Belief that intentional weight loss is harmful to seniors is unfounded

Winston-Salem, NC – A new study by researchers at Wake Forest University Baptist Medical Center is the first to refute the widely held belief that intentional weight loss in older adults leads to increased risk of death.

In fact, the research shows that seniors who intentionally exercised and/or modified their diets to lose weight were half as likely to die within eight years of follow-up as their peers who did not work toward weight loss, said M. Kyla Shea, Ph.D., first author on the study and a research associate in the Department of Internal Medicine, Section on Gerontology and Geriatric Medicine.

“It was an unusually strong and surprising finding,” Shea said. “Our data suggest that people should not be concerned about trying or recommending weight loss to address obesity-related health problems in older adults.”

The study, funded by the National Institute on Aging, is currently available online and is schedule to appear in a future print issue of the Journal of Gerontology: Medical Sciences.

Prior to this study, research that has looked at the association between mortality and weight loss has not factored in the many different potential causes of the weight loss. So, using a more rigorous randomized trial approach, Shea and colleagues sought to prove or disprove the idea that older individuals who actively tried to lose weight increased their risk of death.

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Obesity Associated With Depression and Vice Versa

Chicago — Obesity appears to be associated with an increased risk of depression, and depression also appears associated with an increased risk of developing obesity, according to a meta-analysis of previously published studies in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

“Both depression and obesity are widely spread problems with major public health implications,” the authors write as background information in the article. “Because of the high prevalence of both depression and obesity, and the fact that they both carry an increased risk for cardiovascular disease, a potential association between depression and obesity has been presumed and repeatedly been examined.” Understanding the relationship between the two conditions over time could help improve prevention and intervention strategies.

Floriana S. Luppino, M.D., of Leiden University Medical Center and GGZ Rivierduinen, Leiden, the Netherlands, and colleagues analyzed the results of 15 previously published studies involving 58,745 participants that examined the longitudinal (over time) relationship between depression and overweight or obesity.

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How to lower childhood obesity

Family meals, adequate sleep and limited TV may lower childhood obesity

Columbus, Ohio – A new national study suggests that preschool-aged children are likely to have a lower risk for obesity if they regularly engage in one or more of three specific household routines: eating dinner as a family, getting adequate sleep and limiting their weekday television viewing time.

In a large sample of the U.S. population, the study showed that 4-year-olds living in homes with all three routines had an almost 40 percent lower prevalence of obesity than did children living in homes that practiced none of these routines.

Other studies have linked obesity to the individual behaviors of excessive TV viewing, a lack of sleep and, to a lesser extent, a low frequency of family meals. But this is the first study to assess the combination of all three routines with obesity prevalence in a national sample of preschoolers.

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Model Estimates Risks and Benefits of Bariatric Surgery for Severely Obese

Chicago — A computerized model suggests that most morbidly obese individuals would likely live longer if they had gastric bypass surgery, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. However, the best decision for individual patients varies based on factors such as age, increasing body mass index and the effectiveness of surgery.

An estimated 5.1 percent of the U.S. population is morbidly obese, often defined as having a body mass index (BMI) of 40 or higher, according to background information in the article. Available evidence suggests that dietary, behavioral and pharmacologic treatments frequently do not result in meaningful weight loss for individuals in this group. Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese. However, the procedure is not without risk, including in-hospital death.

Daniel P. Schauer, M.D., M.Sc., of the University of Cincinnati Academic Health Center, and colleagues used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery for individuals with morbid obesity. The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications; data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates following the procedures; and outcomes from participants in a seven-year study to determine the effects of surgery on survival and to calibrate and validate the model.

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Obesity linked to common form of kidney cancer and each extra BMI point increases risk

Being obese could lead to a greater risk of developing the most common form of renal cell cancer, according to research in the January issue of the UK-based urology journal BJUI.

US researchers found that obese patients with kidney tumours have 48 per cent higher odds of developing a clear-cell renal cell cancer (RCC) than patients with a body mass index (BMI) of less than 30. And the odds increase by four per cent for every extra BMI point.

The team at the Memorial Sloan-Kettering Cancer Center in New York, USA, studied 1,640 patients with kidney tumours. They found that 88 per cent had malignant tumours and 61 per cent of these were clear-cell RCCs. The remaining 12 per cent had benign tumours.

When they factored in the patient’s weight, they discovered that there was a significant association between obesity and clear-cell RCC, which accounts for up to 80 per cent of RCC cases and is one of the more lethal variants.

“Recent scientific breakthroughs about what causes clear-cell RCC have led to the development of new targeted therapies” says lead author Dr William T Lowrance.

“This makes it more important than ever to identify those people who face an increased risk of developing this variant, which is on the rise in the USA.

“The widespread use of abdominal imaging has definitely contributed to increased detection of RCC, but fails to account for it entirely.

“A number of studies have suggested that obesity could be a risk factor for RCC, but the exact reason is unknown. Researchers suggest it might be secondary to hormonal changes, decreased immune function, hypertension or diabetes in obese patients.”

The study looked at all patients who had undergone surgery at the Center between January 2000 and December 2007. Patients with hereditary renal cancer syndrome were excluded and BMI data was missing for a further 64, giving a study size of 1,640.

Key findings included:

* Patients had an average age of 62 years, 63 per cent were male and 88 per cent were white.
* 38 per cent of patients had a BMI of 30 or more, which is classified as obese, and this figure rose to 42 per cent in the patients with clear-cell RCC. By contrast, only 31 per cent of the patients with benign tumours were obese.
* 67 per cent of the obese patients had malignant tumours with clear-cell RCC, compared with 57 per cent of the non-obese patients.
* The rates for the other kinds of malignant tumours – including papillary, chromophobe and collecting duct – were similar between the obese and non-obese patients.

“We also looked at other health and lifestyle factors, like diabetes, hypertension and smoking” adds Dr Lowrance. “This showed that the only other factors that were independent predictors of clear-cell RCC were male gender and tumour size.”

The researchers conclude that BMI is an independent predictor of clear-cell RCC and that as BMI increases, the odds of having a clear-cell RCC also increases.

“Although we still need to find out more about the pathology of clear-cell RCC, this study is useful as it provides individual predictors of the chance of developing this form of cancer” concludes Dr Lowrance. “Of these, obesity provides the strongest association.”

Source: Wiley.com

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Obesity Now Poses As Great a Threat to Quality of Life As Smoking

San Diego, CA – As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the American Journal of Preventive Medicine, researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

QALYs use preference-based measurements of Health-Related Quality of Life (HRQOL) which allow a person to state a relative preference for a given health outcome. Since one person may value a particular outcome differently than another person, these measures capture how each respondent views his or her own quality of life.

The 1993–2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5%, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85% and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

Investigators Haomiao Jia, PhD and Erica I. Lubetkin, MD, MPH, state, “Although life expectancy and QALE have increased over time, the increase in the contribution of mortality to QALYs lost from obesity may result in a decline in future life expectancy. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.”

The article is “Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity” by Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH. The article appears in the American Journal of Preventive Medicine, Volume 38, Issue 2 (February 2010) published by Elsevier.

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Overweight children may develop back pain and spinal abnormalities

Chicago – Being overweight as a child could lead to early degeneration in the spine, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“This is the first study to show an association between increased body mass index (BMI) and disc abnormalities in children,” said the study’s lead author, Judah G. Burns, M.D., fellow in diagnostic neuroradiology at The Children’s Hospital at Montefiore in New York City.

In this retrospective study, Dr. Burns and colleagues reviewed MR images of the spines of 188 adolescents between the ages of 12 and 20 who complained of back pain and were imaged at the hospital over a four-year period. Trauma and other conditions that would predispose children to back pain were eliminated from the study.

The images revealed that 98 (52.1 percent) of the patients had some abnormality in the lower, or lumbar, spine. Most of those abnormalities occurred within the discs, which are sponge-like cushions in between the bones of the spine. Disc disease occurs when a bulging or ruptured disc presses on nerves, causing pain or weakness.

“In children, back pain is usually attributed to muscle spasm or sprain,” Dr. Burns said. “It is assumed that disc disease does not occur in children, but my experience says otherwise.”

According to the Centers for Disease Control and Prevention, 15 percent of U.S. children (age 6 – 11) and 18 percent of U.S. adolescents (age 12 -19) are overweight. BMI, a mathematical ratio of body weight and height, is a widely used measurement for obesity. Lower BMI is associated with being underweight or a healthy body size; higher BMI scores are associated with being overweight or obese. Children above the 85th percentile are generally classified as overweight or at risk of being overweight.

The researchers were able to determine an age-adjusted BMI for 106 of the total 188 patients. Fifty-four had BMI greater than the 75th percentile for age. Thirty-seven (68.5 percent) of these children showed abnormal findings on their spine MRI. Fifty-two patients fell into the lowest three quartiles. Only 18 (34.6 percent) of the children at or below a healthy weight had an abnormal MRI of the spine.

“We observed a trend toward increased spine abnormality with higher BMI,” Dr. Burns said. “These results demonstrate a strong relationship between increased BMI in the pediatric population and the incidence of lumbar disc disease.”

According to Dr. Burns, data revealed in the study could signal a significant public health problem given the health costs of back pain in the U.S.

“Back pain causes significant morbidity in adults, affecting quality of life and the ability to be productive,” he said.

Source: Radiological Society of North America

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