Despite a general belief among physicians that extreme obesity is too difficult to treat, except with bariatric surgery, researchers at the Pennington Biomedical Research Center have learned a substantial proportion of individuals with extreme obesity can lose 10-percent or more of their body weight through medical treatment that does not include surgery.

10% Loss Improves Risk Factors and Health

Furthermore, even though those individuals are still obese, they have improvements in risk factors and other health markers.

Weight Loss Surgery Not Often Affordable or Reimbursed by Insurance

"This is important, because surgery is not often affordable or reimbursed by insurance," said leading scientist Dr. Donna Ryan. "In fact, many medical treatments are frequently not reimbursed by insurance if they are for obesity. So this research is needed to show that primary care doctors are capable of helping obese patients lose weight to improve health, even those with extreme obesity. "

Ryan said losing only five-percent of body weight can reap healthy benefits for the extremely obese, and nearly 61-percent of those in her clinical trial achieved that. More than 40-percent lost 10-percent body weight or more.

Physicians Trained in Intensive Medical Intervention

Ryan and her team spread out across Louisiana to recruit and train practicing physicians and their office staffs in eight cities in what she called "intensive medical intervention," in which physicians used a combination of medication, low-calorie diets and behavior changes. All of the techniques were endorsed by national guidelines for obesity management. Training of physicians and their staffs took about a day and a half.

Funded by the Louisiana Office of Group Benefits, which provides health coverage for state employees, the research team contacted state employees, seeking participants to screen for and enroll in the trial. Nearly 400 participants enrolled in the two-year trial, called LOSS, using the nearest trained physicians.

About half of the participants received the intensive medical intervention, the other half received what Ryan called "usual care." 

Program Starts with Low-calorie Liquid Diet

Those in the intense intervention group were immediately placed on a low-calorie liquid diet. They gradually moved to a low calorie, highly controlled diet using meal replacements, and received weight loss medication and group behavioral therapy that included lessons in exercise, activity, self-monitoring and recommendations for walking, water exercise and weight training. The group sessions were supervised by office staff.

Recommended Activities

• exercise
• activity
• self-monitoring
  
• recommendations for walking
• water exercise
  
• weight training

Success in Daily Routine of Doctor's Practice

"We conducted this trial as close to the reality of a typical clinic setting as we could," Ryan said, "We didn't want to learn just if these strategies worked, but if they would work in the daily routine of a doctor's practice."

Challenge of Keeping Weight Off

Ryan noted that the continual challenge in weight loss is keeping weight off, and that means sticking with a routine.

More than 50% of the LOSS participants stuck with it for two years or more, keeping much of the weight off, but Ryan said that does leave room for improving weight loss maintenance.

The LOSS trial results were published in the current issue of the Archives of Internal Medicine.

The Pennington Biomedical Research Center is a campus of the Louisiana State University System and conducts basic, clinical and population research.

Chronic kidney disease affects 26 million people in the United States.

Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children's Center shows that even mild to moderate kidney disease may seriously diminish a child's quality of life.

The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.

"Even mild and moderate declines in kidney function may lead to serious physical, emotional, intellectual and social challenges," says lead investigator Arlene Gerson, Ph.D., a pediatric psychologist at Hopkins Children's.

Kidney Disease Screening is Needed

"What this means is we should be thinking about screening children for these challenges and intervening earlier than we once thought."

Recently diagnosed children who report learning problems may benefit from help before grades drop, researchers say, noting that children with chronic diseases currently do not qualify for special education until their scores decline dramatically.

Links Between Kidney Function and Quality of Life

In their study of 402 children, ages 2 to 16, with mild-to-moderate kidney disease, researchers analyzed the link between kidney function, disease severity, age of onset and disease duration, on the one hand, and physical, emotional, psychological and school functioning on the other.

The researchers also compared quality-of-life outcomes between healthy children and children with early-stage kidney disease. Children with mild-to-moderate kidney disease and their parents reported worse overall outcomes on standard quality-of-life questionnaires and worse outcomes on all quality-of-life factors.

Specifically, children with early-stage kidney disease scored on average 75 out of 100 on quality-of-life measures, compared to 83 out of 100 for healthy children. The difference was especially pronounced in school functioning, where children with early-stage kidney disease scored 64 out 100, compared to 80 out of 100 for healthy children.

How Children Cope with Kidney Disease

The study also found that the younger the child at the time of the diagnosis and the longer the child lived with kidney disease, the better the overall quality of life, a surprising finding, suggesting that as time passes children learn to cope better with their condition, the researchers say.

The researchers found that children with impaired growth and shorter stature, a common effect of their disease, had worse overall quality of life and poorer physical functioning, an indicator of the importance of early treatment.

Treatments for Children's Kidney Disease

"Timely and individually tailored treatment, be it with nutrition, salt supplements or growth hormones, if needed, can make a big difference. We cannot overemphasize the importance of early intervention in children with early stages of chronic kidney disease," says senior investigator Susan Furth, M.D. Ph.D., a pediatric nephrologist at Hopkins Children's.

The research is part of an ongoing 57-center study funded by the National Institutes of Health to study chronic kidney disease in children.

Reduce Heart Disease, Stroke and Heart Attacks

Scientists writing in The New England Journal of Medicine conclude that lowering the amount of salt people eat by even a small amount could reduce cases of heart disease, stroke and heart attacks as much as reductions in smoking, obesity and cholesterol levels.

If Americans consumed half a teaspoon less salt per day, there would be between 54,000 - 99,000 fewer heart attacks each year and between 44,000 - 92,000 fewer deaths, according to the study, which was conducted by scientists at University of California San Francisco, Stanford University Medical Center and Columbia University Medical Center.

Processed Foods are the Key Source of Salt

Health authorities at federal, state and municipal levels are considering policies to mandate that food companies reduce salt in processed foods, which are considered to be the source of much of the salt Americans eat.

For 40 years in this country we've been trying to get individuals to reduce the amount of sodium we consume and it hasn't worked.

New York City announced an initiative to urge food manufacturers and restaurant chains to reduce salt in their products nationwide by 25 percent over the next five years.

California, according to an author of the study, Kirsten Bibbins-Domingo, an associate professor of medicine and epidemiology at University of California, San Francisco, is considering setting salt limits on food the state purchase for schools, prisons and other public institutions.

The Institute of Medicine, the independent research arm of the National Academies of Science, will be issuing a report soon that will make recommendations about reducing salt intake, including actions government and manufacturers can take.

The Food and Drug Administration was considering whether to change the designation of salt from a food additive that is generally considered safe to a category that would require companies to give consumers more information alerting them to high levels of salt in food.

Greatest Benefit:  Blacks, Hypertension and Seniors

The researchers found that everyone would benefit from less salt, but people at higher risk for heart problems -- blacks, people with hypertension and people over 65 -- would benefit most.

While research isn't showing that individuals will be greatly affected by small changes in salt intake, "Small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population," researchers said.

Huh?  Does YOUR salt intake affect MY health?   I understand public health concepts, but this seems a bit strained.  However, if what they mean is that people who eat way too much salt will take action and reduce their personal health... I can see that rationale. 

In the meantime, ask your medical adviser if you are overdoing the salt for your own good health!

Read More at NY Times

Newswise -- Buying medicine by mail may encourage patients to stick to their doctor-prescribed medication regimen, new research suggests.

Patients with diabetes, high blood pressure and high cholesterol

Researchers from UCLA and Kaiser Permanente's Division of Research in Oakland, Calif., found that patients with diabetes, high blood pressure and high cholesterol who ordered their medications by mail were more likely to take them as prescribed by their physicians than patients who obtained medications from a local pharmacy.

"The field of medication adherence research typically focuses on patient factors for poor adherence, leading to a 'blame the patient' approach for non-adherence," said Dr. O. Kenrik Duru, the study's lead researcher and an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

Streamline the medication-acquisition process

"Our work helps to place this issue in a larger perspective," Duru said. "Our findings indicate that mail-order pharmacies streamline the medication-acquisition process, which is associated with better medication adherence."

The researchers found that 84.7 percent of patients who received their medications by mail at least two-thirds of the time stuck to their physician-prescribed regimen, compared with 76.9 percent of those who picked up their medications at traditional "brick-and-mortar" Kaiser Permanente pharmacies.

"The results were consistent for all three classes of medication, including medications to control diabetes, high blood pressure and high cholesterol," said co-investigator Julie A. Schmittdiel, Ph.D., a research scientist with the Kaiser Permanente research division.

Other findings include:

• Before adjusting for other variables, white patients were more likely than Hispanics to obtain medications by mail (61.0 percent vs. 37.1 percent) and to be in the highest socioeconomic status quartile (27.5 percent vs. 17.8 percent).

• Mail-order pharmacy users were more likely than local pharmacy users to have a financial incentive to fill their prescriptions (49.6 percent vs. 23.0 percent) and to live a greater distance from a local pharmacy (8.0 miles vs. 6.7 miles). An example of a financial incentive is receiving a three-month supply of medication for the cost of a two-month supply.

• After adjusting for other variables, whites were more likely to use mail-order pharmacies (24.1 percent) than were Asian/Pacific Islanders (8.4 percent), Hispanics (5.2 percent), African Americans (4.0 percent) and individuals of mixed race (8.0 percent).

While other research has examined the association between medication costs and mail-order and local pharmacies, this is the first study to look at the relationship between pharmacy type and medication adherence. Furthermore, it controls for differences in out-of-pocket costs and medication supply (by number of days) between mail-order and local pharmacy users, something other datasets have not included.

"In other words, our study is able to isolate the use of mail-order pharmacies specifically, without the results being affected by differences in cost or in the number of pills provided with each dispensing," Duru said.

The study does have some limitations. For example, the findings need to be confirmed by a randomized controlled trial.

Still, the research suggests that increased mail-order use to obtain medications could improve patients' adherence.

In addition to Duru and Schmittdiel, researchers included Wendy Dyer, Melissa Parker, Connie Uratsu, James Chan and Andrew J. Karter of the research division at Kaiser Permanente Northern California.

Grants from the U.S. Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large.

The General Internal Medicine and Health Services Research Division in the department of medicine at the David Geffen School of Medicine at UCLA provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work.  

What aerobic exercise does for your health

According to one of my favorite online health information sources, Mayo Clinic, physical activity is a "best practice" for everyone's health.

Regardless of age, weight or athletic ability, aerobic activity is good for you. As your body adapts to regular aerobic exercise, you'll get stronger and your body's organs get more efficient.

Consider these 10 ways that aerobic activity can help you feel better and enjoy life to the fullest.

Aerobic activity can help you:

1. Keep excess pounds at bay. Combine with a healthy diet to lose weight -- and keep it off.
2. Increase your stamina. But over the long term, you'll enjoy increased stamina and reduced fatigue.
3. Ward off viral illnesses. Aerobic exercise activates your immune system to ward off minor viral illnesses, such as colds and flu.
4. Reduce health risks. Aerobic exercise reduces the risk of many conditions, including obesity, heart disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer. Weight-bearing aerobic exercises, such as walking, reduce the risk of osteoporosis.
5. Manage chronic conditions. Aerobic exercise helps lower high blood pressure and control blood sugar.  
6. Strengthen your heart. A stronger heart also pumps blood more efficiently, which improves blood flow to all parts of your body.
7. Keep your arteries clear. Aerobic exercise can limit buildup of plaques in your arteries.
8. Boost your mood. Aerobic exercise can ease depression, anxiety and promote relaxation.
9. Stay active and independent as you get older. Aerobic exercise keeps your muscles strong, which can help you maintain mobility, keep your mind sharp and reduce cognitive decline in older adults.
10. Live longer. People who participate in regular aerobic exercise appear to live longer than those who don't exercise regularly.

Learn more at MayoClinic.com

Researchers from the University of Alabama at Birmingham (UAB) have discovered that

restricting consumption of glucose, the most common dietary sugar, can extend the life of healthy human-lung cells and speed the death of precancerous human-lung cells, reducing cancer's spread and growth rate.

Calorie-Intake Restriction: Longevity and Prevent Diseases

The research has wide-ranging potential in age-related science, including ways in which calorie-intake restriction can benefit longevity and help prevent diseases like cancer that have been linked to aging, said principal investigator Trygve Tollefsbol, Ph.D., D.O., a professor in the Department of Biology.

• Extend the Lifespan of Healthy Cells
• Kill Off Cancer-Forming Cells
  

"These results further verify the potential health benefits of controlling calorie intake." Tollefsbol said. "Our research indicates that calorie reduction extends the lifespan of healthy human cells and aids the body's natural ability to kill off cancer-forming cells."

The UAB team conducted its tests by growing both healthy human-lung cells and precancerous human-lung cells in laboratory flasks. The flasks were provided either normal levels of glucose or significantly reduced amounts of the sugar compound, and the cells then were allowed to grow for a period of weeks.

"In that time, we were able to track the cells' ability to divide while also monitoring the number of surviving cells. The pattern that was revealed to us showed that restricted glucose levels led the healthy cells to grow longer than is typical and caused the precancerous cells to die off in large numbers," Tollefsbol said.

In particular, the researchers found that two key genes were affected in the cellular response to decreased glucose consumption. The first gene, telomerase, encodes an important enzyme that allows cells to divide indefinitely. The second gene, p16, encodes a well known anti-cancer protein.

Healthy Cell Growth

"Opposite effects were found for these genes in healthy cells versus precancerous cells. The healthy cells saw their telomerase rise and p16 decrease, which would explain the boost in healthy cell growth," Tollefsbol said. "The gene reactions flipped in the precancerous cells with telomerase decreasing and the anti-cancer protein p16 increasing, which would explain why these cancer-forming cells died off in large numbers."

The UAB research into the links between calorie intake, aging and the onset of diseases related to aging is thought to be a first of its kind given that it used the unique approach of testing human cells versus laboratory animals.

Caloric Restriction

"Our results not only support previous findings from the feeding of animals but also reveal that human longevity can be achieved at the cellular level through caloric restriction," Tollefsbol said.

"The hope is that this UAB breakthrough will lead to further discoveries in different cell types and facilitate the development of novel approaches to extend the lifespan of humans," he added.

Tollefsbol's research team included Yuanyuan Li, Ph.D., M.D., a UAB biology research associate, and Liang Liu, Ph.D., a UAB assistant professor of medicine.

The group's study titled "Glucose Restriction Can Extend Normal Cell Lifespan and Impair Precancerous Cell Growth Through Epigenetic Control of hTERT and p16 Expression" has been published in the online edition of The Journal of the Federation of American Societies for Experimental Biology, or FASEB Journal.

The research was funded by grants from the National Institutes of Health and the Glenn Foundation for Medical Research.

About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, UAB is an internationally renowned research university and academic medical center. Providing a broad-based graduate and undergraduate curriculum, the UAB Department of Biology is a dynamic academic partnership. Most members of the graduate faculty have research specialties in comparative biochemistry, physiology, environmental microbiology and eco-physiology of aquatic organisms.

The aroma of foods could become a new weapon in the battle of the bulge by quenching the sensation of hunger. Credit: Wikimedia Commons, Jon Sullivan

A real possibility exists for developing a new generation of foods that make people feel full by releasing anti-hunger aromas during chewing.

Scientists in the Netherlands are reporting  that foods could fight the global epidemic of obesity with aromas that quench hunger and prevent people from overeating. Their article appears in ACS' Journal of Agricultural and Food Chemistry: "Retronasal Aroma Release and Satiation: A Review".

Rianne Ruijschop and colleagues note that scientists long have tried to develop tasty foods that trigger or boost the feeling of fullness. Until recently, that research focused on food's effects in stomach after people swallow it.

Efforts now have expanded to include foods that release hunger-quenching aromas during chewing. Molecules that make up a food's aroma apparently do so by activating areas of the brain that signal fullness.

Their analysis found that aroma release during chewing does contribute to the feeling of fullness and possibly to consumers' decisions to stop eating. The report cites several possible applications, including developing foods that release more aroma during chewing or developing aromas that have a more powerful effect in triggering feelings of fullness.

SOURCE:

"Retronasal Aroma Release and Satiation: A Review"
Journal of Agricultural and Food Chemistry

The Dietary Reference Intakes: The Essential Guide to Nutrient Requirements is sold only as a printed book; the PDF offered free of charge for download contains only the references.

Dietitians, community nutritionists, nutrition educators, nutritionists working in government agencies, and nutrition students at the postsecondary level, as well as other health professionals, will find Dietary Reference Intakes: The Essential Reference for Dietary Planning and Assessment an invaluable resource.

Widely regarded as the classic reference work for the nutrition, dietetic, and allied health professions since its introduction in 1943, Recommended Dietary Allowances has been the accepted source in nutrient allowances for healthy people. Responding to the expansion of scientific knowledge about the roles of nutrients in human health, the Food and Nutrition Board of the Institute of Medicine, in partnership with Health Canada, has updated what used to be known as Recommended Dietary Allowances (RDAs) and renamed their new approach to these guidelines Dietary Reference Intakes (DRIs). Since 1998, the Institute of Medicine has issued eight exhaustive volumes of DRIs that offer quantitative estimates of nutrient intakes to be used for planning and assessing diets applicable to healthy individuals in the United States and Canada. Now, for the first time, all eight volumes are summarized in one easy-to-use reference volume, Dietary Reference Intakes: The Essential Reference for Dietary Planning and Assessment. Organized by nutrient for ready use, this popular reference volume reviews the function of each nutrient in the human body, food sources, usual dietary intakes, and effects of deficiencies and excessive intakes. For each nutrient of food component, information includes:

Estimated average requirement and its standard deviation by age and gender.

Recommended dietary allowance, based on the estimated average requirement and deviation.

Adequate intake level, where a recommended dietary allowance cannot be based on an estimated average requirement.

Tolerable upper intake levels above which risk of toxicity would increase. Along with dietary reference values for the intakes of nutrients by Americans and Canadians, this book presents recommendations for health maintenance and the reduction of chronic disease risk. Also included is a Summary Table of Dietary Reference Intakes, an updated practical summary of the recommendations. In addition, Dietary Reference Intakes: The Essential Reference for Dietary Planning and Assessment provides information about:

Guiding principles for nutrition labeling and fortification

Applications in dietary planning

Proposed definition of dietary fiber

A risk assessment model for establishing upper intake levels for nutrients

Proposed definition and plan for review of dietary antioxidants and related compounds

A free PDF download of an errata page to Dietary Reference Intakes: The Essential Guide to Nutrient Requirements is available from: http://books.nap.edu/html/11537/dri_errata.pdf.

HHS Secretary Kathleen Sebelius released a new report, Preventing and Treating Diabetes: Health Insurance Reform and Diabetes in America.

"Americans with diabetes are suffering in our current health care system," Secretary Sebelius said. "Health insurance reform will help ensure these Americans can get the prescription drugs and supplies they need and bring down premiums so all Americans can have high-quality, affordable health insurance."

As affordable treatment remains inaccessible to many Americans suffering from chronic diseases, people with diabetes shoulder some of the nation's highest health care expenses.

Annual health care expenses for a diabetic topped $11,477 in 2007.

The report notes:

• One in six individuals with diabetes report avoiding or delaying needed medical care because of cost. A box of 100 test strips for blood sugar monitors can cost up to $60 while the price of a vial of insulin can range from $30 to $70, mainly because generic brands are not manufactured in the United States.
• A study showed that 80 percent of people with diabetes went uninsured after having lost coverage due to health insurance transitions triggered by job change or layoff, a move, divorce, graduation from college, or a change in income or health status.
• If all states improved diabetes control to the level of the top four best performing states, at least 39,000 fewer patients would have been admitted for uncontrolled diabetes in 2004, potentially saving $216.7 million.
• Fourteen percent of American Indians, 12 percent of African Americans, and 10 percent of Hispanics have type 2 diabetes. These rates of diabetes are greater than in the non-Hispanic White population, which has a rate of only 7 percent.

The report outlines the ways health insurance reform will lower costs and improve access to quality health care services for Americans with diabetes. Health insurance reform will lower health care costs for people with diabetes by capping annual out-of-pocket expenses, eliminate discrimination for pre-existing conditions and health status, create a health insurance exchange so families can shop for suitable plans, provide coverage for preventive screenings, and reduce health disparities so that all Americans can have access to quality, affordable health care.

To learn more about how health insurance reform will help Americans with diabetes and view the complete report, visit www.HealthReform.gov.

Diabetes, which can lead to heart disease, stroke, blindness and amputation, is currently the fifth-leading cause of death among Asian Americans, Native Hawaiians and other Pacific Islanders (AA & NHOPIs).

The new online diabetes information database was developed for physicians, advocates, health educators, patients and their families who need high-quality materials in a variety of Asian and Pacific Islander languages.

Registered users and visitors alike can search and find diabetes information on different topics such as what traditional New Year's foods to eat or avoid, tips on foot care and diabetes during pregnancy. Most materials--fact sheets, brochures, booklets, posters, etc.--are available for download in a multitude of languages including Cambodian, Chamorro, Chinese, Chuukese, Gujarati, Hindi, Hmong, Japanese, Korean, Lao, Samoan, Tagalog, Thai, Tongan and Vietnamese.

High-Quality, Community-Reviewed Materials

The Gateway provides access to tested health materials from the National Diabetes Education Program and also community-contributed health materials. The Gateway's community-contributed health materials are reviewed through a unique two-pronged process that ensures not only medical accuracy, but also cultural and linguistic appropriateness. As a community-curated collection of high-quality, in-language diabetes information, Gateway provides free access to all materials; in fact, registered users can view both reviewed and still-to-be reviewed diabetes health materials to decide for themselves what is most appropriate for their needs. Users even have the option of rating a material based on their experience or adding comments, thereby enriching the database for future Gateway visitors.

AAPCHO is a national association representing 27 community health organizations dedicated to promoting advocacy, collaboration and leadership that improves the health status and access of Asian Americans, Native Hawaiians, and other Pacific Islanders in the United States. Since 1987, AAPCHO has advocated for policies and programs that improve the provision of healthcare services that are community driven, financially affordable, linguistically accessible and culturally appropriate.

More Information

AAPCHO