Investigational drug may promote weight loss

A medication that is under review by the Food and Drug Administration for the treatment of Type 2 diabetes may also promote weight loss, according to a study published online today in the Lancet. The drug, liraglutide, was approved earlier this year in Europe for the treatment of diabetes. It is marketed under the brand name Victoza.

Liraglutide is an injected drug that stimulates the release of insulin when glucose levels become too high. It also helps curb appetite. In the new study, researchers in Denmark assigned 564 obese individuals to one of four liraglutide doses, a placebo or the weight-loss drug orlistat. All the participants followed a diet of about 500 less calories than they normally consumed. They also increased their physical activity levels.

After 20 weeks, those on liraglutide lost more weight than those on the placebo. Participants on the highest dose of liraglutide lost 15 pounds compared with 6 pounds on the placebo and 9 pounds on orlistat. Three-quarters of the subjects on the two highest doses of liraglutide lost 5% or more of their body weight. The medication also reduced blood pressure and symptoms of pre-diabetes.

Side effects were nausea and vomiting but no serious adverse events were reported. Patients did not seem to mind injecting the drug, the authors noted. However, longer studies are needed on the drug, said in an accompanying editorial by Dr. George A. Bray of the Pennington Biomedical Research Center at Louisiana State University.

"Whether long-term use of an injectable drug is palatable as a treatment for obesity is yet to be established," he said.

The FDA has also raised questions about whether the medication can cause thyroid tumors, said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York.

"As a weight loss drug, liraglutide faces many hurdles," Roslin said in a statement. But, "drugs that can control diabetes, without causing weight gain, have huge potential. Furthermore, this group of patients is used to injections of insulin and Byetta. For a primary obesity drug to require injections would require blockbuster data."

- Shari Roan 

Photo credit: Tim Sloan  /  AFP  /  Getty Images.

Looking for health advice? Dr. Coca-Cola will see you now

When the American Academy of Family Physicians announced it had received a substantial grant to enhance educational information about nutrition on its FamilyDoctor.org site, you’d think health experts would have been happy.

But the money was earmarked to focus on the role of beverages and sweeteners in a healthy diet. And it came from the world’s largest beverage maker, the Coca-Cola Co.

No, “happy” isn’t exactly the word to describe the way some health experts feel about this deal. “Distressed” and “disappointed” are more like it, according to a sharply worded letter sent Wednesday to Dr. Douglas E. Henley, the academy’s chief executive.

“We urge the AAFP to regain its credibility by rejecting the deal with Coca-Cola,” the letter stated. “If the AAFP declines to do that, we urge your organization to reassert its support for the public health (and its own independence) by supporting a warning label on caloric sugar-sweetened beverages and a federal tax on soft drinks to support health promotion or health insurance programs.”

The letter was signed by 22 doctors, nutritionists and health advocates, including obesity experts Dr. George Bray of Louisiana State University’s Pennington Biomedical Research Center, Dr. Matthew Gillman of Harvard Medical School, and Barry Popkin, director of the University of North Carolina's Interdisciplinary Obesity Center. It asks Henley to respond to Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest, a leading proponent of a soda tax.

The letter noted that soda is “the only food or beverage that has been demonstrated to promote overweight and obesity.” (Click here for an L.A. Times story on the scientific studies that support this claim.) But the signatories warned that the six-figure grant from Coca-Cola will prevent the doctors group from “criticizing sugar-sweetened beverages in the strongest language.”

In its own statement, Jacobson's group noted that Coca-Cola – which sells 1.6 billion servings of beverages each day – has a track record of partnering with health groups:

“In 2003, the American Academy of Pediatric Dentists took a $1 million payment from Coca-Cola. Before the payment, the dentists' group acknowledged the connection between sugary drinks and dental disease. But after the payment, the president of the AAPD told reporters that the ‘scientific evidence is certainly not clear’ on the role soft drinks play.”

American Family Physician, the academy's journal, published an article last year recommending that children and teens “consume no more than one serving of sweetened beverages (e.g., fruit juice, fruit drink, regular-calorie soft drink, sports drink, energy drink, sweetened or flavored milk, sweetened iced tea) per day.”

But today, FamilyDoctor.org advises parents of overweight children only to cut down on fast food and dessert. It makes no mention of soda or other sweetened drinks.

Henley told Food Navigator-USA.com that the academy was aware of the letter. But he stood by the partnership with Coke.

“We will move forward with this commitment together by providing educational materials on sweeteners and how to maintain a healthy, active lifestyle while still enjoying many of the foods and beverages consumers love,” he said in a statement.

Celeste Bottorff, Coca-Cola North America’s vice president of living well (yes, that’s actual her title), told FoodNavigatorUSA.com that the company has a long history of philanthropy that includes “many health organizations.”

-- Karen Kaplan

Photo: Would you trust health advice from the makers of this drink? Credit: Amy Sancetta / Associated Press

Extra pounds, and attitudes about them, can affect doctor-patient relationships

Doctors can be fairly significant, one would think, in helping people combat obesity-related health problems. But a good working relationship usually begins with respect. And that might be a stumbling block.

In a new study, researchers at Johns Hopkins University School of Medicine report on their questioning of  238 patients -- and their physicians -- from 14 medical offices about their encounters. The patients for whom doctors said they had little respect just happened to have higher body-mass index scores. 

Here's the news release. The study is to appear in the November issue of the Journal of General Internal Medicine.

And here's a recent L.A. Times column from Dr. Valerie Ulene suggesting that doctors might be at least partly to blame for those weight problems: What the doc doesn't say: You're overweight

Plus, an article exploring the effect of a physician's excess weight on patients: Does a doctor's weight matter?

Apparently, attitudes about weight can affect both sides of the doctor-patient relationship.

-- Tami Dennis

Photo: Daniel Acker / Bloomberg

 

Recommendations for new school meal nutrition standards

The nutrition standards behind the National School Lunch Program and the School Breakfast Program have not been updated since 1995. Today, the federal Institute of Medicine is issuing a report recommending new standards, calling for more produce, more whole grains. And for the first time, a limit to calories.

Thirty million children eat school lunch, and 10 million eat school breakfast -- and the IOM panel says it hopes new standards will help those children develop good habits that they carry into adulthood. That, the panel says, should help curb obesity and other health problems associated with diet.

The panel's recommendations go to the U.S. Department of Agriculture for possible implementation. It was the USDA which requested the report.

The panel says new standards would cost money -- for food as well as for training and capital improvements. But it says food costs would go up by less than 10% for breakfast and 25% or less for lunches. The government now spends $8.7 billion a year in reimbursements for school meals to school districts.

The recommendations are meant to bring school food in line with the dietary guidelines the government issues for Americans. It seeks to have the amount of sodium in school meals reduced by more than half over the next decade.

Among its recommendations: that calories be limited, based on age level, for breakfast and lunch, and that the sodium level for a typical lunch be eventually reduced to 740 milligrams. It also sets out targets for weekly servings of fruits and vegetables, and it calls for more whole grains.

"It's about time," says Matthew Sharp of the California Food Policy Advocates and one of the people who testified before the panel. Meals, he says, should be nutritious and affordable and they also should "teach kids healthy habits" and expose them to a variety of foods.

-- Mary MacVean

Extra help for the portion-challenged

The obesity crisis may be chalked up to a hundred different factors, but portion control is probably in the top 10. With people piling more and more food on their plates, it's no wonder that physicians and health experts are forever telling us we need to cut back on what we eat. They've even given us helpful tips, like using a deck of cards as a template for how big our protein servings should be.

But evidently people don't play cards anymore, or they don't know basic measurement units, because somebody felt extra help was needed.

Thus, Flavor Magic Portion Control Sheets were born. These thin sheets of dry marinade measuring three inches by four inches serve as both a guide for accurately measuring three to five ounces of protein cut one-half to one inch thick, plus add flavor and seasoning. Place the meat, chicken or fish on top of the sheet until the marinade and seasonings have transferred (about half an hour), then cook as desired. Flavors include zesty Cajun-Creole, garlic citrus teriyaki, Dijon honey mustard, and riviera tomato and basil, and the company claims they contain no MSG or preservatives. Each package of 15 servings retails for about $9.

While we're all for whatever works when it comes to eating more healthfully (within reason), it seems most people can figure out a reasonable portion size once they're given the dimensions. Of course, those same people are usually shocked when they come face to face with what a normal portion really looks like, but once they get used to it, it's not difficult to nail it. This isn't rocket science.

-- Jeannine Stein

Photo credit: Courtesy of Real Chef

Childhood abuse and neglect may be linked to adult obesity

Childhood neglect and abuse can leave mental and physical scars, but that's not all -- a new study says there may also be a correlation between abuse and obesity.

Researchers looked at court records of 410 children up to age 11 from 1967 to 1971 in a Midwest county who had court-substantiated cases of physical and sexual abuse and neglect. They were matched with 303 children of similar ages, sex, race and ethnicity and social class who had no abuse or neglect. On a followup of both groups about 30 years later, their body mass index scores were compared.

Among whites, those who were abused and neglected overall and those who were physically abused had significantly higher BMI scores as adults than the control group. Childhood physical abuse predicted higher adult BMI scores even when controlling for demographics, smoking and drinking alcohol. However, childhood sexual abuse or neglect were not predictive of having a higher BMI as an adult.

While this doesn't prove a causative effect, the study authors propose two theories why BMI scores could be higher among these groups: The physical abuse could have had affected the activation of the hypothalamic-pituitary-adrenal axis, in turn increasing peripheral cortisol, which has been associated with abdominal obesity. That axis is a part of the neuroendicrine system and controls functions such as calorie burning and reactions to stress. Also, overeating could be a way of coping with the trauma of abuse.

The study appears in the October issue of the journal Obesity.

-Jeannine Stein

Photo credit: Tim Sloan / AFP/Getty Images

More study needed to determine whether adding calorie counts to menus curbs obesity, researcher says

Going to McDonald's or KFC? What if you see the calorie counts posted on the menu? Would you change your plans? Researchers in New York tried to answer the question. You can read about their study here.

It’s no surprise that eating habits are hard to change. But the lead researcher also notes that it’s hard to assess the many anti-obesity public health efforts underway. Brian Elbel of New York University says more research is needed into the effects of putting calorie counts on menus.

It’s possible, he says, that the labels -- required in New York since July 2008 -- need more time to make a difference. Or perhaps the effect is hard to track at fast-food outlets. The researchers surveyed customers and examined receipts from several fast-food places. But what if the labels have kept some people away all together?

Elbel and other researchers are still evaluating the data they collected. And they’re planning another study, this time in a city (still to be decided) that’s about to adopt labeling laws, so they can look at the before and after.

Menu labeling is just one effort to combat obesity, and the diseases associated with it -- such as high blood pressure and diabetes. And Elbel says it may take several programs in conjunction. In L.A., the City Council banned new fast food spots in South Los Angeles -- an effort that isn't likely to help, according to a Rand Corp. study.

-- Mary MacVean

Photo: Mel Melcon / Los Angeles Times

This weight-loss message was brought to you by the makers of Oreos

The makers of Haagen-Dazs ice cream, Chef Boyardee canned pasta, Oreo cookies and Snickers bars are joining forces to combat … obesity.

That’s right. Nestle USA, ConAgra Foods, Kraft Foods Inc. and Mars, Inc. – along with the Coca-Cola Co., PepsiCo Inc., Hershey Co., Sara Lee Corp. and other giant food manufacturers – today announced the launch of the Healthy Weight Commitment Foundation. The goal of this new initiative is to reduce obesity, particularly in kids, by an unspecified amount over the next six years.

Eating less junk food may – or may not – be part of the solution. Participating companies are welcome to reformulate their products and reduce portion sizes, but they’re under no obligation to do so.

Instead, the emphasis is on the notion of “energy balance.” Regardless of what you eat, you’ll gain weight if the total number of calories consumed is greater than the number of calories burned through exercise and other activities. As David Mackay, the chairman of the foundation’s board, put it, kids and adults could do a better job of balancing their “calories in and calories out.”

It’s a convenient message for Mackay, who is also the president and CEO of Pop-Tart, Cheez-It and Keebler cookie-maker Kellogg Co. (Its Froot Loops and other cereals may or may not be considered health foods, depending on who you ask.)

Safeway Inc. and other large grocers are also part of the coalition, which has pledged $20 million to the don’t-necessarily-eat-less-but-definitely-exercise-more effort. As one skeptical consumer commented on a CBC News website: “$20M doesn't seem like very much for these huge companies. What is that, like 6 Super Bowl commercials?”

The foundation also includes several nonprofits, such as the American Council for Fitness and Nutrition Foundation, PE4life and the American Dietetic Assn. Foundation. The ADA was in hot water recently for appearing to back – and then backing away from – the controversial Smart Choices food labeling system.

Dr. Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, said she would be keeping the new initiative honest by tracking its progress and evaluating whether it is making “a significant difference for our nation’s children.” RWJF has committed $500 million – or roughly 150 Super Bowl commercials – to reducing childhood obesity by 2015.

The Healthy Weight Commitment Foundation does not yet appear to have sprung for a website detailing its efforts, but a news release can be found here.

-- Karen Kaplan

Photo: Can you eat like this if you just exercise more? Photo credit: Bryan Chan/Los Angeles Times

This number screams: Diet!

Confused by the various recommendations from doctors and nutritionists on how much he should weigh, a University of Nevada, Reno, statistician has devised a better way for people to gauge their weight.

The Maximum Weight Limit is a tool to advise people of the number that should set off alarm bells and whistles when they step on the scales. Using calculations, George Fernandez devised the tool so that it closely corresponds to weight recommendations listed on body mass index charts. But it's far easier to calculate and remember compared to BMI.

"When you drive, you have a speed limit. This is similar to that concept," says Fernandez, director of the Center for Research Design and Analysis. "This number tells people, 'This is your maximum weight. You should not going over that weight.' It's a simple concept that should stay in their heads."

The Maximum Weight Limit is calculated on a baseline height and weight. A man who is 5 feet 9 should weigh no more than 175 pounds. A woman who is 5 feet should weigh no more than 125 pounds. To find your Maximum Weight Limit, calculate how much taller or shorter you are in inches. A man should subtract or add 5 pounds for every inch taller or shorter than 5 feet 9. A woman should add or subtract 4.5 pounds for every inch she differs from the baseline height of 5 feet.

The number does not reflect a person's ideal weight, Fernandez says, because people differ in their build and muscle mass. The tool is meant to give people a stop sign. "This is something strict that says, 'This is your limit,' " he says. People who reach their limit should change their lifestyle to eat healthier and exercise more or should seek professional guidance to curtail further weight gain. "It's time to intervene and take steps immediately," he says.

Fernandez came up with the formula after talking to doctors and nutritionists about his own weight. "They all came up with different numbers: a weight range, ideal weight, healthy weight, BMI." After delving into research on weight guidelines, Fernandez says he was struck by how complex the BMI calculation was. BMI was introduced by a Belgian statistician more than 200 years ago, Fernandez says. "It's a fine, valid measurement for identifying or diagnosing overweight and obesity. But for common people, it's hard."

Fernandez is presenting his theory today at a conference of the Nevada Public Health Assn. He plans to begin testing the Maximum Weight Limit to see whether people find it helpful and to identify whether the number could replace BMI in clinical studies on weight.

-- Shari Roan

Photo: Maximum Weight Limit charts for men and women. Credit: George Fernandez, University of Nevada, Reno.

Rodent of the Week: Fat messes with your mind

The brain is increasingly the target for understanding why people overeat and become obese. A new study, in rodents, shows that some forms of dietary fat apparently sabotage a system in the body that is designed to prevent overeating.

The study, from researchers at UT Southwestern Medical Center, showed that certain fats cause the brain to send messages to the body to ignore the normal mechanisms involved in weight regulation. Those mechanisms are hormones, such as leptin and insulin, that normally work by telling us we're full and should stop eating, said Dr. Deborah Clegg, the lead author of the study. One type of saturated fat, palmitic acid, is particularly effective at blunting the normal hormone response. Palmitic acid is found in butter, cheese, ice cream, milk and beef.

"Normally, our body is primed to say when we've had enough," Clegg said in a news release. "But that doesn't always happen when we're eating something good. What we've shown in this study is that someone's entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets 'hit' with the fatty acids, and you become resistant to insulin and leptin. Since you're not being told by the brain to stop eating, you overeat."

The researchers also found that this effect lasts for about three days. So one splurge of foods high in fatty acids can cause a lengthy eating binge.

Though the study was in animals, Clegg said that saturated fat "causes you to eat more."

The study appears in the September issue of the Journal of Clinical Investigation.

-- Shari Roan

Photo credit: Advanced Cell Technology, Inc.