Above-normal weight alone does not necessarily increase short-term risk of death, U.S. data suggest

ScienceDaily (July 6, 2012) — An evaluation of national data by UC Davis researchers has found that extra weight is not necessarily linked with a higher risk of death.

See Also:Health & MedicineObesityDiet and Weight LossFitnessDiseases and ConditionsHypertensionChronic IllnessLiving WellReferenceOverweightDiabetes mellitus type 2Body mass indexHypertension

When compared to those with normal weight, people who were overweight or obese had no increased risk of death during a follow-up period of six years. People who were severely obese did have a higher risk, but only if they also had diabetes or hypertension.

The findings, which appear in the July-August issue of The Journal of American Board of Family Medicine, call into question previous studies -- using data collected when obesity was less common -- linking higher short-term mortality with any amount of extra weight.

"There is currently a widespread belief that any degree of overweight or obesity increases the risk of death, however our findings suggest this may not be the case," said Anthony Jerant, professor of family and community medicine and lead author of the study. "In the six-year timeframe of our evaluation, we found that only severe obesity was associated with an increased risk of death, due to co-occurring diabetes and hypertension."

Based on the study, Jerant recommends that doctors' conversations with patients who are overweight or obese, but not severely obese, focus on the known negative effects of these conditions on mental and physical functioning, rather than on an increased short-term risk of death.

By contrast, Jerant added that it is important for doctors to talk with severely obese patients who also have diabetes or hypertension about their increased short-term mortality risk and treatment, including weight loss.

"Our results do not mean that being overweight or obese is not a threat to individual or public health," said Jerant. "These conditions can have a significant impact on quality of life, and for this reason alone weight loss may be advisable."

In conducting the study, Jerant used nationwide data from 2000 to 2005 of nearly 51,000 adults aged 18 to 90 years who participated in the Medical Expenditure Panel Surveys on health-care utilization and costs. The surveys include information on health conditions such as diabetes and hypertension.

Body mass index (BMI), or weight adjusted for height, was calculated for each respondent. The study categorized people as underweight (BMI < 20), normal weight (BMI 20 to < 25), overweight (BMI 25 to < 30), obese (BMI 30 to 35) or severely obese (BMI > 35).

Mortality was assessed using the National Death Index. Of the 50,994 people included in the UC Davis analysis, just over 3 percent (1,683) died during the six years of follow-up.

The investigators found that severely obese people were 1.26 times more likely to die during follow-up than people in the normal weight group. However, if people with diabetes or hypertension were eliminated from the data, those who were overweight, obese or even severely obese had similar or even lower death rates than people of normal weight. Consistent with a number of prior studies, underweight people were nearly twice as likely to die than people with normal weight, regardless of whether diabetes or hypertension was present.

The prevalence of overweight and obesity has increased dramatically in recent decades. An estimated one-third of all U.S. adults over age 20 are obese and another one-third are overweight. In addition to diabetes and hypertension, health problems associated with these conditions include heart disease, osteoarthritis and sleep apnea.

The relationship between weight and mortality is a controversial topic in public health. Although studies based on data collected 30 years ago showed that mortality risk rose as weight increased, analyses of more recently collected data, including the current one, call this assumption into question.

"Our findings indicate that the risk of having an above-normal BMI may be lower than in the past," said Jerant. "While this study cannot explain the reasons, it is possible that as overweight and obesity have become more common, physicians have become more aware of associated health issues like high blood pressure, cholesterol and blood sugar, and are more aggressive about early detection and treatment of these conditions."

Jerant said that the six-year period of his investigation limits the ability to make assumptions about the link between unhealthy weight and the risk of death over a longer timeframe.

"We hope our findings will trigger studies that re-examine the relationship of being overweight or obese with long-term mortality," said Jerant.

The study co-author was Peter Franks, professor in the UC Davis Department of Family and Community Medicine. Franks and Jerant used public access data in conducting the study, which involved no external funding.

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:

View the Original article

Short-term intensive weight loss program works for four years: Valid option seen to bariatric surgery

ScienceDaily (June 12, 2012) — A study by a team of clinicians and researchers at the Joslin Diabetes Center in Boston has shown for the first time that patients with diabetes who enrolled in a short-term intensive weight management program were able to lose weight and keep it off on their own for four years. The findings suggest an alternative course to bariatric surgery in the fight against type 2 diabetes.

See Also:Health & MedicineDiet and Weight LossObesityFitnessDiabetesWounds and HealingDiseases and ConditionsReferenceDiabetes mellitus type 2HyperglycemiaDiabetic dietDiabetes mellitus type 1

The study, presented recently as a late-breaking abstract at the American Diabetes Association's 72nd Scientific Sessions, strongly counters the popular view that people generally cannot maintain long-term the weight loss achieved during lifestyle intervention programs.

"The notion that most people in the medical field have is that when you apply intensive lifestyle interventions, the majority of patients gain all or most of the weight back in a year," said Osama Hamdy, M.D., Ph.D., Medical Director of the Obesity Clinical Program and Director of Inpatient Diabetes Management at Joslin and lead author of the paper.

"People have been pessimistic," he added. "They think they may need bariatric surgery. But we are sending an optimistic message. Think again. There is something else that can work effectively in real-world clinical practice and save money too. This is a very important observation."

The study showed that around 50 percent of the 120 patients who enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program for 12 weeks were able to maintain an average of 9.5 percent weight loss at four years, while the total group maintained 6.3 percent at four years.

Why WAIT is a multidisciplinary diabetes weight management program designed for clinical practice. The program included a change in diabetes medications to enhance weight reduction, structured dietary intervention with lower carbohydrates and higher protein and meal replacement, an exercise program, with emphasis on strength training and weekly educational and support sessions.

Although subjects in this study were followed for four years, they were on their own after the initial 12-week program. The study found that about half of the subjects did not regain the weight -- on average 24 pounds -- after four years. This group also maintained a significant improvement in their metabolic control as measured by hemoglobin A1c and the improvement in other vascular risk factors like blood pressure and lipids.

It also found that those who maintained at least seven percent of their weight loss at one year were most likely to continue the weight reduction over the long term.

"This is very important information," Dr. Hamdy said. "It tells us not everyone gains the weight back. In reality, these are similar numbers to the weight loss gained by some bariatric surgeries at that time frame."

Those who had lost at least seven percent of their body weight after one year lost an average of 29 pounds -- or 11.9 percent of their body weight -- at 12 weeks and maintained an average loss of 31.5 pounds -- or 12.6 percent -- at one year.

A second group included those who lost an average of 19.6 pounds -- or eight percent -- at 12 weeks but was down to a loss of just 5.6 pounds -- or 2.3 percent -- at one year.

Those in the first group maintained weight losses of 23.9 pounds at two years, 23.5 pounds at three years and 24.1 pounds at four years. Those in the second group only maintained losses of 6.9 pounds at two years, 6.3 pounds at three years and 8 pounds at four years.

Blood sugar levels in the first group dropped over the four year period, but levels in the second group rebounded after dropping initially. However, there were no differences in the groups when reductions in blood pressure, HDL cholesterol and triglyceride levels were compared at the end of the four years.

"Those who gained the weight back still got some benefits," Dr. Hamdy said.

He said the findings of this study are more robust than the four-year results initially reported from the National Institutes of Health's Look Ahead (Action for Health and Diabetes) study, designed to assess the long-term health consequences of intentional weight loss in overweight and obese individuals with type 2 diabetes.

He said this probably due to the fact that patients in the Why WAIT study received an optimal intensive lifestyle intervention, which included close evaluation at the outset, and that all interventions were in group format. In addition, diabetes medications were also adjusted by diabetologists at the start and during the follow-up, and patients were fed less carbohydrates and exercised more -- up to 300 minutes per week, he said.

Subjects in Why WAIT were able to cut their diabetes medications by half on average at the end of the 12 week program. It saved them $561 a year on diabetes medications alone, he said. Based on other valid cost-effective analysis, patients in the program saved $2,000 per year or 27 percent on overall health care costs and around $1,000 or 44 percent on diabetes-related costs, he added.

Dr. Hamdy said the study proves that intensive lifestyle intervention is at least as effective as some common bariatric surgeries in helping people lose weight and deal with their diabetes issues, with less cost and fewer short and long-term side effects.

"Surgery carries a lot of long-term risks," he said. "And a significant number of surgical patients gain their weight back after one or two years."

He also said that bariatric surgery costs in the range of $20,000 while the optimal intensive lifestyle intervention through the Why WAIT model cost just $2,700. After those results, "we are ready to debate them on the long-term value," he added.

He concluded: "So many physicians have been telling the governmental authorities that weight loss in clinical practice is a waste of money and that they will never keep the weight off. We now have a message for them. It is very effective in at least half of people in terms of weight loss and cost savings. Intensive lifestyle intervention can be a very valid option."

Dr. Hamdy said a new study involving Joslin and Brigham and Women's Hospital in Boston is underway that aims to compare the Why WAIT model directly to bariatric surgery.

Co-authors included Amy Rossi, MD; Adham Abdel Mottalib, MD; Nuha El Sayed, MD; Ann Goebel-Fabbri, Gillian Arathuzik, Jacqueline Shahan, Joan Beaton, Pamela Needle, Amanda Kirpitch, John Zrebiec, Michael Seem Catherine Carver, Jo-Anne Rizzotto and Martin Abrahamson, M.D..

The study was internally funded by Joslin Diabetes Center.

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:

View the Original article

Little Short-Term Risk of Repeat Bout of Shingles, Study Finds

background:url(http://l.yimg.com/a/p/us/news/editorial/a/5b/a5ba32682eb601fb573b57542c19b9c1.png);width:115px;height:25px;margin-left:50px;margin-top:7px

View the Original article