Seattle—Children in King County, Washington, are more likely to be obese if they live in socially disadvantaged neighborhoods. This is according to a team of researchers at Seattle Children’s Research Institute, the University of Washington (UW), and Group Health Research Institute. Social Science & Medicine e-published the research this week in advance of printing it.

The researchers found obesity most common in children living in neighborhoods with the least-educated females, most single-parent households, lowest median household income, highest proportion of non-white residents, and fewest homes owned. Together, these five socioeconomic factors accounted for 24 percent of the variability in childhood obesity rates across neighborhoods.

“What we found confirms that it takes a village to raise a child,” said lead author H. Mollie Greves Grow, MD MPH, an assistant professor of pediatrics at the UW, Seattle Children’s, and Harborview Medical Center. “Children are raised not only at home but also in their community.” Disadvantaged neighborhoods may present many obstacles for children’s weight, such as less access to healthy foods and more unhealthy fast-food outlets. They also often lack safe places for children to play outdoors.

“Childhood obesity is not just a family problem, but a larger community and societal problem,” Dr. Grow added. “A disadvantaged environment can set families up for ill health, and it’s unfair to blame them for not taking enough ‘personal responsibility’ to manage their weight. We don’t yet know all of the factors that may create disadvantage, but we know it is present and associated with higher obesity.”

The research team collected anonymous, “de-identified” electronic medical record information on 8,616 children age 6–18 receiving care at Group Health Cooperative—and then correlated these data to the social and economic characteristics of Seattle-area census tracts.

This study of childhood obesity helped overcome the limitations of previous studies by using weight measurements pulled from medical records, not self-reported by study subjects. Self-reporting is often less accurate. This was the first study evaluating childhood obesity to use rigorous statistical methods of spatial modeling to smooth out differences based on arbitrary census tract lines. Using this technique helped provide a more accurate effect of neighborhoods on children’s weight.

“We were a little surprised that each of the census tract factors we included appeared to contribute, in a slightly different way, to the likelihood of childhood obesity,” Dr. Grow said. The likelihood of childhood obesity rose by 17 percent to 24 percent for each of three measures of neighborhood social disadvantage: each 10 percent decrease in female education and two-parent households, and each $10,000 decline in household income. Effects related to race and homeownership were smaller but still statistically significant.

Overall, King County’s demographics resemble those of other urban U.S. areas. “But King County has one of the strongest public health efforts, a relatively walkable environment, and efforts to expand affordable access to healthy, fresh foods,” said Dr. Grow. So she and her colleagues expect the links between childhood obesity and neighborhood disadvantage may be even more pronounced elsewhere.

Dr. Grow and her coauthors are not only continuing to study how neighborhoods with low socioeconomic status raise the risk of childhood obesity. They are also contributing to solutions by leading programs to help overweight youth and their families:

• Dr. Grow helps lead ACT! (Actively Changing Together!), a YMCA of Greater Seattle program helping children and families increase physical activity and eat nutritiously. (ACT! was previously called Strong Kids Strong Teens.)
• Coauthor Paula Lozano, MD, MPH, an associate investigator at Group Health Research Institute and associate professor of pediatrics at the UW and Seattle Children’s, runs Group Health’s Family Wellness Program.
• Another coauthor, Brian E. Saelens, PhD, of the UW and Seattle Children’s, leads COMPASS, a study of a yearlong program at Seattle Children’s to help local families lose weight.

“I have seen some resilient families beat the odds by boosting their children’s health despite their environment, and I hope to help other families do the same,” Dr. Grow said. “Still, even more health gains would come from narrowing the inequality gaps that have been widening between rich and poor in this country. We should strive for all families to have access to walkable neighborhoods, safe parks, healthy grocery store options, and active schools. Tax dollars, voters, community planners, builders, and green spaces can all help make an impact.”

Drs. Grow, Lozano, and Saelens’s co-authors were Group Health Research Institute’s David E. Arterburn, MD, MPH, and Andrea J. Cook, PhD; and the UW’s Adam Drewnowski, PhD. This research started as a joint project between the UW Exploratory Center for Obesity Research (ECOR) and Group Health that was funded by a pilot grant from Dr. Drewnowski’s National Institutes of Health (NIH) Roadmap Initiative project. ECOR is part of the UW’s Center for Public Health Nutrition. The Health Resources and Services Administration (HRSA) also provided funding.

These latest findings build on research that Dr. Drewnowski’s group has conducted on so-called “fat ZIP codes.” For instance, in May 2010, he and a team of UW researchers released a study on economic access to healthy, affordable foods. The study revealed obesity rates by supermarket chain in King County and tracked where consumers go to buy groceries.

Source: Rebecca Hughes, Group Health via EurekAlert

“In the midst of America’s obesity epidemic, physicians frequently advise their patients to reduce the number of calories they are consuming on a daily basis. This research shows that simply dieting will not likely cause substantial weight loss. Instead, diet and exercise must be combined to achieve this goal,” explained Judy Cameron Ph.D., a senior scientist at OHSU’s Oregon National Primate Research Center, and a professor of behavioral neuroscience and obstetrics & gynecology in the OHSU School of Medicine, as well as a professor of psychiatry at the University of Pittsburgh.

To conduct the research, Cameron and OHSU post-doctoral fellow Elinor Sullivan, Ph.D., studied 18 female rhesus macaque monkeys at the Oregon National Primate Research Center. The monkeys were placed on a high-fat diet for several years. They were then returned to a lower-fat diet (standard monkey food) with a 30 percent reduction in calories. For a one-month period, the monkeys’ weight and activity levels were closely tracked. Activity was tracked through the use of an activity monitor worn on a collar.

“Surprisingly, there was no significant weight loss at the end of the month,” explained Sullivan. “However, there was a significant change in the activity levels for these monkeys. Naturally occurring levels of physical activity for the animals began to diminish soon after the reduced-calorie diet began. When caloric intake was further reduced in a second month, physical activity in the monkeys diminished even further.”

A comparison group of three monkeys was fed a normal monkey diet and was trained to exercise for one hour daily on a treadmill. This comparison group did lose weight.

“This study demonstrates that there is a natural body mechanism which conserves energy in response to a reduction in calories. Food is not always plentiful for humans and animals and the body seems to have developed a strategy for responding to these fluctuations,” added Cameron. “These findings will assist medical professionals in advising their patients. It may also impact the development of community interventions to battle the childhood obesity epidemic and lead to programs that emphasize both diet and exercise.”

Source: Jim Newman, Oregon Health & Science University

Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.

Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.

“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”

“This study confirms our clinical observations that metabolic regulation — specifically homeostasis of glucose — occurs quickly after gastric bypass surgery,” said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. “It’s clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.

“UC Davis has the perfect environment for collaboration between basic and clinical scientists to take this discovery to the next step, which is identifying the molecular signals that set these physiologic changes in motion,” said Ali, who was not a participant in this study, but has collaborated with Havel on previous research.

Source: UC Davis

Dr Jason Halford, Reader in Appetite and Obesity at the University of Liverpool, points out that anti-obesity drug developers focus primarily on weight loss as their end goal, and do not take into consideration the motivational and behavioural factors that most commonly cause obesity. Obesity typically results from eating too much food combined with too sedentary a lifestyle. However, obese people may also have a complicated psychological relationship with food that makes it difficult for them to control their appetite sufficiently to manage their weight.

Obesity is one of the most serious public health problems of the 21st century and, according to Government predictions, is set to affect half of all men and more than a third of all women in the UK by 2025. Obesity is not only associated with a number of serious health problems, including type 2 diabetes, heart disease and reduced life expectancy, but also has a knock-on effect for the health service, industry, education and government – with a multi-billion pound cost to the economy.

Dr Halford said, “Anti-obesity drugs haven’t successfully tackled the wider issues of obesity because they’ve been focused predominantly on weight loss. Obesity is the result of many motivational factors that have evolved to encourage us to eat, not least our susceptibility to the attractions of food and the pleasures of eating energy rich foods – factors which are, of course, all too effectively exploited by food manufacturers.

“As psychological factors are critical to the development of obesity, drug companies should take them into consideration when designing new drug therapies. We’ve learned a great deal about the neurochemical systems that govern processes like the wanting and liking of food, and it’s time to exploit that knowledge to help people manage their eating behaviour.”

Anti-obesity drugs can work in different ways; for example, by suppressing appetite, altering metabolism or inhibiting the absorption of calories. There have, however, been serious concerns over the safety of the most commonly prescribed drugs, leading to the recent withdrawal of the European market leaders Sibutramine (Reductil, Meridia) and Rimonabant (Accomplia). As a consequence of these setbacks, there are few anti-obesity drugs in development.

Dr Halford and his co-authors explain that there are motivational, emotional and behavioural traits which are common to the obese. Typically, obese people have a heightened desire to eat, which is easily provoked by environmental factors such as food adverts. They display a pre-occupation with food and have a heightened preference for high fat and high sugar foods. Obese people also tend to eating faster and take larger mouthfuls which together result in them eating bigger meals.

However, despite eating larger than normal portions, obese people are less likely to feel full after eating, partly because of the energy-dense foods they prefer have a reduced impact on gastrointestinal hormone signals that help promote feelings of satisfaction and fullness. Consequently, there are a number of reasons why obese people have enduring, and easily provoked, feelings of excessive hunger which culminate in overconsumption.

Professor Tim Kirkham, an authority on the biopsychology of appetite at the University of Liverpool, said: “Novel, effective anti-obesity treatments must address these different factors. We need to identify drugs that can selectively affect the desire to eat, the enjoyment of eating, fullness and satisfaction. Interventions designed specifically to modulate these processes could help reduce the aversive experience of dieting, and maximize an individual’s capacity to successfully gain control over their appetite. Currently, we know little about the behavioural effects of anti-obesity drugs under development, and so we have little indication whether these new treatment address the underlying causes of obesity.”

The research is published in Nature Reviews Endocrinology.

Source: Sarah Stamper, University of Liverpool via EurekAlert

Don’t be so quick to give up this time. When you arm yourself with a few last strategies you can bypass this hurdle with success. If you implement two or three of the following strategies, you should be able to see a five-pound weight loss in about two-and-a-half to three weeks time, which is a safe rate that will ensure it is fat loss and not lean muscle loss.

Here are five things you should start doing immediately to drop those five pounds.

1- Implement extreme carb cycling

You may already be on a diet that does make use of higher carbohydrate days along with lower carbohydrate days, but typical approaches tend to be quite moderate. When trying to strip off those last five pounds, you’re going to have to kick it up a notch and really go to the extremes.

Try making your low carbohydrate days very low carb, where you’re focused on strictly eating protein and fibrous vegetables. This will create a very high calorie deficit, thereby accelerating fat loss. Then, place your high carbohydrate days on your training days and bring the calorie balance up to maintenance value — or even slightly above — by adding a very large number of carbs back.

Since carbohydrates are the macronutrient that most influences the metabolic rate, this drastic zigzag approach keeps the metabolism firing while you enjoy a faster rate of total fat loss.

2- Take one week off training

In some instances, the reason you’ve hit a wall with weight loss is because the body hasn’t received enough rest. When you’re verging on overtraining, it’s quite common for the body to actually retain water, making it harder to lean down.

Take one week off training while eating closer to a maintenance diet. This will help to reset the metabolism and water balance. Many people are very surprised at the impacts one week off can have.

3- Shift the rep ranges of your exercises

Plateaus are quite common when you’ve been performing the same workout for a lengthy period of time and can keep you from dropping those last five pounds of fat. A simple way to crank up the calorie burn of your workout is to increase the reps to 10 for one single week while decreasing the rest period to only one minute between sets.

Note that you’re not aiming to make this a circuit training workout, but simply quickening the pace of the workout to add intensity. The nature of this protocol (10 reps with 1 minute rest periods) compared to a typical strength program of 5 reps and 3 minute rest periods tends to produce a greater release of growth hormone in the body, which is beneficial for promoting lean muscle mass development.

4- Increase protein intake

The fourth way to lose those last five pounds is to increase the protein content of your diet. It’s important to remember that the leaner you get and the lower you take your total calorie intake, the more protein you will need. This helps to prevent lean muscle mass loss and ensure recovery.

An added benefit of bringing your protein intake higher is that it will increase the metabolic rate. Over the course of a week or two this could mean the difference between staying at a standstill or losing another half to one pound.

Great sources of protein to include regularly are chicken, lean beef, egg whites, white fish, and low-fat cottage cheese.

5- Combine sprint training with steady state cardio

Finally, consider altering the method of cardio you’re doing so that you start with 5 to 8 interval sprints of 30 seconds in length interspersed with 90-second rest periods. Then, proceed to finish the cardio session off with another 15 minutes of moderate paced cardio.

This gives you the best of both worlds where you’ll get the metabolic spark that interval training offers, along with the benefit of moderate cardio that strictly uses fatty acids for fuel.

Source: Jeff Bayer, AskMen.com

When diet and exercise attempts haven’t worked, increasing numbers of overweight people have turned to bariatric, or weight-loss, surgery to shed pounds.

But research reported in 2009 pointed to an unintended result: One of every five people who had bariatric surgery had broken a bone within a few years.

Were the breaks a result of the surgery? Or of the weight loss that followed? Might they have been related to something going on in the body, either before or after the surgery? Or might something else altogether have been at work?

The answers remain unclear.

The finding came from an early analysis of data from a study by researchers from the Mayo Clinic, in Rochester, Minn. The study included 97 people, most middle-age and mostly women. All had had bariatric surgery — either stapling of the stomach, called gastric bypass, or stomach banding, called gastric band surgery. In the next seven years, 21 of them had 31 fractures.

The researchers compared the fracture rate for the people in the study with the rate for residents of Olmsted County, Minn., and found that people who had undergone weight-loss surgery were nearly twice as likely to have broken a bone for the first time as were those in the general population. The rate for specific sites was higher, with the risk for fracturing a foot, for instance, nearly four times higher among people who’d had bariatric surgery than in the general population.

The researchers did not determine what caused the increase in broken limbs. Their research, presented at a meeting in June of the Endocrine Society, continues and, through a Mayo Clinic spokesman, they declined further comment.

Until more findings are in, experts can only speculate about the cause and advise people who have had or plan to have bariatric surgery to pay close attention to bone health.

Dr. John Wilder Baker, director of the medical weight-loss program and co-director for the bariatric surgery program at Baptist Health in Little Rock, Ark., said that people in the study might have been deficient in vitamin D before the surgery.

Many people don’t include enough dairy products in their diet and so are lacking in vitamin D and calcium, both important for bone strength, said Baker, who is also president of the American Society for Metabolic and Bariatric Surgery and was familiar with the Mayo research.

Weight-loss surgery, he said, could bring about changes in absorption of calcium. “With gastric bypass, there could be some malabsorption of calcium,” he said.

“Before and after gastric bypass, patients are routinely told to take at least 1,200 milligrams of calcium daily, and usually 800 milligrams of D, but that may not be enough,” Baker said.

Monitoring patients closely is crucial, he said. “No matter which surgery [of several bariatric surgery options] they have had done, they need to be monitored for calcium, vitamin D levels and parathyroid hormones long term,” he said. Parathyroid hormones help increase calcium levels in the blood.

An orthopedic surgeon also familiar with the study said that it’s important to remember that the research was reported at a preliminary stage.

“I would be very careful drawing too much from one study,” said Dr. Leon Benson, a professor of orthopedic surgery at the University of Chicago, a hand surgery consultant at the Illinois Bone and Joint Institute and a spokesman for the American Academy of Orthopaedic Surgeons.

Benson said he has not noticed an increase in fracture patients with a history of bariatric surgery.

As for the mechanism, he speculated, like Baker, that the higher fracture rate could be linked to absorption issues.

Another possibility? “Maybe the patients lost enough weight [that] it changes body image and they have balance issues,” Benson said.

For now, people who’ve had bariatric surgery “should be as careful as they can to avoid preventable fractures,” he said. “That means paying close attention to their physician’s advice about their intake of calcium and vitamin D as well as their advice about exercise, which can help keep bones strong.”

Source: Kathleen Doheny, HealthDay Reporter

For those considering bariatric surgery to combat significant obesity, a new study suggests the risk of complications may be much lower than what has previously been reported.

The study, which looked at both gastric bypass surgery and laparoscopic adjustable gastric banding (lap-band surgery), found that the risk of death for these surgeries was 0.3 percent and the risk of a major adverse outcome was 4.3 percent.

“Bariatric surgery is safe,” said study co-author Dr. Bruce Wolfe, a professor of surgery at Oregon Health & Science University in Portland. “Certain factors [such as a history of blood clots, obstructive sleep apnea or impaired functional status] increase the risk of complications, but you can discuss these risks as well as the potential benefits with your surgeon.”

Results of the study appear in the July 30 issue of the New England Journal of Medicine.

As obesity rates have risen, so, too, has the popularity of bariatric surgery. Although it is a major surgical procedure, the benefits to the severely obese generally far outweigh the risks. In fact, the risk of death over time is about 35 percent lower for someone who’s had the surgery compared to someone who remains extremely obese, according to background information in the study.

However, the surgery isn’t for everyone. “If you’re five or 10 pounds overweight, bariatric surgery isn’t for you,” said Dr. Malcolm K. Robinson, an assistant professor of surgery at Harvard Medical School, and the author of an accompanying editorial in the same issue of the journal.

“Basically, when I or my colleagues advise surgery, it’s because the benefits of surgery outweigh the risks. In general, that’s the case for someone with a BMI [body-mass index] of 35 and weight-related health problems like diabetes or high blood pressure, or someone with a BMI of 40 or more,” said Robinson, who added that as the risks of the surgery keep dropping, those BMI numbers may get even lower in the future.

The current study included 4,776 people who underwent one of the following types of bariatric surgery: lap-band surgery (1,198 patients), laparoscopic gastric bypass (2,975 patients), open gastric bypass (437 patients) or another procedure (166 patients). All of the surgeries were done by surgeons specifically qualified for this study. All of the surgeries took place between March 2005 and December 2007.

The average age of the study participant was 44.5 years old, 22 percent of the study volunteers were male and 11 percent were nonwhite. The average BMI in the study was 46.5. More than half of the study group had at least two coexisting medical conditions, the study authors noted.

In his editorial, Robinson points out that these procedures may represent “best-case scenarios” because they were done by experienced surgeons in high-volume bariatric centers. However, he said that because the field of bariatric surgery has advanced so much in the past few years, he believes these results are a “generally achievable phenomenon.”

Both Robinson and Wolfe recommend that any person considering bariatric surgery should choose a facility that’s been designated as a “Center of Excellence” because that means that the surgeon and the whole health-care team are qualified and experienced.

Source: Serena Gordon, HealthDay Reporter

Science is searching for the causes of obesity and exploring the role of genes, the diets of pregnant women, and the feeding habits of babies. But the bottom line is this: Most of us have settled into sedentary lifestyles and have trouble resisting the temptations of cheap, plentiful food our culture has served up.

The biggest health issues for overweight men
It isn’t good to be fat, but there’s just so much good food and so many ways of entertaining ourselves from a swivel chair or a couch. As a result, a host of health issues linked to obesity threatens us unless we learn how to push back from the table earlier and head out the door for a walk or something faster more often.

“By the time you reach 35,” says George L. Blackburn, MD, PhD, “you don’t need to gain any more weight.” Blackburn holds the S. Daniel Abraham Chair of Nutrition at Harvard Medical School, and he tells WebMD that as men get older, muscle tends to be replaced by fatty tissue. Since fatty tissue doesn’t need the same amount of energy to maintain itself, you gain weight. But if you’ve gained more than 20 pounds since college, Blackburn says, something about your food selection and exercise program is out of balance. “You need to run, not walk,” he says, “to see a health care provider who’s experienced in finding healthy lifestyles.”

While women put weight on their hips, breasts, and limbs, men gather it around the waist, where it circulates through the liver, causing metabolic problems like diabetes. Added weight puts you at risk of heart attack, cancer, hypertension, and sleep apnea. It can also affect your sex life and make it harder to exercise and enjoy your kids.

Can genes cause obesity in men?

How did we get so fat? “Obviously there’s a genetic component to obesity, “ says Barbara Rolls, PhD. Rolls holds the Helen A. Guthrie Chair in Nutritional Sciences at Pennsylvania State University. “But,” she adds, “the surge in obesity clearly can’t be due to genetic changes. We don’t evolve that quickly.”

That said, when it comes to getting fat, not all men are created equal. The genetic differences are clear from studies conducted by Claude Bouchard, PhD, of the Pennington Biomedical Research Center at Louisiana State University. Controlled portions of food were given over 100 days to sets of identical twins. While weight gain was similar for each pair of twins, it varied dramatically among the pairs. Some sets of twins gained as few as eight pounds during the “overfeeding” experiment, while others put on as much as 26 pounds.

We all know a few men who can quaff and stuff it all in their wooden legs and still weigh what they did in college. Some people are more predisposed to gain more weight than others, and research indicates that gaining weight rapidly as an infant is associated with a higher risk of adult obesity.

“We don’t know whether the weight gain in infancy is a cause of obesity, or whether they are both controlled by the same gene or perhaps by cultural practices,” says Nicolas Stettler, MD, MSCE, a professor of pediatrics at the University of Pennsylvania. But it may well be that some of us developed metabolic patterns in infancy that continue to influence our eating habits throughout life.

But genes don’t explain the increase in obesity. “I think we can safely say that at the end of the day, the cause of obesity is eating more than you need for your physical activity,” says Stettler. “We eat more, and the availability of more sedentary entertainment leads people to be more sedentary.”

Bigger portions breed bigger appetites which can lead to obesity

Men eat 70% more at a sitting than women do, Rolls tells WebMD. But, she says, men are “the primordial eating machines.” They tend to listen to their bodies more while women eat what they think they are supposed to eat.

The biggest change in eating habits, Rolls believes, is portion size, which started growing in the 1970s in restaurants and recipe books. Then supersizing really took off in the 1980s. It might seem logical to assume that when a person eats a really big meal that person will back off on subsequent meals or days. But Rolls’ research has shown this not to be the case.

At her laboratory, she feeds human test subjects large portion sizes without telling them and observes how they respond. They respond by pigging out. Over a period of 11 days, in a recent experiment, the overfed group sucked up 5,000 more calories than the “control” group, which was given healthy, complete meals but with half the portion size.

Obviously, there are vested interests in favor of selling more food and drink, even if that does help fuel the obesity epidemic. “From the popcorn stand in movie theaters to fast food, we’ve been had by the most skilled advertising people in the world,” says Blackburn. “They keep telling us that it’s our right to be instantly gratified. Well, there’s a sucker born every minute, and you’re a sucker to let yourself gain more than 20 pounds in 20 years.”

Fighting back: How bigger portions can be used to stem the rise in obesity

When it comes to finding solutions to the fat epidemic, Rolls has done some pragmatic thinking. Her research told her that it would be difficult to convince people to eat smaller meals. So what she has done is focused on encouraging them to eat less energy-dense meals.

A bowl of Cheerios, for example, provides the same calories as a couple tablespoons of granola. But, as she points out in The Volumetrics Eating Plan: Techniques and Recipes for Feeling Full on Fewer Calories (Morrow Cookbooks, 2005),eating the larger portion of Cheerios is more satisfying than eating the smaller portion of granola. “Bigger is better if it’s low-cal,” Rolls says. “Big portions of salad and soup can fill you up and displace other, more energy dense foods.”

Blackburn applauds Rolls’ book. But he also thinks the government should intervene to encourage healthier eating by charging a tax on junk food and offering incentives for buying healthy food. “But the people who own the junk food are not going to let you do that,” he says. “They’ll say people like me are crazy and it’s your right to have a miserable life and be able to pig out.”

Looking for a cure for obesity
Genetic research holds out the hope that in 10 or 20 years there may be new drugs to treat obesity. But there are more than 25 candidate genes involved in abnormal weight gain, and each person may have 12 or so of them, all making a very small contribution. So it’s unlikely that drug companies will find blockbuster drugs that can counteract the effects of all these genes together. “It will be very hard to have a medication driven by your personal predisposition,” says Bouchard.

In the meantime, though, according to Blackburn, “The craziest thing you can do is to overeat and under-exercise.”

Source: Arthur Allen, Web MD

Newly released research in the May issue of The Journal of Internal General Medicine reveals that patients think their physicians are not doing enough to help them manage their weight.

“Patients expect their doctors to initiate the discussion and not ignore their weight issues,” says lead researcher Stephanie Ward, M.D., M.P.H., assistant professor of medicine and public health at the School of Medicine. “They also feel doctors have the knowledge, but don’t take the time to give concrete advice on how to lose weight.”

Ward, a general internist at Temple University Hospital, conducted focus groups on 43 obese patients, all African-Americans recruited through the general internal medicine practices at Temple. While obesity does not discriminate, national data shows it disproportionately affects African-Americans, which leads to severe health complications and even death. The patients were asked a number of preset questions on how their primary care physicians address weight management.

“We were surprised by their desire for a degree of specific information which they wanted from their doctor. Not whether low-carb or no-carb is the right diet, but rather they wanted their doctor to set long and short term goals and provide referrals to resources that would help them change behaviors they needed to change to reach a healthy weight.”

And behavior change, says Ward, is what’s needed to assist patients in weight loss. But it’s an area doctors feel ill-equipped to venture into. In fact, The United States Preventive Services Task Force (USPSTF) recommends that physicians screen all patients for overweight and obesity, and then offer intensive counseling to patients who need to lose weight. However, figures show such counseling occurs in less than 20 percent of primary care visits. Given that office visits are relatively short, Ward says there isn’t a lot of time to cover the basics and then get into a talk on weight management.

“Lots of times doctors focus on the disease without taking it a step further in how a patient’s weight might be influencing all of their chronic conditions.”

Ward adds those doctors who do “take it a step further” should be mindful of which techniques and terms work and which actually hinder weight loss. Study participants overwhelmingly disliked the word obese and insisted it should be used only in reference to zoo animals. A majority found doctors who were open and encouraging and acknowledged their efforts were beneficial, whereas doctors who ignored a patient’s weight or blamed all the patient’s ills on obesity were viewed more negatively. Scare tactics evoked a mixed reaction; some participants felt motivated, while others did not respond well to an ultimatum of “diet or die.”

“Overall, they feel doctors should know their patients well enough to know who would respond well to those tactics. I hope physicians recognize that whatever method they choose, obese patients really do want to be counseled on weight management to understand how it’s impacting the medical conditions they have as well as their daily lives.”

This study was funded by a Department of Medicine Faculty Development Research Award from Temple University School of Medicine.

Source: Temple University