Tuesday, March 4, 2014

Can Eating More Fat Make You Leaner?

sharma-obesity-visceral-fat-mriYes, if the excess fat is poly-unsaturated – no, if it is saturated.

At least this was the finding in an overfeeding study conducted by Fredrik Rosqvist and colleagues from the Uppsala University, Sweden, published in DIABETES.

The study with the memorable acronym LIPOGAIN, was a double-blind, parallel-group, randomized trial involving 39 young normal-weight individuals who were overfed muffins either high in saturated fats (palm oil) or in n-6 poly-unsaturated fats (sunflower oil) for seven weeks.

The number of muffins that each subject had to consume were individually adjusted to ensure that each subject increased their body weight by about 1.5 Kg (or 3%). To achieve this, the subjects consumed on average three muffins or about an extra 750 kcals/day.

However, where the excess calories went was quite different.

While the subjects eating saturated fat markedly increased their liver fat and gained almost twice as much visceral fat as those in the poly-unsaturated fat group, the latter experienced a nearly three-fold larger increase in lean tissue than the saturated fat group.

The two diets also had quite different effects on the expression of genes regulating energy dissipation, insulin resistance, body composition and fat cell differentiation in subcutaneous fat tissue.

Thus, the authors conclude that while overeating saturated fat promotes liver and visceral fat storage, the excess energy from poly-unsaturated fat may instead promote the growth of lean tissue.

What I learnt from this study is that there are indeed important differences in how the body handles excess calories depending on where they come from.

In that respect at least, not all calories are equal.

@DrSharma
Edmonton, AB

Fat Jokes Are Not Funny! Help publish this anti-bullying children’s book

ResearchBlogging.orgRosqvist F, Iggman D, Kullberg J, Jonathan Cedernaes J, Johansson HE, Larsson A, Johansson L, Ahlström H, Arner P, Dahlman I, & Risérus U (2014). Overfeeding Polyunsaturated and Saturated Fat Causes Distinct Effects on Liver and Visceral Fat Accumulation in Humans. Diabetes PMID: 24550191

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Friday, February 7, 2014

No Easy Path To Dropping Pounds After Pregnancy

sharma-obesity-pregnancy5Gaining excessive weight during pregnancy and retaining much of it after delivery is ones of the most common drivers of adult obesity in women.

Emerging evidence supports the notion that both may well be detrimental to the health of mothers (and their kids).

Unfortunately, it appears that behavioural intervention during pregnancy to reduce long-term weight retention is a lot more challenging that one may expect.

This is the rather disappointing outcome of a randomised controlled trial by Suzanne Phelan and colleagues, published in the American Journal of Clinical Nutrition.

The trial included 400 US Women, half of who were overweight or obese, randomly assigned to a behavioural intervention or control group beginning around the 13th week into their pregnancy.

The intervention (Fit for Delivery) consisted of one face-to-face visit with an interventionist at the onset of treatment, the provision of body-weight scales, food records, and pedometers to promote adherence to daily self-monitoring, weekly postcards prompting healthy eating and exercise habits, personalized graphs of their weight gain with feedback, and supportive phone calls from the dietitian during the intervention. This intervention continued till delivery.

Four out of five of the participants completed the 12-mo assessment.

Overall the intervention did not increase the participants’ chances of achieving their prepregnancy weights. Even the completer analysis showed non-significant trends at best – this despite women in the intervention group reporting higher levels of dietary restraint and more frequent self-monitoring of body weight.

Thus, this level if intervention, which far exceeds usual care during pregnancy for most women, does not appear to effectively reduce post-pregnancy weight retention.

Incidentally, the only predictors of excessive weight retention were pre-pregnancy BMI and excessive gestational weight gain. Breastfeeding, age, parity, and delivery weeks were not.

Thus, although excessive pregnancy weight gain and post-pregnancy weight retention are common problems with significant negative health impacts on both mother and child, it will apparently take far more than an additional visit with a dietitian and exercise counsellor or postcards and telephone reminders to impact body weight.

I wonder if anyone else is not all too surprised by these findings?

@DrSharma
Edmonton, AB

ResearchBlogging.orgPhelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, & Wing RR (2014). Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. The American journal of clinical nutrition, 99 (2), 302-11 PMID: 24284438

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Wednesday, January 15, 2014

Bariatric Care: Weighing in on Waiting Lists

sharma-obesity-waiting-timeThe first arm of the APPLES study, a prospective parallel group study to evaluate outcomes in a publicly funded population based bariatric program, now published by Raj Padwal and colleagues in Medical Care, looked at weight and health indicators in wait-listed patients.

When APPLES study was initiated in 2008, approximately 1,500 adults were wait-listed for clinic entry with an average wait time of two years.

To get on the waiting list, eligible patients (BMI greater than 35) had to be referred to the bariatric centre by their primary medical practitioner through a central referral service.

Wait-listed patients were advised to attend communitybased group education sessions before clinic entry but otherwise received no specific intervention.

During the 24 months of the APPLES study, structural changes to the program and increased clinic capacity resulted in a shortening of waiting times.

Thus, out of the 150 participants enrolled into the wait-list group, 93 (62%) were seen in the clinic before the end of the 24-month study period. Another 18 (12%) wait-listed subjects dropped out of the study. As a result, complete 24-month follow-up data was only available for 38 (26%) of individuals in this arm of the study.

At 24 months (using a last-observation-carried-forward (LOCF) approach for individuals who dropped out or were no longer on the waiting list), the absolute and relative (% of baseline) mean weight losses were 1.5 kg (0.9%) in the wait-listed group.

While this may seem modest, about one in six participants (17%) achieved a 5% weight-loss, while one in ten (9%) achieved a 10% weight loss at 24 months (or at the time of attrition).

Conversely, about one in eight (13%) of wait-listed participants gained more than 5% during their time on the waiting list.

No significant overall changes in health status were noted during this time.

Thus, this arm of the APPLES study provides some very important insights into what happens to bariatric patients on waiting lists (with the important caveat that waiting times were considerably less than the 24 months anticipated at the commencement of the study).

1) The vast majority of wait-listed patients are weight stable.

2) A roughly equal number of wait-listed patients will experience a clinically significant (5%) weight loss or weight gain (17 vs 13%).

3) During this 1.5 to 2 year waiting period, the overall burden of cardiovascular disease remains about the same.

While health system experts and policy makers may well see this outcome as support for the notion that a 12 or even 24 month waiting time to receive tertiary care bariatric services may well be justifiable, it is important to note that this may be viewed very differently by the folks actually on the waiting list.

I have previously posted insights into how patients in the APPLES study felt about their time on the waiting list.

The majority of subjects expressed concern over wait times (65%) and felt that waiting was very stressful (53%) and physically, emotionally and mentally taxing (62%).

According to the wait-list impact questionnaire, 47% of subjects agreed or strongly agreed that waiting affected their quality of life, 65% described wait times as ‘concerning’ and 81% as ‘frustrating’, 73% worried about the consequences of extended wait times on their health, 68% were frustrated with the allocation of resources and 59% felt that they should not have to wait for obesity treatment.

Surprisingly, however, only 31% were dissatisfied/very dissatisfied with their overall medical care.

This is in line with finding in wait listed bariatric patients in other parts of Canada.

It appears that bariatric patients are overall a very patient and “accepting” crowd – or perhaps just very “Canadian”.

@DrSharam
Edmonton, AB

ResearchBlogging.orgPadwal RS, Rueda-Clausen CF, Sharma AM, Agborsangaya CB, Klarenbach S, Birch DW, Karmali S, McCargar L, & Majumdar SR (2013). Weight Loss and Outcomes in Wait-listed, Medically Managed, and Surgically Treated Patients Enrolled in a Population-based Bariatric Program: Prospective Cohort Study. Medical care PMID: 24374423

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Wednesday, November 27, 2013

PTSD Risk Factor For Weight Gain

sharma-obesity-sexualabuseRegular readers will be well aware of the common association of emotional, physical or sexual trauma with increased emotional eating, binge eating disorder and weight gain.

Now, a study by Kubzansky and colleagues from the Harvard School of Public Health, published in JAMA-Psychiatry, confirms the relationship between post-traumatic stress syndrome (PTSD) and excess weight gain in the Nurses Health Study II.

This study includes over 54,000 participants, who were between 24 and 44 years of age in 1989 and were prospectively followed up to 2005.

Among women already presenting with at least 4 PTSD symptoms at the time of inclusion in the study, BMI increased more steeply during follow up than those, who did not have such symptoms.

Furthermore, women, who developed PTSD symptoms after inclusion in the study, showed steeper BMI gain and increased risk of becoming overweight or obese (almost 40% greater risk) despite having a normal weight trajectory prior to this diagnosis.

These effects were independent of whether or not the women also showed signs of depression.

These findings should remind us to explore a history of PTSD in patients presenting with excess weight and take appropriate measures to prevent weight gain in patients experiencing trauma that may prompt PTSD.

If you have experience with weight gain following a significant trauma, I’d like to hear about it.

@DrSharma
Thunder Bay, ON

ResearchBlogging.orgKubzansky LD, Bordelois P, Jun HJ, Roberts AL, Cerda M, Bluestone N, & Koenen KC (2013). The Weight of Traumatic Stress: A Prospective Study of Posttraumatic Stress Disorder Symptoms and Weight Status in Women. JAMA psychiatry (Chicago, Ill.) PMID: 24258147

 

 

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Monday, September 23, 2013

BMI Trajectories Better Predictors of Mortality Than BMI in The Elderly

sharma-obesity-weight-gainRegular readers may recall past posts on the notion that stable weight (at any weight) may be less of a health risk that large variations in body weight (up or down).

A study by Zheng and colleagues form Ohio State University, published in the American Journal of Epidemiology examined the relationship between BMI trajectories and mortality risk in 9,538 adults aged 51 to 77 years from the US Health and Retirement Study (1992-2008).

Participants were divided into 6 latent BMI trajectories: normal weight downward, normal weight upward, overweight stable, overweight obesity, class I obese upward, and class II/III obese upward.

As the authors note,

“…people in the overweight stable trajectory had the highest survival rate, followed by those in the overweight obesity, normal weight upward, class I obese upward, normal weight downward, and class II/III obese upward trajectories.”

The results remained significant even after controlling for baseline demographic and socioeconomic characteristics, smoking status, limitations in activities of daily living, a wide range of chronic illnesses, and self-rated health.

This study supports the idea that weight gain – even after the age of 51 confers a greater risk than simply maintaining the current weight status.

Although causality cannot be inferred from such studies, it may be prudent to focus public health (and perhaps clinical) efforts on prevention of weight gain rather than weight loss.

@DrSharma
Edmonton, AB
ResearchBlogging.orgZheng H, Tumin D, & Qian Z (2013). Obesity and Mortality Risk: New Findings From Body Mass Index Trajectories. American journal of epidemiology PMID: 24013201

 

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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