Every day, people willingly trade good foot health for stylish shoes—think stilettos, platforms, and pointy toeboxes. For some time, however, patients who wore diabetic footwear didn’t have the option of worrying about style versus substance.
“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.
Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.
With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.
Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.
On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.
The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.
This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.
Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.
In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.
Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.
“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.
But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.
Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.
“You want to avoid completely taking away options from a patient,” Brenner said.
Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.
“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”
If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.
Showing posts with label diabetic and obesity. Show all posts
Showing posts with label diabetic and obesity. Show all posts
Saturday, January 28, 2012
Wednesday, January 25, 2012
Bariatric Surgery Not a Cure for Diabetes
According to Dimitrios Pournaras, MD as reported in the BMJ, "Bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) leads to complete remission in only about one third of patients with type 2 diabetes, and should be viewed as a means for improving glycemic control, not as a cure."...
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria.
Using data from 1006 patients, 209 of whom had type 2 diabetes at the time of gastric surgery, and a median follow-up of 23 months postsurgery, complete remission rates, using the new ADA standard, were 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). However, the authors explain, "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5 per cent; P = 0.003)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria.
The data, which were collected prospectively in 2 bariatric surgery centers in the United Kingdom and 1 center in Norway, also showed that on average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (compared with 7.5% before sleeve gastrectomy), and 6.3% (compared with 7.7% before gastric banding; P < .001 for each comparison).
The authors note that these findings are important for "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission.
The authors conclude, "The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. The findings of this study emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."
Br J Surg. 2012:88:100-103.
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria.
Using data from 1006 patients, 209 of whom had type 2 diabetes at the time of gastric surgery, and a median follow-up of 23 months postsurgery, complete remission rates, using the new ADA standard, were 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). However, the authors explain, "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5 per cent; P = 0.003)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria.
The data, which were collected prospectively in 2 bariatric surgery centers in the United Kingdom and 1 center in Norway, also showed that on average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (compared with 7.5% before sleeve gastrectomy), and 6.3% (compared with 7.7% before gastric banding; P < .001 for each comparison).
The authors note that these findings are important for "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission.
The authors conclude, "The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. The findings of this study emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."
Br J Surg. 2012:88:100-103.
Tuesday, August 30, 2011
Obesity Ranking System Predicts Mortality
An obesity classification system that distinguishes between fat and lean tissue and takes into account functional status and the various comorbid conditions that can be associated with obesity may be a more effective mortality prediction tool than standard body mass index (BMI), according to new research....
Raj S. Padwal, MD, from the Department of Medicine, University of Alberta, Edmonton, Canada, explains, "Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility." The new tool, called the Edmonton obesity staging system (EOSS), ranks obese and overweight people according to a 5-point scale based on factors relating to an individual's underlying health status and the presence or absence of underlying health conditions and, therefore, may be a better predictor of mortality.
A "0" on the EOSS scale, for instance, represents "no apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range), physical symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesity," according to the study authors.
A ranking of 2 indicates "the presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis), moderate limitations in activities of daily living and/or well-being," and the highest ranking indicates, "severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being."
In determining efficacy of the tool, researchers with the University of Alberta applied it to data on 8143 people aged 20 years and older in the 1988-1994 and 1999-2004 US National Health and Human Nutrition Examination Surveys (NHANES).
The results indicated that 77.2% of overweight or obese people in the 1988-1994 survey and 90.3% of those in the 1999-2004 survey were classified as stage 1 or 2 in the EOSS, and their risk for death was significantly lower than that of overweight or obese people classified as stage 3.
In the NHANES 1988-1994 data, scores of 2 and 3 each were associated with a higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI], 1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared with scores 0 or 1.
The higher risk was seen even after adjustment for BMI, metabolic syndrome, and hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for women), as well as in a cohort eligible for bariatric surgery.
Measurements of BMI and waist circumference are typically among key factors in the assessment of appropriate treatments for obesity, such as bariatric surgery or anti-obesity therapies.
But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.
In considering the broader range of factors, the EOSS is intended to provide more clinically relevant prognostic information in a manner similar to that of the tumor, node, metastasis system used in the staging of cancer, the authors write.
"The major incremental contribution of this staging system to anthropometric indices and cardiovascular risk equations is the direct measurement of the presence and severity of underlying obesity-related comorbidities, which enables a more comprehensive and individualized assessment of risk," they said.
"Such enhanced risk assessment may enable a greater understanding of obesity-related prognosis and may also assist in determining the urgency of intervention."
The system could be particularly beneficial in prioritizing patients for bariatric surgery according to ranking that reflects a broader assessment of obesity and obesity-related comorbid conditions than simply a BMI ranking, the authors added.
Canadian Medical Association Journal, August 15, 2011 cmaj.110387
Raj S. Padwal, MD, from the Department of Medicine, University of Alberta, Edmonton, Canada, explains, "Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility." The new tool, called the Edmonton obesity staging system (EOSS), ranks obese and overweight people according to a 5-point scale based on factors relating to an individual's underlying health status and the presence or absence of underlying health conditions and, therefore, may be a better predictor of mortality.
A "0" on the EOSS scale, for instance, represents "no apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range), physical symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesity," according to the study authors.
A ranking of 2 indicates "the presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis), moderate limitations in activities of daily living and/or well-being," and the highest ranking indicates, "severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being."
In determining efficacy of the tool, researchers with the University of Alberta applied it to data on 8143 people aged 20 years and older in the 1988-1994 and 1999-2004 US National Health and Human Nutrition Examination Surveys (NHANES).
The results indicated that 77.2% of overweight or obese people in the 1988-1994 survey and 90.3% of those in the 1999-2004 survey were classified as stage 1 or 2 in the EOSS, and their risk for death was significantly lower than that of overweight or obese people classified as stage 3.
In the NHANES 1988-1994 data, scores of 2 and 3 each were associated with a higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI], 1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared with scores 0 or 1.
The higher risk was seen even after adjustment for BMI, metabolic syndrome, and hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for women), as well as in a cohort eligible for bariatric surgery.
Measurements of BMI and waist circumference are typically among key factors in the assessment of appropriate treatments for obesity, such as bariatric surgery or anti-obesity therapies.
But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.
In considering the broader range of factors, the EOSS is intended to provide more clinically relevant prognostic information in a manner similar to that of the tumor, node, metastasis system used in the staging of cancer, the authors write.
"The major incremental contribution of this staging system to anthropometric indices and cardiovascular risk equations is the direct measurement of the presence and severity of underlying obesity-related comorbidities, which enables a more comprehensive and individualized assessment of risk," they said.
"Such enhanced risk assessment may enable a greater understanding of obesity-related prognosis and may also assist in determining the urgency of intervention."
The system could be particularly beneficial in prioritizing patients for bariatric surgery according to ranking that reflects a broader assessment of obesity and obesity-related comorbid conditions than simply a BMI ranking, the authors added.
Canadian Medical Association Journal, August 15, 2011 cmaj.110387
Wednesday, June 29, 2011
Nobiletin in Tangerines Fights Obesity and Protects against Heart Disease
New research has discovered a substance in tangerines not only prevents obesity, but also offers protection against Type 2 diabetes, and even atherosclerosis....
Murray Huff, a vascular biology scientist at the Schulich School of Medicine & Dentistry, studied the effects of a flavonoid in tangerines called Nobiletin. In a model of metabolic syndrome developed by the Huff laboratory at the Robarts Research Institute, mice were fed a "western" diet high in fats and simple sugars. One group became obese and showed all the signs associated with metabolic syndrome: elevated cholesterol and triglycerides, high blood levels of insulin and glucose, and a fatty liver. These metabolic abnormalities greatly increase the risk of cardiovascular disease and Type 2 diabetes.
The second group of mice, fed the exact same diet but with Nobiletin added, experienced no elevation in their levels of cholesterol, triglycerides, insulin or glucose, and gained weight normally. Mice became much more sensitive to the effects of insulin. Nobiletin was shown to prevent the buildup of fat in the liver by stimulating the expression of genes involved in burning excess fat, and inhibiting the genes responsible for manufacturing fat.
"The Nobiletin-treated mice were basically protected from obesity," says Huff, the Director of the Vascular Biology Research Group at Robarts. "And in longer-term studies, Nobiletin also protected these animals from atherosclerosis, the buildup of plaque in arteries, which can lead to a heart attack or stroke. This study really paves the way for future studies to see if this is a suitable treatment for metabolic syndrome and related conditions in people."
Huff's research has focused on the pharmacological properties of naturally-occurring bioactive molecules. Two years ago, his research drew international attention when he discovered a flavonoid in grapefruit called Naringenin offered similar protection against obesity and other signs of metabolic syndrome. Huff says, "What's really interesting to us is that Nobiletin is ten times more potent in its protective effects compared to Naringenin, and this time, we've also shown that Nobiletin has the ability to protect against atherosclerosis."
Diabetes, April 2011
Murray Huff, a vascular biology scientist at the Schulich School of Medicine & Dentistry, studied the effects of a flavonoid in tangerines called Nobiletin. In a model of metabolic syndrome developed by the Huff laboratory at the Robarts Research Institute, mice were fed a "western" diet high in fats and simple sugars. One group became obese and showed all the signs associated with metabolic syndrome: elevated cholesterol and triglycerides, high blood levels of insulin and glucose, and a fatty liver. These metabolic abnormalities greatly increase the risk of cardiovascular disease and Type 2 diabetes.
The second group of mice, fed the exact same diet but with Nobiletin added, experienced no elevation in their levels of cholesterol, triglycerides, insulin or glucose, and gained weight normally. Mice became much more sensitive to the effects of insulin. Nobiletin was shown to prevent the buildup of fat in the liver by stimulating the expression of genes involved in burning excess fat, and inhibiting the genes responsible for manufacturing fat.
"The Nobiletin-treated mice were basically protected from obesity," says Huff, the Director of the Vascular Biology Research Group at Robarts. "And in longer-term studies, Nobiletin also protected these animals from atherosclerosis, the buildup of plaque in arteries, which can lead to a heart attack or stroke. This study really paves the way for future studies to see if this is a suitable treatment for metabolic syndrome and related conditions in people."
Huff's research has focused on the pharmacological properties of naturally-occurring bioactive molecules. Two years ago, his research drew international attention when he discovered a flavonoid in grapefruit called Naringenin offered similar protection against obesity and other signs of metabolic syndrome. Huff says, "What's really interesting to us is that Nobiletin is ten times more potent in its protective effects compared to Naringenin, and this time, we've also shown that Nobiletin has the ability to protect against atherosclerosis."
Diabetes, April 2011
Sunday, June 19, 2011
Stress Predicts Development of Impaired Glucose Metabolism
Perceived stress and stressful life events predict the development of impaired glucose metabolism (IGM) over 5 years in previously normoglycemic individuals, according to results from the Australian Diabetes, Obesity, and Lifestyle study AusDiab)....
The study by Emily Williams, PhD, Monash University, Melbourne, Australia, showed that perceived stress increased the risk for incident IGM over 5 years by between 1.04 and 1.06, depending on the model used. Using the same models, high levels of stressful life events also increased the risk for incident IGM by between 1.24 and 1.35 in the same longitudinal cohort.
Dr. Williams reported that, "The effect size sounds quite small but for every point increase [in these models], there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM." "And we think stress management should be incorporated into multiple health behavioral interventions for the most effective prevention and management of diabetes."
AusDiab included 11,247 adults older than 25 years who were randomly selected from 42 areas of Australia. At baseline, a 2-hour, 75-g oral glucose tolerance test was given along with the Perceived Stress Questionnaire and a life events score to measure psychosocial adversity.
At 5 years, more than 6,500 of the original participants returned for follow-up during which another 2-hour oral glucose test was taken and the questionnaires re-administered.
"We used the outcome of a polled analysis of fasting glucose, impaired glucose tolerance, and diabetes to have a larger category of impaired glucose metabolism to try and tap into a wider range of abnormal glucose metabolism, and by measuring perceived stress as well as the experience of stress, we tried to measure both objective and subjective markers of stress. Only subjects who were normoglycemic at baseline were included in the analyses," said Dr. Williams.
At 5-year follow-up, 474 subjects had progressed to IGM. Adjusting for age, sex, and education, logistic regression analyses showed that perceived stress increased the odds of IGM by 1.06. Controlling for the same variables, those reporting high levels of stressful life events were 34% more likely to have developed IGM at 5 years compared with those reporting low levels of stressful life events.
When health behaviors were added to the model, results showed that perceived stress increased the odds of IGM by 1.05. The same model also showed that those reporting high levels of stressful life events had a 35% higher risk of developing IGM compared with those reporting low levels of stressful life events. Adding obesity to the mix attenuated the effect of perceived stress as a risk factor for IGM but not by much, at an odds ratio of 1.04.
Similarly, obesity slightly attenuated the risk for stressful life events contributing to IGM at an odds ratio of 1.26. Lastly, when all variables plus traditional cardiovascular disease (CVD) risk factors were added to the analysis, perceived stress still had the same effect on IGM risk at an odds ratio of 1.04. Again, compared with those who reported low levels of stressful life events, those reporting high levels of stressful life events had a 24% greater chance of developing IGM at 5 years when analyzed in the final model.
Table 1. Perceived Stress as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1: Age, sex, education
1.06
Model 1 plus health behaviors (model 2)
1.05
Model 2 plus obesity (model 3)
1.04
Model 3 plus cardiovascular disease risk factors (model 4)
1.04
Table 2. Stressful Life Events as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1 low life stress vs high life stress
1.34
Model 2 low life stress vs high life stress
1.35
Model 3 low life stress vs high life stress
1.26
Model 4 low life stress vs high life stress
1.24
Investigators also evaluated how stress affected glycemic control over time among subjects who already had diabetes at baseline. Interestingly, said Dr. Williams, there no relationships between stress and glycemic control was observed in men, but among women with diabetes at baseline, both perceived stress and stressful life events were shown to predict elevated glycosylated hemoglobin at follow-up, after adjustment for other risk factors (P = .024).
Dr. Williams stated that, "All of the evidence in CVD suggests that stress is a key independent risk factor for the development of heart disease, but it hasn't been done in diabetes, and yet they are on the same chronic disease trajectory. "So there is no reason to think stress isn't involved in the development of diabetes too and even more so because diabetes requires so much daily management it's bound to affect a person's experience."
The study by Emily Williams, PhD, Monash University, Melbourne, Australia, showed that perceived stress increased the risk for incident IGM over 5 years by between 1.04 and 1.06, depending on the model used. Using the same models, high levels of stressful life events also increased the risk for incident IGM by between 1.24 and 1.35 in the same longitudinal cohort.
Dr. Williams reported that, "The effect size sounds quite small but for every point increase [in these models], there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM." "And we think stress management should be incorporated into multiple health behavioral interventions for the most effective prevention and management of diabetes."
AusDiab included 11,247 adults older than 25 years who were randomly selected from 42 areas of Australia. At baseline, a 2-hour, 75-g oral glucose tolerance test was given along with the Perceived Stress Questionnaire and a life events score to measure psychosocial adversity.
At 5 years, more than 6,500 of the original participants returned for follow-up during which another 2-hour oral glucose test was taken and the questionnaires re-administered.
"We used the outcome of a polled analysis of fasting glucose, impaired glucose tolerance, and diabetes to have a larger category of impaired glucose metabolism to try and tap into a wider range of abnormal glucose metabolism, and by measuring perceived stress as well as the experience of stress, we tried to measure both objective and subjective markers of stress. Only subjects who were normoglycemic at baseline were included in the analyses," said Dr. Williams.
At 5-year follow-up, 474 subjects had progressed to IGM. Adjusting for age, sex, and education, logistic regression analyses showed that perceived stress increased the odds of IGM by 1.06. Controlling for the same variables, those reporting high levels of stressful life events were 34% more likely to have developed IGM at 5 years compared with those reporting low levels of stressful life events.
When health behaviors were added to the model, results showed that perceived stress increased the odds of IGM by 1.05. The same model also showed that those reporting high levels of stressful life events had a 35% higher risk of developing IGM compared with those reporting low levels of stressful life events. Adding obesity to the mix attenuated the effect of perceived stress as a risk factor for IGM but not by much, at an odds ratio of 1.04.
Similarly, obesity slightly attenuated the risk for stressful life events contributing to IGM at an odds ratio of 1.26. Lastly, when all variables plus traditional cardiovascular disease (CVD) risk factors were added to the analysis, perceived stress still had the same effect on IGM risk at an odds ratio of 1.04. Again, compared with those who reported low levels of stressful life events, those reporting high levels of stressful life events had a 24% greater chance of developing IGM at 5 years when analyzed in the final model.
Table 1. Perceived Stress as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1: Age, sex, education
1.06
Model 1 plus health behaviors (model 2)
1.05
Model 2 plus obesity (model 3)
1.04
Model 3 plus cardiovascular disease risk factors (model 4)
1.04
Table 2. Stressful Life Events as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1 low life stress vs high life stress
1.34
Model 2 low life stress vs high life stress
1.35
Model 3 low life stress vs high life stress
1.26
Model 4 low life stress vs high life stress
1.24
Investigators also evaluated how stress affected glycemic control over time among subjects who already had diabetes at baseline. Interestingly, said Dr. Williams, there no relationships between stress and glycemic control was observed in men, but among women with diabetes at baseline, both perceived stress and stressful life events were shown to predict elevated glycosylated hemoglobin at follow-up, after adjustment for other risk factors (P = .024).
Dr. Williams stated that, "All of the evidence in CVD suggests that stress is a key independent risk factor for the development of heart disease, but it hasn't been done in diabetes, and yet they are on the same chronic disease trajectory. "So there is no reason to think stress isn't involved in the development of diabetes too and even more so because diabetes requires so much daily management it's bound to affect a person's experience."
Friday, April 8, 2011
How Body Shape Affects Diabetes Risk
Where do you carry your excess fat? The answer may have implications for your type 2 diabetes risk.
Apple or pear? The question may imply a healthy snack — or an important distinction between body shapes that affects type 2 diabetes risk.
In general, people whose fat collects on their abdomen — making them resemble apples over time — are at greater risk for type 2 diabetes. But the good news is, you can escape your shape.
Being overweight is a significant risk factor for diabetes, no matter your shape. “Patients who have a higher body mass index have a higher risk [of diabetes],” says Danny Sam, MD, an internal medicine physician with Kaiser Permanente in Santa Clara, Calif., who specializes in the treatment of adult diabetes. Body mass index (BMI) is calculated by comparing weight and height.
But while any overweight person is at increased risk for diabetes, those who carry a lot of that extra weight over the belly are at particular risk. The apple shape not only predisposes you to diabetes but to poor heart health as well.
Identifying Your Type 2 Diabetes Body Type
Body shapes determined by fat deposits seem to predict your type 2 diabetes risk. It may be helpful to know the terms for the body shape categories:
Apple. People whose fat collects around their waistline may end up looking more like apples than any other fruit. This body type is also called “android” and the fat collection is sometimes referred to as “central adiposity.”Pear. In women especially, fat can be drawn to the buttocks and thighs. The good news is that this type of fat distribution is less likely than abdominal fat to lead to insulin resistance or type 2 diabetes. This is also called the “gynecoid” body shape or “gluteo-femoral” fat.Overall. Some people collect fat everywhere at a fairly even rate. But because being overweight or obese, regardless of your body shape, increases type 2 diabetes risk over being normal weight, the fact that you don’t fall into either apple or pear shape doesn’t completely let you off the hook when it comes to preventing type 2 diabetes and other chronic health conditions.
Measure Your Waist
Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, there is one important measurement that can help you determine your risk of diabetes and heart disease: your waist. If you are a woman and your waistline is greater than 35 inches, you are at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you are at or above these numbers, it’s time for a little waist whittling.
Escape Your Shape
The good news is that your body shape is not your disease destiny. There is one way to reduce your type 2 diabetes risk: weight loss to maintain a healthy body weight.
Here are the steps you can take:
Be physically active. Sam emphasizes that physical activity has been shown to help prevent diabetes and will help you control your weight. Mix up your activities to include both aerobic activities, such as walking or swimming, and some weight training or core-strengthening so you get overall slimming benefits.Watch your weight. If you already know you are an apple or a pear, chances are you are also overweight. Getting back to a normal weight and staying there is your best bet for staving off diabetes. If you are having a hard time figuring out what your goal weight should be, talk to your doctor.Eat a healthy diet. A nutritious, varied diet full of lean protein, whole grain, fruits, and veggies is your best bet for long-term health. If you are pre-diabetic or have diabetes already, you must also control your blood sugar. Aim for low-fat menu planning as well, if you want to whittle down your waist. If the body shape you see in the mirror seems riskier than you want it to be, don’t despair. With some work you can beat your diabetes risk — while feeling and looking healthier.
Apple or pear? The question may imply a healthy snack — or an important distinction between body shapes that affects type 2 diabetes risk.
In general, people whose fat collects on their abdomen — making them resemble apples over time — are at greater risk for type 2 diabetes. But the good news is, you can escape your shape.
Being overweight is a significant risk factor for diabetes, no matter your shape. “Patients who have a higher body mass index have a higher risk [of diabetes],” says Danny Sam, MD, an internal medicine physician with Kaiser Permanente in Santa Clara, Calif., who specializes in the treatment of adult diabetes. Body mass index (BMI) is calculated by comparing weight and height.
But while any overweight person is at increased risk for diabetes, those who carry a lot of that extra weight over the belly are at particular risk. The apple shape not only predisposes you to diabetes but to poor heart health as well.
Identifying Your Type 2 Diabetes Body Type
Body shapes determined by fat deposits seem to predict your type 2 diabetes risk. It may be helpful to know the terms for the body shape categories:
Apple. People whose fat collects around their waistline may end up looking more like apples than any other fruit. This body type is also called “android” and the fat collection is sometimes referred to as “central adiposity.”Pear. In women especially, fat can be drawn to the buttocks and thighs. The good news is that this type of fat distribution is less likely than abdominal fat to lead to insulin resistance or type 2 diabetes. This is also called the “gynecoid” body shape or “gluteo-femoral” fat.Overall. Some people collect fat everywhere at a fairly even rate. But because being overweight or obese, regardless of your body shape, increases type 2 diabetes risk over being normal weight, the fact that you don’t fall into either apple or pear shape doesn’t completely let you off the hook when it comes to preventing type 2 diabetes and other chronic health conditions.
Measure Your Waist
Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, there is one important measurement that can help you determine your risk of diabetes and heart disease: your waist. If you are a woman and your waistline is greater than 35 inches, you are at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you are at or above these numbers, it’s time for a little waist whittling.
Escape Your Shape
The good news is that your body shape is not your disease destiny. There is one way to reduce your type 2 diabetes risk: weight loss to maintain a healthy body weight.
Here are the steps you can take:
Be physically active. Sam emphasizes that physical activity has been shown to help prevent diabetes and will help you control your weight. Mix up your activities to include both aerobic activities, such as walking or swimming, and some weight training or core-strengthening so you get overall slimming benefits.Watch your weight. If you already know you are an apple or a pear, chances are you are also overweight. Getting back to a normal weight and staying there is your best bet for staving off diabetes. If you are having a hard time figuring out what your goal weight should be, talk to your doctor.Eat a healthy diet. A nutritious, varied diet full of lean protein, whole grain, fruits, and veggies is your best bet for long-term health. If you are pre-diabetic or have diabetes already, you must also control your blood sugar. Aim for low-fat menu planning as well, if you want to whittle down your waist. If the body shape you see in the mirror seems riskier than you want it to be, don’t despair. With some work you can beat your diabetes risk — while feeling and looking healthier.
Thursday, April 7, 2011
Diabetes Tied to Poor Impulse Control
Patients with newly diagnosed Type 2 diabetes were significantly more likely to show poor impulse control in psychological testing than healthy people....
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
Sunday, February 6, 2011
The Growing Problem of Childhood Obesity
With childhood obesity starting at ever-younger ages, it's never too soon to educate kids about a healthy diet. Learn about creating an obesity-fighting diet for your children at home and at school. Childhood obesity is a growing problem. Figuring out how to help your children eat a healthy diet and avoid obesity may be challenging, especially in the face of favorite high-calorie snacks, finger foods, and sugary drinks. But the stakes are high: A recent study of 3,098 children between 3 and 6 years old showed that excess weight causes an increase in heart disease risk factors even in toddlerhood.
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
Wednesday, December 15, 2010
Obese Adolescents at Greatest Risk of Becoming Severely Obese Adults
Obese adolescents are 16 times more likely to become severely obese by age 30 than their healthy weight or even overweight peers, according to a new study....
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
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