Reduction in Cancer Risk Following Bariatric Surgery

Dr. Rustgi Interview with:
Vinod K Rustgi, MD, MBA
Professor of Medicine
Clinical Director of Hepatology
Director, Center for Liver Diseases and Liver Masses
Professor of Epidemiology
Professor of Pathology and Laboratory Medicine
New Brunswick, NJ 08901  What is the background for this study?  What are the main findings?

Response: ​Obesity is a burgeoning problem in the USA and globally. It is estimated that over $100 billion are spent in healthcare expenditures each year on those patients with fatty liver disease related to obesity-induced problems.

Lifestyle modification is very difficult to achieve on a sustained basis. Insurance companies have strict criteria for bariatric surgery. Our study of a database of over 100 million lives spanning the years of 2007 to 2017 showed a marked reduction in all malignancies after bariatric surgery and particularly in obesity-related cancers such as colorectal, esophageal, pancreatic, ovarian, uterine, postmenopausal breast and kidney cancers.

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Retail Outlets Promote Impulse Buys of Sugary Items in Check-Out Aisles

Placement of these items may drive impulse buys, and because these stores sold products for children, parents and caregivers should be aware of these practices at the outset. Interview with:
Corey Hannah Basch, Ed.D., M.P.H., CHES
Professor and Department Chair Public Health
William Paterson University

Dr. Basch  What is the background for this study?  What are the main findings?

Response: There are many factors that influence food choices, which are not limited simply to access and availability. This study focused on exposure to opportunities for unplanned food and beverage purchases, specifically candy, snack foods, and sugary beverages are available in checkout lines in a convenience sample retail chain stores in New York City that sell products for children.

The main findings are that most of the stores in the sample sold at least one form of convenience foods at the checkout. In addition, “corral-style” checkout lines had a more diverse sample of snack foods available throughout the line.  

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Personalized Coupons, Recipes and Education Helped Shoppers Make Healthier Food Purchases

we are interested in scaling this work so it can reach more US adults and help them improve their diet quality and diet-related health. Interview with:
Maya Vadiveloo, PhD, RD
Assistant Professor
Nutrition and Food Sciences
University of Rhode Island

Dr.  Vadiveloo  What is the background for this study?  What are the main findings?

Response: We conducted this study with the goal of helping people make healthier dietary choices while at the grocery store. We know that food companies use personalized messages and discounts that prompt people to buy unhealthy foods. We tested whether similar approaches could be used to encourage people to buy healthier foods by sending people 2 personalized, healthy food coupons each week to make these foods more affordable. We also wanted our recommendations to reflect people’s dietary preferences, so we only sent people coupons that aligned with preferences they told us at the beginning of the study .

The coupons were directly linked to people’s loyalty cards and they also received a brief nutrition message and recipe via email every week.

Overall, we found that people liked the personalized healthy food incentives, that it prompted them to purchase more healthy foods, and improved the overall diet quality of their grocery purchases.

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Lockdown Effects of Obesity During the COVID-19 Pandemic

Our research suggests that we have to look beyond the direct effect of COVID-19 and mortality, and need to consider the medium- and long-term effects on non-COVID diseases such as diabetes. Interview with:
Associate Professor in Clinical Data Science and Honorary Consultant Cardiologist
Institute of Health Informatics, University College London
 Adjunct Associate Professor in Public Health
Amrita Institute of Medical Sciences, Kochi, India  What is the background for this study?

Response: Severe obesity was on the UK government’s list of moderate risk conditions for severe COVID-19 on 16 March 2020(1), with increased importance for social distancing and other measures.  Obesity is in itself a risk factor for chronic diseases, including diabetes and cardiovascular disease, which themselves increase the risk of severe COVID-19. We aimed to project the number of excess deaths in severely obese individuals. In addition, the lockdown can lead to prolonged periods of inactivity and weight gain, which could lead to increased burden of chronic diseases, particularly diabetes and cardiovascular diseases. To provide these projections, we used national electronic health records representative of the UK population.

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Successful Weight Loss Counseling with Both In-Clinic and Remote Primary Care Visits

Primary healthcare, even in under-resources rural settings, has the capacity to offer effective weight loss counseling through different types of patient visits Interview with:
Christie A. Befort, Ph.D., Professor

Associate Director, Cancer Prevention and Control
Co-Leader, Cancer Control and Population Health Program
KU Cancer Center  What is the background for this study?

Response: Primary care clinics are an important place for patients to get help with weight loss, especially for those who are at risk from obesity-related health complications or who have other medical conditions that may make weight loss more difficult.  This is especially true in remote rural areas where obesity prevalence is higher and there is less access to effective programs. What are the main findings?

Response: Rural primary care clinics are able to offer weight loss counseling to their patients with clinically meaningful long-term weight loss after 2 years for approximately 2 out of 5 patients.  In-clinic group visits have a small advantage over in-clinic individual visits for weight loss outcomes.

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Mediterranean Diet Linked to Liver Fat Reduction

The main finding from this study is that the green Mediterranean diet, the enhanced version of the Mediterranean diet, rich in walnuts, green tea, and Mankai aquatic plant and low in red/processed meat, was the most successful in liver fat reduction. Interview with:
Anat Yaskolka Meir RD Ph.D.
Post-doctoral fellow
Department of Epidemiology
Faculty of Health Sciences
Ben-Gurion University, Beer-Sheva, Israel  What is the background for this study?  What are the main findings?

Response: In the past 15 years, Prof. Shai’s group at the Ben Gurion University of the Negev has conducted several large-scale, long-term clinical trials among over 1000 participants. Results from our previous DIRECT, CASCADE, and CENTRAL trials indicated that the Mediterranean diet is superior to other diets in terms of reducing cardiometabolic risk (e.g., by achieving lower blood lipids levels). Moreover, specific plant components named “polyphenols” (secondary metabolites of plants with antioxidant properties) might associate with this beneficial effect observed. Following the conclusions from these trials, we designed the DIRECT PLUS trial, aimed to examine whether we can enhance the observed and known effect of the Mediterranean diet by adding specific polyphenol-rich food items. Specifically, we enriched the Mediterranean diet, naturally rich in polyphenols, by adding specific components: Mankai aquatic plant (as green shake), walnuts, and green tea, which provided additional 1240 mg polyphenols a day. We also instructed the participants to avoid red and processed meat. 

The main finding from this study is that the green Mediterranean diet, the enhanced version of the Mediterranean diet, rich in walnuts, green tea, and Mankai aquatic plant and low in red/processed meat, was the most successful in liver fat reduction. This group showed the greatest reduction of hepatic fat (-39%), as compared to the traditional Mediterranean diet (-20%) and the healthy dietary guidelines (-12%). The results were significant after adjusting for weight loss (currently, the primary treatment for fatty liver). Moreover, the prevalence of non-alcoholic fatty liver diseases was reduced in the green group by 50%.

Fried Foods Linked to Cardiovascular Disease Interview with:

Fulan Hu
School of Public Health
Shenzhen University Health Science Center
Shenzhen, Guangdong
People’s Republic of China  What is the background for this study?  What are the main findings?

Response: Increasing number of studies has explored the association of fried food consumption and risk of cardiovascular events and all-cause mortality. However, the association remains contradictory and dose–response association is unknown.

In this meta-analysis, we found that total fried food consumption was significantly associated with increased risk of major cardiovascular events, coronary heart disease, and heart failure. A linear association was observed for the relation of fried food consumption and major cardiovascular events, coronary heart disease, and heart failure.

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Intellihealth: Population Health Guidelines + Online Support Improves Weight Loss

Even small amounts of weight loss, even 3%-5% of body weight, can provide significant health benefits to individuals with overweight and obesity. Interview with:
Dr. Louis Aronne, MD, FACP
Chief Medical Officer, Intellihealth
Medical Director, Comprehensive Weight Control Center,
Weill Cornell Medicine

Dr. Louis Aronne  What is the background for the study “Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial”?

Response: More than 70% of U.S. adults have overweight or obesity. Online programs promoting lifestyle change have had some success in helping people achieve and maintain weight loss, but study results have been variable, and these programs have not been widely implemented in primary care. We studied the effectiveness of an online program we have developed (Intellihealth, formerly known as BMIQ) in routine primary care practices, both alone and integrated with population health management (with participants receiving additional support and outreach from nonclinical staff). The study’s objective was to determine whether a combined intervention integrating online weight management with population health management would increase weight loss at 12 months among primary care patients compared with the online program only and usual care.

The study, funded through an award from the Patient-Centered Outcomes Research Institute (PCORI), was carried out as a cluster randomized trial with 840 patients within the Brigham and Women’s Hospital Primary Care Center of Excellence, a group of 15 primary care practices, between 2016 and 2019. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes.

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Experimental Antibiotic May Boost Metabolism and Mitigate Obesity

No clinical trial has been conducted to prove this concept in humans just yet, current fluoroquinolones are not to be used for weight control at this point. Interview with:
Dr. Marcelo Alves da Silva Mori PhD
Professor,University of Campinas What is the background for this study? What are the main findings?

Response: microRNAs are small non-coding RNAs that play important roles in gene expression regulation. Aging and obesity leads to dysfunction of microRNA processing in adipose tissue, which in turn impairs the thermogenic capacity of brown fat and results in insulin resistance. Enoxacin is a small molecule fluoroquinolone that promotes microRNA biogenesis.

In our most recent paper, we used enoxacin as proof of principle to demonstrate in mice and human cells that drugs targeting the microRNA processing pathway can be used to enhance oxidative metabolism and promote thermogenesis, thus mitigating obesity.  

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Older Patients Are Able to Lose Weight As Well as Younger Patients

Weight gain and obesity can affect anyone, regardless of age. There may be barriers that exist for older people with obesity. Interview with:
Dr. Thomas M Barber MRCP, PhD
Associate Professor
Honorary Consultant Endocrinologist
University of Warwick and UHCW NHS Trust

Dr. Barber What is the background for this study? What are the main findings?

Response: Obesity management within the UK is structured into a 4-tiered system. Tier 3 refers to hospital-based management that usually consists of medical input combined with focused dietary and psychological support where required. Typically within hospital-based tier 3 obesity services, certain subgroups of the population are under-represented, including men and older people. There are likely multiple reasons for this. However, obesity can affect anyone regardless of sex, age or any other classification.

To improve the health and wellbeing of the nation, it is important that we facilitate effective weight management for as many people with obesity as possible. Much of the chronic effects of weight gain and obesity are similar to those that occur with ageing (including, for example increased cardiovascular risk). Therefore, older people with obesity can experience a type of ‘accelerated ageing’ with increased risk for co-morbidities and premature mortality.

The effective management of obesity is therefore particularly important for older people. Unfortunately, we live in an ageist society, which perhaps explains, at least in part, why older people are currently under-represented in obesity services provided by the NHS. The aim of our study was to explore the effects of older age on ability to lose weight within the context of a hospital-based tier 3 obesity service.