Overweight NewsNovember 2, 2009 Written by JP [Font too small?]
There are some fairly obvious reasons why obesity is such a prevalent issue in the 21st century. Likewise, there are many predictable consequences that frequently befall those carrying around excess weight. However, there are also some modifiable risk factors that tend to fly under the mainstream media’s radar. It could be that these topics are just “too boring” or, perhaps, they’re deemed too specific for a mass audience. But the fact remains that being unaware of these threats can seriously endanger one’s health.
A recent study in the journal Circulation helps to clarify the well established link between excess body fat and the risk of blood clots (venous thromboembolism – VTE). A ten year observational trial followed a group of 57,054 middle-aged men and women. Measurements of body fat, hip and waist circumference and weight were taken at baseline. Other potential risk factors for VTEs were also noted – such as diabetes, high blood pressure and cholesterol, hormone replacement therapy and physical activity. Over the next decade, a total of 641 blood clotting incidents were verified via a review of medical records. After all of the data were carefully examined, it was determined that women with a higher hip circumference were at an increased risk of having blood clots. In men, a larger waist circumference was associated with more VTEs. This indicates that specific fat distribution may influence the likelihood of these potentially life threatening events. Previous studies have also identified abdominal obesity and “subcutaneous obesity” (fat located just under the skin) with increased venous thromboembolism risk. (1,2,3)
Antipsychotic medications are frequently prescribed to patients of all ages. Some psychiatrists believe this strategy is one of the best ways to stabilize individuals with a variety of mental disorders. The October edition of the Journal of the American Medical Association points out an important concern associated with the use of this class of drugs. A total of 205 children and adolescents completed the study. All of the youngsters had been diagnosed with aggressive/disruptive behavior, mood or schizophrenia spectrum disorders. The specific medications used in the 12 week study were: aripiprazole, olanzapine, quetiapine or risperidone.
- After 11 weeks of treatment, patients using aripiprazole gained approximately 19 lbs.
- Those receiving olanzapine gained about 13 lbs.
- Quetiapine users increased their weight by roughly 12 lbs.
- Risperdione patients gained just under 10 lbs.
A group of 15 patients “who refused participation or were non-adherent served as a comparison group”. The untreated children gained less than .5 lbs. On the other hand, those given olanzapine and quetiapine demonstrated increases in blood sugar, LDL (“bad”) cholesterol and trigylceride concentrations. Risperidone caused a significant elevation in triglycerides as well. These side effects caused between 10% – 36% of the young patients to be classified as overweight or obese by the end of the 11 week experiment. These alarming findings led the authors to remark that, “These medications can be lifesaving for youth with serious psychiatric illnesses such as schizophrenia, classically defined bipolar disorder, or severe aggression associated with autism. However, given the risk for weight gain and long-term risk for cardiovascular and metabolic problems, the widespread and increasing use of atypical antipsychotic medications in children and adolescents should be reconsidered.” (4)
These results do not appear to be a fluke. A prior study involving adults living in Singapore found similar results after 6 months of antipsychotic treatment. In that trial, an average weight gain of over 12 lbs was observed. Undesirable shifts in cholesterol levels were likewise reported. In addition, other research suggests that certain psychiatric patients may be more sensitive to these adverse reactions. For instance, scientists from the University of Toronto Department of Psychiatry state that women may be more susceptible to “weight gain, diabetes and specific cardiovascular risks of antipsychotics”. (5,6)
Serum Vitamin D Levels in Obese vs. “Healthy” Volunteers
|Non-Obese (BMI < 30 kg/m2)||Obese (BMI = 30 kg/m2)|
|May 2006 Study||70.7||56.0|
|Feb. 2008 Study||54 (females)||40 (females)|
|59 (males)||34 (males)|
Vitamin D Measured as 25(OH)D (nmol/l)
Source 2: Am J of Clin Nutr, Vol. 87, February 2008 (link)
There is a growing consensus in the scientific community that being overweight predisposes men and women to inadequate vitamin D levels. A recent analysis suggests that 1 out of 2 obese men and 1 of every 3 obese women are clinically deficient in this vital nutrient. Now, an Australian study published in the American Journal of Medicine rings a new bell of alarm. 17 obese hospital patients with “severe vitamin D deficiency” were given 10,000 IUs of Vitamin D3 daily for 1 week. Blood tests were taken before and after to determine any changes in serum 25-OH D concentrations – a measure of D levels in the blood. The researchers discovered that those with the highest body mass index (BMI) responded the least to the “medication”. Therefore they concluded that “Efficacy of Vitamin D supplementation is depended on BMI. Overweight and obese patients with hypovitaminosis D might require higher doses of Vitamin D to achieve Vitamin D repletion compared with individuals with normal body weight”. (7,8,9)
Every “problem” I’ve written about today has a practical solution. Eating a more healthful diet and exercising regularly can decrease body fat accumulation and, thereby, possibly reduce the risk of blood clots. Those same changes may also help one to avoid the underlying need for certain antipsychotic medications. If those strategies aren’t enough, there are plenty of natural remedies that are known to support healthier circulation and psychological stability (fish oil, niacin, Vitamin D). Some people may still require carefully selected prescription drugs to manage their medical issues. But even if they do, simply being aware of the possible side effects can help them and their physicians to take steps to avoid such complications. It is precisely this kind of integrative approach that I hope will become the future of health care. (10,11,12,13,14,15)
Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!
Tags: Circulation, Vitamin D, Weight
Posted in Diet and Weight Loss, Heart Health, Mental Health
November 2nd, 2009 at 8:40 pm
Sub Q obesity – does that include cellulite?
Another great and thought-provoking article, JP!
November 2nd, 2009 at 10:46 pm
I believe that it would. To the best of my knowledge, cellulite is generally classified as a form of subcutaneous fat – even though it’s appearance is influenced by connective tissue as well.
November 3rd, 2009 at 7:41 am
Some of my Hospice patients lose sub q fat – the Nurse measures the circumference of the forearm to differentiate between sub q and adipose loss.
The Vit D deficiency – “what if” there are people who are chronically mis-diagnosed (or at least mis-understood) who have underlying issues as simple as this… or maybe blood sugar spikes (instead of being pathologically psych) It couldn’t hurt anyone to get a wee bit more healthy, eh?
And think of all the things it might help change.
November 3rd, 2009 at 2:44 pm
Thanks for sharing your insider’s P.O.V., Anne. 🙂
re: Vitamin D
I couldn’t agree more. BTW, my parents have requested that their doctor (a general practitioner) include a Vitamin B12 and D test along with their yearly physical exam. So far, the doctor has been willing to do so. The tests have been covered by their insurance and the results have helped to guide us in selecting an appropriate level of B12 & D (to supplement with).
February 15th, 2010 at 11:33 pm
This is pretty significant considering how important Vitamin D is for bone health, mood, and general mental health. Thanks for posting the research on this!
February 16th, 2010 at 1:21 am
Thank you, Dave. Glad you found it to be of interest. 🙂
March 14th, 2015 at 2:42 pm
Update: Higher protein diets may lower risk of cardiometabolic disease …
J Nutr. 2015 Mar;145(3):605-14.
Higher-Protein Diets Are Associated with Higher HDL Cholesterol and Lower BMI and Waist Circumference in US Adults.
BACKGROUND: Protein intake above the RDA attenuates cardiometabolic risk in overweight and obese adults during weight loss. However, the cardiometabolic consequences of consuming higher-protein diets in free-living adults have not been determined.
OBJECTIVE: This study examined usual protein intake [g/kg body weight (BW)] patterns stratified by weight status and their associations with cardiometabolic risk using data from the NHANES, 2001-2010 (n = 23,876 adults ≥19 y of age).
METHODS: Linear and decile trends for association of usual protein intake with cardiometabolic risk factors including blood pressure, glucose, insulin, cholesterol, and triglycerides were determined with use of models that controlled for age, sex, ethnicity, physical activity, poverty-income ratio, energy intake (kcal/d), carbohydrate (g/kg BW) and total fat (g/kg BW) intake, body mass index (BMI), and waist circumference.
RESULTS: Usual protein intake varied across deciles from 0.69 ± 0.004 to 1.51 ± 0.009 g/kg BW (means ± SEs). Usual protein intake was inversely associated with BMI (-0.47 kg/m(2) per decile and -4.54 kg/m(2) per g/kg BW) and waist circumference (-0.53 cm per decile and -2.45 cm per g/kg BW), whereas a positive association was observed between protein intake and HDL cholesterol (0.01 mmol/L per decile and 0.14 mmol/L per g/kg BW, P < 0.00125). CONCLUSIONS: Americans of all body weights typically consume protein in excess of the RDA. Higher-protein diets are associated with lower BMI and waist circumference and higher HDL cholesterol compared to protein intakes at RDA levels. Our data suggest that Americans who consume dietary protein between 1.0 and 1.5 g/kg BW potentially have a lower risk of developing cardiometabolic disease. Be well! JP
March 15th, 2015 at 4:39 pm
Update: Diets rich in fiber reduce excessive inflammation in overweight adolescents …
Pediatr Obes. 2015 Mar 2.
Dietary fibre linked to decreased inflammation in overweight minority youth.
OBJECTIVE: The objective of this study was to examine the relationship between diet and inflammation, and adiposity in minority youth.
DESIGN AND METHODS: The study was designed as a cross-sectional analysis of 142 overweight (≥85th body mass index percentile) Hispanic and African-American adolescents (14-18 years) with the following measures: anthropometrics, adiposity via magnetic resonance imaging, dietary intake via 24-h dietary recalls, and inflammation markers from fasting blood draws utilizing a multiplex panel. Partial correlations were estimated and analysis of covariance (ancova) models fit to examine the relationship among dietary variables, inflammation markers and adiposity measures with the following a priori covariates: Tanner stage, ethnicity, sex, total energy intake, total body fat and total lean mass.
RESULTS: Inference based on ancova models showed that the highest tertile of fibre intake (mean intake of 21.3 ± 6.1 g d-1 ) vs. the lowest tertile of fibre intake (mean intake of 7.4 ± 1.8 g d-1 ) was associated with 36% lower plasminogen activator inhibitor-1 (P = 0.02) and 43% lower resistin (P = 0.02), independent of covariates. Similar results were seen for insoluble fibre. No other dietary variables included in this study were associated with inflammation markers.
CONCLUSIONS: These results suggest that increases in dietary fibre could play an important role in lowering inflammation and therefore metabolic disease risk in high-risk minority youth.
June 5th, 2015 at 1:42 pm
Food Funct. 2015 Jun 1.
Effects of Nigella sativa oil with a low-calorie diet on cardiometabolic risk factors in obese women: a randomized controlled clinical trial.
Obesity is typically associated with increased risk factors of cardiovascular diseases (CVDs). Therefore, a therapeutic approach that aims to control body weight and metabolic profile might be effective in preventing CVDs. We aimed to determine the effects of Nigella Sativa (NS) oil with a low-calorie diet on cardiometabolic risk factors in obese women. In this double-blind randomized controlled clinical trial, 90 obese women were recruited. Participants were females aged 25-50 years old with body mass index (BMI) between 30 and 35 kg m-2. They were randomly assigned to receive a low-calorie diet with 3 g per day (1 g before each meal) NS oil or placebo for 8 weeks. Anthropometric indices, dietary intake and biochemical parameters were measured at the baseline and after the intervention. Eighty-four females completed the trial (intervention n = 43, placebo n = 41). Two groups were similar in the baseline characteristics. After the intervention, dietary intake was changed in both groups compared to the baseline, but the differences were not significant between the two groups. In the NS group, weight (-6.0 vs. -3.6%; p < 0.01) and waist circumference (-6.9 vs. -3.4%; p < 0.01) decreased significantly compared with the placebo group at the end of the trial. Comparison of biochemical parameters presented a significant decline in triglyceride (-14.0 vs. 1.4%; p = 0.02) and very low density lipoprotein (-14.0 vs. 7%; p < 0.01) levels in the NS group compared to the placebo group. NS oil concurrent with a low-calorie diet can reduce cardiometabolic risk factors in obese women. However, more clinical trials are needed to elucidate efficacy of NS as a complementary therapy in obese subjects. Be well! JP
June 7th, 2015 at 12:59 am
J Am Coll Nutr. 2015 May 19:1-12.
The Effect of the Mediterranean Diet on Serum Total Antioxidant Capacity in Obese Patients: A Randomized Controlled Trial.
OBJECTIVE: The aim of this work was to evaluate the combined effect of physical activity and 1 and 12 months’ adherence to Mediterranean diet (MD) on serum total antioxidant capacity (TAC) in obese patients, as well as factors contributing to TAC.
METHODS: One hundred twenty-four patients were randomly assigned to either MD combined with physical activity or standard hypolypemic diet (SHD) with physical activity. Both groups received counseling and education during the initial week and were invited for the follow-up visits, where data on body weight and blood samples were collected. TAC was determined by Trolox equivalent antioxidant capacity and urate was determined using a uricase spectrophotometric method at the initial visit and after 1 and 12 months.
RESULTS: Eighty-four patients finished the 12-month program and were analyzed. The baseline and 1- and 12-month mean (±SD) TAC values in the MD group (n = 40) were 2.38 ± 0.48, 2.51 ± 0.47, and 2.47 ± 0.45 mmol Trolox equivalent (TE)/L, respectively. In the SHD group (n = 44), TAC values were 2.37 ± 0.49, 2.48 ± 0.49, and 2.31 ± 0.51 mmol TE/L, respectively. There was a statistically significant main effect for time (p < 0.001), as well as statistically significant time-diet interaction effect (p = 0.009). There was no statistically significant correlation between TAC and uric acid after 1 month (p = 0.733) or 12 months (p = 0.844) of the intervention. Based on the regression model, which included gender, diet, physical activity level, and percentage body weight change, the type of diet was the only significantly contributing factor to TAC change after the 12-month period, F = 3.867, df = 3, p = 0.012, R = 0.358, R2 = 0.128. CONCLUSION: This randomized controlled trial with diet and physical activity intervention and TAC as a primary outcome demonstrated initial antioxidant improvement in both MD and SHD groups and a long-term beneficial effect of MD. The results imply that diet composition-olive oil, nuts, and fish in particular-combined with physical activity modify antioxidant capacity. Be well! JP
June 11th, 2016 at 8:03 pm
Lancet Diabetes Endocrinol. 2016 Jun 6.
Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial.
BACKGROUND: Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese.
METHODS: PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55-80 years) and women (aged 60-80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin olive oil (n=2543); Mediterranean diet supplemented with nuts (n=2454); or a control diet (advice to reduce dietary fat; n=2450). Energy restriction was not advised, nor was physical activity promoted. In this analysis of the trial, we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population. The PREDIMED trial is registered with ISRCTN.com, number ISRCTN35739639.
FINDINGS: After a median 4·8 years (IQR 2·8-5·8) of follow-up, participants in all three groups had marginally reduced bodyweight and increased waist circumference. The adjusted difference in 5 year changes in bodyweight in the Mediterranean diet with olive oil group was -0·43 kg (95% CI -0·86 to -0·01; p=0·044) and in the nut group was -0·08 kg (-0·50 to 0·35; p=0·730), compared with the control group. The adjusted difference in 5 year changes in waist circumference was -0·55 cm (-1·16 to -0·06; p=0·048) in the Mediterranean diet with olive oil group and -0·94 cm (-1·60 to -0·27; p=0·006) in the nut group, compared with the control group.
INTERPRETATION: A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in bodyweight and less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance.
April 11th, 2017 at 1:42 pm
Obes Sci Pract. 2017 Mar;3(1):99-105.
25(OH)D status: Effect of D3 supplement.
BACKGROUND: Excess adipose tissue may lead to sequestrating of vitamin D, making it less available for use in the body.
OBJECTIVE: This study determined if overweight or obese individuals (BMI > 25 kg m-2) had insufficient (<30 ng mL-1) levels of 25-hydroxyvitamin D [25(OH)D] and, if so, would serum levels respond to exogenous supplementation.
METHODS: Sixty-three women who were overweight/obese (BMI = 31.07 ± 5.00 kg m-2) were randomly assigned in a double-blind manner to receive 5,000 IU of vitamin D3 (D3) (n = 31) or a placebo (PL) (n = 32) daily. Serum 25(OH)D concentrations were measured by finger-stick analyses at baseline and after 8 weeks of supplementation. Data were analyzed by using a 2 × 2 (group × time) repeated measure multivariate analysis of variance to determine group differences for pre-values and post-values (p < 0.05). RESULTS: On day one of the study, both D3 and PL groups had insufficient levels of vitamin D (mean ± SD) 24.03 ± 9.78 ng mL-1 and 23.62 ± 9.77 ng mL-1, respectively. After 8 weeks of supplementation, the D3 group 25(OH)D level rose to a mean of 43.57 ± 10.87 ng mL-1 (p < 0.001) versus the PL group whose 25(OH)D level remained statistically unchanged 24.31 ± 8.84 ng mL-1. Women who were overweight/obese had insufficient vitamin D levels prior to supplementation. CONCLUSIONS: Following supplementation with 5,000 IU of vitamin D3, all subjects' 25(OH)D levels rose to a sufficient level (≥30 ng mL-1). The findings of this study concur with the Institute of Medicine and Endocrine Society recommendations in that two to three times the daily requirement of vitamin D is required to improve serum vitamin D levels in individuals who are overweight or obese. Be well! JP
November 25th, 2018 at 4:18 pm
Int J Obes (Lond). 2018 Nov 23.
Effect of intermittent compared to continuous energy restriction on weight loss and weight maintenance after 12 months in healthy overweight or obese adults.
BACKGROUND AND OBJECTIVE: Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight loss. There are few long-term trials comparing efficacy of these methods. The objective was to compare the effects of CER to two forms of IER; a week-on-week-off energy restriction and a 5:2 program, during which participants restricted their energy intake severely for 2 days and ate as usual for 5 days, on weight loss, body composition, blood lipids, and glucose.
SUBJECTS AND METHODS: A one-year randomized parallel trial was conducted at the University of South Australia, Adelaide, Australia. Participants were 332 overweight and obese adults, ages 18-72 years, who were randomized to 1 of 3 groups: CER (4200 kJ/day for women and 5040 kJ/day for men), week-on-week-off energy restriction (alternating between the same energy restriction as the continuous group for one week and one week of habitual diet), or 5:2 (2100 kJ/day on modified fast days each week for women and 2520 kJ/day for men, the 2 days of energy restriction could be consecutive or non-consecutive). Primary outcome was weight loss, and secondary outcomes were changes in body composition, blood lipids, and glucose.
RESULTS: For the 146 individuals who completed the study (124 female, 22 male, mean BMI 33 kg/m2) mean weight loss, and body fat loss at 12 months was similar in the three intervention groups, -6.6 kg for CER, -5.1 kg for the week-on, week-off and -5.0 kg for 5:2 (p = 0.2 time by diet). Discontinuation rates were not different (p = 0.4). HDL-cholesterol rose (7%) and triglycerides decreased (13%) at 12 months with no differences between groups. No changes were seen for fasting glucose or LDL-cholesterol.
DISCUSSION AND CONCLUSION: The two forms of IER were not statistically different for weight loss, body composition, and cardiometabolic risk factors compared to CER.