After posting on obesity and some of its consequences, I’ve received mixed responses (on and offline) with feedback like... “informative and interesting” implying, politely, that they read the piece but
were not moved to further comment. What I was hoping for is commentary from
persons that have a vested interest in the topic, skin in the game if you will,
to give their opinion or tell their story on some aspects of the points raised. Although there is not a lot of glamor in the
topic (obesity and its consequences) it is a public health concern. But equally important is the fact (as made in one of the post) that there
are many solicitations out there that try to market weight loss to improve body
image and improve social life in a quick - painless – way without the
discipline needed for true sustained weight loss and a healthier lifestyle. These methods often do not have the science to back them and are often misleading. The
next post will be on the metabolic syndrome. This is a constellation of conditions
including obesity, hypertension (high blood pressure), diabetes, and derangements
of cholesterol (good and bad). These conditions when present together form the
perfect storm for the development of heart disease, kidney disease and stroke.
Tuesday, December 9, 2014
Friday, December 5, 2014
On treating obesity and diabetes with herbal preparations
I am often surprised when I receive
advertisements – online - clearly targeting the obese population that offer to
reduce weight over a short period of time and without significant diet or
exercise. The ads describe some fat altering diet supplement that can be purchased,
and there is some urgency to purchase, as the offer is usually time limited. And
accompanying the ad there is often a before and after photo over a very short
period (weeks) demonstrating a dramatic change in body image. I often wonder
who would have such expectation of – weight loss and improvement in body image
over such a short period? And what of the complications of obesity that are not
obvious in the body image photos? In these ads there is little or no mention of
any of the complications associated with obesity such as diabetes rather just
the focus on the before and after image. Should
health consequences of being overweight or obese be mentioned in weight loss ads?
Obesity is linked to type II diabetes
mellitus (DM). Data obtained form the
NHANES (National Health and Nutrition Examination Survey) collected over a five-year
period studied a large population (over twenty-one thousand) with diabetes. Over
80% of patients with DM had a BMI (body mass index – a measure of body fat
using height and weight) over 25% placing them in the overweight category, and
50% had BMI of over 30% placing them in the obese category1. In obese individuals the body’s production and
sensitivity to insulin (the hormone secreted by the pancreas that regulates
blood sugar levels – glucose) can be altered and either you don’t produce
enough or there may be resistance to insulin.
Even if you take insulin (exogenous) obesity can alter the way the body
reacts to it, and if there is resistance to insulin higher levels may be needed
to keep the blood glucose level under control. DM related complications are
quite serious. They affect every organ in the body. The most well known
complications are kidney disease – leading to dialysis, cardiovascular disease –
leading to heart attacks and strokes, and the effects on the circulatory system
leading to limb loss; these are a few of the most serious complications. Knowing
the significance of DM’s consequences it is hard to believe that obesity, which
is linked to DM, is not taken as seriously as it should be by those individuals
who are obese and at risk for DM? Lifestyle modification (the foundation
of the treatment of obesity) includes diet, and exercise. And healthcare providers should repeatedly reinforce
this to their patients. Lifestyle modifications alone have been documented to
significantly reduce weight and reduce the risk of developing diabetes, and if
medications are ultimately needed for treatment of DM they should be
administered by a knowledgeable healthcare professional in addition to the
lifestyle modifications.
Would you attempt to treat DM yourself with herbal medications
without the guidance of a healthcare professional? Lately I have been paying attention to online ads that promote the treatment of DM using herbal preparations.
I am not sure where the science is that documents the efficacy and safety of
these products - I have not found it in peer review journals. But a disease
such as DM should be monitored under the supervision of a healthcare
professional, and not self treated with online mail order preparations that
have not been properly been evaluated by regulatory agencies. At very least
these preparations will probably not provide the desired effect and at worst they
may even do harm. So please, consult your healthcare professional about these
and other alternative medications. If one were to attempt to use a supplement
for DM and glucose control (and I am not advocating this) how would you monitor
the efficacy of the preparation? This leads into a discussion about monitoring
blood glucose levels, and the over all periodic evaluation required when
dealing with DM or any other chronic disease.
1- JAMA 2006 April 5, 295 (13) 1549.
Wednesday, December 3, 2014
The obesity crisis
Obesity is a growing public
health concern. Multiple studies have evaluated not only adverse health effects
caused by obesity but also direct and indirect medical cost associated with it.
In a ten-year period (1999-2010) one in three Americans were categorized as obese. The classification used to define (and grade)
obesity may vary between experts. The WHO (World Health Organization) uses a
1-3 grading system based on BMI (body mas index) whereas some experts define
obesity based on the percentage of body fat generally (greater than 25%). However
it is defined it is a health risk that is associated with - and can lead to - other
medical conditions form asthma to varicose veins, but is of particular
importance when the heart, brain or endocrine/metabolic systems are involved - more
on this later. Lifestyle modification is the first course of action and the
foundation of the treatment of obesity. The major components of the
modification (diet, exercise, and behavior therapy) have been documented to
significantly reduce weight and reduce the risk of developing diabetes (a major
complication linked to obesity). In one study the effects of weight loss and the
attendant glucose control lowered cardiovascular (heart) risk following the
modification and the benefits were still evident four years later 1.
It is little wonder that public health
experts spend so much effort trying to create public policy – requiring
disclosure of calorie counts in foods, and size limits of sugar containing
drinks - that will stem the tide of obesity. But should food and drink consumption be dictated by healthcare policy decisions?
This is a matter of public debate for policy and public health experts, but in
my opinion prudent restraints limiting excessive consumption can’t hurt. After
all you can be refused alcohol if you are visibly intoxicated.
Practically speaking life
style modification is much easier to advocate that to actually accomplish. Factors
including poverty, education, and socioeconomic status have been linked to
obesity. Although the research is not conclusive in this area, there is a
relationship between family income, food insecurity and obesity. And in certain
populations there is a direct link between poverty and obesity in children and
adolescents2. Is there really
a link between poverty, food insecurity and obesity? Food security is the
availability of safe, consumable, and sufficient food. Food insecurity is the
opposite where the possibility of hunger and even starvation may exist. The
recent financial crisis of 2008 resulted in a rise in food insecurity in the
U.S. One report sites up to 14.5% of households as food insecure in 2012 (four
years after the crisis) with households of single parents, and Black and
Hispanic households being higher than the general population 3. In poorer
neighborhoods it is easier to satisfy a calorie requirement with readily
available fast food that are cheap and maybe available 24/7 than higher nutritional
foods such as fruits, vegetables, and high value proteins, which may be in
short supply, and at a premium. Persons that derive their calories form high
calorie low nutritional value meals not only suffer the effects of the poor
nutrition but are also at risk for obesity. And the wonderful produce that comes
to the local farmers market once or twice a week is often not found in inner
city and if it is the cost of those foods may be prohibitive to poorer
populations. So the high calorie fast food though satisfying and relative
inexpensive is more the food of necessity and less of choice. These are
sociopolitical issues that go far beyond the scope of this post. These and
other questions both social scientist and medical scientist will have to work
through. For now public healthcare advocates will continue to advise on prudent
management of the modifiable risk (calorie consumption and exercise). We must
watch what we eat (within financial means) and we must also promote exercise
and healthy activities i.e. Get Active work out, popularized by the First Lady and
the NFL Play 60 that will help burn the calories. Hopefully the socioeconomic
issues will be addresses by our lawmakers in a judicious and equitable manner.
1- Circulation. 2012
March 6; 125(9): 1157–1170
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