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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Study Shows that Lap-Band Weight-Loss Surgery Can Reverse Metabolic Syndrome in Obese Teens

Minimally Invasive Procedure Lowers Risk of Future Cardiovascular Disease and Diabetes in Adolescents

According to research by NewYork-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, Lap-Band weight loss surgery lowers the risk of future cardiovascular disease and diabetes in adolescents. The new study of obese adolescents has shown that laparoscopic gastric banding surgery -- the "Lap-Band" procedure -- not only helps them achieve significant weight loss, but can also improve and even reverse metabolic syndrome, reducing their risk for cardiovascular disease and diabetes.¹

Metabolic syndrome is defined as a cluster of risk factors: high blood pressure; low levels of HDL or "good" cholesterol; excessive abdominal fat; and elevated levels of blood sugar, C-reactive protein and triglycerides that increase a person's chances of developing cardiovascular disease or diabetes later in life. The single biggest risk factor is obesity, and metabolic syndrome usually improves when a person loses weight.

The study was led by Drs. Ilene Fennoy, Jeffrey Zitsman and colleagues at New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center and presented at the annual Endocrine Society meeting in Washington, D.C. 

"An estimated 17 percent of all American adolescents are obese, and increasing numbers of them also have metabolic syndrome," says Dr. Fennoy, a pediatric endocrinologist at Morgan Stanley Children's Hospital, clinical professor of pediatrics at Columbia University College of Physicians and Surgeons and co-author of the study. "Until recently, there have been few treatments capable of helping these young patients lose weight, much less improving their lifelong health prospects. The Lap-Band may well be a useful intervention for tackling teen obesity, which is why it is so important to investigate the procedure's safety and efficacy in this growing population."

In the new study, Dr. Fennoy and her colleagues followed 24 morbidly obese adolescents between the ages of 14 and 17 who underwent the Lap-Band procedure. The study participants either had a BMI of greater than 40 or greater than 35 if already suffering from diabetes or obesity-related illnesses.
Six months after surgery, they noted a significant drop in participants' BMI, waist circumference, and blood levels of C-reactive protein. These indicators continued to improve among the 12 patients being followed up at the one-year point.

Other measures of metabolic syndrome such as blood lipid and sugar levels, the authors reported, came down quickly in the first six months, with "less dramatic" changes seen one year after surgery.

"Of all the bariatric procedures," she says, "the Lap-Band is the most benign, with complication rates of less than 1 percent." The device, inserted via minimally invasive laparoscopic surgery, consists of a simple band to make the stomach smaller and a balloon that can be decompressed when necessary, she explains.

Although it is technically reversible, the procedure should be considered a long-term solution for extreme and intractable obesity.

The Lap-Band is the favored bariatric procedure in Europe, while in the U.S., gastric bypass has been the preferred approach. At present, NewYork-Presbyterian Morgan Stanley Children's Hospital/Columbia University Medical Center is one of a few medical centers offering the Lap-Band option in this country.

The Lap-Band procedure, an approved treatment for adults with extreme obesity, has not yet been thoroughly studied in adolescents. Larger, multicenter studies with longer follow-up periods will be needed, Dr. Fennoy says, to validate the findings of the current study.

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¹NewYork Presbyterian/Morgan Stanley Children's Hospital/Columbia University Medical Center. August 5, 2009. http://childrensnyp.org. 

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Lap Band Weight Loss Surgery Reduces Teens' Risk Factors For Heart Disease, Diabetes

The Metabolic Syndrome

An increasing number of obese adolescents have the metabolic syndrome, said a study co-author, Ilene Fennoy, MD, MPH, a pediatric endocrinologist at New York City's Columbia University Medical Center.¹

The metabolic syndrome is a cluster of metabolic risk factors that increase the chance of later developing diabetes and cardiovascular disease. Weight loss can reduce the risk factors that are part of the syndrome: abdominal obesity as shown by a large waist circumference (waistline), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar.

"Few treatments, however, have succeeded in achieving major weight loss or greatly improving adolescents' medical complications of obesity—until now," Fennoy said.

In the new study, 24 morbidly obese teens between the ages of 14 and 17 years underwent laparoscopic gastric banding, also called the "Lap-Band" procedure. This minimally invasive weight loss surgery uses a band that can repeatedly be adjusted to make the stomach smaller.

Six months after the operation, patients had a statistically significant decrease in their body mass index (BMI, a measure of body fat) as well as their waist circumference and blood levels of C-reactive protein, a measure of inflammation that is linked to increased risk of cardiovascular disease. These improvements continued to 1 year in the 12 patients whose follow-up was that long.

Other features of the metabolic syndrome improved rapidly in the first 6 months and continued to a year, but with "less dramatic" changes, the authors reported in their abstract.

Five patients with 12-month follow-up met the criteria for a diagnosis of the metabolic syndrome before surgery. Only two still had this diagnosis a year later, a decrease in prevalence from 41.7 to 16.7 percent.

"Laparoscopic gastric banding surgery may be a useful intervention for morbidly obese teenagers to decrease the risk of early development of cardiovascular disease and other illnesses related to obesity," Fennoy said.

Currently approved for use only in adults, the Lap-Band procedure is being studied in teenagers under age 18. Long-term studies are needed to confirm that this procedure effectively improves the metabolic syndrome in adolescents, Fennoy said.

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¹physorg.com. June 11, 2009. http://www.physorg.com/news163946909.html

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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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Adults, Especially Women, Have Calorie-Burning "Brown Fat"

Keeping Your Baby Fat Turns Out To Be A Good Thing

Keeping your baby fat turns out to be a good thing, as long as it is “brown fat”—the kind that burns calories, according to a study that found adults have much more of this type of fat than previously thought. The results, which suggest a new way to treat obesity, were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.¹

Brown fat burns off calories and generates heat in babies and small mammals. Most of our body fat is white fat, which also provides insulation but stores calories. It becomes “bad” fat when you have too much. The “good” fat—brown fat—was considered essentially nonexistent in human adults.

“We now know that it is present and functional in adults,” said the study’s lead author, Aaron Cypess, MD, PhD, MMSc, of the Joslin Diabetes Center in Boston. “Three ounces of brown fat can burn several hundred calories a day.”

For the first time, the researchers were able to measure patches of brown adipose tissue—brown fat—in people, thanks to a high-tech imaging method that combines positron emission tomography and computed tomography, called PET/CT. By evaluating biopsy tissue of what appeared to be brown fat on PET/CT scans in some patients who had neck surgery, the authors confirmed that they were, indeed, looking at stores of brown fat. More than 1,970 study participants had PET/CT scans, from mid-skull to mid-thigh.

Brown fat (when it could be detected) was located in an area extending from the front of the neck to the chest. Of the subjects who had detectable brown fat, about 6 percent had 3 ounces or more of the fat.

“We believe that this percentage greatly underestimates the number of adults in the population who have a large amount of brown fat,” said Cypess, whose results were published in the April 9 issue of the New England Journal of Medicine, along with those of two other independent studies of brown fat in adults.

That is because one of the other studies found that PET/CT can detect much more brown fat if people are in a room cooled to 61°F. Likewise, Cypess and his colleagues found that people who underwent PET/CT in the winter had more brown fat activity than those scanned in the summer.

They also discovered that brown fat is most abundant in young women and least frequent in older, overweight men. In fact, women were more than twice as likely as men to have substantial amounts of brown fat.

“One theory for this is that women may have less muscle mass overall, so they need more brown fat to generate heat and keep warm,” Cypess said.

Brown fat provides a new focus for developing treatments protecting against obesity and its complications, according to Cypess. However, it may not be enough to lose weight to just have brown fat. The researcher said, “We may have to turn it on and make sure it burns calories in a regulated, safe manner.”

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¹newswise. June 11, 2009. http://www.newswise.com/articles/view/553270/

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