hanging out at home, instead of taking their babies on a walk together."

New moms with a higher BMI did report more depressive symptoms, but overall felt competent as parents. Those with lower BMIs reported more physical activity (and less depressive symptoms) but more concern about their competence as parents.

"We know that physical activity improves your mood and helps you lose weight, but no one has ever asked how physical activity is related to parenting stress in first-time moms," Young-Hyman said. "The bottom line is that parenting stress does impact the postpartum lifestyles of new moms," she said.

Based on a current study tracking how first-time mothers adjust to parenthood, researchers will develop an intervention to help new moms create healthy lifestyles for both themselves and their babies ?" preventing overweight mothers and children.

Study Finds Children In Public Housing Play Outdoors More, May Impact Obesity Prevention

Young children living in urban public housing spend more time playing outdoors than other urban children, according to researchers at Rice University, Columbia University and Princeton University.

Contrary to the expectations of the researchers, who hypothesized that children living in poorer circumstances would be playing outside less, the study found that 5-year-olds living in public housing played outside 13 percent more per day, on average, than did other urban 5-year-olds. Children living in places of high physical disorder - areas with visible graffiti, trash, and abandoned homes - also played outside more per day.

The researchers also concluded that the ratio of outdoor play to television watching is a significant predictor of body mass indexes (BMIs). The study, "Young Children in Urban Areas: Links Among Neighborhood Characteristics, Weight Status, Outdoor Play and Television-Watching," showed that for each additional hour the children played outside over the amount of time spent watching television, children scored 1.5 percentile points lower on BMI. BMI is a measure of body fat based on height and weight. The higher a person's BMI, the higher their risk for heart disease, high blood pressure, type 2 diabetes and other health problems.

"A key to solving obesity problems among poor, urban children is to create safe and open spaces where these kids can play, because now we know that they are outside playing," said Rachel Kimbro, assistant professor of sociology at Rice University and lead author of the new study. "It's possible that children living in public housing have access to community playgrounds and courtyards for children to play outdoors, which could be why we see more outside play time for them."

Kimbro and her co-authors - Jeanne Brooks-Gunn of Columbia University and Sara McLanahan of Princeton University - also found that a mother's perception of her neighborhood's physical and social environment was a key predictor of how much her children would play outdoors. They measured mothers' perceptions of collective efficacy by asking them questions that gauged how likely the mother thought that neighbors would intervene in certain situations (such as if a child were skipping school and hanging out on the street) and whether mothers thought their neighborhoods were cohesive (such as people's willingness to help their neighbors).

Children of mothers who perceived higher levels of collective efficacy in their neighborhoods played outside for longer periods each day, watched less television and visited the park or playground more often each week.

The researchers tested whether subjective and objective neighborhood measures - socioeconomic status, type of dwelling, perceived collective efficacy and interviewer-assessed physical disorder of the immediate environment outside the home - were associated with children's activities.

"Maternal perceptions of neighborhood environments, both positive and negative, truly override objective measures, such as neighborhood poverty status, when considering children's activities," Kimbro said. "Given the importance of maternal perception, it becomes critical to create community-based programs that seek to facilitate trust and neighborhood social networks in these low-income, urban areas."

The data, collected through the Fragile Families and Child Well-being Study, represent more than 1,800 5-year-olds in 2003-2004 in urban areas of the U.S. Overall, 19 percent of the sample was overweight (between the 85th and 95th percentiles) and 16 percent was obese (above the 95th percentile).

Notes:

This study was funded by Active Living Research, a national program of the Robert Wood Johnson Foundation.

"Young Children in Urban Areas: Links Among Neighborhood Characteristics, Weight Status, Outdoor Play and Television-Watching" will be published in an upcoming issue of Social Science & Medicine and is available online.

 

Aetna Foundation To Fund Over $1 Million In Research To Deepen Understanding Of Obesity Epidemic

The Aetna Foundation announced significant funding in support of five research studies designed to deepen understanding of the root causes of the nation's well-documented obesity epidemic and drive viable solutions to the core problems. More than $1 million in funding will be granted in support of separate studies at New York University School of Medicine, Boston University, the University of Michigan, the University of Pennsylvania and Yale University's CARE program.

"While on its surface, the nation's obesity epidemic appears simple - we consume too many calories and don't get enough exercise - the issue is far more complex and the data available on what drives these unhealthy behaviors, particularly in urban, poor or minority communities, is scant," said Anne C. Beal, MD, MPH, president of the Aetna Foundation. "To help build the knowledge base and support development of effective policies that will foster healthier communities and a healthier nation, we are supporting these key research projects. These studies will consider issues such as the availability of broad food choices and the pricing of food, as well as the impact these factors have on individual food choices. The studies also will look at the role of our neighborhoods - and the impact of what is or isn't in the 'built environment' where we live, work and play-- on population health and weight loss."

Details on the grants announced today are as follows:

-- $250,000 to New York University School of Medicine for a two-year study of the impact of the introduction of supermarkets through tax credits and other incentives in areas that are classified as "food deserts." This study will examine the impact of the introduction of a supermarket on the local food environment in the Bronx, as well as the corresponding impact it may have on healthy eating habits of residents in local communities in the area, which include large Latino and African-American populations. The study will collect data on the eating patterns of 2,000 adults who are racially and ethnically diverse. Encouraging the introduction of supermarkets in food deserts through tax credits and other incentives is a growing strategy to address the problem of food deserts in some communities, but there is little data to support the effectiveness of this approach. Researchers at NYU hope to provide this critical insight to help shape federal, state and local policies.

-- $233,000 to Boston University's Slone Epidemiology Center for a two-year study of factors that influence obesity among African-American women, including both individual and neighborhood-level factors, and the identification of the most effective small changes individuals can make to decrease obesity rates among African-American women. Data from more than 20,000 participants in the ongoing Black Women's Health Study will be examined, including diet and exercise patterns, psychosocial stressors, and the neighborhood environment where the women live. Researchers hope to identify small, actionable changes women can take to reduce weight gain, and acquire evidence that will lead to policy and institutional level changes that can impact weight gain and obesity, such as neighborhood safety and walkability and grocery store accessibility.

-- $248,000 to the University of Michigan for a two-year study of how the built environment in an urban setting - in this case Detroit - may influence the risk of obesity among residents. The study seeks to identify specific features of the built and social environments that can be influenced to reduce racial and ethnic inequalities in obesity and related morbidity and mortality. The findings could inform the development of interventions and policies to promote health in urban communities. The study will bring together an interdisciplinary team of health researchers, urban planners, health service providers and community representatives and will build upon existing data sets compiled by the Healthy Environments Partnership.

-- $250,000 to the University of Pennsylvania's African American Collaborative Obesity Research Network for a one-year study of how variations in food prices influence food and beverage purchases among African-American women. The project will study the typical food shopping patterns in a sample of African-American women and seek to understand how food prices influence those patterns. Price variations for selected products at grocery stores within a defined geographical area will be analyzed in conjunction with data obtained from study participants to determine how price fits in with other considerations such as convenience and quantity when purchasing foods and beverages. Researchers hope to assess the potential for adjustments to food prices for high calorie-low nutrient foods and beverages to discourage their consumption and encourage the purchasing of healthier alternatives.

-- $150,000 to the Community Alliance for Research and Engagement (CARE) at Yale University for a study of the role of the neighborhood environment on childhood obesity risk factors and health outcomes. This study will look at a variety of built environment factors in six low-income, predominately minority neighborhoods in New Haven, as well as those factors closer to schools to see which of these might have a greater influence on the children's body mass index, diet and exercise. The study will also look at whether environmental factors have different effects on adults versus children.

The Aetna Foundation remains committed to targeted grant-making in three major areas which include addressing the rising incidence of obesity among U.S. residents, including children; promoting racial and ethnic equity in health and health care for common chronic conditions and infant mortality; and advancing integrated health care, by improving coordination and communications among health care professionals, creating informed and involved patients, and promoting cost-effective, affordable care.

 

Obesity And Diabetes May Be A Downside Of Human Evolution

New research in the FASEB Journal suggests that a gene called CMAH has been lost during the course of recent evolution, and may lead to an increased risk of Type 2 diabetes in humans

As if the recent prediction that half of all Americans will have diabetes or pre-diabetes by the year 2020 isn't alarming enough, a new genetic discovery published online in the FASEB Journal provides a disturbing explanation as to why: we took an evolutionary "wrong turn." In the research report, scientists show that human evolution leading to the loss of function in a gene called "CMAH" may make humans more prone to obesity and diabetes than other mammals.

"Diabetes is estimated to affect over 25 million individuals in the U.S., and 285 million people worldwide," said Jane J. Kim, M.D., a researcher involved in the work from the Department of Pediatrics at the University of California, San Diego in La Jolla, CA. "Our study for the first time links human-specific sialic acid changes to insulin and glucose metabolism and therefore opens up a new perspective in understanding the causes of diabetes."

In this study, which is the first to examine the effect of a human-specific CMAH genetic mutation in obesity-related metabolism and diabetes, Kim and colleagues show that the loss of CMAH's function contributes to the failure of the insulin-producing pancreatic beta cells in overweight humans, which is known to be a key factor in the development of type 2 diabetes. This gene encodes for an enzyme present in all mammalian species except for humans and adds a single oxygen atom to sialic acids, which are sugars that coat the cell surface.

To make their discovery, the researchers used two groups of mice. The first group had the same mutant CMAH gene found in humans. These mice demonstrated that the CMAH enzyme was inactive and could not produce a sialic acid type called NeuSGc at the cell surface. The second group had a normal CMAH gene. When exposed to a high fat diet, both sets of mice developed insulin resistance as a result of their obesity. Pancreatic beta cell failure, however, occurred only in the CMAH mutant mice that lacked NeuSGc, resulting in a decreased insulin production, which then further impaired blood glucose level control. This discovery may enhance scientific understanding of why humans may be particularly prone to develop type 2 diabetes. Results may also suggest that conventional animal models may not accurately mirror the human situation.

"The diabetes discovery is an important advance in its own right. It tells us a lot about what goes wrong in diabetes, and where to aim with new treatments," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, "but its implications for human evolution are even greater. If this enzyme is unique to humans, it must also have given us a survival advantage over earlier species. Now the challenge is to find the function of CMAH in defending us against microbes or environmental stress or both. This evolutionary science explains how we can win some and lose some, to keep our species ahead of the extinction curve."

Details:
Sarah Kavaler, Hidetaka Morinaga, Alice Jih, WuQiang Fan, Maria Hedlund, Ajit Varki, and Jane J. Kim. Pancreatic ß-cell failure in obese mice with human-like CMP-Neu5Ac hydroxylase deficiency. FASEB J. fj.10-175281; doi:10.1096/fj.10-175281.

FDA Approves Expanded Use Of LAP-BAND(R) Adjustable Gastric Banding System For Obese Adults

Allergan, Inc. (NYSE: AGN) announced the U.S. Food and Drug Administration (FDA) approved the expanded use of the LAP-BAND® System, Allergan's gastric band, for adults with obesity who have failed more conservative weight reduction alternatives, such as diet and exercise and pharmacotherapy, and have a Body Mass Index (BMI) of 30-40 and at least one obesity related comorbid condition. Currently, approximately 37 million Americans have a BMI of 30-40 and at least one comorbid condition,1,2 underscoring obesity as a growing health epidemic in the United States and the need for additional effective treatment options.

"Given the proven and significant health ramifications of obesity, we are pleased with the FDA's decision to expand the use of the LAP-BAND® System," said Frederick Beddingfield, M.D., Allergan's Vice President of Clinical Research and Development. "Although this label expansion represents a significant advancement in obesity treatment, the LAP-BAND® System is not intended for everyone. The LAP-BAND® System does represent a potential treatment option for those patients with obesity and a related health condition, who have failed more conservative weight-loss therapies, such as diet and exercise and pharmacotherapy, and under consultation with their physician, have determined that weight-loss surgery is the next best treatment option."

Obesity is the second-leading cause of preventable death in the United States, second only to smoking.3 Given its known correlation to life-threatening comorbid conditions, such as heart disease, stroke, Type 2 diabetes, high blood pressure, sleep apnea and even premature death, obesity is a disease that requires medical treatment. Medical research has found that, if left untreated, those individuals who are currently obese will likely remain obese.4 However, not all weight-loss treatments are effective over the long term - as a preponderance of data, published literature and scientific research have found that diet and exercise is unsuccessful in 80-85% of patients at one year.5,6

"As a surgeon, I see patients every day who have been obese for years and have tried several diet and exercise programs without success," said Robert Michaelson, M.D., Ph.D., Northwest Surgical Weight Loss Surgery, Everett, Washington, and Clinical Trial Investigator. "These patients frequently feel judged by their weight, as obesity is often viewed as a lack of will power, which it is not. Obesity is a disease, which requires medical treatment, but unfortunately diet and exercise alone do not work for everyone. The LAP-BAND® System meets an unmet clinical need, as it provides an effective treatment option, which is used in combination with diet and exercise, to enable sustained weight loss."

The approval to expand the use of the LAP-BAND® Adjustable Gastric Banding System is based on a review of full 12-month data and available 24-month data from a prospective, single-arm, non-randomized, multi-center five year-study and the more than 17-year safety and effectiveness record of the LAP-BAND® System. Following approval, the patients in the trial will continue to be followed for a total of five years. In addition, there will be an analysis of the outcomes of patients with BMI of 30 to 40 recorded in the Bariatric Outcomes Longitudinal DatabaseSM (BOLDSM). Established in 2007 by the Surgical Review Corporation, BOLD is now the world's largest and most comprehensive repository of clinical bariatric surgery patient information. The database currently contains more than 300,000 patients and 12,000 new patients are added monthly. The BOLD analysis will consist of examining the explant rates, adverse events, weight loss, and changes in the status of obesity related comorbid conditions observed in LAP-BAND® System patients over the course of 10 years.

About the LBMI-001 Clinical Study

The LAP-BAND® System study, initiated by Allergan, Inc., is a prospective, single-arm, non-randomized, multi-center five year-study conducted under an FDA-approved Investigational Device Exemption (IDE G070039; registered at www.clinicaltrials.gov, registration # NCT00570505). The study was conducted to determine the safety and effectiveness of the LAP-BAND® System as a treatment for obesity in adult patients with a BMI of = 30 and < 40, with and without comorbid conditions. The study was initiated in 2007, and included 149 patients, who had a mean excess weight of 62.8 lbs and had been obese on average for 17 years and who underwent the LAP-BAND® System procedure.

The criterion for success was at least 40% of patients achieving clinically meaningful weight loss at the 12-month timepoint, where clinically meaningful weight loss was defined as at least 30% Excess Weight Loss (EWL). Percent excess weight loss (%EWL) is defined as the percent of "excess weight" - i.e., the weight above ideal weight - that is lost. Results from the 12-month dataset demonstrate clinically significant weight loss in this patient group with a low risk of serious complications. Specifically, 83.9% of the patients lost at least 30% of their excess weight at the one-year timepoint, more than twice the percentage required for success. More than 65% of the patients in the trial were no longer obese after one year. Weight loss was maintained in the second year of the study. This level of weight loss exceeds what is typically seen with more conservative treatment, such as diet and exercise.

The secondary endpoints for the trial were improvement in obesity related comorbid conditions of dyslipidemia, Type 2 diabetes, and hypertension and improvement in Quality of Life (QoL). Eighty five percent of subjects in the trial had at least one comorbid condition. In terms of improvement in comorbid conditions of dyslipidemia, Type 2 diabetes, and hypertension, 22-33% of patients with those conditions, saw their conditions resolved after one year. In addition, approximately 60% of patients, who had a comorbidity at baseline, had improvement of at least one comorbid condition by month 12. Also, there was a statistically significant improvement in QoL at months six and 12.

During the 12-month study period, the types of Adverse Events (AEs) reported by patients were as expected for the surgical procedure, such as vomiting, dysphagia, and gastroesophageal reflux disease (GERD). Most AEs were mild to moderate in severity and resolved in less than four weeks.

About the LAP-BAND® System

The LAP-BAND® System was originally approved by the FDA in 2001 for use in severely obese adults, individuals with a BMI of 35 with at least one severe comorbid condition or a BMI of 40, or those who are at least 100 pounds or more overweight. In addition, the LAP-BAND® System has been approved internationally since 1993. The LAP-BAND® System is now the first and only FDA-approved device for bariatric surgery in patients with a BMI of 30-35. Over the past 18 years, more than 650,000 procedures have been performed, leading to over two million patient years of exposure for the device.

Important LAP-BAND® Safety Information

Indications: The LAP-BAND® System is indicated for weight reduction for patients with obesity, with a Body Mass Index (BMI) of at least 40 kg/m2 or a BMI of at least 30 kg/m2 with one or more obesity related comorbid conditions.

It is indicated for use in adult patients who have failed more conservative weight reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.

Contraindications: The LAP-BAND® System is not recommended for non-adult patients, patients with conditions that may make them poor surgical candidates or increase the risk of poor results (e.g., inflammatory or cardiopulmonary diseases, GI conditions, symptoms or family history of autoimmune disease, cirrhosis) who are unwilling or unable to comply with the required dietary restrictions, who have alcohol or drug addictions or who currently are or may be pregnant.

Warnings: The LAP-BAND® System is a long-term implant. Explant and replacement surgery may be required. Patients who become pregnant or severely ill, or who require more extensive nutrition, may require deflation of their bands. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to an increased risk of band erosion.

Adverse Events: Placement of the LAP-BAND® System is major surgery and, as with any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure and the patient's ability to tolerate a foreign object implanted in the body.

Band slippage, erosion and deflation, reflux, obstruction of the stomach, dilation of the esophagus, infection or nausea and vomiting may occur. Reoperation may be required.

Rapid weight loss may result in complications that may require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or esophageal dilation.

© 2011 Allergan, Inc. Irvine, CA 92612. ® marks owned by Allergan, Inc. All rights reserved.

1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA: The Journal of the American Medical Association 2010;303:235-41.

2. 2009 CDC Behavioral Risk Factor Surveillance System (BRFSS) annual data.

3. Jia H, Lubetkin E. Trends in quality-adjusted life-years lost contributed by smoking and obesity. Am J Prev Med 2010;38:138-44.

4. Kuczmarski MD, Prevelance of Overweight and Weight Gain in the United States. Am J Clin Nutr 1992; 55:495S-502S.

5. Kraschnewski, JL et al. Long-term weight loss maintenance in the United States. International Journal of Obesity 2010; 1-11

6. Sacks FM, et al, Comparison of Weight-Loss Diets with Different Composition of Fat, Protein, and Carbohydrates. NEJM 2009; 360:859-73.

Study Reveals A Dismal 1 In 1,900 People Met AHA's Definition Of Ideal Heart Health

Main Category: Cardiovascular / Cardiology
Also Included In: Obesity / Weight Loss / Fitness;  Cholesterol;  Hypertension
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Only one out of more than 1,900 people evaluated met the American Heart Association (AHA) definition of ideal cardiovascular health, according to a new study led by researchers at the University of Pittsburgh School of Medicine. Their findings were recently published online in Circulation.

Ideal cardiovascular health is the combination of these seven factors: nonsmoking, a body mass index less than 25, goal-level physical activity and healthy diet, untreated cholesterol below 200, blood pressure below 120/80 and fasting blood sugar below 100, explained senior investigator and cardiologist Steven Reis, M.D., associate vice chancellor for clinical research at Pitt.

"Of all the people we assessed, only one out of 1,900 could claim ideal heart health," said Dr. Reis. "This tells us that the current prevalence of heart health is extremely low, and that we have a great challenge ahead of us to attain the AHA's aim of a 20 percent improvement in cardiovascular health rates by 2020."

As part of the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, the researchers evaluated 1,933 people ages 45 to 75 in Allegheny County with surveys, physical exams and blood tests. Less than 10 percent met five or more criteria; 2 percent met the four heart-healthy behaviors; and 1.4 percent met all three heart-healthy factors. After adjustment for age, sex and income level, blacks had 82 percent lower odds than whites of meeting five or more criteria.

A multipronged approach, including change at the individual level, the social and physical environment, policy and access to care, will be needed to help people not only avoid heart disease, but also attain heart health, Dr. Reis said.

"Many of our study participants were overweight or obese, and that likely had a powerful influence on the other behaviors and factors," he noted. "Our next step is to analyze additional data to confirm this and, based on the results, try to develop a multifaceted approach to improve health. That could include identifying predictors of success or failure at adhering to the guidelines."

Notes:

The team includes Claudia Bambs, M.D., M.Sc., Pontificia Universidad Cato´lica de Chile, Santiago, Chile; Kevin E. Kip, Ph.D., University of South Florida, Tampa; Andrea Dinga, M.Ed., R.D., L.D.N., Suresh R. Mulukutla, M.D., and Aryan N. Aiyer, M.D., University of Pittsburgh School of Medicine.

The study was funded by the National Institutes of Health and the Pennsylvania Department of Health.

Source:
Anita Srikameswaran
University of Pittsburgh Schools of the Health Sciences

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Knee Replacement Surgeries Take More Time, Are More Costly In Overweight Individuals

Knee replacement surgery takes far more time to conduct in overweight and obese patients than in normal weight patients, according to recent research at Hospital for Special Surgery in New York. The study will be presented at the American Academy of Orthopaedic Surgeons annual meeting, held Feb. 15-19 in San Diego, Calif. The study has implications for hospital staff scheduling surgeries, operating room utilization and personnel staffing, and also raises the question of whether knee replacements should be reimbursed based on time.

"When we schedule surgery, the body mass index is never considered," said Geoffrey Westrich, M.D., an adult reconstruction and joint replacement surgeon and co-director of Joint Replacement Research at Hospital for Special Surgery who led the study. "If I have four or five knee replacements in a day, they will just put them on the OR schedule but they don't look at whether a person is heavy or obese class II or obese class III. What this study shows is that the utilization is greatly increased. If you have a 20 percent greater utilization for someone who is obese and if you multiply that by five or six knee replacements over the course of a day, at the end of the day the operating room staff could be finishing up two hours later. In many cases, the hospital has to pay the staff overtime which greatly increases hospital expenditures."

Obesity causes a variety of health problems, including an increased need for total knee arthroplasty (TKA) or knee replacement surgery extra weight puts extra stress on knees. Researchers at Hospital for Special Surgery wondered whether weight might impact the time it took to perform a knee replacement. "Intuitively, one would think that as people get heavier, knee replacement surgery may be more difficult and more time consuming because the fatty tissue makes surgery more difficult," Dr. Westrich said. "Now that we have collected data on the different stages of knee replacement surgery, we wanted to use the objective data to determine if there was an increase in the time of surgery based on a patient's weight and whether we could correlate a patient's weight or BMI with the different steps of knee replacement surgery."

The investigators retrospectively reviewed a consecutive series of 454 TKAs conducted by one surgeon at HSS between 2005 and 2009. They categorized patients into groups based on the World Health Organization classification of body mass index: normal weight 18.5-25 kg/m2, overweight 25-30 kg/m2, obese class I 30-35 kg/m2, obese class II 35-40 kg/m2, and obese class III >40 kg/m2. The investigators then correlated weight with five factors: anesthesia induction time, tourniquet time, time spent surgically closing the knee after completing the procedure, total surgery time, and total amount of time spent in the operating room. The tourniquet time is measured from the time of the initial incision, includes the time it takes to implant the knee prosthesis, and ends when the bone cement is hard. The closure time is not included in the tourniquet time.

The investigators found that as BMI increased, so did the time it took to perform all parts of the surgery. "As BMI increased, surgery times progressively increased," Dr. Westrich said. In patients who were a healthy weight, the overall room time was two hours and increased as weight category increased; for obese class III patients, it was two hours and 24 minutes, a difference that was 20 % greater and highly statistically significant. In comparing normal weight to obese class III patients, the times were also greater for obese patients in total room time (24 minutes, P<0.01), surgery time (16 minutes, P<0.01), tourniquet time (7.5 minutes, P<0.01), anesthesia time (4.5 minutes, P=0.005) and closure time (8 minutes, P<0.01).

Obesity is a growing epidemic in the United States with currently 71 percent of individuals over the age of 60 classified as obese. While the number of obese people has grown, so has the number of TKAs performed between 2000 and 2004, there was a 53 percent increase in the number of TKAs conducted in the United States. Dr. Westrich said that, in this study, seventy percent of his patients were classified as overweight or obese I, II, III and 50 percent were obese class I, II, III. The number of obese people being scheduled for TKAs will likely increase.

"Before this particular study, we knew that when people are heavier, we knew the surgery could be more challenging but we never had objective data to support it," Dr. Westrich said. "Hospitals should not only take into account the type of surgery and its complexity, but also the patient's body mass index when appropriately allocating OR time."

Focus On How, Not Why To Increase Physical Activity

Most people know that exercise is important to maintain and improve health; however, sedentary lifestyles and obesity rates are at all-time highs and have become major national issues. In a new study, University of Missouri researchers found that healthy adults who received interventions focused on behavior-changing strategies significantly increased their physical activity levels. Conversely, interventions based on cognitive approaches, which try to change knowledge and attitudes, did not improve physical activity.

"The focus needs to shift from increasing knowledge about the benefits of exercise to discussing strategies to change behaviors and increase activity levels," said Vicki Conn, associate dean for research and Potter-Brinton professor in the MU Sinclair School of Nursing. "The common approach is to try and change people's attitudes or beliefs about exercise and why it's important, but that information isn't motivating. We can't 'think' ourselves into being more active."

Behavior strategies include feedback, goal setting, self-monitoring, exercise prescription and stimulus or cues. Self-monitoring, any method where participants record and track their activity over time, appears to significantly increase awareness and provide motivation for improvement, Conn said.

"Health care providers should ask patients about their exercise habits and help them set specific, manageable goals," Conn said. "Ask them to try different strategies, such as tracking their progress, scheduling exercise on their phones or calendars, or placing their pedometers by their clothes. Discuss rewards for accomplishing goals."

The study, featured in the American Journal of Public Health, incorporated data from 358 reports and 99,011 participants. The researchers identified behavioral strategies were most effective in increasing physical activity among healthy adults. Successful interventions were delivered face-to-face instead of mediated (i.e. via telephone, mail, etc.) and targeted individuals instead of communities.

"The thought of exercise may be overwhelming, but slowly increasing activity by just 10 minutes a day adds up weekly and is enough to provide health benefits," Conn said. "Even small increases in physical activity will enhance protection against chronic illnesses, including heart disease and diabetes. Preventing or delaying chronic disease will reduce complications, health care costs and overall burden."

Previously, Conn completed a meta-analysis of interventions for chronically ill patients and found similar results. Conn found that interventions were similarly effective regardless of gender, age, ethnicity and socioeconomic status.

The study, "Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes," is featured in this month's issue of the American Journal of Public Health. Conn's research is funded by a more than $1 million grant from the National Institutes of Health.