Efforts to fight obesity among children and teens should include strategies to help them think differently about their eating and exercise habits, researchers conclude based on a review of 64 studies of lifestyle "therapy" and drug interventions.
And it's important for parents to get involved, especially for pre-adolescent children, Dr. Hiltje Oude Luttikhuis, of the Beatrix Children's Hospital in Groningen, The Netherlands, and her colleagues say.
The review is published in the Cochrane Library, which is put out by The Cochrane Collaboration, an international group that produces systematic reviews of health care interventions.
The current review is an update of the first one, done in 2003. No direct conclusions could be drawn from the earlier review, Luttikhuis and her team note, because of the small size of many of the studies as well as quality concerns. The new review incorporates randomized, controlled trials published as recently as May 2008, including 12 targeting increased activity; 6 focused on diet; 36 of behavioral treatment; and 10 of drug therapy. The studies included 5,230 children in all.
Participants in many of these studies did lose significant amounts of weight, Luttikhuis and her colleagues report, but differences in the ways the studies were designed and their quality made it difficult to analyze the studies in combination.
While their review couldn't show that one method was better than the others, the researchers add, it does confirm that behavioral lifestyle interventions can help kids lose weight.
One-third of the lifestyle intervention studies included measures of potential adverse effects including disordered eating behavior, growth stunting, and worsening of psychological well-being. None of these potential adverse effects were seen in any of the studies.
The researchers were able to analyze the trials that included treatment with orlistat, a drug that blocks fat absorption, and those that included treatment with sibutramine, an appetite suppressant. Both sets of drug trials showed significant weight loss benefits from these two agents -- along with a number of adverse drug effects. They were unable to discern whether one medication was more effective than another.
"Evidence from this review shows that family-based, lifestyle interventions with a behavioral program aimed at changing diet and physical activity thinking patterns provide significant and clinically meaningful decrease in overweight in both children and adolescents compared to standard care or self-help in the short- and the long-term," the researchers write.
While orlistat and sibutramine should be considered as part of a lifestyle treatment program for obese adolescents, they add, "such therapy needs to be carefully weighed up against the potential for adverse events."
NEW YORK (Reuters Health)
Fat Loss And Bodybuilding News! Even a modest amount of fat loss can reduce your risk of a serious illness and means you will enjoy a better, heathier and longer life expectancy.
Thursday 22 January 2009
Obesity epidemic shows perils to health reform
For years, Bob Clegg's insurance company paid out some $3,000 a month for doctor visits, drugs and medical devices to treat the health problems caused by his obesity.
In September 2007, when his weight peaked at 380 pounds (172 kg), he had gastric bypass surgery, and now his health issues -- joint pain, sleep apnea and esophageal problems -- have vanished, and so have the medical bills.
But even though the surgery -- in which the stomach is made smaller and part of the intestine is bypassed -- has saved his insurance company money, Clegg, who now weighs 240 pounds (108 kg), had to pay the $20,000 cost out of his own pocket.
"It wasn't until the doctor said my sleep apnea was at a point where we seriously had to consider a tracheotomy that we talked about gastric bypass," said Clegg, 54. "The irony is that insurance would pay for the tracheotomy, but not the surgery."
Clegg's experience highlights the difficulties facing the United States as it confronts an epidemic of obesity, and the problems for President Barack Obama as he sets about extending health insurance to more Americans at a time of runaway costs.
While his experience is typical, unlike most other people, Clegg was in a position to make some changes.
As a member of New Hampshire's senate, he took what he knew about obesity and the cost of treating related chronic illnesses to the state capitol, where he introduced a bill in January 2008 requiring insurers to offer surgery as a treatment option, just as the state's Medicaid program for the poor does.
While other states -- some of which don't cover any obesity treatment -- are studying New Hampshire's approach, experts say economics will increasingly drive policy at a time of burgeoning budget deficits.
EPIDEMIC COSTS
About two-thirds of American adults are overweight or obese, putting them at an increased risk for diabetes, hypertension, heart disease, osteoarthritis, stroke, gallbladder disease, sleep apnea and respiratory problems and even some cancers.
The direct and indirect costs of obesity is $117 billion each year, according to a 2000 report by the U.S. Surgeon General.
Christine Ferguson, associate professor at George Washington University School of Public Health and the director of STOP Obesity Alliance, said the stigma surrounding obesity and belief that it is not a disease are keeping the government from addressing the crisis.
"At the root of this is that people still have a real problem thinking about obesity as anything other than a willpower issue," said Ferguson. "It is still perfectly acceptable to think about excluding treatment."
Ferguson, who has held high level healthcare posts in Massachusetts and Rhode Island, acknowledged the difficulty in changing the way government thinks about spending on obesity.
"If I have to balance my budget at the end of each year, I have a choice between investing money in children who have mental retardation, or children with developmental disabilities ... or investing in people who have obesity, choosing obesity is a very hard case to make," she said.
This is even though insurers would recover the costs of bariatric surgery within two to four years, according to Pierre-Yves Cremieux, a researcher with the economic consulting firm Analysis Group.
Cremieux led a study that showed the operation helps patients' health and ultimately leads to cost savings. The study was paid for by Johnson & Johnson, which makes bariatric surgery instruments.
OBESITY BIAS
Ronald Williams, the chairman and chief executive of health insurer Aetna, said most large employers that it sells policies to have at least one plan that covers bariatric surgery.
But, he said, he's more focused on prevention.
"The bigger end of the story is, How do we help people not become obese to begin with?" he said. "If they are suffering the complications from being overweight or obese, how can we help them manage those conditions?"
Clegg blamed difficultly in pushing his bill through partly on society's bias against the obese. The bill finally passed in June, six months before he left the senate in December.
Other states have had similar difficulties, including Utah, where Jeff Haaga has lobbied the state to require insurers to provide greater coverage there.
"If we could only get our lawmakers to understand, like they did in New Hampshire," said Haaga, who at 360 pounds is classified as morbidly obese.
"Insurers are covering people who are morbidly obese one way or the other, whether it's surgery or just keeping us alive with medication."
In Mississippi, rated the nation's fattest state for the third consecutive year, a bill that would have banned restaurants from serving obese customers died almost immediately after it was introduced in February.
The Trust for America's Health, a nonprofit group that focuses on disease prevention, reported that adult obesity rates rose in 37 states in the past year, while no state saw a decrease.
In its 2008 report: 'F as in Fat: How Obesity Policies are Failing in America', the Trust said Mississippi has per capita medical costs that are among the highest in the nation. It also has a Medicaid policy that specifically excludes coverage for bariatric surgery.
For Clegg, the former New Hampshire lawmaker, Mississippi's obesity problems are clearly linked to its refusal to pay for bariatric surgery under its Medicaid program.
"If Mississippi is that ignorant and would rather pay for diabetic medicine every month and watch people have heart attacks at a cost of $40,000 ... but wont spend $10,000 or $20,000 (for the surgery), well maybe that's why Mississippi has a problem," he said.
(Reporting by Debra Sherman; Editing by Eddie Evans)
CHICAGO (Reuters)
In September 2007, when his weight peaked at 380 pounds (172 kg), he had gastric bypass surgery, and now his health issues -- joint pain, sleep apnea and esophageal problems -- have vanished, and so have the medical bills.
But even though the surgery -- in which the stomach is made smaller and part of the intestine is bypassed -- has saved his insurance company money, Clegg, who now weighs 240 pounds (108 kg), had to pay the $20,000 cost out of his own pocket.
"It wasn't until the doctor said my sleep apnea was at a point where we seriously had to consider a tracheotomy that we talked about gastric bypass," said Clegg, 54. "The irony is that insurance would pay for the tracheotomy, but not the surgery."
Clegg's experience highlights the difficulties facing the United States as it confronts an epidemic of obesity, and the problems for President Barack Obama as he sets about extending health insurance to more Americans at a time of runaway costs.
While his experience is typical, unlike most other people, Clegg was in a position to make some changes.
As a member of New Hampshire's senate, he took what he knew about obesity and the cost of treating related chronic illnesses to the state capitol, where he introduced a bill in January 2008 requiring insurers to offer surgery as a treatment option, just as the state's Medicaid program for the poor does.
While other states -- some of which don't cover any obesity treatment -- are studying New Hampshire's approach, experts say economics will increasingly drive policy at a time of burgeoning budget deficits.
EPIDEMIC COSTS
About two-thirds of American adults are overweight or obese, putting them at an increased risk for diabetes, hypertension, heart disease, osteoarthritis, stroke, gallbladder disease, sleep apnea and respiratory problems and even some cancers.
The direct and indirect costs of obesity is $117 billion each year, according to a 2000 report by the U.S. Surgeon General.
Christine Ferguson, associate professor at George Washington University School of Public Health and the director of STOP Obesity Alliance, said the stigma surrounding obesity and belief that it is not a disease are keeping the government from addressing the crisis.
"At the root of this is that people still have a real problem thinking about obesity as anything other than a willpower issue," said Ferguson. "It is still perfectly acceptable to think about excluding treatment."
Ferguson, who has held high level healthcare posts in Massachusetts and Rhode Island, acknowledged the difficulty in changing the way government thinks about spending on obesity.
"If I have to balance my budget at the end of each year, I have a choice between investing money in children who have mental retardation, or children with developmental disabilities ... or investing in people who have obesity, choosing obesity is a very hard case to make," she said.
This is even though insurers would recover the costs of bariatric surgery within two to four years, according to Pierre-Yves Cremieux, a researcher with the economic consulting firm Analysis Group.
Cremieux led a study that showed the operation helps patients' health and ultimately leads to cost savings. The study was paid for by Johnson & Johnson, which makes bariatric surgery instruments.
OBESITY BIAS
Ronald Williams, the chairman and chief executive of health insurer Aetna, said most large employers that it sells policies to have at least one plan that covers bariatric surgery.
But, he said, he's more focused on prevention.
"The bigger end of the story is, How do we help people not become obese to begin with?" he said. "If they are suffering the complications from being overweight or obese, how can we help them manage those conditions?"
Clegg blamed difficultly in pushing his bill through partly on society's bias against the obese. The bill finally passed in June, six months before he left the senate in December.
Other states have had similar difficulties, including Utah, where Jeff Haaga has lobbied the state to require insurers to provide greater coverage there.
"If we could only get our lawmakers to understand, like they did in New Hampshire," said Haaga, who at 360 pounds is classified as morbidly obese.
"Insurers are covering people who are morbidly obese one way or the other, whether it's surgery or just keeping us alive with medication."
In Mississippi, rated the nation's fattest state for the third consecutive year, a bill that would have banned restaurants from serving obese customers died almost immediately after it was introduced in February.
The Trust for America's Health, a nonprofit group that focuses on disease prevention, reported that adult obesity rates rose in 37 states in the past year, while no state saw a decrease.
In its 2008 report: 'F as in Fat: How Obesity Policies are Failing in America', the Trust said Mississippi has per capita medical costs that are among the highest in the nation. It also has a Medicaid policy that specifically excludes coverage for bariatric surgery.
For Clegg, the former New Hampshire lawmaker, Mississippi's obesity problems are clearly linked to its refusal to pay for bariatric surgery under its Medicaid program.
"If Mississippi is that ignorant and would rather pay for diabetic medicine every month and watch people have heart attacks at a cost of $40,000 ... but wont spend $10,000 or $20,000 (for the surgery), well maybe that's why Mississippi has a problem," he said.
(Reporting by Debra Sherman; Editing by Eddie Evans)
CHICAGO (Reuters)
Most successful dieters lose weight on their own
To shed excess pounds, forget expensive commercial diets or diet pills; most successful dieters lose weight on their own, largely by eating right and exercising regularly, according to a survey by Consumer Reports.
Their specific successful do-it-yourself weight loss tactics are unveiled at www.ConsumerReportsHealth.org.
A total of 21,632 subscribers to Consumer Reports were asked recently about their lifetime weight history and their eating, dieting and exercise habits.
The "always thin" group - those who had never been overweight -- made up 16 percent of the sample, while "successful losers" made up an additional 15 percent. Successful losers were defined as people who, at the time of the survey, weighed at least 10 percent less than they did at their heaviest, and had been at that lower weight for at least 3 years.
"Failed dieters" - those would said they'd like to slim down yet still weighed at or near their lifetime high -- made up the largest group at 42 percent. The remaining 27 percent of respondents, such as people who had lost weight more recently, didn't fit into any of the categories.
Among the "always thin" group, only 3 percent said that they never exercised and that they ate whatever they wanted. In fact, the eating and exercise habits of the vast majority of the "always thin" group mirrored the eating and exercise habits of the "successful losers," a finding that downplays the idea that people who are able to stay fit and trim have a genetic edge.
Both the "always thin" and the "successful losers" say they regularly eat healthy foods such as fruits, vegetables, and whole grains and stay away from excessive dietary fat. They also practice portion control and engage in regular vigorous exercise.
The only advantage the "always thin" have over the "successful dieters" is that those habits seem to come a bit more naturally to them, according to Consumer Reports.
"When we've compared people maintaining a weight loss with (those) who've always had a normal weight, we've found that both groups are working hard at it; the maintainers are just working a little harder," Dr. Suzanne Phelan of the California Polytechnic State University and co-investigator of the National Weight Control Registry, which tracks people who have successfully maintained a weight loss over time, noted in a Consumer Reports press statement.
According to the magazine, more than half of "successful losers" reported shedding the weight themselves, without the help of commercial diet program, a medical treatment, a book, or diet pills. This finding confirms a prior diet survey by Consumer Reports, in which 83 percent of "super losers" -- people who'd lost at least 10 percent of their starting weight and kept it off for 5 years or longer -- had done it entirely on their own.
NEW YORK (Reuters Health)
Their specific successful do-it-yourself weight loss tactics are unveiled at www.ConsumerReportsHealth.org.
A total of 21,632 subscribers to Consumer Reports were asked recently about their lifetime weight history and their eating, dieting and exercise habits.
The "always thin" group - those who had never been overweight -- made up 16 percent of the sample, while "successful losers" made up an additional 15 percent. Successful losers were defined as people who, at the time of the survey, weighed at least 10 percent less than they did at their heaviest, and had been at that lower weight for at least 3 years.
"Failed dieters" - those would said they'd like to slim down yet still weighed at or near their lifetime high -- made up the largest group at 42 percent. The remaining 27 percent of respondents, such as people who had lost weight more recently, didn't fit into any of the categories.
Among the "always thin" group, only 3 percent said that they never exercised and that they ate whatever they wanted. In fact, the eating and exercise habits of the vast majority of the "always thin" group mirrored the eating and exercise habits of the "successful losers," a finding that downplays the idea that people who are able to stay fit and trim have a genetic edge.
Both the "always thin" and the "successful losers" say they regularly eat healthy foods such as fruits, vegetables, and whole grains and stay away from excessive dietary fat. They also practice portion control and engage in regular vigorous exercise.
The only advantage the "always thin" have over the "successful dieters" is that those habits seem to come a bit more naturally to them, according to Consumer Reports.
"When we've compared people maintaining a weight loss with (those) who've always had a normal weight, we've found that both groups are working hard at it; the maintainers are just working a little harder," Dr. Suzanne Phelan of the California Polytechnic State University and co-investigator of the National Weight Control Registry, which tracks people who have successfully maintained a weight loss over time, noted in a Consumer Reports press statement.
According to the magazine, more than half of "successful losers" reported shedding the weight themselves, without the help of commercial diet program, a medical treatment, a book, or diet pills. This finding confirms a prior diet survey by Consumer Reports, in which 83 percent of "super losers" -- people who'd lost at least 10 percent of their starting weight and kept it off for 5 years or longer -- had done it entirely on their own.
NEW YORK (Reuters Health)
Subscribe to:
Posts (Atom)