In body-conscious Brazil, half are now overweight

One of the world's most body-conscious countries, Brazil is now threatened by growing obesity rates, with half of the population already overweight.

08 sept 2012--As a result of an unbalanced diet and a rise in more sedentary lifestyles, Brazil, which moved 30 million people out of poverty and into the middle class over the past decade, is paying a heavy price for its frenetic growth.

Official statistics corroborate the alarming rise in the number of overweight or obese people in the world's sixth largest economy.

Nearly half of the country's 194 million people are overweight and 16 percent obese, according to a health ministry report released in April.

The percentage of overweight people jumped from 42.7% in 2006 to 48.5% in 2011, while the obesity rate increased from 11.4% to 15.8% in the same period.

The most overweight section of the population are men aged 35-45, of whom almost two thirds are fat, and women aged 45-54.

"It is high time to reverse the trend so as to avoid becoming like the United States, where nearly 35.7 percent of the adult population is obese," Health Minister Alexandre Padilha warned.

"Brazilians have a poor diet. They could eat green vegetables but they prefer beans and fat," said Solange de Goncalves, a 38-year-old from Rio who weighs 123 kilos (271 pounds) and is among Brazil's 30 million obese citizens.

Overweight since her childhood, she also suffers from high blood pressure and diabetes and concedes that her life is not easy.

"People look at you in the street. You cannot find clothes matching your size. Once I even got stuck in a bus turnstile," she told AFP, her voice cracking with emotion.

Goncalves is envious of the celebrities who make headlines or star in telenovelas, like Suede Junior, a male model sporting a "Made in Brazil" tattoo on his chest.

"To go to the gym, take good care of one's body is something common in Rio," he told AFP on Ipanema beach.

After a 12-year wait, Goncalves had a gastric ring inserted in July, a procedure covered by her public health insurance.

"I am happy. I already lost 15 of the 50 kilograms I want to lose," she said.

With the operation, which reduces the size of the stomach, a patient can lose 80 percent of his excess weight but must be monitored by a surgeon, an endocrinologist, a psychologist and a nutritionist for the rest of his life.

"The key to a successful treatment is dieting. The surgery is meant to help the patient, but if he drops the diet, he will regain weight," explained Octavio Falcao, a specialist who carries out the surgery.

The number of Brazilians undergoing the ring procedure soared 275 percent between 2003 and 2010 to 60,000 a year.

After enduring 10 years of obesity, Jederson Edealdo das Dores finally decided to undergo the 45-minute operation by coelioscopy, the most common procedure used by private doctors.

"I used to be thin. I want to be normal again," said Dores.

Brazil has laws that protect against "Big Food" and "Big Snack"

Under pressure from civil society organizations, the Brazilian government has introduced legislation to protect and improve its traditional food system, standing in contrast to the governments of many industrialized countries that have partly surrendered their prime duty to protect public health to transnational food companies, argue nutrition and public health experts writing in this week's PLoS Medicine.

04 july 2012--Carlos Monteiro and Geoffrey Cannon, from the Center for Epidemiological Studies in Health and Nutrition of the University of São Paulo, explain that, in Brazil, traditional long-established food systems and dietary patterns are being displaced by ultra-processed products made by transnational food corporations ("Big Food" and "Big Snack") contributing to increases in the incidence of obesity and of major chronic diseases, and adversely affecting public health and public goods by undermining culture, meals, the family, community life, local economies, and national identity.

The authors argue: "The use of law to protect and improve food systems and supplies, and thus public health, may be difficult in parts of the world where governments have already ceded the responsibility of governance to transnational and other corporations. However, in Brazil protection of public health still remains a prime duty of government ."

The authors explain that by law, all Brazilian children attending state schools are entitled to one daily meal at school, at least 70% of the food supplied to schools must be fresh or minimally processed, and a minimum of 30% of this food must be sourced from local family farmers. They say that such measures help to check the penetration of transnational corporations into Brazil.

Although the penetration of such corporations into Brazil has been rapid, the tradition of shared and family meals remains strong and is likely to provide protection to national and regional food systems.

The authors say: "Notwithstanding intense pressures, which include ubiquitous television and internet propaganda designed to turn eating and drinking into constant individual snacking, food and drink consumption is not yet dislocated and isolated from family and social life in Brazil."

The authors argue that Brazil's experiences in resisting "Big Food" and "Big Snack" can help other countries. They say: "the Brazilian experience provides a basis for the design of rational, comprehensive, and effective public health policies and actions designed to protect and promote nutrition in all its senses."

More information: Monteiro CA, Cannon G (2012) The Impact of Transnational ''Big Food'' Companies on the South: A View from Brazil. PLoS Med 9(7): e1001252.doi:10.1371/journal.pmed.1001252

Provided by Public Library of Science

More reasons to keep this New Year's weight loss resolution uncovered

Long-term healthy dietary interventions frequently induce a rapid weight decline, mainly in the first four to six months, followed by weight stabilization or regain, despite continued dieting. The partial regain may discourage people from adhering to healthier habits, but research now shows that improvements to health remain even if weight is regained.

25 dec 2011--The study recently released online in Diabetes Care (Print: February 2012) identified two distinct biomarker patterns that correspond to weight change, one of which continues to improve with time.

The study was conducted among 322 participants during the two-year Dietary Intervention Randomized Controlled Trial (DIRECT) performed by Ben-Gurion University of the Negev at the Nuclear Research Center Negev, Israel (New England Journal of Medicine). The population was randomized to three different, but healthy interventions: low-fat, Mediterranean or low-carbohydrate diets, and unprecedented adherence rates were maintained throughout the entire two-year period.

According to BGU Faculty of Health Sciences Prof. Assaf Rudich, "This study tells us that we may all have tunnel vision on weight when it comes to healthy dieting. Although maintaining ideal body weight is linked to better health, when it comes to adopting healthier dietary habits in mild to moderately obese people, there are benefits beyond weight loss, such as decreasing inflammatory tone and elevating the 'good cholesterol' HDL."

Rudich explains that switching to healthier dieting extends benefits beyond the single outcome of weight loss. In fact, important improvements that likely signify decreased risk for cardiovascular disease occur even despite weight regain, as long as dieting continues.

The researchers identified two distinct patterns:

"Pattern-A" includes biomarkers [insulin, triglycerides, leptin, chemerin, monocyte-chemotactic-protein-1(MCP-1), and retinol-binding-protein-4(RBP4)] whose dynamics tightly corresponded to changes in body weight. They significantly improved during the first six months of the "rapid weight loss phase." Then, unfortunately, they significantly trended in the opposite direction once participants started to regain weight during months 7-24 (the "weight maintenance/regain phase").

"Pattern B" that includes high-molecular-weight (HMW) [adiponectin, HDL-cholesterol, high-sensitive C-reactive protein (hsCRP), fetuin-A, progranulin, and vaspin], which displayed a continued, cumulative improvement throughout the intervention, despite the partial weight regain observed during months 7-24 of continued dieting, a totally different pattern of biomarkers.

These patterns were similar, although of different magnitude, across the low-carb, Mediterranean and low-fat diets.

Along the same line of continued benefit of adopting healthier dietary habits, the research team published an article last year in Circulation (a journal of the American Heart Association) that participants in DIRECT showed regression of the atherosclerotic plaque in their carotid artery, a process underlying a large percentage of the cases of stroke. Regression of atherosclerosis was previously only demonstrated with medications or with rather extreme dietary regimens.

According to Prof. Iris Shai, principal investigator of DIRECT, these findings contain a strong message for the public. A researcher at BGU's S. Daniel Abraham International Center for Health and Nutrition in the Department of Epidemiology, Shai says that, "Switching to a healthy lifestyle is a long-term strategy that should be done moderately but persistently. There are no magic shortcuts," she says.

"There is no doubt that moderate weight loss is an important goal for specific populations, and losing weight will indeed improve several markers that are rather tightly related to fat mass, such as triglycerides, insulin and leptin. These, however, will tend to change similarly to weight dynamics.

"Yet, it is encouraging that adhering to a healthy diet per-se will continue to improve other blood biomarkers, some of which quite strongly associate with improved cardio-metabolic health, likely because they reflect adipose tissue and other organ function, such as HDL-c, adiponectin and CRP. Such markers may signify long-term effects of the initial weight loss, or, maybe even more promisingly, reveal to us the capacity of healthier dietary habits to reverse obesity-associated adipose tissue and liver dysfunction."

Provided by American Associates, Ben-Gurion University of the Negev

Supersized market economy, supersized belly: Wealthier nations have more fast food and more obesity

New research from the University of Michigan suggests obesity can be seen as one of the unintended side effects of free market policies.

24 dec 2011--A study of 26 wealthy nations shows that countries with a higher density of fast food restaurants per capita had much higher obesity rates compared to countries with a lower density of fast food restaurants per capita.

"It's not by chance that countries with the highest obesity rates and fast food restaurants are those in the forefront of market liberalization, such as the United States, the United Kingdom, Australia, New Zealand and Canada, versus countries like Japan and Norway, with more regulated and restrictive trade policies," said Roberto De Vogli, associate professor in the U-M School of Public Health, and lead researcher of the study.

For example, in the United States, researchers reported 7.52 fast food restaurants per 100,000 people, and in Canada they reported 7.43 fast food restaurants per 100,000 people. The paper reported the obesity rates among US men and women were 31.3 percent and 33.2 percent, respectively. The obesity rates for Canadian men and women were 23.2 percent and 22.9 percent, respectively.

Compare that to Japan, with 0.13 fast food restaurants per 100,000 people, and Norway, with 0.19 restaurants per capita. Obesity rates for men and women in Japan were 2.9 percent and 3.3 percent, respectively. In Norway, obesity rates for men and women were 6.4 percent and 5.9 percent, respectively. The relationships remain consistent even when researchers controlled for variables such as income, income inequality, urban areas, motor vehicles and internet use per capita.

Obesity research largely overlooks the global market forces behind the epidemic, De Vogli said.

"In my opinion the public debate is too much focused on individual genetics and other individual factors, and overlooks the global forces in society that are shaping behaviors worldwide. If you look at trends overtime for obesity, it's shocking," De Vogli said.

"Since the 1980s, since the advent of trade liberalization policies that have indirectly…promoted transnational food companies…we see rates that have tripled or quadrupled. There is no biological, genetic, psychological or community level factor that can explain this. Only a global type of change can explain this."

Researchers chose one fast food restaurant to use as a proxy measure for how many fast food restaurants were present per 100,000. The study is in no way an indictment of that restaurant, De Vogli said, but rather an indicator of fast food density in a particular area.

Fast food refers to food sold in restaurants or stores with preheated or precooked ingredients, and served to the customer in a packaged form. A typical fast food meal includes a hamburger, fries and a soft drink, the paper said. Fast food is usually high in fat and calories, and several studies have found associations between fast food intake and increased body mass index, weight gain and obesity. Obesity accounts for approximately 400,000 deaths each year in the United States alone. Fast food consumption is also related to insulin resistance and type II diabetes, another major worldwide public health threat.

More information: The paper, "Globesization: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies," will be published in the December print issue of Critical Public Health.

Provided by University of Michigan

Study shows Brazilian waistlines expanding

The girl from Ipanema is putting on a few pounds

RIO DE JANEIRO, 08 april 2009 –Some 13.6 percent of Brazilian women are obese, and 12.4 percent of men — a combined 1.6 percent increase from the last survey in 2006, a Health Ministry study announced Tuesday.

In 1975, just 7.8 percent of Brazilian women and 2.8 percent of men were obese.

An additional 43.3 percent of Brazilians are now considered overweight, the study found.

The Health Ministry blames increased alcohol consumption, among other factors, saying people eat excessively when they drink.

"It's very worrying," said Deborah Malta, a researcher at the ministry who helped run the study.

About 19 percent of Brazilians consume alcohol excessively, downing four or more drinks in one sitting for women and five or more for men. About 17.3 percent did so in 2006.

Obesity is still far less common in Brazil than in the U.S., where 35 percent of women and 33 percent of men are considered obese. But while obesity in Brazilian women had appeared to stabilize in recent years, it appears to be on the rise again, Malta said.

Obesity is defined by height-weight ratio. A person who is 5-foot-4 (1.6 meters) and weighs 175 pounds (79 kilogramss) would be considered obese.

ADA releases updated position statement on weight management

CHICAGO, 05 feb 2009 – The American Dietetic Association has released an updated position statement on weight management calling for people to make a "lifelong commitment to healthful lifestyle behaviors" that includes the prevention of weight gain.

The statement also urges ADA members – primarily registered dietitians and dietetic technicians, registered – to take an active role in addressing the country's obesity epidemic through partnerships among health professionals, government, schools and other organizations.

ADA's statement, which has been endorsed by the American College of Sports Medicine, is published in the February issue of the Journal of the American Dietetic Association and represents ADA's official position on weight management: It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity.

While the wording of this statement is identical to ADA's last weight management position issued in 2002, it is accompanied by a new 17-page evidence-based review of the latest research and interventions. That includes updated information on weight-loss surgery and weight-loss medications and other dietary and behavioral interventions. The evidence-based approach uses ADA's evidence analysis process and information developed for ADA's Evidence Analysis Library, providing important added benefits to support its conclusions.

"The major advantage of the approach is the more rigorous standardization of review criteria, which minimizes the likelihood of reviewer bias and increases the ease with which disparate articles may be compared," according to the position's authors.

"The evidence supporting ADA's position is clear: Excess weight and obesity affect the health and quality of life in all segments of the population, increasing health-care costs and putting significant burdens on our society," said registered dietitian and ADA Spokesperson Elisa Zied. "This new position provides guidance to ADA members who are uniquely qualified to improve the health of the public through effective weight management interventions and strategic partnerships."

Highlights of ADA's 2009 weight management position statement include:

• The importance of weight gain prevention and the challenge of weight loss maintenance in addition to the necessary continued attention on the implementation of effective weight loss interventions.
• The value of the unique contribution ADA members can make through collaborations with other health-care providers, government agencies, scientific organizations, schools, and community organizations to create social and environmental solutions to the epidemic of overweight and obesity.

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The American Dietetic Association is the world's largest organization of food and nutrition professionals. ADA is committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy. Visit the American Dietetic Association at www.eatright.org.

Physical activity may not be key to obesity epidemic

MAYWOOD, Ill., 07 jan 2008 -- A recent international study fails to support the common belief that the number of calories burned in physical activity is a key factor in rising rates of obesity.

Researchers from Loyola University Health System and other centers compared African American women in metropolitan Chicago with women in rural Nigeria. On average, the Chicago women weighed 184 pounds and the Nigerian women weighed 127 pounds.

Researchers had expected to find that the slimmer Nigerian women would be more physically active. To their surprise, they found no significant difference between the two groups in the amount of calories burned during physical activity.

"Decreased physical activity may not be the primary driver of the obesity epidemic," said Loyola nutritionist Amy Luke, Ph.D., corresponding author of the study in the September 2008 issue of the journal Obesity. Luke is an associate professor in the Department of Preventive Medicine and Epidemiology at Loyola University Chicago Stritch School of Medicine.

Physical activity is defined as anything that gets your body moving. U.S. government guidelines say that each week, adults need at least 2 ½ hours of moderate aerobic activity (such as brisk walking) or 75 minutes of vigorous activity (such as jogging). Adults also should do muscle-strengthening activities, such as weight-lifting or sit-ups, at least twice a week.

Physical activity has many proven benefits. It strengthens bones and muscles, improves mental health and mood, lowers blood pressure, improves cholesterol levels and reduces the risk of cardiovascular disease, diabetes, breast cancer and colon cancer.

But Loyola research suggests that weight control might not be among the main benefits. People burn more calories when they exercise. But they compensate by eating more, said Richard Cooper, Ph.D., co-author of the study and chairman of the Department of Preventive Medicine and Epidemiology.

"We would love to say that physical activity has a positive effect on weight control, but that does not appear to be the case," Cooper said.

The recent study included 149 women from two rural Nigerian villages and 172 African American women from the west side of Chicago and suburban Maywood.

Adjusted for body size, the Chicago women burned an average of 760 calories per day in physical activity, while the Nigerian women burned 800 calories. This difference was not statistically significant.

Diet is a more likely explanation than physical activity expenditure for why Chicago women weigh more than Nigerian women, Luke said. She noted the Nigerian diet is high in fiber and carbohydrates and low in fat and animal protein. By contrast, the Chicago diet is 40 percent to 45 percent fat and high in processed foods.

Results of the new study are similar to those of a 2007 study of men and women in Jamaica. Researchers from Loyola and other centers found there was no association between weight gain and calories burned during physical activity.

"Evidence is beginning to accumulate that dietary intake may be more important than energy expenditure level," Luke said. "Weight loss is not likely to happen without dietary restraint."

Persistent pollutant may promote obesity

02 dez 2008--Compound shown to affect gene activity at extremely low concentrations
Tributyltin, a ubiquitous pollutant that has a potent effect on gene activity, could be promoting obesity, according to an article in the December issue of BioScience. The chemical is used in antifouling paints for boats, as a wood and textile preservative, and as a pesticide on high-value food crops, among many other applications.
Tributyltin affects sensitive receptors in the cells of animals, from water fleas to humans, at very low concentrations—a thousand times lower than pollutants that are known to interfere with sexual development of wildlife species. Tributyltin and its relatives are highly toxic to mollusks, causing female snails to develop male sexual characteristics, and it bioaccumulates in fish and shellfish.
The harmful effects of the chemical on the liver and the nervous and immune systems in mammals are well known, but its powerful effects on the cellular components known as retinoid X receptors (RXRs) in a range of species are a recent discovery. When activated, RXRs can migrate into the nuclei of cells and switch on genes that cause the growth of fat storage cells and regulate whole body metabolism; compounds that affect a related receptor often associated with RXRs are now used to treat diabetes. RXRs are normally activated by signaling molecules found throughout the body.
The BioScience article, by Taisen Iguchi and Yoshinao Katsu, of the Graduate University for Advanced Studies in Japan, describes how RXRs and related receptors are also strongly activated by tributyltin and similar chemicals. Tributyltin impairs reproduction in water fleas through its effects on a receptor similar to the RXR. In addition, tributyltin causes the growth of excess fatty tissue in newborn mice exposed to it in utero. The effects of tributytin on RXR-like nuclear receptors might therefore be widespread throughout the animal kingdom.
The rise in obesity in humans over the past 40 years parallels the increased use of industrial chemicals over the same period. Iguchi and Katsu maintain that it is "plausible and provocative" to associate the obesity epidemic to chemical triggers present in the modern environment. Several other ubiquitous pollutants with strong biological effects, including environmental estrogens such as bisphenol A and nonylphenol, have been shown to stimulate the growth of fat storage cells in mice. The role that tributyltin and similar persistent pollutants may play in the obesity epidemic is now under scrutiny.
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After noon EST on 1 December and for the remainder of the month, the full text of the article will be available for free download through the copy of this Press Release available at http://www.aibs.org/bioscience-press-releases/.

Speedy eaters seen likelier to get fat

LONDON, 24 oct 2008– People who eat quickly until full are three times more likely to be overweight, a problem exacerbated by the availability of fast food and the decline of orderly dining habits, Japanese researchers said on Wednesday.
The findings, published in the British Medical Journal, highlight how eating styles, and not just what or how much is eaten, can contribute to an obesity epidemic fueled by the spread of Western-style affluence in many parts of the world.
The World Health Organization classifies around 400 million people as obese, 20 million of them under the age of five. The condition raises the risk of diseases like type 2 diabetes and heart problems.
For their study, Hiroyasu Iso and colleagues at Osaka University asked more 3,000 Japanese volunteers aged 30 to 69 about their eating. About half of the men and a little more than half of the women said they ate until full. About 45 percent of the men and 36 percent of the women said they ate quickly.
Those who said they ate until full and ate quickly were three times more likely to be fat than people in the "not eating until full and not eating quickly" group, the researchers found.
They cited as causes both the availability of cheap food in big portions and habits like watching television while eating.
To counteract the "supra-additive effect" of speedy or glut eating among children prone to obesity, parents should encourage them to eat slowly and in calm surroundings, the study found.
(Reporting by Michael Kahn; Editing by Dan Williams)

Obesity caused by deficit of brain 'pleasure centers': study

WASHINGTON, 18 oct 2008– Obese people may have a diminished ability to experience the pleasure of eating, prompting them to overindulge to boost their satisfaction, according to a study released Thursday.
The study, published this week in the journal Science, found that obese individuals may have fewer pleasure receptors in their brains, requiring them "to take in more of a rewarding substance such as food or drugs to experience the same level of pleasure as other people," said Eric Stice, a psychology researcher at the University of Texas (UT) at Austin and lead author of the study.
In a throwback to humankind's evolutionary past, the human brain releases the "pleasure chemical" dopamine, a reward to the body for consuming life-sustaining nutrition.
But the researchers theorize that weak "reward centers" in the brain prompt obese people to eat more.
"The research reveals obese people may have fewer dopamine receptors, so they overeat to compensate for this reward deficit," said Stice, who has studied eating disorders and obesity for almost two decades.
Although past research has shown that biological factors play a major part in obesity, the study is one of the first to positively identify factors that increase people's weight gain risk in the future.
The researchers from UT, worked alongside scientists from the Oregon Research Institute, and brain scientists from the Yale University School of Medicine, Connecticut.
Using a technique called functional Magnetic Resonance Imaging (fMRI), researchers examined the extent to which pleasure receptors in individuals were activated in response to a taste of chocolate milkshake versus a tasteless solution.
The participants were next tested for the presence of a genetic variation linked to a lower number of the dopamine receptors.
Researchers then tracked changes in the test participants' body mass index over a one-year period.
The results, said Stice, are key for understanding weight gain, and to helping at-risk individuals.
"Although people with decreased sensitivity of reward circuitry are at increased risk for unhealthy weight gain, identifying changes in behavior or pharmacological options could correct this reward deficit to prevent and treat obesity," he said.

Obesity Drives Heart Risk for Most Racial and Ethnic Groups

By Judith Groch
WINSTON, 13 may 2008-- Obesity rates in the U.S. , and attendant cardiovascular risk factors, were high among whites, blacks, and Hispanics but not among Chinese Americans, according to an observational cohort study.
Only 5% of Chinese Americans were obese compared with a range of 30% to 50% in the other population groups, Gregory L. Burke, M.D., of Wake Forest University, and colleagues reported in the May 12 issue of Archives of Internal Medicine.
Those of Chinese heritage were also less likely to be overweight (33%) than whites, blacks, and Hispanic participants, in whom percentages ranged from 60% to 85%, the researchers said.
An important component of this analysis, the researchers said, was the association between obesity and subclinical risk factors and markers for cardiovascular disease that persisted even after adjustment for traditional risk factors.
From 1960 to 2000, the percentage of the U.S. population categorized as obese increased from 11% to 28% in men and 16% to 34% in women, the researchers wrote, with higher rates observed in certain racial and ethnic groups.
Thus, they said, the obesity epidemic could reduce further gains in U.S. life expectancy, largely through obesity's effect on cardiovascular disease mortality.
To assess the importance of the obesity epidemic on cardiovascular disease risk, the researchers analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA), an observational cohort study of 6,814 men and women, ages 45 to 84, who were free of clinical cardiovascular disease at the 2000-2002 baseline.
They assessed the association between body size and cardiovascular disease risk factors, medication use, and subclinical vascular disease (coronary artery calcium, carotid artery intima-medial thickness, and left ventricular mass).
The most striking differences were seen across racial and ethnic lines, the researchers said.
A prevalence of 75% or more for overweight was observed in white men and African-American and Hispanic participants of both genders, with more than 60% prevalence observed in white women.
In contrast, only one-third of Chinese-American men and women were classified as overweight.
As for obesity, overall, more than 50% of black women, 40% of Hispanic women, and 30% of black and Hispanic men, and nearly 30% of white men and women, were obese.
In contrast only 5% of Chinese-American participants were classified as obese.
The pattern of being obese or overweight was similar in middle age and older adults, the researchers found.
Subclinical risk factors for heart disease and stroke -- including blood pressure, lipoproteins, and fasting glucose levels -- also rose with higher body mass index (BMI). This despite a much higher use of antihypertensive and/or antidiabetic medications.
Obesity was also associated with:
A 17% greater risk of coronary artery calcium
A 32% greater risk of internal carotid artery intima-medial thickness greater than the 80th percentile
A 45% greater risk of having a common carotid artery intimal medial thickness greater than the 80th percentile
A 2.7-fold greater risk of having a left ventricular mass greater than the 80th percentile compared with normal body size
These associations persisted after adjustment for traditional
cardiovascular disease risk factors, the investigators said.
Systolic blood pressure levels were significantly higher in the obese than in the normal BMI group in all racial/ethnic and gender groups (6-20 mm Hg higher, age adjusted).
HDL levels were significantly lower in all racial/ethnic and sex groups (4-14 mg/dL lower, age adjusted), and fasting glucose levels were significantly higher in white, African-American,
and Hispanic participants (8-17 mg/dL higher, age adjusted).
Triglyceride levels (18-55 mg/dL higher, age adjusted), and LDL particle size (109-173 nmol/L higher, age adjusted) were significantly greater in all racial/ethnic and gender groups.
No consistent differences across body size groups were observed for LDLs.
In addition, greater BMI was associated with a significantly higher Framingham coronary heart disease risk in all racial-ethnic and gender groups, except African-American and Hispanic women.
Chinese-American participants were an exception to these findings with much lower rates of obesity.
The researchers noted, however, that these findings could not be compared with national data because of a paucity of such data for these individuals. But, they said, international comparisons have documented similarly lower rates of overweight and obesity in China compared with the U.S.
The observed association between obesity and cardiovascular disease is likely mediated through a variety of different pathways, the investigators said, including the effect on blood pressure, dyslipidemia, and glycemic state, which in turn affect atherosclerosis progression and left ventricular mass over a lifetime.
Reviewing study limitations, the researchers said that because the morbidly obese were excluded, the true burden of obesity and cardiovascular disease may have been underestimated.
Also the data were cross-sectional and could not incorporate the known time lag between the development of cardiovascular risk factors and their impact on subclinical atherosclerosis. Adjusting for current levels of cardiovascular risks may not fully consider a past or lifelong history of a more adverse risk profile for heart disease, the researchers wrote.
The low prevalence of obesity in Chinese-American participants indicates that a high rate of obesity should not be viewed as being inevitable, the researchers said.
These findings, they added, "support the imperative to redouble our efforts to assist in increasing healthy behaviors and to remove environmental barriers to maintaining a healthy weight."
No financial conflicts were reported. This study was supported by contracts from the National Heart, Lung, and Blood Institute and by the Wake Forest University General Clinical Research Center.

Primary source: Archives of Internal MedicineSource reference:Burke GL, et al "The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: The multi-ethnic study of atherosclerosis" Arch Intern Med 2008; 168: 928-935.

Drugs Alone Don't Lower Heart Disease Risks for Overweight Americans

By Carolyn Colwell
13 may 2008 -- Daily doses of statins and blood pressure medications will not be enough to prevent heart disease among the ever-growing number of Baby Boomers who are overweight or obese, a new study suggests.
The simple truth, experts say, is that pounds must also be shed to keep cardiovascular trouble away.
"There is a debate out there about whether this generation is going to live as long as their parents, and the truth is they probably won't," said study author Dr. Gregory L. Burke, director of the division of public health sciences at Wake Forest University School of medicine in Winston-Salem, NC.
"My ultimate worry is that we've seen a 50-year decline in cardiovascular disease mortality, but if you begin to look at recent trends, it's beginning to plateau," he added. "And my fear is that because of the increase in obesity we're going to begin to see a reversal of that trend where heart disease rates begin to go up."
The research involving 6,814 men and women aged 45 to 84 revealed an even greater prevalence of overweight and obesity than shown in similar studies done five years earlier. Depending on the demographic group, between 60 percent and 85 percent of the participants were overweight and between 30 percent and 50 percent were obese, the federally funded study found. The obesity epidemic is more likely environmentally than genetically driven, Burke said. The differences between the weights of white, black and Hispanic Americans are no longer as meaningful, he stressed. Only Chinese-Americans have significantly less obesity (5 percent) than other ethnic groups.
A decade ago, experts thought the heart-related risks of obesity could be counterbalanced by the treatment of risk factors such as high cholesterol and glucose intolerance, Burke explained. People thought that, "Gosh, all we need to do is treat those risk factors and we can ameliorate the effects of obesity. So, our study looked at whether that is indeed true," he added.
It isn't, said Burke, noting that this is where his study breaks new ground. There is a relationship between less obvious, subclinical cardiovascular disease markers, such as the thickening of the walls of the carotid artery, and obesity, he explained. Even though the overweight and obese people studied hadn't had heart attacks they did show various markers that are predictors of future cardiovascular events, Burke added. This is was true despite the high number of people who were taking medications for the well-known triad of risk factors of high cholesterol, diabetes and high blood pressure.
Lona Sandon, a spokeswoman for the American Dietetic Association, said that the findings show that "many of the people who were obese were being treated with various medications, but they still were not improving to the point where they were decreasing their risk."
The American mentality is that "if I just take those pills, I'll be OK," said Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical School. The study "kind of says you have to make some changes, some lifestyle changes and some food changes, to lead to a healthier weight."
Sandon added that even greater emphasis needs to be placed on prevention. "It's easier to prevent with an hour of exercise a day than correct with three hours of exercise a day," she noted. "Hopefully [the study] can be some kind of a wake-up call to tell us we need to do something more than hand out a prescription."

Top researcher argues most physicians aren't prepared to deal with obesity epidemic

The soaring obesity rates across the globe have been called the most critical challenge to public health of the 21st century. A top university researcher argues that most physicians are not adequately prepared to deal with this obesity epidemic.
In an article published in Canadian Family Physician, University of Alberta researcher Tim Caulfield examines the vital role physicians play in managing and identifying obesity and highlights the obstacles these physicians must overcome when treating obese patients. Caulfield, who is the Canada Research Chair in Health Law at the U of A and professor and research director in public health sciences, is recognized as one of the foremost experts in health law research in Canada.
In North America, physicians have a legal obligation to provide their patients with a reasonable standard of care, says Caulfield. By law, overweight and obese patients are entitled to the same level of care as the general public; however, there are reasons to believe this patient population is not, in some circumstances, receiving optimal care and advice.
Available data indicates that many physicians do not have the skills and knowledge to address obesity. According to Caulfield, this could contribute to substandard care in the way obesity is handled and in the way obese patients are treated.
"Family physicians play a crucial role in identifying and managing obesity," says Caulfield. "As the rates of obesity become more prevalent, we need to recognize and become aware of the issues that can reduce liability and improve the care of these patients."
Caulfield notes that earlier studies have found that most physicians (83 per cent) were less likely to perform physical examinations on reluctant obese patients, and 17 per cent admitted reluctance to perform pelvic exams on obese patients. One study found that one-fourth of physicians think that they are not at all or only slightly competent recommending treatment for obese patients.
As obesity rises, Caulfield notes, so will the number of malpractice suits. "By identifying the legal issues that may come with treating these patients, it will become easier for family physicians to address weight management."
Steps should be taken, according to Caulfield, to ensure family physicians have the skills, tools and resources necessary to satisfy their legal duties and to optimize their role in managing this complex public health concern.