Low carb diets may have harmful effects on brain function

The study out of Tufts University focused on women aged 22 to 55 engaging in low carb diets similar to the Atkins Diet. Participants were found to have significantly diminished memory scores than the control groups consuming a normal diet. Their scores were lower when tested for reaction time and visual spatial memory. The decline was short lived however as memory scores returned to normal upon resumption of a regular balanced diet.

The nation's obesity epidemic has reached alarming levels despite decades of fad dieting, ignoring American's simultaneous trend toward decreasing amounts of physical activity. Americans today burn 700 calories less per day than they did during the 1960's. Treadmill desks offer a unique solution compared with fad dieting. They offer employees the chance to burn significant amounts of calories during the day, enhance their health and at the same time enhance cognitive function.

"Study after study is showing that supplements and diets are at best ineffective at attaining long term overall health and many pose potential harmful side effects as well, yet proven methods such as walking garner slight attention," states Steve Bordley, President of TrekDesk, a treadmill desk manufacturer. TrekDesk, a full sized height adjustable workstation, fits any existing treadmill. Featuring a 72 x 34 inch surface area, there is sufficient space for any desk related task. Workers simply place their computer, phone, files, reading materials, pens and paper and coffee (yes, it has cup holders) and start walking.

It is that simple. Consistent daily walking is very effective in both long term weight loss and also offers significant increases in brain function. A study by the University of Illinois recently showed that memory can be increased by as much as 15% in just 6 months, due to increased blood flow to the brain and that the production of small blood vessels in the brain can be boosted as much as 43%. "A variety of studies have already proven that walking greatly reduces the risk of developing dementia and Alzheimers later in life as well as offering protection from major diseases such as cancers, heart disease, and diabetes," stated Bordley, "weight loss is an important additional bonus."

So why aren't more people walking? A recent study by America on the Move found Americans do not exercise regularly due to time constraints, their second reason cited was will power. TrekDesk answers both concerns. it is automatic and does not take any additional time out of an employees day. Just start walking and working. At day's end an employee has burned between 800-1400 calories, stimulated the lymphatic system to ward off disease and earned a paycheck while doing it.

Source: Medical News Today

Weight-loss pill Lorcaserin passes early test

In recently released phase 2 trials, the drug, known as lorcaserin, resulted in substantial weight loss in obese men and women. "Lorcaserin is a completely novel mechanism and we think it can bring very robust weight loss. But, also, the safety profile of the compound is excellent," said Dominic P. Behan, co-founder and chief scientific officer of Arena Pharmaceuticals in San Diego, which makes the drug and sponsored a study published in the Dec. 4 issue of the journal Obesity.

"We demonstrated a highly statistically significant, progressive weight loss. This study involved no diet or exercise and the weight loss was rapid and we saw the weight loss in as little as two weeks," he added. A phase 3 trial is under way and, if all goes well, Arena Pharmaceuticals may file a new drug application with the U.S. Food and Drug Administration at the end of 2009, Behan said.

With some two-thirds of Americans either overweight or obese, the need for an effective weight loss tool is tremendous. Excess weight can lead to a variety of health problems, including heart disease, stroke, cancer, arthritis and type 2 diabetes. "Obesity is an epidemic," said Dr. Stuart Weiss, a clinical assistant professor of medicine at New York University's Langone Medical Center in New York City. "Diabetes trails behind obesity by a short few years and the numbers of patients that are developing diabetes is staggering."

Diet and exercise are proven antidotes for excess weight, but few people are able to sustain such changes and, even if they lose weight, will regain it.
Some weight-loss drugs are already on the market -- such as Xenical and Meridia -- but have certain side effects. The drug Fen-phen, a combination of fenfluramine and dexfenfluramine, worked for many but was withdrawn from the market in 1997 when it was linked with increased rates of heart valve problems in patients.

Fen-phen acted on serotonin receptors both in the brain and in the heart and therein lay the problem, Behan said.
"The challenge was to design a compound that was purely selective for the receptor involved, namely the 2c receptor [located in the hypothalamus region of the brain and involved in weight loss] and avoiding the 2b receptor [located in the heart]," Behan said.

The result was lorcaserin, which targets the 5-HT2C serotonin receptor only.
For the phase 2 trial, 469 men and women with a body mass index ranging from 30 to 45 were randomly assigned to one of four groups: 10 milligrams (mg) of lorcaserin once a day, 15 mg once a day, 10 mg twice a day, or a placebo.
Participants taking lorcaserin at 10 mg, 15 mg and 20 mg a day lost 4 pounds, 5.7 pounds and 7.9 pounds, respectively, over the 12-week period. Those in the placebo group lost less than a pound.

In the 10 mg, 15 mg and 20 mg groups, respectively, 12.8 percent, 19.5 percent and 31.2 percent of participants lost 5 percent or more of their starting body weight, versus only 2.3 percent of patients on the placebo.
Participants taking the two higher doses of lorcaserin also shaved inches off their waist and dropped their cholesterol levels. Also, their echocardiograms -- ultrasound images of the heart -- were normal.

"It [lorcaserin] certainly looks a bit better [than other weight-loss medications]," Weiss said. "We don't have much out there. They're really just modest medications and they don't do much at all."

Source: iVillage

Laparoscopic Roux-en-Y gastric bypass elevates the risk of kidney stone formation

According to a pair of studies. The two studies—one from the University of Minnesota, Minneapolis, and a second led by researchers from Wake Forest University Baptist Medical Center, Winston-Salem, NC—had relatively short follow-up periods of 1 year and 6 months, respectively. Owing to their brevity, neither study found an increased incidence of stones among the patients undergoing the surgery, but both found significant increases in oxalate secretion.

Both also found a supersaturation of calcium oxalate in a number of patients relatively soon after the surgical procedure. "The take-home message from our study is that morbidly obese patients should be counseled regarding the increased risks for kidney stones postoperatively," Bryan Hinck, a former research assistant for senior author Manoj Monga, MD, at the University of Minnesota, told Urology Times. "Not that this should dissuade them from the surgery, but rather inform them of the importance of compliant follow-up."

Hinck is currently a medical student at Rosalind Franklin University's Chicago Medical School.
"Based on our findings, patients who have gastric bypass are at increased risk for forming stones," added Bhavin N. Patel, MD, a Wake Forest urology resident who worked on that group's study with Dean G. Assimos, MD, and colleagues. "Indeed, some are at increased risk of nephropathy and perhaps irreversible kidney damage."

Source: Urology Times

Holiday challenges are greater for people who have undergone weight loss surgery.

For most of us, the holidays are a non-stop food fest that challenges our resolve to eat healthy. From office parties and cookie exchanges to holiday parties and tasty gifts, the temptations are all around. Holiday challenges are even greater for people who have undergone weight loss surgery. “Because people who have undergone weight loss surgery can only eat a half cup of food at a time, they have to focus on portion control,” said Gregory Barnes, M.D., weight loss surgeon on the medical staff at Baylor All Saints Medical Center in Fort Worth.

Portion restrictions, along with the need to avoid drinking any liquids within 30 minutes of eating, require some special eat-smart strategies for enjoying the holidays. “Although the holidays may challenge their commitment, I believe that weight loss surgery patients can stick with their goals and remain on track if they’ll do some advanced planning,” said Dr. Barnes.

Try these tips for not just surviving, but actually enjoying holiday parties and food:- Eat something healthy before a party so you don’t arrive hungry.

- Consider bringing a healthy tray of vegetables and dip or other healthy dish to your family gathering or a holiday party.
- Because you’re limited to only a half cup-sized portion, be very selective at a buffet. Look for non-fried, healthy options, and keep in mind that a bite or two of a dessert can often satisfy your craving.
- Grab your drink and focus on socializing since you will need to wait before eating.
- Stand away from the table or buffet so you’ll be less tempted.

More than any other time of year, the holidays are a time when a support system is critical for success. “Our weight loss patients need to find a friend or group that can hold them accountable and keep them focused on their goals at this time of year,” said Dr. Barnes. “Having support is one of the most effective ways to achieve all the benefits of weight loss surgery.”

Source: Baylor All Saints

FDA warning consumers nationwide not to purchase any of the following tainted weight loss products

- Fatloss Slimming
- 2 Day Diet
- 3x Slimming Power
- Japan Lingzhi 24 Hours Diet
- 5x Imelda Perfect Slimming
- 3 Day Diet
- 7 Day Herbal Slim
- 8 Factor Diet

- 7 Diet Day/Night Formula

- 999 Fitness Essence
- Extrim Plus
- GMP
- Imelda Perfect Slim
- Lida DaiDaihua
- Miaozi Slim Capsules
- Perfect Slim
- Perfect Slim 5x
- Phyto Shape
- ProSlim Plus
- Royal Slimming Formula
- Slim 3 in 1
- Slim Express 360
- Slimtech
- Somotrim
- Superslim
- TripleSlim
- Zhen de Shou
- Venom Hyperdrive 3.0

After analysing these products the FDA found they contained undeclared active pharmaceutical ingredients, in some case in amounts that exceeded FDA-recommended levels, thereby putting consumers' health at risk.

The director of the FDA's Center for Drug Evaluation and Research, Dr Janet Woodcock said: "These tainted weight loss products pose a great risk to public health because they contain undeclared ingredients and, in some cases, contain prescription drugs in amounts that greatly exceed their maximum recommended dosages.""Consumers have no way of knowing that these products contain powerful drugs that could cause serious health consequences. Therefore FDA is taking this action to protect the health of the American public," she added.Among the undeclared ingredients they found were:

Sibutramine: this can cause high blood pressure, palpitations, tachycardia, seizures, heart, attack, and stroke. It can also interact with other medications to cause adverse reactions. Its safety for use by children under 16 or pregnant or breastfeeding women is unknown.

Rimonabant: an appetite suppressant that has been evaluated but not approved by the FDA for sale in the US. This drug is approved for sale in Europe, where is has been implicated in 5 deaths and 720 reported adverse reactions in the last two years. The drug has also been linked to increased risk of depression and suicidal thoughts.

Phenytoin: an anti-seizure drug.
Phenolphthalein: a suspected carcinogen that is used to test for acidity in chemical experiments. Some of the products are advertised as containing only "herbal" or "natural" ingredients, but in reality contain potentially harmful substances that are not listed on product labels or advertisements.

The FDA warns that:"These products have not been approved by the FDA, are illegal and may be potentially harmful to unsuspecting consumers."If you have bought or own any of these products you should stop taking them and talk to your doctor immediately said the FDA, who also advises consumers to talk to a healthcare professional before buying any weight loss products.The federal agency has inspected a number of firms selling or connected with the selling of these illegal products and is seeking to recall the products.

The FDA may proceed with a number of enforcement actions, escalating from warning letters to seizures, injunctions and criminal prosecution. Whether you are a consumer or healthcare professional, you can report serious adverse events or side effects, or problems with product quality to the FDA's MedWatch Adverse Event Reporting program in any of the following ways:

- Going online at http://www.fda.gov/MedWatch/report.htm
- Faxing to the fax number: (800) FDA-0178.-- Calling phone number: (800) FDA-1088.-- Writing to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787.
- Filling in postage-paid FDA form 3500 available at: http://www.fda.gov/MedWatch/getforms.htm and then mailing to above address.Click here for more information about these weight loss products and consumer-directed questions and answers.

Source: Medical News Today

Weight-Loss: Eat from a salad plate, not a dinner plate

"If people could cut down on their portion sizes, this would be the single greatest way to combat the creeping obesity epidemic," said Madelyn Fernstrom, founding director of the University of Pittsburgh Medical Center Weight Management Center.
"It's such a simple concept, but it's hard to do. There's so much hidden fat in food, it's hard to know what a serving size is.


"It may seem like cutting back on one's portions wouldn't have much impact - until you realize that just "100 calories a day more than you need adds up to 10 pounds in one year," said Miriam Pappo, clinical nutrition manager at Montefiore Medical Center in New York City. "That's only one or two tablespoons of salad dressing."

In a recent study, 120 healthy adults were divided into two groups, with equal numbers of men and women in each. Both groups were educated about healthy eating and given a target of consuming 1,700 calories daily for the men and 1,365 calories for the women. They were also told to eat 55 percent carbohydrates, 25 percent protein and 20 percent fat. One group, however, was given prepackaged portions of meat and rice for daily consumption, and was told to include two large salads, fruit and two glasses of skim milk a day. The other group was allowed to choose its own portion sizes.

  

After two months, the "prepackaged" women had lost 12 pounds, as against eight pounds for the self-selected-portion women. The men who ate prepackaged portions lost 16 pounds versus 11 pounds for the other group.

What we can learn from this, Fernstrom said, is that prepackaged frozen meals might be a good weight-loss option.

If you like your meals home-cooked, you can save the containers from frozen meals to measure your portion sizes.In addition, she said, eat from a salad plate, not a dinner plate, which is unnaturally large to hold a proper portion. The food on your plate, Pappo said, should be half vegetables and a quarter each protein and starchy food.

Source: Empowered Doctor

Weight-loss food is often as fattening as standard fare and not worth buying

One healthy-option exception is low-fat supermarket sausages, which contain half as many calories, 81% less fat and 80% less saturated fat. But a range of food from Asda, Morrisons, Sainsbury's, Tesco, M&S and Waitrose was found to offer little or no benefit over standard versions, Which? said. Kellogg's Special K, marketed as a slimming cereal, had the same amount of calories (171 per 30g) as Cornflakes and even more than Branflakes.

Weight Watchers white bread (68 kcal per 29 g slice) was so similar to Warburtons (69kcal per 29 g slice) and Asda Danish (63 kcal per 25 g slice), that Which? recommended consumers bought the one they preferred.

Nikki Ratcliff, head of services research at Which?, said: "If you're looking for a New Year quick-fix to shed a few pounds, weight-loss products aren't the answer."

But a Kellogg's spokeswoman said: "Consumers aren't stupid. The reason Special K is one of the UK's biggest selling cereals is because it works. Bran Flakes and Corn Flakes are an equally good choice if you're following a low calorie and low fat diet - which we've been saying for years."

Source: Nursing in Practice

Gastric banding with one small incision

Gastric banding is an important weapon in the war chest of the bariatric surgeon - but it typically requires five incisions and a considerable recovery time. But a new technique just coming into use needs just a single incision to accomplish the task of gastric banding, that is, tying off the top portion of the stomach so that food flow is restricted and slowed down. When the small, top part of the stomach is full, it signals the brain, which tells the body it's no longer hungry.

This can lead to large reductions in weight for the morbidly obese, who are the only category of patients allowed to undergo the surgery.



With the new procedure, a single incision is made in the navel. Therefore, it's not surprising that the new surgery is called single-incision laparoscopic surgery (SILS). Laparoscopic refers to a device with a video camera attached that's inserted through the incision to allow the doctor to see inside the abdominal cavity.

"SILS is an important new option that holds the potential of less pain, fewer scars and quicker recovery," explained Shawn Garber, chief of bariatric surgery at Mercy Medical Center on Long Island, who also heads the New York Bariatric Group. "And most patients report that they can barely notice the single incision hidden in the bellybutton."

The procedure is completed using a special camera to see around obstructions and special graspers with a curved tip.

"There's a current revolution in minimally invasive surgery: Can we make laparoscopic surgery better by decreasing the number of incisions?" said Dr. Daniel Scott, associate professor of surgery and director of the Center for Minimally Invasive Surgery at University of Texas Southwestern Medical Center. "The theory behind this, not yet proven, is that fewer scars are better cosmetically and for pain control. The pain may be less because you alleviate additional cuts, and therefore the recovery may be hastened."

Source: Empowered Doctor

The Qnexa phase 3 obesity program

A pharmaceutical company dedicated to the development and commercialization of novel therapeutic products, today announced positive results from the EQUATE study (OB-301), a 28-week, phase 3 obesity trial conducted at 32 sites with Qnexa™, an investigational drug. The EQUATE study met the primary endpoint by demonstrating superior weight loss with both the full-dose and mid-dose of Qnexa, as compared to the individual components and placebo.

Subjects treated with full-dose and mid-dose Qnexa had an average weight loss of 9.2%and 8.5% respectively, as compared to weight loss of 1.7% reported in the placebo group. Average weight loss was 19.8 pounds and 18.2 pounds in the treatment arms as compared to 3.3 pounds in the placebo group. Qnexa was well-tolerated, with no drug-related serious adverse events in the study.

"The results from the EQUATE trial once again confirmed our belief in Qnexa. In addition to hitting the primary endpoints of the study with the full-dose, we were also able to show excellent results with the mid-dose of Qnexa," commented Leland Wilson, president and chief executive officer of VIVUS. "The EQUATE study is the first of three studies in the Qnexa phase 3 obesity program. Data from the EQUIP and CONQUER studies, which combined enrolled over 3,750 subjects, is expected in mid-2009."

Read more

Seven new genetic variants found that make people put on weight

Two large scientific studies have found seven new genetic variants that make people put on weight, to add to two genes that were already linked to obesity in the general population. Both research teams - one led by deCode Genetics, an Icelandic biotechnology company, and the other an international academic consortium - published their findings yesterday in the journal Nature Genetics. The discoveries will be important for the global fight against obesity, one of the greatest public health problems of the 21st century.

The most significant feature of the newly identified genes is that almost all of them are active in the brain, implying that they affect appetite rather than the biochemical processes of energy or fat metabolism. "This suggests that, as we work to develop better means of combating obesity, including using these discoveries as the first step in developing new drugs, we need to focus on the regulation of appetite at least as much as on the metabolic factors of how the body uses and stores energy," said Kari Stefansson, chief executive of deCode. Samples from a total of more than 100,000 people were analysed in the two "genome-wide association studies", which used the latest DNA-reading technology to associate genetic variations with body mass index.

Body mass index is the most commonly used measure of obesity.
Family and twin studies have shown that genetic factors account for 40-70 per cent of population variation in body mass index. Yet the first gene contributing to obesity in the general population, as opposed to people with rare metabolic disorders, was not discovered until 2007. Each of the newly identified genetic variations has only a modest effect: someone who carries all seven would typically be 1.5kg to 2kg heavier than an average adult.

That meant that dozens, or even hundreds, more genetic variations probably contributed small amounts to obesity, said Joel Hirschhorn, of Children's Hospital Boston, who led the academic consortium. Mark McCarthy, of Oxford University, another member of the consortium, said: "It may seem surprising that we know so little about the biology of such an important medical and social issue.

"We are finding that common diseases have complex causes and it is only by understanding the biology that we can start to make rational attempts to treat and prevent conditions such as obesity," he added.

Source: FT.com

Low-carb, no-carb diets have the strongest potential for negative impact on thinking and cognition

Low-carbohydrate diet might help you shed those extra pounds, but it can have an adverse impact on your cognition skills, says a new study. Tufts University researchers found that when dieters eliminated carbohydrates from their meals, they performed more poorly on memory-based tasks. "This study demonstrates that the food you eat can have an immediate impact on cognitive behaviour," said Holly A. Taylor, professor of psychology at Tufts and corresponding author of the study.

"The popular low-carb, no-carb diets have the strongest potential for negative impact on thinking and cognition," Taylor added. While the brain uses glucose as its primary fuel, it has no way of storing it. Rather, the body breaks down carbohydrates into glucose, which is carried to the brain through the blood stream and used immediately by nerve cells for energy. Reduced carbohydrate intake should thus reduce the brain's source of energy.

The study included 19 women ages 22 to 55 who were allowed to select the diet plan they preferred. Nine women chose a low-carbohydrate diet and 10 selected the low-calorie diet. They were asked to complete five testing sessions that assessed cognitive skills, including attention, long-term and short-term memory, and visual attention, and spatial memory.

The first session was held before participants began their diets, the next two sessions occurred during the first week of the diet, which corresponded to the week when low-carb dieters eliminated carbohydrates.

The final two sessions occurred in week two and week three of the diets, after carbohydrates had been reintroduced for those on the low-carb diet.
Low-carb dieters showed a gradual decrease on the memory-related tasks compared with the low-calorie dieters. Reaction time for those on the low-carb diet was slower and their visuospatial memory was not as good as those on the low-calorie diet.

However, low-carb dieters actually responded better than low-calorie dieters during the attention vigilance task. "The data suggest that after a week of severe carbohydrate restriction, memory performance, particularly on difficult tasks, is impaired," Taylor said. The study appears in the February 2009 edition of the journal Appetite.

Source: MedIndia

Insufficient vitamin D can stunt growth and foster weight gain during puberty

According to a new study published in the Journal of Clinical Endocrinology & Metabolism. Even in sun-drenched California, where scientists from the McGill University Health Centre (MUHC) and the University of Southern California conducted their study, vitamin D deficiency was found to cause higher body mass and shorter stature in girls at the peak of their growing spurt.

While lack of vitamin D is common in adults and has been linked to diseases such as osteoporosis, cancer and obesity, until this study, little was known about the consequences of insufficient vitamin D in young people.

The research team measured vitamin D in girls aged 16 to 22 using a simple blood test (25-hydroxy vitamin D). They also assessed body fat and height to determine how vitamin D deficiency could affect young women's health. "The high prevalence of vitamin D insufficiency in young people living in a sun-rich area was surprising," says study lead author, Richard Kremer, co-director of the Musculoskeletal Axis of the MUHC. "We found young women with vitamin D insufficiency were significantly heavier, with a higher body mass index and increased abdominal fat, than young women with normal levels.

" Vitamin D fosters growth, healthier weight The researchers examined 90 Caucasian and Hispanic girls and discovered that young women with normal vitamin D levels were on average taller than peers deficient in vitamin D. Yet in contrast to what's been previously reported in older women, their investigation found no association between lack of vitamin D and bone strength. "Although vitamin D is now frequently measured in older adults, due to a higher level of awareness in this population, it is rarely measured in young people - especially healthy adolescents," says Dr. Kremer.

"Clinicians need to identify vitamin D levels in younger adults who are at risk by using a simple and useful blood test," says the co-author, Dr. Vicente Gilsanz, head of musculoskeletal imaging at the Children's Hospital Los Angeles of the University of Southern California. "Because lack of vitamin D can cause fat accumulation and increased risk for chronic disorders later in life, further investigation is needed to determine whether vitamin D supplements could have potential benefits in the healthy development of young people," added Dr. Gilsanz.

Source: Medical News Today

60-minute workout on a treadmill affects the release of two key appetite hormones, ghrelin and peptide YY

While 90 minutes of weight lifting affects the level of only ghrelin, according to a new study. Taken together, the research shows that aerobic exercise is better at suppressing appetite than non-aerobic exercise and provides a possible explanation for how that happens.

This line of research may eventually lead to more effective ways to use exercise to help control weight, according to the senior author, David J. Stensel of Loughborough University in the United Kingdom.

The study, “The influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin and peptide YY in healthy males,” appears in the online edition of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, published by The American Physiological Society. The authors are David R. Broom, James A. King and David J. Stensel of Loughborough University, and Rachel L. Batterham of University College, London.

Treadmill versus weight lifting
There are several hormones that help regulate appetite, but the researchers looked at two of the major ones, ghrelin and peptide YY. Ghrelin is the only hormone known to stimulate appetite. Peptide YY suppresses appetite.

Ghrelin was discovered by researchers in Japan only about 10 years ago and was originally identified for its role as a growth hormone. Only later did its role in stimulating appetite become known. Peptide YY was discovered less than 25 years ago.

In this experiment, 11 male university students did three eight-hour sessions. During one session they ran for 60 minutes on a treadmill, and then rested for seven hours. During another session they did 90 minutes of weight lifting, and then rested for six hours and 30 minutes. During another session, the participants did not exercise at all.

During each of the sessions, the participants filled out surveys in which they rated how hungry they felt at various points. They also received two meals during each session. The researchers measured ghrelin and peptide YY levels at multiple points along the way.

They found that the treadmill (aerobic) session caused ghrelin levels to drop and peptide YY levels to increase, indicating the hormones were suppressing appetite. However, a weight-lifting (non-aerobic) session produced a mixed result. Ghrelin levels dropped, indicating appetite suppression, but peptide YY levels did not change significantly.

Based on the hunger ratings the participants filled out, both aerobic and resistance exercise suppressed hunger, but aerobic exercise produced a greater suppression of hunger. The changes the researchers observed were short term for both types of exercise, lasting about two hours, including the time spent exercising, Stensel reported.

“The finding that hunger is suppressed during and immediately after vigorous treadmill running is consistent with previous studies indicating that strenuous aerobic exercise transiently suppresses appetite,” Stensel said. “The findings suggest a similar, although slightly attenuated response, for weight lifting exercise.”

Focus on active ghrelin
Previous studies have been inconclusive about whether exercise decreases ghrelin levels, but this study may help explain those mixed results, according to the researchers.

Ghrelin comes in two forms, acylated and non-acylated. The researchers measured acylated ghrelin, also called active ghrelin, because it can cross the blood-brain barrier and reach the appetite center in the brain. Stensel suggests that future research concentrate on active ghrelin.

While the study showed that exercise suppresses appetite hormones, the next step is to establish whether this change actually causes the suppression of eating.

Source: Newswise

People who carry an obesity gene eat up to 100 extra calories per meal

When 100 schoolchildren aged from four to 10 were given an identical meal, those with the gene ate more of the calorie-dense foods (cheese, crisps, chocolate) containing more fat and sugar and less of the healthy foods (grapes, cucumber) than those without.

The scientists, from the University of Dundee, found the gene made no difference to the rate at which the children burnt energy or to their level of physical exercise.

There was also no evidence that it affected how much they needed to eat to feel satisfied. The results are published in the New England Journal of Medicine.

The study was led by Professor Colin Palmer, who was part of a group of British scientists who identified the obesity gene, FTO, in 2007.

They found people carrying one copy of a variant of the gene (49 per cent) had a 30 per cent increased risk of obesity. Individuals carrying two copies (14 per cent) had a 70 per cent increased risk.

Source: The Independent

Food that will help to boost the rate at which calories are burned

If you're struggling to shift a few extra pounds, you might want to add afew of these metabolism-boosting items to your shopping list.

GREEN TEA
If the celebrities, such as Jennifer Lopez and Gwyneth Paltrow, swear by it for weight loss, then who is going to argue? It's long been believed that green tea extract may boost the metabolism - and it does a good job of enhancing the mood, too. No wonder sales of green tea have soared in recent years.

APPLES AND PEARS
These fruit contain a fibre called pectin, which is thought to limit how much fat your cells can absorb. They have the added benefit of suppressing the appetite, too.

APPLE CIDER VINEGAR
Long heralded as a health tonic, it's thought that apple cider vinegar may also be an aid in the battle against the bulge by burning fat. There is even an apple cider vinegar diet that involves taking one to three teaspoons of the vinegar or apple cider vinegar pills before each meal.

CAYENNE PEPPER
This is a super fat-burning spice and eating it with lean protein foods, such as chicken or turkey, could boost your metabolism for hours afterwards.

CINNAMON
Studies show that just a pinch of the sweet-smelling spice will force your body to metabolise sugar at 20 times the normal rate. Try sprinkling it on your morning porridge or cereal, or on top of a cafe latte.

CITRUS FRUITS
A US medical study found that participants who ate half a vitamin C- packed grapefruit with each meal in a 12-week period lost an average of 3.6lbs. The research indicates that the unique chemical properties in this vitamin C-packed citrus fruit reduce insulin levels, which may promote weight loss. Others claim that oranges, lemons, limes and tomatoes are great for boosting metabolism.

ESSENTIAL FATTY ACIDS
These are a must for slimmers. The best sources of these fat-busting beauties are pumpkin seeds, flaxseeds and oily fish. The essential oils are said to stimulate the removal of stored body fat and have powerful moodenhancing qualities.

GARLIC
Already shown to be an effective blood thinner, garlic may also have the ability to break down fat. Garlic can be taken in capsule form or added to pasta, stir fries and soups.

GINGER
Some researchers believe that the spice will increase your internal body heat, boost the circulation of blood and removal of toxins, as well as elevating metabolism and improving digestion. You could add ginger to stir fries or even soups.

HOT PEPPERS
The fiery pepper is claimed to speed up metabolism and cool your food cravings, researchers in Canada have found. It's believed that capsaicin - a chemical found in jalapeno and cayenne peppers - temporarily stimulates the body to release more stress hormones, which can speed up the rate at which calories are burned.

LOW-FAT DAIRY
Research in America revealed that people on a reduced-calorie diet who included three to four servings of low-fat dairy foods, such as yoghurt and cottage cheese, lost significantly more weight than those who ate a low-dairy diet containing the same number of calories. It's believed that the combination of lean protein and calcium can increase fat metabolism and maintain muscle mass.

SOYA BEANS
This versatile foodstuff contains a potent fat blocking compound called lecithin, in addition to protein and essential minerals. Try a handful of roasted soya beans as a healthy snack. Or you can buy soya bean milk and use instead of dairy milk.

TURKEY
Many studies show that protein can help to boost metabolism. It's proven that the higher the lean muscle to fat ratio in your body the more efficient you'll be at burning calories. And, after all, lean meats are a body builder's favourite.

WATER
A German study found that metabolic rates increased by up to 30 per cent when participants drank 500ml of water. It has been found that many people confuse hunger pangs with a need to drink more water. So there are double the reasons for drinking water to aid weight loss.

Source: News Now

Bariatric Surgery: surgeons don't choose just anyone

If you're obese and have tried every diet imaginable, sticking to it faithfully, and still can't lose the excess poundage, you might be a candidate for weight-loss surgery. To qualify, a prospective patient must satisfy certain criteria. First, a person's body mass index, or BMI, must be at least 40 - or he or she must weigh at least 100 pounds more than his or her ideal weight.

Those with a BMI of 40 or more are considered morbidly obese. If you have a body mass index of 35-39, you're classified as severely obese. A doctor will still perform weight-loss surgery on you, but only if you have at least one serious medical condition accompanying your weight problem. These conditions include diabetes, sleep apnea, hypertension, depression and high cholesterol.

Second, you need to be a person who makes healthy lifestyle choices. These include not smoking, not drinking to excess, and avoiding drug abuse. People who are used to making good lifestyle decisions have the best chances for success with weight-loss surgery.

Third, you as a prospective patient must demonstrate commitment and willpower in your life. You must be able to adhere to a diet no matter what, and stick to an exercise regimen come what may. These accompaniments to weight-loss surgery are permanent lifestyle changes that must be adopted as lifelong habits if the surgery is to be successful.

Only with these qualifications will a bariatric surgeon accept a patient for weight-loss surgery.

Source: Empowered Doctor

Obesity during childhood may cause the function and structure of the thyroid to change

The thyroid gland controls metabolism by setting the rate at which a person produces energy from their body's stores.Dr Giorgio Radetti, from the Regional Hospital of Bolzano in Italy, revealed that his team appears to have uncovered a link between alterations in thyroid function and structure and obesity.

The researchers studied 186 overweight and obese children for nearly three years and found changes in thyroid structure which they believe may be due to obesity.Dr Radetti said: 'We found an association between body mass index and thyroid hormone levels, which suggests that fat excess may have a role in thyroid tissue modification.'Obesity has previously been linked with a range of health problems, including high blood pressure, heart disease, diabetes and several forms of cancer.

Source: NetDoctor.co.uk

Having an imperfect body may come with some substantial benefits

The hormones that make women physically stronger, more competitive and better able to deal with stress also tend to redistribute fat from the hips to the waist, according to Elizabeth Cashdan, an anthropologist at the University of Utah. So in societies and situations where women are under pressure to procure resources, they may be less likely to have the classic hourglass figure.

Cashdan’s hypothesis aims to explain a peculiar observation. Women around the world tend to have larger waist-to-hip ratios—more cylindrical rather than hourglass-shaped bodies—than is considered optimal.Medical studies have shown that a curvy waist-to-hip ratio of 0.7 or lower is associated with higher fertility and lower rates of chronic disease. Studies have also shown that men prefer a ratio of 0.7 or lower when looking for a mate.

The preference makes perfect sense, according to evolutionary psychologists, because the low ratio is a reliable signal of a healthy, fertile woman.But in data that Cashdan compiled from 33 non-Western populations and four European populations, the average waist-to-hip ratio for women is above 0.8. If 0.7 is the magic number both in terms of health and male mate choice, why are most women significantly higher?That’s where the hormones come in.Androgens, a class of hormones that includes testosterone, increase waist-to-hip ratios in women by increasing visceral fat, which is carried around the waist. But on the upside, increased androgen levels are also associated with increased strength, stamina, and competitiveness.

Cortisol, a hormone that helps the body deal with stressful situations, also increases fat carried around the waist.“The hormonal profile associated with high WHR (waist-to-hip ratio) … may favor success in resource competition, particularly under stressful circumstances,” writes Cashdan. “The androgenic effects—stamina, initiative, risk-proneness, assertiveness, dominance—should be particularly useful where a woman must depend on her own resources to support herself and her family.”In other words, trading the benefits of a thin waist for better ability to collect resources may be a good deal in certain societies and situations. And there is evidence that male mate preferences may reflect this trade-off, according to Cashdan.

In Japan, Greece and Portugal, where women tend to be less economically independent, men place a higher value on a thin waist than men in Britain or Denmark, where there tends to be more sexual equality. And in some non-Western societies where food is scarce and women bear the responsibility for finding it, men actually prefer larger waist-to-hip ratios.“Waist-to-hip ratio may indeed be a useful signal to men, then, but whether men prefer a WHR associated with lower or higher androgen/estrogen ratios (or value them equally) should depend on the degree to which they want their mates to be strong, tough, economically successful and politically competitive,” Cashdan writes.“And from a woman's perspective, men's preferences are not the only thing that matters.”

Source: Newswise

Complications of nonalcoholic fatty liver disease appeared to improve after bariatric surgery

According to a study published in Clinical Gastroenterology and Hepatology.
"Even today, the effect of weight loss after bariatric surgery on the liver, particularly NAFLD, remains unclear. There is a lack of well-defined trials exploring this relationship," said lead author Gagan K. Sood, MD, University of Texas Medical Branch, Galveston, Texas.

"Our team assessed and quantified this effect and found encouraging news: a majority of patients experience complete resolution of NAFLD after bariatric surgery, and the risk of progression of inflammatory changes and fibrosis seems to be minimal."

For the meta-analysis, 15 studies were selected for final data extraction. The mean age of the participants at the time of weight loss surgery ranged from 35.6 to 49 years. Mean body mass index (BMI) at the time of weight loss surgery ranged from 43.9 to 56 kg/m2 and the mean BMI at follow-up liver biopsies ranged from 28.6 to 39 kg/m2. Percentage reduction in mean BMI values ranged from 19.11 to 41.76.

The pooled proportion of patients with improvement or resolution in steatosis was 91.6%, steatohepatitis was 81.3%, fibrosis was 65.5%, and complete resolution of nonalcoholic steatohepatitis was 69.5%.

The authors noted that the results may require confirmation from large, multicentre trials using uniform histopathological criteria for liver biopsy specimens.

Source: Doctor's Guide

Dieters are more susceptible to influenza, says a new study

Michigan State University nutritional immunology professor Elizabeth Gardner conducted the research which has been published in the November issue of the Journal of Nutrition.In the study, the researcher showed that mice with a calorie-restricted diet were more likely to die during the first few days of infection than mice with a normal diet. Caloric restriction is the practice of reducing the intake of calories to 40 percent of a normal diet, while maintaining adequate vitamins and minerals.

"If you are exposed to a new strain of influenza, to which your body has not made adequate antibodies to protect you from infection, your body must rely on cells that will kill the virus," Gardner said. "The natural killer cells are important in controlling the early stages of virus infection, because they act quickly once they encounter virus-infected cells. Our studies show that calorically restricted mice have increased susceptibility to influenza, and their bodies are not prepared to produce the amount of natural killer cells needed to combat the stress of fighting an infection," the expert added.

In Gardner's research, both regularly fed mice and calorically restricted mice exposed to the virus exhibited decreased food intake as they tried to fight off the infection. Yet the mice on calorically restricted diets took longer to recover and exhibited increased mortality, weight loss and other negative effects. Even though both sets of mice had a diet fortified with appropriate vitamins, the mice consuming normal amounts of food had their appetites back sooner and recovered faster.

"Our research shows that having a body ready to fight a virus will lead to a faster recovery and less-severe effects than if it is calorically restricted," Gardner said. "Adults can calorically restrict their diet eight months out for the year, but during the four months of flu season they need to bump it up to be ready. You need the reserves so your body is ready for any additional stress, including fighting a virus," the expert added.

Source: newKerala

Gastric bypass surgery may be the single most important advancement in the treatment of the chronic disease since the discovery of insulin

Doctors in Canada are taking part in a study to see if a surgery used to treat severe obesity may also help people with Type 2 diabetes.

However, they caution that so far, only anecdotal evidence results suggesting the surgery works.Still, researchers are encouraged that the operation has helped some patients get rid of the disease entirely.

Cindy Dugas, 48, is one such patient. She recently had the surgery and says it has worked wonders. "My goal is to live without diabetes," she told CTV News, adding that the disease could seriously impact her health in years to come.



"You are looking at nerve damage, you are looking at liver damage, you are looking at heart damage, and I don't want to be looking at those things."
Ten days after the operation, Dugas said that her blood sugar levels have dramatically improved.

Critics are skeptical, but a new study may shed some light on the surgery's effectiveness in helping diabetic patients.

Dr. Mehran Anvari, a McMaster University professor and surgeon at St. Joseph's Healthcare in Hamilton, is contributing to the study, which he hopes will be extremely useful.

"This is at the moment the only treatment being evaluated as a potential cure for diabetes," he told CTV News. Here's how the surgery works. First, doctors insert tools into the abdomen and cut down the size of the stomach, which is then attached to a lower part of the intestine.

The surgery seems to change hormone levels in patients, thus eliminating their diabetes. Anvari says he's tried the surgery on six patients and it's worked on all of them. "(The patients) go off medications almost immediately after surgery, and by six months they are normal," he said.

Some doctors argue that the surgery is a risky option. They also say that no one knows how long a patient's diabetes remission may last. But researchers hope the data coming from the Canadian study will convince doctors that the surgery is indeed a new way of treating those with uncontrolled diabetes. So far, doctors said they've enrolled 20 people in the study and are hoping to have 100 in total.

Source: CTV.ca

Treatments designed to boost NAPE levels might offer a new way to fight obesity

Researchers discovered one type of lipid produced in the gut rises after eating fatty foods. The lipid, called N-acylphosphatidylethanolamines or NAPE, enters the bloodstream and goes straight to the brain. NAPEs concentrate in a brain region that controls food intake and energy expenditure. The most abundant form of NAPE seems to be effective in controlling fat intake even when administered artificially.

In a study where rats were given NAPE for five days, researchers saw a continuous reduction in food intake and a decline in body weight. Infusion of NAPE directly into their brains also led the animals to cut back on calories.
Study authors conclude these findings warrant longer-term studies in rodents and non-human participants to examine the potential for treatment and prevention of diet-induced obesity.

Source: Ivanhoe Medical News

Scientists are trying to understand how Fen-phen behaves in the brain

In order to develop safer anti-obesity drugs with fewer side effects. Once hailed as a miracle weight-loss drug, Fen-phen was removed from the market more than a decade ago for inducing life-threatening side effects, including heart valve lesions.

In a study appearing in the Nov. 25 issue of Neuron, the researchers define a circuit in the brain that explains the ways fenfluramine, a component of Fen-phen, suppresses appetite.“Our findings provide evidence that the neural circuit we’ve proposed is sufficient for the neurotransmitter serotonin to regulate food intake and body weight, ” said Dr. Joel Elmquist, professor of internal medicine and pharmacology at UT Southwestern and senior author of the study. “Fen-phen works directly on this pathway. Unfortunately, that drug also adversely affects peripheral tissue such as the heart.”

For the current study, the researchers engineered mice in which the expression of a serotonin receptor called 5-hydroxytryptamine 2C was blocked throughout the entire body. This was previously known to produce obese mice resistant to the anorexic actions of fenfluramine. When activated by serotonin, however, this receptor is also known to suppress appetite. Using this mouse model, the authors engineered another set of mice in which the same serotonin receptor was blocked everywhere in the body except within a group of brain cells called pro-opiomelanocortin, or POMC, neurons. The POMC neurons, which are found in the hypothalamus, are also known to play an important role in suppressing appetite and inducing weight loss.

The researchers found that the animals with no serotonin 2c receptors expectedly developed obesity as well as other metabolism disorders such as increased food intake, hyperactivity and leptin insensitivity. They also were prone to spontaneous seizures, said Dr. Elmquist.In contrast, the mice in which the serotonin receptor was re-expressed and functioning only in the POMC neurons stayed slim and responded to fenfluramine.“The POMC-specific reactivation of the receptor only in POMC neurons normalizes the abnormal metabolism in these mice,” Dr. Elmquist said. “The animals don’t eat excessively.

Their hyperactivity is also gone.”Previous work from the UT Southwestern group led to the hypothesis that Fen-phen worked by activating the serotonin 2c receptor in the POMC neurons in the hypothalamus. The current work provides genetic proof supporting this model.“Conventional wisdom is that fenfluramine increases serotonin release that then activates serotonin receptors in the brain to regulate food intake and body weight, but unfortunately, this drug also causes lesions in heart valves,” he said. “If you could develop a drug that would travel to both the brain and the peripheral tissues, and then give a blocker to protect the heart, it’s possible that you could prevent the harmful side effects and still aid weight loss.

Admittedly, that’s a bit farfetched, but this mouse model could be used to test that theory.”The team’s next step is to determine whether they’ve identified the sole circuit required to suppress appetite and induce weight loss.

Source: UT Southwestern

Three cups of Spearole tea a day helps the pounds melt away

Spearole Tea, a blend of green tea, spearmint, grape seed and olive leaf, also cuts blood pressure and makes it easier for the body to process sugar, a medical conference will hear tomorrow.
Researcher Dr Lindsay Brown said: 'If someone had told me you could do all these things with something as simple as green tea with olive extract I would said they'd been out in the sun too long.

'It is simply amazing.'
Dr Brown, a pharmacologist at Brisbane's Queensland University, studied the effect of the tea on the health of a group of rats.
The creatures were fed a fat and sugar-laden diet caused the amount of fat around their bellies to double in eight weeks and their blood pressure to soar.
When Spearole Tea was added to their diet, their waistlines and their blood pressure quickly returned to normal. This was despite the continuing to eat junk food, the Australian Health and Medical Research Congress will hear.

Dr Brown said it was likely three cups of the tea a day could also help people stay trim, improving overall health.
Warning that the obesity epidemic threatened to wipe out the gains achieved by improvements to heart health, he said: 'The UK, the US and Australia all have something like 60 per cent of the adult population overweight or obese.
'The decrease in cardiovascular mortality in the last 40 years has added on average six years to life expectancy.

'That is the biggest increase in life expectancy in one generation in the history of the species.
'The control of cardiovascular disease has had an amazing effect on survival and that is at risk from obesity.'

Source: Daily Mail

Fat oxidation, or the body's ability to 'burn' fat, improves in obese people when they eat a higher protein diet.

The study, in Nutrition & Dietetics published by Wiley-Blackwell, found higher protein meals may have a subtle fat-burning effect in overweight or obese people. And the study showed the glycaemic index (GI) of a meal has no additional effect on fat breakdown. Study co-author Dr. Marijka Batterman, an Advanced Accredited Practising Dietitian, said: 'We know from past research that overweight or obese people are not as efficient at burning fat.

Study participants were put on two protein-enriched meals and one standard meal, which all contained the same number of kilojoules. The two protein-enriched meals differed in the type of carbohydrate they contained - either high- or low-GI. The amount of kilojoules subjects burnt was then measured. The high-protein meals led to the greatest level of fat oxidation. This plan included a cheese and tomato omelette for breakfast, and a beef, chutney and salad sandwich, with a tub of low-fat yoghurt, for lunch. "We found a clear relationship between body composition and the effect of dietary protein on fat oxidation.

Our bodies burn energy and use fat differently, and we need to take this into account when planning our diets,' said Dr. Batterman who works at the Smart Foods Centre at the University of Wollongong. Claire Hewat, Executive Director of the Dietitians Association of Australia (DAA), said all foods could fit into a healthy diet if eaten in the right amounts, and combined with regular physical activity. 'Forget the fad diets that are so fashionable these days. Instead, include lean protein from healthy foods like lean red meat, chicken and fish, legumes, eggs, nuts and reduced-fat dairy foods. People wanting individual advice on how much protein they need should see an Accredited Practising Dietitian,' said Ms Hewat.

Source: Medical News Today

New approaches to treat obesity and type 2 diabetes

GI Dynamics, a medical device company announced today a paper appearing in the advance online publication of the journal Obesity, which demonstrates that implantation of an innovative endoluminal sleeve mimics key, beneficial effects of Roux-en-Y gastric bypass (RYGB) surgery, inducing substantial weight loss and improved metabolic function in rats with diet-induced obesity.

The dramatic effects of the removable device on blood glucose levels in this animal model suggest an important role for the duodenum (the first part of the small intestine) and jejunum (the central part of the small intestine) in the regulation of this metabolic function. GI Dynamics is developing an endoluminal sleeve, known as the EndoBarrier™ Gastrointestinal Liner, and is currently in late-stage clinical trials.

Source: BioSpace

Finally you achieved your weight loss goal and now you want a TUMMY TUCK!

Cosmetic surgery
Patients who feel they are at their ideal weight are the best candidates for a tummy tuck. Many patients combine their tummy tuck with other cosmetic procedures such as liposuction or breast augmentation.

Your procedure
There are three basic techniques used to flatten a protuberant abdomen.Liposuction alone can produce a thin abdominal wall for some patients with firm skin but excess fat.
For those with laxity of their abdominal muscle and especially excessive skin, a tummy tuck (complete or partial) may be their only solution. A tummy tuck is usually performed under general anesthesia with the patient asleep.
The classical, complete tummy tuck done in most places involves an incision around the belly button and another long incision that runs in the lower abdomen. The entire abdominal skin is lifted and the muscle is tightened with sutures, and the excess skin and fat is removed.

The ‘Mini-Dissection’ Tummy Tuck
This ‘Mini-Dissection’ Tummy tuck is often performed on our patients using minimal dissection. With this partial tummy tuck, a smaller incision is made in the lower abdomen. Your excess skin and fat are removed through this incision. In certain cases, permanent sutures may also be placed through this incision to tighten the muscles of the abdominal wall. This Mini-Dissection technique allows you to return home the same day.

What will my recovery be like?
Any discomfort that follows surgery can be controlled with oral medication. If small drains are used, they are removed the next day.

Source: CosmeticSurgery.com

Increased physical activity after gastric bypass surgery can yield better postoperative outcomes

Bariatric surgery is quickly emerging as a standard treatment for severe obesity, although weight loss outcomes vary. These results suggest that patient behaviour, particularly physical activity, may promote both enhanced weight loss and greater improvements in health-related quality of life following bariatric surgery," says lead author Dale Bond, PhD, The Miriam Hospital's Centers for Behavioral and Preventive Medicine, Providence, Rhode Island.Approximately 190 patients who underwent gastric bypass surgery at Virginia Commonwealth University participated in the study.

A validated, self-administered questionnaire was used to assess physical activity levels of participants both before surgery and 1 year after surgery. Researchers set a benchmark of 200 minutes of weekly moderate or vigorous physical activity to differentiate between inactive versus active individuals.Participants also completed a standardised self-reported questionnaire designed to measure health-related quality of life, focusing on areas such as physical functioning, limitations because of physical or emotional problems, bodily pain, general health, energy levels (vitality), social functioning, and mental health. Overall, researchers observed a positive relationship between changes in physical activity and improved bariatric outcomes.



More than two-thirds (68%) of those individuals who went from being inactive before surgery to highly active 1 year afterward lost an additional 13.2 lbs, reduced their body mass index (BMI) by 2 more units and lost 8% more of their excess weight compared with those who remained inactive after surgery. This group also increased their daily physical activity duration from an average of less than 10 minutes before surgery to approximately 2 hours postoperatively.

Nearly a third (32%) of participants who engaged in less frequent physical activity did not change their activity levels postoperatively, accumulating fewer than 10 minutes of daily exercise both before and after surgery. When researchers looked at health-related quality of life, they discovered that individuals who became active following bariatric surgery, as well as those who were already physically active, reported greater improvements in areas such as general health, vitality, depression, and anxiety symptoms compared with those who remained inactive."Future studies should focus on identifying factors that can target those individuals who are likely to remain inactive after surgery and might require additional interventions to increase their level of physical activity," said Dr. Bond.

Source: Doctor's Guide

How did Britney Spears regain her slim figure?

The mother-of-two has mapped out a new healthy eating plan, in a bid to shed some pounds.

Britney: ''My diet has a lot to do with my getting into shape, "I have no sugar. I don't eat fruit or even fruit juice because of the sugar. I eat chicken and salmon and rice. "I eat avocados. I'll have egg whites for breakfast and sometimes turkey burgers for lunch. "I try to do just 1,200 calories a day. It may sound like it's not much, but it's actually a lot of food if you eat the right things,'" she added.

Transoral gastroplasty is feasible and apparently safe

“Transoral gastroplasty is feasible and apparently safe,” reported Jacques Deviere, MD, Department of Gastroenterology and Hepatopancreatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. Presenting these results during the 2008 Digestive Disease Week, Dr. Deviere reported that the second pilot study, which employed an approach modified from the first, has been sufficiently promising that a randomized study with a sham control has been recently launched. Participating centers are in the United States and Europe.

The transoral approach is based on a patented system called TOGA (Satiety Inc.), which employs transoral endoscopically guided staplers to create a stapled restrictive pouch along the lesser curve of the stomach. In the first pilot study with 21 patients, published earlier this year (Surg Endosc 2008;22:589-598), the device showed promise, producing a 24.4% excess weight loss at six months, but gaps in the staple line were observed in 13 (62%) of the patients. The device was modified before this second pilot study was conducted. The modifications were made in the stapler to improve precision and in the vacuum ports that are used to maneuver the gastric tissue.

In this more recent pilot study, 29 patients were treated at centers in Brussels and Mexico City. In the current protocol, the procedure is performed under general anesthesia. The stapling device is introduced along a guidewire and an endoscope is introduced through the device by a second operator for visualization. Tissue is sucked into vacuum ports to produce serosa-to-serosa and mucosa-to-mucosa apposition and is then stapled with a triple line of staples to create a pouch. The pouch restricts food volume for early satiety and has a narrowed outlet to slow emptying. In the second pilot study, the average procedure time was 94 minutes.
The procedure result was likened to a vertical band gastroplasty, but the major advantage over previous surgical procedures for obesity is the ability to avoid incisions in the abdominal wall, which is considered the source of many of the complications of bariatric surgery, including a slow recovery time.

“There were two serious adverse events in this series. The first was a case of respiratory insufficiency in a very obese patient who required prolonged intubation. The patient was fully recovered by the following day. The other was a case of acute gallstone pancreatitis seven months after the procedure,” Dr. Deviere said. He noted that staple line gaps were observed in 11 patients in this series, which is a large proportional reduction relative to the first pilot series. Most gaps were small and thought to be nonfunctional.
As part of the protocol, additional gastric restrictions were permitted after three months. This was performed in seven patients who were not considered to have achieved sufficient weight loss. Sedation rather than general anesthesia may be used for these procedures.

The most commonly reported side effects were pain, gastric ulcer, asthenia, diarrhea and nausea, but most resolved over time. Indeed, quality-of-life (QOL) measures produced “dramatic improvements” whether based on obesity-related QOL or general QOL, according to Dr. Deviere. Although he conceded that far longer follow-up is needed to assess the ability of this approach to provide sustained weight loss, the results have been sufficiently encouraging to prompt the randomized trial now under way.
Others have not overlooked the potential advantages of a transoral approach to obesity surgery. Another endoscopic device for full-thickness gastroplasty, which may be appropriate for surgical treatment of gastroesophageal reflux disease (GERD) as well as obesity, has also demonstrated promise in experimental models of disease. Although at an earlier stage of development, this device, which is also patented (SafeStich Medical Inc.), has an integrated excision and suture apparatus and also uses vacuum ports to maneuver the gastric wall.
This device, developed by Charles J. Filipi, MD, professor of surgery at Creighton University School of Medicine, Omaha, Neb., produces a pouch with a full-thickness muscularis propria-to-muscularis propria apposition.

“The preclinical work has demonstrated the feasibility of this device,” confirmed Rudolf J. Stadlhuber, MD, who presented the results on behalf of a team of researchers working at Creighton University. In animals, the procedure has been conducted with conscious sedation. Based on results so far, Dr. Stadlhuber predicted that clinical trials will begin next year.
Responding to Dr. Deviere’s comparison of this transoral approach to vertical band gastroplasty, a procedure that has been largely abandoned because of lack of long-term benefit, Eric Hungness, MD, a bariatric surgeon and assistant professor of surgery at Northwestern University Feinberg School of Medicine, Chicago, suggested that it might be appropriate to remain circumspect until longer follow-up is performed. He indicated that despite the obvious advantages to a transoral route, there are now many bariatric procedures discarded because of lack of sustained weight loss.

Acknowledging the gap often observed between short- and long-term benefits, Dr. Deviere agreed that the feasibility of a transoral route does not prove efficacy. He also acknowledged the need for larger numbers of patients evaluated in a controlled trial. However, he also suggested that easier surgical procedures are needed for the massive public health threat posed by obesity.
According to Dr. Deviere, “surgery is the major player in the treatment of obesity” outside of lifestyle changes, making easier, less risky, and less costly procedures a priority as the obesity epidemic expands.

Source: General Surgery News

Urinary and fecal incontinence is common among women considering bariatric surgery for obesity

Now, researchers have found that the severity of fecal incontinence worsens for a majority of patients after the procedure, although the reason is not known.
“This is important because it’s an underappreciated problem,” said principal investigator Erica N. Roberson, MD, women’s health fellow at the University of Wisconsin in Madison. “Nobody really talks enough about incontinence among these patients.” More than half of patients who have the problem do not even mention it to their physicians, Dr. Roberson added, and physicians tend not to ask about the condition.

Recent studies have documented a high prevalence of urinary incontinence and fecal incontinence (67% and 32%, respectively) in women considering bariatric surgery and improvement of urinary incontinence after the procedure (Obstet Gynecol 2005. 106:1272-1277. NIH Consens State Sci Statements, 2007;24).
Dr. Roberson and her team mailed questionnaires to all patients who underwent bariatric surgery at the University of Wisconsin–Madison over a four-year span. The survey covered background information, type of surgery, weight change, symptoms of bowel and bladder disorders, and perceived effects of surgery on those symptoms.

Of 194 patients who responded (82% female), 51.2% who had liquid fecal incontinence prior to surgery said their conditions worsened afterward, compared with only 9.3% who reported improvement after surgery. Of the patients with solid fecal incontinence, 44.1% reported worsening diarrhea and 11.8% reported improvement of diarrhea after surgery. Of those patients with solid fecal incontinence prior to surgery, 54% said it worsened after surgery, and 11.8% reported an improvement. Urinary incontinence was reported by 73.4% of the respondents, although most reported either improvement or no change after surgery.

What’s the connection between bariatric surgery and incontinence? “We don’t have a good answer,” said Dr. Roberson. She offered some possibilities, including a change in diet or an anatomic change of the gastrointestinal tract. Diarrhea is known to occur frequently following bariatric surgery, and may relate to changes in diet after the procedure. Many patients change their diets drastically after surgery. Dr. Roberson hopes to address issues of causation in future studies.

Mark DeLegge, professor of medicine in the Department of Gastroenterology and Hepatology at the Medical University of South Carolina, Charleston, acknowledged that he had not realized that the problem of worsening incontinence was so prevalent in post–bariatric surgery patients.
“I see a lot of these patients and most have never mentioned this to me,” Dr. DeLegge said. In what he calls a “very unscientific evaluation” of a small number of his own patients, Dr. DeLegge found that some patients experienced somewhat worse fecal incontinence after the surgery, although they had not volunteered the information.

Dr. DeLegge speculated that fecal incontinence becomes a problem because many patients become more physically active after bariatric surgery. “I don’t think it’s a result of the surgery itself,” he said.

Source: General Surgery News

Large waist circumference is related to a higher risk of death

Whether you're shaped like an apple or a pear, if you're overweight, you have a higher risk of dying than someone of normal weight, a new European study says.

But, those who tend to collect their weight around the middle -- apple-shaped -- face an even higher risk of death than those whose excess weight tends to settle in their hips and thighs -- pear-shaped.

"We found that a large waist circumference is related to a higher risk of death even for individuals who have the same BMI [body mass index, a ratio of weight to height]," said the study's lead author, Dr. Tobias Pischon, of the German Institute of Human Nutrition. "Therefore, you could say that adipose [fat] accumulation in the abdominal region is even more detrimental than just having an elevated BMI level," he added.

Previous research had linked abdominal fat with a higher risk of chronic diseases. But past research generally hadn't assessed the risk of death in those who were overweight and those who were overweight with more abdominal fat, according to background information in the study.

The new research, published in the Nov. 13 issue of the New England Journal of Medicine, included almost 360,000 people from nine European countries who were part of the European Prospective Investigation into Cancer and Nutrition (EPIC).

In addition to weight information and whether or not the study participants had died, the researchers also adjusted the data for education level, smoking status, alcohol consumption, physical activity and height.

During a follow-up period of almost 10 years, slightly less than 15,000 people enrolled in the study had died.

Those with the lowest risk of death were men with a BMI of 25.3 and women with a BMI of 24.3. A body mass index between 25 and 29.9 is considered overweight, and a BMI over 30 is considered obese, according to the U.S. National Heart, Lung, and Blood Institute.

Men with a BMI between 30 and 35 had a 24 percent increased risk of death compared to normal weight men. And women with a BMI between 30 and 35 had a 17 percent increased risk of death compared to their slimmer counterparts, Pischon said.

When the researchers factored in abdominal fat, they found that men with the largest waist circumference had more than double the risk of death, and women with the largest waist circumference increased their risk of death by 78 percent.

"Having a large waist circumference is related to a higher risk of death. This is even true for people who -- in terms of BMI -- would be considered as being normal weight," Pischon said.

Dr. Marc Siegel, an internist at New York University Langone Medical Center in New York City, said, "Fat is a problem. Obesity of all kinds correlates with heart disease, stroke, diabetes, and more. But, abdominal fat is a more rudimentary indicator of risk.

"The bottom line is, if you want to live a long and healthy life, eat right, exercise and reduce stress. Fat is bad for you, period," Siegel added.

Source: ShermanHealth

Weight-loss surgery that takes just an hour and leaves no scars

The usual method of reducing the size of the stomach - to cut food intake and encourage weight-loss is to perform 'open' surgery on the abdomen.

This requires a major incision and is risky for obese patients, who are at greater risk from complications such as stroke or heart attack. But now doctors can reduce the size of the stomach - by operating through the mouth.

In America, patients were discharged just a few hours later and the technique could soon arrive in the UK.

The procedure involves putting a camera attached to a tube into the mouth and lowering it down the digestive tract into the stomach.

Mounted on the camera are instruments, including a needle which allows the surgeon to sew a series of pleats in the lining of the stomach to reduce its size.

Source: Daily Mail

Banned drug Fenfluramine has been shown to have serious long-term effects

In a report published in the open access journal BMC Medicine, researchers have shown that people who stopped using fenfluramine eleven years ago had damaged heart valves up to seven years later.

Fenfluramine (and the closely related dexfenfluramine) were widely prescribed as half of a so-called 'fen/phen' drug combination used to combat obesity. Since its withdrawal, there have been reports that tens of thousands of lawsuits have been filed against the drug's manufacturers over damage caused. In this study, Charles Dahl from the Central Utah Clinic led a team of researchers who studied the heart condition of 5743 former fenfluramine users. He said, "Valve problems were common in individuals exposed to fenfluramines, more frequent in females and associated with duration of drug use in all valves assessed".

Heart valves, such as the aortic, mitral and tricuspid valves, ensure that blood flows in the correct direction around the heart. When they fail, blood back-flows (termed regurgitation). If the regurgitation is severe enough, congestive heart failure and/or the need for heart valve surgery may occur. Dahl said, "We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation".

This is the largest study to examine duration of exposure to the drug and the first to estimate the incidence of valvular surgery among prior users. The authors found that 0.44% of former fenfluramine users in this group had valve surgery as a result of the use of fenfluramines. This risk for valve surgery was increased approximately seven fold. They write, "This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer".

Source: Medical News Today

A chemical cousin of red wine extract resveratrol tricks the body to lose weight

The University of Louis Pasteur team found the drug protected mice against weight gain and insulin resistance. The drug SRT1720 - a chemical cousin of red wine extract resveratrol - targets the protein SIRT1, which is thought to combat ageing, Cell Metabolism reports. UK obesity experts said new drug treatments were needed but should be used alongside lifestyle changes. About a quarter of men and a third of women in the UK are overweight, according to government statistics. A change in diet and an increase in physical exercise can shift excess weight, but can be hard for many to maintain. With the removal of the anti-obesity pill rimonabant, also known as Acomplia, from the market amid safety concerns, fewer drug options exist.

Potent drug
The French team from the University Louis Pasteur became interested in the SIRT1 protein after earlier studies showing resveratrol countered some effects of a high-calorie diet via SIRT1.
But tests in mice suggested gallons of wine would be necessary for humans to stand a chance of getting the same benefits. The scientists turned their attention to creating a more potent drug that would specifically target SIRT1.

They found that a low dose of SRT1720 partially protected mice from gaining weight on a high-fat diet after 10 weeks of treatment. The drug worked by shifting the metabolism to a fat-burning mode that normally takes over only when energy levels are low.

At higher doses, the drug completely prevented weight gain. It also improved the rodents' blood sugar tolerance and insulin sensitivity, which are important for warding off diabetes. The mice showed no sign of side effects. However, the scientists say further studies are needed to test the drug's safety and efficacy before it could be used in humans.

Other scientists are investigating SIRT1 activators similar to SRT1720 developed by Sirtris Pharmaceuticals. Professor Stephen Bloom, who has been researching obesity at Imperial College London, said: "This sounds interesting but is terribly early. "We do need new treatments for obesity, particularly as there are 1,000 deaths a week in the UK from obesity."

Prof Ian Broom, of the Centre for Obesity Research and Epidemiology at The Robert Gordon University, said: "Research in this area is to be welcomed as an additional route of combating the obesity epidemic and associated comorbid disease." He added that any such drug should be used alongside dietary and lifestyle changes to tackle obesity.

Source: BBC News