Archive for obesity
In case you missed the recent series of articles on obesity in The Tampa Tribune, or if you’d like to enjoy the article in its entirety, here are the respective links:
Read the latest in the Obesity Paradox series, Part 2 here:
Read part 1 of a 2 part sereis from the Tampa Tribune here:
You can debate the merits of the recent New York City ban on extra large sugary soft drinks. What can not be debated is the data. Here in this blog we reported a while ago on the link between consumption of large amounts of sugar in the form of sugary soft drinks and an increased risk of hypertension. Recent studies have looked at the consumption of sugary soft drinks and its effect on children. There were two recent studies reported in The New England Journal of Medicine. One study was done at Boston Children’s Hospital. This trial looked at teenagers’ weight gain over a one year period where one group got water and diet drinks and the other did not. The group not receiving water or diet drinks gained and additional 4.2 pounds (3.5 versus 7.7). Another study looking at younger children, aged 4 to 11, was done in Amsterdam. They were followed over an eighteen month period. The children were given a no-calorie beverage or a sugar sweetened one. Those receiving the sugary drinks gained an additional 2.3 pounds (13.9 versus 16.2). A different study examining adult health professionals over a several year period found that among those who exhibited a genetic predisposition towards obesity (looking at 32 known genetic markers for the development of obesity) and consumed sugar containing drinks had a significantly increased risk of becoming obese; more than those who had markers but did not drink sugary beverages and more than those without markers who did drink sugary beverages. Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, has called for taxes on sugar containing products. He has said that taxes are “the single most effective measure to reverse the obesity epidemic.” The debate continues.
Discuss amongst yourselves!
The paradox grows-and that isn’t just myself and a colleague gaining weight (pair a docs…get it…never mind). During several of my last lectures/book signings I have discussed the concept of the obesity paradox. For those unable to attend, the obesity paradox refers to a number of well-done of studies showing that among patients with established heart disease, other medical conditions and even the general population at large, those who are overweight or even mildly obese by BMI standards fare better and survive longer than those of “normal” or” ideal” weight.
A most recent study was particularly interesting[i]. It pooled the data from five previous studies examining over 2500 patients, both men and women over age 40 with newly diagnosed diabetes (DM).Participants were classified as normal weight if their body mass index (BMI) was 18.5 to 24.99 or overweight/obese if the BMI was 25 or greater. Although only about 12% of the study group was normal weight, they had the highest rates of total, cardiovascular, and noncardiovascular mortality. After adjusting for other variables, the “ideal” weight group still had higher mortality levels in every category. The study concluded that adults “who were normal weight at the time of incident diabetes [italics mine] had higher mortality than adults who are overweight or obese.”
The take away regarding obesity by BMI and morbidity/mortality is three-fold. Firstly, BMI while it can be applied as a population measure, should be applied to individuals with great discretion and restraint. Secondly, at some level of increasing weight (BMI) there is increasing morbidity/mortality when you exceed it. Lastly and perhaps most importantly, where that level lies is currently quite debatable. What is “ideal” today may be more deadly tomorrow.
[i] (Mercedes R. Carnethon, et al., 2012)
Mercedes R. Carnethon, P., Peter John D. De Chavez, M., Mary L. Biggs, P., Cora E. Lewis, M., James S. Pankow, P., Alain G. Bertoni, M. M., et al. ( 2012). Association of Weight Status With Mortality in Adults With Incident Diabetes . JAMA., 308(6):581-590. doi:10.1001/jama.2012.9282 .
Much like the French Paradox of the late 1990′s, the current obesity paradox remains an enduring mystery; a Bermuda Triangle of medicine. For several years now, many a well done study has demonstrated a reduction in the incidence of cardiovascular and other morbidity and mortality in those over the ideal body mass index (BMI) of 18-25. The groups having the best outcomes are often in the overweight, and in some cases in the slightly obese category, according to BMI measures. To some extent that was attributable to the overall poor job that BMI does as a measure of obesity, something covered many times here in the blog (search the archives for BMI to catch up!). However, this new wrinkle to obesity paradox might even have Stephen Hawking scratching his head. It is remarkable because a better correlate to obesity, waist circumference was also used as a measure. In men, a waist circumference of 40 inches or more indicates a high risk group. For women, it is 37 inches or more that is considered high risk. Even more intriguing was the improved survival of the heavier group with heart failure; a condition for which previous studies have shown obesity to be a risk factor for developing. Heart failure has many causes, but the end result is a condition in which the heart muscle is weakened and unable to pump efficiently enough to meet the demands of the body. A condition, by which all conventional wisdom would agree should be exacerbated by increased weight.That’s not what the data showed.A study done at The University of California found that adults with heart failure who were overweight or obese had lower risk of death. Their survival was superior to both underweight (a known higher risk group) and those with a “normal” BMI (between 18-25). Not only was the risk of death lower, but the higher weight groups were less likely to require a heart transplant or suffer other related morbidities. The study examined approximately 2,700 heart failure patients. The participants were followed for two years. The study found men with a high waist circumference and a high BMI were more likely to survive and were less likely to need a heart transplant. Overweight and obese women also fared better than normal-weight women. The cardioprotective effect was significant: men with a normal BMI and smaller waist circumference had a 34 percent higher risk for adverse outcomes and normal-weight women had a 38 percent higher risk for adverse outcomes.An interesting hypothesis suggested by the study authors involves increased serum lipoproteins (molecules in the body which transport fats), which they suggest may have anti-inflammatory properties. Fascinating food for thought-for those attending the American Culinary Federation national Convention in Orlando, Florida next week, Dr. Mike will be lecturing on this and related topics.
Horwich, T. et al.American Journal of Cardiology, July 1 2012
This is Twitter’s fault. I read a tweet about how Paula is going Kid Krazy. Then, with the irresistible compulsion of a traffic wreck, I had to see more. Airing May 30th and again June 6th, Paula’s Best Dishes is indeed ‘Kid Krazy.’ Is this really a good idea?
Firstly, traditional Southern cooking while delicious; in certain hands is not exactly a paragon of healthful eating. It can be given to excesses in certain ingredients (read here FAT and SUGAR) and in the quantity of said ingredients (read here LOTS of fat and sugar). And the cuisine of Ms. Deen has less restraint in these areas than her muumuu.
Secondly, while promoting her cookery, which includes all the ingredients for a diabetes pot pie-except the supplemental insulin; she developed diabetes herself. Did she come clean and announce her condition? No. Did she address the dietary aspects of living with diabetes? No. Did she start to modify her program and address portion sizes-or even her own size? No. Did she at least mention if that you’re going to consume more sweets than Orson Wells on a 3 day candy-land bender you might want to look into an exercise program? No.The one thing it seems Paula was doing during the ensuing years before she made a public announcement regarding diabetes was securing for herself a lucrative contract as a spokesperson for…ready…a diabetes drug!
While she was hiding her sweet side she was busy promoting her latest children’s cookbook at the time; Paula Deen’s Cookbook for the Lunch-Box Set. This little gem offered cheesecake for breakfast and chocolate cake for lunch. Don’t take my word for it, Barbara Walters noted when Ms. Deen visited The View, “You tell kids to have cheesecake for breakfast. You tell them to have chocolate cake and meatloaf for lunch. And french fries… Everything you have here is enormously fattening.”
But hearken, ye of jaded view, now she is promoting a ‘healthy twist on her classic recipes.’ What qualifies someone to be an ‘expert’ in healthy cuisine on the television, I have no idea. It does not seem any medical, nutritional, physiological or dietetic knowledge is prerequisite. Like the sage on a recent television show telling people to eat with their non-dominant hand to slow down and consume less. And spill half their food in their lap; your date will be so impressed at the calories you saved by hiding your food in your crotch. Oh, and put carbonated water in your wine to cut calories. Why are you drinking it in the first place? You can also piss in my glass and that will limit consumption of any wine. Along with leaving a steaming dump on my plate; I guarantee that will compel me to eat less. But while it may work, none of that means it is a well advised strategy.
Yet perhaps Ms. Deen has actually exchanged her dessert shovel for a salad fork; what’s on the menu for her kids’ show? Well, there’s cheesy quesadillas featuring butter and sour cream. There’s green eggs and ham featuring eggs, bread and processed meats like ham-oh and more butter. But the kids are alright, she serves some healthy yogurt pops for dessert. In between there is some rendition of a meatball made with several canned goods. Don’t want to miss out on your daily dose of BPAs. All this and Paula claims she is The Matron of Moderation? The only message I see from this Gordon Gekko of Gastronomy seems to be “Gluttony is Good.”
Putting Paula Deen in front of your kids to teach them healthful eating habits is like putting Bernie Madoff in charge of the Treasury. Worse it’s like giving Bernie your kid’s piggy bank-and their pancreas. Might as well put Captain Jack in charge of the rum. At least he tells you he is a pirate. He is honestly dishonest. There is that whole code thing, you know. What is Paula’s code beyond a buck? The networks continue to air her old programs with their self destructive message. Her new ones just can’t seem to break with her tried and true formula that had brought her such success. When she is queried about the her cuisine, her response is, “All things in moderation.”
My prescription is that bit of advice be applied to her, her food and her programming. And for those particularly susceptible, like kids, I think she garners an XXX-tra large label. No one under eighteen allowed to view -it could be hazardous to their waistlines, and their health.
If you agree please ‘like’ and share on FB! Let’s try for 100 ‘likes’ before this thing airs!
For a long time here at this blog you have heard the data and problems with BMI measurements, the most commonly used measure to publicly communicate the definition of obesity. Other, equally easy but less commonly used measures such as waist circumference and the waist-to-hip ratio seem to correlate much better with the risk of morbidity and mortality. This is because evidence continues to accumulate that it is not just weight-which includes lean muscle mass-and fat but where the adipose tissue deposits that correlates with risk. Studies suggest that it is the dreaded “belly fat” that has the connection to death and disease. Another recent study confirms that having the big ol’ jelly belly, like Santa’s, may be a reason not sign up for next year’s Christmas account. In a study from the University of Minnesota, the waist-to-hip ratio strongly correlated with the risk of sudden cardiac death. The research evaluated data on 15,156 people who had participated in the Atherosclerosis Risk in Communities (ARIC) study, which enrolled individuals ages 45 to 64 at baseline in 1987 to 1989. Over a mean follow-up of 12.6 years, there were 301 cases of sudden cardiac death, defined as a death that occurred within 1 hour of symptom onset when witnessed or within 24 hours of being seen alive when unwitnessed. A waist-to-hip ratio greater than 0.85 for women and greater than 1.0 for men is considered high risk In this particular study, for those in the top quintile of waist-to-hip ratio (0.97 and higher for women and 1.01 and higher for men), the risk of sudden cardiac death was a relative 40% greater (HR 1.40, 95% CI 0.94 to 2.11) compared with those in the lowest quintile (less than 0.82 for women and less than 0.92 for men. BMI, waist circumference and waist -to-hip ratio measures of obesity were all evaluated for an association with sudden cardiac death. After adjustment for age, sex, race, study center, education level, smoking status, family history of coronary heart disease, diabetes, LDL cholesterol, hypertension, prevalent coronary heart disease, heart failure, and left ventricular hypertrophy (all known risk factors) only the waist-to-hip ratio emerged as a significant predictor of sudden cardiac death. The BMI did not correlate with risk.
Selcuk Adabag, MD, the lead author of the study remarked that it is unclear why waist-to-hip ratio appears to be more informative than waist circumference or BMI. He hypothesized that it may have to do with the correlation between abdominal fat deposition and increased inflammation.
Adabag S, et al “Risk of sudden cardiac death in obese individuals: The Atherosclerosis Risk in Communities (ARIC) study” HRS 2012; Abstract PO1-67.
If beauty is in the eye of the beholder, beware the consequences of the red eye. That’s because there is some new data supporting the role of adequate sleep on impacting the development of diabetes and obesity. We have previously mentioned on this blog several articles and discussions about how lack of adequate sleep is a major risk factor for the development of obesity. A recent study was reported in Science Translational Medicine. Although the study was extremely small, involving only 21 men and women, the results were marked and consistent with an accumulating body of data supporting the hypothesis we have discussed here many times that obesity (and its risk for diabetes, heart disease, etc.) is very multi-factorial and more complex than just carbs or calories. The study results report that not only a lack of adequate sleep, which has previously been shown to be a significant risk factor in obesity development, but even disrupted sleep can result in these untoward outcomes. The study was performed in a very controlled environment, allowing adequate measure of the periods of both adequate sleep and deprivation. The study was a 39 day replication of what someone working various shifts or traveling frequently might experience. Having gotten just several hours of rest in the last 48 with middle of the night emergencies, I can attest to it affecting people in many industries and in large numbers. The study revealed that in only 3 weeks, study participants who were allowed less than 6 hours of sleep (about 5.6 hours) a night had a measurable reduction in their basal metabolic rate. The reduction in the overall metabolic rate was 8%. Without changes in diet and exercise/activity levels this correlates to about an additional 10 pound weight gain in a year. Their ability to secrete insulin likewise decreased. This resulted in elevations in their glucose (blood sugar levels) mimicking the effect of diabetes. The effect of the disruption to a normal circadian rhythm has also been shown to impact the immune system with decreased resistance to infection. The specifics involve possible effects on what is known as toll-like receptor 9 (TLR9), but the depressive immune system response is also a characteristic of diabetes. The good news was that the final 9 days of the testing included a recovery phase of normal sleep patterns. After this recovery period the abnormalities were no longer present and the subjects returned to their previously healthy state. This suggest that at least in the early phases, the sleep deprivation effects are completely reversible.
SOURCES: Orfeu M. Buxton, Sean W. Cain, Shawn P. O’Connor, James H. Porter, Jeanne F. Duffy, Wei Wang, Charles A. Czeisler, and Steven A. Shea. Adverse Metabolic Consequences in Humans of Prolonged Sleep Restriction Combined with Circadian Disruption. Sci Transl Med. 11 April 2012, 4:129ra43