User login
GLP-1s for Obesity: Your Questions Answered
The arrival of GLP-1 receptor agonists has revolutionized treatment options for people with obesity and medical practice.
This news organization recently hosted a panel of experts across specialties — including endocrinology, gastroenterology, and obesity medicine — to discuss these potentially life-changing medications and to answer questions from the audience.
Because of the flood of queries from our audience, we asked our panelists to address some of the questions that didn’t make the recording. Their answers are below.
Beverly Tchang, MD, endocrinologist, Weill Cornell Medicine, New York City
Audience member: Can you initiate glucagon-like peptide-1 agonists (GLP-1 RAs) as a primary drug in a patient with obesity and newly diagnosed type 2 diabetes?
BT: We often prescribe GLP-1 RAs to individuals with type 2 diabetes as a first-line medication. Guidelines from the American Diabetes Association are really emphasizing a patient-centered approach, and metformin may not be the best first-line medication anymore.
Audience member:
BT: GLP-1 RAs do not need to be renally dosed, but I still recommend conferring with the patient’s nephrologist because the glomerular filtration rate might decrease in the setting of dehydration. Because GLP1s suppress the thirst, not just appetite, patients can go all day without drinking water and not feel thirsty.
Michael Camilleri, MD, gastroenterologist, Mayo Clinic, Rochester, Minnesota
Audience member: Should GLP-1 RAs be held for 1 week or 4 weeks prior to surgery to reduce the patient’s risk for aspiration? And is tapering required?
MC: For a patient taking liraglutide, I would hold the drug for 1 week prior to surgery. For patients taking other GLP-1 RAs, including extended exenatide, I advise holding for between 2 and 3 weeks before the procedure. It’s also important to make sure the patient’s diabetes is well-controlled with other medications — not GLP-1 RAs — during this period.
After surgery, you can restart GLP-1 RA therapy once there is recovery of oral food intake and normal bowel function.
Audience member: Is treatment with GLP-1 RAs appropriate for a patient with a family history of colon cancer but an otherwise unremarkable medical and family history?
MC: I have not seen a contraindication to receiving GLP-1 RAs based on a family history of colorectal cancer or other malignancies. An analysis of the French national healthcare insurance system database has suggested 1-3 years use of GLP-1 RAs (exenatide, liraglutide, and dulaglutide) may be linked with increased occurrence of thyroid cancer. Data from 37 randomized controlled trials and 19 real-world studies having 16,839 patients in placebo control group, 16,550 patients in active control group, and 13,330 patients in real-world studies were analyzed in a 2023 systematic review and meta-analysis. Compared to placebo or active control treatments, occurrence of pancreatic cancer, thyroid cancer, and all neoplasms — benign, malignant, and otherwise unspecified — were similar in the semaglutide group.
Toshi Iroku-Malize, MD, MPH, MBA, FAAFP, family physician, Zucker School of Medicine, Hempstead, New York
Audience member: What do you do about elevated liver functions after starting treatment with GLP-1 RAs, and what do you do when a patient has reached their weight loss goal?
TI-M: I recommend monitoring the liver function tests, evaluating for underlying causes, such as viral hepatitis, alcohol-related damage, or problems with other medications, and consulting a gastroenterologist or liver specialist if necessary. It’s also important to discuss the risk-benefit of continuing on the GP-1 RA for that particular patient.
Audience member: What effects will GLP-1 RAs have on sleep-disordered breathing/obstructive sleep apnea (OSA)? Are you aware of any ongoing trials addressing this subject?
TI-M: GLP-1 RAs may have beneficial effects on sleep-disordered breathing and OSA through weight loss, which can lead to a reduction in excess adipose tissue, and improvements in metabolic parameters. In terms of studies, a 2023 paper addressed this question, but more research is needed.
Audience member: Is it within a psychiatric provider’s scope of practice to prescribe GLP-1 agents for the reduction of weight gain associated with psychiatric medications?
TI-M: Obesity medicine is an interdisciplinary process. Numerous medications prescribed for mental health can contribute to obesity, and psychiatrists can play a role in collaborating with a patient’s primary care provider and/or obesity medicine specialist to determine which medications can be adjusted or replaced. It is important to remember that obesity management is not just about medications. It requires managing nutrition and activity in addition to behavioral health issues and social determinants of health. If the clinician has had the training to manage these pillars and is comfortable managing this chronic illness — similar to diabetes, hypertension, and other conditions — then this is a possibility. Otherwise, team-based care is appropriate.
Holly Lofton, MD, obesity medicine, NYU Langone Health, New York City
Audience member: Can we safely use them on patients who have had bariatric surgery and regularly develop dumping syndrome?
HL: These medications can be used after bariatric surgery in patients who meet the criteria for pharmacologic treatment. If a patient is having postoperative symptoms of dumping syndrome or excessive gastrointestinal losses from vomiting or diarrhea, dietary adjustments and other methods of managing the dumping syndrome in gastric bypass patients should be initiated before considering GLP-1 RAs because these patients do not have a functioning pylorus in their alimentary tract and these drugs are not indicated to treat dumping syndrome. The first-line approach typically involves reducing the patient’s intake of simple carbohydrates but can also include medications or surgical intervention when appropriate.
Audience member: Would teaching a patient to fast intermittently while they’re on GLP-1 RAs help them preserve weight loss if they choose to wean off the medication?
HL: Personally, I feel it is best to use the titration period and the time in which the patient is actively losing weight when on GLP-1 RAs. These are the best periods to help develop an individualized treatment plan, one that includes nutrition, activity, behavior modification, and resistance training. The patient’s lifestyle plan will likely change based on their environment and other factors. Intermittent fasting can be a part of such a plan. There is no consensus as to exactly which eating pattern will help patients maintain weight once they lose the physiologic benefit of the weight loss medications. However, studies have been published that demonstrate an average weight regain of 66% or greater when patients go from taking the maximum dose of a GLP-1 RA to taking none at all. Thus, patients should still be followed closely for weight regain when they discontinue a GLP-1 RA.
A version of this article appeared on Medscape.com.
The arrival of GLP-1 receptor agonists has revolutionized treatment options for people with obesity and medical practice.
This news organization recently hosted a panel of experts across specialties — including endocrinology, gastroenterology, and obesity medicine — to discuss these potentially life-changing medications and to answer questions from the audience.
Because of the flood of queries from our audience, we asked our panelists to address some of the questions that didn’t make the recording. Their answers are below.
Beverly Tchang, MD, endocrinologist, Weill Cornell Medicine, New York City
Audience member: Can you initiate glucagon-like peptide-1 agonists (GLP-1 RAs) as a primary drug in a patient with obesity and newly diagnosed type 2 diabetes?
BT: We often prescribe GLP-1 RAs to individuals with type 2 diabetes as a first-line medication. Guidelines from the American Diabetes Association are really emphasizing a patient-centered approach, and metformin may not be the best first-line medication anymore.
Audience member:
BT: GLP-1 RAs do not need to be renally dosed, but I still recommend conferring with the patient’s nephrologist because the glomerular filtration rate might decrease in the setting of dehydration. Because GLP1s suppress the thirst, not just appetite, patients can go all day without drinking water and not feel thirsty.
Michael Camilleri, MD, gastroenterologist, Mayo Clinic, Rochester, Minnesota
Audience member: Should GLP-1 RAs be held for 1 week or 4 weeks prior to surgery to reduce the patient’s risk for aspiration? And is tapering required?
MC: For a patient taking liraglutide, I would hold the drug for 1 week prior to surgery. For patients taking other GLP-1 RAs, including extended exenatide, I advise holding for between 2 and 3 weeks before the procedure. It’s also important to make sure the patient’s diabetes is well-controlled with other medications — not GLP-1 RAs — during this period.
After surgery, you can restart GLP-1 RA therapy once there is recovery of oral food intake and normal bowel function.
Audience member: Is treatment with GLP-1 RAs appropriate for a patient with a family history of colon cancer but an otherwise unremarkable medical and family history?
MC: I have not seen a contraindication to receiving GLP-1 RAs based on a family history of colorectal cancer or other malignancies. An analysis of the French national healthcare insurance system database has suggested 1-3 years use of GLP-1 RAs (exenatide, liraglutide, and dulaglutide) may be linked with increased occurrence of thyroid cancer. Data from 37 randomized controlled trials and 19 real-world studies having 16,839 patients in placebo control group, 16,550 patients in active control group, and 13,330 patients in real-world studies were analyzed in a 2023 systematic review and meta-analysis. Compared to placebo or active control treatments, occurrence of pancreatic cancer, thyroid cancer, and all neoplasms — benign, malignant, and otherwise unspecified — were similar in the semaglutide group.
Toshi Iroku-Malize, MD, MPH, MBA, FAAFP, family physician, Zucker School of Medicine, Hempstead, New York
Audience member: What do you do about elevated liver functions after starting treatment with GLP-1 RAs, and what do you do when a patient has reached their weight loss goal?
TI-M: I recommend monitoring the liver function tests, evaluating for underlying causes, such as viral hepatitis, alcohol-related damage, or problems with other medications, and consulting a gastroenterologist or liver specialist if necessary. It’s also important to discuss the risk-benefit of continuing on the GP-1 RA for that particular patient.
Audience member: What effects will GLP-1 RAs have on sleep-disordered breathing/obstructive sleep apnea (OSA)? Are you aware of any ongoing trials addressing this subject?
TI-M: GLP-1 RAs may have beneficial effects on sleep-disordered breathing and OSA through weight loss, which can lead to a reduction in excess adipose tissue, and improvements in metabolic parameters. In terms of studies, a 2023 paper addressed this question, but more research is needed.
Audience member: Is it within a psychiatric provider’s scope of practice to prescribe GLP-1 agents for the reduction of weight gain associated with psychiatric medications?
TI-M: Obesity medicine is an interdisciplinary process. Numerous medications prescribed for mental health can contribute to obesity, and psychiatrists can play a role in collaborating with a patient’s primary care provider and/or obesity medicine specialist to determine which medications can be adjusted or replaced. It is important to remember that obesity management is not just about medications. It requires managing nutrition and activity in addition to behavioral health issues and social determinants of health. If the clinician has had the training to manage these pillars and is comfortable managing this chronic illness — similar to diabetes, hypertension, and other conditions — then this is a possibility. Otherwise, team-based care is appropriate.
Holly Lofton, MD, obesity medicine, NYU Langone Health, New York City
Audience member: Can we safely use them on patients who have had bariatric surgery and regularly develop dumping syndrome?
HL: These medications can be used after bariatric surgery in patients who meet the criteria for pharmacologic treatment. If a patient is having postoperative symptoms of dumping syndrome or excessive gastrointestinal losses from vomiting or diarrhea, dietary adjustments and other methods of managing the dumping syndrome in gastric bypass patients should be initiated before considering GLP-1 RAs because these patients do not have a functioning pylorus in their alimentary tract and these drugs are not indicated to treat dumping syndrome. The first-line approach typically involves reducing the patient’s intake of simple carbohydrates but can also include medications or surgical intervention when appropriate.
Audience member: Would teaching a patient to fast intermittently while they’re on GLP-1 RAs help them preserve weight loss if they choose to wean off the medication?
HL: Personally, I feel it is best to use the titration period and the time in which the patient is actively losing weight when on GLP-1 RAs. These are the best periods to help develop an individualized treatment plan, one that includes nutrition, activity, behavior modification, and resistance training. The patient’s lifestyle plan will likely change based on their environment and other factors. Intermittent fasting can be a part of such a plan. There is no consensus as to exactly which eating pattern will help patients maintain weight once they lose the physiologic benefit of the weight loss medications. However, studies have been published that demonstrate an average weight regain of 66% or greater when patients go from taking the maximum dose of a GLP-1 RA to taking none at all. Thus, patients should still be followed closely for weight regain when they discontinue a GLP-1 RA.
A version of this article appeared on Medscape.com.
The arrival of GLP-1 receptor agonists has revolutionized treatment options for people with obesity and medical practice.
This news organization recently hosted a panel of experts across specialties — including endocrinology, gastroenterology, and obesity medicine — to discuss these potentially life-changing medications and to answer questions from the audience.
Because of the flood of queries from our audience, we asked our panelists to address some of the questions that didn’t make the recording. Their answers are below.
Beverly Tchang, MD, endocrinologist, Weill Cornell Medicine, New York City
Audience member: Can you initiate glucagon-like peptide-1 agonists (GLP-1 RAs) as a primary drug in a patient with obesity and newly diagnosed type 2 diabetes?
BT: We often prescribe GLP-1 RAs to individuals with type 2 diabetes as a first-line medication. Guidelines from the American Diabetes Association are really emphasizing a patient-centered approach, and metformin may not be the best first-line medication anymore.
Audience member:
BT: GLP-1 RAs do not need to be renally dosed, but I still recommend conferring with the patient’s nephrologist because the glomerular filtration rate might decrease in the setting of dehydration. Because GLP1s suppress the thirst, not just appetite, patients can go all day without drinking water and not feel thirsty.
Michael Camilleri, MD, gastroenterologist, Mayo Clinic, Rochester, Minnesota
Audience member: Should GLP-1 RAs be held for 1 week or 4 weeks prior to surgery to reduce the patient’s risk for aspiration? And is tapering required?
MC: For a patient taking liraglutide, I would hold the drug for 1 week prior to surgery. For patients taking other GLP-1 RAs, including extended exenatide, I advise holding for between 2 and 3 weeks before the procedure. It’s also important to make sure the patient’s diabetes is well-controlled with other medications — not GLP-1 RAs — during this period.
After surgery, you can restart GLP-1 RA therapy once there is recovery of oral food intake and normal bowel function.
Audience member: Is treatment with GLP-1 RAs appropriate for a patient with a family history of colon cancer but an otherwise unremarkable medical and family history?
MC: I have not seen a contraindication to receiving GLP-1 RAs based on a family history of colorectal cancer or other malignancies. An analysis of the French national healthcare insurance system database has suggested 1-3 years use of GLP-1 RAs (exenatide, liraglutide, and dulaglutide) may be linked with increased occurrence of thyroid cancer. Data from 37 randomized controlled trials and 19 real-world studies having 16,839 patients in placebo control group, 16,550 patients in active control group, and 13,330 patients in real-world studies were analyzed in a 2023 systematic review and meta-analysis. Compared to placebo or active control treatments, occurrence of pancreatic cancer, thyroid cancer, and all neoplasms — benign, malignant, and otherwise unspecified — were similar in the semaglutide group.
Toshi Iroku-Malize, MD, MPH, MBA, FAAFP, family physician, Zucker School of Medicine, Hempstead, New York
Audience member: What do you do about elevated liver functions after starting treatment with GLP-1 RAs, and what do you do when a patient has reached their weight loss goal?
TI-M: I recommend monitoring the liver function tests, evaluating for underlying causes, such as viral hepatitis, alcohol-related damage, or problems with other medications, and consulting a gastroenterologist or liver specialist if necessary. It’s also important to discuss the risk-benefit of continuing on the GP-1 RA for that particular patient.
Audience member: What effects will GLP-1 RAs have on sleep-disordered breathing/obstructive sleep apnea (OSA)? Are you aware of any ongoing trials addressing this subject?
TI-M: GLP-1 RAs may have beneficial effects on sleep-disordered breathing and OSA through weight loss, which can lead to a reduction in excess adipose tissue, and improvements in metabolic parameters. In terms of studies, a 2023 paper addressed this question, but more research is needed.
Audience member: Is it within a psychiatric provider’s scope of practice to prescribe GLP-1 agents for the reduction of weight gain associated with psychiatric medications?
TI-M: Obesity medicine is an interdisciplinary process. Numerous medications prescribed for mental health can contribute to obesity, and psychiatrists can play a role in collaborating with a patient’s primary care provider and/or obesity medicine specialist to determine which medications can be adjusted or replaced. It is important to remember that obesity management is not just about medications. It requires managing nutrition and activity in addition to behavioral health issues and social determinants of health. If the clinician has had the training to manage these pillars and is comfortable managing this chronic illness — similar to diabetes, hypertension, and other conditions — then this is a possibility. Otherwise, team-based care is appropriate.
Holly Lofton, MD, obesity medicine, NYU Langone Health, New York City
Audience member: Can we safely use them on patients who have had bariatric surgery and regularly develop dumping syndrome?
HL: These medications can be used after bariatric surgery in patients who meet the criteria for pharmacologic treatment. If a patient is having postoperative symptoms of dumping syndrome or excessive gastrointestinal losses from vomiting or diarrhea, dietary adjustments and other methods of managing the dumping syndrome in gastric bypass patients should be initiated before considering GLP-1 RAs because these patients do not have a functioning pylorus in their alimentary tract and these drugs are not indicated to treat dumping syndrome. The first-line approach typically involves reducing the patient’s intake of simple carbohydrates but can also include medications or surgical intervention when appropriate.
Audience member: Would teaching a patient to fast intermittently while they’re on GLP-1 RAs help them preserve weight loss if they choose to wean off the medication?
HL: Personally, I feel it is best to use the titration period and the time in which the patient is actively losing weight when on GLP-1 RAs. These are the best periods to help develop an individualized treatment plan, one that includes nutrition, activity, behavior modification, and resistance training. The patient’s lifestyle plan will likely change based on their environment and other factors. Intermittent fasting can be a part of such a plan. There is no consensus as to exactly which eating pattern will help patients maintain weight once they lose the physiologic benefit of the weight loss medications. However, studies have been published that demonstrate an average weight regain of 66% or greater when patients go from taking the maximum dose of a GLP-1 RA to taking none at all. Thus, patients should still be followed closely for weight regain when they discontinue a GLP-1 RA.
A version of this article appeared on Medscape.com.
Weight Loss Surgery Yields Long-Term BP Control in Obesity
For adults with obesity and uncontrolled hypertension, bariatric surgery is an effective and durable strategy to control high blood pressure (BP), final, 5-year follow-up data from the GATEWAY trial suggested.
In the trial, those who underwent bariatric surgery had lower body mass index (BMI) and were on fewer antihypertensive medications after 5 years while maintaining normal BP than those who only used antihypertensive medications.
The results show that “bariatric and metabolic surgery can be very effective in the treatment of patients with obesity and hypertension in the long term,” chief investigator Carlos Aurelio Schiavon, MD, with the Research Institute, Heart Hospital, São Paulo, Brazil, told this news organization.
“The most important clinical implication of this trial is that we must treat obesity to accomplish success when treating patients with cardiovascular diseases, such as hypertension and obesity,” Dr. Schiavon said.
The study was published online on February 5, 2024, in the Journal of the American College of Cardiology.
A Gateway to Lasting BP Control
GATEWAY enrolled 100 adults (76% women) with grade 1/2 obesity (BMI, 30 to < 40 kg/m2; mean, 37 kg/m2) who were on at least two antihypertensive medications at maximum doses at baseline.
Half were randomly allocated to laparoscopic Roux-en-Y gastric-bypass surgery (RYGB) plus medications and half to medication alone. The primary outcome was at least a 30% reduction of antihypertensive medications while maintaining BP < 140/90 mm Hg. Five-year results were based on 37 patients in the surgery group and 32 in the medication only group.
After 5 years, BMI was 28.01 kg/m2 for those who had surgery vs 36.40 kg/m2 for those on medication alone (P < .001).
Patients who underwent RYGB had an 80.7% reduction in the number of antihypertensive medications they were taking while maintaining BP < 140/90 mm Hg compared with a 13.7% reduction in those on medication alone.
After 5 years, surgery patients were taking a mean of 0.80 antihypertensive medications vs 2.97 in the medication only group to control BP at or below the target.
Despite using less antihypertensive medications in the RYGB, ambulatory BP monitoring data revealed similar 24-hour, daytime, and nighttime BP profiles compared with medication alone.
The rate of hypertension remission (controlled BP without medication) was nearly 20-fold higher in the surgery group than in the medication only group (46.9% vs 2.4%; P < .001).
In addition, the rate of apparent resistant hypertension was lower with than without surgery (0% vs 15.2%). The surgery group also showed evidence of less atrial remodeling.
The 5-year results were consistent with the 1-year GATEWAY results Dr. Schiavon presented at the American Heart Association 2017 scientific sessions, as reported by this news organization. They also mirrored the results reported at 3 years.
Limitations of the study include its single-center, open-label design with a small sample size and loss of follow-up in some patients.
“Taken together, these results support the long-term effective role of bariatric surgery in reducing the burden of hypertension and related polypharmacy, which is frequently observed in patients with obesity and is a cause of concern for them,” the authors wrote.
“In clinical practice, obesity is an overlooked condition. As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension. Our results underscore the importance of approaching obesity in reducing hypertension rates,” they added.
Important Data, Lingering Questions
The coauthors of an accompanying editorial said this study provides “important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.”
Yet, Michael Hall, MD, MSc, with University of Mississippi Medical Center in Jackson, and coauthors noted that the study only included patients undergoing RYGB; it remains unclear if other bariatric surgery procedures would have the same long-term results.
“Sleeve gastrectomy has become more common than RYGB because it is less complex and has earlier recovery and similar effectiveness for treating obesity and type 2 diabetes,” they pointed out. “Further comparative randomized controlled trials are needed to determine whether sleeve gastrectomy is as effective as RYGB for long-term BP control.”
As reported previously by this news organization, in SLEEVEPASS, there was greater weight loss and higher likelihood of hypertension remission with RYGB than with sleeve gastrectomy (24% vs 8%; P = .04), although BP control was not the primary outcome.
The GATEWAY study was supported by a grant from Ethicon. Dr. Schiavon received a research grant from Ethicon and has received lecture fees from Ethicon and Medtronic. The editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
For adults with obesity and uncontrolled hypertension, bariatric surgery is an effective and durable strategy to control high blood pressure (BP), final, 5-year follow-up data from the GATEWAY trial suggested.
In the trial, those who underwent bariatric surgery had lower body mass index (BMI) and were on fewer antihypertensive medications after 5 years while maintaining normal BP than those who only used antihypertensive medications.
The results show that “bariatric and metabolic surgery can be very effective in the treatment of patients with obesity and hypertension in the long term,” chief investigator Carlos Aurelio Schiavon, MD, with the Research Institute, Heart Hospital, São Paulo, Brazil, told this news organization.
“The most important clinical implication of this trial is that we must treat obesity to accomplish success when treating patients with cardiovascular diseases, such as hypertension and obesity,” Dr. Schiavon said.
The study was published online on February 5, 2024, in the Journal of the American College of Cardiology.
A Gateway to Lasting BP Control
GATEWAY enrolled 100 adults (76% women) with grade 1/2 obesity (BMI, 30 to < 40 kg/m2; mean, 37 kg/m2) who were on at least two antihypertensive medications at maximum doses at baseline.
Half were randomly allocated to laparoscopic Roux-en-Y gastric-bypass surgery (RYGB) plus medications and half to medication alone. The primary outcome was at least a 30% reduction of antihypertensive medications while maintaining BP < 140/90 mm Hg. Five-year results were based on 37 patients in the surgery group and 32 in the medication only group.
After 5 years, BMI was 28.01 kg/m2 for those who had surgery vs 36.40 kg/m2 for those on medication alone (P < .001).
Patients who underwent RYGB had an 80.7% reduction in the number of antihypertensive medications they were taking while maintaining BP < 140/90 mm Hg compared with a 13.7% reduction in those on medication alone.
After 5 years, surgery patients were taking a mean of 0.80 antihypertensive medications vs 2.97 in the medication only group to control BP at or below the target.
Despite using less antihypertensive medications in the RYGB, ambulatory BP monitoring data revealed similar 24-hour, daytime, and nighttime BP profiles compared with medication alone.
The rate of hypertension remission (controlled BP without medication) was nearly 20-fold higher in the surgery group than in the medication only group (46.9% vs 2.4%; P < .001).
In addition, the rate of apparent resistant hypertension was lower with than without surgery (0% vs 15.2%). The surgery group also showed evidence of less atrial remodeling.
The 5-year results were consistent with the 1-year GATEWAY results Dr. Schiavon presented at the American Heart Association 2017 scientific sessions, as reported by this news organization. They also mirrored the results reported at 3 years.
Limitations of the study include its single-center, open-label design with a small sample size and loss of follow-up in some patients.
“Taken together, these results support the long-term effective role of bariatric surgery in reducing the burden of hypertension and related polypharmacy, which is frequently observed in patients with obesity and is a cause of concern for them,” the authors wrote.
“In clinical practice, obesity is an overlooked condition. As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension. Our results underscore the importance of approaching obesity in reducing hypertension rates,” they added.
Important Data, Lingering Questions
The coauthors of an accompanying editorial said this study provides “important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.”
Yet, Michael Hall, MD, MSc, with University of Mississippi Medical Center in Jackson, and coauthors noted that the study only included patients undergoing RYGB; it remains unclear if other bariatric surgery procedures would have the same long-term results.
“Sleeve gastrectomy has become more common than RYGB because it is less complex and has earlier recovery and similar effectiveness for treating obesity and type 2 diabetes,” they pointed out. “Further comparative randomized controlled trials are needed to determine whether sleeve gastrectomy is as effective as RYGB for long-term BP control.”
As reported previously by this news organization, in SLEEVEPASS, there was greater weight loss and higher likelihood of hypertension remission with RYGB than with sleeve gastrectomy (24% vs 8%; P = .04), although BP control was not the primary outcome.
The GATEWAY study was supported by a grant from Ethicon. Dr. Schiavon received a research grant from Ethicon and has received lecture fees from Ethicon and Medtronic. The editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
For adults with obesity and uncontrolled hypertension, bariatric surgery is an effective and durable strategy to control high blood pressure (BP), final, 5-year follow-up data from the GATEWAY trial suggested.
In the trial, those who underwent bariatric surgery had lower body mass index (BMI) and were on fewer antihypertensive medications after 5 years while maintaining normal BP than those who only used antihypertensive medications.
The results show that “bariatric and metabolic surgery can be very effective in the treatment of patients with obesity and hypertension in the long term,” chief investigator Carlos Aurelio Schiavon, MD, with the Research Institute, Heart Hospital, São Paulo, Brazil, told this news organization.
“The most important clinical implication of this trial is that we must treat obesity to accomplish success when treating patients with cardiovascular diseases, such as hypertension and obesity,” Dr. Schiavon said.
The study was published online on February 5, 2024, in the Journal of the American College of Cardiology.
A Gateway to Lasting BP Control
GATEWAY enrolled 100 adults (76% women) with grade 1/2 obesity (BMI, 30 to < 40 kg/m2; mean, 37 kg/m2) who were on at least two antihypertensive medications at maximum doses at baseline.
Half were randomly allocated to laparoscopic Roux-en-Y gastric-bypass surgery (RYGB) plus medications and half to medication alone. The primary outcome was at least a 30% reduction of antihypertensive medications while maintaining BP < 140/90 mm Hg. Five-year results were based on 37 patients in the surgery group and 32 in the medication only group.
After 5 years, BMI was 28.01 kg/m2 for those who had surgery vs 36.40 kg/m2 for those on medication alone (P < .001).
Patients who underwent RYGB had an 80.7% reduction in the number of antihypertensive medications they were taking while maintaining BP < 140/90 mm Hg compared with a 13.7% reduction in those on medication alone.
After 5 years, surgery patients were taking a mean of 0.80 antihypertensive medications vs 2.97 in the medication only group to control BP at or below the target.
Despite using less antihypertensive medications in the RYGB, ambulatory BP monitoring data revealed similar 24-hour, daytime, and nighttime BP profiles compared with medication alone.
The rate of hypertension remission (controlled BP without medication) was nearly 20-fold higher in the surgery group than in the medication only group (46.9% vs 2.4%; P < .001).
In addition, the rate of apparent resistant hypertension was lower with than without surgery (0% vs 15.2%). The surgery group also showed evidence of less atrial remodeling.
The 5-year results were consistent with the 1-year GATEWAY results Dr. Schiavon presented at the American Heart Association 2017 scientific sessions, as reported by this news organization. They also mirrored the results reported at 3 years.
Limitations of the study include its single-center, open-label design with a small sample size and loss of follow-up in some patients.
“Taken together, these results support the long-term effective role of bariatric surgery in reducing the burden of hypertension and related polypharmacy, which is frequently observed in patients with obesity and is a cause of concern for them,” the authors wrote.
“In clinical practice, obesity is an overlooked condition. As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension. Our results underscore the importance of approaching obesity in reducing hypertension rates,” they added.
Important Data, Lingering Questions
The coauthors of an accompanying editorial said this study provides “important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.”
Yet, Michael Hall, MD, MSc, with University of Mississippi Medical Center in Jackson, and coauthors noted that the study only included patients undergoing RYGB; it remains unclear if other bariatric surgery procedures would have the same long-term results.
“Sleeve gastrectomy has become more common than RYGB because it is less complex and has earlier recovery and similar effectiveness for treating obesity and type 2 diabetes,” they pointed out. “Further comparative randomized controlled trials are needed to determine whether sleeve gastrectomy is as effective as RYGB for long-term BP control.”
As reported previously by this news organization, in SLEEVEPASS, there was greater weight loss and higher likelihood of hypertension remission with RYGB than with sleeve gastrectomy (24% vs 8%; P = .04), although BP control was not the primary outcome.
The GATEWAY study was supported by a grant from Ethicon. Dr. Schiavon received a research grant from Ethicon and has received lecture fees from Ethicon and Medtronic. The editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
FROM JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
‘It’s Time’ to Empower Care for Patients With Obesity
A few weeks ago, I made a patient who lost 100 pounds following a sleeve gastrectomy 9 months prior feel bad because I told her she lost too much weight. As I spoke to her, I realized that she found it hard to make life changes and that the surgery was a huge aide in changing her life and her lifestyle. I ended up apologizing for initially saying she lost too much weight.
For the first time in her life, she was successful in losing weight and keeping it off. The surgery allowed her body to defend a lower body weight by altering the secretion of gut hormones that lead to satiety in the brain. It’s not her fault that her body responded so well!
I asked her to be on my next orientation virtual meeting with prospective weight management patients to urge those with a body mass index (BMI) > 40 to consider bariatric surgery as the most effective durable and safe treatment for their degree of obesity.
Metabolic bariatric surgery, primarily sleeve gastrectomy and Roux-en-Y gastric bypass , alters the gut hormone milieu such that the body defends a lower mass of adipose tissue and a lower weight. We have learned what it takes to alter body weight defense to a healthy lower weight by studying why metabolic bariatric surgery works so well. It turns out that there are several hormones secreted by the gut that allow the brain to register fullness.
One of these gut hormones, glucagon-like peptide (GLP)-1, has been researched as an analog to help reduce body weight by 16% and has also been shown to reduce cardiovascular risk in the SELECT trial, as published in The New England Journal of Medicine (NEJM).
It’s the first weight loss medication to be shown in a cardiovascular outcomes trial to be superior to placebo in reduction of major cardiovascular events, including cardiovascular deaths, nonfatal myocardial infarction, and nonfatal stroke. The results presented at the 2023 American Heart Association meetings in Philadelphia ended in wholehearted applause by a “standing only” audience even before the presentation’s conclusion.
As we pave the way for nutrient-stimulated hormone (NuSH) therapies to be prescribed to all Americans with a BMI > 30 to improve health, we need to remember what these medications actually do. We used to think that metabolic bariatric surgery worked by restricting the stomach contents and malabsorbing nutrients. We now know that the surgeries work by altering NuSH secretion, allowing for less secretion of the hunger hormone ghrelin and more secretion of GLP-1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY (PYY), cholecystokinin (CCK), oxyntomodulin (OXM), and other satiety hormones with less food ingestion.
They have pleiotropic effects on many organ systems in the body, including the brain, heart, adipose tissue, and liver. They decrease inflammation and also increase satiety and delay gastric emptying. None of these effects automatically produce weight loss, but they certainly aid in the adoption of a healthier body weight and better health. The weight loss occurs because these medications steer the body toward behavioral changes that promote weight loss.
As we delve into the SELECT trial results, a 20% reduction in major cardiovascular events was accompanied by an average weight loss of 9.6%, without a behavioral component added to either the placebo or intervention arms, as is usual in antiobesity agent trials.
Does this mean that primary care providers (PCPs) don’t have to educate patients on behavior change, diet, and exercise therapy? Well, if we consider obesity a disease as we do type 2 diabetes and dyslipidemia or hypertension, then no — PCPs don’t have to, just like they don’t in treating these other diseases.
However, we should rethink this practice. The recently published SURMOUNT-3 trial looked at another NuSH, tirzepatide, with intensive behavioral therapy; it resulted in a 26.6% weight loss, which is comparable to results with bariatric surgery. The SURMOUNT-1 trial of tirzepatide with nonintensive behavioral therapy resulted in a 20.9% weight loss, which is still substantial, but SURMOUNT-3 showed how much more is achievable with robust behavior-change therapy.
In other words, it’s time that PCPs provide education on behavior change to maximize the power of the medications prescribed in practice for the most common diseases suffered in the United States: obesity, type 2 diabetes, cardiovascular disease, and hypertension. These are all chronic, relapsing diseases. Medication alone will improve numbers (weight, blood glucose, A1c, and blood pressure), but a relapsing disease continues relentlessly as patients age to overcome the medications prescribed.
Today I made another patient feel bad because she lost over 100 pounds on semaglutide (Wegovy) 2.4 mg over 1 year, reducing her BMI from 57 to 36. She wanted to keep losing, so I recommended sleeve gastrectomy to lose more weight. I told her she could always restart the Wegovy after the procedure if needed.
We really don’t have an answer to this issue of NuSH therapy not getting to goal and bariatric surgery following medication therapy. The reality is that bariatric surgery should be considered a safe, effective treatment for extreme obesity somewhere along the trajectory of treatments starting with behavior (diet, exercise) and medications. It is still considered a last resort, and for some, just too aggressive.
We have learned much about the incretin hormones and what they can accomplish for obesity from studying bariatric — now called metabolic — surgery. Surgery should be seen as we see stent placement for angina, only more effective for longevity. The COURAGE trial, published in 2007 in NEJM, showed that when compared with medication treatment alone for angina, stent placement plus medications resulted in no difference in mortality after a 7-year follow-up period. Compare this to bariatric surgery, which in many retrospective analyses shows a 20% reduction in cardiovascular mortality after 20-year follow-up (Swedish Obesity Study). In the United States, there are 2 million stent procedures performed per year vs 250,000 bariatric surgical procedures. There are millions of Americans with a BMI > 40 and, yes, millions of Americans with angina. I think I make my point that we need to do more bariatric surgeries to effectively treat extreme obesity.
The solution to this negligent medical practice in obesity treatment is to empower PCPs to treat obesity (at least uncomplicated obesity) and refer to obesity medicine practices for complicated obesity with multiple complications, such as type 2 diabetes and cardiovascular disease, and to refer to obesity medicine practices with a surgical component for BMIs > 40 or > 35 with type 2 diabetes, sleep apnea, and/or cardiovascular disease or other serious conditions.
How do we empower PCPs? Insurance coverage of NuSH therapies due to life-saving properties — as evidenced by the SELECT trial — without prior authorizations; and education on how and why metabolic surgery works, as well as education on behavioral approaches, such as healthy diet and exercise, as a core therapy for all BMI categories.
It’s time.
Caroline Apovian, MD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, adviser, consultant, or trustee for Altimmune; Cowen and Company; Currax Pharmaceuticals; EPG Communication Holdings; Gelesis, Srl; L-Nutra; and NeuroBo Pharmaceuticals. Received research grant from: National Institutes of Health; Patient-Centered Outcomes Research Institute; and GI Dynamics. Received income in an amount equal to or greater than $250 from: Altimmune; Cowen and Company; NeuroBo Pharmaceuticals; and Novo Nordisk.
A version of this article appeared on Medscape.com.
A few weeks ago, I made a patient who lost 100 pounds following a sleeve gastrectomy 9 months prior feel bad because I told her she lost too much weight. As I spoke to her, I realized that she found it hard to make life changes and that the surgery was a huge aide in changing her life and her lifestyle. I ended up apologizing for initially saying she lost too much weight.
For the first time in her life, she was successful in losing weight and keeping it off. The surgery allowed her body to defend a lower body weight by altering the secretion of gut hormones that lead to satiety in the brain. It’s not her fault that her body responded so well!
I asked her to be on my next orientation virtual meeting with prospective weight management patients to urge those with a body mass index (BMI) > 40 to consider bariatric surgery as the most effective durable and safe treatment for their degree of obesity.
Metabolic bariatric surgery, primarily sleeve gastrectomy and Roux-en-Y gastric bypass , alters the gut hormone milieu such that the body defends a lower mass of adipose tissue and a lower weight. We have learned what it takes to alter body weight defense to a healthy lower weight by studying why metabolic bariatric surgery works so well. It turns out that there are several hormones secreted by the gut that allow the brain to register fullness.
One of these gut hormones, glucagon-like peptide (GLP)-1, has been researched as an analog to help reduce body weight by 16% and has also been shown to reduce cardiovascular risk in the SELECT trial, as published in The New England Journal of Medicine (NEJM).
It’s the first weight loss medication to be shown in a cardiovascular outcomes trial to be superior to placebo in reduction of major cardiovascular events, including cardiovascular deaths, nonfatal myocardial infarction, and nonfatal stroke. The results presented at the 2023 American Heart Association meetings in Philadelphia ended in wholehearted applause by a “standing only” audience even before the presentation’s conclusion.
As we pave the way for nutrient-stimulated hormone (NuSH) therapies to be prescribed to all Americans with a BMI > 30 to improve health, we need to remember what these medications actually do. We used to think that metabolic bariatric surgery worked by restricting the stomach contents and malabsorbing nutrients. We now know that the surgeries work by altering NuSH secretion, allowing for less secretion of the hunger hormone ghrelin and more secretion of GLP-1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY (PYY), cholecystokinin (CCK), oxyntomodulin (OXM), and other satiety hormones with less food ingestion.
They have pleiotropic effects on many organ systems in the body, including the brain, heart, adipose tissue, and liver. They decrease inflammation and also increase satiety and delay gastric emptying. None of these effects automatically produce weight loss, but they certainly aid in the adoption of a healthier body weight and better health. The weight loss occurs because these medications steer the body toward behavioral changes that promote weight loss.
As we delve into the SELECT trial results, a 20% reduction in major cardiovascular events was accompanied by an average weight loss of 9.6%, without a behavioral component added to either the placebo or intervention arms, as is usual in antiobesity agent trials.
Does this mean that primary care providers (PCPs) don’t have to educate patients on behavior change, diet, and exercise therapy? Well, if we consider obesity a disease as we do type 2 diabetes and dyslipidemia or hypertension, then no — PCPs don’t have to, just like they don’t in treating these other diseases.
However, we should rethink this practice. The recently published SURMOUNT-3 trial looked at another NuSH, tirzepatide, with intensive behavioral therapy; it resulted in a 26.6% weight loss, which is comparable to results with bariatric surgery. The SURMOUNT-1 trial of tirzepatide with nonintensive behavioral therapy resulted in a 20.9% weight loss, which is still substantial, but SURMOUNT-3 showed how much more is achievable with robust behavior-change therapy.
In other words, it’s time that PCPs provide education on behavior change to maximize the power of the medications prescribed in practice for the most common diseases suffered in the United States: obesity, type 2 diabetes, cardiovascular disease, and hypertension. These are all chronic, relapsing diseases. Medication alone will improve numbers (weight, blood glucose, A1c, and blood pressure), but a relapsing disease continues relentlessly as patients age to overcome the medications prescribed.
Today I made another patient feel bad because she lost over 100 pounds on semaglutide (Wegovy) 2.4 mg over 1 year, reducing her BMI from 57 to 36. She wanted to keep losing, so I recommended sleeve gastrectomy to lose more weight. I told her she could always restart the Wegovy after the procedure if needed.
We really don’t have an answer to this issue of NuSH therapy not getting to goal and bariatric surgery following medication therapy. The reality is that bariatric surgery should be considered a safe, effective treatment for extreme obesity somewhere along the trajectory of treatments starting with behavior (diet, exercise) and medications. It is still considered a last resort, and for some, just too aggressive.
We have learned much about the incretin hormones and what they can accomplish for obesity from studying bariatric — now called metabolic — surgery. Surgery should be seen as we see stent placement for angina, only more effective for longevity. The COURAGE trial, published in 2007 in NEJM, showed that when compared with medication treatment alone for angina, stent placement plus medications resulted in no difference in mortality after a 7-year follow-up period. Compare this to bariatric surgery, which in many retrospective analyses shows a 20% reduction in cardiovascular mortality after 20-year follow-up (Swedish Obesity Study). In the United States, there are 2 million stent procedures performed per year vs 250,000 bariatric surgical procedures. There are millions of Americans with a BMI > 40 and, yes, millions of Americans with angina. I think I make my point that we need to do more bariatric surgeries to effectively treat extreme obesity.
The solution to this negligent medical practice in obesity treatment is to empower PCPs to treat obesity (at least uncomplicated obesity) and refer to obesity medicine practices for complicated obesity with multiple complications, such as type 2 diabetes and cardiovascular disease, and to refer to obesity medicine practices with a surgical component for BMIs > 40 or > 35 with type 2 diabetes, sleep apnea, and/or cardiovascular disease or other serious conditions.
How do we empower PCPs? Insurance coverage of NuSH therapies due to life-saving properties — as evidenced by the SELECT trial — without prior authorizations; and education on how and why metabolic surgery works, as well as education on behavioral approaches, such as healthy diet and exercise, as a core therapy for all BMI categories.
It’s time.
Caroline Apovian, MD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, adviser, consultant, or trustee for Altimmune; Cowen and Company; Currax Pharmaceuticals; EPG Communication Holdings; Gelesis, Srl; L-Nutra; and NeuroBo Pharmaceuticals. Received research grant from: National Institutes of Health; Patient-Centered Outcomes Research Institute; and GI Dynamics. Received income in an amount equal to or greater than $250 from: Altimmune; Cowen and Company; NeuroBo Pharmaceuticals; and Novo Nordisk.
A version of this article appeared on Medscape.com.
A few weeks ago, I made a patient who lost 100 pounds following a sleeve gastrectomy 9 months prior feel bad because I told her she lost too much weight. As I spoke to her, I realized that she found it hard to make life changes and that the surgery was a huge aide in changing her life and her lifestyle. I ended up apologizing for initially saying she lost too much weight.
For the first time in her life, she was successful in losing weight and keeping it off. The surgery allowed her body to defend a lower body weight by altering the secretion of gut hormones that lead to satiety in the brain. It’s not her fault that her body responded so well!
I asked her to be on my next orientation virtual meeting with prospective weight management patients to urge those with a body mass index (BMI) > 40 to consider bariatric surgery as the most effective durable and safe treatment for their degree of obesity.
Metabolic bariatric surgery, primarily sleeve gastrectomy and Roux-en-Y gastric bypass , alters the gut hormone milieu such that the body defends a lower mass of adipose tissue and a lower weight. We have learned what it takes to alter body weight defense to a healthy lower weight by studying why metabolic bariatric surgery works so well. It turns out that there are several hormones secreted by the gut that allow the brain to register fullness.
One of these gut hormones, glucagon-like peptide (GLP)-1, has been researched as an analog to help reduce body weight by 16% and has also been shown to reduce cardiovascular risk in the SELECT trial, as published in The New England Journal of Medicine (NEJM).
It’s the first weight loss medication to be shown in a cardiovascular outcomes trial to be superior to placebo in reduction of major cardiovascular events, including cardiovascular deaths, nonfatal myocardial infarction, and nonfatal stroke. The results presented at the 2023 American Heart Association meetings in Philadelphia ended in wholehearted applause by a “standing only” audience even before the presentation’s conclusion.
As we pave the way for nutrient-stimulated hormone (NuSH) therapies to be prescribed to all Americans with a BMI > 30 to improve health, we need to remember what these medications actually do. We used to think that metabolic bariatric surgery worked by restricting the stomach contents and malabsorbing nutrients. We now know that the surgeries work by altering NuSH secretion, allowing for less secretion of the hunger hormone ghrelin and more secretion of GLP-1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY (PYY), cholecystokinin (CCK), oxyntomodulin (OXM), and other satiety hormones with less food ingestion.
They have pleiotropic effects on many organ systems in the body, including the brain, heart, adipose tissue, and liver. They decrease inflammation and also increase satiety and delay gastric emptying. None of these effects automatically produce weight loss, but they certainly aid in the adoption of a healthier body weight and better health. The weight loss occurs because these medications steer the body toward behavioral changes that promote weight loss.
As we delve into the SELECT trial results, a 20% reduction in major cardiovascular events was accompanied by an average weight loss of 9.6%, without a behavioral component added to either the placebo or intervention arms, as is usual in antiobesity agent trials.
Does this mean that primary care providers (PCPs) don’t have to educate patients on behavior change, diet, and exercise therapy? Well, if we consider obesity a disease as we do type 2 diabetes and dyslipidemia or hypertension, then no — PCPs don’t have to, just like they don’t in treating these other diseases.
However, we should rethink this practice. The recently published SURMOUNT-3 trial looked at another NuSH, tirzepatide, with intensive behavioral therapy; it resulted in a 26.6% weight loss, which is comparable to results with bariatric surgery. The SURMOUNT-1 trial of tirzepatide with nonintensive behavioral therapy resulted in a 20.9% weight loss, which is still substantial, but SURMOUNT-3 showed how much more is achievable with robust behavior-change therapy.
In other words, it’s time that PCPs provide education on behavior change to maximize the power of the medications prescribed in practice for the most common diseases suffered in the United States: obesity, type 2 diabetes, cardiovascular disease, and hypertension. These are all chronic, relapsing diseases. Medication alone will improve numbers (weight, blood glucose, A1c, and blood pressure), but a relapsing disease continues relentlessly as patients age to overcome the medications prescribed.
Today I made another patient feel bad because she lost over 100 pounds on semaglutide (Wegovy) 2.4 mg over 1 year, reducing her BMI from 57 to 36. She wanted to keep losing, so I recommended sleeve gastrectomy to lose more weight. I told her she could always restart the Wegovy after the procedure if needed.
We really don’t have an answer to this issue of NuSH therapy not getting to goal and bariatric surgery following medication therapy. The reality is that bariatric surgery should be considered a safe, effective treatment for extreme obesity somewhere along the trajectory of treatments starting with behavior (diet, exercise) and medications. It is still considered a last resort, and for some, just too aggressive.
We have learned much about the incretin hormones and what they can accomplish for obesity from studying bariatric — now called metabolic — surgery. Surgery should be seen as we see stent placement for angina, only more effective for longevity. The COURAGE trial, published in 2007 in NEJM, showed that when compared with medication treatment alone for angina, stent placement plus medications resulted in no difference in mortality after a 7-year follow-up period. Compare this to bariatric surgery, which in many retrospective analyses shows a 20% reduction in cardiovascular mortality after 20-year follow-up (Swedish Obesity Study). In the United States, there are 2 million stent procedures performed per year vs 250,000 bariatric surgical procedures. There are millions of Americans with a BMI > 40 and, yes, millions of Americans with angina. I think I make my point that we need to do more bariatric surgeries to effectively treat extreme obesity.
The solution to this negligent medical practice in obesity treatment is to empower PCPs to treat obesity (at least uncomplicated obesity) and refer to obesity medicine practices for complicated obesity with multiple complications, such as type 2 diabetes and cardiovascular disease, and to refer to obesity medicine practices with a surgical component for BMIs > 40 or > 35 with type 2 diabetes, sleep apnea, and/or cardiovascular disease or other serious conditions.
How do we empower PCPs? Insurance coverage of NuSH therapies due to life-saving properties — as evidenced by the SELECT trial — without prior authorizations; and education on how and why metabolic surgery works, as well as education on behavioral approaches, such as healthy diet and exercise, as a core therapy for all BMI categories.
It’s time.
Caroline Apovian, MD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, adviser, consultant, or trustee for Altimmune; Cowen and Company; Currax Pharmaceuticals; EPG Communication Holdings; Gelesis, Srl; L-Nutra; and NeuroBo Pharmaceuticals. Received research grant from: National Institutes of Health; Patient-Centered Outcomes Research Institute; and GI Dynamics. Received income in an amount equal to or greater than $250 from: Altimmune; Cowen and Company; NeuroBo Pharmaceuticals; and Novo Nordisk.
A version of this article appeared on Medscape.com.
100% Fruit Juices: Watch Out for the Impact on Weight
Juices made of 100% fruit can have a slight impact on children’s body mass index (BMI), which increases with each serving consumed. In addition, an effect on weight is noticeable in adults. These are some of the conclusions drawn from a literature review and meta-analysis published in JAMA Pediatrics.
“Consumption of 100% fruit juice can serve as a convenient means to meet daily fruit recommendations and offers many of the nutrients found in whole fruit including essential vitamins, antioxidants, and polyphenols that can contribute to a healthy dietary pattern. However, there is concern that intake of 100% fruit juice may contribute to weight gain due to the high amounts of free sugars and energy,” wrote the authors, led by Michelle Nguyen, research assistant at the University of Toronto.
As the authors point out, available data on the subject are conflicting, and recommendations in national and international guidelines are not perfectly aligned. “With the rising overweight and obesity rates in children and adults worldwide, evidence-based recommendations for 100% fruit juice consumption are needed,” wrote the authors.
What the Literature Says
To shed light on such a crucial topic, researchers conducted a literature review with a meta-analysis of prospective cohort studies lasting at least 6 months and randomized controlled trials (RCTs) lasting at least 2 weeks. The analysis included 42 studies: 17 on the pediatric population (only cohort studies; totaling 45,851 children) and 25 on the adult population (6 cohort studies and 19 RCTs; 268,095 adults involved).
In children, each daily serving of 100% fruit juice (equivalent to a glass of about 230 mL) was associated with a 0.03 increase in BMI, with a higher increase in younger children (0.15 in those under 11 years) compared with older ones (−0.001).
As for adults, the overall analysis of cohort studies did not show significant associations. Further analyses without adjusting for energy intake showed a significant association between 100% fruit juices and weight gain (0.21 kg), whereas after adjustment, an inverse association with weight gain (−0.08 kg) emerged. This finding suggests that the association may be mediated by calorie intake, wrote the researchers, adding that no association was found in the analysis of randomized controlled trials.
A Closer Look
“Our comprehensive systematic review and meta-analysis provides a novel analysis of 100% fruit juice and weight gain assessing children and adults using data from both prospective cohort studies and RCTs,” explained the authors, commenting on some of the obtained results.
Regarding the observed differences between children of different age groups, the researchers explained that a standard glass of fruit juice represents a higher proportion of the daily energy intake for a younger child compared with an older one. “Our findings are in line with American Academy of Pediatrics guidelines that children younger than 6 years should consume less than a glass of fruit juice per day,” they wrote. “Limiting intake of fruit juice among children is an important strategy for them to develop healthy weight trajectories.”
Experts also state that high-quality RCTs are needed in children and adults to explore the effect of fruit juice consumption on body weight at different intake levels and with different types of juice. “Our findings are in support of public health guidance to limit consumption of 100% fruit juice to prevent overweight and obesity,” the authors wrote.
This article was translated from Univadis Italy, which is part of the Medscape Professional Network. A version of this article appeared on Medscape.com.
Juices made of 100% fruit can have a slight impact on children’s body mass index (BMI), which increases with each serving consumed. In addition, an effect on weight is noticeable in adults. These are some of the conclusions drawn from a literature review and meta-analysis published in JAMA Pediatrics.
“Consumption of 100% fruit juice can serve as a convenient means to meet daily fruit recommendations and offers many of the nutrients found in whole fruit including essential vitamins, antioxidants, and polyphenols that can contribute to a healthy dietary pattern. However, there is concern that intake of 100% fruit juice may contribute to weight gain due to the high amounts of free sugars and energy,” wrote the authors, led by Michelle Nguyen, research assistant at the University of Toronto.
As the authors point out, available data on the subject are conflicting, and recommendations in national and international guidelines are not perfectly aligned. “With the rising overweight and obesity rates in children and adults worldwide, evidence-based recommendations for 100% fruit juice consumption are needed,” wrote the authors.
What the Literature Says
To shed light on such a crucial topic, researchers conducted a literature review with a meta-analysis of prospective cohort studies lasting at least 6 months and randomized controlled trials (RCTs) lasting at least 2 weeks. The analysis included 42 studies: 17 on the pediatric population (only cohort studies; totaling 45,851 children) and 25 on the adult population (6 cohort studies and 19 RCTs; 268,095 adults involved).
In children, each daily serving of 100% fruit juice (equivalent to a glass of about 230 mL) was associated with a 0.03 increase in BMI, with a higher increase in younger children (0.15 in those under 11 years) compared with older ones (−0.001).
As for adults, the overall analysis of cohort studies did not show significant associations. Further analyses without adjusting for energy intake showed a significant association between 100% fruit juices and weight gain (0.21 kg), whereas after adjustment, an inverse association with weight gain (−0.08 kg) emerged. This finding suggests that the association may be mediated by calorie intake, wrote the researchers, adding that no association was found in the analysis of randomized controlled trials.
A Closer Look
“Our comprehensive systematic review and meta-analysis provides a novel analysis of 100% fruit juice and weight gain assessing children and adults using data from both prospective cohort studies and RCTs,” explained the authors, commenting on some of the obtained results.
Regarding the observed differences between children of different age groups, the researchers explained that a standard glass of fruit juice represents a higher proportion of the daily energy intake for a younger child compared with an older one. “Our findings are in line with American Academy of Pediatrics guidelines that children younger than 6 years should consume less than a glass of fruit juice per day,” they wrote. “Limiting intake of fruit juice among children is an important strategy for them to develop healthy weight trajectories.”
Experts also state that high-quality RCTs are needed in children and adults to explore the effect of fruit juice consumption on body weight at different intake levels and with different types of juice. “Our findings are in support of public health guidance to limit consumption of 100% fruit juice to prevent overweight and obesity,” the authors wrote.
This article was translated from Univadis Italy, which is part of the Medscape Professional Network. A version of this article appeared on Medscape.com.
Juices made of 100% fruit can have a slight impact on children’s body mass index (BMI), which increases with each serving consumed. In addition, an effect on weight is noticeable in adults. These are some of the conclusions drawn from a literature review and meta-analysis published in JAMA Pediatrics.
“Consumption of 100% fruit juice can serve as a convenient means to meet daily fruit recommendations and offers many of the nutrients found in whole fruit including essential vitamins, antioxidants, and polyphenols that can contribute to a healthy dietary pattern. However, there is concern that intake of 100% fruit juice may contribute to weight gain due to the high amounts of free sugars and energy,” wrote the authors, led by Michelle Nguyen, research assistant at the University of Toronto.
As the authors point out, available data on the subject are conflicting, and recommendations in national and international guidelines are not perfectly aligned. “With the rising overweight and obesity rates in children and adults worldwide, evidence-based recommendations for 100% fruit juice consumption are needed,” wrote the authors.
What the Literature Says
To shed light on such a crucial topic, researchers conducted a literature review with a meta-analysis of prospective cohort studies lasting at least 6 months and randomized controlled trials (RCTs) lasting at least 2 weeks. The analysis included 42 studies: 17 on the pediatric population (only cohort studies; totaling 45,851 children) and 25 on the adult population (6 cohort studies and 19 RCTs; 268,095 adults involved).
In children, each daily serving of 100% fruit juice (equivalent to a glass of about 230 mL) was associated with a 0.03 increase in BMI, with a higher increase in younger children (0.15 in those under 11 years) compared with older ones (−0.001).
As for adults, the overall analysis of cohort studies did not show significant associations. Further analyses without adjusting for energy intake showed a significant association between 100% fruit juices and weight gain (0.21 kg), whereas after adjustment, an inverse association with weight gain (−0.08 kg) emerged. This finding suggests that the association may be mediated by calorie intake, wrote the researchers, adding that no association was found in the analysis of randomized controlled trials.
A Closer Look
“Our comprehensive systematic review and meta-analysis provides a novel analysis of 100% fruit juice and weight gain assessing children and adults using data from both prospective cohort studies and RCTs,” explained the authors, commenting on some of the obtained results.
Regarding the observed differences between children of different age groups, the researchers explained that a standard glass of fruit juice represents a higher proportion of the daily energy intake for a younger child compared with an older one. “Our findings are in line with American Academy of Pediatrics guidelines that children younger than 6 years should consume less than a glass of fruit juice per day,” they wrote. “Limiting intake of fruit juice among children is an important strategy for them to develop healthy weight trajectories.”
Experts also state that high-quality RCTs are needed in children and adults to explore the effect of fruit juice consumption on body weight at different intake levels and with different types of juice. “Our findings are in support of public health guidance to limit consumption of 100% fruit juice to prevent overweight and obesity,” the authors wrote.
This article was translated from Univadis Italy, which is part of the Medscape Professional Network. A version of this article appeared on Medscape.com.
FROM JAMA PEDIATRICS
New Injectable Weight Loss Drugs Pose Ethical Issues, Says Ethicist
This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.
Offsetting Side Effects of New Antiobesity Medications
It’s 2 a.m. and my phone wakes me up with a start. My patient, Christine Z*, is vomiting uncontrollably, and Dr Google has diagnosed her with acute pancreatitis from semaglutide (Wegovy). Ten hours, several imaging studies, one blood draw, and many bags of fluids later, the verdict is in: Christine is alarmingly constipated. In fact, her entire large intestine is packed to the brim with stool. In residency, we called this diagnosis FOS, and I’ll leave it to your imagination to figure out what it stands for.
In retrospect, Christine mentions that upon raising her Wegovy dose, her bowel movements had become increasingly smaller and infrequent. This begs the question:
Proper nutrition always starts with drinking copious amounts of water. In general, I recommend a minimum of 64 ounces of water daily in patients taking incretins such as semaglutide (Wegovy for weight loss, Ozempic and Rybelsus for type 2 diabetes) or tirzepatide (Zepbound for weight loss, Mounjaro for type 2 diabetes). While these medications don’t directly dehydrate patients, they can increase the risk for dehydration due to severe nausea. Drinking copious amounts of water can prevent dehydration, preserve kidney function, and minimize fatigue and dizziness. In addition, fluids help soften bowel movements, making them easier to pass.
Occasionally incretins make it so easy for patients to drop pounds that their eating patterns become sloppier — more sweets and simple carbohydrates. I recommend a realistic and low glycemic index meal plan. While no foods are strictly contraindicated, processed, high-sugar, and fatty foods are likely to worsen side effects like nausea and gastrointestinal distress. Similarly, alcohol not only worsens nausea, but it’s also likely to exacerbate reflux by relaxing the sphincter that separates the stomach from the esophagus.
The next most important dietary advice is consuming sufficient fiber. In the majority of patients, increasing fiber intake relieves constipation. There are two types of fiber: soluble and insoluble. In practical terms, most fiber-rich foods contain a mixture of these two types. The general recommendation is 38 g/d for men and 25 g/d for women. The caveat to this advice is that a minority of patients, such as those with irritable bowel syndrome, may develop worsening constipation with increasing fiber.
To minimize side effects, some patients find it useful to eat five small meals throughout the day rather than three larger meals. In addition, I recommend eating slowly and stopping before the point of satiety. Finally, because weight loss of any kind is inevitably associated with muscle loss, I stress the importance of adequate protein. In general, I advise 25-30 g of protein per meal.
Christine eventually restarted her Wegovy after recovering from her grueling night in the emergency room. As this was her second go-around on Wegovy, she dug out my “guide to preventing side effects of incretins” and followed it to a T. So far, she’s feeling great.
*The patient’s name has been changed.
A version of this article appeared on Medscape.com.
It’s 2 a.m. and my phone wakes me up with a start. My patient, Christine Z*, is vomiting uncontrollably, and Dr Google has diagnosed her with acute pancreatitis from semaglutide (Wegovy). Ten hours, several imaging studies, one blood draw, and many bags of fluids later, the verdict is in: Christine is alarmingly constipated. In fact, her entire large intestine is packed to the brim with stool. In residency, we called this diagnosis FOS, and I’ll leave it to your imagination to figure out what it stands for.
In retrospect, Christine mentions that upon raising her Wegovy dose, her bowel movements had become increasingly smaller and infrequent. This begs the question:
Proper nutrition always starts with drinking copious amounts of water. In general, I recommend a minimum of 64 ounces of water daily in patients taking incretins such as semaglutide (Wegovy for weight loss, Ozempic and Rybelsus for type 2 diabetes) or tirzepatide (Zepbound for weight loss, Mounjaro for type 2 diabetes). While these medications don’t directly dehydrate patients, they can increase the risk for dehydration due to severe nausea. Drinking copious amounts of water can prevent dehydration, preserve kidney function, and minimize fatigue and dizziness. In addition, fluids help soften bowel movements, making them easier to pass.
Occasionally incretins make it so easy for patients to drop pounds that their eating patterns become sloppier — more sweets and simple carbohydrates. I recommend a realistic and low glycemic index meal plan. While no foods are strictly contraindicated, processed, high-sugar, and fatty foods are likely to worsen side effects like nausea and gastrointestinal distress. Similarly, alcohol not only worsens nausea, but it’s also likely to exacerbate reflux by relaxing the sphincter that separates the stomach from the esophagus.
The next most important dietary advice is consuming sufficient fiber. In the majority of patients, increasing fiber intake relieves constipation. There are two types of fiber: soluble and insoluble. In practical terms, most fiber-rich foods contain a mixture of these two types. The general recommendation is 38 g/d for men and 25 g/d for women. The caveat to this advice is that a minority of patients, such as those with irritable bowel syndrome, may develop worsening constipation with increasing fiber.
To minimize side effects, some patients find it useful to eat five small meals throughout the day rather than three larger meals. In addition, I recommend eating slowly and stopping before the point of satiety. Finally, because weight loss of any kind is inevitably associated with muscle loss, I stress the importance of adequate protein. In general, I advise 25-30 g of protein per meal.
Christine eventually restarted her Wegovy after recovering from her grueling night in the emergency room. As this was her second go-around on Wegovy, she dug out my “guide to preventing side effects of incretins” and followed it to a T. So far, she’s feeling great.
*The patient’s name has been changed.
A version of this article appeared on Medscape.com.
It’s 2 a.m. and my phone wakes me up with a start. My patient, Christine Z*, is vomiting uncontrollably, and Dr Google has diagnosed her with acute pancreatitis from semaglutide (Wegovy). Ten hours, several imaging studies, one blood draw, and many bags of fluids later, the verdict is in: Christine is alarmingly constipated. In fact, her entire large intestine is packed to the brim with stool. In residency, we called this diagnosis FOS, and I’ll leave it to your imagination to figure out what it stands for.
In retrospect, Christine mentions that upon raising her Wegovy dose, her bowel movements had become increasingly smaller and infrequent. This begs the question:
Proper nutrition always starts with drinking copious amounts of water. In general, I recommend a minimum of 64 ounces of water daily in patients taking incretins such as semaglutide (Wegovy for weight loss, Ozempic and Rybelsus for type 2 diabetes) or tirzepatide (Zepbound for weight loss, Mounjaro for type 2 diabetes). While these medications don’t directly dehydrate patients, they can increase the risk for dehydration due to severe nausea. Drinking copious amounts of water can prevent dehydration, preserve kidney function, and minimize fatigue and dizziness. In addition, fluids help soften bowel movements, making them easier to pass.
Occasionally incretins make it so easy for patients to drop pounds that their eating patterns become sloppier — more sweets and simple carbohydrates. I recommend a realistic and low glycemic index meal plan. While no foods are strictly contraindicated, processed, high-sugar, and fatty foods are likely to worsen side effects like nausea and gastrointestinal distress. Similarly, alcohol not only worsens nausea, but it’s also likely to exacerbate reflux by relaxing the sphincter that separates the stomach from the esophagus.
The next most important dietary advice is consuming sufficient fiber. In the majority of patients, increasing fiber intake relieves constipation. There are two types of fiber: soluble and insoluble. In practical terms, most fiber-rich foods contain a mixture of these two types. The general recommendation is 38 g/d for men and 25 g/d for women. The caveat to this advice is that a minority of patients, such as those with irritable bowel syndrome, may develop worsening constipation with increasing fiber.
To minimize side effects, some patients find it useful to eat five small meals throughout the day rather than three larger meals. In addition, I recommend eating slowly and stopping before the point of satiety. Finally, because weight loss of any kind is inevitably associated with muscle loss, I stress the importance of adequate protein. In general, I advise 25-30 g of protein per meal.
Christine eventually restarted her Wegovy after recovering from her grueling night in the emergency room. As this was her second go-around on Wegovy, she dug out my “guide to preventing side effects of incretins” and followed it to a T. So far, she’s feeling great.
*The patient’s name has been changed.
A version of this article appeared on Medscape.com.
Most Americans Believe Bariatric Surgery Is Shortcut, Should Be ‘Last Resort’: Survey
Most Americans’ views about obesity and bariatric surgery are colored by stigmas, according to a new survey from the healthcare system at Orlando Health.
For example, most Americans believe that weight loss surgery should be pursued only as a last resort and that bariatric surgery is a shortcut to shedding pounds, the survey found.
Common stigmas could be deterring people who qualify for bariatric surgery from pursuing it, according to Orlando Health, located in Florida.
“Bariatric surgery is by no means an easy way out. If you have the courage to ask for help and commit to doing the hard work of changing your diet and improving your life, you’re a champion in my book,” said Andre Teixeira, MD, medical director and bariatric surgeon at Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, Florida.
“Surgery is simply a tool to jumpstart that change,” he said. “After surgery, it is up to the patient to learn how to eat well, implement exercise into their routine, and shift their mindset to maintain their health for the rest of their lives.”
The survey results were published in January by Orlando Health.
Surveying Americans
The national survey, conducted for Orlando Health by the market research firm Ipsos in early November 2023, asked 1017 US adults whether they agreed or disagreed with several statements about weight loss and bariatric surgery. The statements and responses are as follows:
- “Weight loss surgery is a shortcut to shedding pounds” — 60% strongly or somewhat agreed, 38% strongly or somewhat disagreed, and the remainder declined to answer.
- “Weight loss surgery is cosmetic and mainly impacts appearance” — 37% strongly or somewhat agreed, 61% strongly or somewhat disagreed, and the remainder declined to respond.
- “Exercise and diet should be enough for weight loss” — 61% strongly or somewhat agreed, 37% strongly or somewhat disagreed, and the remainder declined to respond.
- “Weight loss surgery should only be pursued as a last resort” — 79% strongly or somewhat agreed, 19% strongly or somewhat disagreed, and the remainder declined to answer.
- “Surgery should be more socially accepted as a way to lose weight” — 46% strongly or somewhat agreed, 52% strongly or somewhat disagreed, and the remainder declined to respond.
Men’s responses indicated that they are more likely to have negative views toward weight loss surgery than women. For example, 66% of men vs 54% of women respondents see weight loss surgery as a shortcut to losing weight. Conversely, 42% of men vs 50% of women said that surgery should be a more socially accepted weight loss method.
Opinions that might interfere with the willingness to have weight loss surgery were apparent among people with obesity. The survey found that 65% of respondents with obesity and 59% with extreme obesity view surgery as a shortcut. Eighty-two percent of respondents with obesity and 68% with extreme obesity see surgery as a last resort.
At the end of 2022, the American Society of Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders updated their guidelines for metabolic and bariatric surgery for the first time since 1991, with the aim of expanding access to surgery, Orlando Health noted. However, only 1% of those who are clinically eligible end up undergoing weight loss surgery, even with advancements in laparoscopic and robotic techniques that have made it safer and less invasive, the health system added.
“Because of the stigma around obesity and bariatric surgery, so many of my patients feel defeated if they can’t lose weight on their own,” said Muhammad Ghanem, MD, a bariatric surgeon at Orlando Health.
“But when I tell them obesity is a disease and that many of its causes are outside of their control, you can see their relief,” he said. “They often even shed a tear because they’ve struggled with their weight all their lives and finally have some validation.”
Individualizing Treatment
Obesity treatment plans should be tailored to patients on the basis of individual factors such as body mass index, existing medical conditions, and family history, Dr. Teixeira said.
Besides bariatric surgery, patients also may consider options such as counseling, lifestyle changes, and medications including the latest weight loss drugs, he added.
The clinical approach to obesity treatment has evolved, said Miguel Burch, MD, director of general surgery and chief of minimally invasive and gastrointestinal surgery at Cedars-Sinai, Los Angeles, California, who was not involved in the survey.
“At one point in my career, I could say the only proven durable treatment for obesity is weight loss surgery. This was in the context of patients who were morbidly obese requiring risk reduction, not for a year or two but for decades, and not for 10-20 pounds but for 40-60 pounds of weight loss,” said Dr. Burch, who also directs the bariatric surgery program at Torrance Memorial Medical Center, Torrance, California.
“That was a previous era. We are now in a new one with the weight loss drugs,” Dr. Burch said. “In fact, it’s wonderful to have the opportunity to serve so many patients with an option other than just surgery.”
Still, Dr. Burch added, “we have to change the way we look at obesity management as being either surgery or medicine and start thinking about it more as a multidisciplinary approach to a chronic and potentially relapsing disease.”
A version of this article appeared on Medscape.com.
Most Americans’ views about obesity and bariatric surgery are colored by stigmas, according to a new survey from the healthcare system at Orlando Health.
For example, most Americans believe that weight loss surgery should be pursued only as a last resort and that bariatric surgery is a shortcut to shedding pounds, the survey found.
Common stigmas could be deterring people who qualify for bariatric surgery from pursuing it, according to Orlando Health, located in Florida.
“Bariatric surgery is by no means an easy way out. If you have the courage to ask for help and commit to doing the hard work of changing your diet and improving your life, you’re a champion in my book,” said Andre Teixeira, MD, medical director and bariatric surgeon at Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, Florida.
“Surgery is simply a tool to jumpstart that change,” he said. “After surgery, it is up to the patient to learn how to eat well, implement exercise into their routine, and shift their mindset to maintain their health for the rest of their lives.”
The survey results were published in January by Orlando Health.
Surveying Americans
The national survey, conducted for Orlando Health by the market research firm Ipsos in early November 2023, asked 1017 US adults whether they agreed or disagreed with several statements about weight loss and bariatric surgery. The statements and responses are as follows:
- “Weight loss surgery is a shortcut to shedding pounds” — 60% strongly or somewhat agreed, 38% strongly or somewhat disagreed, and the remainder declined to answer.
- “Weight loss surgery is cosmetic and mainly impacts appearance” — 37% strongly or somewhat agreed, 61% strongly or somewhat disagreed, and the remainder declined to respond.
- “Exercise and diet should be enough for weight loss” — 61% strongly or somewhat agreed, 37% strongly or somewhat disagreed, and the remainder declined to respond.
- “Weight loss surgery should only be pursued as a last resort” — 79% strongly or somewhat agreed, 19% strongly or somewhat disagreed, and the remainder declined to answer.
- “Surgery should be more socially accepted as a way to lose weight” — 46% strongly or somewhat agreed, 52% strongly or somewhat disagreed, and the remainder declined to respond.
Men’s responses indicated that they are more likely to have negative views toward weight loss surgery than women. For example, 66% of men vs 54% of women respondents see weight loss surgery as a shortcut to losing weight. Conversely, 42% of men vs 50% of women said that surgery should be a more socially accepted weight loss method.
Opinions that might interfere with the willingness to have weight loss surgery were apparent among people with obesity. The survey found that 65% of respondents with obesity and 59% with extreme obesity view surgery as a shortcut. Eighty-two percent of respondents with obesity and 68% with extreme obesity see surgery as a last resort.
At the end of 2022, the American Society of Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders updated their guidelines for metabolic and bariatric surgery for the first time since 1991, with the aim of expanding access to surgery, Orlando Health noted. However, only 1% of those who are clinically eligible end up undergoing weight loss surgery, even with advancements in laparoscopic and robotic techniques that have made it safer and less invasive, the health system added.
“Because of the stigma around obesity and bariatric surgery, so many of my patients feel defeated if they can’t lose weight on their own,” said Muhammad Ghanem, MD, a bariatric surgeon at Orlando Health.
“But when I tell them obesity is a disease and that many of its causes are outside of their control, you can see their relief,” he said. “They often even shed a tear because they’ve struggled with their weight all their lives and finally have some validation.”
Individualizing Treatment
Obesity treatment plans should be tailored to patients on the basis of individual factors such as body mass index, existing medical conditions, and family history, Dr. Teixeira said.
Besides bariatric surgery, patients also may consider options such as counseling, lifestyle changes, and medications including the latest weight loss drugs, he added.
The clinical approach to obesity treatment has evolved, said Miguel Burch, MD, director of general surgery and chief of minimally invasive and gastrointestinal surgery at Cedars-Sinai, Los Angeles, California, who was not involved in the survey.
“At one point in my career, I could say the only proven durable treatment for obesity is weight loss surgery. This was in the context of patients who were morbidly obese requiring risk reduction, not for a year or two but for decades, and not for 10-20 pounds but for 40-60 pounds of weight loss,” said Dr. Burch, who also directs the bariatric surgery program at Torrance Memorial Medical Center, Torrance, California.
“That was a previous era. We are now in a new one with the weight loss drugs,” Dr. Burch said. “In fact, it’s wonderful to have the opportunity to serve so many patients with an option other than just surgery.”
Still, Dr. Burch added, “we have to change the way we look at obesity management as being either surgery or medicine and start thinking about it more as a multidisciplinary approach to a chronic and potentially relapsing disease.”
A version of this article appeared on Medscape.com.
Most Americans’ views about obesity and bariatric surgery are colored by stigmas, according to a new survey from the healthcare system at Orlando Health.
For example, most Americans believe that weight loss surgery should be pursued only as a last resort and that bariatric surgery is a shortcut to shedding pounds, the survey found.
Common stigmas could be deterring people who qualify for bariatric surgery from pursuing it, according to Orlando Health, located in Florida.
“Bariatric surgery is by no means an easy way out. If you have the courage to ask for help and commit to doing the hard work of changing your diet and improving your life, you’re a champion in my book,” said Andre Teixeira, MD, medical director and bariatric surgeon at Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, Florida.
“Surgery is simply a tool to jumpstart that change,” he said. “After surgery, it is up to the patient to learn how to eat well, implement exercise into their routine, and shift their mindset to maintain their health for the rest of their lives.”
The survey results were published in January by Orlando Health.
Surveying Americans
The national survey, conducted for Orlando Health by the market research firm Ipsos in early November 2023, asked 1017 US adults whether they agreed or disagreed with several statements about weight loss and bariatric surgery. The statements and responses are as follows:
- “Weight loss surgery is a shortcut to shedding pounds” — 60% strongly or somewhat agreed, 38% strongly or somewhat disagreed, and the remainder declined to answer.
- “Weight loss surgery is cosmetic and mainly impacts appearance” — 37% strongly or somewhat agreed, 61% strongly or somewhat disagreed, and the remainder declined to respond.
- “Exercise and diet should be enough for weight loss” — 61% strongly or somewhat agreed, 37% strongly or somewhat disagreed, and the remainder declined to respond.
- “Weight loss surgery should only be pursued as a last resort” — 79% strongly or somewhat agreed, 19% strongly or somewhat disagreed, and the remainder declined to answer.
- “Surgery should be more socially accepted as a way to lose weight” — 46% strongly or somewhat agreed, 52% strongly or somewhat disagreed, and the remainder declined to respond.
Men’s responses indicated that they are more likely to have negative views toward weight loss surgery than women. For example, 66% of men vs 54% of women respondents see weight loss surgery as a shortcut to losing weight. Conversely, 42% of men vs 50% of women said that surgery should be a more socially accepted weight loss method.
Opinions that might interfere with the willingness to have weight loss surgery were apparent among people with obesity. The survey found that 65% of respondents with obesity and 59% with extreme obesity view surgery as a shortcut. Eighty-two percent of respondents with obesity and 68% with extreme obesity see surgery as a last resort.
At the end of 2022, the American Society of Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders updated their guidelines for metabolic and bariatric surgery for the first time since 1991, with the aim of expanding access to surgery, Orlando Health noted. However, only 1% of those who are clinically eligible end up undergoing weight loss surgery, even with advancements in laparoscopic and robotic techniques that have made it safer and less invasive, the health system added.
“Because of the stigma around obesity and bariatric surgery, so many of my patients feel defeated if they can’t lose weight on their own,” said Muhammad Ghanem, MD, a bariatric surgeon at Orlando Health.
“But when I tell them obesity is a disease and that many of its causes are outside of their control, you can see their relief,” he said. “They often even shed a tear because they’ve struggled with their weight all their lives and finally have some validation.”
Individualizing Treatment
Obesity treatment plans should be tailored to patients on the basis of individual factors such as body mass index, existing medical conditions, and family history, Dr. Teixeira said.
Besides bariatric surgery, patients also may consider options such as counseling, lifestyle changes, and medications including the latest weight loss drugs, he added.
The clinical approach to obesity treatment has evolved, said Miguel Burch, MD, director of general surgery and chief of minimally invasive and gastrointestinal surgery at Cedars-Sinai, Los Angeles, California, who was not involved in the survey.
“At one point in my career, I could say the only proven durable treatment for obesity is weight loss surgery. This was in the context of patients who were morbidly obese requiring risk reduction, not for a year or two but for decades, and not for 10-20 pounds but for 40-60 pounds of weight loss,” said Dr. Burch, who also directs the bariatric surgery program at Torrance Memorial Medical Center, Torrance, California.
“That was a previous era. We are now in a new one with the weight loss drugs,” Dr. Burch said. “In fact, it’s wonderful to have the opportunity to serve so many patients with an option other than just surgery.”
Still, Dr. Burch added, “we have to change the way we look at obesity management as being either surgery or medicine and start thinking about it more as a multidisciplinary approach to a chronic and potentially relapsing disease.”
A version of this article appeared on Medscape.com.
Mental Health Screening May Benefit Youth With Obesity
TOPLINE:
Mental health comorbidities are prevalent among youth with overweight or obesity, with the strongest risk factors being male sex, older age, and extreme obesity.
METHODOLOGY:
- Researchers compared clinical characteristics and outcomes among children, adolescents, and young adults with overweight or obesity with or without a comorbid mental disorder who participated in a lifestyle intervention program.
- Overall, data from 114,248 individuals (age, 6-30 years; 53% females) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry were evaluated.
- Individuals were excluded if they had bariatric surgery or used weight-modifying drugs (metformin, orlistat, or glucagon-like peptide-1 analogues).
- Body mass index (BMI) was calculated as a standard deviation score (SDS) from a German youth population reference and was used to define overweight (90th to < 97th percentile), obesity (97th percentile), and severe obesity (≥ 99.5th percentile), which at age 18 correspond to adult cutoffs for overweight and obesity (25 kg/m2 and 30 kg/m2, respectively).
- Regression analysis identified the factors associated with mental disorders in those with overweight or obesity.
TAKEAWAY:
- A comorbid mental disorder was reported in 3969 individuals, with attention-deficit disorder (ADHD, 42.5%), anxiety (31.3%), depression (24.3%), and eating disorders (12.9%) being the most common.
- The factors most strongly associated with mental health comorbidity were male sex (odds ratio [OR], 1.39; 95% CI, 1.27-1.52), older age (OR, 1.42; 95% CI, 1.25-1.62), and severe obesity (OR, 1.45; 95% CI, 1.30-1.63).
- Mean BMI-SDS was higher in individuals with depression and eating disorders and lower in individuals with ADHD (both P < .001) than in those without mental disorders.
- Individuals with and without mental disorders benefited from similar BMI changes from lifestyle intervention programs.
IN PRACTICE:
The authors wrote, “Healthcare professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders, and regular mental health screening should be considered.”
SOURCE:
This study, led by Angela Galler from the Charité – Universitätsmedizin Berlin, Germany, was published online on January 9, 2024, in the International Journal of Obesity.
LIMITATIONS:
The study’s findings are based on data from a group of children, adolescents, and young adults with overweight or obesity treated in specialized obesity centers and may not be generalizable to all youth with obesity. Moreover, the study could not establish any conclusions regarding the cause or effect between obesity and mental disorders. Individuals were not tested psychologically for mental disorders and might have been underreported.
DISCLOSURES:
The manuscript is part of the Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy project, which was funded by the Innovative Medicines Initiative 2 Joint Undertaking. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
Mental health comorbidities are prevalent among youth with overweight or obesity, with the strongest risk factors being male sex, older age, and extreme obesity.
METHODOLOGY:
- Researchers compared clinical characteristics and outcomes among children, adolescents, and young adults with overweight or obesity with or without a comorbid mental disorder who participated in a lifestyle intervention program.
- Overall, data from 114,248 individuals (age, 6-30 years; 53% females) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry were evaluated.
- Individuals were excluded if they had bariatric surgery or used weight-modifying drugs (metformin, orlistat, or glucagon-like peptide-1 analogues).
- Body mass index (BMI) was calculated as a standard deviation score (SDS) from a German youth population reference and was used to define overweight (90th to < 97th percentile), obesity (97th percentile), and severe obesity (≥ 99.5th percentile), which at age 18 correspond to adult cutoffs for overweight and obesity (25 kg/m2 and 30 kg/m2, respectively).
- Regression analysis identified the factors associated with mental disorders in those with overweight or obesity.
TAKEAWAY:
- A comorbid mental disorder was reported in 3969 individuals, with attention-deficit disorder (ADHD, 42.5%), anxiety (31.3%), depression (24.3%), and eating disorders (12.9%) being the most common.
- The factors most strongly associated with mental health comorbidity were male sex (odds ratio [OR], 1.39; 95% CI, 1.27-1.52), older age (OR, 1.42; 95% CI, 1.25-1.62), and severe obesity (OR, 1.45; 95% CI, 1.30-1.63).
- Mean BMI-SDS was higher in individuals with depression and eating disorders and lower in individuals with ADHD (both P < .001) than in those without mental disorders.
- Individuals with and without mental disorders benefited from similar BMI changes from lifestyle intervention programs.
IN PRACTICE:
The authors wrote, “Healthcare professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders, and regular mental health screening should be considered.”
SOURCE:
This study, led by Angela Galler from the Charité – Universitätsmedizin Berlin, Germany, was published online on January 9, 2024, in the International Journal of Obesity.
LIMITATIONS:
The study’s findings are based on data from a group of children, adolescents, and young adults with overweight or obesity treated in specialized obesity centers and may not be generalizable to all youth with obesity. Moreover, the study could not establish any conclusions regarding the cause or effect between obesity and mental disorders. Individuals were not tested psychologically for mental disorders and might have been underreported.
DISCLOSURES:
The manuscript is part of the Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy project, which was funded by the Innovative Medicines Initiative 2 Joint Undertaking. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
Mental health comorbidities are prevalent among youth with overweight or obesity, with the strongest risk factors being male sex, older age, and extreme obesity.
METHODOLOGY:
- Researchers compared clinical characteristics and outcomes among children, adolescents, and young adults with overweight or obesity with or without a comorbid mental disorder who participated in a lifestyle intervention program.
- Overall, data from 114,248 individuals (age, 6-30 years; 53% females) from 226 centers in Germany and Austria participating in the Adiposity Patient Registry were evaluated.
- Individuals were excluded if they had bariatric surgery or used weight-modifying drugs (metformin, orlistat, or glucagon-like peptide-1 analogues).
- Body mass index (BMI) was calculated as a standard deviation score (SDS) from a German youth population reference and was used to define overweight (90th to < 97th percentile), obesity (97th percentile), and severe obesity (≥ 99.5th percentile), which at age 18 correspond to adult cutoffs for overweight and obesity (25 kg/m2 and 30 kg/m2, respectively).
- Regression analysis identified the factors associated with mental disorders in those with overweight or obesity.
TAKEAWAY:
- A comorbid mental disorder was reported in 3969 individuals, with attention-deficit disorder (ADHD, 42.5%), anxiety (31.3%), depression (24.3%), and eating disorders (12.9%) being the most common.
- The factors most strongly associated with mental health comorbidity were male sex (odds ratio [OR], 1.39; 95% CI, 1.27-1.52), older age (OR, 1.42; 95% CI, 1.25-1.62), and severe obesity (OR, 1.45; 95% CI, 1.30-1.63).
- Mean BMI-SDS was higher in individuals with depression and eating disorders and lower in individuals with ADHD (both P < .001) than in those without mental disorders.
- Individuals with and without mental disorders benefited from similar BMI changes from lifestyle intervention programs.
IN PRACTICE:
The authors wrote, “Healthcare professionals caring for youth with overweight or obesity should be aware of comorbid mental disorders, and regular mental health screening should be considered.”
SOURCE:
This study, led by Angela Galler from the Charité – Universitätsmedizin Berlin, Germany, was published online on January 9, 2024, in the International Journal of Obesity.
LIMITATIONS:
The study’s findings are based on data from a group of children, adolescents, and young adults with overweight or obesity treated in specialized obesity centers and may not be generalizable to all youth with obesity. Moreover, the study could not establish any conclusions regarding the cause or effect between obesity and mental disorders. Individuals were not tested psychologically for mental disorders and might have been underreported.
DISCLOSURES:
The manuscript is part of the Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy project, which was funded by the Innovative Medicines Initiative 2 Joint Undertaking. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
Do Your Patients Hate Exercise? Suggest They Do This Instead
Have patients who want to lose weight? Tell them to put on their dancing shoes.
Dancing can be an effective fat-loss tool for people who are overweight or have obesity, according to a recent meta-analysis in PLOS One.
Participants who danced three times a week for at least 3 months reaped maximum benefits. And the more they let loose, the better — more creative dance forms led to more pronounced improvements in body composition.
The study builds on previous research that suggests dance can be beneficial for weight loss and overall health. A 2017 meta-analysis found that dance significantly improved body composition, blood biomarkers, and musculoskeletal function. Other research has linked dance with improvements in cognitive function, mental health, and quality of life.
What makes dance special? It’s a full-body workout that might be easier to stick with than other exercises. “Enjoyment” is key for sustainability, the researchers wrote: “As a form of physical activity that integrates exercise, entertainment, and sociality, dance possesses innate advantages in fostering motivation for exercise.”
“The best exercise is the one you’ll do every day, and something that you like to do,” said Nicholas Pennings, DO, chair and associate professor of family medicine at Campbell University, Buies Creek, NC. (Dr. Pennings was not involved in the study.) For patients who enjoy dancing, dance could be that thing — or at least one workout to add to the mix.
Help your patients get started with these tips.
Frame it as a hobby, not exercise. Ask what hobbies they used to enjoy in high school, suggests Deirdre Mattina, MD, a cardiologist at the Cleveland Clinic and a former professional dancer. “ This can sometimes evoke happy memories of younger years and perhaps hobbies that they’d given up because they thought they were too old,” she said. If they used to play sports or dance, that’s your in. “I usually talk about hot yoga as a transition to get back their flexibility and then something like a dance aerobics or Zumba class to start.”
Recommend a group class. “Any intervention promoting social relationships is expected to increase adherence,” said Giulio Marchesini Reggiani, MD, a recently retired professor of internal medicine and dietetics at the University of Bologna in Italy. “You are motivated by the group, and you create a relationship among participants, and this means that you are no longer alone.” Try local gyms, health clubs, or even dance studios (yes, where kids go — they offer adult classes, too).
Help patients find their unique groove. Dr. Mattina has some patients who take cardio dance classes, some who line dance, and others who pole dance or heels dance. “Those are the things that keep it fun,” she said. “It doesn’t seem like exercise. It seems more like going out and hanging out.”
Encourage those who “don’t know how to dance.” You don’t need fancy choreography or the grace of a prima ballerina.”Simply move aided by the music,” said Dr. Reggiani. “As long as you start engaging in physical activity, you improve your health, and you improve your movement.” Suggest patients start with beginner Zumba or a step class to get the hang of moving to a beat. Or try a home dance video, like Barre Blend by BODi (which offers a 14-day free trial). “You can try taking a couple classes in the privacy of your own home first, so you feel comfortable getting out there and doing it with a group,” said Dr. Mattina.
Modify as needed. If a patient has mobility limitations or lower-body pain, they can still dance — just do the upper-body portion of the moves. “Dance involves both upper and lower body movement, and so many dance activities could easily be performed in a chair,” said Dr. Pennings. A good joint-friendly option: Some health clubs offer dance classes that take place in a swimming pool.
Involve the whole family. Support from a partner can help patients stick with exercise, said Dr. Reggiani, and dance can also help a couple strengthen their bond. Invite kids and grandparents to join, too. “Dancing is something that can be done at any age,” said Dr. Reggiani. “For kids, it is important to make it fun,” said Dr. Pennings. “Start when they are young with music they are familiar with and enjoy.” For skeptical partners? “Keep it simple and nonjudgmental,” he said.
Remind patients to warm up. We lose flexibility with age, so ease into it, said Dr. Mattina. Many classes include warmups, but if you’re at home, do a few minutes of light, low-impact cardio — jumping jacks, mountain climbers, jogging, or brisk walking — before stretching. Or just put on a slow song and start lightly bouncing to the beat or stepping your feet to one side, together, then to the other side and together.
Tell them to take dance breaks. No time to join a class? Break up the workday with a few 10-minute dance parties. (That’s about three songs.) “Short bursts of exercise throughout the day, like if you do 10 minutes of exercise six times a day, actually has a greater health benefit than doing 60 minutes of continuous exercise,” said Dr. Pennings. It helps counter the negative effects of prolonged sitting “by increasing blood flow and increasing utilization of your muscles.”
Manage expectations about weight loss. Patients often have outsized expectations about how much weight they’ll lose when starting a new exercise regimen, Dr. Pennings said. Dancing burns about 300 calories per hour, so it takes roughly 12 hours to lose one pound. Consistency over time is the key. “My goal is to both emphasize the health benefits of exercise while maintaining realistic expectations about weight loss,” said Dr. Pennings. Focus less on the weight part and highlight other benefits: Dancing builds strength, balance, and coordination, said Dr. Pennings. It can help improve blood pressure and other heart health markers and boost cognition in older adults. And it’s fun.
A version of this article appeared on Medscape.com.
Have patients who want to lose weight? Tell them to put on their dancing shoes.
Dancing can be an effective fat-loss tool for people who are overweight or have obesity, according to a recent meta-analysis in PLOS One.
Participants who danced three times a week for at least 3 months reaped maximum benefits. And the more they let loose, the better — more creative dance forms led to more pronounced improvements in body composition.
The study builds on previous research that suggests dance can be beneficial for weight loss and overall health. A 2017 meta-analysis found that dance significantly improved body composition, blood biomarkers, and musculoskeletal function. Other research has linked dance with improvements in cognitive function, mental health, and quality of life.
What makes dance special? It’s a full-body workout that might be easier to stick with than other exercises. “Enjoyment” is key for sustainability, the researchers wrote: “As a form of physical activity that integrates exercise, entertainment, and sociality, dance possesses innate advantages in fostering motivation for exercise.”
“The best exercise is the one you’ll do every day, and something that you like to do,” said Nicholas Pennings, DO, chair and associate professor of family medicine at Campbell University, Buies Creek, NC. (Dr. Pennings was not involved in the study.) For patients who enjoy dancing, dance could be that thing — or at least one workout to add to the mix.
Help your patients get started with these tips.
Frame it as a hobby, not exercise. Ask what hobbies they used to enjoy in high school, suggests Deirdre Mattina, MD, a cardiologist at the Cleveland Clinic and a former professional dancer. “ This can sometimes evoke happy memories of younger years and perhaps hobbies that they’d given up because they thought they were too old,” she said. If they used to play sports or dance, that’s your in. “I usually talk about hot yoga as a transition to get back their flexibility and then something like a dance aerobics or Zumba class to start.”
Recommend a group class. “Any intervention promoting social relationships is expected to increase adherence,” said Giulio Marchesini Reggiani, MD, a recently retired professor of internal medicine and dietetics at the University of Bologna in Italy. “You are motivated by the group, and you create a relationship among participants, and this means that you are no longer alone.” Try local gyms, health clubs, or even dance studios (yes, where kids go — they offer adult classes, too).
Help patients find their unique groove. Dr. Mattina has some patients who take cardio dance classes, some who line dance, and others who pole dance or heels dance. “Those are the things that keep it fun,” she said. “It doesn’t seem like exercise. It seems more like going out and hanging out.”
Encourage those who “don’t know how to dance.” You don’t need fancy choreography or the grace of a prima ballerina.”Simply move aided by the music,” said Dr. Reggiani. “As long as you start engaging in physical activity, you improve your health, and you improve your movement.” Suggest patients start with beginner Zumba or a step class to get the hang of moving to a beat. Or try a home dance video, like Barre Blend by BODi (which offers a 14-day free trial). “You can try taking a couple classes in the privacy of your own home first, so you feel comfortable getting out there and doing it with a group,” said Dr. Mattina.
Modify as needed. If a patient has mobility limitations or lower-body pain, they can still dance — just do the upper-body portion of the moves. “Dance involves both upper and lower body movement, and so many dance activities could easily be performed in a chair,” said Dr. Pennings. A good joint-friendly option: Some health clubs offer dance classes that take place in a swimming pool.
Involve the whole family. Support from a partner can help patients stick with exercise, said Dr. Reggiani, and dance can also help a couple strengthen their bond. Invite kids and grandparents to join, too. “Dancing is something that can be done at any age,” said Dr. Reggiani. “For kids, it is important to make it fun,” said Dr. Pennings. “Start when they are young with music they are familiar with and enjoy.” For skeptical partners? “Keep it simple and nonjudgmental,” he said.
Remind patients to warm up. We lose flexibility with age, so ease into it, said Dr. Mattina. Many classes include warmups, but if you’re at home, do a few minutes of light, low-impact cardio — jumping jacks, mountain climbers, jogging, or brisk walking — before stretching. Or just put on a slow song and start lightly bouncing to the beat or stepping your feet to one side, together, then to the other side and together.
Tell them to take dance breaks. No time to join a class? Break up the workday with a few 10-minute dance parties. (That’s about three songs.) “Short bursts of exercise throughout the day, like if you do 10 minutes of exercise six times a day, actually has a greater health benefit than doing 60 minutes of continuous exercise,” said Dr. Pennings. It helps counter the negative effects of prolonged sitting “by increasing blood flow and increasing utilization of your muscles.”
Manage expectations about weight loss. Patients often have outsized expectations about how much weight they’ll lose when starting a new exercise regimen, Dr. Pennings said. Dancing burns about 300 calories per hour, so it takes roughly 12 hours to lose one pound. Consistency over time is the key. “My goal is to both emphasize the health benefits of exercise while maintaining realistic expectations about weight loss,” said Dr. Pennings. Focus less on the weight part and highlight other benefits: Dancing builds strength, balance, and coordination, said Dr. Pennings. It can help improve blood pressure and other heart health markers and boost cognition in older adults. And it’s fun.
A version of this article appeared on Medscape.com.
Have patients who want to lose weight? Tell them to put on their dancing shoes.
Dancing can be an effective fat-loss tool for people who are overweight or have obesity, according to a recent meta-analysis in PLOS One.
Participants who danced three times a week for at least 3 months reaped maximum benefits. And the more they let loose, the better — more creative dance forms led to more pronounced improvements in body composition.
The study builds on previous research that suggests dance can be beneficial for weight loss and overall health. A 2017 meta-analysis found that dance significantly improved body composition, blood biomarkers, and musculoskeletal function. Other research has linked dance with improvements in cognitive function, mental health, and quality of life.
What makes dance special? It’s a full-body workout that might be easier to stick with than other exercises. “Enjoyment” is key for sustainability, the researchers wrote: “As a form of physical activity that integrates exercise, entertainment, and sociality, dance possesses innate advantages in fostering motivation for exercise.”
“The best exercise is the one you’ll do every day, and something that you like to do,” said Nicholas Pennings, DO, chair and associate professor of family medicine at Campbell University, Buies Creek, NC. (Dr. Pennings was not involved in the study.) For patients who enjoy dancing, dance could be that thing — or at least one workout to add to the mix.
Help your patients get started with these tips.
Frame it as a hobby, not exercise. Ask what hobbies they used to enjoy in high school, suggests Deirdre Mattina, MD, a cardiologist at the Cleveland Clinic and a former professional dancer. “ This can sometimes evoke happy memories of younger years and perhaps hobbies that they’d given up because they thought they were too old,” she said. If they used to play sports or dance, that’s your in. “I usually talk about hot yoga as a transition to get back their flexibility and then something like a dance aerobics or Zumba class to start.”
Recommend a group class. “Any intervention promoting social relationships is expected to increase adherence,” said Giulio Marchesini Reggiani, MD, a recently retired professor of internal medicine and dietetics at the University of Bologna in Italy. “You are motivated by the group, and you create a relationship among participants, and this means that you are no longer alone.” Try local gyms, health clubs, or even dance studios (yes, where kids go — they offer adult classes, too).
Help patients find their unique groove. Dr. Mattina has some patients who take cardio dance classes, some who line dance, and others who pole dance or heels dance. “Those are the things that keep it fun,” she said. “It doesn’t seem like exercise. It seems more like going out and hanging out.”
Encourage those who “don’t know how to dance.” You don’t need fancy choreography or the grace of a prima ballerina.”Simply move aided by the music,” said Dr. Reggiani. “As long as you start engaging in physical activity, you improve your health, and you improve your movement.” Suggest patients start with beginner Zumba or a step class to get the hang of moving to a beat. Or try a home dance video, like Barre Blend by BODi (which offers a 14-day free trial). “You can try taking a couple classes in the privacy of your own home first, so you feel comfortable getting out there and doing it with a group,” said Dr. Mattina.
Modify as needed. If a patient has mobility limitations or lower-body pain, they can still dance — just do the upper-body portion of the moves. “Dance involves both upper and lower body movement, and so many dance activities could easily be performed in a chair,” said Dr. Pennings. A good joint-friendly option: Some health clubs offer dance classes that take place in a swimming pool.
Involve the whole family. Support from a partner can help patients stick with exercise, said Dr. Reggiani, and dance can also help a couple strengthen their bond. Invite kids and grandparents to join, too. “Dancing is something that can be done at any age,” said Dr. Reggiani. “For kids, it is important to make it fun,” said Dr. Pennings. “Start when they are young with music they are familiar with and enjoy.” For skeptical partners? “Keep it simple and nonjudgmental,” he said.
Remind patients to warm up. We lose flexibility with age, so ease into it, said Dr. Mattina. Many classes include warmups, but if you’re at home, do a few minutes of light, low-impact cardio — jumping jacks, mountain climbers, jogging, or brisk walking — before stretching. Or just put on a slow song and start lightly bouncing to the beat or stepping your feet to one side, together, then to the other side and together.
Tell them to take dance breaks. No time to join a class? Break up the workday with a few 10-minute dance parties. (That’s about three songs.) “Short bursts of exercise throughout the day, like if you do 10 minutes of exercise six times a day, actually has a greater health benefit than doing 60 minutes of continuous exercise,” said Dr. Pennings. It helps counter the negative effects of prolonged sitting “by increasing blood flow and increasing utilization of your muscles.”
Manage expectations about weight loss. Patients often have outsized expectations about how much weight they’ll lose when starting a new exercise regimen, Dr. Pennings said. Dancing burns about 300 calories per hour, so it takes roughly 12 hours to lose one pound. Consistency over time is the key. “My goal is to both emphasize the health benefits of exercise while maintaining realistic expectations about weight loss,” said Dr. Pennings. Focus less on the weight part and highlight other benefits: Dancing builds strength, balance, and coordination, said Dr. Pennings. It can help improve blood pressure and other heart health markers and boost cognition in older adults. And it’s fun.
A version of this article appeared on Medscape.com.
Bone Mineral Density Higher in Children Living Near Green Areas
A recently published prospective study in JAMA Network Open identified a significant association between children’s bone health and their proximity to green areas.
The literature emphasized the benefits of childhood exposure to green spaces for neurocognitive, social, behavioral, and mental development, as well as well-being. In addition, such exposure is linked to lower body mass index, increased physical activity, and reduced risks for overweight, obesity, and hypertension. However, specific data on bone mineral density implications are limited.
To address this gap, Hanne Sleurs, PhD, a researcher at the Universiteit Hasselt in Belgium, and colleagues followed the bone health of 327 participants from birth to 4-6 years and examined correlations with individuals’ exposure to green areas. Data collection occurred from October 2014 to July 2021.
Green spaces were categorized as high (vegetation height > 3 m), low (vegetation height ≤ 3 m), and mixed (combination of both). The distances of green spaces from participants’ residences ranged from a radius of 100 m to 3 km. Radial bone mineral density assessment was conducted using quantitative ultrasound during follow-up consultations.
The scientists found that participants frequently exposed to high and mixed vegetation areas within a 500-m radius of their homes had significantly higher bone mineral density than those at other distances or those frequenting spaces with different vegetation. In addition, access to larger green spaces with mixed and high vegetation within a 1-km radius was significantly associated with a lower likelihood of low bone density in children.
“These findings illustrate the positive impact on bone health of early childhood exposure to green areas near their homes during critical growth and development periods, with long-term implications,” wrote the researchers.
The results aligned with those of a prior study in which authors noted factors contributing to families’ frequent park visits, including shorter distances, safety, and park organization, as well as the natural diversity and activities offered.
One hypothesis explaining improved bone density in children visiting green areas was increased physical activity practiced in these locations. The mechanical load from exercise can activate signaling pathways favoring bone development. Literature also gathered data on the influence of green areas on young populations engaging in physical activities, showing positive outcomes.
According to the study authors, the findings are crucial for public health because they emphasize the need for urban investments in accessible green spaces as a strategy for fracture and osteoporosis prevention. In the long term, such initiatives translate to reduced public health expenses, along with physical and emotional gains in communities adopting environmental strategies, they concluded.
This article was translated from the Medscape Portuguese edition. A version of this article appeared on Medscape.com.
A recently published prospective study in JAMA Network Open identified a significant association between children’s bone health and their proximity to green areas.
The literature emphasized the benefits of childhood exposure to green spaces for neurocognitive, social, behavioral, and mental development, as well as well-being. In addition, such exposure is linked to lower body mass index, increased physical activity, and reduced risks for overweight, obesity, and hypertension. However, specific data on bone mineral density implications are limited.
To address this gap, Hanne Sleurs, PhD, a researcher at the Universiteit Hasselt in Belgium, and colleagues followed the bone health of 327 participants from birth to 4-6 years and examined correlations with individuals’ exposure to green areas. Data collection occurred from October 2014 to July 2021.
Green spaces were categorized as high (vegetation height > 3 m), low (vegetation height ≤ 3 m), and mixed (combination of both). The distances of green spaces from participants’ residences ranged from a radius of 100 m to 3 km. Radial bone mineral density assessment was conducted using quantitative ultrasound during follow-up consultations.
The scientists found that participants frequently exposed to high and mixed vegetation areas within a 500-m radius of their homes had significantly higher bone mineral density than those at other distances or those frequenting spaces with different vegetation. In addition, access to larger green spaces with mixed and high vegetation within a 1-km radius was significantly associated with a lower likelihood of low bone density in children.
“These findings illustrate the positive impact on bone health of early childhood exposure to green areas near their homes during critical growth and development periods, with long-term implications,” wrote the researchers.
The results aligned with those of a prior study in which authors noted factors contributing to families’ frequent park visits, including shorter distances, safety, and park organization, as well as the natural diversity and activities offered.
One hypothesis explaining improved bone density in children visiting green areas was increased physical activity practiced in these locations. The mechanical load from exercise can activate signaling pathways favoring bone development. Literature also gathered data on the influence of green areas on young populations engaging in physical activities, showing positive outcomes.
According to the study authors, the findings are crucial for public health because they emphasize the need for urban investments in accessible green spaces as a strategy for fracture and osteoporosis prevention. In the long term, such initiatives translate to reduced public health expenses, along with physical and emotional gains in communities adopting environmental strategies, they concluded.
This article was translated from the Medscape Portuguese edition. A version of this article appeared on Medscape.com.
A recently published prospective study in JAMA Network Open identified a significant association between children’s bone health and their proximity to green areas.
The literature emphasized the benefits of childhood exposure to green spaces for neurocognitive, social, behavioral, and mental development, as well as well-being. In addition, such exposure is linked to lower body mass index, increased physical activity, and reduced risks for overweight, obesity, and hypertension. However, specific data on bone mineral density implications are limited.
To address this gap, Hanne Sleurs, PhD, a researcher at the Universiteit Hasselt in Belgium, and colleagues followed the bone health of 327 participants from birth to 4-6 years and examined correlations with individuals’ exposure to green areas. Data collection occurred from October 2014 to July 2021.
Green spaces were categorized as high (vegetation height > 3 m), low (vegetation height ≤ 3 m), and mixed (combination of both). The distances of green spaces from participants’ residences ranged from a radius of 100 m to 3 km. Radial bone mineral density assessment was conducted using quantitative ultrasound during follow-up consultations.
The scientists found that participants frequently exposed to high and mixed vegetation areas within a 500-m radius of their homes had significantly higher bone mineral density than those at other distances or those frequenting spaces with different vegetation. In addition, access to larger green spaces with mixed and high vegetation within a 1-km radius was significantly associated with a lower likelihood of low bone density in children.
“These findings illustrate the positive impact on bone health of early childhood exposure to green areas near their homes during critical growth and development periods, with long-term implications,” wrote the researchers.
The results aligned with those of a prior study in which authors noted factors contributing to families’ frequent park visits, including shorter distances, safety, and park organization, as well as the natural diversity and activities offered.
One hypothesis explaining improved bone density in children visiting green areas was increased physical activity practiced in these locations. The mechanical load from exercise can activate signaling pathways favoring bone development. Literature also gathered data on the influence of green areas on young populations engaging in physical activities, showing positive outcomes.
According to the study authors, the findings are crucial for public health because they emphasize the need for urban investments in accessible green spaces as a strategy for fracture and osteoporosis prevention. In the long term, such initiatives translate to reduced public health expenses, along with physical and emotional gains in communities adopting environmental strategies, they concluded.
This article was translated from the Medscape Portuguese edition. A version of this article appeared on Medscape.com.