Older men don't live longer with weight-loss surgery (Reuters)

NEW YORK (Reuters Health) – Weight-loss surgery may not help obese middle aged and older men live longer, according to new research that runs counter to earlier findings in younger people.

The results mean doctors should be extra careful when counseling obese patients about their treatment options, Matthew Maciejewski of Durham VA Medical Center in North Carolina and colleagues write in the Journal of the American Medical Association.

In 2009, more than 220,000 Americans had some type of weight loss surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

Experts say surgery is the most enduring way to bring down one's weight, and earlier studies have suggested it will increase life expectancy by up to three years.

At first, the new study did appear to confirm those findings, but the benefit didn't hold up when comparing similar patients who did or did not have surgery.

The researchers looked back at the outcomes of 850 veterans, mostly men over 50 years old, who'd had weight-loss surgery between 2000 and 2006.

Six years after their surgery, about seven percent of the men had died, compared to 15 percent among a comparison group of obese men who didn't have surgery.

But when patients from the two groups were matched closely according to weight, age, race and other factors, the survival gap disappeared.

Previous studies have found that about seven percent of patients having weight-loss surgery experience complications, although most are minor wound problems.

Serious complications -- such as massive bleeding or kidney failure -- occurred in 2.6 percent of patients in one study from last year.

The new study is the first to compare death rates among heavy middle aged and older men who did or did not have weight-loss surgery, the researchers say, but it did have a number of limitations.

For instance, it's possible that following the patients for longer than six years would have changed the picture in favor of those who had surgery. And, the researchers stress, patients may still want surgery, even if it turns out not to affect their life expectancy, because the weight loss is likely to improve other medical conditions and quality of life.

SOURCE: http://bit.ly/ifujZX Journal of the American Medical Association, online June 12, 2011.

View the original article here

Scientists find "master switch" gene for obesity (Reuters)

LONDON (Reuters) – Scientists have found that a gene linked to diabetes and cholesterol is a "master switch" that controls other genes found in fat in the body, and say it should help in the search for treatments for obesity-related diseases.

In a study published in the journal Nature Genetics, the British researchers said that since fat plays an important role in peoples' susceptibility to metabolic diseases like obesity, heart disease and diabetes, the regulating gene could be target for drugs to treat such illnesses.

"This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes," said Tim Spector of King's College London, who led the study.

More than half a billion people, or one in 10 adults worldwide, are obese and the numbers have doubled since the 1980s as the obesity epidemic has spilled over from wealthy into poorer nations.

In the United States, obesity-related diseases already account for nearly 10 percent of medical spending -- an estimated $147 billion a year.

Type 2 diabetes, which is often linked to poor diet and lack of exercise, is also reaching epidemic levels worldwide as rates of obesity rise.

Scientists have already identified a gene called KLF14 as being linked to type 2 diabetes and cholesterol levels, but until now they did know what role it played.

Spector's team analyzed more than 20,000 genes in fat samples taken from under the skin of 800 British female twin volunteers. They found a link between the KLF14 gene and the levels of many other distant genes found in fat tissue, showing that KLF14 acts as a master switch to control these genes.

They then confirmed their findings in 600 fat samples from a separate group of people from Iceland.

In a report of their study, the researchers explained that other genes found to be controlled by KLF14 are linked to a range of metabolic traits, including body mass index, obesity, cholesterol, insulin and glucose levels.

"KLF14 seems to act as a master switch controlling processes that connect changes in the behavior of subcutaneous fat to disturbances in muscle and liver that contribute to diabetes and other conditions," said Mark McCarthy from Britain's Oxford University, who also worked on the study.

"We are working hard...to understand these processes and how we can use this information to improve treatment of these conditions."

(Reporting by Kate Kelland, editing by Mark Heinrich)

View the original article here

Prolonged bottle-feeding tied to kids' obesity (Reuters)

NEW YORK (Reuters Health) – Two-year-olds who are still using bottles are more likely to be obese by kindergarten, a new study finds.

Researchers who studied 6,750 U.S. children found that toddlers who were still drinking from bottles at age 2 were one-third more likely than other kids to be obese at the age of 5.

The researchers do not know whether long-term bottle-feeding is directly to blame.

But they say their findings raise the possibility that weaning babies from the bottle around their first birthday could help prevent excessive weight gain.

Pediatricians already advise parents to wean children from the bottle to toddler-friendly cups when they are about 12 to 14 months old, or even earlier.

That, however, is largely because prolonged bottle-feeding, especially overnight, is thought to boost the risk of cavities. It may also contribute to iron deficiency.

The current findings, published in the Journal of Pediatrics, may offer parents added incentive to follow those recommendations, according to lead researcher Rachel A. Gooze, a doctoral candidate in public health at Temple University in Philadelphia.2

And that incentive may be needed, she noted in an interview, since it seems that many 2-year-olds are still using bottles.

Of the children Gooze and her colleagues studied, 1 in 5 was still using a bottle at the age of 24 months -- either at night or all the time.

And of those long-term bottle users, roughly 1 in 5 was obese at the age of 5, versus about 1 in 6 children who'd been weaned earlier.

The researchers then looked at a number of factors that could affect a child's risk of obesity -- including the mother's weight, family income and education, and whether the child had ever been breastfed.

They found that prolonged bottle-feeding, itself, was linked to a 33 percent increase in children's risk of obesity.

The connection does not prove cause-and-effect, Gooze said.

But it's possible that for some kids, the bottle is providing unneeded calories.

"The bottle may be providing a source of comfort, rather than meeting nutritional needs," Gooze said.

And the extra calories could be substantial. As an example, Gooze noted that if an average-size 2-year-old girl drinks an 8-ounce bottle of whole milk at bedtime, that would meet 12 percent of her calorie needs for the day.

Prolonged bottle-feeding may also get in the way of toddlers having a varied, nutritious diet, according to Dr. Marc S. Jacobson, a member of the American Academy of Pediatrics' Obesity Leadership Workgroup.

"Parents often say that it's hard to get kids to eat vegetables," Jacobson noted in an interview.

One way to help with that, he said, is to "start early" -- gradually introducing foods of different tastes, textures and colors into babies' and toddlers' diets.

In general, parents should start introducing solid foods at the age of 6 months. Before that, experts recommend exclusive breastfeeding -- a practice that has been linked to a lower risk of childhood obesity, Jacobson pointed out.

Like Gooze, Jacobson noted that the current study shows an association, and not necessarily cause-and-effect. But he said the findings do turn attention to the importance of early life in the risk of childhood obesity.

"A lot of the public discussion about the obesity epidemic has been about fast food, junk food and soda," Jacobson said. "But there are also infant feeding issues associated with obesity."

Weaning babies from the bottle to the cup can be hard, Gooze noted, particularly from the "ritual" of the bedtime bottle.

Jacobson said that if parents are having a tough time, they can talk with their pediatrician about ways to smooth the transition. "That's what the pediatrician is there for," he said.

SOURCE: http://bit.ly/mnCVrl Journal of Pediatrics, online May 5, 2011.2

View the original article here

Low-fat diet may not increase diabetes risks (Reuters)

NEW YORK (Reuters Health) – While the low-fat diet craze led some doctors to worry that Americans would instead start eating too many carbohydrates, a new study suggests that eating low-fat doesn't have to increase carbohydrate-fueled health risks.

Instead, if extra carbohydrates are part of a diet plan that includes more fruits, vegetables, and whole grains, the risk of diabetes - the biggest related health concern -- could actually drop, at least in older women, according to the findings.

However, a low-fat, high-carbohydrate diet could create problems in people who already have diabetes, researchers caution.

"Generally when people reduce the fat in the diet they replace it with carbohydrates," study author Dr. James Shikany told Reuters Health. "There was some concern that the increased carbohydrate intake might lead to if not increased diabetes itself...changes that over time could lead to diabetes."

"We had been telling women to decrease their fat intake for a long time and we really didn't know the possible effects this would have" on diabetes, added Shikany, from the University of Alabama at Birmingham.

The results suggest that balancing both diabetes and other disease risks requires considering the kinds of carbohydrates, fats, and proteins we eat, researchers said, rather than just cutting back on one food group and eating more of another.

The study, published in the American Journal of Clinical Nutrition, included a group of about 2,300 postmenopausal women who were part of the Women's Health Initiative trial, which looked at the effect of diet and hormone therapy on disease risks.

About 900 of the women, selected randomly, were told to decrease their total fat intake so that fat accounted for about 20 percent of the calories in their diet. For a 2,000-calorie diet, that would mean eating 44 grams of fat each day.

As part of the new diet, women were also told to increase the number of fruit, vegetable, and grain servings they ate, and they attended regular sessions with nutritionists to help them do that.

The other 1,400 women, serving as a comparison group, were not given any extra nutritional guidance or told to change their diet.

The researchers followed women for the next 6 years with surveys on diet and exercise and also tested their blood for sugar and insulin levels to look for diabetes or its warning signs.

Women in the low-fat group, on average, said they got between 25 and 29 percent of their calories from fat in follow-up surveys. That compared to 36 to 37 percent in the group without a diet intervention.

U.S. government guidelines suggest adults get between 20 and 35 percent of their calories from fat.

The diet group also generally ate fewer total calories and more fruits, vegetables, grains, and sugar than the comparison group, on average.

After 1 year, women on the low-fat diet had lost more weight than the comparison group and had bigger decreases in their blood sugar and insulin levels. By 6 years, the groups looked similar on those measures. That told researchers that the lower-fat, higher-carbohydrate diet hadn't increased women's chances of getting diabetes.

However, in women who already had diabetes at the start of the study, those on the low-fat diet had a larger increase in blood sugar levels in the first year compared to women who didn't change their diet. That could be because people with diabetes had lost the ability to process the extra carbohydrates, Shikany said.

Carbohydrates are "obviously not a poison," said Dr. David Jenkins, head of the Clinical Nutrition and Risk Factor Modification Center at St. Michael's Hospital in Toronto. "If eaten wisely (they're) useful."

However, in general, "we went from a diet that was rich in saturated fat and cholesterol and was also not good (to) a diet which was equally tasty, but relying on refining the carbohydrates in a particular way" that ups the risk of obesity and diabetes, Jenkins, who was not involved in the new research, told Reuters Health.

Refined carbohydrates include white bread and rice and sugary drinks and snacks.

Jenkins said that getting more fat and protein from vegetable sources, such as by eating beans or adding hummus or peanut butter to bread, is a good way to stave off both diabetes and heart disease.

Doctors now generally recommend a diet that has plenty of healthy, non-saturated fats, rather than one that tries to cut back on all fats, Shikany said - but that doesn't mean the new data isn't useful.

"Things have kind of changed, but there still are plenty of (doctors) who recommend low-fat diets and people who are on these diets," he said. "I certainly think it's a very safe diet, but the question is, is this the best diet?"

Mary Gannon, of the University of Minnesota, said that a diet lower in carbohydrates and higher in fat and protein may actually help people feel fuller sooner - which could lead to weight loss over time. In male patients with diabetes she has studied, men had the most improvement in diabetes markers when they got the smallest percent of their calories from carbohydrates.

Shikany added that because the research was limited to women age 50 and up, his findings don't necessarily apply to men or younger women on a low-fat diet.

SOURCE: http://bit.ly/ktCLuv American Journal of Clinical Nutrition, online May 11, 2011.

View the original article here

McDonald's stockholders reject obesity proposal (Reuters)

OAK BROOK, Illinois (Reuters) – McDonald's Corp spurned calls to assess the impact of its food on childhood obesity, and said its trademark clown Ronald McDonald would be hawking Happy Meals to kids for years to come.

"This is about choice and we believe in the democratic process," Chief Executive Jim Skinner told a packed room at its shareholders' meeting, to an enthusiastic wave of applause. "This is about the personal and individual right to choose."

Shareholders of the world's largest fast-food chain resoundingly rejected a proposal that would have required it to issue a report outlining its role in the childhood obesity epidemic, saying customers were free to make their own dietary choices.

"Ronald McDonald is an ambassador to McDonald's and he is an ambassador for good. Ronald McDonald is going nowhere," Skinner said firmly, prompting more cheers from shareholders.

Among the dissenters at the meeting was Dr. Donald Zeigler, director of Prevention and Health Lifestyles at the American Medical Association, who asked when the burger chain will stop marketing to children using Ronald McDonald.

Zeigler, who is also visiting assistant professor at Rush University Medical Center, was one of 550 healthcare professionals who had signed an open letter to McDonald's pleading that it "stop making the next generation sick."

On Tuesday, a watchdog group placed ads in newspapers across the country calling for McDonald's to stop marketing to children through the clown, toy giveaways and other tactics.

Some 17 percent of children and adolescents are obese, according to the U.S. Centers for Disease Control and Prevention. Being overweight during childhood raises the risk of developing type 2 diabetes, high cholesterol, hypertension and a host of other diseases.

McDonald's has been a lightning rod for criticism for years over its marketing tactics and sales of Happy Meals for children that include toys as inducements.

McDonald's allows parents to swap milk or juice for soda in its Happy Meals. It also offers sliced apples with caramel sauce and chicken nuggets as alternatives to french fries and hamburgers.

The restaurant chain has added healthier options to its menu, including salads and oatmeal, but critics argue there is still too much fat, salt and sugar in its meals. Even the oatmeal, one critic noted, contains about as much sugar as a Snickers candy bar.

Skinner defended McDonald's strategy, which has resulted in hefty sales and earnings for shareholders. McDonald's shares have gained nearly 12 percent in the last four months and rallied to a record high of $82.63 on Thursday.

But as experts point out, obese children often grow into obese adults, overburdening the entire healthcare system.

Ironically, Miles White, chairman and chief executive of diversified healthcare company Abbott Laboratories, has been a director of the McDonald's board since 2009.

Abbott makes a broad range of drugs, including cholesterol-lowering statins, and medical devices, such as heart stents used on patients with clogged arteries.

(Reporting by Debra Sherman, Lisa Baertlein and Jessica Wohl; Editing by Richard Chang)

View the original article here