Will taxes make us skinny?

Probably not, concedes an article in the NEJM calling for a tax on sugar-sweetened beverages. Efforts to discourage people from drinking caloric beverages have usually not resulted in significant weight loss, their analysis of the literature concludes. But a soda tax is still worthwhile, in their opinion, because it can reduce the degree of weight gain and provide funding for other public health efforts. Think of it like the tobacco tax. Will drinking a Coke soon carry the cost and stigma as toting pack of cigs?

Not if the soft drink manufacturers have anything to do with it, reports the New York Times. Obama may like the idea but it's going to be a hard sell, given the level of organized opposition. The opponents of the soda tax are calling themselves "Americans Against Food Taxes," the NYT says. The group's name might hint at the difference in understanding that has led to this conflict--do they really think that soda is a food?

Labels: health policy, taxes, weight loss

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posted by Stacey Butterfield at 10:27 AM   1 Comments

Mediterranean diet trumps low-fat diet for diabetes management

Researchers compared the effects of a Mediterranean-style diet versus a typical low-fat diet for diabetes management in one of the longest-term randomized trials of its kind to assess their effectiveness, durability and safety on the need for diabetes medications in overweight patients with newly-diagnosed type 2 diabetes.

Researchers randomly assigned 215 patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years. Nutritionists and dietitians counseled both groups in monthly sessions for the first year and bimonthly sessions for the next three years. Patients on the low-carbohydrate Mediterranean diet avoided medication, lost more weight, and decreased some coronary risk factors. Results were reported in Annals of Internal Medicine.

After four years, 44% of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy compared to 70% in the low-fat diet group. Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.

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Labels: Diabetes, diet, obesity, weight loss

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posted by Ryan DuBosar at 7:00 AM   0 Comments

Medical news of the obvious

Depressed people were almost three times as likely to have impaired cognition after gloomy weather in one study. Researchers screened by phone 16,800 Americans enrolled in a stroke study for signs of depression and then administered a cognition test. Data were correlated with NASA's daily records of how bright sunlight was at any given location for the two weeks before the test. We're not rocket scientists, but two weeks of cloudy weather is enough to fog anyone's senses, let alone people who are already depressed.

This next video starts off with what exercisers knew intuitively: Working out makes one hungrier. But does exercise really make it harder to lose weight? Let's sit on the couch for a while and mull that over ...

Labels: depression, exercise, medical news of the obvious, weight loss

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posted by the staff of ACP News at 9:00 AM   0 Comments

Bye bye for BMI?

My dance major friend who was once classified as obese by a school nurse would appreciate this new article on Slate. After reviewing the the history of the body-mass index (did you know it was developed in 1832?), the author makes a case for giving it up as a measure of individual patients' health. A doctor's eyeballing is often a better judge of whether a person should lose weight than the BMI, the article argues.

It may be worthwhile to also have a more objective measure. (After all, we wouldn't want weight assessment to slide into the common standard I once heard an expert describe for alcohol abuse: "Anything more than mine.") So why not a tape measure around the waist? It's cheap, quick, and an evidence-based predictor of disease, notes the Slate article.

Will the tape measure be replacing the scale in an office near you? Probably not, but it's another reason to start doing those sit-ups. Better be ready to suck it in when the time comes.

Labels: BMI, weight loss

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posted by Stacey Butterfield at 3:35 PM   0 Comments

DDW: Nonalcoholic steatohepatitis

Although everyone would like a quick fix to treat nonalcoholic steatohepatitis (NASH) and its attendant problems with blood pressure and diabetes, the best bet seems to be the one that can be hardest to sell to patients: weight loss.

The question then becomes, which is the most effective way to make that happen? During today's session on "Approaches to Weight Loss in NASH: When and How Aggressive," presenter Kittichai Promrat, MD, made the case for lifestyle intervention. He said a recent study he was involved with showed a 9.3% weight reduction in patients who received a portion-control diet, a meal plan, a pedometer to measure steps, and other interventions versus 0.2% of those who did not.

The major challenge after that, he said, is finding a self-regulating program that will help patients maintain that weight loss.

Is one diet better than another? According to Dr. Promrat, the answer is no. He cited a recent study that found that while a low-carb diet reduced more fat initially, once patients reached 7% weight loss, the amount of fat reduction was the same. And because compliance is so difficult, he recommended that doctors be flexible.

"A diet that fits the patient's personal preference and can be maintained is best," he said.

Before recommending surgery...
At that same session, Raphael Merriman, MD, urged caution when looking to bariatric surgery to resolve NASH. He said that's a very real concern given that in 2008 there were more than 200,000 bariatric surgeries, what he called "a staggering number."

Although some data show promising results with certain types of bariatric procedures, he said more is needed to make the recommendation. He noted that the surgery's main goal is weight loss--not fixing NASH. In fact, not all patients undergoing the procedure have fatty liver disease.

--By Paula Katz, special to ACP Internist

Labels: digestive disease week, NASH, weight loss

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posted by Janet Colwell at 8:39 AM   0 Comments

Step away from the doughnut

Physicians--and everyone else in the world--know that diet and exercise are the pillars to weight loss. But a study presented Friday at the European Congress on Obesity suggests that diet is, by far, the main culprit when it comes to packing on pounds, and should be the focus of weight-loss efforts as well, Science Daily reports.

The rise of obesity in the U.S. since the 1970s can pretty much be blamed on eating more calories, the study found. In order to get back to those sleek '70s physiques, adults would need to cut about 500 calories a day from their diets, and children would need to cut about 350 calories a day.

The alternative is to add about 2 extra hours of walking time to your day (2.5 hours if you're a kid). Which doesn't seem very realistic. Exercise is, of course, wonderful for many reasons and should be maintained and promoted, the study authors said. But to really combat the obesity epidemic in the country, Americans have simply got to stop pigging out.

Labels: obesity, weight loss

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posted by Jessica Berthold at 11:15 AM   0 Comments

Fat is bad, you know

It was a small feeding of the mind to put you off feeding. The lecture this morning by Louis Arronne, FACP, reviewed all the negative consequences of obesity and offered a few additional tidbits:

• Hoodia, the trendy OTC weight loss supplement, is not a good idea. The extract it comes from could have negative cardiac effects. "The good news is that most compounds that are said to have hoodia actually have no hoodia in them," Dr. Arronne said.
• Exercise is important, particularly for weight maintenance. You're not going to lose weight with just exercise, unless you work out like Michael Phelps. But exercise can compensate for the increased muscle efficiency that follows weight loss, the doctor said.

Labels: internal medicine 2009, weight loss

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posted by Stacey Butterfield at 12:16 PM   0 Comments

Finally, a practical use for Twittering

One of our constant questions at ACP Internist is: What is Twitter really useful for? Everyone has a feed but no one is really saying anything. Just as we'd given up on a practical purpose for it, (surgery aside) we found two bread-and-butter applications for internal medicine: smoking cessation and weight loss.

Qwitter helps users track how many cigarettes they smoke, keep a journal, view progress over time and share info with supporters.

Next, you can Tweet what you Eat, using Twitter to set up a diary, track consumption, enter calories and find our how many are in the food you eat.

Personally, I think Twittering would help reduce smoking or eating just because it's something else to do with your hands. If you try these, or let patients try them, let us know how you fare.

Labels: diet, smoking cessation, social networking, weight loss

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posted by Ryan DuBosar at 8:30 AM   2 Comments

Athletes want to share the fat

Studies about weight typically focus on how to lose it, but a recent study in Spain reveals that fat is sometimes coveted in the world of professional sports.

Researchers at the University of the Basque Country hypothesized that top-flight soccer players are generally more satisfied with their body images than other young men, according to a news release from Spain's Scientific Information and News Service. Predictably, a control group of university-age men said they'd like more muscular bodies but another group of Spanish League soccer players said that while they always try to build muscle they'd also like to add body fat in order to look more like other young men their age. Goes to show that the grass is always greener...

Turns out fat can also help you look younger, according to a new study of identical twins. After age 40, twins who had substantially higher BMIs than their identical sibling also had much younger looking faces.

Labels: obesity, weight loss

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posted by Janet Colwell at 8:38 AM   0 Comments

Don't let Halloween go to waist

With obesity and in particular childhood obesity in the news so much, parents are finding ways to cut back on Halloween candy excesses, including exchanging candy for money or toys.

It takes about 3,500 calories to produce a pound of weight gain. Exercising off 3,500 calories produces a pound of weight loss. But how much candy makes up 3,500 calories?

Kid's Health, the well-respected, ad-free resource, offers an easy and kid-enticing game to calculate how much candy makes up a day's worth of calories, which they estimated at 2,000 for kids ages 8-12. Eight big candy bars is all it takes to get a day's worth of calories. By the same measure, 13 would produce an extra pound of weight. Keep that in mind when checking over the Halloween loot.

Labels: diet, obesity, weight loss

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posted by Ryan DuBosar at 6:00 AM   0 Comments

Patient weight loss tool

I've stumbled upon an online weight loss tool I really like, and some of your patients might like it, too.

It's "Calorie Count Plus", a food and activity tracker on About.com. With minimum effort on the user's part, the site keeps track of the daily calories you burn as well as those you consume, and will chart the results over time. (remember, this strategy works: an August study in the American Journal of Preventive Medicine found keeping a food diary can double the chances of losing weight.)

The site also has a feature where you can look up the calorie and nutrition information of the foods you eat, and it will give you a nutrition analysis and grade (A-F) according to how balanced your diet is. You can also keep a journal, participate in message boards and make "friends" through the site, if you choose.

My favorite feature: The "calories burned" counter resets to zero at midnight and updates throughout the day, using a projection based on your weight and height, plus any activities you tell it to include. It's kind of fun (and motivating) to watch that number climb.

Heck, I burned 10 calories just sitting here writing this blog post.

Labels: obesity, weight loss

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posted by Jessica Berthold at 12:11 PM   0 Comments