Obesity Epidemic

Published Online: Friday, May 15, 2009

Exercise Benefits Lessened by Food Rewards
Whereas exercise is a great way to fight the battle of the bulge, it can all be for nothing without sensible decisionmaking. Researchers have concluded that many have an inflated assumption about the number of calories burned while exercising, causing them to feel entitled to eat more than usual as a reward.

A study published in the February 2009 issue of PLoSONE reported that, of 411 overweight or obese, sedentary women, the group instructed to do the most exercise was also the one with the lowest weight loss after 6 months. The women who engaged in 72 minutes of physical activity per week lost 2 to 3 lb, which was typical for that amount of exercise. Also meeting the researchers’ expectations were the women doing 136 minutes of activity each week; they lost >4 lb during the study. Women partaking in 194 minutes of exercise per week were expected to lose about 6 lb in 6 months, but instead only lost 2 to 3 lb.

Medicare to Cover Bariatric Surgery
Acknowledging the health complications that often exist for morbidly obese individuals with type 2 diabetes, the Centers for Medicare&Medicaid Services (CMS) announced in February that its policy will cover bariatric surgery for these patients. For eligibility, a patient must have a body mass index of ≥35. Although the CMS recognized recent data stating that all obese individuals could benefit from bariatric surgery, the federal group concluded that insufficient evidence existed to prove such claims. Instead, they said risks could override benefits in patients who are nonmorbidly obese. Morbidly obese Medicare patients are eligible for bariatric surgery if diagnosed with comorbidities, including hypertension, coronary artery disease, or osteoarthritis, after a 2006 decision expanded coverage of the procedure. This recent decision adds type 2 diabetes to the comorbidity criteria. Four types of bariatric surgery procedures are covered by CMS: gastric bypass, open and laparoscopic Rouxen-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch.

Count on Calories to Make or Break a Diet
The obesity epidemic is exploited by the multitude of diets promising lasting results. Weight loss hinges on 1 factor—calories—according to study results. The foolproof way to drop pounds is to curb calorie intake while increasing the ones burned with greater exercise, the researchers found.

The study, published in the February 19, 2009, issue of the New England Journal of Medicine, involved 811 participants assigned to 1 of 4 diets to measure results. The investigators examined outcomes of diets including low fat, compared with high fat; average protein versus high protein; and high-carbohydrate content, compared with low-carbohydrate content. As all participants completing the 2-year study period lost an average of 8 lb, the researchers concluded that a reduction in calories will result in weight loss, irrespective of which macronutrients are consumed.

Clinicians Can Help Mold Healthy, Lean Teens
When dealing with teens, it can be a delicate balance between working to prevent obesity while also averting the dangerous pitfalls of eating disorders.

An article published in the March 2009 issue of The Journal of Adolescent Health provided 5 recommendations for health care providers to use when addressing weight-related issues with teens, according to study author Dianne Neumark-Sztainer, PhD:

• Let them know that dieting can potentially have effects opposite to those desired, especially when it involves harmful practices like skipping meals, taking diet pills, or inducing vomiting after meals. Such methods of weight loss can actually lead to obesity. Instead, encourage healthy lifestyle changes.

• Promote positive body image as opposed to focusing on weight loss due to body dissatisfaction. Negative body image can often lead to weight gain.

• Encourage families to share meals together more frequently.

• Urge families to talk less about weight, instead promoting physical activity and eating right.

• Assume teens have been mistreated because of their weight, and address the issue with them and their parents. The recommendations were gleaned from the findings of Project EAT, a large-scale, population-based, 5-year study on adolescent eating and weight issues. ■



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