Health and Fitness Blog

PHILADELPHIA – Police investigating the death of a morbidly obese woman found her disabled mother living in their squalid mobile home with more than 60 caged birds, a few of them dead.

Judith Kresge sought help from a family friend on Christmas Eve after getting no response to repeated calls to her daughter’s bedroom, police said Wednesday. The friend found Wendy Kresge’s body in her bed and called the police.

Investigators discovered deplorable conditions and no running water in the Stroud Township home and deemed it unfit for the surviving woman and the animals.

Kresge is not ambulatory and spent her time on a couch strewn with trash bags, clothing and other items, the police report said. She told police she kept a cooler with food in it nearby, although she could not find it the day they arrived. They found the bird cages filthy.

“Because of the handicapped mother, the condition of the trailer, the 60 birds, the nonfunctioning toilet, basically, we determined it to be unfit living conditions,” said Lt. Brian Kimmins of the Stroud Area Regional Police.

Kresge was uncooperative, refusing to surrender the birds or leave her home after her daughter’s death, officials said. A relative finally persuaded her to accept a move to an assisted living facility, while the Society for the Prevention of Cruelty to Animals charged her with animal neglect and cruelty in order to get a search warrant and remove the birds, Kimmins said.

The birds included macaws, parrots, parakeets and lovebirds, police said.

“I suspect that it was a typical hoarding case,” Kimmins said.

Wendy Kresge, 45, who weighed more than 500 pounds, died of natural causes, the Monroe County coroner’s office said.

The home is located in a trailer park about 80 miles north of Philadelphia. Several welfare agencies were aware of the family, but the severity of the women’s problems was not apparent, Kimmins said.

“They weren’t off the radar. The Office of the Aging had a case, the SPCA had a case,” he said. “They always seemed to be just below the level required to take action against somebody who does not want to be assisted.”

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NEW YORK (Reuters Health) –
Among pregnant women at higher-than- average risk of premature delivery, those who are overweight or obese seem to be afforded some protection, a new study suggests.

Researchers found that of 253 women who were followed during pregnancy, those who were overweight or obese had a far lower rate of preterm delivery compared with normal-weight or underweight women. Just over 8 percent gave birth before the 35th week of pregnancy, versus nearly 22 percent of normal-weight or underweight women.

All of the women in the study were considered to be at higher-than-normal risk of preterm delivery because of previous preterm births or bleeding problems during the current pregnancy. But excess weight seemed to lower this risk, the researchers report in the journal Obstetrics & Gynecology.

The reason may be related to differences in the frequency of uterine contractions, according to the investigators, led by Dr. Hugh M. Ehrenberg of Ohio State University Medical Center in Columbus.

They found that normal-weight and underweight women tended to have more contractions between the 22nd and 34th weeks of pregnancy.

The explanation for this finding is not clear, but may have to do with the fact that body fat affects hormone levels, which may in turn affect the frequency of uterine contractions during pregnancy, the researchers note.

Whatever the reason, they conclude, the findings suggest that when doctors screen women for their risk of preterm birth, overweight women who show uterine-contraction patterns similar to those of thinner women may need to be considered high-risk for early delivery.

SOURCE: Obstetrics & Gynecology, January 2009.

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NEW YORK (Reuters Health) –
Obese men are more than three times as likely to have low sperm counts compared with their normal-weight peers, a study out this month in the journal Fertility and Sterility shows.

The heaviest men were also at triple the risk of having a low count of progressively motile sperm — sperm that swim forward in a straight line, Dr. Ahmad O. Hammoud of the University of Utah in Salt Lake City and colleagues found.

“There is a strong relationship between overweight and obesity and altered sperm parameters,” Hammoud and his team write. Future studies should look at this relationship over time, they say, as well as how weight loss might affect sperm characteristics.

There has been some evidence that obesity may impair fertility in men, the researchers note, while increased body fat can contribute to lower testosterone levels and higher estrogen levels. To examine how body mass index (BMI) affects sperm quality, they evaluated 390 men who sought infertility treatment with their partners over a 2-year period.

Twenty-four percent of the men were normal weight, 43 percent were overweight, and 33 percent were obese. Overall, 10.5 percent had low sperm counts.

The prevalence of low sperm counts rose as BMI increased; obese men were 3.3 times more likely to have low sperm counts than normal-weight men. The risk of having a low count of progressively mobile sperm also rose with BMI; obese men were 3.4 times more likely than normal-weight men to have a low progressively mobile sperm count. Obese men were also 1.6 times more likely than overweight or normal-weight men to have a high percentage of abnormally shaped sperm.

While there was a trend toward increasing likelihood of erectile dysfunction with increasing BMI, the relationship wasn’t statistically significant. However, the researchers note, other studies have found that obesity is associated with a greater risk of impotence.

The fact that the study was done among men seeking infertility treatment makes it likely that the study group had worse sperm quality than the population at large, Hammoud and colleagues point out. Nevertheless, they add, the correlation of poor sperm quality and increased BMI in the general population is probably similar.

SOURCE: Fertility and Sterility, December 2008.

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MONDAY, Dec. 29 (HealthDay News) — Obese teenagers who have gastric
bypass surgery not only lose weight but see their type 2 diabetes
disappear, a new study finds.

Also called bariatric surgery, the procedure works by limiting the size
of the stomach and thereby reducing the amount of food one can eat. In
this study, researchers used the Roux-en-Y method, which involves placing
an adjustable band to block off most of the stomach. The band limits how
much food the body absorbs.

“Previous studies have shown frequent remission of type 2 diabetes in
adults following bariatric surgery, but until now, no research had been
done to provide information about outcomes of adolescent diabetics who are
considering surgical weight loss,” said lead researcher Dr. Thomas H.
Inge, an associate professor of surgery and pediatrics at Cincinnati
Children’s Hospital Medical Center.

“Our study found that, in most cases, teens can lose one-third of their
weight and come off diabetes medications with remission of their diabetes
one year after bypass surgery. This is certainly not the case for similar
diabetic teenage patients who did not undergo surgery,” Inge noted.

The report is published in the January issue of Pediatrics.

For the study, Inge’s group looked at 78 teens with type 2 diabetes.
Eleven patients underwent gastric bypass surgery, while the other 67
patients received usual care for their diabetes.

For the teens who had surgery, not only did they have an average 34
percent reduction in their weight, but their diabetes went into remission.
Teens that did not have surgery saw an average weight loss of less than
two pounds and still needed their diabetes medication.

“In addition to the impressive weight loss and type 2 diabetes results,
patients undergoing the gastric bypass surgery also showed significant
improvement in blood pressure, insulin, glucose, cholesterol and
triglyceride levels,” Inge said.

Type 2 diabetes takes a huge toll on the body, and the earlier it
starts, the more of an impact it can have, Inge explained.

“These early surgical research findings suggest that diabetes may not
be a diagnosis kids have to live with for the rest of their lives,” Inge
said. “They may not have to face diabetic retinopathy, progressive
coronary heart disease and renal failure. In fact, there is good reason to
be optimistic about their future cardiovascular health.”

“If you are a type 2 diabetic and morbidly obese, gastric bypass
surgery should be considered in the treatment pathway,” Inge added.

Dr. David L. Katz, director of the Prevention Research Center at Yale
University School of Medicine, thinks that while surgery is effective it
does not deal with the cause of the obesity epidemic among teens.

“Bariatric surgery is clearly effective in treating severe obesity,
preventing and reversing type 2 diabetes, and even extending survival when
applied to adults,” Katz said. “That similar benefits ensue when the
procedure is applied to adolescents is important, but by no means
surprising.”

Despite the success of surgery, these results should be viewed with
caution, Katz said.

“A large and growing proportion of all children and adolescents are
subject to obesity, and its complications,” Katz said. “Surgery can
mitigate those complications, but can we really condone ushering more and
more young people through the OR doors for a major surgical procedure to
fix what policies and programs that foster healthful eating and regular
activity could have prevented in the first place?”

Gastric bypass surgery is an effective last resort for severe obesity
in adolescence, as in adulthood, Katz said. “But a last resort it should
be, and we should do all we can to minimize the need for this procedure by
combating the root causes of obesity in our society.”

More information

For more on gastric bypass surgery, visit the U.S. National Institute of Diabetes and Digestive and Kidney
Diseases.

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NEW YORK (Reuters Health) –
Obese children who have difficulty breathing while they sleep have excessive daytime sleepiness compared with slimmer children who are also chronic snorers, new research in the journal Pediatrics shows.

The symptoms in heavy children are “strikingly reminiscent of excessive daytime sleepiness patterns in adults with obstructive sleep apnea,” Drs. David Gozal and Leila Kheirandish-Gozal of the University of Louisville in Kentucky write. The findings suggest, they add, that obstructive sleep apnea looks different in obese children than it does in normal weight kids, which may have implications both for how the condition is treated and how it ultimately affects organ function.

The researchers previously observed that among children with sleep problems, daytime tiredness seemed to be the main symptom in obese kids, while sleepiness tended to manifest itself as inattention and hyperactivity for normal-weight children.

To investigate their hypothesis that kids with the same level of snoring severity would be more likely to be sleepy during the day if they were obese, they observed 50 healthy 6- to 9-year-old, normal-weight children who were habitual snorers and 50 obese children, also snorers, who had been matched by gender, age and ethnicity.

Children were observed for a full night of sleep in the lab, and then the researchers conducted a multiple sleep latency test, which assessed the degree of sleepiness by measuring the time it took the children to fall asleep during the day. The test involved giving the children a chance to nap for 30 minutes every 2 hours, beginning at 8 a.m. Each child had five nap opportunities.

On average, the obese children took 12.9 minutes to fall asleep, compared with 17.9 minutes for the non-obese children. Twenty-one of the obese kids had sleep latency times of 12 minutes or less, while just 5 of the normal-weight children did. Daytime sleepiness was most strongly associated with how many times a child woke up every hour due to respiratory disturbances.

This suggests, the researchers say, that sleep fragmentation my be more common in obese children and that a lack of oxygen during sleep may play a significant role in triggering the biological response that ultimately leads to increased daytime sleepiness.

While obstructive sleep apnea was more common among the obese children than the slimmer children, obese children without the condition were still more likely to have excessive daytime sleepiness than their slimmer counterparts.

Both obesity and obstructive sleep apnea are disorders related to low-level, system-wide inflammation, the researchers add. So both conditions could act together to further increase the levels of inflammation- and sleepiness-promoting substances in the body, the researchers suggest.

While the mechanism behind the link requires further study, they conclude, for now, children with symptoms of excessive daytime sleepiness who have trouble staying awake should be evaluated for obstructive sleep apnea.

SOURCE: Pediatrics, January 2009.

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NEW YORK – Obesity surgery can reverse diabetes in teens, just as it does in adults, according to a small study.

All but one of the 11 extremely obese teens studied saw their diabetes disappear within a year after weight-loss surgery, the researchers reported. The 11th patient still had diabetes, but needed much less insulin and stopped taking diabetes pills.

Previous studies have shown the diabetes benefits of obesity surgery for adults. Dr. Thomas Inge, a pediatric surgeon at Cincinnati Children’s Hospital Medical Center, and his colleagues wanted to find out if the same was true for adolescents.

Although more research is needed, Inge said the study “opens the door” to weight-loss surgery as a treatment option for severely obese teens with Type 2 diabetes.

The results are in the January issue of Pediatrics and are being released Monday.

About a third of U.S. youngsters are either overweight or obese. Increasing numbers of obese children are being diagnosed with Type 2 diabetes, the most common form of the disease and the one linked to obesity. It was seldom seen before in kids.

“It’s marching south through the generations, which is very scary,” said Dr. Larry Deeb, a former president of the American Diabetes Association and a spokesman for the group.

Teen candidates for weight-loss surgery need to be carefully selected, he said, since the long-term consequences of the operation for children aren’t yet known.

The 11 patients in the study were 14 to 21 years old and all were extremely obese, ranging from 250 to 403 pounds. They were taking diabetes pills and one was on insulin. At five different medical centers, they had gastric bypass surgery, or stomach stapling, to reduce their stomach to a small pouch.

They were compared to 67 mostly obese teens with diabetes at Cincinnati Children’s whose blood sugar was being controlled through diet or medication.

After one year, those who had surgery had lost between 72 and 218 pounds, although none had dropped to a normal weight. For 10 of them, their diabetes was in remission and they stopped taking diabetes medicine.

For the teens who didn’t have surgery, they all still had diabetes after a year and there was no difference in their weight or their use of diabetes medication. Their blood sugar levels did improve, the researchers said.

As for the one surgery patient whose diabetes wasn’t reversed, the researchers said the reason wasn’t known, but they noted his mother and a younger sibling also had Type 2 diabetes. Three years after the surgery, the teen was no longer overweight but still needed to take insulin.

Another explanation could be that his diabetes was more advanced that the other teens, Inge said. Adult studies have indicated that the chances of diabetes reversal are better the sooner surgery is done after diagnosis, he said.

“We caught the others in early stage of disease,” Inge said. “Did we miss the boat on this one?”

___

On the Net:

Pediatrics: http://www.aap.org/

American Diabetes Association: http://www.diabetes.org/

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NEW YORK (Reuters Health) –
Death rates soon after anti-obesity or “bariatric” surgery in Sweden are low, statistics show.

“Most published series are from high-volume expert centers,” according to lead investigator Dr. Richard Marsk from Danderyd Hospital, Stockholm. “We have shown that bariatric surgery can be performed with low mortality on a national level.”

Marsk and colleagues assessed deaths from any cause after weight loss surgery in Sweden using data from 14,768 bariatric procedures conducted between 1980 and 2005.

The early post-surgery death rate ranged from 0.2 percent at 30 days to 0.3 percent at 90 days, they report, with a 1-year cumulative death rate of 0.5 percent.

The 1-year cumulative death rate adjusted for age was higher for men (1.1 percent) than for women (0.4 percent) and higher for patients older than age 50 (1.2 percent) than for patients younger than age 50 (0.4 percent).

Including the entire follow-up period, the age-adjusted death rate was twice as high for men (100 per 10,000 persons per year) than for women (50 per 10,000 persons per year).

“I believe that the increased mortality seen among men is due to increased preoperative co-morbid disease and also later referral to surgery, such that men to a greater extent have established cardiovascular disease at the time of surgery,” Marsk said.

“Further studies are needed to explain this in full,” he added.

Cumulative mortality did not differ between patients having primary surgery or “revisional” surgery, the researchers note.

The most common causes of death during the first year after weight loss surgery were non-heart related, the investigators report, whereas the most common causes of late death were heart attack and cancer.

SOURCE: Annals of Surgery, November 2008.

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CHICAGO (Reuters) –
Youth who study just a short walk from a fast-food outlet eat fewer fruit and vegetables, drink more soda and are more likely to be obese than students at other schools, according to research published Tuesday.

The study, which involved more than 500,000 adolescents at middle schools and high schools in California, lends new fuel to a growing backlash against the fast-food industry as studies suggest they contribute to the rising obesity epidemic in the United States.

“We’ve basically discovered that kids who are going to a school that is near a fast-food restaurant have a higher chance of being overweight and obese than kids who are at a school that is not near a fast-food restaurant,” said Brennan Davis of Azusa Pacific University in California, whose study appears in the American Journal of Public Health.

U.S. youth obesity rates have tripled since 1980, although they leveled off this decade. The government says 32 percent of U.S. children are overweight and 16 percent are obese.

Consumer groups have pushed for laws such as July’s moratorium on new fast-food restaurants in certain Los Angeles neighborhoods, while the food industry often maintains that a lack of exercise is more to blame.

The researchers said it is not yet clear whether their results apply to other parts of the United States, and this should be studied further.

But their study adds to prior research showing that fast-food restaurants tend to be clustered near schools.

“We are actually making a connection between fast food proximity to schools and obesity,” Davis said in a telephone interview.

“Students who were exposed to nearby fast food have a higher level of body mass index — they weigh more. They are more likely to be overweight and obese,” he said.

For the study, Davis and colleagues examined the relationship between fast-food restaurants located within one half mile of schools and obesity among middle and high school students in California.

They took weight and dietary information from a statewide school survey between 2002 and 2005 and cross referenced the data with a database of top fast food chains located near each school.

“Overall, our patterns are consistent with the idea that fast food near schools affects students’ eating habits, overweight and obesity,” Davis and colleagues wrote.

They also found that students whose schools were located near-fast food restaurants eat fewer servings of vegetables and fruits, and drink far more soda than students at schools not located near fast-food restaurants.

The study could not determine why fast-food restaurants near schools have such an impact, but Davis said it likely goes well beyond access to burgers, fries and tacos.

“A nearby fast-food restaurant is really a hangout place for people to socialize,” Davis said.

(Editing by Anthony Boadle)

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MONDAY, Dec. 22 (HealthDay News) — Even a few extra pounds and
just a little inactivity increased the risk of heart failure in a major
study of American doctors.

“What this study shows is that even overweight men who are not obese
have an increase in heart failure risk,” said Dr. Satish Kenchaiah, lead
author of a report on the finding in the Dec. 23 issue of
Circulation.

As for exercise, “even a little amount of physical activity appears to
decrease the risk of heart failure,” said Kenchaiah, who did the research
as a epidemiologist at Brigham and Women’s Hospital in Boston and is now
at the U.S. National Heart, Lung, and Blood Institute.

The study has followed more than 21,000 doctors for two decades,
measuring among other factors the influence of overweight and physical
activity on development of heart failure, the progressive loss of ability
to pump blood, which is often a prelude to major coronary events.

Outright obesity, defined as a body-mass index of 30 or over, has long
been known as a risk factor for heart failure. The new report concentrated
on men who were borderline overweight, with a body-mass index of 25 to
29.9.

About 5 percent of the doctors were obese, and 40 percent were
overweight, when the study began. Adjusting for other risk factors such as
high blood pressure and high cholesterol, the study found a 49 percent
increased incidence of heart failure in overweight men compared to those
with a body-mass index of 25 or less. Incidence of heart failure was 180
percent for the obese men compared to the leaner ones.

It was the same story for physical activity. “Men who engaged in
physical activity anywhere from one to three times a month had an 18
percent reduction in heart failure risk,” Kenchaiah said. “For those who
were active five to seven times a week, the reduction was 36 percent. The
more you exercise, the more reduction you achieve.”

The association of even minimal physical activity with reduced risk
could be explained as an indicator of good habits in general, he said. “It
is possible that they have a healthier lifestyle in general,” Kenchaiah
said.

The study found that doctors who rarely or never exercised were older,
smoked cigarettes more often, and were more likely to have high blood
pressure or diabetes.

“This new report reinforces what we’ve said in the past,” said Dr.
Gerald Fletcher, a preventive cardiologist at the Mayo Clinic in
Jacksonville, Fla. “Not being obese but being overweight is definitely a
risk factor for heart failure.”

While Fletcher said he would have liked a more definitive indicator of
physical activity — the report described it as simply breaking a sweat —
he said the study showed again that “vigorous exercise makes the
difference. The more you do, the better it is for you.”

Two-thirds of Americans have excess body weight, and only about 30
percent exercise regularly, Kenchaiah said. About 660,000 new cases of
heart failure are diagnosed each year in the United States, he said, and
80 percent of the men and 75 percent of the women aged 65 and older who
are diagnosed with heart failure die within eight years.

More information

Heart failure and its treatment are described by the American Heart Association.

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WASHINGTON (Reuters) –
Even a little bit of extra weight can raise the risk of heart failure, according to a U.S. study published on Monday that calculated the heart hazards of being pudgy but not obese.

It comes as little surprise that obesity makes a person much more apt to get heart failure, a deadly condition in which the heart is unable to pump enough blood throughout the body.

But researchers who tracked the health of 21,094 U.S. male doctors for two decades found that even those who were only modestly overweight had a higher risk — and it grew along with the amount of extra weight.

In men who are 5 feet 10 inches tall, for every seven pounds (3.2 kg) of excess body weight, their risk of heart failure rose on average by 11 percent over the next 20 years, the researchers wrote in the journal Circulation.

The average age of the men at the outset of the so-called Physicians’ Health Study was 53. During the study, 1,109 of them developed heart failure.

Overall, the risk of heart failure increased by 180 percent in men who met the definition of obesity according to their body mass index (BMI of 30 and higher), and by 49 percent in men who met the definition of overweight (a BMI of 25 to 30).

Heart failure, also known as congestive heart failure, contributes to 300,000 deaths each year in the United States.

Conditions such as coronary artery disease and high blood pressure can leave the heart too weak or stiff to fill and pump blood efficiently.

Dr. Satish Kenchaiah of Brigham and Women’s Hospital in Boston and colleagues also looked at how physical activity affected heart failure risk.

“The lean and active group had the lowest risk and the obese and inactive group had the highest risk,” Kenchaiah said in a telephone interview.

“As far as vigorous physical activity is concerned, even if somebody said they exercised one to three times per month — which is a very low level of exercise — they had an 18 percent reduction in the risk of heart failure after accounting for all other established risk factors,” Kenchaiah added.

The benefit of exercise in cutting heart failure risk was seen in lean, overweight and obese men, the researchers found. But regardless of the level of activity, higher body mass index also meant higher heart failure risk.

(Editing by Julie Steenhuysen and Xavier Briand)

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