Metabolism shifts

On January 13, 2010, in Uncategorized, by Andrea

JAMA article  about metabolism shifts.

Extra Calories Cause Weight Gain—But How Much?

Martijn B. Katan, PhD; David S. Ludwig, MD, PhD

JAMA. 2010;303(1):65-66.

How much weight would an individual gain by eating an extra chocolate chip cookie every day for life? One approach to answering this question, frequently used in textbooks1 and scientific articles, is based on the assumption that a pound (454 g) of fat tissue has about 3500 kilocalories (kcal). Thus, a daily 60-kcal cookie would be expected to produce 0.2 kg (0.5 lb) weight gain in a month, 2.7 kg (6 lb) in a year, 27 kg (60 lb) in a decade, and many hundreds of pounds in a lifetime. This of course does not happen. In this article, the physiology of weight gain and loss is reviewed, and the amount of reduction of caloric intake necessary to avoid becoming overweight or obese is estimated.

Weight Change Is Self-limiting

Body weight remains stable as long as the number of calories consumed equals the number expended through physical activities and metabolic processes. When energy intake increases above expenditure, the excess is used to build new tissue, and weight gain results. However, weight gain does not continue indefinitely. Carefully controlled overfeeding experiments show that calorie expenditure increases progressively because of the energetic costs of maintaining the newly created tissue. A person who consumes an extra cookie every day will initially experience weight gain, but over time an increasing proportion of the cookie’s calories will go into repairing, replacing, and carrying the extra body tissue. After a few years of daily cookie eating, weight gain will level off at approximately 2.7 kg (6 lb).2 Thus, a one-time step-up in caloric intake will cause body weight to increase asymptotically to a new, stable level.

The converse occurs when an individual reduces food intake. As body size diminishes, so does the amount of fuel needed to maintain and move it, and weight settles at a new steady level. In addition, weight loss produces changes in hormones, the autonomic nervous system, and the intrinsic efficiency of muscle that serve to conserve energy.3 Therefore, additional weight loss can only be achieved by a more severe diet or a more arduous physical activity routine. Most individuals do the opposite: after having achieved some weight loss, they resume their original diet and exercise habits. Consequently, weight gain recurs rapidly.

How Much Are Americans Overeating?

According to the first National Health and Nutrition Examination Survey (NHANES)—a nationally representative study of the US population—women aged 20 to 29 years had a mean body mass index (BMI) of 23 in the early 1970s.4 The fourth NHANES, conducted in 1999 to 2002, found that women aged 50 to 59 years (who would have been in their 20s in the original study), had a mean BMI of 29,4 representing a weight gain of approximately 16 kg (35 lb) in 28 years (Figure, A). How much overeating is needed to gain this amount of weight? Physiologists and physicists have developed mathematical models that accurately predict the effect of a discrete change in energy intake on body weight.2, 5-6 These equations suggest that a young adult woman must increase energy intake by 370 kcal per day to increase BMI from 23 to 29.2 That increase probably occurs gradually. For example, adding 30 mL (1 oz) of sugar-sweetened beverage and walking 1 minute less per day creates a temporary energy surplus of about 13 kcal/d, leading to a weight gain of 0.6 kg (1.4 lb). Repeating changes in diet and physical activity of this magnitude on an annual basis for 28 years would produce the 370 kcal/d “energy gap” and 16-kg (35-lb) weight gain considered above.

Figure 1
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Figure. The Effects of Graded Reductions in Calorie Intake Beginning at Age 25 Years on Body WeightSolid curves demonstrate the predicted effects of a decrease in energy intake initiated at age 25 years on the weight gain that results from progressive changes in diet and physical activity in 2 situations. Panel A represents deviations from the natural course of weight gain (the dashed line) for the average US women interpolated from National Health and Nutrition Examination Survey (NHANES) I to IV data covering a 28-year period.4 Panel B represents the hypothetical case of a man aged 25 years whose body mass index increased from 25 to 35 over 28 years (dashed line). Mathematical models were based on Hall et al.10

To become obese, a much larger cumulative change in lifestyle would be required. The 90th percentile of BMI is 35 for men aged 50 to 59 years.7 To reach this degree of adiposity from a BMI of 25 at age 25 years (Figure, B), an individual would need to increase energy intake, decrease physical activity, or both by 680 kcal per day.2 For obese children, this energy gap is even greater. An adolescent at the 95th percentile of BMI at age 15 to 17 years is approximately 26 kg (58 lb) over ideal body weight.6 Assuming normal weight at age 5 to 7 years, this individual must overconsume 700 to 1000 kcal every day during this period.6 It is difficult to determine with certainty how energy intake has changed since the early 1970s, but some studies suggest a per capita increase of up to 500 kcal/d.8

Preventing Weight Gain

Obesity is difficult to reverse. But what would it take for a lean young adult to stay that way, instead of gaining about 1 or 2 lbs every year? If the effect of excess energy intake on body weight were linear, a small, one-step change in energy balance initiated at age 25 years would be sufficient to prevent overweight by middle age for most individuals.9 However, any single change in diet or physical activity, even if permanent, will elicit compensatory mechanisms that limit long-term effect on body weight. Since the weight gain experienced by a typical American must be caused by repeated changes in diet, physical activity, or both, a small decrease in food intake or increase in physical activity will halt this increase only temporarily (Figure).


These calculations suggest that small changes in lifestyle would have a minor effect on obesity prevention. Walking an extra mile a day expends, roughly, an additional 60 kcal compared with resting—equal to the energy in a small cookie. Physiological considerations suggest that the apparent energy imbalance for much of the US population is 5- to 10-fold greater, far beyond the ability of most individuals to address on a personal level. Rather, an effective public health approach to obesity prevention will require fundamental changes in the food supply and the social infrastructure. Changes of this nature depend on more stringent regulation of the food industry, agricultural policy informed by public health, and investments by government in the social environment to promote physical activity.


Corresponding Author: Martijn B. Katan, PhD, Institute of Health Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands (

Financial Disclosures: Dr Katan reported receiving royalties from a book about nutrition and health, earning fees for periodically writing a newspaper science section column and for serving as a radio health commentator, and receiving grants from the Netherlands Heart Foundation and the Netherlands Organization for Health Research and Development for research on childhood obesity. Dr Ludwig reported receiving royalties from a book about childhood obesity and grants from foundations and the National Institutes of Health for obesity-related research, mentoring, and patient care.

Funding/Support: Dr Katan is supported by an Academy Professorship from the Royal Netherlands Academy of Sciences. Dr Ludwig is supported in part by career award K24DK082730 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Role of Sponsors: Neither the National Institute of Diabetes and Digestive and Kidney Diseases nor the Royal Netherlands Academy of Sciences had any role in the preparation, review, or approval of the manuscript.

Disclaimer: The content of this commentary is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.

Additonal Contributions: We thank Steven Gortmaker, PhD, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts; Kevin D. Hall, PhD, Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and Boyd Swinburn, MB, ChB, MD, FRACP, World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia, for their critical reading of the manuscript. We also thank Dr Hall for assistance in preparing the figure. None received remuneration for their contributions.

Author Affiliations: Institute of Health Sciences, VU University, Amsterdam, the Netherlands (Dr Katan); and Optimal Weight for Life Program, Department of Medicine, Children’s Hospital, Boston, Massachusetts (Dr Ludwig).

1. Shils ME, ed, Shile M, ed, Ross AC, ed, Caballero B, ed, Cousins RJ, ed. Modern Nutrition in Health and Disease. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:982.

2. Hall KD, Jordan PN. Modeling weight-loss maintenance to help prevent body weight regain. Am J Clin Nutr. 2008;88(6):1495-1503. FREE FULL TEXT

3. Goldsmith RL, Joanisse DR, Gallagher D; et al. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects [published online November 4, 2009]. Am J Physiol Regul Integr Comp Physiol. doi:10.1152/ajpregu.00053.2009. 2009. FREE FULL TEXT

4. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height, and body mass index, United States 1960-2002. Adv Data. 2004;347(347):1-17. PUBMED

5. Weinsier RL, Bracco D, Schutz Y. Predicted effects of small decreases in energy expenditure on weight gain in adult women. Int J Obes Relat Metab Disord. 1993;17(12):693-700. WEB OF SCIENCE | PUBMED

6. Wang YC, Gortmaker SL, Sobol AM, Kuntz KM. Estimating the energy gap among US children: a counterfactual approach. Pediatrics. 2006;118(6):e1721-e1733. FREE FULL TEXT

7. McDowell MA, Fryar CD, Hirsch R, Ogden CL. Anthropometric reference data for children and adults: US population, 1999-2002. Adv Data. 2005;361(361):1-5. PUBMED

8. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity [published online October 14, 2009]. Am J Clin Nutr. doi:10.3945/ajcn.2009.28595. 2009;90(6):1453-1456. FREE FULL TEXT

9. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science. 2003;299(5608):853-855. FREE FULL TEXT

10. Hall KD, Guo J, Dore M, Chow CC. The progressive increase of food waste in America and its environmental impact. PLoS One. doi:10.1371/journal.pone.0007940. 2009;4(11):e7940. FULL TEXT | PUBMED

Maximum capacity? — Updated

On January 13, 2010, in Uncategorized, by Andrea

Sad, but possibly true.  Especially given the rate of childhood obesity.

So here’s the question — or maybe a few.  When will we, as a country, redefine obesity to include fewer people?  And when will WLS become even more prevalent than it is now?

BTW MSNBC?  I take a few issues with your language.  Just so you know — not that you care.

Updated to include Medscape article.


Obesity rates idle as most of us are already fat

Have we simply reached a maximum level of tubbiness?

America’s rapid rise in obesity appears to have leveled off, with new government figures showing no significant increase in a decade.

But there’s little reason to cheer. More than two-thirds of adults and almost a third of children are overweight, and there are no signs of improvement.

Experts say they’re not sure whether the lull in the battle of the bulge can be attributed to more awareness and better diets — or whether society has simply reached a maximum level of tubbiness.

Story continues below ↓

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“Maybe in this environment, this is as overweight as we’ll get,” said Gary Foster, director of the Temple University Center for Obesity Research and Education.

Being thin is the exception
Not only are the vast majority of adults — 68 percent — overweight, 34 percent are obese; and 17 percent of children are obese. Even the youngest Americans are affected — 10 percent of babies and toddlers are precariously heavy.

The most recent Centers for Disease Control and Prevention data, from the years 2007 to 2008, were contained in two reports published online Wednesday in the Journal of the American Medical Association.

“The absolute numbers here are staggering,” said Foster. “This isn’t something that should be celebrated.”

The new data are based on health surveys involving height and weight measurements of 5,700 adults and 4,000 children, surveys the CDC does every two years.

“In the most recent decade, we saw a slowing in the increase,” said Carolyn Ogden, the report’s author and a CDC researcher who has tracked obesity for years. “It was better news, but it’s still a serious problem.”

In most age groups, black adults had the highest rates of obesity, followed by Mexican-Americans and whites.

Heaviest boys getting heavier
Among children ages 2 to 19, 32 percent were too heavy — a rate that was mostly unchanged. But disturbingly, most obese kids were extremely obese. And the percentage of extremely obese boys ages 6 to 19 has steadily increased, to 15 percent from about 9 percent in 1999-2000.

Ogden said it was disappointing to see no decline, and troubling that the heaviest boys seem to be getting even heavier. The study didn’t examine the causes, but Ogden cited the usual reasons — soft drinks, video games and inactivity — as possible explanations.

“We shouldn’t be complacent. We still have a problem,” Ogden said.

Dr. William Dietz, an obesity expert with the CDC, cautiously called the results promising. “We’re at the corner; we haven’t turned the corner,” he said.

Turning point?
One factor in the plateau may be the barrage of information about the obesity epidemic — and what to do about it, said Foster.

“There’s an increased availability of healthier options than there was five years ago,” he said.

School- and community-based efforts to emphasize fitness and healthy eating may also have had some effect, although Foster acknowledges that there’s no good data to prove the point.

“I think there’s lot of things you could point to, but the truth is, it’s a confluence of factors,” he said.

One of those factors might be the intersection of genetic predisposition to obesity and an environment that encourages weight gain, Foster said.

“This is about what we can expect,” he said. “For it to go down, we’re going to have to greatly change the environment for the better.”

The obesity epidemic is considered a top White House priority. President Barack Obama has pushed to make obesity prevention part of health care reform. Overhaul measures pending in Congress include encouraging employer-based wellness programs and requiring large restaurant chains to list calories. And Michelle Obama has made childhood obesity and healthy eating habits a pet project.

People like Darrell Pender are paying attention.

Obesity “is constantly in the news,” said Pender, a 42-year-old New York City computer technician who decided to get serious about fighting fat after being diagnosed with diabetes three years ago.

Pender was tempted by a TV ad for obesity surgery, but chose a less drastic option — a nutrition support group that he credits with helping him make healthier food choices. So far, he’s lost 50 pounds over several months. At 350 pounds, he’s still very obese, but his diabetes is under control and he feels healthier.

From Medscape:

Most Americans Overweight, and One-Third Are Obese: NHANES

Michael O’Riordan

January 13, 2010 (Hyattsville, Maryland) — Two new studies this week draw attention to the alarming number of individuals in the US considered overweight or obese [1,2]. Based on the latest surveys, more than two-thirds of US adults are overweight or obese, one-third are considered obese, and more than 10% of children and adolescents are also considered too heavy for their age.

The good news, however, is that the increasing obesity trends observed over the past decade appear to be leveling off, according to investigators.

“The levels are still very high, and obesity is a significant health concern,” Dr Cynthia Ogden (Centers for Disease Control, Hyattsville, MD), an investigator on both studies, told heartwire . “On the other hand, we’ve seen a slowing down, if you will, in the rate of increase compared with what it was in the 1980s and 1990s, so that’s a positive thing. But the prevalence remains very high, and significant disparities remain, and we did see an increase within this 10-year period. It’s not as if there were no increase.”

The data, from analyses of the National Health and Nutrition Examination Survey (NHANES), are published online January 13, 2010 in the Journal of the American Medical Association. In an editorial accompanying the studies [3], Dr J Michael Gaziano (Brigham and Women’s Hospital, Boston, MA) argues that the despite the leveling off, the magnitude of the obesity problem threatens to undo gains made in recent years.

“Despite the many advances in preventive medicine and treatment that reduced cardiovascular disease, the new stage of the epidemiologic transition, the age of obesity and inactivity, emerged to threaten the progress made in postponing illness and death to later in adult life spans,” he writes. “The steady gains made in both quality of life and longevity by addressing risk factors such as smoking, hypertension, and dyslipidemia are threatened by the obesity epidemic.”

Two-Thirds of US Adults Obese or Overweight

Speaking with heartwire , Ogden, the first author of the study investigating trends in the prevalence of high body-mass index (BMI) in children and adolescents and an author, along with lead investigator Dr Katherine Flegal (Centers for Disease Control, Hyattsville, MD) of the study in adults, said NHANES provides enough data every two years to examine the natural prevalence of obesity in the US population. The purpose of these studies was to document trends over two-year periods for the past 10 years.

In the first study, they analyzed the prevalence of obesity and overweight in 5555 adult men and women based on height and weight measurements used to calculate BMI. Overweight was defined as a BMI of 25.0 to 29.9 kg/m2 and obesity defined as a BMI >30.0 kg/m2.

In 2007–2008, the overall prevalence of obesity was 33.8%, with more women than men, 35.5% vs 32.2%, considered obese. Combining obesity and overweight, the overall prevalence was 68.0%, this time with more men than women, 72.3% vs 64.1%, considered overweight and/or obese. The prevalence of obesity varied by age group and by racial and ethnic groups.

Prevalence of Obesity and Overweight (%) for Adults >20 Years

Category All (n=5555) Non-Hispanic white (n=2618) Non-Hispanic black (n=1114) All Hispanic (n=1566) Mexican-American (n=945)
BMI >30 33.8 32.4 44.1 38.7 40.4
All men 32.2 31.9 37.3 34.3 35.9
All women 35.5 33.0 49.6 43.0 45.1
BMI >25 68.0 66.7 73.8 77.9 78.8
All men 72.3 72.6 68.5 79.3 80.0
All women 64.1 61.2 78.2 76.1 76.9

Over the 10-year period, however, the prevalence of obesity did not significantly increase for women. There was a significant linear trend for men in the prevalence in 2007–2008 compared with the prevalence in 1999–2000, but the most recent figures were not statistically different when compared with data in 2003–2004 and 2005–2006.

In the second NHANES analysis, 11.9% of children and adolescents aged two to 19 years were considered obese, in this case defined as being at or above the 97th percentile of the BMI-for-age growth charts. Using less stringent definitions, 16.9% and 31.7% of the kids were at or above the 95th and 85th percentile of the BMI-for-age growth charts. Like adults, disparities existed by age and by race and ethnic groups.

“In children, we saw no change over the 10-year period except for in boys six to 19 years of age,” noted Ogden. “Here we saw an increase among the heaviest boys, among a cut point that is usually heavier than what we use to determine obesity. For those kids, the prevalence did increase, so there is a suggestion that the heaviest kids are getting even heavier. There is definitely still a concern.”

Statistics Are Still Staggering

In his editorial, Gaziano writes that while a slowing of the steady upward trend in overweight and obesity is good news, “the statistics are still staggering,” given that most Americans are overweight and one-third are obese.

The results of the survey are sobering, “given the wide variety of deleterious health effects strongly linked to excess weight,” such as coronary heart disease, ischemic stroke, hypertension, dyslipidemia, type 2 diabetes, joint disease, cancer, sleep apnea, asthma, and other chronic conditions. Early obesity, he notes, strongly predicts later cardiovascular disease, and excess weight might help explain the dramatic increase in type 2 diabetes, a major risk factor for cardiovascular disease.

“If left unchecked, overweight and obesity have the potential to rival smoking as a public-health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years,” writes Gaziano.

Unlike smoking, high blood pressure, and dyslipidemia, however, the best approach to treating overweight and obese individuals is still unknown. The current approach involves changes in lifestyle, but as most clinicians are aware, promoting lifestyle changes to encourage weight reduction has been disappointing, according to the editorial. Still, given the risk of obesity-related health concerns, a massive public-health campaign to raise awareness about the dangers is needed, and the longer the delay in doing so increases the likelihood of negating the significant progress achieved in decreasing chronic disease in the past four decades, writes Gaziano.

Brain, genetics roles probed in obesity

On January 9, 2010, in Uncategorized, by Andrea

Some skinny people think that fat people are lazy.  That we sit around all day and shovel food into our mouths like gluttonous pigs while we complain about being fat at the same time.  There are even pieces in the media claiming that fat people lie when facing dietary scrutiny.  I’ve been there — I’m sure some of you have, too.

Not all of us sit on our asses all day, eating bon-bons and watching Jerry Springer.  I occasionally mix it up with Oprah, too.

(OK, I’m kidding.  You wouldn’t catch me watching either of them even paid, and I cannot tell you the last time I had a bon-bon.. do they even still make them?  Where does one even buy bon-bons in the grocery store?  I couldn’t tell you.)

So when a fat person tells you “I’m genetically fat” they may, you know, actually mean it.  And given some news from JAMA, hey!  Some scientists are believing it as well.

Scientists Probe Brain’s Role in Obesity

Huan J. Chang, MD, MPH

JAMA. 2010;303(1):19.

Chicago—Genetic and environmental influences on the brain may contribute to obesity, suggests research presented at the Society for Neuroscience’s annual meeting here in October.

The meeting provided a timely forum for bringing together basic and clinical researchers who conduct studies of the causes of overeating and obesity, which largely support the concept of obesity as a biological problem rather than an issue of overindulgence.

Ilia Karatsoreos, PhD, a postdoctoral fellow at Rockefeller University in New York, and colleagues studied the effects of changing the circadian rhythm in mice by artificially creating a 20-hour day (10 hours of light and 10 hours of dark). After 6 to 8 weeks, the mice experiencing these shorter days showed weight gain, changes in body temperature rhythms, and levels of metabolic hormones (including leptin and insulin) when compared with the control group. Behavioral changes, which included increased impulsivity and decreased cognitive flexibility (meaning the mice were less able to adopt new strategies in new situations), occurred in conjunction with neural changes in the prefrontal cortex, an area known to be important for regulating these behavioral traits. The findings may be relevant to humans, given the widespread occurrence of both shift work and jet lag.

Several studies explored the role of epigenetic changes—heritable changes in gene expression that act independently of changes in DNA sequence—in obesity. For instance, Tracy Bale, PhD, associate professor of neuroscience at the University of Pennsylvania, and colleagues showed that pregnant mice not only get fatter and show elevated glucose, leptin, and insulin, when fed a high-fat diet, they also produced pups that were longer, weighed more, and had reduced insulin sensitivity (Dunn GA and Bale TL. Endocrinology. 2009;15[11]:4999-5009). These traits persisted into the next generation, although only females were affected. Further study revealed that these second-generation mice had altered programming of their growth hormone axis, a key gene pathway that controls growth and metabolism. In an interview with JAMA, Bale stated that the changes seen in the second generation of mice have “nothing to do with the diet itself as they have never seen the diet. Thus it has to be inherited by an epigenetic mechanism.”

Similarly, studies by Teresa Reyes, PhD, research assistant professor at the University of Pennsylvania, and colleagues suggest that a high-fat diet in pregnant and lactating mice can affect their pups’ brain development, increasing their vulnerability to becoming obese and to engaging in addictionlike behaviors in adulthood. Such pups exhibited a greater preference for sugar solution and a greater physical response to cocaine than did pups of mothers that were fed a standard diet.

Clinical researchers presented other possible mechanisms for overeating and for the preference of high-sugar and high-fat foods. This research was based on the premise that innate biological factors interact with the environment to predispose individuals to eat.

Kathleen L. Keller, PhD, of the New York Obesity Research Center of Saint Luke’s-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, and colleagues followed up on animal studies by French researchers demonstrating that dietary fat may be one of the basic tastes (such as sweet, salty, and bitter) and is associated with expression of the gene encoding CD36, a receptor in the tongue found to play a role in fat detection and preference (Faugerette F et al. J Clin Invest. 2005;115[11]:3177-3184). In their work, Keller and colleagues are the first group to report the relevance of the CD36 gene to humans. They found that those who were heterozygous for the gene were less likely to be able to discriminate fat and tended to dislike low-fat and fat-free foods. In their study, humans who could not discriminate fat ate more high-fat meats, sweets, and spreads.

Dana M. Small, PhD, assistant professor at Yale University, and colleagues identified brain regions where response to ingestion of a milkshake may represent a biomarker of weight-gain susceptibility in humans, and that the response is moderated by the Taq1A A1 polymorphism, which is associated with fewer dopamine receptors. In subjects carrying Taq1A A1, the relative activity (as measured by event-related functional magnetic resonance imaging) of the caudate nucleus, part of the brain’s reward system and an important area for habit learning, predicts an individual’s future weight gain over the next year. The researchers also found that response in the dorsal striatum is inversely related to trait impulsivity.

“This means that overweight people with the A1 allele do not experience less food reward but rather that they may be more prone to impulsive eating,” Small said in an interview with JAMA.

An opinion piece.

From Medical News Today:

Commentary: Obese Pregnant Women Should Gain Less Weight Than Currently Recommended

Recent recommendations by the Institute of Medicine (IOM) call for women who are overweight or obese to gain more weight than they should, a Saint Louis University obstetrician wrote in a January commentary for Obstetrics & Gynecology.

Joined by several colleagues, Raul Artal, M.D., chair of the department of obstetrics, gynecology and women’s health at Saint Louis University who has conducted extensive research on weight gain during pregnancy, did not endorse the IOM’s May 2009 recommendation. The IOM, a non-governmental, independent, nonprofit organization, provides advice that is designed to improve health to national decision makers and the public.

“The recently published IOM recommendations for gestational weight gain are virtually identical to those published in 1990 with one exception: obese women are now recommended to gain 11 – 20 pounds compared to the previous recommendations of at least 15 pounds,” Artal said.

“Recommending a single standard of weight gain for all obese classes is of concern since higher BMI levels are associated with more severe medical conditions and have long-term adverse health implications.”

Artal recommended obese women eat a nutrient-rich diet of between 2,000 and 2,500 calories a day, which would cause them to cap their weight gain at 10 pounds, and in some cases, lose weight.

Under a doctor’s guidance, he said, obese pregnant women can safely engage in physical activities and modify their diets to successfully limit their weight gain with no harmful effects on the fetus.

When obese women reduce the amount of weight they gain, they also cut their risk of developing complications such as gestational diabetes and preeclampsia. By contrast, obese women who gain too much weight increase their risk of developing these conditions who affect both mother and fetus.

Artal called excessive weight gain during pregnancy a significant contributor to the obesity epidemic.

“Excessive gestational weight gain has been implicated in an intergenerational vicious cycle of obesity as overweight and obese mothers give birth to big daughters who are more likely to become obese themselves and deliver large infants,” he said.

Pregnancy is an ideal time for women who are obese to exercise and watch what they eat, Artal added. These lifestyle changes are safe and carry benefits that last long after they have given birth, Artal added.

“Similar to smoking cessation programs, pregnancy provides a unique and ideal opportunity for behavior modifications given high motivation and enhanced access to medical supervision,” he said.

“Limited weight gain in obese pregnant women has the added potential for setting the foundation for a healthier lifestyle over a woman’s lifespan.”

Artal led the team of obstetricians who drafted the American College of Obstetricians and Gynecologists’ guidelines for exercise during pregnancy. He was joined in writing the commentary by Charles Lockwood, M.D., chair of the department of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and Haywood Brown, M.D., chair of obstetrics and gynecology at Duke University Medical Center.

Popularly known as “The Green Journal,” Obstetrics & Gynecology is the official publication of the American College of Obstetricians and Gynecologists.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

Source: Saint Louis University Medical Center

Fit AND Fat?

On January 7, 2010, in Uncategorized, by Andrea

The usual standard of fitness, the BMI, or Body Mass Index chart, is a crappy indicator.  We all know this.  I mean, anything that puts celebrities like Arnold Schwarzenegger in the “obese category” is not a good indicator of health.  So this is a big “duh” for many of us.

But I always said I had been a “healthy” fat person.  And given my lack of co-morbs prior to surgery, I was.  I had low blood pressure, no signs of heart disease, low cholesterol, no diabetes — even LOW blood sugar rather than trending upward sugar levels, no sleep apnea, no PCOS — but would I have stayed that way?

So again, is there a question of Fit, but Fat?

It’s interesting to me that there were two different things about this — both from two different countries, studying two different genders, that say the complete opposite of each other.  Now given, one is a short-term glimpse of life and one is a long-term study.  I’m more apt to look at the long-term study, but the video does bring in the relevance of waist circumference versus BMI (although I’m not certain it would have made a difference in either case), but it does bring the point home that a different measure should be made.

From Medscape:

Overweight, Obesity up CV Risk Regardless of Metabolic Markers in Long-Term Study

Michael O’Riordan

January 5, 2010 (Uppsala, Sweden) — Middle-aged men with the metabolic syndrome are at an increased risk of cardiovascular disease and death regardless of their body-mass index (BMI), new research shows [1]. On the flip side of that combination, investigators also showed that overweight and obese individuals without the metabolic syndrome are at an increased risk of cardiovascular events and death.

Publishing their results online December 28, 2009 and in the January 19, 2010 issue of Circulation, Dr Johan Ärnlöv (Uppsala University, Stockholm, Sweden) and colleagues say the “data refute the notion that overweight and obesity without the metabolic syndrome are benign conditions.”

As the researchers note in their paper, previous studies have shown that obese individuals without the metabolic syndrome–sometimes referred to metabolically healthy obese, or even healthy fat–were not at an increased risk of cardiovascular disease events. Follow-up in these studies was around 13 years, leaving some question as to the long-term impact of different BMI/metabolic-syndrome combinations.

In this new Swedish examination, cardiovascular risk factors were assessed in 1758 middle-aged individuals without diabetes in the Uppsala Longitudinal Study of Adult Men (ULSAM). During a median follow-up of 30 years, 788 participants died and 681 developed cardiovascular disease. In hazard models that adjusted for age, smoking, and LDL cholesterol, metabolic syndrome was associated with an increased risk in normal, overweight, and obese individuals. As noted, even obese and overweight individuals without metabolic syndrome were at an increased risk for death and cardiovascular events.

ULSAM: Death and Major Cardiovascular Events (HR, 95% CI) in the Different Groups

End point Normal weight without metabolic syndrome Normal weight with metabolic syndrome Overweight without metabolic syndrome Overweight with metabolic syndrome Obese without metabolic syndrome Obese with metabolic syndrome
Total death Referent 1.28 (0.90–1.82) 1.21 (1.03–1.40) 1.53 (1.19–1.96) 1.65 (1.03–2.66) 2.43 (1.81–3.27)
CV death Referent 1.77 (1.11–2.83) 1.44 (1.14–1.83) 2.19 (1.57–3.06) 1.20 (0.49–2.93) 3.20 (2.12–4.82)
Major CV events Referent 1.63 (1.11–2.37) 1.52 (1.28–1.80) 1.74 (1.32–2.30) 1.95 (1.14–3.34) 2.55 (1.82–3.58)

The researchers note that there appeared to be a lag time of approximately 10 years before the Kaplan–Meier curves for overweight and obese individuals without the metabolic syndrome diverged from the curve of normal-weight participants without the syndrome.

“This could be important, because it is possible that the transition from overweight/obesity without metabolic derangements to overt cardiovascular disease is a pathological process that spans several decades,” write Ärnlöv and colleagues.

They note that based on previous studies, weight loss in these so-called metabolically healthy obese and overweight individuals had been questioned, with some researchers even suggesting it might be harmful for them to lose weight. Based on their results, however, the “potential benefits of diagnosing metabolically healthy obese in clinical practice appears limited,” and the data do not support the existence of a healthy obese phenotype based on the absence of metabolic syndrome or insulin resistance.

And conversely, from

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