Americans are falling into three gaps that threaten personal health and national solvency. Unless we reverse the trend, 43 percent of Americans will be overweight or obese by 2018, and the nation will spend $344 billion to address health-related problems.
The fat gap, a term coined by British researchers, refers to the discrepancy between how individuals see themselves and the number on the bathroom scale. Evidently, our notion of what constitutes being overweight or obese has been supersized because those around us -- friends, family and colleagues -- have similarly supersized their bodies.
In a British study reported Sept 2009, in the Telegraph, only 1 person in 10 identified themselves as being obese, when in fact 1 in 4 was obese (roughly 30 or more pounds overweight). As a result, "Ten million Brits are unaware they are obese because being fat is now seen as the 'norm.'" This lack of awareness unwittingly places the individual at risk for medical problems triggered by obesity.
In the United States, 2 out of 3 adults are overweight or obese. And since there is no reason to believe that our self-perception skills are more acute than those of our cousins in England, we can assume that millions of Americans are unaware that they are similarly at risk for medical problems associated with surplus weight.
Lest you think I am judging these individuals for their lack of self-awareness, I hasten to add that when, at 5 feet 1 inch, I tipped the scales at 183 pounds, I did not see myself as obese. Even though I was 60 pounds overweight, I saw myself as slightly pudgy. Besides, I didn't think I looked any worse than the people around me. I was trapped in the fat gap and was in the 90th percentile for risk of heart disease, cancer, stroke and diabetes. If I hadn't lost weight and got fit, I would likely have become disabled or died.
I'm not alone in my self-deception. Dr. Nick Yphantides, author of My Big Fat Greek Diet, fell into a similar massive fat gap because of an inaccurate self-perception. Just before his own radical, nonsurgical weight-loss adventure of 270 pounds, Nick estimated and told others that he weighed around 350 pounds. Not until he straddled two scales did he discover that he actually weighed 467 pounds. One of Nick's core messages is "you have to change the way you see before you can change the way you look, and this certainly applies to how we see ourselves."
These anecdotes explain why the fat gap is triggering a generation gap that is reversing decades of improvements in the health of seniors. For the first time in decades, Americans currently in their 60s are going to suffer more disabilities and medical problems -- leading to a loss of independence -- than did the preceding generations.
Researchers report this disturbing trend in a study funded by the National Institute on Aging reported in the November 2009 issue of the American Journal of Public Health. Seniors who grew up in the 1920s and 1930s enjoyed healthier food (junk food had yet to be introduced) and regularly participated in physical exercise in schools. They may also have worked in jobs that required physical effort. These and other factors have tended to protect their health.
In contrast, the biggest factor contributing to the declining health of the next generation of seniors is the expanding rate of obesity. Those who are overweight or obese strain their joints and cardiovascular systems, and they are more susceptible to diabetes and stroke. Consequently, even if the members of this generation survive a heart attack or stroke, they may be left with disabilities.
The decline in health may increase as future generations with even higher rates of obesity reach their senior years. In 2018, researchers predict that 43 percent of Americans will be obese.
Diabetes has already reached epidemic proportions among children, and 70 percent of adults 65 and older are either diabetic or prediabetic, which means they are on their way to being diabetic unless lifestyle changes are undertaken.
The explanation for the rising incidence of obesity may be related to yet another phenomenon -- the appetite gap. The appetite gap is the discrepancy between what the body needs to maintain a normal weight and a sense of satiety that triggers an end to eating. If food doesn't trigger a sense of having eaten enough, individuals keep eating even though they may already have consumed more calories than required to maintain their weight.
The results of an experiment with rats, reported in the September 2009 issue of the Journal of Clinical Investigation, attempt to explain the chemistry behind appetite gaps. Rats fed a diet high in saturated fat for only three days -- comparable to a human eating cheeseburgers and French fries for three days -- showed a reduction in the hormones that trigger a sense of satiety.
Eating a diet high in saturated fats increased the appetites of the rats and these findings raised an interesting question: why would consuming saturated fat trigger a craving for more fat? Logic tells us that the opposite should occur: if the rat ate copious amounts of fat, the rat should feel satisfied. That the biochemical mechanism would trigger a craving for more fat seems counterintuitive. (Interestingly enough, healthy fats, such as those found in olive oil, did not suppress the satiety hormones.)
If a diet high in saturated fats produces weight gain in rats and the body chemistry of rats is similar to that of humans, then the growing epidemic of human obesity would be understandable. Saturated fats are common in many American foods -- from fatty cuts of meat, bacon and processed meats to cookies, cakes, ice cream and muffins. Consuming these foods may be triggering a craving for even more fatty food and contributing to the rising level of obesity.
The mystery of the appetite gap remains unsolved pending further investigation. Although pieces of the puzzle are being put in place, it's unlikely that scientists will quickly determine the precise cause (or causes) of obesity and mass-market a simple, safe solution that will help us bridge the gap. It's more likely we'll need to modify our own behavior.
Dr. Yphantides considers behavior modification to be a key issue. "In order to achieve and sustain an ideal weight, people need to rediscover the importance of eating to the point of appropriate satisfaction and satiety rather than packing themselves like a cannon or a Thanksgiving turkey."
Besides moderating portion size, individuals who want to avoid falling into the fat gap may want to replace junk food with the Mediterranean-based diet suggested by the Mayo Clinic. The diet recommends the following:
--Eating a generous amount of fruits and vegetables
--Consuming healthy fats such as olive oil and canola oil
--Using herbs and spices instead of salt to flavor foods
--Eating small portions of nuts
--Drinking red wine, in moderation, for some
--Consuming very little red meat
--Eating fish or shellfish at least twice a week
Besides including the food groups from the Mediterranean diet, individuals can also benefit from regular exercise and meals with family and friends.
We have choices, and we must make them in full knowledge that our future is at stake. If we want to enjoy longer, healthier lives and reduce our burgeoning medical expenses, we'll have to find or create ways to close the gaps.
Dubbed "An Apostle for Fitness" by the Wall Street Journal, Carole Carson was the inspiration behind the Nevada County Meltdown, where more than 1,000 people lost nearly 8,000 pounds. Carole is the author of From Fat to Fit: Turn Yourself into a Weapon of Mass Reduction and serves as the national coach for the AARP Fat to Fit Community Challenge, a free weight-loss program welcoming all ages.
Disturbing: Obesity Rate For 2 To 5 Yr. Olds Between 8.5 percent And 13.4 percent
30,000 Premature Cardiovascular Deaths Per Year--Preventable
Olympia Dukakis Urges Diabetic Screening: 7 Of 10 Aged 65+ At Risk
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Showing posts with label Obesity and Diabetes. Show all posts
Showing posts with label Obesity and Diabetes. Show all posts
Saturday, December 12, 2009
Tuesday, September 29, 2009
Diabetes and the Pancreas
The pancreas functions as a linchpin in some of the biggest medical crises that we face, including with diabetes and obesity.
Should anybody in the reliably pestilent health care debate be casting about for a mascot organ to represent some of the biggest medical crises that we face, allow me to nominate a nonobvious candidate: the pancreas.
It may lie in the hidden depths of the abdominal cavity, and its appearance, size and purpose may be obscure to the average person. Yet the pancreas turns out to be a linchpin in two epidemics that are all too familiar.
As the organ entrusted with the manufacture of insulin and other hormones that help control blood sugar, the pancreas gone awry is a source of diabetes, which afflicts more than 23 million people in the United States. The World Health Organization estimated the global figure in 2000 at 171 million, and projected that by 2030, 366 million would be affected. And as the tireless brewer of digestive juices that help shear apart the amalgamated foodstuffs that we consume each day, the pancreas is at the frontlines of obesity.
Researchers are discovering that the pancreas helps mediate much of the appetite-related cross talk between the brain and the gastrointestinal tract, the streams of chemical signals that say, I'm starving down here, how about some dinner, or, enough already, step away from that dessert cart and no one will be hurt. By better understanding the precise role of the pancreas in conveying sensations of hunger or satiety, suggested Rodger A. Liddle of Duke University Medical School, we may find new ways to combat obesity.
Other researchers are intrigued by the pancreas' ability to shield itself from harm, to churn out huge quantities of enzymes that can rapidly reduce a cheeseburger and fries to so many particles of amino acids, carbohydrates and fats, without digesting its own tissue in the process. They suspect that the organ's set of self-protective mechanisms has a terrible downside, and helps explain why pancreatic cancer can be so difficult to treat -- insights that are just beginning to offer hope in the fight against one of the most lethal of all malignancies.
Early anatomists were certainly aware of the pancreas but mostly ignored it, and the organ's name reflects that ho-hum attitude. Pancreas is Greek for all-meat, a reference to its seeming homogeneity from one end to the other.
Much of the neglect may well have been practical. "The pancreas has always been difficult to study," Dr. Liddle said. For one thing, it's hidden. Measuring some 6 to 8 inches, or 15 to 20 centimeters, in length, and slippery and lobular to the touch, the yellowish- brown pancreas is located deep in the abdomen, wedged between the stomach and the spinal cord and extending horizontally right above the waistline. Think of it as an oblong eel.
Add to that inaccessibility a prima donna sensitivity. "If you do anything to the pancreas, you initiate an inflammatory response," Dr.Liddle said. "It tends to become inflamed more easily than other organs."
In fact, inflammation of the pancreas, or pancreatitis, is a relatively common and often debilitating condition, brought on by excess alcohol, drug reactions, gallstones, genetic predisposition or other reasons. Unfortunately, said Dr. Anthony Kalloo, a professor of medicine at the Johns Hopkins University School of Medicine, the symptoms of pancreatitis, like chronic abdominal pain radiating into the back, could be misdiagnosed or dismissed as a hypochondriac's lament.
As a result, Dr. Kalloo said, patients do not always receive the right pain medications, the optimal diet, surgery when necessary.
For all the difficulty of studying the pancreas, researchers eventually came to appreciate the organ as a gland of many talents, serving both an exocrine role -- secreting its products through ducts, as the breast secretes milk and the sweat glands perspiration -- and an endocrine role, fabricating hormones and squirting them into the bloodstream, as the ovaries and testes dispense sex hormones and the thyroid thyroxine.
Roughly 90 percent of the pancreas is devoted to its exocrinic role of generating digestive enzymes and funneling them into the small intestine, a burbling broth that flows forth from the pancreas at a rate of perhaps a quart a day.
The other 10 percent of pancreatic tissue consists of so-called islet cells, the endocrine players that synthesize insulin and glucagon to manipulate and titrate blood sugar, the body's energy currency, as needed. In people with Type 1, or juvenile-onset, diabetes -- among them Justice Sonia Sotomayor of the Supreme Court - - an autoimmune reaction ends up destroying many of these islet cells, resulting in the need for lifelong insulin injections. Among sufferers of Type 2, or adult-onset, diabetes, the reasons for insulin imbalance are more varied, and the condition can often be treated through diet and exercise alone.
Imagine the pancreas as a tree, Dr. Liddle suggested. The trunk and branches are the ducts that deliver digestive juices, the leaves the factories that make digestive enzymes, and the islet cells birds' nests scattered throughout -- in the tree but not of it.
When cancer strikes, it generally arises in the ductal tissue of the pancreas, the woody parts of our metaphoric tree, and intriguingly, they feel the part. "These tumors are rock-hard masses," said Peter Olson, an oncology researcher at the University of California, San Francisco. "They're white on dissection, very tough and fibrous."
Pancreatic cancer is almost impossible to cure. About 34,000 Americans will be diagnosed with it this year, and nearly as many will die of it. As doctors have long known, some of that lethality is positional: There is no easy way to screen the deep-set pancreas for early signs of malignancy, and by the time symptoms arise, the cancer already has spread to other organs.
Another reason for the ferocity, however, might be the nature of the tumors themselves. Most cancers are thought to spur the growth of new blood vessels to supply them with the extra oxygen and nutrients necessary for frenzied cell division, but pancreatic tumors are markedly devascularized.
"The number of blood vessels in a pancreatic tumor is 10 percent what it is in normal tissue, of the pancreas or anywhere else," said David A. Tuveson of the Cambridge Research Institute in England. The results are devastating. In the anoxic microenvironment beneath the fibrous, bloodless capsule, any malignant cells that survive become increasingly unstable and virulent, like super-roaches proliferating in the wake of a pesticide bomb. Moreover, without blood vessels, nothing can get into the tumor to kill the renegade cells, so chemotherapy is almost useless.
Reporting recently in the journal Science on results with genetically engineered mice, Dr. Tuveson and his colleagues described a new approach to treating pancreatic cancer, in which the tumors were revascularized and thus made sensitive to cancer drugs. Clinical trials are now under way to test the basic strategy in people, and with all due caveats, Dr. Tuveson said, "I am cautiously optimistic."
Should anybody in the reliably pestilent health care debate be casting about for a mascot organ to represent some of the biggest medical crises that we face, allow me to nominate a nonobvious candidate: the pancreas.
It may lie in the hidden depths of the abdominal cavity, and its appearance, size and purpose may be obscure to the average person. Yet the pancreas turns out to be a linchpin in two epidemics that are all too familiar.
As the organ entrusted with the manufacture of insulin and other hormones that help control blood sugar, the pancreas gone awry is a source of diabetes, which afflicts more than 23 million people in the United States. The World Health Organization estimated the global figure in 2000 at 171 million, and projected that by 2030, 366 million would be affected. And as the tireless brewer of digestive juices that help shear apart the amalgamated foodstuffs that we consume each day, the pancreas is at the frontlines of obesity.
Researchers are discovering that the pancreas helps mediate much of the appetite-related cross talk between the brain and the gastrointestinal tract, the streams of chemical signals that say, I'm starving down here, how about some dinner, or, enough already, step away from that dessert cart and no one will be hurt. By better understanding the precise role of the pancreas in conveying sensations of hunger or satiety, suggested Rodger A. Liddle of Duke University Medical School, we may find new ways to combat obesity.
Other researchers are intrigued by the pancreas' ability to shield itself from harm, to churn out huge quantities of enzymes that can rapidly reduce a cheeseburger and fries to so many particles of amino acids, carbohydrates and fats, without digesting its own tissue in the process. They suspect that the organ's set of self-protective mechanisms has a terrible downside, and helps explain why pancreatic cancer can be so difficult to treat -- insights that are just beginning to offer hope in the fight against one of the most lethal of all malignancies.
Early anatomists were certainly aware of the pancreas but mostly ignored it, and the organ's name reflects that ho-hum attitude. Pancreas is Greek for all-meat, a reference to its seeming homogeneity from one end to the other.
Much of the neglect may well have been practical. "The pancreas has always been difficult to study," Dr. Liddle said. For one thing, it's hidden. Measuring some 6 to 8 inches, or 15 to 20 centimeters, in length, and slippery and lobular to the touch, the yellowish- brown pancreas is located deep in the abdomen, wedged between the stomach and the spinal cord and extending horizontally right above the waistline. Think of it as an oblong eel.
Add to that inaccessibility a prima donna sensitivity. "If you do anything to the pancreas, you initiate an inflammatory response," Dr.Liddle said. "It tends to become inflamed more easily than other organs."
In fact, inflammation of the pancreas, or pancreatitis, is a relatively common and often debilitating condition, brought on by excess alcohol, drug reactions, gallstones, genetic predisposition or other reasons. Unfortunately, said Dr. Anthony Kalloo, a professor of medicine at the Johns Hopkins University School of Medicine, the symptoms of pancreatitis, like chronic abdominal pain radiating into the back, could be misdiagnosed or dismissed as a hypochondriac's lament.
As a result, Dr. Kalloo said, patients do not always receive the right pain medications, the optimal diet, surgery when necessary.
For all the difficulty of studying the pancreas, researchers eventually came to appreciate the organ as a gland of many talents, serving both an exocrine role -- secreting its products through ducts, as the breast secretes milk and the sweat glands perspiration -- and an endocrine role, fabricating hormones and squirting them into the bloodstream, as the ovaries and testes dispense sex hormones and the thyroid thyroxine.
Roughly 90 percent of the pancreas is devoted to its exocrinic role of generating digestive enzymes and funneling them into the small intestine, a burbling broth that flows forth from the pancreas at a rate of perhaps a quart a day.
The other 10 percent of pancreatic tissue consists of so-called islet cells, the endocrine players that synthesize insulin and glucagon to manipulate and titrate blood sugar, the body's energy currency, as needed. In people with Type 1, or juvenile-onset, diabetes -- among them Justice Sonia Sotomayor of the Supreme Court - - an autoimmune reaction ends up destroying many of these islet cells, resulting in the need for lifelong insulin injections. Among sufferers of Type 2, or adult-onset, diabetes, the reasons for insulin imbalance are more varied, and the condition can often be treated through diet and exercise alone.
Imagine the pancreas as a tree, Dr. Liddle suggested. The trunk and branches are the ducts that deliver digestive juices, the leaves the factories that make digestive enzymes, and the islet cells birds' nests scattered throughout -- in the tree but not of it.
When cancer strikes, it generally arises in the ductal tissue of the pancreas, the woody parts of our metaphoric tree, and intriguingly, they feel the part. "These tumors are rock-hard masses," said Peter Olson, an oncology researcher at the University of California, San Francisco. "They're white on dissection, very tough and fibrous."
Pancreatic cancer is almost impossible to cure. About 34,000 Americans will be diagnosed with it this year, and nearly as many will die of it. As doctors have long known, some of that lethality is positional: There is no easy way to screen the deep-set pancreas for early signs of malignancy, and by the time symptoms arise, the cancer already has spread to other organs.
Another reason for the ferocity, however, might be the nature of the tumors themselves. Most cancers are thought to spur the growth of new blood vessels to supply them with the extra oxygen and nutrients necessary for frenzied cell division, but pancreatic tumors are markedly devascularized.
"The number of blood vessels in a pancreatic tumor is 10 percent what it is in normal tissue, of the pancreas or anywhere else," said David A. Tuveson of the Cambridge Research Institute in England. The results are devastating. In the anoxic microenvironment beneath the fibrous, bloodless capsule, any malignant cells that survive become increasingly unstable and virulent, like super-roaches proliferating in the wake of a pesticide bomb. Moreover, without blood vessels, nothing can get into the tumor to kill the renegade cells, so chemotherapy is almost useless.
Reporting recently in the journal Science on results with genetically engineered mice, Dr. Tuveson and his colleagues described a new approach to treating pancreatic cancer, in which the tumors were revascularized and thus made sensitive to cancer drugs. Clinical trials are now under way to test the basic strategy in people, and with all due caveats, Dr. Tuveson said, "I am cautiously optimistic."
Wednesday, September 16, 2009
Waist-hip ratio better than BMI for gauging obesity in elderly
NewsRx.com
09-11-09
Body mass index (BMI) readings may not be the best gauge of obesity in older adults, according to new research from UCLA endocrinologists and geriatricians. Instead, they say, the ratio of waist size to hip size may be a better indicator when it comes to those over 70 (see also University of California - Los Angeles).
In a new study published online in the peer-reviewed journal Annals of Epidemiology, researchers from the David Geffen School of Medicine at UCLA found that the waist-to-hip circumference ratio was a better yardstick for assessing obesity in high-functioning adults between the ages of 70 and 80, presumably because the physical changes that are part of the aging process alter the body proportions on which BMI is based.
"Basically, it isn't BMI that matters in older adults - it's waist size," said Dr. Preethi Srikanthan, UCLA assistant professor of endocrinology and the study's lead investigator. "Other studies have suggested that both waist size and BMI matter in young and middle-aged adults and that BMI may not be useful in older adults; this is one of the first studies to show that relative waist size does matter in older adults, even if BMI does not matter."
Using data from the MacArthur Successful Aging Study - a longitudinal study of high-functioning men and women between the ages of 70 and 79 - researchers examined all-cause mortality risk over 12 years by BMI, waist circumference and waist-hip ratio. They adjusted for gender, race, baseline age and smoking status. The average age of participants was 74.
Obesity is often associated with premature mortality because it leads to an increased risk of diabetes, heart attack, stroke and other major health problems, the study authors say.
The researchers found no association between all-cause mortality and BMI or waist circumference; the link was only with waist-hip ratio. In women, each 0.1 increase in the waist-hip ratio was associated with a 28 percent relative increase in mortality rate (the number of deaths per 100 older adults per year) in the group sampled. Thus, if the waist-hip ratio rose from 0.8 to 0.9 or from 0.9 to 1.0, it would mean a 28 percent relative increase in the death rate. Put another way, if hip size is 40 inches, an increase in waist size from 32 to 36 inches signaled a 28 percent relative death-rate increase.
The relationship was not graded in men. Instead there was a threshold effect: The rate of dying was 75 percent higher in men with a waist-hip ratio greater than 1.0 - that is, men whose waists were larger than their hips - relative to those with a ratio of 1.0 or lower. There was no such relationship with either waist size or BMI.
The study may have some limitations, the authors noted. For instance, participants' BMI may be underestimated because height and weight were self-reported and older adults tend to report those numbers from their younger, peak years. Also, waist-hip ratios, waist circumference and BMI numbers were based on single measurements, limiting the researchers' ability to gauge how changing body size in old age can affect mortality risk.
09-11-09
Body mass index (BMI) readings may not be the best gauge of obesity in older adults, according to new research from UCLA endocrinologists and geriatricians. Instead, they say, the ratio of waist size to hip size may be a better indicator when it comes to those over 70 (see also University of California - Los Angeles).
In a new study published online in the peer-reviewed journal Annals of Epidemiology, researchers from the David Geffen School of Medicine at UCLA found that the waist-to-hip circumference ratio was a better yardstick for assessing obesity in high-functioning adults between the ages of 70 and 80, presumably because the physical changes that are part of the aging process alter the body proportions on which BMI is based.
"Basically, it isn't BMI that matters in older adults - it's waist size," said Dr. Preethi Srikanthan, UCLA assistant professor of endocrinology and the study's lead investigator. "Other studies have suggested that both waist size and BMI matter in young and middle-aged adults and that BMI may not be useful in older adults; this is one of the first studies to show that relative waist size does matter in older adults, even if BMI does not matter."
Using data from the MacArthur Successful Aging Study - a longitudinal study of high-functioning men and women between the ages of 70 and 79 - researchers examined all-cause mortality risk over 12 years by BMI, waist circumference and waist-hip ratio. They adjusted for gender, race, baseline age and smoking status. The average age of participants was 74.
Obesity is often associated with premature mortality because it leads to an increased risk of diabetes, heart attack, stroke and other major health problems, the study authors say.
The researchers found no association between all-cause mortality and BMI or waist circumference; the link was only with waist-hip ratio. In women, each 0.1 increase in the waist-hip ratio was associated with a 28 percent relative increase in mortality rate (the number of deaths per 100 older adults per year) in the group sampled. Thus, if the waist-hip ratio rose from 0.8 to 0.9 or from 0.9 to 1.0, it would mean a 28 percent relative increase in the death rate. Put another way, if hip size is 40 inches, an increase in waist size from 32 to 36 inches signaled a 28 percent relative death-rate increase.
The relationship was not graded in men. Instead there was a threshold effect: The rate of dying was 75 percent higher in men with a waist-hip ratio greater than 1.0 - that is, men whose waists were larger than their hips - relative to those with a ratio of 1.0 or lower. There was no such relationship with either waist size or BMI.
The study may have some limitations, the authors noted. For instance, participants' BMI may be underestimated because height and weight were self-reported and older adults tend to report those numbers from their younger, peak years. Also, waist-hip ratios, waist circumference and BMI numbers were based on single measurements, limiting the researchers' ability to gauge how changing body size in old age can affect mortality risk.
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