Monday, August 14, 2017

Determining the Best Diet for a Person with Prediabetes or Type 2 Diabetes



It is becoming more and more apparent that no single weight loss or weight maintenance approach will work for everybody. For example, no type of exercise that works for one person will necessarily work for another. An anti-obesity drug that causes one person to lose weight might not cause someone else to lose weight. And a diet that enables one individual to lose weight may actually cause someone else to gain weight. So biomarkers that indicate what might work for a specific person would be valuable for designing personalized weight loss and weight maintenance approaches. And these types of biomarkers are being looked at. With respect to diet, fasting plasma glucose and insulin may be biomarkers that can aid in diet personalization.

A study was done at the University of Copenhagen to determine if fasting plasma glucose and fasting insulin could be used to predict the diets that would lead to weight loss for specific people. The researchers looked at 1200 subjects in three clinical trials. And the researchers concluded that “for most people with prediabetes, a diet rich with vegetables fruits and whole grains should be recommended for weight loss and could potentially improve diabetes markers. For people with type 2 diabetes, the analysis found that a diet rich in healthy fats from plant sources would be effective for achieving weight loss. These diets could also be effective independent of caloric restriction.”

As always, more research is needed, and the researchers at the University of Copenhagen will continue to investigate fasting plasma glucose and insulin. And if further research indicates that these two biomarkers and other biomarkers can indeed provide insight into which diets would be the most beneficial for specific individuals, it would be an important tool in the fight against weight loss and diabetes.

These kinds of predictive mechanisms should be embraced by primary care physicians and other providers engaged in providing obesity medicine. Indeed, these types of biomarkers should be of particular interest to obesity medicine specialists.

Monday, July 24, 2017

The Impact on Health of No Exercise

Most experts agree that exercise by itself is not the best way to lose weight and maintain weight loss. However, those experts would likely agree that exercise is important in a weight loss and weight maintenance program. They would no doubt agree, also, that exercise is important to good health in general. And recent research has shown that the absence of exercise can have dire effects on a person's health.

While exercise can benefit a weight loss and weight maintenance program, exercise can also enhance a person's health in other ways. For example, exercise can increase cognitive abilities. 

In one study, it was shown that exercise and a healthy diet can improve cognitive abilities in children. The investigators suggested that "Physical activity and healthy diets in early childhood are associated with better cognitive outcomes."

In another study, the researchers concluded that "three months of physical activity" could improve a child's ability to shift his or her attention from one situation to another, and do it smoothly and quickly. Further, the researchers indicated that physical activity "programs ... improved executive function-related set-shifting performance, as measured by the total number of errors" committed by the obese young adolescents in the study.

So the inclusion of exercise is beneficial. And the exclusion of exercise can be quite unhealthy.  In a study done at the University of Liverpool, "a group of 28 healthy people of a normal weight with an average age of 25" was followed. And it was found that "14 days of sitting around reduces muscle mass, increases body fat and raises the potential for high cholesterol."

Therefore, from the above, it is obvious that including exercise in our daily lives is beneficial to health, while the exclusion of exercise can raise the risk of poor health. Hence, primary providers should make a point of emphasizing the importance of exercise, while informing patients that even a two-week lack of exercise can be detrimental to health.

Tuesday, July 18, 2017

Liraglutide Can Be a Key Tool in Maintaining Weight Loss

Researchers are learning more and more about hormones and peptides that play a role in weight gain and weight loss. Knowledge of these hormones is important in understanding how our bodies gain and lose weight. Knowledge of these hormones may lead to treatment approaches that can enable providers to apply techniques that can enable a person to maintain weight loss. Maintaining a lower weight, after weight loss, is more difficult for most people than the initial weight loss. But research is ongoing to solve the weight maintenance problem. And liragutide, recently approved for weight loss by the FDA, may prove to be an important tool in this endeavor.

Some hormones or peptides that decrease hunger are leptin, peptide YY (PYY), gastric inhibitory polypeptide (GIP), and glucagon-like peptide-1 (GLP-1). Some hormones or peptides that increase hunger include ghrelin and neuropeptide Y (NPY).  It follows that if the number of hunger hormones increases in our body, the risk of weight gain increases, and if there is an increase in hunger reducing hormones in our bodies, the chances of weight loss improve. 

There has been research to determine if injecting leptin, mentioned above, into obese patients would cause them to lose weight. The thought-to-be hunger reducing hormone, leptin, mentioned above, was injected into obese patients. And it was found that injecting leptin into obese patients did not lead to weight loss.

But injecting liraglutide, an analog of the hunger reducing peptide GLP-1, did lead to weight loss. In fact, the FDA has approved liraglutide (trade name Saxenda) for obesity treatment.

While injecting liraglutide can lead to weight loss, a recent study has shown the GLP-1 analog, along with a low calorie diet and exercise, can also be effective in weight maintenance. In the study, 212 subjects, who had lost at least 5% of their weight, were randomized to a group to use Saxenda, and 210 subjects were randomized to a placebo group. And more than 50% of the subjects in the Saxenda group maintained their weight loss.

So, liraglutide may be an important option in weight maintenance as well as weight loss. Obesity specialist should consider liraglutide when treating obese patients.

Thursday, June 29, 2017

Exercise Is Important in Obesity Treatment

There was a 2009 New York Time magazine article that argued that exercise alone is not a good way to lose weight. The author implied that a well-chosen diet was a lot more effective for losing weight than exercise. Indeed, what you eat counts more than your physical activity when trying to get rid of excess body fat. However, exercise is important in obesity treatment. Exercise can reduce the risks of a heart attack for an obese person, and exercise can reduce the "effects of the fat gene" according to a recent study.

In the study, investigators looked at 9,427 middle aged people who didn’t have cardiovascular disease to see how exercise affected the protein called high-sensitivity cardiac troponin. This protein is viewed as a marker for heart damage.

Obese people who got “at least 75 minutes of vigorous exercise or 150 minutes of moderate exercise” had lower levels of the high-sensitivity cardiac troponin protein and obese persons who did not engage in the recommended level of exercise. Investigators concluded that “physical activity prevents at least some of the heart damage associated with obesity.”

A gene called the “fat mass obesity associated” or FTO gene is known to heighten the risk of obesity. This gene was documented in 2007. Recent study concluded that exercise “can reduce the effects of the … FTO gene by as much as 30%. This might even be important in areas other than obesity. One study has shown that a variant of the FTO gene can increase the risk of Alzheimer’s disease.

At any rate, even without weight loss, it appears that a person can lessen the effects of obesity on his or her health by engaging in exercise. Therefore, obesity medicine specialists should counsel their patients on the benefits of exercise with or without associated weight loss. 
 

Tuesday, June 6, 2017

MACRA and The Balanced Scorecard

The Medicare Access and Chip Rauthorization Act or MACRA was passed in 2015. The law was passed to further many of the goals of the Affordable Care Act which went into effect in 2010. An important part of MACRA is the Quality Payment Program or QPP. QPP emphasizes improvements in healthcare quality and healthcare value by putting the focus on pay-for-value rather than fee-for-service. The Balanced Scorecard, a strategic management tool, may enable a healthcare organization to better meet the QPP objectives.

The Balanced Scorecard or the BSC was designed to encourage business managers to focus on more sectors of the organization than the financial sector in strategic planning. The managers are encouraged to consider three additional sectors, along with finance, when making organization-related decisions. The three additional sectors are the customer component, the internal operations component, and the learning and growth component of the organization.

These four components are also important in a healthcare organization. Of course a review of the financial component is important in determining the organization's ability to continue providing healthcare services. But the other three components -- the customer or patient component, the internal operations component, and the learning and growth component -- are also pertinent to the organization's ability to provide high quality, cost effective healthcare.

When analyzing a medical practice from a financial perspective, a medical practice might ask: What does the organization need to do to appropriately serve the patient while achieving and maintaining a healthy financial position? When analyzing the practice from the patient's perspective, the organization might ask: What does the organization need to do to provide the patient with high quality, low cost healthcare services?

When analyzing the practice from the internal operations perspective, the practice might ask: How can internal operations be improved to more effectively and efficiently serve the patient? And lastly, when viewing the healthcare organization from the learning and growth perspective, the organization might ask: How can the organization's personnel learn and grow so that the patient WILL be better served. Appropriate answers to these questions can motivate actions that allow the healthcare organization to improve the quality and value of patient services.

As clinical outcomes become more value-driven in healthcare, assessing quality and cost related outcomes becomes more important. And the BSC has gained prominence as a tool to measure outcomes. Therefore, the BSC is being used increasingly in the healthcare arena.

For example, an orthopedic medical practice consisting of fourteen surgeons implemented the BSC, and the tool has been beneficial for the practice. According to one source, "The BSC process resulted in increased engagement and ownership for the management team and was a positive exercise that created agreement about what processes and results are really important to our success." Some of the outcomes measured by the practice were similar to outcomes that are measured in the QPP -- type 2 diabetes and blood pressure for example.

Healthcare organizations can use the BSC to help satisfy the goals of MACRA. And since the BSC can be used to view the main components of an organization, the tool can help a healthcare organization achieve and maintain financial health while providing the patient low cost, high value healthcare.

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Monday, May 22, 2017

Drugs to Fight Obesity and Type 2 Diabetes

Obesity and diabetes are strongly linked. Obesity heightens the risk of type 2 diabetes. In fact,  according to The Obesity Society, 'the single best predictor of type 2 diabetes is overweight or obesity.' Further, according to the society, “Almost 90% of people living with type 2 diabetes are overweight or have obesity.” Therefore, it is incumbent on us to find ways to reduce obesity and, thus, the risk of type II diabetes. Identifying treatment methods that target obesity as well as type 2 diabetes is an important undertaking.

Among treatment methods that address obesity and type 2 diabetes are medications that might be used in novel ways for treatment approaches. One medication used to treat type 2 diabetes is Dapaglialozin. The medication was developed by Bristol-Myers Squibb, and given FDA approval in January of 2014.

Exenatide is another medication used to treat type 2 diabetes. It is developed by Amylin Pharmaceuticals. It was given FDA approval in 2005. One study has shown that “Dapaglifloozin + exenatide dual therapy produced sustain reduction in body weight, prediabetes, and SBP [systolic blood pressure] over 52 weeks…” So this combination drug may be useful in treating obesity and preventing type 2 diabetes.

Another medication that may be helpful in the treatment of obesity and diabetes is lorcaserin. Lorcaserin was given FDA approval in 2012. It was approved to treat obesity. But the drug may be helpful in the treatment of type 2 diabetes as well as obesity. Researchers in one study concluded that “lorcaserin may have beneficial effects on glycemic control with or without weight loss.”

So drugs already in use may be used in combinations to enhance the treatment of both diabetes and type 2 diabetes. Using existing drugs in combination or in novel protocols may provide new pathways to the reduction of obesity and type 2 diabetes. Obesity medicine specialists should be at the forefront of this approach to the treatment obesity and type 2 diabetes.

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Thursday, May 18, 2017

Gut Bacteria, Diet, Pets and Obesity

In 2008, investigators at the Washington University St. Louis Medical School indicated that trillions of bacteria live in our gut. These bacteria perform a number of functions, including the extraction of calories from food and the management of nutrients. The bacteria are common to all people, but each individual has a unique set of gut bacteria. Studies have shown that these bacteria play an important role in weight control. Further, diet and contact with pets at a young age can influence gut bacteria.

Past research in mice has shown that obese mice had more of the bacteria called Firmicutes in their gut, and fewer of the bacteria called Bacteroidetes.  Therefore, Firmicutes were assumed to be associated with obesity, and Bacteroidetes were assumed to be associated with leanness.

The researchers also concluded that diet played a significant role in the number of Firmicutes and Bacteroidetes in the gut of the mice. The mice that were fed a low-fat diet had more Bacteroidetes and less Firmicutes than the mice who were fed the high-fat diet. Since diet apparently plays an important role in the composition of gut bacteria in mice, there is a good chance that diet plays a significant role in the human gut bacteria composition.

And according to one study, there seems to be a high probability that contact with pets in the home, at a very young age, may heightened gut bacteria that can deter obesity. The researchers concluded that "The impact of pet ownership varies under different birth scenarios; however, in common, exposure to pets increased the abundance of two bacteria, Ruminococcus and Oscillospira, which have been negatively associated with childhood atopy and obesity."

Of course, more study is needed to determine exactly how diet and contact with pets can influence gut bacteria. Healthcare providers could then work to influence the use of certain types of diets, and pet ownership if feasible, that could help grow desirable gut bacteria.

Indeed, organizations that provide meal replacements might be especially interested in creating diets that influence the growth of desirable gut bacteria. And pet shops will likely be interested in the pets that are most associated with healthy gut bacteria. At any rate, understanding how to cause the growth of certain gut bacteria that function to reduce obesity or cause leanness might be useful. 

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