Fulan Hu School of Public Health Shenzhen University Health Science Center Shenzhen, Guangdong People’s Republic of China
WeightControl.com: 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.
Even small amounts of weight loss, even 3%-5% of body weight, can provide significant health benefits to individuals with overweight and obesity.
WeightControl.com Interview with: Dr. Louis Aronne, MD, FACP Chief Medical Officer, Intellihealth Medical Director, Comprehensive Weight Control Center, Weill Cornell Medicine
Dr. Louis Aronne
WeightControl.com: 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.
The readers should take away that lifestyle factors are most important regarding successful weight-loss strategies.
WeightControl.com Interview with: Melanie Heitkamp, PhD Department of Prevention and Sports Medicine Centre for Sports Cardiology, University Hospital Technical University of Munich Munich, Germany
WeightControl.com: What is the background for this study?
Response: There are genetic loci influencing obesity risk in children, which have been identified by large genome-wide association studies. However, the current knowledge about associations between these obesity related genes and obesity treatment success is scarce and the results of previous studies are inconsistent. However, it is an important question as there is a wide inter-individual response to obesity treatment.
I would advise reducing the consumption of sugar-sweetened foods and beverages and instead eating more whole foods, like fruits and vegetables, which have many health benefits.
WeightControl.com Interview with: Katie Page, MD Associate Professor of Medicine Co-Director, Diabetes and Obesity Research Institute Department of Internal Medicine Division of Endocrinology USC Keck School of Medicine
WeightControl.com: What is the background for this study? What are the main findings?
Response:Health experts advise people to cut back on sugar. My team at Keck School of Medicine at USC has been researching whether the type of sugar people consume makes a difference on their health. In this paper, we examined how appetite regulating hormones respond to sucrose compared to glucose. Sucrose is a disaccharide that contains equal parts of glucose and fructose, whereas glucose is a simple sugar (or monosaccharide).
The different structures affect the way the sugars interact with tissues, which influences their effects on the body. In prior studies, we showed that the monosaccharide, fructose, produces lower levels of hunger suppressing hormones than glucose. In this study, we were interested in examining sucrose because it is more of a real-world sugar and one of the most commonly consumed added sugars in our diet.
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.
WeightControl.com Interview with: Dr. Marcelo Alves da Silva Mori PhD Professor,University of Campinas
WeightControl.com: 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.
Weight gain and obesity can affect anyone, regardless of age. There may be barriers that exist for older people with obesity.
Weightcontrol.com Interview with: Dr. Thomas M Barber MRCP, PhD Associate Professor Honorary Consultant Endocrinologist University of Warwick and UHCW NHS Trust
Dr. Barber
Weightcontrol.com: 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.
The severe hyperphagia and the feeling of permanent failure due to the situation of being unable to reduce body weight with conservative treatment options (increase exercise, reduce caloric intake) may affect the relationship within the family
WeightControl.com Interview with: Prof. Dr. Peter Kühnen Institute for Experimental Pediatric Endocrinology Charité Universitätsmedizin Berlin Berlin, Germany
Prof. Dr. Peter Kühnen
WeightControl.com: What is the background for this study? What are the main findings?
Response:The leptin melanocortin signaling pathway plays a pivotal role for central appetite regulation. Gene mutations in this pathway are leading to severe hyperphagia and early onset obesity. We present the data of two phase 3 trials, in which patients with POMC/PCSK1 or LEPR deficiency received treatment with the MC4R agonist setmelanotide. In the past, there were centrally acting obesity drugs, like the cannabinoid receptor inhibitor rimonabant, whose use was associated with depression. Therefore, here we present the data about suicidality and depression of the participants during the treatment with the MC4R agonist setmelanotide.
The main finding was that there was no consistent increase in depression or suicidal ideation / behavior of the treated patients. However, in all cases depressive episode or increase in suicidal ideation was related to the medical history of the participants.
It should be tested whether high fat or ketogenic diets can improve heart failure from typical etiologies such as myocardial infarction and chronic hypertension
WeightControl.com Interview with: Kyle S. McCommis, Ph.D. Assistant Professor Biochemistry & Molecular Biology St. Louis University School of Medicine
WeightControl.com: What is the background for this study? What are the main findings?
Response: It is well established that the heart is normally very flexible in what substrates it can metabolize in order to quickly adapt to different physiological scenarios. However, in cardiomyopathies such as heart failure, this metabolic flexibility is lost and there is a decreased ability for the heart to perform oxidative metabolism. This has previously been attributed mainly to a decrease in fat oxidation by the heart, but some studies also indicate decreased glucose oxidation.
We therefore were interested to see if the mitochondrial pyruvate carrier (MPC), which transports pyruvate derived from glucose or lactate into the mitochondria, could be playing a role in heart failure.
We first identified lower expression of the MPC proteins in failing human hearts compared to non-failing control hearts. We then created a MPC2 knockout mouse, which spontaneously developed heart failure with age. These failing hearts of course could not metabolize pyruvate, but they also displayed lower expression of fat oxidation enzymes.
We hypothesized that the hearts may be improved if we provided the mice with a diet that provided nutrients the hearts were better able to use. When we switched the diet to a low carbohydrate, high fat “ketogenic” diet, these MPC2 knockout mice no longer showed any signs of heart failure. We also aged some mice to where they developed severe heart failure, then switched them to the ketogenic diet, and shockingly observed almost complete reversal of their cardiac dysfunction. This lead us to question how the diet was rescuing these hearts; was it due to improved ketone body metabolism by the hearts, or due to improved fat metabolism from the large amount of dietary fat.
Essentially all of our experiments suggested that these failing hearts we regaining the ability to oxidize fatty acids, and were actually shutting off ketone body metabolism. Feeding the mice a normal “high fat” diet which contains enough carbohydrate and protein to not be overly ketogenic, was also able to prevent the heart failure in these mice.
Clinically significant weight loss is possible in underserved, low-income patients in primary care settings.
WeightControl.com Interview with: Peter Katzmarzyk, Ph.D., FACSM, FAHA, FTOS Professor and Marie Edana Corcoran Endowed Chair Pediatric Obesity and Diabetes Assoc Exec Dir for Population and Public Health Sciences Pennington Biomedical Research Center Baton Rouge, LA
WeightControl.com: What is the background for this study?
Response: Obesity remains one of the greatest public health threats, and there is good evidence that intensive lifestyle interventions should be a primary approach to obesity management and treatment. However, there has been minimal uptake of obesity treatment approaches in primary care, which is the cornerstone of medicine in the US.
WeightControl.com: What are the main findings?
Response: We developed an intervention to reduce calorie intake and increase physical activity that was delivered by health coaches embedded in primary care clinics. The sample was diverse with a large percentage of low-income and African American patients. The results demonstrated that patients in the intensive lifestyle intervention lost approximately 5% of their initial body weight, compared to patients in usual care who lost about 0.5% of their body weight. These weight loss differences between the two groups were maintained out to 2 years, which demonstrates the durability of the intervention.
With the current concerns that the pandemic may lead to increases in obesity rates, it’s important to develop appropriate and large-scale support options for those aiming to manage their weight.
WeightControl.com Interview with:
Dr Sarah-Elizabeth Bennett Senior Research Associate Slimming World, UK
WeightControl.com: What is the background for this study?
Response: This research is part of a larger Health and Wellbeing study, investigating the behaviour changes made by members of Slimming World, the UK’s largest group-based weight management organisation. New members were surveyed regularly over the course of one year and a representative sample of non-members were also surveyed at similar timepoints for comparison. The survey at the six-month point coincided with lockdown, so questions were added to learn more about how lockdown measures had impacted the nation’s health, wellbeing, and lifestyle behaviours. The following findings were based on the responses of 222 members who had completed all 3 surveys to-date and 637 non-members.
