BB&T Contributing Editor
PHOENIX – The Obesity Society (Silver Spring, Maryland) drew about 2,100 attendees to its annual scientific meeting here in early October. The audience included researchers, nutritionists, clinicians, behavioral scientists and a range of physician specialties comprising endocrinology, internal medicine, psychology/psychiatry, pediatrics, bariatric surgery, and family practice. There were 965 oral and poster presentations, many of which focused on the chemistry of obesity and obesity-related health concerns, particularly diabetes, cardiovascular disease, sleep apnea and asthma.
Much blame for the global obesity crisis was placed on poor eating habits that result from the exploitive promotion of unhealthy foods, especially to children, and to a sedentary lifestyle. The consumption of liquid calories was identified as a significant contributor to the obesity epidemic. An estimated 30.3% of children ages 6 through 11 are overweight, and more than 15% are obese.
Researchers have identified many risk factors. If parents are overweight or obese, then their children are also prone to be overweight or obese. Genetics and common eating habits are both likely causes. Researchers have noted the poor food offerings at schools as a major reason for larger kids. They also have cited a decline in required physical education courses and the decreasing amount of activity and exercise as part of the school day.
Some research indicates that children who do not eat together at dinner time with their families are more likely to be overweight. Paying attention to what children eat seems to help with weight control.
The Centers for Disease Control and Prevention (Atlanta) estimates that one in four Americans is obese. Within the U.S., the prevalence for obesity is higher in the South (27.3%) and the Midwest (26.5%). The three states with the greatest percentages of obese people are Mississippi (32%), Alabama (30.3%) and Tennessee (30.1%).
Obesity/diabetes as a co-morbidity
A symposium was held under the heading "Emerging Science and Therapeutic Options in the Management of Obesity and Type 2 Diabetes." It included presentations followed by panel discussions. Robert Kushner, MD, professor of medicine at Northwestern University's Feinberg School of Medicine (Chicago) and president-elect of The Obesity Society, reviewed the integral relationship between obesity, diabetes and cardiometabolic risk. It was shown that obesity (measured as body mass index) is associated with increased risk for diabetes and other cardiovascular risk factors and that weight loss is an effective therapeutic strategy for pre-diabetes and diabetes (see Table 1 ).
Samuel Klein, MD, professor of medicine and nutritional science and medical director of the Weight Management Center at the Washington University School of Medicine (St. Louis), reviewed the physiological effects of weight loss on cardiometabolic risk. He presented data which showed that insulin sensitivity improves with weight loss in patients with Type 2 diabetes (see Table 2) and that the greater the weight loss, the better is the metabolic response.
Similarly, the greater the weight loss, the greater is the reduction in blood pressure. It was concluded that cardiometabolic abnormalities can be improved or normalized with energy deficit-induced weight loss (see Table 3 ).
According to the World Health Organization (Geneva, Switzerland), at least 171 million people worldwide suffer from diabetes, or 2.8% of the world's population. It is increasing rapidly with the greatest increase in the incidence of diabetes occurring in developing countries, following a trend in lifestyle changes, most notably a Western-style diet.
It is estimated that the U.S. will witness a 37% increase in obesity-related diabetes by the year 2030. Statistics are even more sobering in other parts of the world, with estimates of a 76% increase in diabetes in China and a 134% increase in India over the same period.
There are 24 million Americans with diabetes, or 8% of the U.S. population, an increase of 3 million in just two years. Also, there are 6.2 million undiagnosed people in the U.S. and 41 million people that are said to be pre-diabetic. The American Diabetes Association (Alexandria, Virginia), has estimated that medical expenditures for diabetes in 2007 were $116 billion.
Dr. Katie Suriano, an exercise physiologist reported on post-doctoral research on exercise for overweight and obese patients, conducted at the University of Western Australia (Perth). She reported that, paralleling the increasing prevalence of childhood obesity, there has been a significant increase in the incidence of Type 2 diabetes in children and adolescents in Australia. The conclusion from this study is that sedentary behavior is a risk factor for Type 2 diabetes, even in young children.
Asnawi Abdullah, a doctoral student at Monash University (Melbourne), reported on his study, which showed a correlation between the duration of obesity and the risk of Type 2 diabetes. With every five-year increase in the duration of obesity, the risk of diabetes increased by 15%. This finding led to the conclusion that the duration of obesity is an independent risk factor for Type 2 diabetes. This association is significant even after adjusting for a number of confounding factors, including BMI.
Bariatric surgery for morbidly obese
The rising of numbers of obese patients has been a boon for gastric bypass surgery, which accounts for 80% of bariatric surgeries in the U.S. and currently total about 140,000 procedures annually. Several investigators reported on studies demonstrated that need for increased activity and reduced sedentary activities as vital to weight loss along with a change in diet.
Dr. Dale Bond at the Weight Control and Diabetes Research Center in the Warren Alpert Medical School at Brown University (Providence, Rhode Island), reported that bariatric surgery is quickly becoming a standard treatment for severe obesity, given its substantial and sustained effects on body weight, co-morbidities and health-related quality of life. His prospective study showed that for patients undergoing Roux-En-Y gastric bypass surgery, their level of post-operative physical activity affected surgical efficacy with respect to their weight loss and quality of life.
Dr. Ted Adams of the Cardiovascular Genetics Division at the University of Utah School of Medicine (Salt Lake City) reported a significant reduction in total cancer mortality in patients following gastric bypass surgery, as compared with severely obese controls. These findings had been reported in the Aug. 23, 2007, issue of the New England Journal of Medicine and support the recommendation of reducing weight to lower cancer risk.
Dr. Ramon Durazo-Arvizu, associate professor in the department of epidemiology and preventive medicine at Loyola University Stritch School of Medicine (Maywood, Illinois), reviewed data from his study that showed mortality from chronic obstructive pulmonary disease (COPD) in patients with extreme BMI. COPD is the fourth-leading cause of death in the U.S.
Non-invasive and removable devices
G.I. Dynamics (Lexington, Massachusetts) has reported results from a randomized, multi-center clinical trial for its EndoBarrier gastrointestinal liner for treating obesity, Type 2 diabetes and related metabolic diseases. The EndoBarrier is an orally delivered, removable device that lines a portion of the small intestine. It is designed to deliver immediate metabolic control by modifying metabolic pathways.
Patients treated with the EndoBarrier device lost on average, triple the weight of their diet control group, and also resulted in lower blood glucose levels and/or a reduction in diabetic medication. In 12 weeks, the device group lost 30.2 pounds (13.7 kg) versus 9.7 pounds (4.4 kg) for the control group.
Tulip Medical (Tel Aviv, Israel) is developing a disposable medical device that is swallowed as a capsule and creates pressure or tension on the gastric wall which sends satiety signals to the brain, thereby reducing food consumption. The product is based on reports in the medical literature that the creation of tension in the stomach walls is picked up by stress sensors, which cause a feeling of satiety.
iWhisper (Palo Alto, California) is a lightweight and wearable personal weight loss device that monitors acoustic signals generated by users related to eating and drinking and, using a proprietary algorithm, processes them to determine how much and how fast users eat. It whispers short spoken and real-time feedback to help users change their eating habits and is based on clinically validated behavior modification principles of portion and satiation control.
The device connects via the Internet to the iWhisper Network, which tracks progress and enables its users to automatically communicate with their clinician or a real-world virtual coach in order to provide the social context needed for increased compliance and efficacy. iWhisper has been developed to the point of a wearable prototype that it is capable of detecting eating behavior and providing feedback in the lab. It can record data and provide real-voice feedback in the field.
Sentinel Group (Grand Rapids, Michigan) is developing the Full Sense device which is placed via endoscopy in the esophageal/cardiac region of the stomach. It induces satiety by influencing the neurohormonal feedback mechanism. It augments fullness caused by food and simulates fullness in the absence of food. The device is easily removable via endoscopy.
EndoSphere (Redwood City, California) is developing endoscopically implantable devices for weight-loss and for controlling Type 2 diabetes. The company has completed its feasibility trial of 11 patients, all of whom lost weight. Average procedure times for implantation and removal of the devices were 11 minutes and four minutes, respectively. This is an outpatient procedure. A clinical trial on 150 patients is planned.
Body composition analyzers
Bruker Optics (Ettlingen, Germany/Billerica, Massachusetts), a leading manufacturer of spectrometers, featured its TD-NMR spectrometers for determining body composition, such as lean/fat ratios on animals. Its Minispec contrast agent analyzer is used to study the effect of MRI contrast agents on the NMR relaxation of water or fat in vivo and in vitro.
Echo Medical Systems (Houston) markets the EchoMRI whole body composition analyzer for humans and animals that measure body fat, total body water and bone density by utilizing MRI and CT-based techniques.
Life Measurement (Concord, California) manufactures body composition assessment devices using air displacement plethysmography. Its BOD POD body composition tracking system measures percent fat and lean body mass in adults and children. The PEA POD makes the same assessment in infants.
Hologic (Bedford, Massachusetts) showcased its Discovery series of bone densitometers. Its OnePass makes bone density measurements of the hip and spine in 10 seconds. The performance of this test is supported by the FRAX study which assessed fracture probability in men and women in the UK and was published in Osteoporosis International in February.
Metabolic testing equipment
Cosmed (Rome/Chicago) is a marketer of cardiopulmonary diagnostic equipment. It featured its Quark RMR equipment, a metabolic cart for clinical nutrition, including indirect calorimetry (continuous VO2 and VCO2) and metabolism substrates (RQ, FAT, CHO and PRO). Its Fitmate desktop metabolic system is used to accurately measure resting energy expenditure.
Korr Medical Technologies (Salt Lake City) markets the CardioCoach VO2 metabolic analyzer. Its ReeVue indirect calorimeter measures in a 10 minute breath test the body's consumption of oxygen which is used calculate a patient's resting energy expenditure (REE) and for nutritional assessment. Research indicates that measuring REE pre-operatively can be an indicator of the success of bariatric surgery.
Microlife (Golden, Colorado) markets the MedGerm metabolism measurement handheld device that measures oxygen consumption to determine an individual's resting metabolic rate.
Sable Systems International (Las Vegas) featured its Superior Metabolic Intelligence instrumentation and software for providing precise metabolic measurement for preclinical or in vivo researchers. It is used to measure O2, CO2, water vapor, as well as for activity monitoring and temperature telemetry.
Zen-Bio (Research Triangle Park, North Carolina) is a provider of primary cell cultures and reagents for the study of human metabolic disease.