FIGHTING OBESITY
Obesity contributes to diabetes, heart disease, arthritis and cancer
America is fat and not getting any thinner.
For the first time, there are more women who are obese than men. More than 40 per cent of U.S. women are obese compared with 35 per cent of men, according to new data from the Centers for Disease Control and Prevention.
Obesity, calculated with a formula using weight and height, is a major public health problem that contributes to diabetes, heart disease, arthritis and cancer. It’s blamed in part for a slowing rise in life expectancy in the U.S. The problem is most pronounced among black women, who have an obesity rate close to 60 per cent. Asian-Americans are the least likely to be obese, at about 10 to 12 per cent.
“It’s normal to be obese, but it’s not healthy to be obese. Obesity affects every organ system in a negative way,” said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University.
Teams of doctors and scientists in St. Louis are working on the problem in different ways, with prevention programs, research projects and clinical trials for new treatments. Overweight children can receive intense therapy at weight-loss clinics. A reverse feeding tube invented in St. Louis to limit the absorption of calories is newly approved for use. And a new research study with area participants promises to discover more about the biology of obesity than scientists have ever understood.
Research
Klein and his colleagues are recruiting 180 volunteers for a research study on obesity and metabolism. They want to find out why some people who are obese — from 5 per cent to as high as onethird by some estimates — maintain healthy blood sugar and cholesterol levels.
On the other side, there are thin people whose metabolic numbers score in the unhealthy range. If they can figure out why, it could lead to new treatments for obesity complications.
The researchers will look at the participants’ fat tissue and other markers in urine and blood to try to pinpoint the differences in their biology.
Study participants will provide tissue, blood, urine and stool samples over an initial month of testing. There will be weekly medical appointments and several overnight visits for observation. They will be given meals for seven to eight months based on one of three diets: the Mediterranean style, low carbohydrate or a plantbased, low-fat diet.
The volunteers will be studied before and after a projected 8 per cent weight loss. One group will be exercising to gauge those effects. They will swallow tracers to track their muscle, fat and cardiac function, and the effects of weight loss on all of the body’s mechanisms.
“We will know more about the human body than anyone ever has,” Klein said.
New treatments
The most effective treatment for obesity is weight-loss surgery. But several of the procedures permanently alter the body’s anatomy by shrinking the stomach or bypassing the intestines and can cause serious gastrointestinal side effects and recovery time.
hey also require a significant change in diet, with large meals, carbonated drinks and desserts discouraged.
Area researchers have recently tested new options, including a reverse feeding tube that drains food from the stomach before it is digested.
Another alternative involves inserting balloons into the patient’s stomach to take up room. The procedures cost about $7,000. The latest balloon seeking federal approval, called Obalon, is swallowed in a capsule by the patient and then pumped up with gas through a catheter. As the patient loses weight, one or two more balloons are placed to fill up about three-fourths of the stomach’s capacity. The balloons are removed after six months, and new ones can be inserted.
In a trial led by Dr. Shelby Sullivan of Washington University, 185 people with a body mass index of 30 to 40 lost close to 7 per cent of their weight after six months with the Obalon balloons. A control group of similar size lost 3.6 per cent body weight on average. Three-quarters of patients had temporary side effects including cramping and pain, and more than half experienced nausea.
Last year, Lisa Whealon of St. Louis entered the clinical trial weighing 265 pounds and was unknowingly placed in the control group. She did not have the balloons implanted in her stomach, and lost 50 pounds in six months by reducing her portion sizes, eating healthier and receiving nutritional counselling every three weeks. In November, she had the first of three balloons inserted and lost 28 pounds in the next six months.
The balloons were removed in May, and she has continued losing to reach her current weight of 180.
“I flew on a plane and didn’t have to ask for the seatbelt extender,” she said. “It was such a huge feeling of excitement to buckle my seatbelt just like everyone else on the plane.”
Whealon, 32, said she had lost and regained weight on many diets and was scared of weight-loss surgery. She liked the balloon idea because it “seemed like it was temporary to encourage and support you as you made healthy routines and healthy habits.”
While it’s true there is no magic pill for obesity, weight-loss drugs introduced in the last few years are somewhat effective in producing weight loss of up to 5 per cent. But the drugs are expensive, up to $1,000 a month, and have not been popular with patients or doctors.
“The modest benefits, while important for health, from a patient standpoint it’s not enough when they look in the mirror,” said Dr. Steve Miller, chief medical officer of Express Scripts.
Diet and exercise
The old-fashioned method of combining exercise and calorie restriction is the best way to maintain the body’s sugar levels, according to research from St. Louis University. Their study looked at three groups of people who lost weight through diet, exercise or both. The group that did both had twice the improvement in maintaining blood sugar levels, even though they didn’t lose more weight.
Though that may seem obvious, the study challenges the theory that people who maintain healthy weights can eat whatever they want or don’t need to exercise.
“This study says you can be healthier if you exercise and eat the right amount of food,” said Edward Weiss, associate professor of nutrition and dietetics. “Dietary restriction is more potent in the short term, exercise in the long term, and ultimately both are absolutely critical for a good weightmanagement program.”
Weiss’ research team plans to repeat the study and try to figure out more about the biological reasons for the extra benefits from calorie restriction.
The television show “The Biggest Loser” is a high-profile experiment in controlled diet and exercise. A recent study made waves by saying most participants in the show gained back the weight they lost, in part because their bodies’ metabolism fought to return to their higher weights.
Klein thinks the regained weight had more to do with returning to their regular lifestyles after the show than a slowing of their metabolism. He believes the ultimate key to weight loss is “slow, small baby steps forever.”
“Obesity is a chronic disease. Short-term therapies never work. It needs to be a lifelong intervention or the weight comes back,” he said.
Childhood obesity
About 17 per cent of American children are obese, a rate that seems to have peaked after decades of increases. Because preventing obesity is better than treating it, pediatricians have made diet and exercise a focus of their appointments with families.
“Engagement of parents and commitment to healthy eating and exercise is the most important factor in preventing obesity in kids,” said Dr. Ken Haller, a SLUCare pediatrician at Cardinal Glennon Children’s Medical Center. “Pretty much all the evidence points to nutritional counselling from birth in terms of appropriate foods.”
At Cardinal Glennon’s weight management clinic, some children weigh twice as much as they should. Most scientists believe that basic metabolism changes in the human body over time, so the longer a person is obese, the less likely it is that they’ll be able to lose the extra weight.
“Frankly, the results are not what we would like when we have kids with BMIs at the 99th percentile,” Haller said. “When they are 12, 14, 16, it can be really difficult to reduce those patterns.”
A few recent programs are thought to have kept child obesity rates stable: Michelle Obama’s Let’s Move initiative for exercise and healthy eating and improvements to school lunch program. A top factor is reducing or eliminating sugary drinks including sodas and fruit juice in children’s diets.
“As a pediatrician, I am all about hope,” Haller said. “If the parents and the child are all committed to making healthier choices, it’s by far the most important determinant of success.”