Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

ariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

“The rapidly growing epidemics of obesity and diabetes threaten to overburden the world’s health care systems,” the authors write as background information in the article. “From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful.

Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent.”

The use of bariatric surgery-that results in long-term weight loss, improved lifestyle and decreased risk of death-has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications.

Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

“We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected,” the authors write. “This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide.

As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery.”

Health care costs averaged $6,376 per year in the two years before surgery, and the median or midpoint cost of the surgery and hospitalization was $29,959. Total annual health care costs increased by 9.7 percent ($616) in the year following the procedure, but decreased by 34.2 percent ($2,179) in year two and by 70.5 percent ($4,498) in year three.

“Based on these data, we have identified several important implications for health care delivery and public policy,” the authors conclude. “Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management.

Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health.”

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The Battle For Minimum Weight – Blacks and the Obesity Epidemic

Caught up in the frenetic grind of her fashion industry job, Allison Ferrell, 41, paid little attention to her increasing waistline. As Manager of Product Operation and Logistics for Abaete, a New York-based luxury apparel line, lunch was a luxury she couldn’t afford. She said she was crazed and I couldn’t spare the time so If I didn’t eat by 1:00 p.m. that was it for the rest of the day.

After a 2005 surgery left her stomach upset, she routinely avoided a litany of foods and routinely skipped meals. Her erratic eating habits kicked her body into pre-starvation mode. Believing it was starving, her body stopped burning calories and began to store food reserves causing an increase in body fat.

I’d had a good run, but my negative habits were catching up with me and now it was time to take care of myself.”According to the American Council for Exercise, acceptable essential fat is 25-31% and obese is 32%; Ferrell measured almost 39%. Accustomed all her life to being thin, she was flummoxed by 23 pounds of extra fat.

Ferrell is hardly alone in her struggle to manage her weight. Plus sized women and strapping men are a celebrated norm within Black culture – the tacit acceptance of which is inhibitive to weight loss. From Thanksgiving and Easter dinners to barbeques and ho-downs, cooking and meal-sharing have been time-honored means of familial and communal bonding. Meals laden with fat, sugar, salt and cholesterol have long been cornerstones of traditional African American cuisine. While these foods are gastronomically appealing, they are detrimental to healthy living. It’s difficult to change habits that are ingrained in our history, explains, dietician and nutritionist and co-owner of living Proof in New York.

Some of the culturally defining foods in Europe, Asia and the Mediterranean, such as olive oil, grains and vegetables are heart healthy. What is natural for African Americans is further down the food chain of nutritious. The American Obesity Association estimates that approximately 127 million adults are overweight, 60 million are obese and 9 million are morbidly obese. The escalating phenomenon of obesity has become a national crisis and is nowhere more evident than in African American communities. Recent statistics from the Center for Disease Control and Prevention show nearly 51% of black women are obese and a whooping 78% are overweight – the highest of all ethnic groups – almost 30% are obese and 67% are overweight.

Considering body type and height variations, the standard scale fails to provide an accurate measurement of body weight. The Body Mass Index (BMI) is a widely used formula which uses weight and height measurements to assess total body fat and provides healthy weight ranges for all ethnicities.

BMI is also an indicator of heightened risk for developing diabetes, heart disease and other obesity-related illnesses. A BMI of 19-24 is considered healthy. However, a BMI of 25-29.9 is overweight and 30 and higher is obese. The waist circumference measurement calculates abdominal fat and is often used in conjunction with BMI to determine weight related conditions.

Despite glaring evidence, many blacks have a poor perception of weight and fail to recognize their weight as problematic. Dr. Ian Smith, medical and diet expert for VH1′s Celebrity Fit Club and ABC’s The View explains that this speaks to the core concept of self-definition and what we think we look like. To change the tide, he insists, the imperative is to change the cultural mindset that promotes and sustains the behavioral habits cause obesity. The curvaceous, full-figured body is the feminine ideal in Black culture.

Many Black women are resistant to weight loss because they equate maintaining a healthy weight with losing their curves and by extension their attractiveness. Dr. Ian says, “There is a tendency to sexualize weight. You can be on the plus side but still be healthy. We shouldn’t be defined by a condition that is damaging to our health, but instead by our courage, inner and outer beauty and our vigor for life.” Dr. Leggett offers another perspective. There is no conflict between being sexy and physical fitness. Because individuals are resistant to exercise, they convince themselves that being overweight is a paradigm for sexy.

While a variety of factors contribute to obesity and overweight, the root causes remain the same: lack of exercise and poor nutritional choices. Dr. Christopher Leggett, Director of Cardiology for Medical Associates in Georgia and one of the country’s foremost interventional cardiologist says that people enjoy sedentary lifestyle and the lack of dietary discretion in what, when and how much they eat, none of which is tempered by balance.

Moreover, larger food portions, dependence on fast food and the barrage of media marketing by the food industry have played a major role in the erosion of overall health. Today’s historic numbers are also largely attributed to the double-edged sword of technological advancement.

The ease and simplicity of modern living made possible by computer and digital technology discourages physical activity and permeates every aspect of society: food delivery, surfing the internet, computer-based office jobs and play station. Dr. Ian explains that people are less inspired to move and this means calories sit on their bodies and become fat. In addition, relentless work demands – commuting, long hours, working through lunch – requires that the basic necessities of self-preservation are cast aside.

As the singular head of the household, black women are often responsible for balancing home, work, childcare and sometimes education with little time to squeeze in exercise. Dr. Leggett refutes this claim saying that many women spend hours on beautifying their external appearance when they set aside thirty minutes each day for exercise. Until individuals become actively engaged in healthy living the medical consequences of obesity will continue to escalate.

The consequences of obesity present a smorgasbord of debilitating illnesses including diabetes, heart disease, stroke, hypertension and certain cancers and have a domino effect on the body’s physiology. What has been commonly considered “a little sugar” has morphed into a runaway epidemic affecting an estimated 18 million Americans, with Blacks at a 1.6 greater risk of developing the disease than whites.

It also has consequences of stroke, kidney failure, amputation and blindness, and ranks first in direct healthcare costs, consuming $1 of every $7 spent on healthcare. Dr. Leggett explains Obesity is the primary cause of Type II diabetes which increases the occurrence of cardiovascular disease, resulting in an 80% death rate from heart attacks.

Excess abdominal fat is highly active. It expands, releasing chemicals that ensure its continued existence. This in turn creates a resistance to the hormone insulin, which controls blood sugar. Increased insulin-resistance exhausts the pancreatic gland resulting in high blood sugar levels, which sets the stage for diabetes.

The cardio-vasculature of the body is impacted by elevated cholesterol and lipids in the blood. A build-up of Low-density lipoprotein (LDL or “bad” cholesterol) and other food slush form plaque within the coronary arteries, the vessels that supply blood to the heart. This deposit eventually narrows the opening of the blood vessels that supplies organs with oxygen and nutrients.

Dr. Leggett says that rupture of the arteries causes kidney and spinal chord stroke, in the coronary arteries causes heart attacks and in the carotid arteries, stroke or thrombosis, an obstruction of blood flow throughout the circulatory system. Blockages in the lower extremities often cause poor circulation, joint pain and even amputation.

With 45% of women and 42% of men twenty years or older suffering from the condition, African Americans have the highest rate of hypertension in the world. Research conducted by the National Obesity Association indicates that hypertension occurs 9% more frequently in obese individuals. Poorly controlled hypertension leads to stroke, which is the third cause of death and the primary reason for disability.

As fat increases, so does the demand for oxygen and nutrients. The upsurge of blood circulating throughout the body adds pressure to the artery walls causing them to narrow and stiffen, resulting in an enlarged heart, stroke and kidney disease.

An American Cancer Society study shows that up to 90,000 cancer deaths annually can be attributed to obesity and overweight. Increased production of insulin and estrogen stimulates the growth of cancer cells. In women, obesity is related to elevated risk of uterine, breast, cervix, ovarian, renal cell and endometrial cancers; in men, with colon and prostate cancers.

The high incidence and virulence of obesity-related diseases are exacerbated by lack of preventive care and appropriate health screenings. Dr. Ian posits that Blacks tend to visit the doctor later and by then these illnesses are less treatable and curable and the body is weakened. That’s why whether it’s talking to your physician or going to a free clinic, we must become more proactive about our own health.

An unspoken consequence of obesity is the double jeopardy of weight discrimination within the healthcare industry. Doctors’ subjective opinion and prejudice negatively impacts medical treatment, care and outcome. A recent study by the New England Journal of Medicine shows discrimination in treatment of kidney failure, cancers and heart disease, despite the fact that these illnesses are more egregious in blacks than in whites. A physician may withhold treatment or a procedure, which may be optimal, based on latent feelings that the obese patient is lazy, lacks discipline and self-respect or will not follow the prescribed regimen.

With a distressing 30% of children ages 6-19 overweight and 15% obese, the prevalence of childhood obesity has skyrocketed over the past twenty years, ensuring a future wave of chronic, obesity related diseases, diabetes, hypertension and other ailments. According to the American Academy of Pediatrics, the probability of an obese child becoming an obese adult increases approximately 20% at four years old to 80% by adolescence. Alarmingly, African American girls across all socio-economic levels have the highest incidence: of ages 6-11, 38% are overweight and 22% are obese; ages 12-19, 45% and 27% respectively.

The calamitous combination of super-sized fast foods, video game culture and physical inactivity, enabled by parental complicity has swept the tide of childhood obesity to unprecedented heights. The typical adolescent diet is comprised of fats, cholesterol, sugar, Trans fat and devoid of fruits and vegetables; beverages are carbonated and loaded with high fructose corn syrup. Nutritionist Lisa Jubilee maintains there are numerous ways parents can set better examples for children. She says if you must eat fat food, skip the fries sometimes, get a smaller size or choose a salad. Instill the habit of eating a fruit as an after-school snack or have one with cereal in the morning.”

Today’s children are the most inactive in history, largely owing to the pervasiveness of stationary entertainment such as Play station and X box games and video television. Urbanization and the reduction of physical education in schools have resulted in the frequency and decline of exercise.

The American Academy of Pediatrics report shows that 25% of children 8-6 years watch at least four hours of television daily and having a television in the bedroom is a strong indicator of obesity development, even in preschool-aged children. Inner city children are purportedly hindered by the inability to walk or bike safely to school or play outside later. Moreover, many lack the means and the inclination to venture outside the familiar confines of their neighborhood and into suburban or rural environs.

Children are becoming fatter at a younger age, Dr. Leggett observes. Some are presenting early sign of heart disease and blood vessel damage. But you can’t blame them when parents are supposed to be in charge of the food environment. The list of obesity-related illnesses in children is comparable to adults’.

Hypertension occurs 9% more frequently in obese children and doctors have also observed signs of heart disease. In 1997, the growing number of children with environmentally-influenced diabetes prompted a name change from adult-onset to Type 2 diabetes. Excess weight also triggers bronchial spasms, the hallmark of asthma. Other consequences include sleep apnea, orthopedic complications and delayed menstruation in girls. The psychological effects are immensely damaging and often persist into adulthood. Obese children experience social alienation and teasing which become catalysts for depression, eating disorder and high risk behaviors.

Make no mistake – being fat costs. Obese and overweight individuals can expect higher medical expenses and insurance premiums, tend to earn less and create less wealth in their lifetime. As the country faces a burgeoning healthcare crisis, the medical cost of obesity-related illnesses is an estimated $93 billion, 85% of which is covered by government programs such as Medicaid and Medicare.

The cost to each tax payer is $180 annually. Routine care for preventive, diagnostic and treatment services can reach $7,000 in yearly out-of-pocket expense. Decreased productivity, absenteeism, sick days, disability and restricted movements are costly to both workers and employers. Weight penalty is also exacted through social stigmatization and impediments to career advancement. Many experience difficulty finding employment, securing a promotion or a coveted assignment based on the belief that they are lazy and weak-willed.

Is it possible to halt the upward trend of obesity? Healthcare experts agree that education and moderation are keys to incorporating healthy habits into daily living. Despite the promises of diet pill pushers and the growing popularity of bariatric and gastric bypass surgeries, the surest solution to weight loss remains diet and lifestyle changes.

Jubilee, who requires clients to keep a food journal, formulates eating plans tailor-made for the lifestyle and needs of the individual. She suggests that individuals begin by walking every day and introduce new, wholesome foods into your diet so you can live longer than your forefathers.

For Ferrell, she suggested different ways to prepare old favorites such as baking instead of frying and minimizing the amount of batter used to make biscuits. Small steps are necessary to make the big changes that will sustain weight loss. Ultimately, African Americans have the means and opportunity to overcome the tide of obesity and overweight by setting new, grander examples of healthy living for this generation and the next.

Author Denise A. Campbell is the Founder and Creative Director of GoldenPen Writing Ink, a multifacted writing and communication service. Originally published for http://www.blackenterprise.com/magazine/2007/07/01/battle-for-minimum-weight/

Obesity is a Worldwide Epidemic Today – It is Easy to Detect But Difficult to Treat

Obesity is an abnormal accumulation of body fat. A person is said to be obese or overweight when he/she has additional body fat above the ideal body weight; 20-40% over ideal body weight is considered mildly obese; 40-100% over ideal body weight is considered moderately obese; and 100% over ideal body weight is considered severely or morbidly obese. The World Health Organization (WHO) has termed obesity as a worldwide epidemic and obesity-related diseases are becoming increasingly prevalent.

Most medical professionals use a measurement called BMI (body mass index) to diagnose obesity; an individual’s weight in kilograms is multiplied by 703 and then divided by twice the height in inches. BMI of 25.9-29 is considered as overweight while a BMI of over 30 is considered obese. Usually, measurements and comparisons of waist and hip circumference also help provide adequate information; increased waist-hip ratio may lead to weight associated risk factors. In certain cases, measuring skin-fold thickness with the help of calipers can also help determine adipose tissue.

Obesity in children and teens

Obesity is not just a problem that affects adults. More and more children today are afflicted with this problem that was once considered a purely adult disease. The number of obese children has tripled over the last 20 years. At least 10% of six-year-olds and 17% of 15-year-olds are today found to be clinically obese. Childhood obesity is a strong indication that this child will grow up to be obese as an adult. Furthermore, childhood obesity is a strong indicator of weight-related health problems in later life, showing that learned unhealthy lifestyle choices continue into adulthood.

Obesity is associated with increased risk of illness, disability and death. Excessive weight can result in many serious, potentially life-threatening health problems, such as hypertension, Type II diabetes mellitus (non-insulin dependent diabetes), increased risk for coronary disease, increased unexplained heart attack, hyperlipidaemia, infertility as well as higher prevalence of colon, prostate, endometrial and breast cancers. Approximately, 300,000 people die in a year because of obesity. As a result, obesity is termed as the second largest leading cause of preventable deaths. Get more information on Obesity Treatment

Facts about obesity

Globally, there are more than 1 billion overweight adults, at least 300 million of them obese. Obesity and overweight pose a major risk for chronic diseases, including type-2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer. The key causes are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.

Symptoms of obesity

Excessive weight gain and the presence of large amounts of fatty tissue are the two major visible symptoms of obesity. Obesity can affect your day to day life.

Some of the immediate symptoms of obesity include:

Breathlessness
Excessive sweating
Snoring
Difficulty sleeping
Inability to cope with sudden physical activity
Feeling of tiredness
Back and joint pains

Some of the long-term symptoms of obesity include:

High blood pressure
Heart disease and stroke
High cholesterol
Breast cancer and menstrual problems (in women)
Gall bladder disease
Gastro-esophageal reflux disease
Arthritis
Diabetes
Polycystic ovarian syndrome (PCOS)
Skin disorders
Reduced life expectancy

Many people may also experience psychological problems which include:

Low self-esteem
Low self confidence
Feeling of isolation
Poor quality of life because of reduced mobility

Causes of obesity

Obesity is not something that happens overnight – it develops gradually and is generally a result of poor diet and lifestyle choices; to a certain extent your genes may also be responsible.

Genetic: Studies have confirmed that predisposition towards obesity can be inherited. It has been noted that most children with childhood obesity or overweight parents grow up to be overweight. Weight on the hips or around the middle is strongly influenced by heredity.

Lifestyle choices: It also influences your weight. Eating more calories than you need is usually a result of poor food choices. Alcohol also contains a lot of calories and heavy drinkers are often overweight. Bad eating habits run in families.

Lack of physical activity: It is another important obesity related factor. If we do not actively use up the energy provided by food, the extra calories are stored as fat and this gradually leads to obesity.

Medical reasons: Medical reasons are also a well known cause for obesity. In less than one out of every 100 cases, there is a medical reason for obesity. Conditions such as Cushing’s syndrome (over-production of hormones in the body) and an under-active thyroid gland are rare causes of weight gain. Certain medicines, including some steroids and antidepressants, also contribute to weight gain.

How to diagnose obesity?

Obesity is diagnosed by comparing a patient’s weight with ideal weight charts. A direct measure of body fat can also be made with an instrument known as ‘calipers’; it helps to measure the thickness of your fatty tissue at the back of the upper arm. Women with 30% fatty tissue and men with 25% fatty tissue are considered to be obese. Body fat distribution is another good indicator of obesity.

Body Mass Index (BMI) is currently used as the most accurate and reliable way of diagnosing obesity. You can work out your BMI using this calculation:

Measure your height in meters and multiply the number by itself (this is the squared figure)
Measure your weight in kilograms
Divide your weight by the answer you got in step 1 (squared height)
The number that you arrive at is your valid BMI

How to treat obesity?

In view of a surge in obesity and weight-related diseases, more successful long term treatments for obesity are urgently required. Low calorie diet, exercise therapy and lifestyle counseling are effective obesity solutions that can help tackle obesity in the best possible way. Aim of your obesity treatment is to lose weight in order to improve your general quality of life, both physical and psychological; increase mobility; and improve your self-esteem. Use of weight loss treatment drugs in combination with diet and exercise therapy also provides effective weight loss.

Xenical orlistat and Reductil sibutramine are the two popular pills for obesity that are available on the market today. Orlistat slimming pills work by blocking the action of body chemicals called enzymes which digest fat. About 30% of the fat from your food remains undigested and is not absorbed by your body; this passes out with your faeces. Xenical capsule is taken with each main meal of the day. Orlistat is not prescribed to: Pregnant women, breastfeeding mothers and children.

Reductil sibutramine is a type of obesity treatment medication that affects chemicals in the brain called noradrenaline and serotonin to make you feel fuller or satisfied with less food; it is prescribed to help you lose weight. One sibutramine diet pill is taken once a day. If orlistat or sibutramine is prescribed for you, you will also you will also receive advice, support and counseling about diet, exercise and lifestyle changes.

Weight loss surgery is normally considered to restrict the amount of food eaten, or to interrupt the digestive process. These surgeries help you lose weight by reducing your food intake. There are three widely used techniques in weight loss surgery:

Gastric band surgery,
Gastric bypass surgery, and
Intra-gastric balloon

How to prevent obesity?

Eating healthily and regular exercise are some of the best obesity prevention methods. Diet, calorie intake and exercise play a major role in obesity.

Diet rich in fruits, vegetables and unrefined carbohydrates should make up the bulk of your diet. Choosing brown and wholegrain carbohydrates are healthy. Steaming and grilling food are healthier cooking options and prevent weight gain. Avoid overeating as it can be harmful. Cut down on high fat snacks, junk food and ready meals, as they are mostly packed with fat, high levels of sugar and salt.

Calorie-counting can keep your weight down. You must work out your daily calorie requirement.

Exercise in moderate amounts id essential to keep your weight in check. It is recommended that you take at least 30 minutes of moderate intensity exercise, at least five days a week. This can be done in one session, or in split sessions. Exercise burns up calories, increases your metabolic rate and improves appetite.

Finally there is an accurate and informative resource for discussing Obesity (over weight) including the various causes of obesity, as well as, the most beneficial & effective obesity treatment options.

Study Finds Girls Reaching Puberty Increasingly Early

A US study shows that almost one in four black girls and one in 10 white girls had developed breasts by the age of seven. The findings are the latest in a string of studies showing that girls in the US are reaching puberty sooner, with implications both for the social and emotional wellbeing of girls as well as for their physical health in later life.

Early maturation has been shown to cause low self-esteem and doubts about body image, as well as greater rates of eating problems, depression and attempted suicide.

It is linked to earlier sexual experiences, and later on carries greater risks of breast cancer. The researchers found that at the age of seven 23.4% of black girls, 14.9% of Hispanics and 10.4% of white girls had developed breasts.

At 8 those proportions had risen further to 42.9%, 30.9% and 18.3% respectively.

A similar survey completed in 1997 found the proportion of white girls who had developed breasts by seven was 5% — half of what it is today. The proportion of black girls in that bracket has also shot up in the past decade, from 15% in 1997 to 23% today.

Studies have shown that in the 1700s girls began menstruation on average at about age 17-18, though that might be as much to do with widespread malnutrition as with other factors. Experts point to several possible causes of the declining age of puberty.

Top of the list is obesity, as excessive body fat is understood to increase the levels of oestrogen that play a role in breast growth. One in three children in the US are now obese or overweight, a rate that is rising despite efforts from Michelle Obama in the White House down to combat the epidemic.

Other areas of concern include environmental factors. Prime among those are chemicals known as endocrine disrupters that act on hormones to change bodily functions.

The precise role of chemicals on child development is still the subject of debate. But researchers believe that components of plastics such as bisphenol A, which has a similar structure to oestrogen, and is found in plastic bottles and in the lining of drinks cans, may be significant.

Phthalates, chemicals that disrupt the work of hormones, have also been pinpointed as possible culprits. The study, published in the journal Pediatrics and led by a team from the Cincinnati children’s hospital, was based on 1,239 girls aged six to eight. The sample was drawn from three areas across America: East Harlem in New York, Cincinnati and San Francisco.

The importance of diet and environmental factors is highlighted in the new study by region. Cincinnati had a much higher prevalence of the onset of breast development among 7 year olds (18.9%) than either New York (15.3%) or San Francisco (11.6%).

San Francisco’s relatively low ratings may have something to do with the city’s emphasis on healthy eating, exercise and limited use of plastics and other harmful chemicals.

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‘Lap-band’ Weight Loss Surgery in Very Obese Adults Improves Mental Health, Study Finds

ScienceDaily (Aug. 10, 2010) — One year after weight loss surgery with laparoscopic gastric banding, extremely obese adults demonstrate not only better physical health but also improved psychological health, a new study shows.

The results are being presented at The Endocrine Society’s 92nd Annual Meeting in San Diego. “Surgical treatment, such as laparoscopic gastric banding, is increasingly recognized as the most effective means of achieving weight loss and improving blood sugar control in morbidly obese patients with Type 2 diabetes,” said study co-author Andrew Johnson, MD, of Southmead Hospital in Bristol, U.K.

“However, until now, the long-term psychological status of morbidly obese individuals undergoing gastric banding has been unclear despite its increasing use,” said Johnson, a consultant physician specializing in diabetes and endocrinology.

Laparoscopic gastric banding, also called the “Lap-Band” procedure, is a minimally invasive weight loss surgery. It involves repeated adjustment of a band to gradually make the stomach smaller and limit food consumption.

Four men and 21 women (ranging in age from 30 to 58 years) participated in the study and had the weight loss surgery. Of these 25 patients, 16 had Type 2 diabetes and nine did not. All had a body mass index (BMI, a measure of body fat) that classified them as morbidly obese.

Participants completed psychological testing before surgery and six and 12 months after surgery. These tests measured general anxiety and depression, quality of life, and social anxiety, that is, anxiety related to what others might think of one’s appearance.

Compared with before surgery, patients’ psychological test scores improved significantly at both six and 12 months after surgery. They had better psychological and physical quality of life, reductions in levels of general anxiety and depression, and reductions in their levels of social anxiety.

As shown in other studies, gastric banding significantly reduced BMI and hemoglobin A1c, a measure of blood sugar control over time. “These results provide evidence one year after gastric banding that psychological health improves in parallel with physiological health,” Johnson said.

Researchers at the University of the West of England in Bristol also contributed to this study. The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by The Endocrine Society, via EurekAlert!, a service of AAAS.

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Restaurants, Cafes and Pubs to List The Calories in Every Item on Their Menu

Restaurants, cafes and pubs could be forced to list the calories in every item on their menu under Government plans to tackle obesity.

Health Secretary Andrew Lansley wants the public to be made aware of exactly what they are eating in the hope that they will chose healthier dishes.

The plans could also include alcohol with the calorie content of every glass of wine, pint of beer and spirit measure listed alongside its price.

Mr Lansley hopes that chefs would be encouraged to prepare smaller, less fattening menus as they would be more popular with the public. But the proposals – which are still being negotiated – are likely to be met with scepticism by the food and drinks industry.

It is unclear how exactly the Government could force all restaurants, cafes and pubs to work out the nutritional value of every item on their menu and what sanctions they would impose if they did not adhere.

It would also an extremely expensive process which smaller, family-run establishments would be unable to afford.

Previous atempts appear to have failed and a voluntary scheme by the Food Standards Agency to encourage restaurants to display their calorie content has been widely deemed a flop after several of the largest firms had dropped out.

Up to 17 chains initially signed up to the FSA scheme launched last year promising to include nutritional value of all items on their menus and display boards and it was hoped that other establishments would soon follow suit.

But it recently emerged that several well-known fast-food firms, including Pizza Hut, KFC and Burger King had ‘discontinued’ the scheme.

The few firms who have agreed to display the information have spent thousands of pounds breaking down the nutritional value of every item on the menu.

So far the Real Greek, which runs six outlets in London, is the only restaurant to display calorific content on its menu ranging from a bowl of olives to a bottle of Retsina wine.

The chain admitted the whole process cost 3,000 and took several months to complete.

Smaller, family-run cafes and pubs would find it virtually impossible to fund these sorts of measures. A spokesman for the Department of Health said: ‘We are working with industry on a range of options. ‘At present, there are no plans to legislate.’

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Belly Bulge Can Be Deadly For Older Adults: Study

CHICAGO — If your pants are feeling a bit tight around the waistline, take note: Belly bulge can be deadly for older adults, even those who aren’t overweight or obese by other measures.

One of the largest studies to examine the dangers of abdominal fat suggests men and women with the biggest waistlines have twice the risk of dying over a decade compared to those with the smallest tummies.

Surprisingly, bigger waists carry a greater risk of death even for people whose weight is “normal” by the body mass index, or BMI, a standard measure based on weight and height.

“Even if you haven’t had a noticeable weight gain, if you notice your waist size increasing that’s an important sign,” said lead author Eric Jacobs of the American Cancer Society, which funded the study. “It’s time to eat better and start exercising more.”

Other research has linked waist size to dementia, heart disease, asthma and breast cancer.

Bulging bellies are a problem for most Americans older than 50. It’s estimated that more than half of older men and more than 70 per cent of older women have bigger waistlines than recommended. And it’s a growing problem: Average waistlines have expanded by about one inch per decade since the 1960s.

To check your girth, wrap a tape measure around your waist at the navel. No fair sucking in your bulge. Men should have a waist circumference no larger than 40 inches. For women, the limit is 35 inches.

The new study, appearing in Monday’s Archives of Internal Medicine, is the first to analyze waist size and deaths for people in three BMI categories: normal, overweight and obese. In all three groups, waist size was linked to higher risk.

About two per cent of people in the study had normal BMI numbers but larger than recommended waists. Jacobs said the risk increased progressively with increasing waist size, even at waist sizes well below what might be considered too large.

The study used data from more than 100,000 people who were followed from 1997 to 2006. Nearly 15,000 people died during that time.

The researchers crunched numbers on waist circumference, height and weight to draw conclusions about who was more likely to die. Study participants measured their own waists, so some honest mistakes and wishful fudging could have been included, the authors acknowledged.

Four extra inches around the waist increased the risk of dying from between 15 per cent to 25 per cent. Oddly, the strongest link — 25 per cent — was in women with normal BMI.

People with bigger waists had a higher risk of death from causes including respiratory illnesses, heart disease and cancer.

The study was observational, a less rigorous approach that means the deaths could have been caused by factors other than waist size. But the researchers did take into account other risk factors for poor health, such as smoking and alcohol use.

Some older adults gain belly fat while they lose muscle mass, Jacobs said, so while they may not be getting heavier, they’re changing shape — and that’s taking a toll.

A tape measure, or a belt that doesn’t buckle the way it used to, “may tell you things your scale doesn’t,” Jacobs said.

Fat stored behind the abdominal wall may be more harmful than fat stored on the hips and thighs. Some scientists believe belly fat secretes proteins and hormones that contribute to inflammation, interfere with how the body processes insulin and raise cholesterol levels.

But Dr. Samuel Klein, an obesity expert at Washington University School of Medicine in St. Louis, is skeptical about that theory. Removing belly fat surgically doesn’t lead to health improvements. That may mean it’s simply a stand-in for some other culprit that is causing both belly fat and poor health. Klein wasn’t involved in the new research.

Klein said the new study, while showing a link between waist size and mortality, doesn’t pinpoint exactly how much belly fat is dangerous for normal, overweight and obese people. The 40-inch for men and 35-inch for women cutoff points are irrelevant for many people, he said.

What can be done to fight belly fat? It’s the same advice as for losing weight. Eat fewer calories and burn more through walking, bicycling and other aerobic exercise. “Sit-ups are useless,” Klein said.

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Is This The Real Reason Schools Are Calling Our Children Fat?

Children in state schools in England are weighed and measured in reception class (at ages four or five) and then again in Year 6 (at age ten or 11)

Parents of thousands of primary school children have received letters from the NHS telling them their child is overweight.

But, as the Mail has reported, in some cases the letters have been sent to children just a couple of pounds overweight, leading to fierce criticism from campaigners and parents as it exposes children to bullying.

Now, some experts believe the charts used to assess if a child is obese are flawed.

Under a scheme introduced by the NHS in 2005, children in state schools in England are weighed and measured in reception class (at ages four or five) and then again in Year 6 (at age ten or 11).

This was set up following concern about the growing number of obese children.

Research shows that obese children are more likely to grow into obese adults, putting them at risk of problems such as heart disease, diabetes and high blood pressure.

The idea behind the scheme is to help overweight children change their eating and exercise habits, making them less likely to be overweight in later life.

The Department of Health says weighing and measuring children is important because it can be difficult to tell if a child is overweight simply by looking at them.

The general view is that it is a good scheme. Indeed, the feedback from many parents is positive, according to Paul Sacher, chief research and development officer at MEND, a weight-loss programme for children devised by Great Ormond Street Hospital and the University College London Institute of Child Health.

‘Many parents say if it wasn’t for the letter they would not have known their child was overweight. It gives them a chance to get on top of the problem,’ he says.

Dr Matthew Capehorn, a GP and clinical director of the National Obesity Forum, adds: ‘The programme is a brilliant idea. With 85 per cent of children weighed and measured, it provides us with good evidence about the obesity epidemic which can help us plan spending.’

However, Dr Capehorn adds that despite the good intentions, the programme is flawed. It relies on Body Mass Index measurements (BMI) to assess whether a child is overweight. In children under 16, special BMI charts are used to take age and sex into account.

But there is concern about the way officials are using the charts, which were drawn up in 1990. The idea is to compare the child with lines on the chart called centiles.

The average child will be on the 50th centile. Anything above means they are bigger than average, below means smaller. The significant thing for children’s weight is when they are so far above average they are considered worryingly large.

Dr Capehorn says: ‘All the evidence and studies of the last 20 years, including guidelines from the National Institute for Clincal Excellence (NICE), class children with a BMI on or above the 91st centile as overweight and those on or above the 98th centile as obese.’

But when the Department of Health set up the new scheme, it decided that children only needed to be on the 85th centile to be overweight  -  those on the 95th centile or above were obese.

It was suddenly easier to be considered too big. ‘It has caused chaos for clinicians like me and we have never managed to get a reason why they reduced the point at which a child was considered obese,’ says Dr Capehorn.

‘It is confusing and this could be creating the anomalies. Anomolies like we have seen recently in the press.’

when the Mail put this to the Department of Health, we were referred to Dr Harry Rutter, director of the National Obesity Observatory, who said the changing percentiles were not as confusing as they sound. ‘

Dr Capehorn is not so sure. He also believes other measurements such as waist circumference should be used as well as BMI.

‘In adults this is a better indicator of health risks.While the evidence is still to come for using it for children, I have no doubt it will show the same,’ he says.

Another concern is the way parents are being given this information. Mr Sacher says: ‘Some parents are sensitive to the issue if they are overweight. The information could be delivered in a more sensitive way. It should be passed on by GPs rather than in a letter to parents. It is one thing to tell someone there is a problem but they should also advise what they can do about it.’

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Shaping Up PE: The Rise in Childhood Obesity Prompts a Gym Class Makeover

Teacher Donald Hawkins shouts enthusiastically to his 3- and 4-year-old students: “Can you name any animals that hop?”

The answers trickle in from the sleepy but smiling youngsters: a kangaroo, a frog, a rabbit. They decide to mimic the frog. It’s 9:30ish in the morning inside Browne Education Campus’s comfortably warm gymnasium in Northeast Washington. Fast-tempoed music gets the kids in the mood to hop, and off they go, rhythmically squatting and bouncing across the room. When the music stops, the children rise, a little more awake.

“Are you ready?” Hawkins yells. “I can’t hear you!”

“Ready!” they reply.

This is Hawkins’s health and physical education class, but it’s not the PE that these preschoolers’ parents probably remember. The days of students fretting over being the last one picked during volleyball or the first one tagged in dodge ball are fading in many D.C. area schools as physical education classes, such as this one, focus more on individual fitness, personal growth and development.

“The trend is to move away from competitiveness,” Hawkins says.

When his preschoolers’ class is over, Hawkins shifts his attention to his next class, eighth-graders. Beginning with a tutorial on aerobics, Hawkins asks what muscles each activity works, and he and the kids go through a list. When the students overlook the central one, he drops a hint: “It’s been beating since before you were born.”

The students bound into step aerobics and then begin a game of “softball,” a batless version with no teams and a small, yellow rubber ball. Since September 2009, Hawkins’s curriculum has included a program that the D.C. public school system recently adopted called SPARK — Sports, Play, and Active Recreation for Kids — designed to combat child obesity by promoting healthy lifestyle changes and habits.

Through SPARK, all of the District’s schools will receive a new physical education curriculum with age-appropriate fitness lessons and activities, on-site teacher training and equipment: jump ropes, Frisbees, hula hoops and balls, as well as parachutes, rhythm sticks and juggling scarves. The program also comes with follow-up support and assessment tools.

School officials said their goal is to help reduce the increasing number of children who are overweight, which is in line with the Healthy Schools Act, passed this year by the D.C. City Council and signed into law by Mayor Adrian M. Fenty. The act requires schools to provide students a prescribed number of hours of physical education and to serve meals that are higher in nutrition and include more locally grown fresh fruits and vegetables.

Childhood obesity has been the subject of much public attention this year since first lady Michelle Obama in February launched her “Let’s Move” initiative to help today’s kids become adults who maintain a healthy weight.

Nearly 20 percent of the nation’s children ages 6 to 11 and 18 percent of those 12 to 19 are considered obese — more than triple what it was 30 years ago, according to a study published in 2008 in the Journal of the American Medical Association. With 20 percent of children 10 to 17 reported as obese, the District of Columbia joins eight states with the highest rates of obesity in this age group, according to the 2007 National Survey of Children’s Health.

To help finance the changes to its physical education program, the D.C. public school system is using a $1.5 million federal grant that will be awarded over three years through the Carol M. White Physical Education Program. The funds have enabled D.C. school administrators to add two new programs, including SPARK, and expand another one.

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More States Reach 30 Percent Obesity Rate

Obesity is common, serious and costly. Promote policies and programs at school, at work and in the community that make the healthy choice the easy choice.

The obesity epidemic affects every state, according to a new CDC report. No state met the country’s Healthy People 2010 goal to lower obesity to 15 percent. The report also makes recommendations on how to reverse the epidemic.

The CDC Vital Signs report, titled “State-Specific Obesity Prevalence Among Adults – United States, 2009,” points out that people who are obese incurred $1,429 per person extra in medical costs compared to people of normal weight, and that the nation’s total medical costs of obesity were $147 billion in 2008.

New data shows that nine states had an obesity rate of 30 percent or higher in 2009. In comparison, no state had an obesity rate of 30 percent or more in 2000, and only three states reached the 30 percent mark in 2007.

Obesity affects some communities more than others. The highest rates were found among non-Hispanic blacks overall, whose rate was 36.8%, and non-Hispanic black women, whose rate was 41.9%. The rate for Hispanics was 30.7%, and the rate among all non-high school graduates was 32.9%. In addition, the obesity rate was higher in some regions of the country than others. Midwesterners had a rate of 28.2% and residents of the South were at 28.4%.

Obesity is a contributing cause of many other health problems, including heart disease stroke, diabetes, and some types of cancer. These are some of the leading causes of death in the U.S. Obesity can cause sleep apnea and breathing problems as well as limit mobility. Obesity can also causes problems during pregnancy or make it more difficult for a woman to become pregnant.

Obesity is a complex problem that requires both personal and community action. People in all communities should be able to make healthy choices. To reverse this epidemic, we need to change our communities into places that strongly support healthy eating and active living.

Given the magnitude of this problem, past efforts and investments have not been sufficient. Federal funding has been provided to determine what works best through initiatives such as the Communities Putting Prevention to Work (CPPW) program, and CDC’s State-based Nutrition, Physical Activity and Obesity programs. These initiatives build upon existing public health recommendations.

The report recommends individual, community, state and national government efforts.

CDC’s Nutrition, Physical Activity and Obesity and the Communities Putting Prevention to Work programs improve nutrition and physical activity, and prevent obesity through changing policies and environments. CDC provided $139 million to 50 states and $373 million to 30 communities or tribes to fund programs to reverse the obesity epidemic.To eliminate food deserts in 7 years, the National Healthy Food Financing Initiative brings healthy foods to communities that do not currently have access to supermarkets and grocery stores.

Childhood obesity is also a growing problem. First Lady Michelle Obama launched the “Let’s Move” initiative for childhood obesity prevention.The Childhood Obesity Task Force, appointed by President Obama, released 70 recommendations to prevent and control childhood obesity. Government, business and communities working together on these approaches will help to prevent obesity.

The MMWR report is based on new data from the Behavioral Risk Factor Surveillance System (BRFSS), which is the states’ source of data for monitoring Healthy People 2010 objectives. To assess obesity prevalence, about  400,000 survey respondents are asked to provide their height and weight, which is used to calculate their body mass index (BMI). A person is considered obese if they have a BMI of 30 or above.

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