Tuesday, July 27, 2021

Intensive Lifestyle Intervention Can Benefit Health While Changing Our Microbiota

Trillions of microbiota live in our gut. Some of these microbiota perform activities such as the extraction of calories from food and the management of nutrients. While the microbiota are common to all people, each individual has a unique set of the microbiota. And some of the microbiota have a positive impact on our health, while some do not. And one study has concluded that intensive lifestyle intervention plus an energy-restricted Mediterranean diet can improve heath while causing a change in certain microbiota.

The study consisted of two groups: an intensive lifestyle intervention group (IG) and a control group (CG). Both groups followed a Mediterranean diet. The IG participants followed an energy-restricted Mediterranean diet and the participants were advised to engage in physical activity. The CG participants followed a non energy-restricted Mediterranean diet with no advice on physical activity.

The study consisted of men and women from the age of 55 to 75. Participants did not have a “documented history of cardiovascular disease at baseline.” The participants' BMI range from 27 to 40. Each participant also had at least three of the components of metabolic syndrome as defined by American Heart Association and the National Heart, Lung, and Blood Institute.

There were 400 participants in the study. The participants were randomized to one of the two groups, each group consisting of 200 subjects. The CG participants received information on the Mediterranean diet, along with one individual and one group session every six months, to keep the participants on track. The information was delivered by trained dietitians and nurses.

The IC participants received more individualized attention, including motivational interviewing delivered by trained dietitians. The IC group also participated in group sessions. And for one year, the IC participants received a monthly follow-up phone call. The IC group members were also given specific weight loss goals.

At the end of the one-year study, the researchers concluded that for the IC participants, there was a  decrease in “BMI, fasting glucose, glycated hemoglobin, and triglycerides and an increase in HDL cholesterol” compared to the CG participants. There was also a decrease in microbiota, including "Butyricicoccus, Haemophilus, Ruminiclostridium 5, and Eubacterium hallii in the IG compared with the CG."

So, there appears to be a relationship between an intensive lifestyle intervention plus a Mediterranean diet and gut microbiota.  Of course, more research is needed to determine what the relationship is, but intensive lifestyle intervention appears, once more, to be a positive factor in improving health.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis, prediabetes, overfat

Saturday, July 24, 2021

Waist Circumference and Waist-To-Height Ratio for Determining Diabetes Risk

BMI is probably the most commonly used obesity related measurement. However, BMI is not necessarily the best measurement for abdominal obesity. And BMI is not the best predictor of cardiometabolic risks, such as diabetes. Anthropomorphic measurements involving waist are better indicators of these risks in many cases. These measurements include waist circumference (WC), waist-to hip ratio (WHR), and waist-to-height ratio (WHtR).

Two reasons why BMI is the measurement used most often for obesity are its ease of calculation (Weight in Kilograms/(Height in Meters2 ) and the U.S. government's recommendation that the measurement be used by physicians. The "government guidelines urge physicians to screen all adult patients for obesity, and offer health and lifestyle counseling for those with a high body mass index (BMI)."

However, a recent study shows that WC and WHtR are better measurements for predicting diabetes risk than BMI. The study was done in China, and consisted of 4052 adult  participants, who were at least 40 years of age. Sixty-seven percent of the participants were women.

The researchers used face-to-face interviews or physical examinations to obtain the data. The researchers found that the risk of diabetes increased with the age of the participants and when related family members had had diabetes. Also, the risk of diabetes was less in those participants with a college degree or more. The researchers also found that WC and WHtR were more closely related to diabetes, and, therefore, better predictors of the disease.

It should be noted that investigators in one study did find that WHtR was a more useful measurement in Asians than in non-Asians. Still, the investigators indicated that their study results supported "the use of WHtR in identifying adults at increased cardiometabolic risk."

Physicians and other healthcare providers might want to consider using WC and WHtR, as well as BMI, as part of patient assessment tools. Including WC and WHtR in their set of patient assessment tools could give providers more insight into unhealthy cardiometabolic conditions like diabetes.  Using these measurements could help providers deliver better care to the patient.

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Monday, June 28, 2021

Prediabetes Affects Body Composition and Handgrip

The generally accepted definition of prediabetes is as follows: prediabetes is where an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. Prediabetes can affect the body in a number of ways. According to a recent study done in India, prediabetes can cause unwanted changes in body composition and hand grip. Treating prediabetes may mitigate these changes.

One of the blood-based criteria India typically uses to diagnose prediabetes is as follows: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL. This is also one of the criteria the American Diabetes Association uses.

In the India study, 200 subjects were examined. One hundred of the subjects had prediabetes and 100 had normal blood glucose. The researchers used special measuring devices to assess the body fat percentage, the visceral fat, and the handgrip strength.

After crunching the data, the researchers found that the mean body fat percentage for the subjects with prediabetes was approximately 29% compared to approximately 25% for the subjects who had normal blood glucose. The visceral fat percentage was approximately 11% for the subjects with prediabetes compared to approximately 7% for the subjects who had normal glucose. And the handgrip strength was approximately 12% less for the subjects with prediabetes compared to the subjects who had normal blood glucose.  

So, the body fat percentages were higher for persons with prediabetes, while handgrip was lower compared with persons with normal glucose. Therefore, the researchers concluded that "changes in body composition and handgrip strength can be included as a primary care strategy to motivate lifestyle modifications."

Many people are interested in being slim and maintaining strength. Being slim is associated with attractiveness. And treating prediabetes to improve appearance and handgrip strength may be something a lot of people will be interested in. 

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Thursday, June 24, 2021

Chronic Pain, Weight Loss and the Diabetes Prevention Program

The CDC’s Diabetes Prevention Program (DPP) is a program whose objective is to delay or prevent type 2 diabetes, and one of the key tools used in the program is weight loss. The DPP is a lifestyle change program. And lifestyle change programs can be very effective in weight loss. However, chronic pain can hamper the weight loss process. Therefore, chronic pain could be a negative factor for some participants in a diabetes prevention program, as well as other weight loss programs.

Chronic pain can exacerbate problems associated with weight loss and weight gain. Chronic pain increases inflammation, and inflammation can make it more difficult to lose weight and easier to gain weight. And persons experiencing chronic pain may be more likely to overeat. “The overeating occurs either as a response to pain itself, depression, and/or sleeplessness due to pain.” And of course, chronic pain often leads to less exercise because exercise is painful and chronic pain can hamper enthusiasm for exercise.

A recent retrospective study was done to determine the effect of chronic pain on weight loss. Health records were analyzed to identify persons who suffered from chronic pain during a weight loss study. Three-hundred and ninety-seven adults were studied. The study lasted 24 months. One third of the participants experienced chronic pain.

At six months, participants with and without chronic pain lost about 7 kg of weight. However, after 24 months, the participants with chronic pain lost less weight, losing 3.6 kg compared to 5.2 kg for the participants without chronic pain. The researchers concluded that "participants with chronic pain lost ∼33% less weight over 2 years, which was driven by greater weight regain after the first 6 months.”

Of course the effect that chronic pain has on weight loss and weight regain requires more research. Chronic pain might be an impediment in diabetes prevention, because the existence of chronic pain could hinder weight loss. And this would make it harder for a participant to meet the weight loss goals of the diabetes prevention program.

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Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis, prediabetes, overfat

Tuesday, May 25, 2021

Prediabetes Can Shorten a Person's Life

The CDC estimates that 88 million adult Americans have prediabetes. And most persons with prediabetes are not aware that they have the condition. The CDC’s diabetes prevention program trial that took place between 1996 and 2001 showed that lifestyle intervention could reduce the risk of progression from prediabetes to diabetes by 58% compared to people with prediabetes who were receiving usual care. And a recent study suggests that prediabetes can shorten a person’s life.

The investigators studied 2844 subjects to determine how the “years of potential life lost,” or YPLL, for persons with prediabetes compared with the YPLL of persons with diabetes and the YPLL of persons with normoglycemia. The subjects were male and female with an average age of 52. From 1976 to 1982 the participants were given oral glucose tolerance tests. Also, anthropometric measurements were made during the study period.

The researchers concluded “that adjusted life expectancy of middle-aged individuals with prediabetes” was two years shorter than the life expectancy of individuals with normoglycemia, and the expectancy of individuals with diabetes was eight years shorter than individuals with normoglycemia.  The researchers went on to say that “YPLL was greater in women, younger individuals (less than 16 year) and in those with moderate overweight.” The researchers indicated that both the intrinsic risk associated with prediabetes and the risk of progressing from prediabetes to diabetes could be factors impacting lifespan.

The study confirms the importance of addressing prediabetes, especially in middle-aged adults. Healthcare providers should endeavor to work with at-risk prediabetes patients. They should work with the patients, if appropriate, to get them into a diabetes prevention program. These programs can delay or prevent diabetes which could increase the lifespan of a person with prediabetes. Delaying or preventing diabetes can not only increase a person’s lifespan. It could also lower the person’s healthcare costs.

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Sunday, May 23, 2021

Predicting Bariatric Surgery Outcomes

Bariatric surgery is the most effective obesity treatment in use today. However, the surgery does have associated failures and related side effects. Therefore, it would be useful to have methods in place to predict the bariatric surgical success so that risks could be weighed against the probable outcomes. This would benefit patients and physicians. A recent study was done to determine if bariatric surgery outcomes could be predicted.

The two most common forms of bariatric surgery are gastric bypass and sleeve gastrectomy. For many years gastric bypass surgery was the most popular form of weight loss surgery. However, more recently, sleeve gastrectomy has gained in popularity because it is an effective weight loss method, and it is typically accompanied by less severe  side effects than gastric bypass. At any rate, in general, bariatric surgery predictive methods focus on gastric bypass and sleeve gastrectomy.

Indeed, there are failures in bariatric surgery. Researchers in Sweden concluded that in the case of laparoscopic gastric bypass surgery, there is “a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure…” So, predictive methods would be useful.

A recent retrospective study looked at 760 patients who underwent bariatric surgery. Approximately 66% of the patients experienced sleeve gastrectomy and approximately 34% of the patients experienced gastric bypass surgery. Linear regression methods were used to predict the weight loss after one year following the surgery. Twelve predictive models were developed and used to predict the weight loss for each patient.

The investigators determined that while "predicted BMI had reasonable correlation with observed values, none of evaluated models presented acceptable accuracy. All models tend to overestimate the outcome.” Therefore, more research is needed to improve bariatric surgical outcomes predictions.

With good predictive models for bariatric surgical outcomes, healthcare providers could improve the selection of bariatric surgical candidates. For those candidates that are not expected to have good outcomes, another, less expensive and risky weight loss method could be recommended. And for those candidates who are likely to have positive outcomes, the surgery could proceed. This would lower risks and save money, benefiting both the patient and physicians.

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Tags: , , , , bariatric medicine,obesity medicine,obesity medical practice start up,bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Wednesday, April 28, 2021

Lifestyle Intervention for Prediabetes Treatment in the Elderly

Using prediabetes definitions, the Diabetes Prevention Program (DPP) trial showed that lifestyle intervention could delay or prevent diabetes for those persons experiencing prediabetes. While the primary outcome of the trial was diabetes and not a reduction of cardiovascular risk, cardiovascular risk factors such as high blood pressure and high cholesterol were monitored.  However, a recent study did shed light on the effect of lifestyle intervention on cardiovascular risk for older persons.

Indeed, one of the primary goals of the study was to determine if reversion to normal glucose from prediabetes could reduce cardiovascular risk in older people. The study was done by investigators in Germany. The investigators used results from the KORA S4 study which was a population-based health survey. The age range of the participants in the study was 55 to 74 years of age.

To determine prediabetes, the investigators used the following definitions of prediabetes: For HbA1c, they used a range of 5.7 to 6.4 percent. For oral glucose tolerance tests, the investigators used a range of 140 to 199 mg/dl. The investigators found that by lowering the weight and waist circumference, an older person could increase his or her “probabilities of returning to” normal blood glucose and maintaining normal blood glucose.

The investigators concluded that “in older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia." This conclusion supports the results from the original DPP trial. In fact, the results from the trial indicated that lifestyle intervention is, in general, more effective in prediabetes treatment for persons over 60 years of age than for younger persons.

Healthcare providers should consider these results and use the results in consultations with older patients who are diagnosed with prediabetes. The efforts could be beneficial to the patients, and the effort might even improve an organization’s financial position by giving the healthcare organization a strong platform for negotiating contracts with insurers.

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Tags: , , , , bariatric medicine,obesity medicine,obesity medical practice start up,bariatric industry analysis, weight loss industry analysis, weight management industry analysis

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