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  • 19
    Oct
    2012
    9:08am, EDT

    Severe obesity still rising fast among younger Americans

    Reuters

    The number of U.S. residents who are severely obese shot up by 70 percent in the past decade or so, though the increase has slowed in more recent years, according to a U.S. study.

    Between 2000 and 2010, the proportion of U.S. residents who were severely obese - at least 45 kilograms (100 lbs) overweight - rose from 4 percent to almost 7 percent, said researchers whose findings appeared in the International Journal of Obesity.

    The increase showed signs of slowing after 2005, they added. But the bad news is that the severely obese remain the fastest-growing segment of obese Americans, said study leader Roland Sturm, a senior economist at the non-profit research institute RAND Corporation.

    "Everybody's talking about obesity leveling off," Sturm said. But what tends to get lost in the discussion is the fact that severe obesity, with a body mass index (BMI) of 40 or higher - is still rising fast.

    That's important, Sturm said, because those are the people who have the highest healthcare costs, about double those of normal-weight people.

    More than one-third of U.S. adults are obese, which means having a BMI of 30 or higher. BMI is a measure of weight relative to height.

    Recent studies have found that the nation's obesity rate among adults and children may be leveling off, but most of those folks are moderately obese.

    The findings for the current study were based on data from an annual government health survey of U.S. adults. BMI estimates were made based on people's self-reported weight and height.

    Moderate obesity, the study found, rose relatively slowly after 2000 and seemed to level off from 2005 on. In contrast, the proportion of Americans with a BMI of 40 climbed by more than 70 percent - translating to about 15 million U.S. adults.

    The rate of severe obesity was 50 percent higher among women than men, and twice as high among black Americans as among white and Hispanic adults.

    The increases were bigger among people under 40.

    Severely obese people are at high risk of conditions like diabetes, severe arthritis and heart disease - and could also be candidates for obesity surgery.

    But Sturm said there are other costs besides the healthcare price tag, such as the human cost of living with obesity.

    "There's the disability and inability to work. People may be basically forced into retirement because they can't work," he said.

    Sturm said that doctors once thought of severe obesity as a problem that affected a small and stable percentage of people who were genetically vulnerable to huge weight gain.

    "That thinking has been proven wrong. This is something that can happen to a surprisingly large percentage of the population," he added.

    More from NBC News health:

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  • 18
    Sep
    2012
    10:03am, EDT

    If you think we're fat now, wait till 2030

    Image Source / Getty Images file

    In the 13 heaviest states, 60 percent of residents will be obese in less than two decades if current trends continue, finds a new report.

    By Maggie Fox, Senior Writer, NBC News

    Think Americans are fat now? After all, a third of us are overweight and another 35 percent are obese. But a report out Tuesday projects 44 percent of Americans will be obese by 2030.

    In the 13 worst states, 60 percent of the residents will be obese in less than two decades if current trends continue, the report from the Trust for America’s Health projects. That’s not chubby or a little plump – that’s clinically obese, bringing a higher risk of heart attacks, strokes, diabetes, several forms of cancer and arthritis.

    “The initial reaction is to say, ‘Oh it couldn’t be that bad’,” says Jeff Levi, executive director of the Trust for America’s Health. “But we have maps from 1991 and you see almost all the states below 10 percent.” By 2011 every single state was above 20 percent obesity, as measured by body mass index (BMI), the accepted medical way to calculate obesity. Those with a BMI or 30 or above are considered obese.

    In August, the Centers for Disease Control and Prevention reported that 12 states have an adult obesity rate over 30 percent. Mississippi had the highest rate of obesity at 34.9 percent. On the low end, 20.7 percent of Colorado residents are obese. CDC projections for obesity resemble those in Tuesday's report - it projects 42 percent of adults will be obese by 2030.

    The problem isn’t just cosmetic. “The number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020 — and then double again by 2030,” the report projects.  “Obesity-related health care costs could increase by more than 10 percent in 43 states and by more than 20 percent in nine states.”

    That’s bad news when states are already strapped to pay for public health programs such as Medicaid and the federal government is struggling to fund Medicare.

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    Over the next 20 years, more than 6 million patients will be able to blame obesity for their diabetes, 5 million will be diagnosed with heart disease and 400,000 will get cancer caused by obesity.

    And some of them are frighteningly young.

    "Now I am seeing 25-year-olds weighing 350 pounds who present with chest pain or shortness of breath," says Dr. Sheldon Litwin, a cardiologist at Georgia Health Sciences University. “Everything from the heart disease process to its diagnosis and treatment are affected by obesity. We see it every day. This really is the number-one issue facing us," added Litwin, who worked on one of a series of obesity studies published in this week’s issue of the Journal of the American Medical Association.

    The trend is not inevitable, according to the report, entitled “F as in Fat.” Some programs are beginning to make a dent in the rising rates.  “We certainly see, in some communities, the beginning of some changes,” says Levi. “We know what some of the answers are.”

    Convicted killer: I'm too obese to be executed

    For instance, making it easier for people to exercise day in and day out, and making it easier to get healthy food. “A large-scale study of New York City adults found that increasing the density of healthy food outlets, such as supermarkets, fruit and vegetable markets, and natural food stores is associated with lower BMIs and lower prevalence of obesity," the report reads.

    What about initiatives like New York’s controversial ban on the largest sodas? “Every community is going to experiment with different approaches. It is going to be very interesting to see what happens in New York and whether this makes a difference,” Levi said.

    New York’s health commissioner, Dr. Thomas Farley, defends the move in the medical journal’s obesity issue. "How should government address the health problems caused by this successful marketing of food? To do nothing is to invite even higher rates of obesity, diabetes, and related mortality,” he wrote.

    Trust for America's Health

    Many studies have also shown that people who live in big, walkable cities such as New York and Washington D.C. are thinner than their rural and suburban counterparts, and it’s almost certainly because they walk more and use public transportation instead of sitting in cars.

    If everyone lost just a little weight, the savings would be enormous, the study predicts.

    “If we could lower obesity trends by reducing body mass indices (BMIs) by only 5 percent in each state, we could spare millions of Americans from serious health problems and save billions of dollars in health spending —between 6.5 percent and 7.8 percent in costs in almost every state,” the report says.

    Education can’t hurt, either. The more educated people are, the less likely they are to be obese. Higher-earners are also thinner. “More than 33 percent of adults who earn less than $15,000 per year were obese, compared with 24.6 percent of those who earned at least $50,000 per year,” the report notes. And several studies have shown that people who eat more fruits and vegetables are thinner, as well as healthier. “Seven of the 10 states with the highest rates of obesity were also in the bottom 10 for fruit and vegetable consumption,” the report says.

    Levi believes it’s worthwhile targeting kids the hardest. New nutritional guidelines for schools will help, he said, as will initiatives to restore recess and physical education classes. Beverage makers have agreed to replace sugary sodas in vending machines with water and other low-calorie drinks. “It is as simple as an hour a day less of screen time and one less sugar beverage,” Levi says.  “Just 120 calories can make a big difference as to whether a kid crosses over from being normal weight into overweight and obesity.”

    Another study in the Journal of the American Medical Association showed that kids who exercised 20 minutes a day lowered an important measure of diabetes risk by 18 percent. Exercising 40 minutes a day cut the risk by 22 percent. The researchers also noted it’s important to make exercise fun for kids

    "Regulation sports tend to have kids standing around a lot waiting for the ball. We had enough balls so everyone was moving all the time," said Dr. Catherine Davis of Georgia Health Sciences University. "It had to be fun or they would not keep coming.”

    For some people, drastic measures remain an option. One study in the Journal shows that gastric bypass surgery is a viable option. And two doctors present opposing views over whether the Food and Drug Administration holds obesity drugs to an unreasonably high standard. On Tuesday, one of the newest obesity drugs hits the market - Qsymia, made by Vivus.

    Are you obese? The National Institutes of Health has a BMI calculator here. http://www.nhlbisupport.com/bmi/

    If you’re 5 feet 6 inches tall, you become overweight at 160 pounds (a BMI of 25.1) and obese at 192 pounds, when your BMI grows to 30.1.

    Trust for America's Health

     

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  • 22
    Aug
    2012
    1:06pm, EDT

    Antibiotics may help make you fat, studies show

    AP

    A clump of Staphylococcus epidermidis bacteria (green) in the extracellular matrix, which connects cells and tissue, taken with a scanning electron microscope. At right, the bacterium Enterococcus faecalis, which lives in the human gut, is just one type of microbe that live on your skin, up your nose, in your gut; enough bacteria, fungi and other microbes that collected together could weigh a few pounds. (AP Photo/National Institute of Allergy and Infectious Diseases (NIAID, Agriculture Department)

    By Maggie Fox, Senior Writer, NBC News

    Could antibiotics make you fat?

    Two studies this week suggest that using antibiotics may save people’s lives, but could also change their metabolisms. Put together, the studies suggest that taking antibiotics might alter digestion to help people absorb calories from food they normally would be unable to digest.

    Every human carries pounds of microorganisms that we couldn’t live without. They break down food and extract nutrients like Vitamin K for us. Antibiotics will kill some of these beneficial organisms, which is why so many doctors now tell patients to eat yogurt after taking a course of the drugs, to replace some of the good guys.

    “There is emerging evidence suggesting the importance of the microbes in our intestines and their role in absorbing food,” said Dr. Leonardo Trasande of New York University, who led one of the studies.

    The two studies look at different sides of the coin, and help answer two questions -- whether antibiotics really do affect how we absorb nutrients, and how they might do so. Together, they support the idea that the drugs kill off some populations of bacteria and allow microbes to flourish that are very good at getting calories out of hard-to-digest plant foods.

    Trasande’s team looked at the medical records of more than 11,000 newborns in Britain, who were carefully followed after they were born in the 1990s. The babies who got antibiotics before they were 6 months old were 22 percent more likely to be overweight by the time they were 3 years old, the team reported in the International Journal of Obesity. If they got antibiotics later in childhood, there wasn’t a strong effect – something that could suggest the antibiotics changed the balance of the microbes as they were just setting up shop in the infants. Babies are born with sterile digestive tracts, and they acquire bacteria, yeast and other microorganisms mostly from their mothers. The germs are collectively called “flora” by scientists.

    “They play key roles in immune functions, among other things,” Trasande told NBC News. “Antibiotics disrupt the development of the healthy flora in our gut. The earlier the exposure occurs, the more disruptions occur,” Trasande says. “It seems the first few days and months are important. It is difficult to reconstitute that in later life.”

    The other piece of the puzzle is whether it’s the antibiotics or something else that is doing this. Dr. Martin Blaser of New York University has been studying the effects of antibiotics on the body for years. A second team he heads has been studying what happens if you feed antibiotics to animals.

    They wanted to replicate what farmers have known for decades -- that giving low doses of antibiotics to farm animals make them fatter. Many experts had thought the drugs were keeping the animals from getting infections and making them healthier, but Blaser suspected something else was going on.

    When his team gave mice low doses of antibiotics long-term, the mice got fatter even though they weren’t eating any more than other mice. This, they report this week’s issue of the journal Nature, suggests the antibiotics somehow make the mice absorb more calories from their food.

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    “We have other work that is in process that continues to confirm and extend this,” Blaser said. “That work shows that giving antibiotics early in life, similar to what farmers do in their farm animals, is changing metabolism in mice and making them bigger and fatter.”

    The gastrointestinal tract is also the center of hormone production, the researchers said. It’s possible altering the organisms in the intestines – called the microbiome -- could help people better absorb nutrients and calories from “indigestible” foods such as cellulose.

    The second NYU team gave the mice varying combinations of the antibiotics penicillin, vancomycin and chlortetracycline. Mice that got the antibiotics piled on more fat than other mice, even though the fatter mice did not eat more. Also, their poop had fewer calories – suggesting they were absorbing more and eliminating less.

    Other mouse studies being done by Blaser’s team show that giving antibiotics to mice every once in a while -- akin to giving antibiotics to a child to treat ear infections -- also alter the gut bacteria.

    So does that explain why people are getting fatter? Does every dose of antibiotics kill off some bacteria, allowing the energy-efficient species to move in and squeeze every calorie out of an apple peel or bowl of high-fiber cereal?  

    “That’s at least one of the mechanisms,” says Blaser. But he notes that studies in people suggest it’s doses very early in life that matter most, just as various colonies of bacteria are getting established in the colon and intestines. And there’s an effect on the immune system, too. Other studies show that changing the balance of bacteria effects immune cells known as T-cells – something that may someday help explain links between diet and diseases such as inflammatory bowel diseases and perhaps even colon cancer.

    In other words, it is too soon to say whether a 5-day prescription of Zithromax for strep throat could make you fat.

    “A lot of things are interconnected,” Blaser says. “Obesity is multifactorial. I am not saying antibiotic effects on the microbiome are everything but our work suggests it is contributory. Whether it’s 10 percent or 70 percent, we don’t know yet.”

    Another big missing piece of the puzzle: Which species of bacteria are the most important? People have trillions of bacteria in and on their bodies. Microbes outnumber human cells by a factor of at least 10 to one and scientists believe at least 10,000 different species live in and on us. Healthy colonies of microbes not only process vitamins, but maintain pH balance on the skin, prevent tooth decay and even protect against infections. So which ones are killed by the antibiotics, and which do we want more of? No one knows yet.

    “We are just beginning to scratch the surface,” said Dr. Ilseung Cho, who worked on the study in mice.

    While it is important not to use antibiotics when they are not needed, the researchers stress that they do save lives. “I wouldn’t rush to come off any antibiotics right now,” Cho cautioned.

    It’s also not clear if food like yogurt, called probiotics, help much. “There is a concept called prebiotics,” Cho said. “It is essentially introducing nutrients into your digestive tract that would select for particular bacteria. Then you might be able to alter the bacteria.”

    Prebiotics are found in plain old food such as soybeans, jicama and raw oats, all of which are rich in compounds such as inulin, which people cannot digest, but which certain bacteria love.

    Related links:

    • Mapping one man's microbes
    • Bacteria affect mood
    • Ruled by your gut

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  • 11
    Jul
    2012
    1:07pm, EDT

    Fat-melting device a weighty matter for FDA

    Lilly Fowler/ FairWarning.org

    The RevecoMED International offices in Fullerton, Calif.

    By Myron Levin and Stuart Silverstein, FairWarning.org

    For several years, doctors and medical spas around the country have touted a fat-melting device called the LipoTron 3000, or Lipo-Ex, as a revolutionary way for people to slim down.


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    Signature Medical Spa in Tampa, Fla., in an online pitch for its “Lipo-Ex Spring Fling Fat-Off!,” described the technology as “truly the only non-invasive way to reduce fat.”

    Praise also came from Sculpt Medical Spa in Chicago, which called the procedure  “the most innovative, effective, and technologically advanced” non-surgical method of removing fat.


    Doctors have appeared on TV news shows in Houston, Phoenix and Miami to promote LipoTron treatments.

    These testimonials have translated into millions of dollars in sales for physicians,  med spas, and the device’s manufacturer, RevecoMED International of Fullerton, Calif.

    But there’s a problem: The LipoTron, which targets fat with radiofrequency waves, has never been cleared or approved by the U.S. Food and Drug Administration, which would make it illegal under federal law to sell or promote it for weight loss.

    The FDA is aware of the activity. But an investigation by FairWarning found that the agency has not taken enforcement action — even though it has known about the situation at least since January, 2010. At that time, two whistleblowers, one a former LipoTron distributor, provided sales records and a trove of other documents to an FDA criminal investigator.

    The case spotlights the booming, multi-billion-dollar business of aesthetic medicine—and the willingness of some doctors and med spas to use unapproved devices as they vie to be first with the latest technologies to smooth wrinkles, tighten skin and sculpt the body.

    The FDA won’t say if it is investigating Reveco, citing a policy not to discuss investigations or acknowledge if there is one.

    For his part, RevecoMED President James S. Rosen said the agency hasn’t contacted the company. He asserted that, “As of today, we are compliant with the FDA.”

    Still, for observers such as Dr. Patricia K. Farris, a clinical associate professor of medicine at Tulane University and a spokesperson for the American Academy of Dermatology, the situation is baffling.

    Told of the unauthorized sales, Farris responded: “It shocks me the FDA would not have cracked down on them.”

    “I mean, radiofrequency is an electrical device, and you can’t just be throwing these things in the marketplace without doing the right studies to make sure that, A, the device is safe and, B, that the thing does something and has some benefit.”

    Dr. Suzanne Yee, a Little Rock, Ark., plastic surgeon whom Reveco asked several years ago to take part in a LipoTron study, said she was surprised to learn that the company already was selling the device.

    She noted that some medical spas have falsely stated on their websites that the LipoTron is FDA-approved. “It’s not FDA-approved,” Yee said. “I think that’s dishonest.”

    There have been scattered incidents of patients receiving minor shocks and burns from LipoTron treatments, but no known reports of serious injury.

    While the FDA has failed to act, the Texas Department of State Health Services issued a warning letter last September to a Fort Worth distributor for marketing the LipoTron without FDA clearance. According to an agency report, Mark Durante, managing partner of Advanced Aesthetic Concepts, told state investigators that the LipoTron had been cleared by the FDA, but later corrected himself to say paperwork had been filed but no clearance yet given.

    Durante told FairWarning that, in response to the warning, his company changed some language on its website. However, a spokeswoman for the Texas agency said it recently opened a second complaint investigation of Advanced Aesthetic Concepts.

    Selling for as much as $85,000, the LipoTron passes radiofrequency waves through the body to heat, and destroy, fat cells. According to Reveco, the procedure targets subcutaneous fat, which is just below the skin, as well as visceral fat surrounding the vital organs, but without harming adjacent tissues. Spas typically recommend six to eight treatments for about $400 each.

    According to interviews and records, Reveco first sought a green light from the FDA in 2007. It chose the FDA’s market clearance procedure, which is less demanding than the formal approval process.

    To get a new device cleared this way, the manufacturer must show it is similar in safety and effectiveness to products that are already on the market.

    However, Reveco’s bid failed. The company’s initial application “wasn’t in-depth enough,” Rosen said, and the FDA repeatedly sought additional data. Finally, according to Rosen, “We said, ‘You know what, it’s not worth it.”

    According to interviews and a document reviewed by FairWarning, the FDA then told Reveco that the device could not be marketed.

    LipoTron sales continued, however. Rosen wouldn’t disclose how many of the devices have been sold, but the number is believed to be in the low hundreds.

    In 2011, Reveco took another tack with the FDA. It classified the LipoTron as a massager used for relief of minor pain. That would make it, in FDA parlance, a Class 1 device — a category that includes such simple, low-risk items as elastic bandages and examination gloves.

    The advantage for Reveco is that massagers can be sold without a green light from the FDA. They automatically are exempt from FDA review and can be put on the market once a notice is filed.

    Yet doctors and med spas have been promoting the device on the Internet not for massages but for removing fat.

    Rosen said that was not Reveco’s responsibility, stating that the company can’t dictate what doctors do or “police everything out on the Internet.”

    Asked who would pay $85,000 for a massager, Rosen replied: “Anybody that wants to buy it.”

    Physicians are free under federal law to prescribe unapproved, or “off-label,” uses of drugs or medical devices — but only if the products have been cleared or approved for another purpose, according to the FDA.

    FDA spokeswoman Sarah Clark-Lynn said in an email that if a device is not legally on the market, “a physician should not have been able to obtain it, much less use it on a patient.”

    Dr. Sherwood Baxt, a New Jersey plastic surgeon who advertised the procedure in a promotional video, said that when he bought the LipoTron he wasn’t troubled by its lack of FDA clearance. He explained that he had used unapproved devices before and, while he considered the agency’s green light a marketing advantage, he didn’t consider it necessary.

    Besides, Baxt said, “We were told FDA approval was imminent.”  It didn’t work out that way, however, and, he said, “After two years, I just stopped asking.”

    He continues to use the device for skin tightening on certain patients but quit using it for fat reduction. For fat reduction, Baxt said, “It wasn’t as effective as I thought it was going to be.”

    The FDA was informed of the unauthorized sales through an anonymous call. Paige Peterson, a former LipoTron distributor, and Belinda W. Worley, a marketing consultant who worked with her, told FairWarning they dialed in from a hospital phone in hopes the call could not be traced.

    But they agreed to meet with criminal investigator Evan Rae a few days later at a Hilton inn in Waco, mid-way between Rae’s office in Austin and Dallas, where Peterson and Worley lived.

    They found a quiet spot  in the lobby bar, which was closed in the morning, and talked for a couple of hours. Peterson said she gave Rae a detailed statement, a computer flash drive and copies of records, including emails, memos and invoices. Rae taped the conversation and snapped photos of the LipoTron 3000 the women had brought along. Rae declined to be interviewed.

    Peterson told FairWarning she had made 39 LipoTron sales, even though she was aware the device had not been cleared by the FDA. The evidence she gave Rae “was just as damning of me as everybody else. I have zero assurances that the FDA is not going to arrest me.”

    Peterson admitted there was no love lost between her and Reveco. She said she had paid out-of-pocket for some research costs aimed at getting FDA approval, but had not been reimbursed. And she said the company dumped her as a distributor in favor of another sales group.

    But Peterson also said Reveco had misled her with repeated assurances it was taking all proper steps and FDA approval was imminent—and spread this misinformation to some anxious customers.

    “I had run out of acceptable answers to give the doctors that had purchased the LipoTron,” she said. “I needed to fall on my sword and tell the truth.” Better to come clean, Peterson decided, than to wait for the FDA “to come knocking on my door.”

    While declining to comment on Peterson’s statements, Rosen said she had gone over to “the dark side.”

    “She’s a person that’s vindictive,” he said. “She’s doing it out of spite.”

    For her part, Peterson says that after 2½ years she is surprised and frustrated by the apparent lack of action.

    “Why do we have an FDA?” she asked.

    “I tried to do what I thought was right, and nobody’s doing anything about it. Everybody gets to thumb their nose at the law.”

    FairWarning.org is an online, nonprofit publication that seeks to provide robust, public interest journalism on issues of health, safety and corporate conduct.

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