Take it from a doctor: Heart surgeon says statins DO NOT work, can even increase risk of diabetes and obesity


Image: Take it from a doctor: Heart surgeon says statins DO NOT work, can even increase risk of diabetes and obesity

If you aren’t taking statins, there is a good chance you know several people who do. After all, a quarter of the American population over the age of 45 takes one daily. Given their widespread use, you would think they are incredibly effective and safe, but nothing could be further from the truth – and some doctors are speaking out about the dangers.

When a respected heart surgeon like Dr. Dwight Lundell, who is the retired Chief of Surgery and Chief of Staff at Arizona’s Banner Heart Hospital, voices his concerns about statins, everyone should take notice. With 25 years of experience and more than 5,000 open heart surgeries under his belt, the doctor recently confessed that he, like many other physicians, has been getting it wrong when it comes to statins.

Dr. Lundell said that statins are no longer working, and the recommendations to take such medications and severely restrict fat intake are “no longer scientifically or morally defensible.”

As you might expect, his comments were not welcomed by the medical industry. Statins are huge money-makers in a population that is rife with obesity, poor eating habits and heart health concerns. Costing anywhere from $53 to $600 per month, drugs like Lipitor have racked up lifetime sales of $125 billion, while Crestor, 2013’s top-selling statin, generated $5.2 billion of revenue that year alone. With more people taking these drugs than ever, why are heart disease-related deaths still rising?

Lundell says that it’s time for a paradigm shift in how heart disease is treated now that we know its true cause is arterial wall inflammation. He said that foods full of sugars and simple carbohydrates, along with processed foods with omega-6 oils, “have slowly been poisoning everyone” and our bodies react to such “foreign invaders” with inflammation in the walls of arteries. If this inflammation is the cause of heart disease rather than high cholesterol, of course, there is no need for cholesterol-lowering statins. The inflammation, he says, causes the cholesterol to accumulate in blood vessel walls, so it’s the inflammation that we need to target.

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Those whose livelihoods depend on statin profits won’t be too thrilled with his advice: “By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.”

They’d much rather have people continuing to bark up the wrong tree, avoiding beneficial fats in favor of the very processed foods that create high cholesterol in the first place so they can convince you that you need their medications to bring it back down – medications that cause a slew of other health problems that will only drive you to need even more pills as the profits pile up.

For example, statins have been shown in studies to double your chances of developing diabetes and raise your risk of suffering serious diabetic complications, and they’ve also been linked to obesity.

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Try a natural approach to heart health

So what should you do if you want to enhance your heart health? Increasing your physical activity, regardless of your current level, can make an impact, whether you’re completely sedentary and decide to start taking an evening stroll a few times a week or you already lift weights and choose to increase your reps.

Avoiding the foods Dr. Lundell identified as dangerous for heart health is another step that can make a big difference, so say goodbye to simple sugars and carbohydrates like refined sugar, white bread, and cookies, along with processed food.

While statins aren’t nearly as effective or safe as those who sell them would like you to believe, there are some very simple and affordable ways to keep your heart healthy without any negative side effects.

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Obesity, Weight Gain Linked to Fibrosis Progression in NAFLD


Obesity and weight gain are independently associated with an increased risk for fibrosis progression in patients with nonalcoholic fatty liver disease (NAFLD), a large cohort study has found. Weight loss was negatively associated with fibrosis progression.

“This association remained significant after adjustment for confounders including baseline BMI [body mass index], indicating that weight change per se is an independent risk factor for fibrosis progression. Higher BMI at baseline was also positively associated with APRI [aspartate aminotransferase to platelet ratio index] progression,” the researchers write.

The study, by Yejin Kim, MHS, Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues, was published online July 15 in Clinical Gastroenterology and Hepatology.

The researchers analyzed data from 40,700 adults who received comprehensive annual or biennial examinations as part of the Kangbuk Samsung Health Study. They included participants with fatty liver, as evidenced on abdominal ultrasonography, who had undergone a health examination between 2002 and 2016 and who had had two or more follow-up visits through the end of 2016. Patients were followed for a median of 6 years.

The authors explain that they used APRI score to assess fibrosis progression because it is noninvasive and the formula includes neither BMI nor age. The study’s primary endpoint was the development of intermediate to high probability of advanced fibrosis, as assessed by APRI.

The researchers first adjusted for age and sex, and later adjusted for center, year of screening examination, smoking status, alcohol consumption, regular exercise, education level, BMI, diabetes history, cardiovascular disease history, and hypertension history. A second model also adjusted for homeostatic model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP).

There were 275,421.5 person-years of follow-up, during which 5454 patients with low APRI progressed to intermediate or high APRI.

When stratified into quintiles by weight change, those with the greatest weight loss (-43.4 to -2.3 kg) had a significantly reduced risk for progression (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.62 – 0.74), compared with those whose weight was stable. Similarly, patients with small degrees of weight loss (-2.2 to -0.6 kg) had a reduced risk for progression (HR, 0.86; 95% CI, 0.78 – 0.94).

By contrast, any weight gain appeared to increase progression risk. Specifically, those who gained a smaller amount of weight (0.7 to 2.1 kg) showed a 17% risk increase (HR, 1.17; 95% CI, 1.07 – 1.28), and those who gained more (2.2 to 26.5 kg) had a 71% increased risk (HR, 1.71; 95% CI, 1.58 – 1.85).

These associations were not mediated by inflammation or insulin resistance after adjustment for HOMA-IR and hsCRP.

Compared with those whose baseline BMI was from 18.5 to 22.9 kg/m2, the HRs for APRI progression were as follows: 1.67 (95% CI, 0.74 – 3.73) for BMI of <18.5 kg/m2; 1.13 (95% CI, 1.02 – 1.26) for BMI of 23 – 24.9 kg/m2; 1.41 (95% CI, 1.28 – 1.55) for BMI of 25 – 29.9 kg/m2; and 2.09 (95% CI, 1.86 – 2.36) for BMI of ≥ 30. All values were determined after adjusting for age, sex, health center, year of screening examination, smoking status, alcohol consumption, exercise, education, diabetes history, cardiovascular disease history, and hypertension history. These associations remained significant after adjustments for HOMA-IR and hsCRP.

“When the impact of weight change on APRI worsening was compared with that of other metabolic factors, increasing quintiles of weight change, triglyceride, uric acid, and HOMA-IR and decreasing quintiles of high-density lipoprotein cholesterol were associated with increased risk of APRI worsening in a dose-response manner (all P for trend <.001), with weight change showing the greatest magnitude of association among the metabolic factors evaluated,” the authors explain.

The associations of both weight change and BMI with APRI progression were still seen in patients with NAFLD who had no history of diabetes or cardiovascular disease.

“Although the mechanisms underlying the association between excessive adiposity or fat gain and the fibrosis progression are not yet fully understood, insulin resistance and inflammation are thought to be involved,” the researchers write. “However, after adjustment for HOMA-IR and hsCRP, the association between obesity, weight gain, and fibrosis progression remained significant. Multiple other factors, including oxidative stress and lipotoxicity, have also been implicated in fibrosis progression.”

Study limitations include the use of ultrasonography to diagnose NAFLD. Although liver biopsy is considered the gold standard, it is not be feasible in a large, low-risk population, and abdominal ultrasound is acceptable, the authors say. Also, although APRI “has demonstrated a reasonable utility as a noninvasive method for the prediction of histologically confirmed advanced fibrosis…there are no currently available longitudinal data to support the use of worsening noninvasive fibrosis markers as an indicator of histologic progression of fibrosis stage over time.”

The study was conducted among fairly healthy young and middle-aged Koreans and may not be generalizable to those of other ages, or to groups in which comorbidities are more prevalent, or to other racial or ethnic groups.

“In this large cohort study of young and middle-aged adults with NAFLD, obesity and weight gain were significantly and independently associated with an increased risk of developing fibrosis progression. Strategies for maintaining a healthy weight and preventing weight gain may help reduce fibrosis progression and its associated consequences in individuals with NAFLD,” the researchers conclude.

Obesity to Blame for Almost 1 in 20 Cancer Cases Globally


Excess body weight is responsible for about 4 percent of all cancer cases worldwide and an even larger proportion of malignancies diagnosed in developing countries, a new study suggests.

As of 2012, excess body weight accounted for approximately 544,300 cancers diagnosed annually around the world, researchers report in CA: A Cancer Journal for Clinicians, December 12. While overweight and obese individuals contributed to just 1 percent of cancer cases in low-income countries, they accounted for 7 to 8 percent of cancers diagnosed in some high-income Western countries and in Middle Eastern and North African nations.

“Not many people know about excess body weight and its link to cancer,” said lead study author Hyuna Sung of the American Cancer Society in Atlanta.

“Trying to achieve healthy weight and maintaining it is important and may reduce the risk of cancer,” Sung said by email.

But the proportion of people who are overweight and obese has been increasing worldwide since the 1970s, the researchers note. As of 2016, 40 percent of adults and 18 percent of school-age children were overweight or obese, for a total of almost 2 billion adults and 340 million kids worldwide.

While the proportion of people with excess body weight has increased rapidly in most countries and across all population groups, the surge has been most pronounced in some low- and middle-income countries that have adopted a Western lifestyle with too little exercise and too many unhealthy foods, the study team writes.

“The simultaneous rise in excess body weight in almost all countries is thought to be driven largely by changes in the global food system, which promotes energy-dense, nutrient-poor foods, alongside reduced opportunities for physical activity,” Sung said.

Overweight and obesity has been definitively linked to an increased risk of 13 cancers affecting the breast, colon and rectum, uterus, esophagus, gallbladder, kidney, liver, ovary, pancreas, stomach, and thyroid, brain and spinal cord, and blood cells.

More recently, some research has also tied excess weight to risk for prostate tumors as well as cancers of the mouth and throat.

National wealth is the most apparent systematic driver of population obesity, the study authors note.

The economic transition to a wealthier economy brings with it an environment that precipitates obesity; each $10,000 increase in average per capita national income is associated with a 0.4 increase in body mass index among adults, the study authors note.

However, obesity is uncommon in some high-income Asia-Pacific countries, which is likely a result of consuming healthier foods like lean fish and veggies and eating fewer calories, as well as active transportation and walking as part of daily activity, the authors point out.

Still, the report offers fresh evidence of the need for policies that promote healthy eating and exercise habits as a way to battle obesity and reduce the global burden of cancer, the authors argue.

Dietary interventions might include eliminating trans-fats through the development of legislation to ban their use in the food chain; reducing sugar consumption through effective taxation on sugar-sweetened beverages; implementing subsidies to increase the intake of fruits and vegetables; and limiting portion and package size to reduce energy intake and the risk of excess body weight.

Activity interventions might include encouraging urban planning that promotes high-density housing with sidewalks, accessible public transportation and widespread availability of open spaces, parks and places to walk and cycle.

“Based on cancer alone, this report makes the case for allotting significant resources to addressing the global obesity epidemic, and those efforts have to address multiple factors that are creating ‘obesigenic’ societies,” said Dr. Graham A. Colditz of Washington University School of Medicine in St. Louis.

“The actions of individuals are important when it comes to weight – eating a healthy diet and exercising regularly, for example,” Colditz, who wasn’t involved in the report, said by email. “But unless those actions are supported by policies, infrastructure, schools, and employers, they’re less likely to take hold and be broadly successful over time.”

Curcumin reduces the effects of a high-fat diet


Image: Curcumin reduces the effects of a high-fat diet

Diets high in fat are known as major contributors to many health diseases, such as heart disease, and cancer. Researchers at Jawaharlal Institute of Postgraduate Medical Education and Research in India discovered that taking curcumin supplements minimizes the damage caused by a high-fat diet.

In their study, the researchers looked at the beneficial effects of curcumin on inflammation, oxidative stress, and insulin resistance in high-fat-fed rats. They examined two groups of rats: one group fed with a high-fat diet only and another group given a high-fat diet with 200 milligrams per kilogram (mg/kg) body weight of curcumin every day for 10 weeks.

The researchers measured the rats’ food intake, body weight, and biochemical parameters at the start and the end of the study. After 10 weeks, they also measured the oxidative stress parameters in skeletal muscle and liver triglyceride levels.

The results revealed that the high-fat diet increased the body weight and liver fat. It also increased the levels of plasma glucose, insulin, insulin resistance, total cholesterol, triglycerides, and very low-density lipoprotein cholesterol (VLDL-c), and decreased high-density lipoprotein (HDL) cholesterol.

The high-fat diet also increased inflammation and oxidative stress in skeletal muscles. It also increased liver triglyceride content and caused fat buildup in the liver.

However, the supplementation with curcumin significantly improved these changes. Curcumin supplementation significantly reduced body weight, liver adipose tissue, glucose, insulin, and insulin resistance. In addition, it decreased plasma levels of total cholesterol, triglycerides, VLDL-c, and inflammatory markers, and increased HDL cholesterol. Moreover, it reduced oxidative stress, hepatic triglyceride content, and liver fat deposition.

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With these findings, the researchers concluded that curcumin could improve lipid levels, oxidative stress, inflammation, and insulin resistance caused by a high-fat diet.

Curcumin and turmeric

Curcumin is the active ingredient of the spice called turmeric and is responsible for most of the spice’s health benefits. It takes up about two to eight percent of most turmeric preparations and gives turmeric its distinct color and flavor.  Here are some health benefits of turmeric and curcumin backed up by scientific evidence:

  • Cancer: One of the most notable benefits of turmeric and curcumin is their ability to prevent cancer. Turmeric and curcumin may help prevent cancer by reducing the activity of colon and other cancer cells. A new study published in the Proceedings of the National Academy of Sciences revealed that curcumin inhibits to the DYRK2 enzyme. Inhibiting this enzyme stops protein complexes known as proteasomes that contribute to cancer development. This action interrupts the proliferation of cancer cells, reducing tumors, and slowing cancer’s growth. This is beneficial for preventing proteasome-addicted cancers, such as triple-negative breast cancer and multiple myeloma.
  • Antibacterial: Turmeric and curcumin have powerful antibacterial effects. They have been reported to inhibit the growth of many disease-causing bacteria.
  • Antifungal: Studies have also reported that turmeric and curcumin have antifungal effects. They can disrupt fungal cell membranes and could be used with other fungal medicines for better effect.
  • Diabetes: Turmeric and curcumin can improve blood sugar metabolism and potentially reduce the effects of diabetes in the body.
  • Heart disease: As mentioned in the Indian study, curcumin reduced bad LDL cholesterol and triglycerides. These effects, which were also seen in earlier studies, can cut the risk of heart disease.
  • Liver health: Turmeric and curcumin can also protect the liver from damage caused by oxidative stress.
  • Obesity: Research has shown that turmeric and curcumin may inhibit the inflammatory pathway related to obesity and may help control body fat.
  • Osteoarthritis: Plant compounds in turmeric, including curcumin, can decrease inflammatory markers and relieve osteoarthritis symptoms, such as pain and stiffness.

Who’s to Blame for Fat Shaming?


It’s time for the medical community to admit mistakes and stop blaming patients for obesity

Obesity is such an emotionally charged issue in large part because it has become entangled with a person’s willpower and character. This makes it different from almost every other disease due to the unspoken accusation that you did it to yourself.

Many physicians unconsciously engage in fat shaming because they believe that pointing out the many ways a person could’ve done better gives patients extra motivation to lose weight. As if the whole world was not reminding them every single day.

When it comes to fat shaming, I believe the camp that’s popularized the “Calories In, Calories Out” (CICO) mentality are responsible for a share of the blame. I’m talking about physicians and researchers who constantly insist that “a calorie is a calorie” or “it’s all about calories” or “eat less, move more.” What they actually imply with this rhetoric is “it’s all your fault.” Instead of treating the disease of obesity with compassion and understanding, this mentality infuses it with personal shame. I’m here to argue that calories in versus calories out is a pack of lies fed to us by corporate interests.

Obesity has come to be understood as a fundamental imbalance of energy and calories. This is a crucial mistake.

If you develop breast cancer, for example, nobody secretly thinks you should have done more to prevent it. Nobody condescendingly tells you to “get with the program.” If you have a heart attack, you don’t face accusations. Yet obesity has become a disease singularly unique in its association with shame. CICO folks imply that if you could just stop eating and stop being lazy, you too could look like Brad Pitt. But it’s not true. Instead, this deflects the blame for the obesity epidemic from ineffective dietary advice that’s been peddled for decades.

Obesity has come to be understood as a fundamental imbalance of energy and calories. This is a crucial mistake. As I argue in my book The Obesity Code, this obsessive fixation on calories needs to stop.

Up until the 1970s, there was little obesity, and people had virtually no idea how many calories they ate or burned. Yet, without effort, people all around the world lived without obesity.

If the majority of people were able to avoid obesity without counting calories, then how did counting calories become so fundamental to weight stability since 1980? There are two main changes in the American diet since the 1970s. First, we were advised to lower the amount of fat in our diet and increase the amount of carbohydrates. The push to eat more white bread and pasta turned out not to be particularly slimming. But there’s also another problem that largely flew under the radar: the increase in meal frequency.

In the 1970s, people typically ate three times per day: breakfast, lunch, and dinner.

By 2004, the number of meals eaten per day had increased closer to six per day—almost double. Now, snacking was not just an indulgence, it was encouraged as a healthy behavior. Meal skipping was heavily frowned upon.

The admonishments against meal skipping were especially loud. Doctors and dietitians told patients to never ever skip a meal. Yet from a physiological standpoint, if you don’t eat, your body will burn some body fat to get the energy it needs. That’s all that happens. It’s the entire purpose the body carries fat in the first place. We store fat so we can use it. If we don’t eat, our bodies use the body fat.

As people gained more weight, the calls for people to eat more and more frequently grew louder. Doctors would say to cut calories and eat constantly—graze, like a dairy cow in a pasture.

People with obesity are victims of poor advice to eat more often and lower dietary fat in a desperate effort to reduce caloric intake.

But the advice didn’t work. Either the dietary advice for weight loss was bad, or the advice was good, but the person was not following it. I believe that the former is correct. Therefore, people with obesity are victims of poor advice to eat more often and lower dietary fat in a desperate effort to reduce caloric intake. Their weight problems are a symptom of a failure to understand the disease of obesity. I do not believe they have low willpower or weak character. Many physicians and researchers believe the latter conclusion. They believe the problem is the patients. But that conclusion suggests that the obesity epidemic is the result of a worldwide collective simultaneous loss of willpower and character. Was this obesity crisis actually a crisis of weak willpower?

Somewhere around 40 percent of the U.S. adult population is classified as obese and 70 percent are overweight or obese. Suppose a teacher has a class of 100 children. If one student fails, that may certainly be the child’s fault. Perhaps they didn’t study. But if 70 children are failing, then is it not more likely the teacher’s fault? In obesity medicine, the problem was never with the patient. The problem was the faulty dietary advice patients were given.

This is why obesity is not only a disease with dire health consequences but a disease that comes with a lot of shame. People blame themselves because everybody tells them it is their fault. Nutritional authorities throw around the euphemism “personal responsibility.” But it’s not.

The real problem is an underlying assumption that obesity is all about calories eaten versus calories burned. The natural conclusion of this line of thinking is that if you are obese, “it’s your fault” and you “let yourself go.” You either failed to control your eating or did not exercise enough. But obesity is not a disorder of too many calories. I argue it’s a hormonal imbalance of hyperinsulinemia. Cutting calories when the problem is insulin is not going to work.

Not only do people with weight problems suffer all the physical health issues—type 2 diabetes, joint problems, etc.—but they’re also shamed for it. It’s time for the medical community to admit its mistakes and stop playing the patient blame game.

Everything You Know About Obesity Is Wrong


For decades, the medical community has ignored mountains of evidence to wage a cruel and futile war on fat people, poisoning public perception and ruining millions of lives.

It’s time for a new paradigm.

 

From the 16th century to the 19th, scurvy killed around 2 million sailors, more than warfare, shipwrecks and syphilis combined. It was an ugly, smelly death, too, beginning with rattling teeth and ending with a body so rotted out from the inside that its victims could literally be startled to death by a loud noise. Just as horrifying as the disease itself, though, is that for most of those 300 years, medical experts knew how to prevent it and simply failed to.

In the 1600s, some sea captains distributed lemons, limes and oranges to sailors, driven by the belief that a daily dose of citrus fruit would stave off scurvy’s progress. The British Navy, wary of the cost of expanding the treatment, turned to malt wort, a mashed and cooked byproduct of barley which had the advantage of being cheaper but the disadvantage of doing nothing whatsoever to cure scurvy. In 1747, a British doctor named James Lind conducted an experiment where he gave one group of sailors citrus slices and the others vinegar or seawater or cider. The results couldn’t have been clearer. The crewmen who ate fruit improved so quickly that they were able to help care for the others as they languished. Lind published his findings, but died before anyone got around to implementing them nearly 50 years later.

This kind of myopia repeats throughout history. Seat belts were invented long before the automobile but weren’t mandatory in cars until the 1960s. The first confirmed death from asbestos exposure was recorded in 1906, but the U.S. didn’t start banning the substance until 1973. Every discovery in public health, no matter how significant, must compete with the traditions, assumptions and financial incentives of the society implementing it.

Which brings us to one of the largest gaps between science and practice in our own time. Years from now, we will look back in horror at the counterproductive ways we addressed the obesity epidemic and the barbaric ways we treated fat people—long after we knew there was a better path.

I have never written a story where so many of my sources cried during interviews, where they shook with anger describing their interactions with doctors and strangers and their own families.

About 40 years ago, Americans started getting much larger. According to the Centers for Disease Control and Prevention, nearly 80 percent of adults and about one-third of children now meet the clinical definition of overweight or obese. More Americans live with “extreme obesity“ than with breast cancer, Parkinson’s, Alzheimer’s and HIV put together.

And the medical community’s primary response to this shift has been to blame fat people for being fat. Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength. It is also an excuse to bully fat people in one sentence and then inform them in the next that you are doing it for their own good. That’s why the fear of becoming fat, or staying that way, drives Americans to spend more on dieting every year than we spend on video games or movies. Forty-five percent of adults say they’re preoccupied with their weight some or all of the time—an 11-point rise since 1990. Nearly half of 3- to 6- year old girls say they worry about being fat.

The emotional costs are incalculable. I have never written a story where so many of my sources cried during interviews, where they double- and triple-checked that I would not reveal their names, where they shook with anger describing their interactions with doctors and strangers and their own families. One remembered kids singing “Baby Beluga” as she boarded the school bus, another said she has tried diets so extreme she has passed out and yet another described the elaborate measures he takes to keep his spouse from seeing him naked in the light. A medical technician I’ll call Sam (he asked me to change his name so his wife wouldn’t find out he spoke to me) said that one glimpse of himself in a mirror can destroy his mood for days. “I have this sense I’m fat and I shouldn’t be,” he says. “It feels like the worst kind of weakness.”

My interest in this issue is slightly more than journalistic. Growing up, my mother’s weight was the uncredited co-star of every family drama, the obvious, unspoken reason why she never got out of the car when she picked me up from school, why she disappeared from the family photo album for years at a time, why she spent hours making meatloaf then sat beside us eating a bowl of carrots. Last year, for the first time, we talked about her weight in detail. When I asked if she was ever bullied, she recalled some guy calling her a “fat slob” as she biked past him years ago. “But that was rare,” she says. “The bigger way my weight affected my life was that I waited to do things because I thought fat people couldn’t do them.” She got her master’s degree at 38, her Ph.D. at 55. “I avoided so many activities where I thought my weight would discredit me.”

Chances of a woman classified as obese achieving a “normal” weight:0.8%Source: American Journal of Public Health, 2015 But my mother’s story, like Sam’s, like everyone’s, didn’t have to turn out like this. For 60 years, doctors and researchers have known two things that could have improved, or even saved, millions of lives. The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.

The second big lesson the medical establishment has learned and rejected over and over again is that weight and health are not perfect synonyms. Yes, nearly every population-level study finds that fat people have worse cardiovascular health than thin people. But individuals are not averages: Studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. They show no signs of elevated blood pressure, insulin resistance or high cholesterol. Meanwhile, about a quarter of non-overweight people are what epidemiologists call “the lean unhealthy.” A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people. Habits, no matter your size, are what really matter. Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.

The terrible irony is that for 60 years, we’ve approached the obesity epidemic like a fad dieter: If we just try the exact same thing one more time, we’ll get a different result. And so it’s time for a paradigm shift. We’re not going to become a skinnier country. But we still have a chance to become a healthier one.

A NOTE ABOUT OUR PHOTOGRAPHSSo many images you see in articles about obesity strip fat people of their strength and personality. According to a recent study, only 11 percent of large people depicted in news reports were wearing professional clothing. Nearly 60 percent were headless torsos. So, we asked our interview subjects to take full creative control of the photos in this piece. This is how they want to present themselves to the world.
“As a kid, I thought that fat people were just lonely and sad—almost like these pathetic lost causes. So I want to show that we get to experience love, too. I’m not some ‘fat friend’ or some dude’s chubby chasing dream. I’m genuinely happy. I just wish I’d known how possible that was when I was a kiddo.”— CORISSA ENNEKING

This is Corissa Enneking at her lightest: She wakes up, showers and smokes a cigarette to keep her appetite down. She drives to her job at a furniture store, she stands in four-inch heels all day, she eats a cup of yogurt alone in her car on her lunch break. After work, lightheaded, her feet throbbing, she counts out three Ritz crackers, eats them at her kitchen counter and writes down the calories in her food journal.

Or not. Some days she comes home and goes straight to bed, exhausted and dizzy from hunger, shivering in the Kansas heat. She rouses herself around dinnertime and drinks some orange juice or eats half a granola bar. Occasionally she’ll just sleep through the night, waking up the next day to start all over again.

The last time she lived like this, a few years ago, her mother marched her to the hospital. “My daughter is sick,” she told the doctor. “She’s not eating.” He looked Enneking up and down. Despite six months of starvation, she was still wearing plus sizes, still couldn’t shop at J. Crew, still got unsolicited diet advice from colleagues and customers.

Enneking told the doctor that she used to be larger, that she’d lost some weight the same way she had lost it three or four times before—seeing how far she could get through the day without eating, trading solids for liquids, food for sleep. She was hungry all the time, but she was learning to like it. When she did eat, she got panic attacks. Her boss was starting to notice her erratic behavior.

“Well, whatever you’re doing now,” the doctor said, “it’s working.” He urged her to keep it up and assured her that once she got small enough, her body would start to process food differently. She could add a few hundred calories to her diet. Her period would come back. She would stay small, but without as much effort.

“If you looked at anything other than my weight,” Enneking says now, “I had an eating disorder. And my doctor was congratulating me.”

Ask almost any fat person about her interactions with the health care system and you will hear a story, sometimes three, the same as Enneking’s: rolled eyes, skeptical questions, treatments denied or delayed or revoked. Doctors are supposed to be trusted authorities, a patient’s primary gateway to healing. But for fat people, they are a source of unique and persistent trauma. No matter what you go in for or how much you’re hurting, the first thing you will be told is that it would all get better if you could just put down the Cheetos.

Emily went to a gynecological surgeon to have an ovarian cyst removed. The physician pointed out her body fat on the MRI, then said, “Look at that skinny woman in there trying to get out.” This phenomenon is not merely anecdotal. Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Some of these doctors are simply applying the same presumptions as the society around them. An anesthesiologist on the West Coast tells me that as soon as a larger patient goes under, the surgeons start trading “high school insults” about her body over the operating table. Janice O’Keefe, a former nurse in Boston, tells me a doctor once looked at her, paused, then asked, “How could you do this to yourself?” Emily, a counselor in Eastern Washington, went to a gynecological surgeon to have an ovarian cyst removed. The physician pointed out her body fat on the MRI, then said, “Look at that skinny woman in there trying to get out.”

“I was worried I had cancer,” Emily says, “and she was turning it into a teachable moment about my weight.”

Other physicians sincerely believe that shaming fat people is the best way to motivate them to lose weight. “It’s the last area of medicine where we prescribe tough love,” says Mayo Clinic researcher Sean Phelan.

In a 2013 journal article, bioethicist Daniel Callahan argued for more stigma against fat people. “People don’t realize that they are obese or if they do realize it, it’s not enough to stir them to do anything about it,” he tells me. Shame helped him kick his cigarette habit, he argues, so it should work for obesity too.

This belief is cartoonishly out of step with a generation of research into obesity and human behavior. As one of the (many) stigma researchers who responded to Callahan’s article pointed out, shaming smokers and drug users with D.A.R.E.-style “just say no” messages may have actually increased substance abuse by making addicts less likely to bring up their habit with their doctors and family members.

Plus, rather obviously, smoking is a behavior; being fat is not. Jody Dushay, an endocrinologist and obesity specialist at Beth Israel Deaconess Medical Center in Boston, says most of her patients have tried dozens of diets and have lost and regained hundreds of pounds before they come to her. Telling them to try again, but in harsher terms, only sets them up to fail and then blame themselves.

89%of obese adults have been bullied by their romantic partnersSource: University of Connecticut, 2017 Not all physicians set out to denigrate their fat patients, of course; some of them do damage because of subtler, more unconscious biases. Most doctors, for example, are fit—“If you go to an obesity conference, good luck trying to get a treadmill at 5 a.m.,” Dushay says—and have spent more than a decade of their lives in the high-stakes, high-stress bubble of medical schools. According to several studies, thin doctors are more confident in their recommendations, expect their patients to lose more weight and are more likely to think dieting is easy. Sarah (not her real name), a tech CEO in New England, once told her doctor that she was having trouble eating less throughout the day. “Look at me,” her doctor said. “I had one egg for breakfast and I feel fine.”

Then there are the glaring cultural differences. Kenneth Resnicow, a consultant who trains physicians to build rapport with their patients, says white, wealthy, skinny doctors will often try to bond with their low-income patients by telling them, “I know what it’s like not to have time to cook.” Their patients, who might be single mothers with three kids and two jobs, immediately think “No, you don’t,” and the relationship is irretrievably soured.

When Joy Cox, an academic in New Jersey, was 16, she went to the hospital with stomach pains. The doctor didn’t diagnose her dangerously inflamed bile duct, but he did, out of nowhere, suggest that she’d get better if she stopped eating so much fried chicken. “He managed to denigrate my fatness and my blackness in the same sentence,” she says.

“There is so much agency taken from marginalized groups to mute their voices and mask their existence. Being depicted as a female CEO—one who is also black and fat—means so much to me. It is a representation of the reclamation of power in the boardroom, classroom and living room of my body. I own all of this.”— JOY COX

Many of the financial and administrative structures doctors work within help reinforce this bad behavior. The problem starts in medical school, where, according to a 2015 survey, students receive an average of just 19 hours of nutrition education over four years of instruction—five hours fewer than they got in 2006. Then the trouble compounds once doctors get into daily practice. Primary care physicians only get 15 minutes for each appointment, barely enough time to ask patients what they ate today, much less during all the years leading up to it. And a more empathic approach to treatment simply doesn’t pay: While procedures like blood tests and CT scans command reimbursement rates from hundreds to thousands of dollars, doctors receive as little as $24 to provide a session of diet and nutrition counseling.

Lesley Williams, a family medicine doctor in Phoenix, tells me she gets an alert from her electronic health records software every time she’s about to see a patient who is above the “overweight” threshold. The reason for this is that physicians are often required, in writing, to prove to hospital administrators and insurance providers that they have brought up their patient’s weight and formulated a plan to bring it down—regardless of whether that patient came in with arthritis or a broken arm or a bad sunburn. Failing to do that could result in poor performance reviews, low ratings from insurance companies or being denied reimbursement if they refer patients to specialized care.

Another issue, says Kimberly Gudzune, an obesity specialist at Johns Hopkins, is that many doctors, no matter their specialty, think weight falls under their authority. Gudzune often spends months working with patients to set realistic goals—playing with their grandkids longer, going off a cholesterol medication—only to have other doctors threaten it all. One of her patients was making significant progress until she went to a cardiologist who told her to lose 100 pounds. “All of a sudden she goes back to feeling like a failure and we have to start over,” Gudzune says. “Or maybe she just never comes back at all.”

60%of the calories Americans consume come from “ultra-processed foods”Source: British Medical Journal, 2016 And so, working within a system that neither trains nor encourages them to meaningfully engage with their higher-weight patients, doctors fall back on recommending fad diets and delivering bland motivational platitudes. Ron Kirk, an electrician in Boston, says that for years, his doctor’s first resort was to put him on some diet he couldn’t maintain for more than a few weeks. “They told me lettuce was a ‘free’ food,” he says—and he’d find himself carving up a head of romaine for dinner.

In a study that recorded 461 interactions with doctors, only 13 percent of patients got any specific plan for diet or exercise and only 5 percent got help arranging a follow-up visit. “It can be stressful when [patients] start asking a lot of specific questions” about diet and weight loss, one doctor told researchers in 2012. “I don’t feel like I have the time to sit there and give them private counseling on basics. I say, ‘Here’s some websites, look at this.’” A 2016 survey found that nearly twice as many higher-weight Americans have tried meal-replacement diets—the kind most likely to fail—than have ever received counseling from a dietician.

“It borders on medical malpractice,” says Andrew (not his real name), a consultant and musician who has been large his whole life. A few years ago, on a routine visit, Andrew’s doctor weighed him, announced that he was “dangerously overweight” and told him to diet and exercise, offering no further specifics. Should he go on a low-fat diet? Low-carb? Become a vegetarian? Should he do Crossfit? Yoga? Should he buy a fucking ThighMaster?

“She didn’t even ask me what I was already doing for exercise,” he says. “At the time, I was training for serious winter mountaineering trips, hiking every weekend and going to the gym four times a week. Instead of a conversation, I got a sound bite. It felt like shaming me was the entire purpose.”

All of this makes higher-weight patients more likely to avoid doctors. Three separate studies have found that fat women are more likely to die from breast and cervical cancers than non-fat women, a result partially attributed to their reluctance to see doctors and get screenings. Erin Harrop, a researcher at the University of Washington, studies higher-weight women with anorexia, who, contrary to the size-zero stereotype of most media depictions, are twice as likely to report vomiting, using laxatives and abusing diet pills. Thin women, Harrop discovered, take around three years to get into treatment, while her participants spent an average of 13 and a half years waiting for their disorders to be addressed.

“A lot of my job is helping people heal from the trauma of interacting with the medical system,” says Ginette Lenham, a counselor who specializes in obesity. The rest of it, she says, is helping them heal from the trauma of interacting with everyone else.

“My weight makes me anxious. I’m constantly sucking my stomach in when I stand, and if I’m sitting, I always grab a pillow or couch cushion to hold in front of it. I’m most comfortable in my bathrobe, alone. At the same time, my brain starves for attention. I want to be onstage. I want to be the one holding a microphone. So, I decided to split the difference with this photograph: to perform and to obscure. The worst part is that intellectually I know that I have worth beyond pounds and waist inches and stereotypes. But I still feel like I have to hide.”— SAM (NOT HIS REAL NAME)

If Sonya ever forgets that she is fat, the world will remind her. She has stopped taking the bus, she tells me, because she can sense the aggravation of the passengers squeezing past her. Sarah, the tech CEO, tenses up when anyone brings bagels to a work meeting. If she reaches for one, are her employees thinking, “There goes the fat boss”? If she doesn’t, are they silently congratulating her for showing some restraint?

Emily says it’s the do-gooders who get to her, the women who stop her on the street and tell her how brave she is for wearing a sleeveless dress on a 95-degree day. Sam, the medical technician, avoids the subject of weight altogether. “Men aren’t supposed to think about this stuff—and I think about it constantly,” he admits. “So I never let myself talk about it. Which is weird because it’s the most visible thing about me.”

Again and again I hear stories of how the pressure to be a “good fatty” in public builds up and explodes. Jessica has four kids. Every week is a birthday party or family reunion or swimming pool social, another opportunity to stand around platters of spare ribs and dinner rolls with her fellow moms.

“Your conscious mind is busy the whole day with how many calories is in everything, what you can eat and who’s watching,” she says. After a few intrusive comments over the years—should you be eating that?—she has learned to be careful, to perform the role of the impeccable fat person. She nibbles on cherry tomatoes, drinks tap water, stays on her feet, ignores the dessert end of the buffet.

Then, as the gathering winds down, Jessica and the other parents divvy up the leftovers. She wraps up burgers or pasta salad or birthday cake, drives her children home and waits for the moment when they are finally in bed. Then, when she’s alone, she eats all the leftovers by herself, in the dark.

“It’s always hidden,” she says. “I buy a package of ice cream, then eat it all. Then I have to go to the store to buy it again. For a week my family thinks there’s a thing of ice cream in the fridge—but it’s actually five different ones.”

Ratio of soda and candy ads seen by black children compared to white children:2:1Source: UConn Rudd Center for Food Policy and Obesity, 2015 This is how fat-shaming works: It is visible and invisible, public and private, hidden and everywhere at the same time. Research consistently finds that larger Americans (especially larger women) earn lower salaries and are less likely to be hired and promoted. In a 2017 survey, 500 hiring managers were given a photo of an overweight female applicant. Twenty-one percent of them described her as unprofessional despite having no other information about her. What’s worse, only a few cities and one state (nice work, Michigan) officially prohibit workplace discrimination on the basis of weight.

Paradoxically, as the number of larger Americans has risen, the biases against them have become more severe. More than 40 percent of Americans classified as obese now say they experience stigma on a daily basis, a rate far higher than any other minority group. And this does terrible things to their bodies. According to a 2015 study, fat people who feel discriminated against have shorter life expectancies than fat people who don’t. “These findings suggest the possibility that the stigma associated with being overweight,” the study concluded, “is more harmful than actually being overweight.”

And, in a cruel twist, one effect of weight bias is that it actually makes you eat more. The stress hormone cortisol—the one evolution designed to kick in when you’re being chased by a tiger or, it turns out, rejected for your looks—increases appetite, reduces the will to exercise and even improves the taste of food. Sam, echoing so many of the other people I spoke with, says that he drove straight to Jack in the Box last year after someone yelled, “Eat less!” at him across a parking lot.

“I don’t want to be portrayed; this is not about me. It’s about that guy you always see on the far treadmill at the gym. Or the lady who brings the most beautiful salads to work every day for lunch. It’s about the little girl who got bullied because of her size, and the little boy who was told he wasn’t man enough. It’s not about me, but had it been about me when I was that chubby little girl, maybe I wouldn’t be standing here, head against the door, wondering if I’m enough.”— ERIKA

There’s a grim caveman logic to our nastiness toward fat people. “We’re attuned to bodies that look different,” says Janet Tomiyama, a stigma researcher at UCLA. “In our evolutionary past, that might have meant disease risk and been seen as a threat to your tribe.” These biological breadcrumbs help explain why stigma begins so early. Kids as young as 3 describe their larger classmates with words like “mean,” “stupid” and “lazy.”

And yet, despite weight being the number one reason children are bullied at school, America’s institutions of public health continue to pursue policies perfectly designed to inflame the cruelty. TV and billboard campaigns still use slogans like “Too much screen time, too much kid” and “Being fat takes the fun out of being a kid.” Cat Pausé, a researcher at Massey University in New Zealand, spent months looking for a single public health campaign, worldwide, that attempted to reduce stigma against fat people and came up empty. In an incendiary case of good intentions gone bad, about a dozen states now send children home with “BMI report cards,” an intervention unlikely to have any effect on their weight but almost certain to increase bullying from the people closest to them.

This is not an abstract concern: Surveys of higher-weight adults find that their worst experiences of discrimination come from their own families. Erika, a health educator in Washington, can still recite the word her father used to describe her: “husky.” Her grandfather preferred “stocky.” Her mother never said anything about Erika’s body, but she didn’t have to. She obsessed over her own, calling herself “enormous” despite being two sizes smaller than her daughter. By the time Erika was 11, she was sneaking into the woods behind her house and vomiting into the creek whenever social occasions made starving herself impossible.

And the abuse from loved ones continues well into adulthood. A 2017 survey found that 89 percent of obese adults had been bullied by their romantic partners. Emily, the counselor, says she spent her teens and 20s “sleeping with guys I wasn’t interested in because they wanted to sleep with me.” In her head, a guy being into her was a rare and depletable resource she couldn’t afford to waste: “I was desperate for men to give me attention. Sex was a good way to do that.”

Eventually, she ended up with someone abusive. He told her during sex that her body was beautiful and then, in the daylight, that it was revolting. “Whenever I tried to leave him, he would say, ‘Where are you gonna find someone who will put up with your disgusting body?’” she remembers.

Emily finally managed to get away from him, but she is aware that her love life will always be fraught. The guy she’s dating now is thin—“think Tony Hawk,” she says—and she notices the looks they get when they hold hands in public. “That never used to happen when I dated fat dudes,” she says. “Thin men are not allowed to be attracted to fat women.”

The effects of weight bias get worse when they’re layered on top of other types of discrimination. A 2012 study found that African-American women are more likely to become depressed after internalizing weight stigma than white women. Hispanic and black teenagers also have significantly higher rates of bulimia. And, in a remarkable finding, rich people of color have higher rates of cardiovascular disease than poor people of color—the opposite of what happens with white people. One explanation is that navigating increasingly white spaces, and increasingly higher stakes, exerts stress on racial minorities that, over time, makes them more susceptible to heart problems.

But perhaps the most unique aspect of weight stigma is how it isolates its victims from one another. For most minority groups, discrimination contributes to a sense of belongingness, a community in opposition to a majority. Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them. In a 2005 study, the words obese participants used to classify other obese people included gluttonous, unclean and sluggish.

Andrea, a retired nurse in Boston, has been on commercial diets since she was 10 years old. She knows how hard it is to slim down, knows what women larger than her are going through, but she still struggles not to pass judgment when she sees them in public. “I think, ‘How did they let it happen?’” she says. “It’s more like fear. Because if I let myself go, I’ll be that big too.”

Her position is all-too understandable. As young as 9 or 10, I knew that coming out of the closet is what gay people do, even if it took me another decade to actually do it. Fat people, though, never get a moment of declaring their identity, of marking themselves as part of a distinct group. They still live in a society that believes weight is temporary, that losing it is urgent and achievable, that being comfortable in their bodies is merely “glorifying obesity.” This limbo, this lie, is why it’s so hard for fat people to discover one another or even themselves. “No one believes our It Gets Better story,” says Tigress Osborn, the director of community outreach for the National Association to Advance Fat Acceptance. “You can’t claim an identity if everyone around you is saying it doesn’t or shouldn’t exist.”

Harrop, the eating disorders researcher, realized several years ago that her university had clubs for trans students, immigrant students, Republican students, but none for fat students. So she started one—and it has been a resounding, unmitigated failure. Only a handful of fat people have ever showed up; most of the time, thin folks sit around brainstorming about how to be better allies.

I ask Harrop why she thinks the group has been such a bust. It’s simple, she says: “Fat people grow up in the same fat-hating culture that non-fat people do.”

Uterine Cancer Incidence and Deaths on the Rise in US


The incidence of uterine cancer and deaths from the disease are on the increase, with black women disproportionately affected, warn researchers at the Centers for Disease Control and Prevention (CDC). They call for greater awareness of the symptoms to allow early detection and treatment.

Uterine cancer “is one of the few cancers with increasing incidence and mortality in the United States,” the CDC notes. This reflects, in part, increases in the prevalence of overweight and obesity since the 1980s.

It is the fourth most common cancer diagnosed in US women and is the seventh most common cause of death.

The findings were published online December 7 in the Morbidity and Mortality Weekly Report.

S. Jane Henley, MSPH, from the National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues studied the official incidence and mortality rates for uterine cancer from 1999 to 2015/6.

They found that rates of the disease have been increasing by approximately 0.7% per year, with uterine cancer deaths rising by an average of slightly more than 1.0% per year.

Worryingly, in comparision with other groups, black women were more likely to be diagnosed with harder-to-treat forms of the disease and with later-stage disease, in particular in comparision with white women.

“Multifactorial efforts at individual, community, clinical, and systems levels to help women achieve and maintain a healthy weight and obtain sufficient physical activity might reduce the risk for developing uterine cancer,” the authors write.

“Promoting awareness among women and health care providers of the need for timely evaluation of abnormal vaginal bleeding can increase the chance that uterine cancer is detected early and treated appropriately,” they add.

Study Details

The team gathered incidence data from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

In addition, they obtained mortality data from the National Vital Statistics System, which covered 98% of the overall US population for the period 1999 to 2015/2016.

Uterine cancers were classified by histologic site and stage at diagnosis. Individuals were classified as white, black, non-Hispanic American, Indian/Alaska Native (AI/AN), non-Hispanic Asian/Pacific Islander (API), or Hispanic.

The researchers found that in 2015, there were 53,911 new, confirmed cases of uterine cancer, which occurred at a rate of 27 cases per 100,000 women. The rates were highest among white and black women (27 per 100,000 each).

The most commonly reported form the disease was endometrioid carcinoma, which occurred in 68% of women. The proportion was much lower in black women, at 47%. Black women who were more likely to have other carcinomas, carcinosarcomas, and sarcomas.

In non-black women, uterine cancers were diagnosed at the localized stage in 66% to 69% of cases. In black women, that rate was 55%.

Black women are also more likely to be diagnosed with disease of distant stage than other groups, at 16% vs 8% to 10%. This was particularly the case for sarcoma.

Sarcomas were more likely to be diagnosed at the distant stage (36%) than carcinosarcomas (22%), other carcinomas (18%), and endometrioid carcinomas (3%).

The incidence rate of uterine cancers increased between 1999 and 2015 by 12%, or an average of 0.7% per year.

The increase was far higher among AI/AN (53%), black (46%), API (38%), and Hispanic (32%) women than among white women (9%).

In 2016, there were 10,733 deaths due to uterine cancer, at five deaths per 100,000 women. The rate was highest among black women, at nine per 100,000 women.

The rate of uterine cancer deaths increased between 1999 and 2016 by 21%, or 1.1% per year on average.

The increases were higher in API (52%), Hispanic (33%) and black (29%) women than white women (18%). Rates of uterine cancer deaths remained stable in AI/AN women.

Obesity a Contributing Factor

The researchers say that one contributing factor in the increase in incidence could be “excess body weight,” inasmuch as overweight or obese women are two to four times more likely to develop endometrial cancer than women of healthy weight.

“During 2013-2016, approximately 40% of women in the United States had obesity, including 56% of black women and 49% of Hispanic women,” they add.

The team points out that, “as with other cancers, the odds of surviving uterine cancer are much higher when it is detected at an early stage, when treatment is more effective.” The rate of survival is 90% for patients with localized cancers, vs <30% for patients with distant cancers.

“This report found that black women were more likely to receive a diagnosis at distant stage and with more aggressive histologic types than were other women, which might in part account for the higher death rate among black women,” the investigators write.

Antibiotic and acid-suppression medications during early childhood are associated with obesity


Abstract

Objective Gut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated the association of antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood with a diagnosis of obesity.

Design We performed a cohort study of US Department of Defense TRICARE beneficiaries born from October 2006 to September 2013. Exposures were defined as having any dispensed prescription for antibiotic, H2RA or PPI medications in the first 2 years of life. A single event analysis of obesity was performed using Cox proportional hazards regression.

Results 333 353 children met inclusion criteria, with 241 502 (72.4%) children prescribed an antibiotic, 39 488 (11.8%) an H2RA and 11 089 (3.3%) a PPI. Antibiotic prescriptions were associated with obesity (HR 1.26; 95% CI 1.23 to 1.28). This association persisted regardless of antibiotic class and strengthened with each additional class of antibiotic prescribed. H2RA and PPI prescriptions were also associated with obesity, with a stronger association for each 30-day supply prescribed. The HR increased commensurately with exposure to each additional medication group prescribed.

Conclusions Antibiotics, acid suppressants and the combination of multiple medications in the first 2 years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.

Prenatal drug exposure may influence stress response, obesity risk in teen girls


Increased cortisol reactivity may play a mechanistic role in predicting weight gain among adolescent girls, suggesting teens exposed to prenatal drug use are at particularly high risk for overweight or obesity due to a blunted stress response, according to findings published in Pediatric Obesity.

“Stressors, such as prenatal drug exposure (cocaine/heroin), may impact fetal brain development and dysregulate the [hypothalamic-pituitary-adrenal] axis and the cortisol response to stress,” Maureen M. Black, PhD, the John A. Scholl, MD and Mary Louise Scholl, MD professor of pediatrics at the University of Maryland School of Medicine, and colleagues wrote in the study background. “It is plausible that repeated activation of cortisol secretion leading to disruption of the neuroendocrine system in response to stressors, such as [prenatal drug exposure], may have detrimental effects on metabolic processes related to appetite and weight gain.”

Black and colleagues analyzed data from 76 black adolescents (mean age, 14 years; 50% boys) exposed to prenatal use of cocaine and heroin enrolled in a home-based trial for women with substance use disorder and their infants, as well as 61 children not exposed to prenatal use of cocaine or heroin recruited from a primary care clinic (controls). All adolescents participated in a lab-based assessment (time 1) and a 1-year follow-up (time 2). At time 1, adolescents completed several neuropsychological assessments, including the Conners’ Continuous Performance Test, and provided saliva samples collected during a 4.5- to 6-hour period (collected after a 3-hour fast), later assayed for cortisol. The first saliva sample was collected before completing computer-based tasks considered to be mild stressors that measured risk-taking propensity; a second sample was collected post-task. BMI z score was measured at baseline and follow-up. Researchers performed a bootstrapped moderated mediation analysis to test for conditional, indirect effects of cortisol reactivity.

Within the cohort, 18% had overweight and 27% had obesity.

Researchers found that lower inhibition was associated with increased cortisol reactivity in adolescents not exposed to prenatal drug use, and increased cortisol reactivity was associated with weight gain in girls only. Cortisol reactivity mediated the relationship between inhibition and BMI z score change for girls in the control group. Further, an examination of the index of moderated mediation showed that indirect effects were different for girls in the control group vs. those exposed prenatally to drugs (–0.006; 95% CI, –0.0136 to –0.0005).

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“Results of the current study highlight the role of biological underpinnings in the relation between inhibition and weight gain,” the researchers wrote. “Results show that physiological processes likely play a mechanistic role. Interventions that target self-regulation skills have produced improvements in executive functioning and weight regulation, and cortisol reactivity may be a biomarker for targeted interventions to improve biological regulation and, ultimately, health risk.” – by Regina Schaffer

Obesity Can Lead to Liver Damage by Age 8


Obesity can lead to liver disease in kids as young as 8 years old, a new study warns.

The long-term study of 635 children in Massachusetts found that a bigger waist size at age 3 increases the odds that a child will have a marker for liver damage and nonalcoholic fatty liver disease by age 8.

That marker is called ALT. By age 8, 23 percent of children studied had elevated blood levels of ALT. Those with a bigger waist size at age 3 and those with larger increases in obesity between ages 3 and 8 were more likely to have elevated ALT at age 8, the researchers found.

About 35 percent of obese 8-year-olds had elevated ALT, compared with 20 percent of children whose weight was normal, according to the Columbia University study.

“With the rise in childhood obesity, we are seeing more kids with nonalcoholic fatty liver disease in our pediatric weight management practice,” study lead author Dr. Jennifer Woo Baidal said in a university news release.

“Many parents know that obesity can lead to type 2 diabetes and other metabolic conditions, but there is far less awareness that obesity, even in young children, can lead to serious liver disease,” she added.

Nonalcoholic fatty liver disease occurs when too much fat accumulates in the liver, triggering inflammation that causes liver damage. The condition affects about 80 million people in the United States, and is the most common chronic liver condition in kids and teens, the researchers said in background notes.

While nonalcoholic fatty liver disease typically does not cause symptoms, it can lead to scarring (cirrhosis) of the liver and cancer.

“Some clinicians measure ALT levels in at-risk children starting at around 10 years old, but our findings underscore the importance of acting earlier in a child’s life to prevent excess weight gain and subsequent liver inflammation,” Woo Baidal said.

She said the best way for kids and adults to combat fatty liver disease is to lose weight, by eating fewer processed foods and getting regular exercise.

“We urgently need better ways to screen, diagnose, prevent and treat this disease starting in childhood,” Woo Baidal said.

Woo Baidal is director of pediatric weight management at the Center for Adolescent Bariatric Surgery at New York-Presbyterian Children’s Hospital, and an assistant professor of pediatrics at Columbia.

The study was published in the Journal of Pediatrics.