Wednesday, August 20, 2014

Healthy Obesity: Losing Weight Won’t Make You Happy

sharma-obesity-depressionThere is ample evidence for improvements in mood and other aspects of mental health with weight loss in people with excess weight, who have these problems to begin with.

But whether or not weight loss in otherwise healthy people living with obesity is associated with any such benefits remains unknown.

This question in now addressed by Sarah Jackson and colleagues from the UK in a paper published in PLOS | ONE.

The researchers examine data from 1,979 overweight and obese adults, free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing.

Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%.

The proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the than weight stable or weight gain groups, respectively.

Compared to the weight stable group, the weight loss group was almost 2 times as likely to report mood problems.

Similarly, individuals in the weight loss group were also more likely to report lower wellbeing.

All effects persisted in analyses controlling for demographic variables, weight loss intention, and baseline characteristics and despite adjusting for illness and life stress during the weight loss period.

Given the longitudinal nature of this study, it is impossible to determine causal relationships in these observations but the findings do suggest that the issue of psychological harm in otherwise healthy individuals undergoing weight loss may warrant closer study.

For the event that there is indeed a causal relationship between weight loss and adverse pychological outcomes, the authors have the following explanation to offer:

The poor long-term maintenance of weight loss is notorious, and in itself could be interpreted as demonstrating that the personal costs of losing weight exceed the benefits. Resisting food in environments that offer abundant eating opportunities requires sustained self-control, and given that self-control appears to be a limited resource, other areas of life may suffer as a consequence. Loss of fat stores may also initiate signals for replenishment of adipocytes, thereby stimulating hunger and appetite and making weight control progressively more difficult. These observations suggest that weight loss is a significant psychobiological challenge, and as such, could affect psychological wellbeing.”

On the other hand, weight loss could also result from adverse changes in mood:

Evidence from the clinical literature is suggestive of a causal relationship in this direction, with major depressive disorder often associated with significant weight loss, and treatment with antidepressant medication leading to weight gain. Population studies have also demonstrated longitudinal associations between depressive symptoms and weight loss. Depressed mood may cause weight loss directly or indirectly through changes in appetite or level of physical activity.”

Thirdly, these correlational findings may be entirely unrelated to each other.

Which ever the true relationship, these findings should perhaps caution us against simply advising all overweight or obese people, irrespective of whether or not they actually have weight-related health issues (or are otherwise unhappy with their weight), to try losing some weight.

@DrSharma
Edmonton, AB

ResearchBlogging.orgJackson SE, Steptoe A, Beeken RJ, Kivimaki M, & Wardle J (2014). Psychological Changes following Weight Loss in Overweight and Obese Adults: A Prospective Cohort Study. PloS one, 9 (8) PMID: 25098417

 

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Friday, July 18, 2014

Birth Control And Obesity

sharma-obesity-birth-control-pillAlthough obesity is a well-recognised factor for female infertility, the vast majority of women with excess weight are probably more interested in effective birth control.

That this is not as simple as it seems is evident from an article by Sheila Mody and Michelle Han from the University of California, San Diego, published in Clinical Obstetrics and Gynecaology.

The paper succinctly reviews a wide range of issues related to birth control and obesity.

To begin with, the authors points out that unintended pregnancies in obese women are often a problem simply because obese women are far less likely to use effective contraception than non-obese women. This non-use may in part be attributable to fear of weight gain, when most studies show that modern hormonal contraception is associated with almost no weight gain. The exception appears to be depot-medroxyprogesterone (DMPA), which may cause about 5 lb weight gain in the first year of use.

As for efficacy, the data show that unintended pregnancy rates among overweight women using oral contraceptives are similar or slightly higher than that among nonoverweight women. The reasons for these higher rates are not exactly clear.

Fortunately, the efficacy of intrauterine devices (IUD) appear no different between obese and non-obese women although the insertion of an IUD maybe more difficult in obese women because of poor visualization of the cervix and limited assessment of uterine position (a problem that can often be solved with the help of an ultrasound).

The paper also discusses the suitability of the vaginal vaginal contraceptive ring, which has been hypothesized to offer higher hormone levels for obese women than oral contraceptives because the hormones are absorbed directly into the vaginal mucosa and do not go through the first- pass liver metabolism.

Finally, the paper discusses issues around contraception for women who have undergone bariatric surgery (who have a particularly high rate of unintended pregnancies) as well as best practices for emergency contraception.

This is clearly information that all clinicians who counsel obese women should be aware of.

@DrSharma
Edmonton, AB

ResearchBlogging.orgMody SK, & Han M (2014). Obesity and Contraception. Clinical obstetrics and gynecology PMID: 25029338

 

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Tuesday, July 15, 2014

The Molecular Biology of Food And Mood

sharma-obesity-brainThe neuroendocrine systems that control ingestive behaviour are intimately linked to the parts of the brain that control mood.

Thus, it is increasingly evident that factors that affect energy homeostasis (diet and exercise) can have profound effects on mood while changes in mood can have significant effects on appetite and energy homeostasis.

But this relationship is far from straightforward – rather, it appears to be rather complex.

Readers interested in an overview of how these two systems interact in the brain may find a recent review by Chen Liu from the University of Texas Southwestern Medical Center, Dallas, published in Cell Metabolism of interest.

The authors review our current understanding of how mood and food are linked with particular attention to appetite, ingestive behaviour and energy homeostasis.

The article also touches on the effects of pharmacological and surgical treatments for obesity on mood.

Clearly clinicians need to be aware of the close links between these systems and draw on our current understanding of both in their counselling of patients presenting with weight gain and/or depression.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLiu C, Lee S, & Elmquist JK (2014). Circuits Controlling Energy Balance and Mood: Inherently Intertwined or Just Complicated Intersections? Cell metabolism, 19 (6), 902-909 PMID: 24630814

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Monday, July 14, 2014

How To Prevent Gallstones During Weight Loss

GallstonesOne of the best recognised complications of weight loss – especially if this occurs too rapidly – are the development of gallstones, which can result in acute symptoms and often require surgery.

Now Caroline Stokes and colleagues from the Saarland University Medical Center, Homburg, Germany, publish a systematic review of strategies to prevent weight-loss associate gallbladder stones in Clinical Gastroenterology and Hepatology.

Their analysis includes 13 randomised-controlled trials, comprising 1836 participants undergoing weight loss through dieting (8 trials) or bariatric surgery (5 trials).

Ursodeoxycholic acid (UDCA) reduced the risk of ultrasound-verified gallstones compared with control interventions with a risk ratio of 0.33 and a number-needed-to-treat (NNT) of only 9.

They also found a significant risk reduction with high-fat weight loss diets (risk ration 0.09).

No adverse effects were noted for either intervention.

Thus, it is evident that UDCA and/or higher dietary fat content prevent the formation of gallstones during weight loss and these treatments should likely be initiated particularly in patients, who are undergoing rapid weight loss (particularly those at high risk of gallbladder stones).

@DrSharma
Edmonton, AB

ResearchBlogging.orgStokes CS, Gluud LL, Casper M, & Lammert F (2014). Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 12 (7), 1090-110000 PMID: 24321208

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Thursday, June 26, 2014

Guidelines for Managing Overweight and Obesity in Adults

the obesity societyRegular readers may recall a previous post on guidelines on obesity management released by The Obesity Society (TOS) together with other organisations, including the American Heart Association and the American College of Cardiology, at Obesity Week in Atlanta last year (2013).

The bottom line, as I have blogged before, was the revelation of just how little we actually know about obesity.

For what it is worth, the complete guidelines are now published as a supplement to its July issue of the Obesity journal (Guidelines (2013) for Managing Overweight and Obesity in Adults: Full Report).

According to The Obesity Society’s press release,

TOS is investing in the improved treatment of obesity by making the full guidelines available in print so they can serve as a go-to resource for health practitioners around the world. Whether you are a physician, nurse, nutritionist or fitness trainer, every professional interacting with individuals with obesity can find value in this insightful treatment guide.

No doubt, a tremendous amount of work went into developing these guidelines – whether they will substantially change practice remains to be seen.

@DrSharma
Vancouver, BC

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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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