Obesity...of course

I'm looking through my notes from the Endo conference for any last tidbits that might be useful for blog readers. Everyone's interested in obesity, so I thought I'd share the observations of Daniel Besessen, MD, of the University of Colorado at Aurora, who led a session on "The Year in Clinical Obesity."

He started off by noting that the CDC data from 2001-2003 suggest the rise in obesity over the last several years in the U.S. is slowing... at least for adults.

"Maybe we have reached a plateau" for adults, Dr. Besessen said. "But obesity in children still grows and there will be health consequences as those kids get older. Even a modest increase in body weight leads to an increase in mortality."

The authors of a 2007 article in the New England Journal of Medicine (NEJM) used 2000 data on adolescent obesity for a computer simulation that found that, by 2020, 37%-40% of 35-year-olds will be obese, he noted.

On the treatment side, bariatric surgery and gastric banding have gotten more popular, he noted. That's good news, in a sense, since a 2007 NEJM study found that bariatric surgery decreased an obese person's risk of death by 30% compared to the use of conventional behavioral therapy.

A 2008 Journal of the American Medical Association study, meanwhile, found that gastric banding in diabetics led to remission for 73% of patients, compared to 13% remission in the conventional therapy group-- all of which came about from the weight lost, Dr. Besessen said.

"Bariatric surgery has been shown to have dramatic benefits, and people are moving toward banding," Dr. Besessen said. "The effectiveness and safety of these treatments really depends on the (skill of the) surgeons, however."

And at a session on Novel Factors Contributing to the Obeisty Epidemic, experts tossed out these interesting tidbits:

• 7.5 hours of sleep is associated with the lowest BMI. More or less than this and the BMI starts creeping up, especially under 5 hours. In part, that's because inadequate sleep leads to an average increase of 24% in one's hunger level-- with people specifically craving fatty and starchy foods.

• High fructose corn syrup is similar to fat in the way it is metabolized. Fructose consumption is up 30% since 1970, with the average person drinking 56 gallons a year of sweetened soda. Diets high in fructose may cause dyslipidemia and insulin sensitivity, and increase intra-abdominal fat.
  
  

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posted by Jessica Berthold at 4:26 PM   0 Comments

Medical news of the obvious

This week's edition focuses on attempts by medicine to delve into basic human psychology.

Our first exhibit comes from the Endo '08 meeting. A group of pituitary researchers recruited recreational athletes for a test of human growth hormone. Some were given the hormones, some were given placebos, then they were asked to guess whether or not they were taking the real thing. The results: study participants who (wrongly) believed that they were taking hormones improved their athletic performance over the course of the study. Experts concluded that this finding could explain why athletes continue to take HGH even though there's no scientific evidence that it works. Uh, yeah. Or maybe the common assumption that HGH works leads people to attribute their performance improvement to it?

Then, a study in Archives of IM explored why HIV-positive patients participated in a phase III drug trial and found that "individuals participating in a clinical trial hope to benefit personally from the research but also understand they are contributing to society." So, to sum up, people actually have logical reasons--expected benefit either for themselves or others--that motivate them to take banned hormones or experimental drugs. Who knew?

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posted by Stacey Butterfield at 4:00 PM   0 Comments

Endo '08: Counseling patients about weight loss

Here's how Daniel Bessesen, MD, of the Univ of Colorado in Aurora, recommends dealing with patients who say they want to lose weight.

• Try to understand what the patient wants, and tailor your approach to that. Some want help with diet and exercise, others just want to take medication. Tell the patient his/her options are to either accept his/her current weight, to diet, to take drugs, or to have surgery. Also share the success rates of these approaches. Weight loss from diet/exercise is usually about 3-5% of current weight, drugs is 5-8%, and surgery is 3%,
• Consider how heavy the person is in considering whether a modest (like diet) or more serious (like surgery) approach is best. Also consider co-morbidities.
• If the patient decides to opt for changing his/her diet, send to a nutritionist if possible. Other options are meal replacement programs (like Slim Fast or Lean Cuisine), commercial programs like Weight Watchers, and Internet diet programs. There isn't much data on Internet programs yet, but there is quite a bit of data supporting the effectiveness of meal replacements.
• Keep circling through the patient's four options if he or she is resistant to your ideas. If, for example, a patient says she hates her weight but doesn't want to diet, then says she doesn't have time to exercise and that medications and surgery are too expensive, say "Well, it sounds like you want to accept your weight, then?" If she says no, then bring up the option of changing her diet again. This tactic works.

...and that concludes our on-site coverage of Endo '08. Hope you enjoyed it half as much as I did!

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posted by Jessica Berthold at 4:48 PM   0 Comments

Endo 08: Rats 1, Birds 0

Here are some interesting endocrinology findings from the animal world, courtesy of a session this morning by David Crews, PhD, a professor of zoology and psychology at UT-Austin:

Male starlings that were fed mealworms pumped with endocrine-disrupting compounds had a more elaborate song repertoire once mating season rolled around, which in turn made them more attractive to female starlings. That's all good, right?

Not really, because thes males were also found to be immuno-compromised, which means there's a pretty good chance their offspring would be, as well.

The good news, though, is that rat studies have shown female rats can actually discriminate (I believe by smell, but I'm not sure on this point) between those male rats that are immuno-compromised and those that aren't, and they prefer to mate with the latter.

Er, I mean, I guess that's good news, if you prefer rats to starlings.

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posted by Jessica Berthold at 2:26 PM   0 Comments

Endo 08: What to do about HRT in menopausal women?

Kathryn Horwitz, PhD, of the Univ. of Colorado Health Science Center, gave a fascinating talk today on "The Year in Hormones and Cancer."

As everyone knows, the WHI showed years ago that HRT increased the risk of breast cancer (though the numbers were small), and that the greatest risk seemed to be for women who were within five years of the start of menopause.

This is "disconcerting," Dr. Horwitz noted, since the effect of HRT on CVD is the opposite-- the further away from the start of menopause one is upon taking HRT, the greater the risk of CV problems.

What to do, then?

That's up to you. But if your patients are gonna use HRT, they should stick to transdermal applications and use the lowest possible dose, since research has found the direct delivery of HRT (as through a skin patch instead of an oral med) may decrease the risk of breast cancer.

And, she advised, don't use HRT at all with breast cancer survivors.

Why? Because research indicates that tumor cells stick around in women who had breast cancer and mastectomies up to 22 years after the mastectomy, even if there are no overt symptoms of the disease.

And-- get this-- one study in which researchers did autopsies on women who did NOT die of breast cancer found that about 10% had evidence of dormant cancerous cells. And 82% of those wouldn't have been detected on a mammogram.

Dr. Horwitz's theory from all this is that HRT doesn't actually cause new cancer cells to develop; instead it activates a reservoir of occult, silent disease cells in some women, and reactivates the dormant cells of breast cancer in others.

The good news is that she thinks this activation can be avoided or mitigated by using local delivery methods of HRT.
And she thinks she'll have a paper out in the next few months to help prove it.

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posted by Jessica Berthold at 5:49 PM   2 Comments

Endo 08: Weight loss fairy dust

In the future, you'll be able to sprinkle a magical powder on your food that will help you lose weight.

Scratch that. The future is now, and this magical formula is already available for the low low price of $210, thanks to Alan Hirsch, MD, neurologic director of the Smell and Taste Treatment and Research Foundation in Chicago. Dr. Hirsch presented the results of a study testing his magical weight-loss powder during a press conference here.

He says his study found that (surprise!) overweight and obese folks who flavored their food with calorie-free seasonings and sweeteners called "tastants" were more successful at losing weight than those who didn't use the tastants.

The 2,436 subjects put salt-free savory flavors on salty food and sugar-free sweet crystals on sweet or neutral foods. The"salty" flavors were cheddar cheese, onion, horseradish, ranch dressing, parmesan or taco, while the "sweet" flavors were cocoa, spearmint, banana, strawberry or malt. A control group of 100 didn't use tastants, and both groups were allowed to diet and exercise if they were already doing so.

After 6 months, the 1,436 subjects who finished the study lost an average of 31 pounds, vs. the average of 2 pounds lost by the control group. The BMI reductions were five vs. 0.3, respectively. Dr. Hirsch said he thinks tastants make people feel full faster and thus eat less and/or that the crystals make bland healthy food, like tofu and certain veggies, taste better-- which makes it easier to stick to healthy eating.

You can buy the powder online-- $210 gives you a six-month supply. The PR staff of the Endocrine Society tested a free sample on an apple mere minutes ago and report that it tastes pretty good. (None of them have lost weight in the last five minutes, however.)

If $210 is a bit rich for your blood, take Dr. Hirsch's alternate advice on how to use your senses for weight loss:

"Sniff your food before you eat. Chew it a lot."

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posted by Jessica Berthold at 4:30 PM   0 Comments

Endo 08: Forecast? Unprepared.

Success can be found in the most unexpected places. Like Walgreen's.

Allow me to explain. Many conference attendees, including me, were caught off guard by the cold and windy front that swept into SF on Sunday and Monday. (The high temperature Monday was 54 degrees. Without the windchill.) I saw several ENDO-badged brethren wandering the floors of the department stores near the convention center looking for warm clothes as they (and I) shivered in lightweight suits. Personally, after going to six stores, I could find only a gold hooded sweatshirt suitable for a 13-year-old, and a winter coat "on sale" for $300 at Macy's.
Then, on a side trip to Walgreen's for toothpaste, I hit upon a bonanza of toasty, affordable sweatshirts and jackets for tourists.

So if you someday find yourself at a conference in SF having a Mark Twain moment (he's the one who said his coldest winter was a summer in SF), you now know where to go to warm up. As long as you don't mind wearing a Giants jacket in front of your colleagues.

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posted by Jessica Berthold at 2:12 PM   0 Comments

Endo 08: Hot topics in reproductive biology

I sat in on an informal session with Kelly Mayo, PhD, a reproductive biologist at Northwestern University in Chicago, yesterday. He and the audience came up with a list of the hottest topics in reproductive biology at the moment, as well as the topics that represent the next frontier for research. Here are some of the ones they came up with:

Hot topics currently: PCOS, the ethics of reproductive science (stem cells, cloning, etc), endometriosis, circadian rhythms, diabetes in pregnancy, ovarian cancer, germ line stem cells, early puberty, hypertension in pregnancy, STDs, endocrine disruptors, orphan receptors.

The next frontier: the immune system role in reproduction, fetal/maternal interaction issues, gamete biology (i.e. what is a high-quality sperm or egg?), ovarian follicle formation, epigenetics in development, novel contraceptive options, reproductive cancers, regulation of meiosis, oocyte preservation, reproduction and metabolism.

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posted by Jessica Berthold at 12:04 PM   0 Comments

Endo 08: The role of exercise in weight loss

Conferences are a hotbed of divergent opinions on the same issue, which is one of the things that make them so exciting.

Today, there was a press conference (which I skipped to attend the session I just blogged about) about how 3 months of aerobic exercise decreased body fat and caloric intake in overweight and obese folks. Researchers think that changes to a CNS factor are the reason; they spotted increased levels of a protein that they think suppresses appetite.

A reasonable hypothesis might be that exercise inhibits appetite, which helps people eat less, and thus diet plus exercise work in tandem to help people lose weight.

Yet just yesterday, Daniel Bessesen, MD, of the Univ of Colorado in Aurora told an audience that if their patients really want to lose weight, the key is diet, not exercise. He said that, to lose weight, a person needs about a 500 kilocalorie deficit each day compared to her current diet, and that's really difficult to achieve through exercise. Exercise, he noted, has great health benefits and is helpful for maintaining weight...but it's not going to get those initial pounds off unless the person also diets.

Further, he said, past research has shown that the amount of weight a person loses from dieting, compared to dieting plus exercise, is pretty much the same. Exercise has the advantage of preserving lean body mass-- which may or may not be important to patients.

What do you think? Any internists out there want to share the weight-loss strategies that worked (or didn't) for their patients?

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posted by Jessica Berthold at 5:32 PM   0 Comments

Endo '08: Hypoglycemia in diabetes

A session on "Innovative Strategies for Prevention and Treatment of Hypoglycemia in Diabetes," by Stephen Davis, MD, was so packed that there was a horde outside the room watching the lecture on a TV screen, and a staffer blocking the door so no one else went in the room ("The fire marshall will have our heads," she said.)

The upshot was that there are multiple approaches under investigation that aim to amplify counterregulatory responses during hypoglycemia. Various recent studies, which point the way for future research and treatment, have found:

• Patients who were given troglitazone for 7 days had increased glucagon.
• Fructose significantly increases epinephrine and endogenous glucose production.
• After 7-days, caffeine-replete patients had significantly improved hypoglycemia awareness and response.
• Oral ingestions of amino acids for hypoglycemia can increase glucagon responses during hypoglycemia.
• SSRIs can progects against the deletrious effects of hypoglycemia. Non-depressed type 1 diabetics who took fluoxetine saw dramatic increases in norepinephrine and epinephrine , and their muscle and nerve activity also significantly increased.

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posted by Jessica Berthold at 5:08 PM   0 Comments

Endo 08: Diabetes gender gap

As soul icon James Brown told us, "This is a man's world."

Ioanna Gouni-Berthold, MD, can attest to that: her new study of almost 45,000 type 2 diabetics shows women with comorbid heart disease get less intensive medical treatment for, and have poorer control of, their diabetes and heart disease than comorbid men. Specifically, the women were 44% more likely than men to have high LDL, yet 15% less likely to get lipid-lowering medication. The women were also 19% more likely to have uncontrolled high BP, and 15% more likely to have poor long-term control of their blood glucose level.

These findings may explain why death from heart disease has decreased among diabetic men in the past 25 years, but it hasn't decreased for diabetic women, said Dr. Gouni-Berthold, a professor of medicine at the University of Cologne in Germany.

...A second study unveiled here found that it's important to stress exercise in type 2 diabetic men, no matter what their body type. That's because maintaining a moderate fitness level can reduce the risk of death by 40-50% for diabetic men, even if they are obese or overweight.

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posted by Jessica Berthold at 3:35 PM   0 Comments

Endo '08: Father's day edition.

Nothing like kicking off a convention with a press conference called "Sexy Sex Findings."

Aksam Yassin, MD, briefed reporters on a study that suggests internists should look carefully at male patients who show up in their office complaining of ED. These patients often have testosterone deficiency, diabetes, high BP and/or dyslipidemia, his study found, yet many of the patients are unaware of their problems. ED can thus be the gateway to finding and treating these issues, said Dr. Yassin, who is from the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany.

And now a little something for the ladies, as they say. Michael Snabes, MD, VP of clinical development at BioSante Pharmaceuticals, spoke about a planned study to test LibiGel, a testosterone treatment for low sexual desire in menopausal women. (Libido + Gel. Get it?) The study is examining CV and breast effects. If all goes well, the gel is expected to be available in 2011 for women age 50+ years. Mr. Snabes declined my offer to speculate on how much it might cost.

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posted by Jessica Berthold at 12:02 PM   0 Comments

Endo 08: Ill-advised session titles

I'm at the Endo '08 conference in San Francisco this week, which means it's time for another round of Ill-Advised Conference Session Titles. Without further ado:

Female Reproduction: Follicle follies in the ovary

Male Sexual function: Turning it on, off and keeping it alive

and my favorite:

The Thyroid & the Heart: A Lifelong Intimate Relationship.

...Feel free to vote on your favorite!

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posted by Jessica Berthold at 11:00 AM   0 Comments