Obesity Driving America's Healthcare to a Tipping Point

The Obesity Society, a leading scientific organization dedicated to the study of obesity, and other steering committee members of the Strategies to Overcome and Prevent (STOP) Obesity Alliance, and two former US Surgeons General, join together today to develop effective recommendations to urge policymakers to act on the inclusion of obesity as the largest and most urgent driving factor in healthcare reform.

The two most recent Surgeons General of the United States, David Satcher MD, PhD and Richard H. Carmona, MD, MPH, respectively 16th and 17th US Surgeons General, jointly urged policymakers to take direct action on obesity and its associated chronic diseases by including obesity as a key element in healthcare reform.

"Health reform will succeed only if we address obesity and the chronic diseases it causes," said Robert Kushner, MD, President of The Obesity Society. "Obesity is the number 1, most serious health issue facing the country. It is also the largest single driver of our increasing healthcare costs and we need to address it now."

More than one third of US adults -- more than 72 million people -- and 16 percent of US children are now estimated to be overweight or obese. Obesity and overweight are associated with several chronic health risks and conditions, including: diabetes, heart disease, stroke, hypertension, some types of cancer, sleep apnea, osteoarthritis, and gallbladder disease. Furthermore, the medical costs of obesity are now estimated at more than $147 billion per year.

The Obesity Society supports the four targeted recommendations for effective healthcare reform issued by the STOP Obesity Alliance at the meeting held today at the Newseum in Washington, DC:

• Standardized and effective clinical interventions, flowing from evidence-based guidelines, such as those approved by the National Heart, Lung and Blood Institute (NHLBI), that include acknowledging the health benefits of five to ten percent sustained weight loss to
  aid and support those individuals who are currently overweight or obese achieve improved health.
• Enhanced use of clinical preventive services to monitor health status and help prevent weight gain, especially for individuals who are already overweight and are at risk of becoming obese.
• Effective, evidence-based community programs and policies that encourage and support healthy lifestyles, focus on health literacy, address health disparities, and represent a significant investment in population-based prevention of obesity.
• Coordinated research efforts to build the evidence for all three of the above elements, continuously improving quality of care, bolstering our understanding of what does and does not work in various settings, and helping to translate the scientific research into practice
  recommendations for real-world clinical settings and communities.

"These recommendations are designed to improve the dialogue and interventions around obesity. Successful reform will address clinical treatment, prevention, community programs and research to reverse the medical burden of obesity," said Dr. Kushner. "Lending our support to the STOP Obesity Alliance recommendations will also bring us one more step closer to providing a health system that can effectively lessen the grip of obesity on our society."

For more information:

• OBESITY, Halting the Epidemic by Making Health Easier (Centers for Disease Control)
• Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, NHLBI.
• Eric A. Finkelstein, Justin G. Trogdon, Joel W. Cohen, William Dietz, [Health Affairs 28, no. 5 (2009): w822-w831 (published online 27 July 2009; 10.1377/hlthaff.28.5.w822)]

Simple ABCs of Weight Loss and Fitness: Advice From Someone who Knows

Modern American society is filled with easily accessible fatty foods, a growing obesity epidemic and a general lack of healthy living. In his new book,Lose Weight, Feel Great: How I Lost Over 60lbs. with the Help of a Personal Trainer,author Kevin Given tells of his personal struggles with obesity, how he lost over 60 pounds with the help of a personal trainer, and how others can change their lifestyles and bodies as well.

Says Given 'This book is different from other weight loss books because it is my personal story of how I overcame the obstacle of obesity. I also avoid going into unnecessary detail. I find that most problems with weight loss books are that they get bogged down with details on how certain things work. My book cuts to the chase and makes it simple. "If you do this, then this is what will happen."

Given Continues: "If you eat certain foods, this is how they will affect your system. If you do a certain exercise; for example dumb-bell curls, then this is what will happen; your biceps will develop. There are no unnecessary details here that will only slow you down. In my book you will find the simple ABCs of weight loss and fitness."

Given had ongoing issues with his weight for over 20 years with many failed attempts at change. He tried numerous fad diets that never worked, so he then decided to hire a personal trainer to aid him in losing weight and keeping it off for good. Now a certified personal trainer himself, Given hopes to help others through a combination of historical knowledge of human health, personal testimony, exercises and fitness techniques, nutrition, and other information vital to weight loss and good health.

While the use of this book and practicing a healthy lifestyle are certainly reliable ways to lose weight and get in shape, Given also believes the aid of a personal trainer helps immensely in this journey toward the ideal you.

"If the military sent a soldier to basic training with only an army manual and no guidance, that soldier wouldn't learn much! How many soldiers would get up at four or five AM without the drill sergeants going through the hall with a stick and a garbage can banging as loudly as he or she can? Who would be motivated to do pushups if the drill sergeant didn't yell, "Drop and give me twenty"? Just as the soldier is guided to his peak performance during army basic training, so an individual seeking to get into better shape will be guided by the personal trainer into reaching his/her goal", Given explains.

Ongoing Safety Review of Weight Loss Drug Orlistat

The U.S. Food and Drug Administration announced today that it is reviewing adverse event reports of liver injury in patients taking the weight loss drug orlistat, marketed as the prescription drug Xenical (orlistat 120 mg) and the over-the-counter medication Alli (orlistat 60 mg).

The drugs were approved for obesity management in conjunction with a reduced caloric diet, and to reduce the risk of regaining weight after prior weight loss.

Between 1999 and 2008, the FDA received 32 reports of serious liver injury, including 6 with liver failure, in patients taking orlistat. Of those cases, 27 reported hospitalization and six resulted in liver failure. Thirty of the adverse events occurred outside the United States. The most commonly reported adverse events included yellowing of the skin or whites of the eyes (jaundice), weakness, and stomach pain.

Reports outlining the adverse events were submitted to FDA’s Adverse Event Reporting System.The FDA is reviewing additional data submitted by orlistat manufacturers on suspected cases of liver injury, and the issue has been discussed at the FDA’s Center for Drug Evaluation and Research Drug Safety Oversight Board.

“The issues here are complex, but FDA has benefited from the input of the Board, including comments from representatives from three FDA Centers and several other Agencies in the Department of Health and Human Services,” said Steven Osborne, M.D., executive director of the Board.The FDA’s analysis of these data is ongoing, and no definite association between liver injury and orlistat has been established at this time.

Consumers taking Xenical should continue to take it as prescribed, and those using over-the-counter Alli should continue to use the product as directed.Consumers who have used orlistat should consult a health care professional if they experience symptoms possibly associated with development of liver injury, particularly weakness or fatigue, fever, jaundice, or brown urine.

Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.The FDA urges both health care professionals and consumers to report suspected side effects from the use of orlistat to FDA's MedWatch Adverse Event Reporting program

Further information regarding orlistat will be released by the FDA as soon as its review of complete.

Orlistat is manufactured by Swiss pharmaceutical firm Roche. The drug is marketed as Alli by British drugmaker GlaxoSmithKline PLC and sold as Xenical by Roche. The FDA first approved Xenical in 1999 and alli in 2007. Glaxo reported $123 million in sales for Alli in 2008, while Roche posted $472 million in revenue for Xenical.

Weight Loss in Overweight and Obese Women Reduces Urinary Incontinence

Reducing urinary incontinence can now be added to the extensive list of health benefits of weight loss, according to a clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Office of Research on Women’s Health (ORWH), both part of the National Institutes of Health (NIH). The paper reporting the results of the trial will be published in the January 29 issue of the New England Journal of Medicine.

The Program to Reduce Incontinence by Diet and Exercise (PRIDE), conducted in Birmingham, Alabama, and Providence, Rhode Island, recruited a total of 338 obese and overweight women who leaked urine at least 10 times per week. The women were randomly assigned to either an intensive six-month weight-loss program of diet, exercise and behavior modification (226 women) or to a group that received information about diet and exercise, but no training to help them change habits (112 women).

The investigators report that women in the intensive weight-loss group lost an average 8 percent of their body weight (about 17 pounds) and reduced weekly urinary incontinence episodes by nearly one-half (47 percent). In contrast, women in the information-only group lost an average 1.6 percent of body weight (about 3 pounds) and had 28 percent fewer episodes.
'Clearly, weight loss can have a significant, positive impact on urinary incontinence, a finding that may help motivate weight loss, which has additional health benefits such as preventing type 2 diabetes,' said NIDDK Director Griffin P. Rodgers, M.D.

Urinary incontinence affects more than 13 million women in the United States and accounts for an estimated $20 billion in annual health care costs, according to the paper. Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence has been lacking. The PRIDE trial provides evidence supporting weight loss as a treatment for incontinence.

An important finding of the study is the difference between the two groups in the reduction of incontinence. Among women in the weight-loss group, 41 percent achieved a clinically relevant reduction of at least 70 percent of total incontinence episodes per week, whereas 22 percent of women in the information-only group achieved the same level of reduction.

At six months, women in the weight-loss group were significantly more satisfied with the change in their incontinence than were women in the information-only group. This was assessed through self-reported perceived change in frequency of incontinence, volume of urine loss, the degree to which incontinence was a problem, and satisfaction with the change in incontinence.

'Studies have documented that behavioral interventions help people lose weight, which helps decrease the risk of developing type 2 diabetes and high blood pressure, improve control of high blood pressure and cholesterol levels, and enhance mood and quality of life,' explained Leslee L. Subak, M.D., of the University of California, San Francisco (UCSF) and lead author of the study. 'Our results suggest that a decrease in urinary incontinence is another health benefit associated with weight loss and that weight reduction can be a first-line treatment in overweight and obese women.'

Results from previous studies suggest that a weight loss of 5% to 10% has an efficacy similar to that of other nonsurgical treatments and should be considered a first line therapy for incontinence.

Weight loss in PRIDE is comparable to that observed in the Diabetes Prevention Program (DPP) and in the ongoing Action for Health in Diabetes (Look AHEAD), two NIDDK-sponsored clinical trials in people with type 2 diabetes. The PRIDE intensive weight-loss program was modeled after these two trials.

In an interview, earlier today, the investigators noted that while the results of the study indicated that incontinence diminished in both groups, they believe that some of reduced incontinence in the 'information-only group' is based on adopting some of the additional techniques included in the educational materials.

Because weight loss and weight maintenance can be highly challenging for the individual patient, clinicians are encouraged to help their patients by identifing a number of appropriate local or online resources to which they can refer patients for additional support.

For more information:

• Subak LL, Wing R, Smith West D, et al. Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women. NEJM 360 (5):481-490, January 29, 2009.

Also read:

• Program to Reduce Incontinence by Diet and Exercise (PRIDE) click here and type NCT00091988 in the search window;
• Diabetes Prevention Program DPP and the Look AHEAD trials.
• Incontinence in women

Also read PubMed abstracts:

• Richter HE, Creasman JM, Myers DL, et al. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Dec;19(12):1653-1658. Epub 2008 Aug 5.
• Subak LL, Whitcomb E, Shen H, et al. Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005 Jul;174(1):190-5. Click here to contact the authors.
• Subak LL, Brubaker L, Chai TC, et al. High costs of urinary incontinence among women electing surgery to treat stress incontinence. Obstet Gynecol. 2008 Apr;111(4):899-907.