Archive for obesity and weight loss
Not that I’ve ever said it, but lifestyle changes are the only way to safely and successfully take off and keep off weight…
The Central Role of Lifestyle Change in Long-term weight management
Clinical Cornerstone 2(3):43-51, 1999
Lifestyle change–most notably, modification of eating behavior, physical activity, and psychologic factors like attitudes, goals, and emotions–is the central determinant of whether people will lose weight and maintain the loss. Even when medical intervention appears to be the primary treatment, as with pharmacotherapy, behavior plays the determining role in successful weight loss.
There is nothing good about visceral fat. Many just worry about the aesthetics of it, but the reality is that visceral fat wreaks havoc on long term health.
The current model of visceral adipose tissue puts this type of fat as its own organ system. The only problem is that this organ system, instead of working with your body, is an invader trying to survive.
Here’s how it goes:
- Fat has always been a storage tissue for extra calories.
- Lord knows we got enough of these in today’s society.
- The fat begins to accumulate.
- For awhile this is ok, but past a certain point these fat cells begin to run out of an adequate blood supply.
After all, these cells need nutrients just like every other cell, but there is only so much blood flow to go around. Once the fat cells don’t have the nutrients they need, they get pissed off. Pissed off fat cells begin to generate pissed off hormones called adipokines that drive inflammation and damage elsewhere in the body.
This is how visceral fat leads to poor blood vessel health (heart attack, stroke, dementia) and other problems like cancer.
While we generally think of fat accumulated around the abdominal region, it also accumulates around other organs like the heart, termed epicardial fat. The problem with epicardial fat is that it is so close to the heart that the hormones released can have a greater effect. The way we usually look for epicardial fat is through an echocardiogram, but this isn’t exactly practical for routine use. Enter this particular study.
Researchers looked at whether we could use the sagittal abdominal diameter as an indirect marker for epidcardial fat without the hassle of an echocardiogram. The sagittal abdominal diameter is measured by a set of calipers, measuring the distance from the small of the back to near the belly button region while lying down.
The findings in this study suggest that measuring the sagittal abdominal diameter is a pretty darn good way to indirectly measure the amount of fat surrounding your heart.
I found this study pleasantly rewarding since our office recent implemented the use of a “laser liposuction” unit (you can read more about this service by clicking here). I realized quickly that the patients seeing the most dramatic results were the ones with the most inflammtory belly fat. Since laser has been known for many years to increase blood flow and decrease inflammation, this makes complete sense.
Using laser to calm down inflammatory body fat, according to this study, is also highly likely to lower the fat accumulated around your heart as well. Not a bad bang for your buck.
If only it were that simple, but physiology rarely is. But this does not mean you can’t use this info on probiotics and weight gain to your advantage.
Out of all the topics I’ve covered in the past 13 years and some 2500 blog posts, there are a few that stand out. Vitamin D, exercise, diabetes prevention, chronic migraine relief. Probiotics, or those beneficial little buggers that should be present in your gut, is also way up on this list.
That is because the research on probiotics is everywhere across multiple specialties and any number of disease states. Many times I do not flag interesting journal articles on probiotics because I sound like such a darn broken record. So why am I doing it again? Certainly not boredom–I’ve got 20 other articles in my inbox for blog fodder. Maybe it’s because, at times, the evidence for a particular benefit becomes so overwhelming that it needs to be said again.
We are clearly at that point when it comes to probiotics and regulation of body weight.
The problem is that it is not a matter of having obese people add in some probiotics and “Viola!” They wake up skinny. The reality is that having the right blend of healthy bacteria in your gut seems to help set the tone for your body weight over a lifetime. This begins from birth. I recently had a patient with a 4 month old infant tell me that her pediatrician actually recommended probiotics, but that she should start after 6 months.
Well intentioned, but off base by 6 months. Passage through the womb begins the process and nursing continues the exposure of the newborn and infant to bacteria. Waiting for 6 months in a formula fed baby is just WAY too long to wait. This could potentially make the difference between a lifetime of being at an ideal weight versus this child fighting his weight for the rest of his life. Needless to say, I stressed how important it was not to wait 6 months.
As this particular article points out, the details on the process still are not ironed out. Frankly, given the difference in everyone’s physiology and the hundreds of species of bacteria that are present in the gut, I don’t think we’ll ever get the specifics.
Besides this study, here are some previous blog articles looking at the relationship between probiotics and weight:
The take home message is twofold. First, the use of antibiotics for non-life threatening situations needs to go away. Nothing will destroy the delicate balance of the bacteria in your gut faster than antibiotics. Second, supplementation of probiotics intermittently is not a bad idea. this concept is particularly important for newborns, infants, toddlers and children.
My general recommendations are as follows:
- Teens and Adults: 20 billion cfu / day taken one or two weeks per month.
- Infants and toddlers: 5-10 billion cfu / day at least several days per week.
- Preschoolers and elementary kids: 10-20 billion cfu several days per week.
While these recommendations vary greatly based on the individual situation, it is a good place to start.
Why should gastroenterologists be interested in nutrition and obesity?
Umm…because it is the keystone upon which health and disease pivots? Because it holds the potential to stave off most diseases known to man? Because it can modify the progression and severity of many (if not all…) chronic diseases, many of them GI disorders? Because the GI tract is the first and largest area food we eat is exposed to? Why is this even a question?? This is a sad state of how behind medicine is when it comes to health.
Human Adenovirus Promotes Weight Gain in Monkeys
While I don’t have much to say on this topic (surprised?), I must admit that I have never given much thought to an infectious etiology for obesity. I just hope that we do not tread too heavily down this path, releasing patients of their own personal responsibility with lifestyle changes promoting a healthy weight and blaming excess weight on a virus that is beyond our control.
Nutrition.org — Abstracts: Dhurandhar et al. 132 (10): 3155
Sarcopenia and increased adipose tissue infiltration of muscle in elderly
The inflitration of fat into skeletal muscle is one of those subtle changes that occurs over time that can have a dramatic effect on long term health. Try this scenario–a young woman skips breakfast in an attempt to cut calories and lose weight. And she is successful. However, some of the weight lost has been replacement of lean muscle mass with intramuscular fat. She even looks like she lost weight. But she has made a devastating change to her biochemical makeup. The weight will come back on–with less lean muscle mass it is inevitable–and each cycle it gets harder and harder to lose the weight.
AJCN — Abstracts: Song et al. 79 (5): 874 -
Weight Loss Reduces CRP Levels in Obese Postmenopausal Women
C-Reative protein is increasingly being recognized as a strong independent risk factor for cardiovascular disease. Interestingly, I had a patient in her mid thirties that we identified high CRP levels that we reduced greatly by avoidance of refined carbs…
Circulation — Abstracts: Tchernof et al. 105 (5): 564
We know that exercise is a critical part of a good cardio workout, but how much do we need? 45 minutes at least 3 times per week is the dogma we all follow.
You have to love our viewpoint here in the United States. We don’t want to spend money on research to determine how much exercise is too much. Nope. We want to know just how little we have to do and still get a benefit.
Now, I’m not saying we shouldn’t be efficient with how we spend our time exercising, but this article begins to push the limits of efficiency.
For those who are patients of the clinic, read this blog regularly or have heard me speak at an event know I am a very big fan of short burst interval training. For most, this means 30 seconds of high intensity exercise on something like a stationary bike or treadmill. Perform 4, 6 or even 10 of these sessions with rest times in between and you have likely just met the demands for what you need to keep your heart healthy.
Most often, when I present this information to patients and groups I am speaking to, they are very happy to hear that hopping on the treadmill for 45 to 60 minutes and running through an entire album on your Walkman may be way overkill. (Ok..so maybe it’s NOT your Walkman, but you can tell how long it’s been since I’ve been on a treadmill….).
This approach has been holding its own in the medical literature for the past few years (you can read up on the latest research in a previous article that can be read by clicking here) and I feel confident sharing this concept with others. So, in summary, YES–5 minutes worth of actual exercise may be enough.
Keep in mind that this is NOT jogging for 30 seconds and taking a break. This is a darn near all out burst for 30 seconds. The rest time between sets is basically however long it takes your heart rate to return back to normal. Overall, it’s pretty simple and could reasonably be completed in 20 minutes (shorter if your rest time improves).
But, as I mentioned in the beginning of this article, what if we could shorten this time even further?
I’m not ready to promote this as a standard approach to exercise for all of my patients, but this particular study certainly makes one ponder. In this small study, researchers took 10 overweight or obese men and had them perform 3 2-day trials. Here were the 3 types of exercise:
- None. Full blown couch potato.
- 4 all out 30 second sprints, followed by 4 1/2 minute breaks.
- 1 single intense exercise burst, matched in the amount of calories burned in group #2 (average 198 seconds).
Sounds pretty simple as far as designs go. So what did they find?
- Insulin sensitivty was improved by 44.6% in the single burst exercise compared to the couch potato.
- There was not much of a difference in insulin sensitivity between the short burst and couch potato.
- In the day following the interval training, fat oxidation was improved by 38%.
- Most striking, the day following exercise fat oxidation increased by 63% in the single burst (Tweet this).
A mere 3 1/2 minutes of straight high intensity exercise led to a huge increase in fat burning the next day. That’s under 4 minutes and slightly more than 3 minutes.
Granted, this study was done on a group of men who were arguably out of shape to begin with, but this is likely the population that needs the most help anyway. So I don’t know if I’m ready to cut patients down to 3.5 minutes of exercise a day, but I will definitely keep my radar up on this one.
How much do YOU exercise per day?
The metabolic syndrome
Okay. Insulin resistance finally makes it to the editorial section of the British Medical Journal. This physiological abnormality has been linked to increased rates of diabetes, obesity, certain types of cancer,and a horde of other chronic diseases. So why is something that is literally the scourge of Western civilization; something that is readily amenable with lifestyle changes–still virtually unknown in clinical practice???? This is one answer that I do not have the answer for. And quite frankly, even if there were an answer, there is no excuse that would suffice.
bmj.com Meigs 327 (7406): 61
Gastric Bypass Surgery for Morbid Obesity Leads to an Increase in Bone Turnover and a Decrease in Bone Mass
I’m sure if I thought about it there may actually be a good reason to perform a gastric bypass, I would guess the majority of these surgeries done would not fall into my category.
Who ever developed this surgery?? Hey–let’s bypass an essential component of human health so a patient can lose some weight!!!
JCEM — Abstracts: Coates et al. 89 (3): 1061 -