Health and Fitness Blog

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.

Source

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)

Source

NEW YORK (Reuters Health) – Painful swelling of the arm or shoulder area following treatment for breast cancer -- a condition called lymphedema - is more common in women who are overweight or obese than in women of normal weight, researchers have found.

Lymphedema is a common, chronic condition that often develops after breast surgery involving the removal or damage to the lymph nodes in the armpit. Radiation therapy, post-operative infection and age have also been implicated. The condition occurs when excess fluid accumulates, leading to swelling, rash, redness and blistering that causes tenderness, numbness, or aching in the arm, chest wall and breast.

In their study of 193 breast cancer survivors, Dr. Jane M. Armer and colleagues at the University of Missouri-Columbia found that the risk of lymphedema was 40 to 60 percent higher in women who are overweight or obese compared to normal-weight women.

The risk of lymphedema is especially high in overweight or obese women who have cancer treatment to the dominant side or experience post-operation swelling, the researchers report. Post-operative swelling significantly increased the risk of lymphedema regardless of a woman's body weight.

Based on their analysis, roughly two thirds of breast cancer survivors are at risk of developing lymphedema within 30 months after surgery, Armer and colleagues report in the current issue of the Journal of Lymphoedema.

"Diagnosing post-breast cancer lymphedema can be difficult," Armer noted. She recommends increased health education for both breast cancer survivors and health care providers.

"Lymphedema has a profound impact on health and well-being, but often goes undiagnosed and untreated by physicians and patients," she said.

In a previous study, Armer and colleagues found that many women who experience lymphedema after breast cancer treatment suffer in silence. Others don't follow the treatment advice of their doctor or use "alternative" treatments, which they may not discuss with their doctors.

SOURCE: Journal of Lymphoedema, 2008.

Source

SATURDAY, Dec. 20 (HealthDay News) -- The holiday season can be especially difficult for overweight or obese people as they struggle to control their eating habits and cope with widely held misconceptions, according to a Duke University expert.

"Social situations make people feel self-conscious about what they wear and what they eat to the point where they feel they're being judged for every morsel that touches their lips," Martin Binks, director of behavioral health at the Duke Diet and Fitness Center, said in a university news release.

"Some of the popular misconceptions about obesity are that people bring it on themselves, and that they look forward to the holidays so they can eat more," he said.

In fact, overweight and obese people are often nervous and anxious during the holiday season because they're worried they don't have the willpower to resist the many temptations. Some put a lot of effort into avoiding social gatherings or certain foods or eating triggers, and others say they can sense the judgmental attitudes of other people.

"Even if they aren't being judged, they become so self-conscious that they think they are," said Binks, who noted that the intense focus on food during the holidays compounds the challenges faced by overweight and obese people.

He offered advice on how overweight or obese people can celebrate the holidays without feeling badly or putting too much pressure on themselves:

• Indulge in the inner spirit of the holidays, not the eating. Focus on spending time with friends and family.
• When faced with food temptation, use portion control. If it's a holiday meal and you eat a bit more than normal, it won't harm your weight loss effort as long as you get back on track the next day.
• If you're doing the party circuit, spend time socializing, not eating. Put something on your plate and use it as a prop.
• Make a resolution to find out what you really hunger for in life and what you're looking for that you can't find in food.

More information

The U.S. Centers for Disease Control and Prevention outlines how to have a healthy holiday season.

Source

THURSDAY, Dec. 18 (HealthDay News) -- Childhood obesity may alter the structure and function of the thyroid gland, an organ in the neck that releases hormones crucial to metabolism.

Studies have found that thyroid disorders can lead to obesity, but a new Italian study suggests that obesity may cause thyroid dysfunction in some cases.

"Our study shows that alterations in thyroid function and structure are common in obese children, and we may have uncovered the link," study author Dr. Giorgio Radetti, of the Regional Hospital of Bolzano, said in an Endocrine Society news release. "We found an association between body mass and thyroid hormone levels, which suggests that fat excess may have a role in thyroid tissue modification."

Radetti and his colleagues evaluated 186 overweight and obese children for nearly three years. The children's thyroid hormone levels and thyroid antibodies were measured, and they underwent a thyroid ultrasound. Thyroid antibodies are present in people with Hashimoto's thyroiditis, an autoimmune disease of the thyroid in which immune system T-cells attack the thyroid. Ultrasound results from 73 of the children were suggestive of Hashimoto's disease, but none of them showed thyroid antibodies.

"The ultrasound findings are a bit mysterious," Radetti said. "However, the findings do suggest the existence of a low-grade inflammation state, which has been known to characterize obesity."

The study was published in the December issue of The Journal of Clinical Endocrinology & Metabolism.

Radetti said that thyroid function has been shown to return to normal after weight loss, which means it may be possible to reverse thyroid abnormalities detected on an ultrasound. However, it's not known whether persistent thyroid abnormalities in obese children could progress into chronic thyroid disease in early adulthood. More research is needed to answer these questions, he said.

More information

The American Thyroid Association has more about the thyroid.

Source

WEDNESDAY, Dec. 17 (HealthDay News) -- Most people know that obese individuals tend to have high blood pressure, but now British researchers have identified the molecular pathway that could explain that link.

In findings published in the Dec. 17 online issue of the New England Journal of Medicine, Sadaf Farooqi, of the University of Cambridge, and her colleagues demonstrated that signaling through the melanocortin-4 receptor (MC4R) helps to regulate blood pressure in humans.

Farooqi and her team studied blood pressure in 46 obese individuals who were missing one copy of the MC4R gene, and compared them to 30 obese individuals who had two normal copies of the gene. Individuals in the MC4R-deficient population tended to have slightly lower blood pressure values than did the control group (123/73 vs. 131/79), and less hypertension overall.

"The people where the MC4R gene is not working correctly actually were protected from high blood pressure," Farooqi explained.

As it turns out, these individuals appeared to have what Farooqi called "impaired sympathetic tone," which is that automatic part of the nervous system that controls the so-called "fight or flight" response to stress, and which apparently mediates this protective effect.

One aspect of the autonomic nervous system, for instance, involves the increase in heart rate that accompanies waking. In both study populations, the heart rate while sleeping was identical and increased upon waking. But the size of the increase in the two groups differed, with MC4R-deficient individuals' heart rate increasing less than control individuals.

Next, Farooqi teamed up with scientists at Eli Lilly, the pharmaceutical company, to test an MC4R agonist -- an experimental compound that works by inducing signaling through the MC4R receptor. The drug is in development as a potential anti-obesity medication, though this study was not assessing its effect on weight loss. Instead, the team looked at the drug's effect on blood pressure in 28 obese individuals (none of whom were MC4R-deficient).

What they observed was an acute, dose-dependent increase in blood pressure upon drug treatment, Farooqi said. "So, basically what this means is that both our own data on the patients with the MC4R gene problem, and the data from Lilly giving the drug, show that this gene is important in controlling blood pressure."

Most people, of course, are not missing the MC4R gene. What normally happens in obese individuals, Farooqi explained, is this: "As people gain weight, they make more fat. And your fat produces a hormone called leptin, and levels of leptin then increase. Leptin then circulates in the bloodstream and goes to the brain, where it triggers MC4R, which then triggers the sympathetic system, and drives up your blood pressure."

Dr. Daniel Marks, of the Oregon Health & Science University in Portland, said, "It is a well-done study and teaches us something about the fundamental physiology of blood pressure regulation in humans."

Yet Marks also cautioned that MC4R is not likely the only link between obesity and blood pressure.

"There's a difference between being statistically significant and clinically significant," he said. "Those are two different issues, and I think the issue of clinical significance is still pretty unknown here."

Dr. George Bakris, of the University of Chicago Pritzker School of Medicine, called the study a "really big deal."

"I think this paper is going to become a real classic," Bakris said, "because it is the first time this kind of characterization has been done in such a very clean way and provides a way of identifying people who may not have a blood pressure problem, even though they may have a weight problem."

Bakris suggested that MC4R antagonists -- drugs that work by blocking MC4R -- could find use as anti-hypertensive medications.

"I personally think that's the most important part of this paper," Bakris said, "is if you prolong the inhibition, you reduce sympathetic tone, blood pressure will go down, and if you don't have any side effects associated with it, that would be huge."

MC4R, Marks explained, is one of five melanocortin receptors in the brain; these proteins regulate skin coloration and stress, among other things. But MC4R regulates body weight, "and it does that by altering both appetite and energetics of your body -- your basal metabolic rate," at least partly via the sympathetic nervous system.

MC4R deficiency is the most common genetic disorder causing obesity, Farooqi said; it accounts for 6 percent of individuals with early-onset obesity and 2.5 percent of obese adults.

More information

For more on hypertension, visit the American Heart Association.

Source

NEW YORK (Reuters Health) – People hoping for a liver transplant and who are obese face prolonged waiting times, reflecting a possible "reluctance to transplant obese patients," according to a new report.

"In transplantation, outcomes are available online to the general public, and compared from hospital to hospital," Dr. Dorry L. Segev explained to Reuters Health.

While this transparency may be welcome, "the side effect is that centers might become too reluctant to take on challenging cases, in fear that a bad outcome would be misinterpreted as poor quality of care."

Segev, from Johns Hopkins University School of Medicine, Baltimore, and colleagues looked into the relationship between body weight and access to transplantation in more than 25,000 consecutive patients.

After adjusting for other factors, severely obese patients had 30 percent lower odds and morbidly obese patients had 38 percent lower odds of getting a priority classification than did non-obese patients, the researchers report in the November issue of the Annals of Surgery.

Similarly, severely obese patients had 10 percent higher likelihood and morbidly obese patients had 16 percent higher likelihood of being turned down for an organ offer.

Among centers posting their waiting lists during this study period, 11 percent listed no patients who were severely obese and 19 percent listed none who were morbidly obese, the investigators report.

"Our findings suggest a reluctance to perform liver transplantation on obese patients," the authors conclude.

"I believe that liver (grafts) should be allocated fairly to patients who are determined by their providers to be good candidates," Segev said. "Many obese patients are predicted to derive a significant survival benefit from liver transplantation."

In fact, Segev concluded, "All patients in our study were already on the waiting list -- in other words, already determined to be good candidates. I believe that there should be no disparities past that hurdle."

SOURCE: Annals of Surgery, November 2008.

Source

NEW YORK (Reuters Health) – Telling teenage would-be smokers that lighting up may make them fat down the road may be a more effective deterrent than harping on the risks of heart disease and cancer from smoking, hints research published in the latest issue of the American Journal of Public Health.

In a study, Finnish researchers found that smoking during adolescence strongly predicted the development of abdominal obesity in adulthood, among both men and women.

In particular, they found that girls who smoked at least 10 cigarettes daily during adolescence had a 3.4-centimeter larger waistline as young adults, on average, than did girls who had never smoked.

Smoking during adolescence also increased a woman's odds of being heavy in general later in life, not just having a large waistline. Girls who smoked at least 10 cigarettes daily during adolescence were twice as likely to become overweight as nonsmokers.

The findings stem from a long-term follow-up study of nearly 4300 Finnish twins born between 1975 and 1979. About 50 percent of the men and women had never smoked and 12 percent had smoked during adolescence. By the time they were in their early 20s, about 24 percent of men and 11 percent of women were overweight.

In comments to Reuters Health, study chief Dr. Suoma E. Saarni, from University of Helsinki, told Reuters Health that smoking in adolescence "seems to predispose" the smoker to a large waistline, independent of health habits and parents body weight (i.e., a young person's genetic predisposition to being overweight or obese).

"And most interesting," said Saarni, the apparent link between smoking during adolescence and being heavy later on was independent of the young person's own body weight -- meaning that those who were heavy smokers had greater waist circumference even within the same body mass index (BMI) levels as their non-smokers peers.

This research, Saarni added, "gives a tool" to highlight the risks of smoking to adolescents and young adults "by showing the unhealthy effect on the body shape." This can be an important deterrent, "because usually young people find cardiovascular disease and type 2 diabetes or even cancer so distant risks that they have very little impact on ones smoking behavior."

SOURCE: American Journal of Public Health, January 2009.

Source

NEW YORK (Reuters Health) – Among children who undergo removal of their adenoids and tonsils to correct breathing problems when they're sleeping, obesity does not necessarily predict an unfavorable outcome, researchers from Greece report.

Obesity and enlarged tonsils are both linked to interrupted breathing or apnea during sleep in childhood, but the relative importance of one or the other is not clear, note Dr. Athanasios Kaditis and colleagues from the University of Thessaly School of Medicine, Larissa.

Furthermore, they add in their report in the medical journal Chest, "Adenotonsillectomy for sleep-disordered breathing is not always curative and obese children are at increased risk for residual disease postoperatively."

To look into these issues, the researchers examined the outcome of adenotonsillectomy for sleep-disordered breathing in 22 obese and 48 non-obese children between 5 and 7 years old.

The kids underwent sleep studies before and after the surgery to measure how often their breathing was interrupted during sleep. The goal was to reduce the occurrence to less than one episode per hour.

There was no difference in the effectiveness of adenotonsillectomy between the groups: 22.7 percent of the obese children and 25 percent of the non-obese children achieved the primary goal.

So why isn't tonsillectomy effective for more kids with sleep apnea? Kaditis and colleagues say individual variations in facial structures or the collapsibility of tissues in the throat could be the reason.

SOURCE: Chest, December 2008.

Source

MONDAY, Dec. 15 (HealthDay News) -- Certain people just may be destined to be obese, based on the discovery of six additional genetic variants tied to people with higher body mass index, a new study says.

The study by an international consortium, published online Dec. 14 in Nature Genetics, adds to previous research that linked two other genetic variants to obesity.

"One of the interesting things is that the genes near these variants are all active in the central nervous system, suggesting that inherited variation in appetite regulation may have something to do with people's predisposition to obesity," study leader Dr. Joel Hirschhorn of Children's Hospital Boston and the Broad Institute of Harvard and MIT, said in a news release issued by some of the consortium participants.

The study, by the Genetic Investigation of Anthropometric Traits (GIANT) consortium, concluded that each individual known variant had a small but cumulative effect on a person's BMI, a ratio of weight to height. In all, it added up to an average of 10 pounds in those with most of the variants, compared to those with the fewest. However, Hirschhorn said the researchers may have found only a handful of possibly hundreds of genetic regions that made such small contributions to one's weight, and more studies would be needed to uncover them all.

"As we learn more about what some of the genes in these regions do, we hope that these discoveries might suggest routes to new therapies for obesity," joint first author of the study, Dr. Elizabeth Speliotes of Massachusetts General Hospital, said in the news release.

Previous studies in families or twins have found that genetics account for up to 70 percent of BMI variation in the general population.

The World Health Association estimates that more than 1 billion adults worldwide are overweight, with at least 300 million of them classified as obese (having a BMI of 30 or above).

More information

The American Heart Association has more about body mass index.

Source