Update
On Obesity and Diabetes
Dave Joffe,
Editor in Chief
I had an
opportunity to attend the 3rd
Annual Conference on Obesity this past weekend. The
conference was attended by more than 125 medical professionals,
including physicians, nurse practitioners, physician assistants,
dietitians, nurses and pharmacists. The topics included
“Fundamental
Insights: Diagnosis and Management of Obesity”
”Overview of the Obesity Epidemic in Our Society”
”Outcomes from Clinical Interventions to Promote Behavior
Change and Weight”
“Management
of Childhood Obesity”
There were
some interesting new data presented about:
“Advancements
in Obesity Clinical Research Brain's Food-Intake Circuitry:
Decisions about Whether or Not to Eat” and “Regulation
of Body Weight in Humans”
I
found special interest in the observations made by Shiriki
Kumanyika, PhD, MPH, RD,
in her discussion “The Role that Ethnicity,
Socioeconomic Factors and Culture Play in Obesity”.
As a diabetes
educator and pharmacist, I have had the opportunity to work with
many minority patients and her overview was very beneficial in
giving me extra insight into some of the challenges I had not
been able to overcome.
Dr.
Kumanyika, informed us that all minority groups have greater obesity than whites. There is a growing
epidemic of obesity in children and that of all groups, young
black adolescent women are the fastest growing. Some of the
reasons for this include the perception that losing too much
weight may look like HIV or crack cocaine abuse.
Her
research showed that there were three times the alcohol access
locations, and 40 percent more fast food restaurants and
convenience stores within minority living areas. In addition
there are only 25% of the supermarkets where healthier foods are
sold in these areas compared to more affluent areas. Television
advertising, which is second only to auto advertising in dollars
spent, doesn’t help either,
Her research found that there were at least 30% more food
commercials during shows focused on black audiences and these
featured mostly junk food.
Dr.
Kumanyika let us know that in order to be successful with these
patients, it will be important to help them to see these things
and to help them to overcome cultural medical myths. These myths
include:
Black women tolerate extra weight well
They don't get heart disease
Men want them less if they lose weight, in
fact after pregnancy black women consume 12% more calories over
long term yet low birth weight is more common.
Overall
Dr. Kumanyika helped all of us understand the special
circumstances that minority groups face and how we could help
them be more successful.
Michael
Rosenbaum, MD, shared
his research into “The Regulation of Body Weight”.
This discussion dealt with the evolutionary process of weight
retention and weight loss. He and his colleagues have spent 18
years studying the genetic, epidemiological, and physiological
evidence that body fatness/weight is regulated and that the
increasing prevalence of obesity in the western society reflects
the interactions of genes that have been selected for over many
millennia with an environment which favors their expression.
They have
looked at the question “Why should evolution select genes
defending body fatness”
The answers
they found include:
Increased
likelihood of survival during frequent periods of under
nutrition
Increased
Fertility in women
Increased
ability of women to feed their offspring.
Dr. Rosenbaum
pointed out that there are no real environmental pressures to
cause a change in our genes. In other words having adequate
processed foods and cars and other conveniences are not
pressures to cause our genes to change.
I
think his research is important to us in the near term, as it
explains why maintaining weight loss is so difficult.
His team
determined that a 10% body weight loss would increase muscle
efficiency by 18% therefore causing a decreased need for
calories per body effort. As an example a 200 lb man who loses
20 lbs to 180 lbs will require 300 kcal/day less to maintain his
weight than a man who’s normal regulated weight is 180 lbs. In
addition this increased muscle efficiency made weight loss
harder as more pounds were lost and may be a good explanation
for the weight loss plateau that many of our patients reach.
He did share
that the higher the wattage of the workout the better the weight
loss.
We will have
more from Dr Rosenbaum in a later issue.
Information
was taken from presentations by:
