Bradley Waggoner, MD

New Eating Device Retrains Dietary Habits and Helps Children Lose Weight

A new computerized device that tracks portion size and how fast people eat is more successful in helping obese children and adolescents lose weight than standard treatments, according to research published on bmj.com¹.

The Mandometer device, a portable computerized weighing scale, was developed at the Karolinska Institutet in Stockholm. It helps to retrain individuals to eat less and more slowly by providing real-time feedback during meal times. The device plots a graph showing the rate at which food actually disappears from the plate, compared to the ideal graph programmed in by a food therapist.

Childhood obesity is an increasing global problem and there is little evidence to support one specific treatment program. While it is unknown whether specific eating patterns are common in all obese people, in this study the patients ate large portions very quickly.

Researchers at Bristol Royal Hospital for Children and the University of Bristol, led by Professor Julian Hamilton-Shield, carried out a randomized controlled trial of 106 obese patients aged between 9-17 years.

One group of participants received Mandometer therapy to lose weight and the other were provided with standard care. Both groups were encouraged to increase their levels of physical activity to 60 minutes of exercise a day and to eat a balanced diet based on the Food Standards Agency "eatwell plate."

Participants were assessed after 12 months and followed up at 18 months. During the research period they were also regularly monitored and offered telephone support and encouragement.

After 12 months, the Mandometer group not only had a significantly lower average body mass index and body fat score than the standard care group, but their portion size was smaller and their speed of eating was reduced by 11% compared with a gain of 4% in the other group. Levels of 'good cholesterol' were also significantly higher in the Mandometer group.

The improvement in body mass index was maintained six months after the end of treatment, suggesting an element of longer term behavioral change, add the authors.

"Mandometer therapy, focusing on eating speed and meal size, seems to be a useful addition to the rather sparse options available for treating adolescent obesity effectively without recourse to pharmacotherapy," say the authors.

They acknowledge that the Mandometer requires further evaluation in other settings and with different groups of patients, but conclude that "Retraining eating behavior and reinforcing feelings of satiety, however, does seem to improve weight loss in obese adolescents."

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¹ http://www.bmj.com. Full text of this study can be found at the BMJ Journal's website.

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Overweight in 20s could lead to serious problems in 40s

People who are obese and have type 2 diabetes in their 20s will be at higher risk of having a heart attack or stroke in their 40s if they do not change their lifestyle.

"If your blood pressure is 136/88 and you’re a man with a waist over 40 or a woman with a waist over 35 it spells trouble," said Dr. Dale J. Hamilton, diabetes clinical services chief at The Methodist Hospital in Houston. "These are two of the five symptoms of metabolic syndrome, a problem that can lead to type 2 diabetes. All you need is three to begin seeing increased atherosclerosis."

"High triglyceride levels over 150, insulin resistance and a low LDL (good cholesterol) are factors of metabolic syndrome, along with high blood pressure and central obesity. According to the American Heart Association more than 47 million Americans have it. Many of these patients will end up suffering with type 2 diabetes, which can eventually lead to coronary artery disease and stroke.

"Small changes every day can help curb big problems later on," Hamilton said. "Losing five to 10 pounds will help lower blood pressure. Reducing saturated fats, carbohydrates, and eating about two-thirds the amount you eat now will help you lose weight around the middle. Walk 45 minutes a day instead of 30."

Some experts believe replacing sugar with high fructose corn syrup in processed foods in the United States and Canada in the 1990s has played a role in the rise of type 2 diabetes cases. High fructose corn syrup is made by changing the sugar in corn starch to fructose, another form of sugar. It has become popular because it extends the shelf life of processed foods and is cheaper than sugar. It has also become a popular ingredient in many sodas and fruit-flavored drinks.

"The problem with high fructose corn syrup is that it promotes central obesity," Hamilton said. "Another problem with it is that it fools your body into thinking you are hungry. I don’t think you need to eliminate it from your diet, you just need to be aware of how much of it you are consuming on a daily basis because too much can lead to serious weight gain."

Keep in mind, he said, type 2 diabetes symptoms often go untreated because there are few or no symptoms until it is too late.

"Having three or more of the risk factors associated with type 2 diabetes over an extended period of time is the equivalent of already having a heart attack," Hamilton said. "These risk factors need to be treated aggressively in order to curb the problem and give you a better chance at a longer, healthier life."

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Story Source: Adapted from materials provided by  The Methodist Hospital - Houston.

Medical Advice Disclaimer: The content of this blog entry is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, or other qualified health provider with any questions you may have regarding a medical condition.

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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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Too Much Selenium Can Increase Your Cholesterol

A new study from the University of Warwick has discovered taking too much of the essential mineral selenium in your diet can increase your cholesterol by almost 10%.

Selenium is a trace essential mineral with anti-oxidant properties. The body naturally absorbs selenium from foods such as vegetables, meat and seafood. However, when the balance is altered and the body absorbs too much selenium, such as through taking selenium supplements, it can have adverse affects.

A team led by Dr Saverio Stranges at the University's Warwick Medical School has found high levels of selenium are associated with increased cholesterol, which can cause heart disease.

In a paper recently published in the Journal of Nutrition, the research team examined the association of plasma selenium concentrations (levels of selenium in the blood) with blood lipids (fats in the blood).

The researchers found in those participants with higher plasma selenium (more than 1.20 µmol/L) there was an average total cholesterol level increase of 8% (0.39 mmol/L (i.e. 15.1 mg/dL). Researchers also noted a 10% increase in non-HDL cholesterol levels (lipoproteins within your total cholesterol that can help predict the risk of someone suffering a heart attack or chest pain). Also, of the participants with the highest selenium levels, 48.2% admitted they regularly took dietary supplements.

The study was conducted among 1042 participants aged 19-64 in the 2000-2001 UK National Diet and Nutrition Survey. All participants were interviewed face-to-face to assess lifestyle factors such as diet and drinking habits. Blood samples were then taken for analysis.

Dr Saverio Stranges said although high selenium levels were not exclusively caused by people taking dietary supplements, the results of the study were concerning because the use of selenium dietary supplements had risen considerably in the UK in recent years. He said this was largely due to the perception that selenium can reduce the risk of cancer and other diseases.

He said: “This use has spread despite a lack of definitive evidence on selenium supplements efficacy for cancer and other chronic disease prevention. The cholesterol increases we have identified may have important implications for public health. In fact, such a difference could translate into a large number of premature deaths from coronary heart disease.

“We believe that the widespread use of selenium supplements, or of any other strategy that artificially increases selenium status above the level required is unwarranted at the present time. Further research is needed to examine the full range of health effects of increased selenium, whether beneficial or detrimental.”

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¹The University of Warwick.  http://www2.warwick.ac.uk/newsandevents/pressreleases/

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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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Joslin Study Identifies ‘Good’ Energy Burning Fat in Lean Adults

Finding May Lead to Treatments for Obesity, Diabetes

Researchers at the Joslin Diabetes Center¹ have demonstrated that adult humans still have a type of “good” fat previously believed to be present only in babies and children. Unlike white fat, which stores energy and comprises most body fat, this good fat, called brown fat, is active in burning calories and using energy. The finding, reported in the April 9th issue of The New England Journal of Medicine, could pave the way for new treatments both for obesity and type 2 diabetes.

Scientists had thought that brown fat only existed in humans during childhood and was mostly gone by adulthood. The paper shows that brown fat not only exists in adult humans, but also for the first time, that the fat is metabolically active.

“The fact that there is active brown fat in adult humans means this is now a new and important target for the treatment of obesity and type 2 diabetes,” said C. Ronald Kahn, M.D., senior author and Head of the Joslin Section on Obesity and Hormone Action and the Mary K. Iacocca Professor of Medicine at Harvard Medical School.

Obesity is a major risk factor for type 2 diabetes. According to the researchers, the idea behind a new therapy would be to find a way to stimulate brown fat growth to both control weight and improve glucose metabolism.

“Not only did we find active brown fat in adult humans, we found important differences in the amount of brown fat based on a variety of factors such as age, glucose levels and, most importantly, level of obesity,” said lead author Aaron Cypess, M.D., Ph.D., a Research Associate and Staff Physician at Joslin.

Not surprisingly, the study found that younger patients were more likely to have larger amounts of brown fat, and the brown fat was more active during colder weather, keeping with its role of burning energy to generate heat. Brown fat was also more common in adults who were thin and had normal blood glucose levels.

“What is of particular interest is that individuals who were overweight or obese as measured by higher Body Mass Index (BMI) were less likely to have substantial amounts of brown fat,” said Kahn. “Likewise, patients taking beta-blockers and patients who were older were also less likely to have active brown fat. For example, individuals both over age 64 and with high BMI scores were six times less likely to have substantial amounts of brown fat.”

The findings, particularly those having to do with BMI, suggest a potential role for brown fat in regulating body weight metabolism, the paper says, suggesting that higher levels of brown fat may protect against age-related obesity.

According to the paper, the researchers are hopeful that an increased ability to measure brown fat mass and activity in vivo in humans will lead to a better understanding of its role in physiology and its potential as a target for therapy of obesity and other metabolic disorders.

This study answered those questions thanks to the use of modern imaging technology.

The researchers analyzed a database of 1,972 patients who had undergone positron emission tomography/computed tomography (PET/CT) scans for a variety of reasons over a three-year period. They identified substantial brown fat deposits in 7.5 percent of the female patients and over 3 percent of males.

“These numbers clearly represent an underestimate, since PET/CT can only detect collections of brown fat cells of a certain size and activity, and could miss smaller and less active deposits,” Kahn explained.

In addition, the researchers identified 33 other patients whose pathology records had indicated the presence of brown fat in their necks in the same places where the PET/CT scans had identified the largest concentrations of brown fat. They tested the tissue of two of those patients and detected the presence of a special heat-generating protein called UCP-1 that is unique to brown fat.

“These findings suggest that there is previously unrecognized, heat-generating brown fat in many adults,” Dr. Cypess said.

“This study, by demonstrating the presence and physiological activity of brown fat in adult humans, shows that this tissue may provide a novel and valuable target for interventions, pharmacological and environmental, to modulate energy expenditure,” said Francesco Celi, M.D., of the Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, who wrote an accompanying editorial but was not involved in the Joslin study.

Dr. Kahn said there is a good possibility that brown fat may be present in significant amounts in much higher percent of the population, but that it may be more spread out and not as easily seen on imaging in many cases. Most of the deposits found on the scans were located in the neck region.

“In the real world, there has been a long debate as to whether brown fat exists in adult humans and whether it was important physiologically,” he said. “This study demonstrates that it is both present and appears to be physiologically important in terms of body weight and glucose metabolism. We hope this opens up a new therapeutic area for obesity and type 2 diabetes by modifying the activity of brown fat.”

In a study published in August 2008, Dr. Kahn and others showed that a protein, BMP-7, known for its role in inducing bone growth, can also help promote the development of brown fat in rodents. And, a 2007 study led by Dr. Kahn found clusters of brown fat cells dispersed between bundles of muscle fibers in strains of mice resistant to obesity and diabetes.

The current study was supported by the Clinical Investigator Training Program, Beth Israel Deaconess Medical Center - Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co.; as well as with grants from the National Institutes of Health and the Eli Lilly Foundation.

Others participating in the research were Allison B. Goldfine, M.D., Yu-Hua Tseng and Alessandro Doria, M.D., all of the Joslin Diabetes Center Research Division; Sanaz Lehman, M.B., B.S., Gethin Williams, M.B., B.S., Ph.D., Ilan Tal, Ph.D., and Dean Rodman, M.D., all of the Division of Nuclear Medicine, Beth Israel Deaconess Medical Center; Frank C. Kuo, M.D., of the Department of Pathology, Brigham and Women’s Hospital; and Edwin L. Palmer, M.D., of the Division of Nuclear Medicine, Massachusetts General Hospital.

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¹Joslin Diabetes Center. April 8, 2009.  "Joslin Study Identifies "Good" Energy Burning Fat in Lean Adults" <http://www.joslin.org/1083_4684.asp>

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