Bradley Waggoner, MD

Scientists Closer to Finding What Causes the Birth of a Fat Cell

Just what causes the birth of a human fat cell is a mystery, but scientists using mathematics to tackle the question have come up with a few predictions about the proteins that influence this process.

The research is intended to increase understanding of how and why preadipocytes, or pre-fat cells, either lie dormant, copy themselves or turn into fat. But the findings eventually could lead to a way to freeze these early cells in their current state before they can ever become the basis of fat tissue, according to Ohio State University researchers.

Every human body needs fat to store and produce energy, but in excess, the tissue made up of fat cells begins to secrete molecules that send out complicated signals. This process can lead to inflammation and, in turn, to insulin resistance or diabetes, and contributes to the development of other diseases.

“A potential benefit of figuring out this process is to see how we could manipulate certain parameters to arrest cells in this quiescent region, and that could have an effect on obesity,” said Huseyin Coskun, a visiting assistant professor in the Department of Mathematics at Ohio State and lead author of the study.

“Obesity is certainly related to the types and amounts of foods people consume. But how the body responds to this can differ from one person to another, and could be related to some abnormalities in these protein interactions. The amount consumed may not be the only reason behind obesity. With this study, we started to understand how protein levels and complex molecular interactions in the body may influence the development of fat cells.”

The research is published in a recent issue of the Journal of Theoretical Biology.

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Source: Reprinted with editorial adaptations from materials provided by The Ohio State University. http://researchnews.osu.edu/archive/fatcellfate.htm

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New Study Strengthens Link Between Everyday Stress and Obesity

Stress can take a daily toll on us that has broad physical and psychological implications. Science has long documented the effect of extreme stress, such as war, injury or traumatic grief on humans. Typically, such situations cause victims to decrease their food intake and body weight. Recent studies, however, tend to suggest that social stress--public speaking, tests, job and relationship pressures--may have the opposite effect--over-eating and weight gain. With the rise of obesity rates, science has increasingly focused on its causes and effects--including stress.

A recent study conducted by the Departments of Psychiatry and Biomedical Engineering at the University of Cincinnati College of Medicine, examined the effects of stress on the meal patterns and food intake of animals exposed to the equivalent of everyday stress on humans. The results suggest that, not only does stress have an impact on us in the short term, it can cause metabolic changes in the longer term that contribute to obesity.

The study was conducted by Susan J. Melhorn, Eric G. Krause, Karen A. Scott, Marie Mooney, Jeffrey D. Johnson, Stephen C. Woods and Randall R. Sakai at the University of Cincinnati College of Medicine, Cincinnati, OH. Their study was published in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology. 

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Source: Reprinted with editorial adaptations from materials provided by The American Physiological Society. http://www.the-aps.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Focusing on Immediate Health Effects May Improve Weight Loss Success

Most weight loss programs try to motivate individuals with warnings of the long-term health consequences of obesity: increased risk for cancer, diabetes, hypertension, heart disease and asthma.  New research suggests the immediate health benefits—such as reduced pain—may be the most effective motivator for helping obese individuals shed extra weight and commit to keeping it off.

 

In a pilot research study, University of Cincinnati (UC) researchers found that 21 percent of participants in a local dietary weight loss program reported significantly less pain in the lower extremities and back after losing an average of 10 pounds. Additionally, study participants reported a 20 to 30 percent reduction in overall bodily pain after weight loss.

 

Researchers say their results indicate that even small weight loss can relieve pain and reduce the burden excessive weight puts on the musculoskeletal system.

 

"By focusing on an immediate benefit that can be felt—like pain reduction—instead of the future health impact of obesity, weight loss programs may be able to inspire overweight individuals to lose weight,” says Susan Kotowski, PhD, study collaborator and director of the Gait and Movement Analysis Laboratory in the UC College of Allied Health Sciences.

 

Kotowski and colleague Kermit DAvis, PhD, report their findings in the August 2010 issue of the journal Work.

 

According to the Centers for Disease Control and Prevention (CDC), 44 million Americans are considered clinically obese. Since 1975, the number of obese Americans has risen from 47 percent to 66.3 percent. Previous studies have estimated obesity-attributable medical expenditures in the United States at $75 billion, with half of these costs financed by Medicare or Medicaid.

 

"Obesity has become a national health crisis, but compliance for weight loss programs is notoriously poor. One potential reason for this is that current programs target long-term diseases, with little direct relevance to the person’s current health status,” adds Davis, senior author of the study and director of the Low Back Biomechanics and Workplace Stress Laboratory at the UC College of Medicine’s environmental health department. "Our study results challenge people to rethink the way they structure weight loss programs.”

 

For this pilot study, UC researchers partnered with a Cincinnati-based weight loss clinic to recruit study volunteers. Thirty two women between the ages of 22 and 76 participated in the study and data was collected over the course of a 12-week dietary weight loss regimen.

 

Researchers collected baseline individual weight and musculoskeletal pain data related to nine body regions: neck, shoulders, elbows, hands and wrists, upper back, lower back, hips, knees and lower legs and feet. Participants were then tracked each week to record any weight loss and asked to rate their pain on a scale of zero to 10 every other week.

 

Significant associations were found between weight loss and overall pain reduction, as well as pain reduction in the elbow, hip region and upper and lower back.

 

Researchers say these preliminary results could have ramifications for companies with a high prevalence of overweight workers with musculoskeletal problems—particularly in industries that require manual or repetitive weight-bearing labor.

 

"From an ergonomics perspective, we can only do so much to alter the work environment to remove body stressors,” explains Kotowski. "Excess weight adds additional stress to the musculoskeletal system and that can only be relieved through weight loss.”

 

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Source: University of Cincinnati . http://www.healthnews.uc.edu/news/

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better than Diet

Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds. The results will be presented Monday at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery,” said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.

Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body’s ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.

The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.

In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.

Surgical patients were able to discontinue all of their diabetes medications by the study’s end, but the dieters reduced their medication use by 55 percent, Korner reported.

The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group were not statistically significant and beta cell function improved to a lesser extent.

Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.

“It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy,” she said.

The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

 

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Source: The Endocrine Society . http://www.endo-society.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Delaying Fat Digestion to Curb Appetite

Institute of Food Research scientists have discovered an unexpected synergy that helps break down fat. The discovery provides a focus to find ways to slow down fat digestion, and ultimately to create food structures that induce satiety.

“Much of the fat in processed foods is eaten in the form of emulsions such as soups, yoghurt, ice cream and mayonnaise,” said Dr Peter Wilde from the Institute of Food Research.

“We are unpicking the mechanisms of digestion used to break them down so we can design fats in a rational way that are digested more slowly.”

If the digestion of fat is delayed and fatty acids are able to reach the ileum, the final section of the small intestine, their presence stimulates satiety-inducing hormones.

IFR scientists have been experimenting with using protein layers to stabilise emulsions and delay fat digestion.

In this study, they found that a normally-stable whey protein is partially broken down when it is attached to the surface of an emulsion. When a surfactant is introduced, this acts synergistically with the fat, breaking down the protein layer even more effectively. With the barrier weakened, access is improved for the enzymes and bile salts that break down fat.

“We are now experimenting with heat and enzyme treatments to reduce the synergistic effect and make the protein barrier stronger,” said Dr Wilde.

The scientists at the Institute of Food Research, an institute of the BBSRC, are the only scientists seeking the precise mechanisms by which emulsions behave under different conditions and how they are digested so they can be used to control satiety.

This research was funded by the BBSRC and by the EU through a Marie Curie Fellowship.

 

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Source: Reprinted from materials provided by Institute of Food Research. 

Journal Reference: Wilde et al. In vitro gastric digestion of interfacial protein structures: visualisation by AFM. Soft Matter, 2010; DOI: 10.1039/c0sm00300j

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Study Finds Obese Women Who Undergo Bariatric Procedures Before Pregnancy Are Three Times Less Likely to Have Gestational Diabetes

Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to new research findings published in the August issue of the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.

Gestational diabetes affects at least seven percent of all pregnancies in the United States, with rates as high as 14 percent among certain populations. Its prevalence is increasing among reproductive-age women, parallel to increasing rates of obesity and type 2 diabetes. Currently, 33 percent of women over 19 years of age meet the criteria for obesity (body mass index [BMI] > 30 kg/m2) and seven percent for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.

“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, assistant professor of obstetrics and gynecology at the Johns Hopkins University School of Medicine in Baltimore, Md.

“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study.

Researchers performed a retrospective study to compare rates of GDM and related outcomes between a group of women who had bariatric operations before pregnancy (n=346) and a group who had bariatric operations after delivery (n=354) between 2002 and 2006. Women who delivered after bariatric procedures had lower incidences of GDM (8 percent vs. 27 percent, odds ratio (OR) 0.23) and cesarean section (28 percent vs. 43 percent, OR 0.53) than those who delivered before bariatric procedures.

Women who delivered after bariatric operations were slightly older (32.5 years vs. 31.1 years, p < 0.001). The median time from surgical procedure to delivery was 19.6 months, which meant that the majority of women did not adhere to the current recommendation to defer pregnancy for two years after bariatric procedures were performed. Deliveries before bariatric operations  occurred at a median time of 16.5 months, meaning that most women waited more than a year after delivery before having bariatric procedures. The majority of women in each group had a bypass procedure (75 percent in the prebariatric delivery group and 87 percent in the postbariatric delivery group). Women who had a prebariatric delivery were more likely to have an adjustable banding procedure than women with a postbariatric delivery (9 percent vs. 3 percent).

 

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Source: American College of Surgeons . http://www.facs.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Lifestyle Intervention for Overweight Patients With Diabetes Provides Long-Term Benefits

An intensive lifestyle intervention appears to help individuals with type 2 diabetes lose weight and keep it off, along with improving fitness, control of blood glucose levels and risk factors for cardiovascular disease, according to a report in the September 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Improving blood glucose control and cardiovascular risk factors in patients with type 2 diabetes is critical in preventing long-term complications of the disease, according to background information in the article. Emphasis has been placed on screening and pharmacologic management of these parameters. "Lifestyle-based weight loss interventions are also recommended to improve glycemic control and risk factors, but the evidence supporting the efficacy of lifestyle approaches is limited to short-term studies of typically less than one year," the authors write.

The Look AHEAD (Action for Health in Diabetes) Research Group conducted a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention to diabetes support and education among 5,145 overweight or obese individuals (average age 58.7) with type 2 diabetes. Of these, 2,570 were assigned to the lifestyle intervention, a combination of diet modification and physical activity designed to induce a 7 percent weight loss in the first year and maintain it in subsequent years. Participants were seen and contacted by phone at least monthly for all four years. The 2,575 individuals assigned to the diabetes support and education group were invited to three group sessions each year focusing on diet, physical activity and social support.

On average, across the four-year period, individuals in the lifestyle intervention group lost a significantly larger percentage of their weight than did those in the diabetes support group (6.2 percent vs. 0.9 percent). They also experienced greater improvements in fitness, hemoglobin A1c level (a measure of blood glucose), blood pressure and levels of high-density lipoprotein (HDL, or "good" cholesterol). Individuals in the diabetes support group, on the other hand, experienced greater reductions in low-density lipoprotein (LDL, or "bad") cholesterol, owing to greater use of cholesterol-lowering medications in this group.

At the end of four years, the lifestyle intervention group maintained greater improvements in weight, fitness, hemoglobin A1c levels, systolic (top number) blood pressure and HDL levels. "Although the differences between the two groups were greatest initially and decreased over time for several measures, the differences between the groups averaged across the four years were substantial and indicate that the intensive lifestyle intervention group spent a considerable time at lower cardiovascular disease risk," the authors write.

"The critical question is whether the differences between groups in risk factors will translate into differences in the development of cardiovascular disease," they continue. "These results will not be available for several additional years. However, effects of the magnitude that we observed for fitness, HDL-C and hemoglobin A1c levels and blood pressure have been associated with decreased cardiovascular events and mortality in previous medication trials and observational studies. Moreover, there may be long-term beneficial effects from the four-year period in which intensive lifestyle intervention participants have been exposed to lower cardiovascular disease risk factors, as seen in other clinical trials."

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Source: Reprinted from materials provided by JAMA and Archives Journals. http://pubs.ama-assn.org/media/

Journal Reference: Arch Intern Med. 2010;170[17]:1566-1575l. 

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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One High Fat Diet, Two Different Outcomes: The Path To Obesity Becomes Clearer

Why is it that two people can consume the same high fat, high-calorie Western diet and one becomes obese and prone to diabetes while the other maintains a slim frame? This question has long baffled scientists, but a study by Yale School of Medicine researchers provides a simple explanation: weight is set before birth in the developing brain.

The results were reported online the week of August 2 in the Proceedings of the National Academy of Sciences.

Led by Tamas Horvath, chair and professor of comparative medicine and professor of neurobiology and obstetrics & gynecology at Yale School of Medicine, the research team analyzed the same question in specific groups of rats. These animals have been bred so that their vulnerability to diet-induced obesity is known before they would be put on high-fat, high-calorie diet diets.

Horvath said animals that become obese already had a significant difference in the feeding center of the brain. Neurons that are supposed to signal when you’ve eaten enough and when to burn calories, are much more sluggish in these animals because they are inhibited by other cells. In animals resistant to obesity, these satiety signaling neurons are much more active and ready to signal to the rest of the brain and peripheral tissues when enough food has been consumed.

“It appears that this base wiring of the brain is a determinant of one’s vulnerability to develop obesity,” said Horvath, who is also co-director of the Yale Program in Integrative Cell Signaling and Neurobiology of Metabolism. “These observations add to the argument that it is less about personal will that makes a difference in becoming obese, and, it is more related to the connections that emerge in our brain during development.”

Horvath points to other unwanted consequences of these brain mechanisms. “Those who are vulnerable to diet-induced obesity also develop a brain inflammation, while those who are resistant, do not,” he said. “This emerging inflammatory response in the brain may also explain why those who once developed obesity have a harder time losing weight.”

Diet-induced obesity has become one of the most critical medical problems in the United States. In particular, the incidence of childhood obesity has reached unprecedented levels. Since genetics alone cannot explain the surge of obesity in society, investigators have been trying to determine the primary underpinnings of the vulnerability to develop obesity on a Western diet.

“What genetic, epigenetic and environmental factor determines this base wiring in the brain is a very important issue to address,” said Horvath. “Specifically, the emerging view is that besides genetics, maternal impact on the developing brain is likely to be critical to imprint these feeding circuits thereby determining one’s vulnerability or resistance to obesity.”

The study was supported by the National Institutes of Health and the American Diabetes Association.

Other Yale authors include Beatrix Sarman, Peter Sotonyi, Marya Shanabrough, Erzsebet Borok and Sabrina Diano. The study also included authors from the following institutions: Monash University, University of Cincinnati, German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Veterans Affairs New Jersey Health Care System and University of Medicine and Dentistry New Jersey.

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Source: Reprinted with editorial adaptations from materials provided by Yale University. http://opa.yale.edu/health-medicine

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Study Finds Lap-Band Weight Loss Surgery in Very Obese Adults Improves Mental Health

One year after weight loss surgery with laparoscopic gastric banding, extremely obese adults demonstrate not only better physical health but also improved psychological health, a new study shows. The results were presented recently at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Surgical treatment, such as laparoscopic gastric banding, is increasingly recognized as the most effective means of achieving weight loss and improving blood sugar control in morbidly obese patients with Type 2 diabetes,” said study co-author Andrew Johnson, MD, of Southmead Hospital in Bristol, U.K.

“However, until now, the long-term psychological status of morbidly obese individuals undergoing gastric banding has been unclear despite its increasing use,” said Johnson, a consultant physician specializing in diabetes and endocrinology.

Laparoscopic gastric banding, also called the “Lap-Band” procedure, is a minimally invasive weight loss surgery. It involves repeated adjustment of a band to gradually make the stomach smaller and limit food consumption.

Four men and 21 women (ranging in age from 30 to 58 years) participated in the study and had the weight loss surgery. Of these 25 patients, 16 had Type 2 diabetes and nine did not. All had a body mass index (BMI, a measure of body fat) that classified them as morbidly obese.

Participants completed psychological testing before surgery and six and 12 months after surgery. These tests measured general anxiety and depression, quality of life, and social anxiety, that is, anxiety related to what others might think of one’s appearance.

Compared with before surgery, patients’ psychological test scores improved significantly at both six and 12 months after surgery. They had better psychological and physical quality of life, reductions in levels of general anxiety and depression, and reductions in their levels of social anxiety.

As shown in other studies, gastric banding significantly reduced BMI and hemoglobin A1c, a measure of blood sugar control over time.

“These results provide evidence one year after gastric banding that psychological health improves in parallel with physiological health,” Johnson said.

Researchers at the University of the West of England in Bristol also contributed to this study.

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Source: The Endocrine Society. http://www.endo-society.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

GSU Professor Finds Link Between Obesity and Federal School Nutrition Programs

With obesity becoming an epidemic among school-aged children in this country, a Georgia State University professor has found a link between overweight children and federal school nutrition programs.

Research reveals that children who eat lunch as part of the National School Lunch Program (NSLP) have an increased likelihood of becoming overweight, according to research co-authored by Rusty Tchernis, associate professor with Georgia State University’s Andrew Young School of Policy Studies¹. The findings also show that the School Breakfast Program (SBP) is a “valuable tool in the current battle against childhood obesity,” according to the research.

“Overweight children are more likely to become obese adults,” Tchernis said. “So the only way to reduce obesity is to prevent it from happening in children.”

The study, "School Nutrition Programs and the Incidence of Childhood Obesity,” will be published in the summer edition of The Journal of Human Resources.

The research – co-authored also by Muna Husain and Daniel Millimet, both of Southern Methodist University – was funded with a $200,000 grant from the U.S. Department of Agriculture through 2011.

For the study, Tchernis and his co-authors analyzed the relationship between the SBP and the NSLP and obesity using data on over 13,500 primary school students. Students were interviewed in kindergarten, first and third grades, and then again in later grades.

Other findings show that those who participate in both federal programs end up less heavy than those who don’t participate in either, or those who only eat lunch as part of NSLP.

The NSLP provides lunch to more than 30 million children every day in approximately 101,000 schools, with 17.5 million students receiving reduced price or free meals, according to the program’s website.

In recent years, some schools have banned soda as well as vending machines containing unhealthy snacks. Many school districts also are considering measures that could impact the government’s program, using “Farm to School” programs.

“Some children don’t know how to peel oranges,” Tchernis said. “It’s surprising how little children know about food.”

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¹Reprinted from materials provided by Georgia State University , via Andrew Young School of Policy Studies.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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