Dr. Zarrinpar[/caption]
Amir Zarrinpar, MD, PhD
Assistant Professor, Division of Gastroenterology
University of California, San Diego
MedicalResearch.com: What is the background for this study?
Response: Over the last decade, physicians are beginning to recognize obesity as a disease that requires specific attention; they are more engaged with treating obesity itself rather than its metabolic consequences (such as type 2 diabetes, high blood pressure, cholesterol problems, and/or non-alcoholic fatty liver disease). However, treating obesity is very difficult and many patients don’t succeed in getting the minimum weight loss (approximately 5%) needed to get beneficial health effects. Recent obesity treatment guidelines recommend avoiding placing patients who are obese on obesogenic medication, or medication that have weight gain as a significant side effect.
Despite this recommendation, we noticed many patients who seek treatment for obesity in our clinics are on obesogenic medications. We first noticed that about 40% of patients who are undergoing bariatric surgery at UCSD were prescribed an obesogenic medication. These patients had worse weight loss outcomes compared to patients who did not have any obesogenic medications published that study recently in the International Journal of Obesity.
We wondered whether these findings were specific to bariatric surgery or if patients who were undergoing behavioral treatment (that is, diet and exercise) also had poor weight loss outcomes if they were on obesogenic medications.
Dr. Chaparro[/caption]
M. Pia Chaparro, MS, PhD
Assistant Professor
Department of Global Community Health and Behavioral Sciences
School of Public Health and Tropical Medicine
Tulane University
New Orleans, LA 70112
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In 2009, the WIC program changed the food packages participants receive to better align them with federal dietary guidelines. These changes included the addition of fruits, vegetables, and whole grains; a reduction in the amount of dairy and juice; and a calibration in formula amounts to match infants’ age and needs.
We found that this change in the food package was associated with a 10-12% lower obesity risk at age 4 years among children who participated in WIC in Los Angeles County continuously from birth until age 4.
Dr. Yanovski[/caption]
Jack A. Yanovski, MD, PhD
Senior Investigator
Section on Growth and Obesity, DIR, NICHD
National Institutes of Health
Hatfield Clinical Research Center
Bethesda, MD 20892‐1103
MedicalResearch.com: What is the background for this study?
Response: Studies of both mouse models and people suggest that obesity induced inflammation may promote insulin resistance and progression to diabetes. Others have proposed that suppressing this chronic, low level inflammation may slow the onset of diabetes. Nod-like Receptor Family Pyrin Domain Containing 3 (NLRP3) has recently been shown to play a strong role in promoting the inflammatory state in obesity. Colchicine, traditionally used to suppress or prevent inflammation in gout and other disorders is believed to inhibit formation of the NLRP3 inflammasome. Our group hypothesized that colchicine would improve obesity associated inflammation in adults with metabolic syndrome who had not yet developed type 2 diabetes.
Dr. Kerem[/caption]
Liya Kerem, MD
Fellow, Pediatric Endocrine Unit
Massachusetts General Hospital for Children
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: The hypothalamic neurohormone Oxytocin (OXT), shown to decrease food intake in animals and humans, is a promising novel treatment for obesity. We previously showed that in men with overweight/obesity, intranasal (IN)OXT reduced the fMRI activation in the ventral tegmental area (VTA), the origin of the mesolimbic dopaminergic reward system, in response to high-calorie food vs non-food visual stimuli.
Here, we employed fMRI functional connectivity analysis, which better characterizes the exchange in information between neural systems in a context-dependent manner. We hypothesized that Oxytocin would reduce the functional connectivity of the VTA with food motivation brain areas in response to high-calorie foods.
Dr. Kassotis[/caption]
Christopher D. Kassotis, Ph.D.
NRSA Postdoctoral Research Scholar
Stapleton Lab
Duke University
Nicholas School of the Environment
Durham, NC 27708
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Kramer[/caption]
Dr. Lynn Kramer, MD FAAN
VP and Chief Clinical Officer & Chief Medical Office
Eisai Co., Ltd
WeightControl.com: What is the background for this announcement?
Response: On February 25th, Eisai announced that the U.S. Food and Drug Administration (FDA) accepted its supplemental New Drug Application to potentially update the label for BELVIQ® (lorcaserin HCI) CIV 10 mg twice-daily/BELVIQ XR (lorcaserin HCI) CIV once daily to include long-term efficacy and safety data from CAMELLIA-TIMI 61, a clinical trial of BELVIQ in 12,000 overweight and obese patients with cardiovascular (CV) disease and/or multiple CV risk factors such as type 2 diabetes mellitus (T2DM).
Dr. McCrory[/caption]
Megan A McCrory, PhD, FTOS
Research Associate Professor
Dept of Health Sciences
Sargent College of Health and Rehabilitation Sciences
Boston University 02215
MedicalResearch.com: What is the background for this study?
Response: The prevalence of overweight and obesity has increased in the US, along with documented increases in portion size in the food supply. Fast food is popular, making up about 11% of adult daily calorie intake in the US, and over 1/3 of U.S. adults eat at fast food establishments on any given day. We therefore sought to examine changes in portion size, calories, and selected nutrients in fast-food entree, side, and dessert menu items across the years 1986, 1991, and 2016.
Dr. Visser[/caption]
Prof. Marjolein Visser PhD
Professor of Healthy Aging
Head section Nutrition and Health
Department of Health Sciences, Vrije Universiteit Amsterdam
Amsterdam Public Health research institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than 40 million Europeans experience a major depressive disorder. One in ten men, and one in five women suffer from clinical depression at least once during their lifetime. Depression is one of the most prevalent and disabling disorders in the EU.
Given the increasing prevalence of depression, more people are actively searching for ways to decrease their risk through lifestyle modification, but are often overwhelmed by confusing and contradictory information.
The MooDFOOD prevention trial is the largest randomized clinical trial to study the effects of nutritional strategies on the prevention of major depressive disorder. Over 1000 overweight or obese participants identified as being at elevated risk for depression but who were not currently depressed, from four European countries -the Netherlands, the United Kingdom, Germany and Spain, took part in the study. Participants were randomized to either take nutritional supplements containing folic acid, vitamin D, zinc, selenium or to a pill placebo, and half of participants also received a behavioral lifestyle intervention intended to change dietary behaviors and patterns.
Dr. Jun Ma[/caption]
Jun Ma, MD, PhD, FAHA, FABMR
Professor and Associate Head of Research
Department of Medicine
Director, Center for Health Behavior Research
The University of Illinois at Chicago
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity and depression are major public health problems. Obesity affects 40% of United States (US) adults. About 20% in US women and 13% in men experience major depressive disorder at some point in their lifetime and, additionally, many adults have elevated depressive symptoms that do not meet clinical diagnostic criteria but can nevertheless negatively affect their health and quality of life. Obesity and depression share common risk factors, such as poor diet and lack of exercise, and cause other health problems, such as diabetes and cardiovascular disease. People with obesity are at increased risk of being depressed and, likewise, people with depression are at increased risk of being obese. Consequently, obesity and depression often co-occur. To date, there has been no integrated therapy to effectively treat patients affected by both conditions at the same time.
The RAINBOW randomized clinical trial addressed this gap.
The main finding from the trial is that, among adult patients with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improve weight loss and depressive symptoms over one year compared with usual care, which patients received through their primary care physicians.
Dr. Loos[/caption]
Ruth Loos, PhD
The Charles Bronfman Professor in Personalized Medicine
Director, Genetics of Obesity and Related Traits Program
Co-Director, Charles Bronfman Institute for Personalized Medicine
Icahn School of Medicine at Mount Sinai
New York, NY
MedicalResearch.com: What is the background for this study? Which type of body fat distribution carries greater risk of diabetes or other obesity-related health disorders?
Response: Obesity broadly consists of two component; [1] there is overall body size (assessed using BMI) and [2] there is fat distribution (assessed using WHR). Both are “heritable”, which mean that they are in part determined by our genome (and the other part is determined by our lifestyle).
Over the past 15 years, geneticists have used an approach to screen the whole genome of thousands of people to identify genetic variations that differ between e.g. obese people vs non-obese people.
We have applied this approach to both components of obesity and have found so far that genes for “overall body size” seem to act in the brain, likely controlling hunger, satiety, reward, etc., whereas the genes that determine where in the body the excess fat will be stored when you gain weight (i.e. fat distribution) seem to act more “locally” at the fat cell level itself, determining the storage and release of fat.
Dr. Henriksson[/caption]
Pontus Henriksson | PhD and Registered Dietitian
Postdoctoral Researcher | SFO-V Fellow
Department of Biosciences and Nutrition
Karolinska Institutet
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In many countries, disability pensions are granted to working-aged persons who are likely to never work full-time again because of a chronic disease or injury diagnosed by a physician. In addition to serving as an important indicator of chronic disease, disability pensions are associated with high societal costs.
Hence, we examined whether cardiorespiratory fitness and obesity (two potentially modifiable factors) were associated with disability pension later in life.
Our main findings were that low physical fitness and/or obesity during adolescence, were strongly associated with disability pension later in life due to a wide range of diseases and causes.
Dr. Valenti[/caption]
Vitor Engrácia Valenti, PhD
Professor
São Paulo State University Marília
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Autonomic modulation and cardiorespiratory variables are influenced by numerous factors. Abdominal fat tissue is a relevant variables related to metabolic and cardiovascular disorders, including diabetes mellitus, dyslipidemia and hypertension, which are associated to increased risk of morbidity and mortality.
We evaluated cardiorespiratory variables and autonomic nervous system before and during recovery from exercise in healthy physically active men divided according to with waist-stature ratio (WSR): G1 – between 0.40 and 0.449 (N = 19), and G2 – between 0.45 and 0.49. This metholodigcal procedure is able to provide important information regarding the risk for developing cardiovascular disease in the future.
Our main findings indicated that healthy physically active men with waist-stature ratio values close to the risk limit (between 0.449 and 0.5) presented slower return of autonomic and cardiorespiratory variables to baseline values after moderate exercise. It suggests that this group present an elevated probability of developing cardiovascular disease in the future compared to the groups with lower values of waist-stature ratio.
Dr. Sung[/caption]
Hyuna Sung, PHD
Principal Scientist, Surveillance Research
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303
MedicalResearch.com: What is the background for this study?
Response: This project was motivated by our previous finding on the rise of colorectal cancer among young adults before age 55. Changes in cancer trends among young age group have significant implications because the newly introduced carcinogenic agents are likely to affect trends among young people before they affect those among older people. Owing to this relationship, cancer trends among young people can be often considered as a bellwether for future disease burden. Given the dramatic increase of the obesity prevalence during 3-4 decades in the US, we wanted to expand the colorectal cancer finding to the more comprehensive list of cancers and explain them in the context of obesity epidemic.
Dr. Lane[/caption]
Brian R. Lane MD PhD
Division of Urology
Spectrum Health
Grand Rapids, Michigan
MedicalResearch.com: Can you explain how you conducted your study, and what the main findings were?
Response: We used large-scale genome-wide association studies (GWAS) to identify genetic variants associated with obesity measures, blood pressure, lipids, type 2 diabetes, insulin, and glucose. these genetic variants were used as proxies for the above-mentioned risk factors and evaluated in relation to renal cell carcinoma risk (kidney cancer) using GWAS data from 10,000 RCC patients and 20,000 control participants.
- Based on these genetic data, we found that multiple measures of obesity, as well as diastolic blood pressure (DBP) and fasting insulin, are associated with renal cell carcinoma risk. In contrast, we found little evidence for an association with RCC risk for systolic blood pressure (SBP), circulating lipids, overall diabetes, or fasting glucose.
Dr. Garcia-Aymerich[/caption]
Judith Garcia Aymerich
Head of the Non-Communicable Diseases and Environment Programme
ISGlobal
MedicalResearch.com: What is the background for this study?
Response: Several studies have assessed the associations of overweight and obesity with lung function in children and adolescents, but they have found contradictory results. An important limitation of these studies is that most of them considered only overall body weight and did not take into account for the different contribution of lean body mass and fat mass, and their relative proportions that vary by age and sex.
Dr. Morrow[/caption]
Casey Morrow, Ph.D.
Leader of the research team and professor emeritus
Department of Cell, Developmental and Integrative Biology
University of Alabama at Birmingham
MedicalResearch.com: What is the background for this study?
Response: The human gastrointestinal tract (GIT) contains several distinct physical environments within the stomach, small intestine (duodenum, jejunum, ileum) and colon that harbor complex microbial communities.
Changes in the fecal microbe composition have been described for Roux-en-Y gastric bypass (RYGB), the most effective and durable treatment for morbid obesity, and sleeve gastrectomy (SG).
Dr. Islami[/caption]
Farhad Islami, MD PhD
Scientific Director, Surveillance Research
American Cancer Society, Inc.
Atlanta, GA 30303
MedicalResearch.com: What is the background for this study?
Dr. Neil Iyengar[/caption]
Neil M. Iyengar, MD
Breast Medicine Service
Department of Medicine
Memorial Sloan Kettering Cancer Center
Evelyn H. Lauder Breast And Imaging Center
New York, NY
MedicalResearch.com: What is the background for this study?
Response: Obesity is one of the leading modifiable risk factors for the development of hormone receptor positive breast cancer in postmenopausal women.
Traditionally, physicians use a person's body mass index (weight in kilograms divided by height in squared meters, kg/m2) to estimate body fat levels. A BMI of 30 or greater is considered to be obese, and this level of BMI increases the risk of at least 13 different cancers.
However, BMI is a crude measure of body fat and can be inaccurate. For example, some normal weight individuals (BMI less than 25) have obesity-related problems like diabetes and high blood pressure. Before our study, it was unknown whether high body fat levels in normal weight women contributes to obesity-related cancers such as breast cancer.
Dr. Liu[/caption]
Ching-Ti Liu, PhD
Department of Biostatistics
Boston University School of Public Health
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Being overweight and obese are increasing worldwide and this obesity epidemic threatens to reverse the gains in life expectancy achieved over the past century. However, many investigators have observed, paradoxically, that overweight individuals are associated with a lower mortality risk. These results may suffer from a potential confounding due to illness or reverse causality in which preexisting conditions may alter both body weight and the risk of death. Recently published studies have tried to mitigate this reverse causal bias by implementing sample exclusion and they came to a different conclusion: between BMI and all-cause mortality there is an increased risk of death for the entire range of weights that are in the overweight and obesity ranges.
However, the elimination strategies may lead to the loss of generalizability or precision due to over-adjustment. In addition, the traditional investigations have only utilized a subject’s weight at a single point in time, which makes it difficult to adequately address bias associated with reverse causality.
Currently, the idea incorporating a subject’s weight history has been proposed to deal with the concern of reverse causality, but the existing works had been based on a subject’s recall or self-reported data, which may lead to misclassification and, therefore, result in overestimating the risk of mortality.
To help assess the relevance of being overweight or obese to the risk of death in the general population, we conducted a prospective study, using an individuals’ maximum BMI before the beginning of survival follow-up instead of their weight status at a single point in time, using data from the Framingham Heart Study (FHS).
We observed increasing risk of mortality across various BMI categories (overweight < obese I < obese II) relative to normal weight using maximum BMI over 24 years of weight history.
Haris Riaz MD (Cardiology Fellow
Haitham Ahmed MD, MPH , Preventive Cardiologist,
Cleveland Clinic, Ohio
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Elevated cholesterol (specially low density lipoprotein) has been causally linked to the development of coronary artery disease whereas the causal relationship between obesity and cardiovascular disease has remained controversial. This is important because of increasing epidemic of obesity and metabolic syndrome. Mendelian randomization studies provide one way of determining a causal association where we can look at the outcomes of individuals stratified by the presence or absence of a particular allele. Since these alleles are randomly distributed in the population of interest, this is "nature's randomized trial" in that the particular allele is naturally distributed and hence minimal risk of bias.
In other words, lets say that I hypothesize that a particular gene "A" is linked with coronary artery disease. If the given gene is indeed causally linked with coronary artery disease, patients with activation of that gene should have significantly greater risk of developing coronary artery disease.
Based on these principles, we conducted a systematic review and meta-analysis of the available evidence and found that the risk of developing coronary artery disease and diabetes is significantly increased with obesity. Although hypothesis generating, we think that these findings may suggest a causal association between obesity and cardiovascular disease.
H.M. Heshmati, M.D.
Executive Vice President, Endocrinology and Metabolism
Gelesis, Inc.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Gelesis Loss Of Weight (GLOW) clinical study is a pivotal, multicenter, double-blind, placebo-controlled study of our lead investigational product candidate, Gelesis100, which is an oral, non-systemic approach to weight loss. The GLOW study was designed to assess change in body weight in adults with overweight or obesity after six months of treatment with Gelesis100.
Main findings from the GLOW study include the following:
Dr. Ard[/caption]
Dr. Jamy Ard MD
Professor of Epidemiology and Prevention
Co-director,the Wake Forest Baptist Health Weight Management Center
Wake Forest School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity continues to be a growing health challenge, and doctors need as many resources as possible to help their patients achieve success. The OPTIWIN trial shows that a total meal replacement program like OPTIFAST can help with significant and sustained weight loss.
The OPTIFAST Program is a medically monitored weight loss program that combines meal replacement with behavioral counseling and personalized support. In the OPTIWIN study, participants were randomized to either the OPTIFAST Program (OP) or a behavioral intervention using a food-based diet (FB).
At both 26 and 52 weeks, the OP group lost, on average, twice as much of their initial body weight as the FB group:
Dr. Field[/caption]
Alison E. Field, ScD
Professor and Chair of Epidemiology
Brown University School of Public Heath
Providence, RI
MedicalResearch.com: What is the background for this study?
Response: In the United States, approximately 40% of adults are obese. There are a range of treatment options, but relatively few people are able to lose weight and maintain the loss. The most effective treatment is bariatric surgery, but even among patients who have undergone bariatric surgery, there is a range in weight change patterns after surgery. This suggests that not all people with obesity are similar. There may be different causes and optimal treatment plans that vary by obesity subgroup. Our goal was to identify subgroups and to examine if they differed in terms of weight loss after bariatric surgery.
Dr. Christopher M Stark
Department of Pediatrics
William Beaumont Army Medical Center
El Paso, Texas
Department of Pediatrics
Walter Reed National Military Medical Center
Bethesda, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Rates of pediatric obesity have increased over the past decade, which has led researchers to search for modifiable risk factors that may explain this increase. Recent studies have identified an association between native gut bacteria alterations and the development of obesity. Several population-based studies have evaluated whether or not there is an association between antibiotic exposure and the development of obesity, with mixed results.
No studies have previously evaluated if acid suppressing medications are associated with developing obesity.
We found that young children prescribed antibiotics, acid suppressants, and combinations of these medications in the first two years of life are more likely to develop obesity after two years of age.
Our study represents the largest study to evaluate pediatric antibiotic prescriptions and obesity risk, with nearly ten times as many patients as the next largest study.
Dr. Wade[/caption]
Dr. Kaitlin Wade PhD
Research Associate and Early Career Researcher Representative
Integrative Epidemiology Unit (IEU)
Bristol Medical School (Population Health Sciences)
Faculty of Health Sciences
University of Bristol
MedicalResearch.com: What is the background for this study?
Response: Whilst severe obesity increases the risk of death in the population, there are conflicting results in the literature with some papers suggesting a protective effect of being overweight. Many observational studies also report a J-shaped association between body mass index – a measure of weight accounting for a person’s height – and mortality, where individuals who are underweight also have an increased risk of mortality compared to those within the ‘normal’ range. Such controversial findings are not without limitation, as bias by age, ill-health and other lifestyle factors are likely. One method to overcome the limitations of observational studies – Mendelian randomization – uses genetic variation in a person’s DNA to help understand the causal relationships between risk factors and health outcomes to provide a more accurate estimate of relationships by removing confounding factors (such as smoking, income and physical activity) and reverse causation (where people lose weight due to ill-health), which can explain conflicting findings in previous studies.
Until now, no study has used such a genetic-based approach to explore the link between body mass index and mortality.