Tuesday, October 17, 2017

Young Adult Obesity Is Worth Addressing

Today, childhood obesity gets a lot of attention in the press, and a lot of research is devoted to the condition. Childhood obesity gets a lot of research and attention because the disease leads to an array of diseases in childhood and in adulthood. So childhood obesity deserves the attention and research it is getting. However, there is another group deserving of attention and research. The group is the young adults who are obese.

It is pretty much agreed that people who are obese during childhood are likely to be obese during adulthood. Further, there is large agreement that children who are obese may suffer from some of the same ailments as adults, such as hypertension and type 2 diabetes. Because of the negative effects of obesity during childhood and later in life, reducing childhood obesity deserves a lot of research.  But in many ways, the effects of obesity on young adults are similar to the effects of obesity on children and adolescents. Young adults between the ages of 20 and 39 are confronted with the same obesity issues as obese children and obese adolescents.

According to a study done at George Washington University, “the prevalence of obesity roughly doubles between pre-adolescents (17% among 6 to 11 year old children) and young adulthood (34% among 20 to 39-year-old adults).” Therefore, there is a very high obesity rate among this young adult age group. And that is important because many life events occur during this period including marriage, first-time job, starting a family and divorce. And obesity impacts all of these events.

And just as in the case of childhood obesity, many comorbidities are associated with the obesity experienced by a large percentage of young adults. So addressing obesity in young adults could lower healthcare costs. And again, as with childhood obesity, adult obesity increases the risk of obesity later in life. So young adulthood obesity is worthy of attention.

Healthcare providers should address overweight and obesity when it occurs in their young adult patients. This can make the young adults healthier while they’re still young, and lower the risk of poor health in the later years.


Tuesday, September 19, 2017

Obese Persons Experience Discrimination in the Workplace

Although there may be disagreement as to how much discrimination affects a person's life, most people would probably agree that discrimination plays some role in all parts of society, including the workplace. The discrimination may be based on an individual’s color, religion, race, national origin, religion, disability, or some other characteristic. And many organizations object to discriminatory activities directed at individuals who possess any of these characteristics. But obesity is typically not one of the characteristics listed on non-discrimination lists. But obese persons are discriminated against in society, including the workplace.

Whether we admit it or not, most of us realize that obese people are discriminated against in the workplace. But we accept it, to some extent, because we feel that obese people have indirectly made a choice to be obese by engaging in lifestyle behavior that contributes to obesity. 

However, many experts now believe that obesity is a chronic illness. And at some point in being overweight, the body fights weight loss and weight-loss maintenance. So, obese people have a very difficult time losing and maintaining weight loss. Still, obese persons face discrimination. And this discrimination can negatively affect a person's workplace experience.

One study done in Canada shows that obese persons receive less support from their fellow workers in the workplace. Another study indicated that obese people are less likely to be hired and less likely to be promoted in the workplace. And a more recent study indicates that obese people make less money than those of normal weight.

The study was done in England at the University of Exeter. The researchers compared normal weight individuals with obese individuals in the workplace to determine if obesity played a major role in the salary difference. After filtering out factors from the results such as education, experience and background, the researchers concluded that normal weight individuals had higher salaries than obese workers. And in another study done in Sweden, “men who are obese at the age of 18 grow to earn 16% less than their peers of more average weight.”

So, obese persons experience discrimination in society and in the workplace. And this discrimination can have a negative impact on an obese person’s life and career. Healthcare providers need to be aware of this discrimination so that they can treat the obese patient with understanding and compassion.

Saturday, September 9, 2017

Not Everyone Who Needs Body Contouring Gets the Surgery

The increase in weight loss surgery increases the need for the removal of excess skin. This surgical procedure is called body contouring. However, only a small number of the persons requiring the skin-removal procedure get the surgery. The surgery can improve weight loss maintenance and the quality of life for bariatric surgical patients.

According to the leader of a study reported in Springer's journal, "Only a small percentage of obese patients who have undergone bariatric surgery to help them control their weight follow up this procedure with further plastic surgery to reshape their bodies and remove excess rolls of skin." This is the case because "Such body contouring surgery is generally only affordable [by] patients with adequate insurance and income ..."

Although the surgery is considered cosmetic, the surgery can improve weight loss and the quality of life for someone who has excess skin after having lost a lot of weight.

Researchers at the Henry Ford Hospital in Detroit, MI, suggested that individuals who get body contouring surgery after bariatric surgery are better able to keep the weight off compared to surgical weight loss patients who do not get the surgery. The researchers were delighted that body contouring surgery increases the chances that a patient will maintain a healthy weight loss long-term. The researchers also felt that those who had the contouring surgery might experience a better quality of life.

The Henry Ford Hospital investigators assessed 94 patients who had received weight loss surgery at the hospital between 2003 and 2013. Forty-seven of the patients also had body contouring surgery. After two and a half years, the patients who had the contouring surgery experienced a BMI decrease of 18.24 compared to 12.45 for the weight loss patients who did not have the surgery.

There is a "huge disparity ... between the number of subjects who want body contouring surgery and those who" get the surgery. Thus, weight loss service providers should make their patients aware of the benefits of the surgery, by indicating that the surgery can improve weight loss maintenance and quality of life.

Sunday, August 27, 2017

Screening for Childhood Obesity

The United States Preventive Services Task Force (USPSTF) is an organization consisting of experts in primary care who review health information. And based on their reviews, the task force makes recommendations for clinical preventive services. The organization has recommended childhood obesity screening as follows:

"The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status."

Childhood obesity continues to receive a lot of attention. This is because reducing childhood obesity will lower the number of adults who experience obesity, since obesity in childhood increases the risk of obesity in adulthood. Further, obesity often leads to type 2 diabetes, hypertension, some forms of cancer, and other illnesses.

Therefore, it makes sense to screen a child for obesity, because signs of adult obesity may appear early in life. And screening for obesity can arm a provider with information that can be useful in guiding the provider. The provider can use the information to counsel parents on what actions to take to reduce the risk of their child experiencing obesity later in life.

The parents can take appropriate actions to motivate their children to follow a healthy diet and increase physical activity. This might include many new and different types of diets and physical activities. For example, past research has shown that some video games might actually provide an avenue for kids to get more exercise. And there may be specific diets that can entice children to be more inclined to engage in health eating.

At any rate, the USPSTF's recommendation to screen children for obesity can be an important step in the fight against childhood obesity. Not just because of the recommendation, but because of the rating given to the screening recommendation.

The task force gives grades of A, B, C, D, and I to its recommendations. Recommended clinical activities given a grade A or B are required to be covered by insurance companies as directed by the Affordable Care Act. The task force gave a grade of B to the childhood obesity screening recommendation, therefore the screening should be covered. Further, because of the "B" rating, under the USPSTF guidelines, the patient is not required to pay any percentage of the cost of the treatment.

In a nut shell, screening children for obesity will benefit both the children and the provider. The screening will benefit the children because the screening will increase the children's chances of improved health. And screening will benefit the provider because he or she will know that appropriate actions are being taken to improve the current and future health of the children.


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.

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