TAG: "Obesity"

Bariatric surgery decreases risk of uterine cancer


Findings indicate obesity may be a modifiable risk factor for endometrial cancer.

Researchers at the UC San Diego School of Medicine and Moores Cancer Center report that bariatric surgery resulting in dramatic weight loss in formerly severely obese women reduces the risk of endometrial (uterine) cancer by 71 percent and as much as 81 percent if normal weight is maintained after surgery.

Published in the April issue of Gynecologic Oncology, the official publication of the Society of Gynecologic Oncology, the findings indicate obesity may be a modifiable risk factor for endometrial cancer, and bariatric surgery a viable option for eligible patients. They are based on a retrospective cohort study of 7,431,858 patients in the University HealthSystem Consortium database, which contains information from contributing academic medical centers in the United States and affiliated hospitals. Of this total, 103,797 patients had a history of bariatric surgery and 44,345 had a diagnosis of uterine malignancy.

Obesity is a widespread public health problem in the United States, with an estimated two-thirds of the U.S. adult population considered to be overweight or obese. The condition is strongly linked to a host of health risks, among them heart disease, diabetes and cancer, in particular endometrial cancer.

“Estimating from various studies that looked at increasing BMI and endometrial cancer risk, a woman with a body mass index (BMI) of 40 would have approximately eight times greater risk of endometrial cancer than someone with a BMI of 25,” said first author Kristy Ward, M.D., the senior gynecologic oncology fellow in the Department of Reproductive Medicine at UC San Diego School of Medicine. “This risk likely continues to go up as BMI goes up.”

Bariatric surgery is often the last resort for obese patients after all other non-surgical weight loss efforts have failed. To qualify, patients must be an acceptable surgical risk and be defined as either severely obese with a BMI of 40 or greater or have a BMI of 35 or greater with at least one related condition: diabetes, obstructive sleep apnea, obesity-related cardiomyopathy or heart muscle disease or severe joint disease.

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Child obesity: cues and don’ts


Study suggests training kids to pay less attention to food might help them eat less.

Kerri Boutelle, UC San Diego

Among the multiple factors that can cause obesity is an abnormal neurocognitive or behavioral response to food cues. The brain becomes wired to seek – and expect – greater rewards from food, which leads to unhealthful overeating.

Attention modification programs, which train a person to ignore or disregard specific, problematic cues or triggers, have been used effectively to treat cases of anxiety and substance abuse. In a novel study published this week in the journal Appetite, Kerri Boutelle, Ph.D., professor of pediatrics and psychiatry at the UC San Diego School of Medicine, and colleagues report using a single session of attention modification to decrease overeating in obese children.

“Attentional bias is a long-studied psychological phenomenon,” said Boutelle. “Attentional bias to food means that food grabs a person’s attention. If two people were in a room with potato chips on the table, the person with attentional bias would be paying attention to, maybe looking at, the chips and the person without the bias would not really notice or pay attention to them.

“We believe that there is a group of people who are inherently sensitive to food cues and, over time, eating in response to paying attention to food makes them pay even more attention.  It’s based on Pavlovian conditioning.”

Obesity in the United States is a well-documented problem, with more than a third of American adults considered to be obese. Child obesity is equally alarming, with an estimated one-third of American children overweight or obese. These children are at greater risk for cardiovascular disease, cancer, orthopedic and endocrine conditions and more likely to die earlier.

Boutelle and colleagues investigated whether attention modification training might be another way to treat problematic eating and obesity in children. In a novel pilot study, they recruited 24 overweight and obese children between the ages of 8 and 12 and split them into two groups.

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Geographic variation of human gut microbes tied to obesity


Changes in latitude may influence more than attitude.

The researchers looked at data from more than 1,000 people from around the world. The blue represents the proportion of obesity-related bacteria in the gut, while red is the proportion of bacteria associated with slimness.

People living in cold, northern latitudes have bacteria in their guts that may predispose them to obesity, according to a new study by researchers at the University of California, Berkeley, and the University of Arizona, Tucson.

The researchers’ analysis of the gut microbes of more than a thousand people from around the world showed that those living in northern latitudes had more gut bacteria that have been linked to obesity than did people living farther south.

The meta-analysis of six earlier studies was published this month in the online journal Biology Letters by UC Berkeley graduate student Taichi Suzuki and evolutionary biology professor Michael Worobey of the University of Arizona.

“People think obesity is a bad thing, but maybe in the past getting more fat and more energy from the diet might have been important to survival in cold places. Our gut microbes today might be influenced by our ancestors,” said Suzuki, noting that one theory is that obesity-linked bacteria are better at extracting energy from food. “This suggests that what we call ‘healthy microbiota’ may differ in different geographic regions.”

“This observation is pretty cool, but it is not clear why we are seeing the relationship we do with latitude,” Worobey said. “There is something amazing and weird going on with microbiomes.”

To Worobey, the results are fascinating from an evolutionary biology perspective. “Maybe changes to your gut community of bacteria are important for allowing populations to adapt to different environmental conditions in lots of animals, including humans,” he said.

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Tighter economic regulation needed to reverse obesity epidemic


Study suggests government action to control food industries can help prevent obesity.

Roberto De Vogli, UC Davis

Roberto De Vogli, UC Davis

Governments could slow — and even reverse — the growing epidemic of obesity by taking measures to counter fast food consumption, according to a study published today (Feb. 2) in the Bulletin of the World Health Organization.

Led by Roberto De Vogli of UC Davis, the study showed that fast food purchases were independent predictors of increases in the average body mass index (BMI) in the U.S. and 24 other wealthy nations from 1999 to 2008. Nations with stronger government regulations — such as producer protection, price controls, and stronger intervention on competition and taxes — experienced slower increases in fast food purchases and average BMIs.

De Vogli’s research is the first to look at the effects of deregulation in the economy, including the agricultural and food sectors, and the resulting increase in fast food transactions and BMIs over time. It suggests that if governments take action to control food industries, they can help prevent overweight and obesity and its serious health consequences, including cardiovascular disease, diabetes, stroke and diet-related cancers.

“Unless governments take steps to regulate their economies, the ‘invisible hand of the market’ will continue to promote obesity worldwide with disastrous consequences for future public health and economic productivity,” said De Vogli, associate professor in the UC Davis Department of Public Health Sciences.

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New insights into controlling pediatric obesity


Electronic health records can be a useful tool to help clinicians educate kids and families.

Ulfat Shaikh, UC Davis

Ulfat Shaikh, UC Davis

Childhood obesity is a growing epidemic. Almost one-third of children in this country are overweight or obese, but how can we stem the tide? One idea is to use electronic health records (EHRs) to help clinicians intervene more aggressively. Programmed alerts could spur caregivers to order key tests and educate patients and families. But how does this approach work in the real world?

n a study published earlier this month in the American Journal of Medical Quality, researchers at UC Davis found mixed results. While EHR alerts definitely changed physician behavior when treating overweight and obese children, they are no magic bullet. The authors believe EHRs must be incorporated into a more comprehensive strategy to help patients overcome their weight issues.

“The alerts led to significant but not dramatic improvements,” said Ulfat Shaikh, lead researcher, pediatrician and director of Healthcare Quality at the UC Davis School of Medicine. “We believe any electronic record intervention must be combined with other approaches.”

To measure whether EHRs enhance practice, the researchers added obesity-related alerts to health records at the UC Davis Health System’s outpatient clinic, which cares for about 12,000 children each year. The alert — highlighted in bright yellow on the screen — warned physicians when a patient’s weight hit the 85th percentile, which is considered “overweight.”

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Resetting the metabolic clock


Insight into mammalian circadian rhythms could lead to therapies for obesity, diabetes.

Circadian rhythms are affected by things like travel over time zones, diet and light exposure. (Illustration by Peter Allen)

Circadian rhythms are affected by things like travel over time zones, diet and light exposure.

We’ve all heard about circadian rhythm, the roughly 24-hour oscillations of biological processes that occur in many living organisms. Yet for all its influence in many aspects of our lives — from sleep to immunity and, particularly, metabolism — relatively little is understood about the mammalian circadian rhythm and the interlocking processes that comprise this complex biological clock.

Through intensive analysis and computer modeling, researchers at UC Santa Barbara have gained insight into factors that affect these oscillations, with results that could lend themselves to circadian regulation and pharmacological control. Their work appears in the early edition of the Proceedings of the National Academy of Sciences.

“Our group has been fascinated with circadian rhythms for over 10 years now, as they represent a marvelous example of robust control at the molecular scale in nature,” said Frank Doyle, chair of UCSB’s Department of Chemical Engineering and the principal investigator for the UCSB team. “We are constantly amazed by the mechanisms that nature uses to control these clocks, and we seek to unravel their principles for engineering applications as well as shed light on the underlying cellular mechanisms for medical purposes.”

“Focus is often given to metabolism, cell division and other generic cell processes, but circadian oscillations are just as central to how life is organized,” said Peter St. John, a researcher in the Department of Chemical Engineering and lead author of the study.

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Men don’t seek obesity surgery as soon as they should


Obese women more likely to seek weight-loss surgery.

Mohamed Ali, UC Davis

Mohamed Ali, UC Davis

Even though obesity affects women and men equally, a UC Davis study shows that obese women are four times more likely than obese men to seek weight-loss surgery. When they do see a bariatric surgeon, male patients tend to be older, more obese and sicker than women.

“It is important for men to realize that obesity poses a serious threat to their health and lifespans,” said Mohamed Ali, senior author of the study and chief of bariatric surgery at UC Davis. “A patient who is 100 pounds or more above his ideal body weight poses a therapeutic dilemma and should be referred to a surgeon.”

For the study, published in the December issue of Surgical Endoscopy, Ali and his colleagues collected information from 1,368 patients who were evaluated for bariatric surgery at UC Davis between 2002 and 2006.

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Pediatric obesity patients like telehealth services, pilot study finds


Approximately 80 percent satisfied with their telehealth appointment.

Fit for Healthy Weight telehealth station

Fit for Healthy Weight telehealth station

For youth dealing with obesity who need extra help losing weight, experts suggest a multidisciplinary approach in which care is provided by several health specialists. However, the logistics of traveling to multiple appointments, even if just across town, can be a barrier to receiving care, especially for low-income families.

UCLA researchers who work with this patient population set up a pilot program using telehealth technology — a secure system that allowed patients to see and speak with their health care providers at UCLA over a computer from their local health clinic — to evaluate if such a system could be an effective strategy to help overcome these issues.

Their study of the program found that the great majority of pediatric patients — approximately 80 percent — were satisfied with their telehealth appointment, saying it was just as good as talking to the doctor in person, that it was easier to go to the local clinic than to the UCLA campus in Westwood, that they felt comfortable and that their privacy was protected.

In addition, 80 percent said they would participate in a telehealth appointment again. Responses from the health care providers were similarly positive.

The results of the project were presented at the Southern California Public Health Association Conference on Dec. 9.

“One surprise was how natural it was to talk with each other through the telehelath system, even though we never met the patients in person,” said lead author Dr. Wendy Slusser, medical director of the Fit for Healthy Weight program at Mattel Children’s Hospital UCLA and director of pediatric wellness programs at the Venice Family Clinic. “The interaction was very much like being in the same room together. Some kids even thought it was fun to see themselves on the screen.”

To conduct the study, researchers with the Fit for Healthy Weight program worked with UCLA colleagues, the Venice Family Clinic and the Los Angeles Unified School District to implement a telehealth system that met a high standard of encryption and was compliant with national regulations to ensure patient privacy.

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UC Irvine heart experts back new guidelines to prevent cardiovascular disease


Updated guidance on risk assessment, cholesterol, obesity, lifestyle management.

Nathan Wong, UC Irvine

Nathan Wong, UC Irvine

UC Irvine Health heart disease specialists fully support new guidelines for the American public for prevention of cardiovascular disease by the American Heart Association and American College of Cardiology. These guidelines, which were released today (Nov. 12), include revised standards for cardiovascular disease risk assessment, cholesterol, obesity and lifestyle management.

“These long-awaited documents were developed by a panel of national experts using the strictest evidence-based methodology to provide updated guidance on what clinicians should be doing to best identify persons at risk for cardiovascular disease,” said Dr. Nathan D. Wong, professor and director of the Heart Disease Prevention Program at UC Irvine and immediate past president of the American Society for Preventive Cardiology. He was not involved with the development of the guidelines.

“They are based on a large body of research evidence from the past two decades and in some cases, such as with cholesterol treatment, reflect the first significant revised guidelines in more than a decade,” he added.

Research done by Wong and his colleagues over the past two decades, and in collaboration with experts around the country has helped to support some of the new guidelines.

“Some of the new approaches being recommended will require a change in culture in order to be successfully implemented,” said Dr. Shaista Malik, medical director of UC Irvine Health’s Preventive Cardiology Program. “We plan to support these new guidelines and help educate our patients and the public as to their necessity and importance.”

“These important new practice guidelines address how best to identify persons at increased risk of cardiovascular disease, who specifically should be taking cholesterol-lowering treatment, the latest recommendations for managing obesity, and what evidence-based lifestyle measures should be used for prevention of cardiovascular disease,” Wong added. Revised blood pressure guidelines are in development and will be released later.

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Solving the pediatric obesity problem in rural communities


HEALTH-COP network improves health in rural California.

Ulfat Shaikh with a patient

Ulfat Shaikh with a patient

Using telemedicine to unite clinicians and provide health education for them — and by extension, their patients — is an effective way to manage childhood obesity in remote areas. For these communities, which often have limited access to pediatric subspecialists, having a HEALTH-COP can make all the difference.

UC Davis research published in the American Journal of Medical Quality has found that HEALTH-COP — the Healthy Eating Active Living TeleHealth Community of Practice — improved health in rural communities throughout California.

Children in small communities are at an increased risk of obesity because they often lack access to healthy foods and a wide range of activities. In turn, obesity puts these kids at risk for diabetes, hypertension, depression and other conditions.

“Obesity prevention and management can be particularly challenging in rural areas,” said Ulfat Shaikh, lead researcher, pediatrician and director of healthcare quality at the UC Davis School of Medicine. “Families don’t have as much access to walking paths, play facilities and places to buy healthy food. There may be only one grocery in town.”

To make matters worse, primary care physicians have their own access issues, lacking the peer support that often can lead to better care. Shaikh notes that earlier studies found that access to continuing medical education and peer support were a high priority for doctors in rural communities.

To provide these and other resources, Shaikh and her collaborators created HEALTH-COP, a virtual learning and quality improvement network that reached out to seven clinics throughout rural California. Clinics were located in a variety of settings and served diverse patient populations. For example, one was located in Imperial County, on the California-Mexico border; another was located in Humboldt County nearly the California Oregon border.

Through video conferencing and other methods, rural clinicians learned how to better assess patients’ weight; provide counseling on nutrition and physical activity; reorganize clinics to provide better care; screen for risk factors; and implement strategies to effectively discuss body weight.

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Innovation Profile: Ulfat Shaikh

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Keeping it off


UC Irvine Weight Management Program help patients lose weight, maintain healthy lifestyle.

John Leggat

John Leggat

When John Leggat, 55, was working in Yorba Linda in a high-pressure job with lots of travel and entertaining clients, his weight was 320 pounds and steadily increasing. He had heard about the UC Irvine Health Weight Management Program through his company and decided to make an appointment. After a physical examination, he decided to participate in a weight loss program that would change his life.

“During my exam, the doctor said I had most of the risk factors that indicated the likelihood of a heart attack in the next 10 years,” says John. Those risk factors included obesity, high blood pressure, cholesterol problems, diabetes and a sedentary lifestyle.

After his physical exam, John signed up for UC Irvine’s very low calorie Decision Free program – a plan designed to maximize weight loss and help John reframe his relationship with food.

“The thing that sold me was that it was a medically supervised program,” says John. “It wasn’t just some fad. I trusted the staff at UC Irvine and that helped a lot.”

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Study finds link between high-fat, high-calorie diet and pancreas cancer


UCLA results support low-fat, low-calorie diet as preventive measure against disease.

Guido Eibl, UCLA

Guido Eibl, UCLA

Researchers at UCLA’s Jonsson Comprehensive Cancer Center have found that mice made obese by high-calorie, high-fat diets develop abnormally high numbers of lesions known to be precursors to pancreas cancer.

This is the first study to show a direct causative link in an animal model between obesity and risk of this deadly cancer.

The study, published today (Sept. 30) in the journal Cancer Prevention Research, was led by Dr. Guido Eibl, a member of the Jonsson Cancer Center and a professor in the department of surgery at the David Geffen School of Medicine at UCLA.

Pancreatic ductal adenocarcinoma, or cancer of the pancreas, is one of the most deadly forms of cancer in humans. Overall five-year survival rates are approximately 3 to 5 percent, and the average survival period after diagnosis is just four to six months. It is a particularly aggressive disease, one that is often beyond the point of effective treatment by the time symptoms appear.

Since current treatments are limited in quantity and effectiveness, researchers are turning to prevention strategies to try to make headway against the disease before it reaches advanced stages.

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