Big review confirms power of fasting diets for weight loss

by Denise Mann

Intermittent fasting is all the rage due to its potential health benefits, and now a new review shows this style of eating really does produce weight loss and may even improve certain markers of heart health.

26 dec 2021--Intermittent fasting is an umbrella term for several diets that alternate between feasts and fasts. The 5:2 diet involves eating normally five days of the week and restricting your calories on the other two days. Alternate-day fasting calls for a fast day-feast day-fast day pattern. In contrast, time-restricted eating refers to eating only during specific time windows each day.

"The new study demonstrates that the different forms of intermittent fasting, i.e., alternate-day fasting, the 5:2 diet and time-restricted feeding, are all effective weight loss interventions for people with obesity," said study author Krista Varady, director of the Human Nutrition Research Unit at the University of Illinois, in Chicago.

"Intermittent fasting may be an effective means of lowering heart disease risk by decreasing blood pressure, low-density lipoprotein [LDL] or 'bad' cholesterol, and triglycerides," she said. What's more, these diets may help prevent type 2 diabetes by lowering insulin resistance and fasting insulin levels.

Most of these benefits likely stem from weight loss.

"All of these regimens induce a calorie restriction of 15% to 30% daily, which results in weight loss," Varady said. "When an obese person loses weight, they almost always see reductions in LDL cholesterol, triglycerides, blood pressure and insulin resistance."

For the review, the researchers analyzed 11 studies that comprised 130 trials of various intermittent fasting regimens. When the investigators looked at all of the studies as a whole, intermittent fasting did produce weight loss and improvements in risk factors for heart health. However, only alternate-day fasting and the 5:2 diet resulted in a clinically significant weight loss of more than 5%, the study showed.

The findings were published online Dec. 17 in JAMA Network Open.

So, should you or shouldn't you jump on the intermittent fasting bandwagon, and if you do, which method is right for you?

Two experts who were not involved with the study agreed that it's too early to make any blanket recommendations.

"The study provides strong evidence that some, but not all, of the regimens result in weight loss and related decreases in body mass metrics and improvements in cardiometabolic risk factors, such as cholesterol levels, blood pressure and measures of insulin resistance," said Benjamin Horne. He is the director of cardiovascular and genetic epidemiology at the Intermountain Heart Institute in Salt Lake City, Utah.

The methods in this study that showed the most profound benefits tend to be the most difficult to follow, he noted. "Future studies should evaluate the ability of the average person to adhere to these regimens, because it is unclear that they are sustainable over the long term," Horne said.

The study also could not address if intermittent fasting reduces heart attacks or strokes or extends longevity. "It is unknown whether the average person can adhere to any of the four intermittent fasting regimens for a long enough period of time [years or decades] to affect those outcomes," Horne added.

And importantly, he asked, can weight loss can be sustained without continuing the regimen?

There are also safety considerations. "The hype surrounding intermittent fasting may be leading to harms to unsuspecting people who want to achieve better health," Horne explained, "especially people with diagnosed chronic diseases and asymptomatic health conditions."

New York City dietician Robin Foroutan isn't a fan of the difficult-to-stick-with intermittent fasting regimens that showed the greatest benefits in this study.

"I only recommend time-restricted eating and fasting-mimicking diets," said Foroutan. Fasting-mimicking diets work by tricking your body into thinking that you're fasting even though you're still eating. These methods are easier to follow so people are more likely to stay the course.

The bottom line? Always talk to your doctor before starting a new eating regimen, she said.

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More information: Chanthawat Patikorn et al, Intermittent Fasting and Obesity-Related Health Outcomes, JAMA Network Open (2021). DOI: 10.1001/jamanetworkopen.2021.39558

Journal information: JAMA Network Open 

New medical advances marking the end of a long reign for 'diet wizards'

French fries and chocolate milkshakes affect people differently. Some are tempted by them, and others are not.

For many years, the long-term success rates for those who attempt to lose excess body weight have hovered around 5-10 percent.
In what other disease condition would we accept these numbers and continue on with the same approach? How does this situation sustain itself?

30 dec 2017--It goes on because the diet industry has generated marketing fodder that obscures scientific evidence, much as the Wizard of Oz hid the truth from Dorothy and her pals. There is a gap between what is true and what sells (remember the chocolate diet?). And, what sells more often dominates the message for consumers, much as the wizard's sound and light production succeeded in misleading the truth-seekers in the Emerald City.
As a result, the public is often directed to attractive, short-cut weight loss options created for the purposes of making money, while scientists and doctors document facts that are steamrolled into the shadows.
We are living in a special time, though – the era of metabolic surgeries and bariatric procedures. As a result of these weight loss procedures, doctors have a much better understanding of the biological underpinnings responsible for the failure to lose weight. These discoveries will upend the current paradigms around weight loss, as soon as we figure out how to pull back the curtain.
As a dual board-certified, interventional obesity medicine specialist, I have witnessed the experience of successful weight loss over and over again – clinically, as part of interventional trials and in my personal life. The road to sustained transformation is not the same in 2018 as it was in 2008, 1998 or 1970. The medical community has identified the barriers to successful weight loss, and we can now address them.
The body fights back
For many years, the diet and fitness industry has supplied folks with an unlimited number of different weight loss programs – seemingly a new solution every month. Most of these programs, on paper, should indeed lead to weight loss. At the same time, the incidence of obesity continues to rise at alarming rates. Why? Because people cannot do the programs.
First, overweight and obese patients do not have the calorie-burning capacity to exercise their way to sustainable weight loss. What's more, the same amount of exercise for an overweight patient is much harder than for those who do not have excess body weight. An obese patient simply cannot exercise enough to lose weight by burning calories.
Second, the body will not let us restrict calories to such a degree that long-term weight loss is realized. The body fights back with survival-based biological responses. When a person limits calories, the body slows baseline metabolism to offset the calorie restriction, because it interprets this situation as a threat to survival. If there is less to eat, we'd better conserve our fat and energy stores so we don't die. At the same time, also in the name of survival, the body sends out surges of hunger hormones that induce food-seeking behavior – creating a real, measurable resistance to this perceived threat of starvation.
Third, the microbiota in our guts are different, such that "a calorie is a calorie" no longer holds true. Different gut microbiota pull different amounts of calories from the same food in different people. So, when our overweight or obese colleague claims that she is sure she could eat the same amount of food as her lean counterpart, and still gain weight – we should believe her.

Strength conditioning builds muscle mass, which can help increase capacity. Credit: Rudd Center for Food Policy and Obesity, CC BY-SA

Lots of shame, little understanding
Importantly, the lean population does not feel the same overwhelming urge to eat and quit exercising as obese patients do when exposed to the same weight loss programs, because they start at a different point.
Over time, this situation has led to stigmatizing and prejudicial fat-shaming, based on lack of knowledge. Those who fat-shame most often have never felt the biological backlash present in overweight and obese folks, and so conclude that those who are unable to follow their programs fail because of some inherent weakness or difference, a classic setup for discrimination.
The truth is, the people failing these weight loss attempts fail because they face a formidable entry barrier related to their disadvantaged starting point. The only way an overweight or obese person can be successful with regard to sustainable weight loss, is to directly address the biological entry barrier which has turned so many back.
Removing the barrier
There are three ways to minimize the barrier. The objective is to attenuate the body's response to new calorie restriction and/or exercise, and thereby even up the starting points.
First, surgeries and interventional procedures work for many obese patients. They help by minimizing the biological barrier that would otherwise obstruct patients who try to lose weight. These procedures alter the hormone levels and metabolism changes that make up the entry barrier. They lead to weight loss by directly addressing and changing the biological response responsible for historical failures. This is critical because it allows us to dispense with the antiquated "mind over matter" approach. These are not "willpower implantation" surgeries, they are metabolic surgeries.
Second, medications play a role. The FDA has approved five new drugs that target the body's hormonal resistance. These medications work by directly attenuating the body's survival response. Also, stopping medications often works to minimize the weight loss barrier. Common medications like antihistamines and antidepressants are often significant contributors to weight gain. Obesity medicine physicians can best advise you on which medications or combinations are contributing to weight gain, or inability to lose weight.
Third, increasing exercise capacity, or the maximum amount of exercise a person can sustain, works. Specifically, it changes the body so that the survival response is lessened. A person can increase capacity by attending to recovery, the time in between exercise bouts. Recovery interventions, such as food supplements and sleep, lead to increasing capacity and decreasing resistance from the body by reorganizing the biological signaling mechanisms – a process known as retrograde neuroplasticity.
Lee Kaplan, director of the Harvard Medical School's Massachusetts Weight Center, captured this last point during a recent lecture by saying, "We need to stop thinking about the Twinkie diet and start thinking about physiology. Exercise alters food preferences toward healthy foods … and healthy muscle trains the fat to burn more calories."
The bottom line is, obese and overweight patients are exceedingly unlikely to be successful with weight loss attempts that utilize mainstream diet and exercise products. These products are generated with the intent to sell, and the marketing efforts behind them are comparable to the well-known distractions generated by the Wizard of Oz. The reality is, the body fights against calorie restriction and new exercise. This resistance from the body can be lessened using medical procedures, by new medications or by increasing one's exercise capacity to a critical point.
Remember, do not start or stop medications on your own. Consult with your doctor first.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

Eating prunes can help weight loss

The study found those in the group eating prunes as part of a healthy life-style diet lost 2kg in weight and shed 2.5cm off their waists

31 may 2014--Research by the University of Liverpool has found that eating prunes as part of a weight control diet can improve weight loss.

Consumption of dried fruit is not readily recommended during weight loss despite evidence it enhances feelings of fullness.

Low fibre consumers

However, a study by the University's Institute of Psychology, Health and Society of 100 overweight and obese low fibre consumers tested whether eating prunes as part of a weight loss diet helped or hindered weight control over a 12-week period.

It also examined if low fibre consumers could tolerate eating substantial numbers of prunes in their diet, and if eating prunes had a beneficial effect on appetite.

To assess the effects of prunes on weight and appetite, participants in the study were divided into two groups – those who ate prunes every day (140g a day for women and 171g a day for men) and those who were given advice on healthy snacks over the period of active weight loss.

The researchers found that members of the group which ate prunes as part of a healthy life-style diet lost 2kg in weight and shed 2.5cm off their waists. However, the people in the group which was given advice on healthy snacks lost only 1.5kg in weight and 1.7cm from their waists.

The study also found that the prune eaters experienced greater weight loss during the last four weeks of the study. After week eight, participants showed increased feelings of fullness in the prune group. Moreover, despite the high daily doses, prunes were well tolerated.

Useful and convenient addition

Liverpool psychologist, Dr Jo Harrold who led the research, said: "These are the first data to demonstrate both weight loss and no negative side effects when consuming prunes as part of a weight management diet. Indeed in the long term they may be beneficial to dieters by tackling hunger and satisfying appetite; a major challenge when you are trying to maintain weight loss."

Professor Jason Halford, Professor of Experimental Psychology and Director of the University's Human Ingestive Behaviour Laboratory, added: "Maintaining a healthy diet is challenging. Along with fresh fruit and vegetables, dried fruit can provide a useful and convenient addition to the diet, especially as controlling appetite during dieting can be tough."

Provided by University of Liverpool

Belief That Intentional Weight Loss Is Harmful To Seniors Is Unfounded

A new study by researchers at Wake Forest University Baptist Medical Center is the first to refute the widely held belief that intentional weight loss in older adults leads to increased risk of death.

11 april 2010--In fact, the research shows that seniors who intentionally exercised and/or modified their diets to lose weight were half as likely to die within eight years of follow-up as their peers who did not work toward weight loss, said M. Kyla Shea, Ph.D., first author on the study and a research associate in the Department of Internal Medicine, Section on Gerontology and Geriatric Medicine.

"It was an unusually strong and surprising finding," Shea said. "Our data suggest that people should not be concerned about trying or recommending weight loss to address obesity-related health problems in older adults."

The study, funded by the National Institute on Aging, is currently available online and is schedule to appear in a future print issue of the Journal of Gerontology: Medical Sciences.

Prior to this study, research that has looked at the association between mortality and weight loss has not factored in the many different potential causes of the weight loss. So, using a more rigorous randomized trial approach, Shea and colleagues sought to prove or disprove the idea that older individuals who actively tried to lose weight increased their risk of death.

The research team re-analyzed data from a study of 318 community-dwelling, older adults over age 60, all with knee arthritis, who were enrolled in a trial assessing the effects of weight loss and/or exercise on physical function in the late 1990s. The initial weight-loss intervention took place over a period of 18 months from 1996 through 1998, during which time the 159 individuals in the intervention groups actively lost an average of 10.5 pounds. The non-intervention group lost an average of 3.1 pounds naturally.

The researchers then checked to see if the study participants were still living eight years later.

"Overall, we found that there were far fewer deaths - half the number - in the group of participants that lost weight compared to the group that did not," Shea said.

The finding was unexpected to seasoned gerontologists.

"For years, the medical community has relied on multiple epidemiological studies that suggested that older people who lost weight were more likely to die," said Stephen B. Kritchevsky, Ph.D., director of the J. Paul Sticht Center on Aging at the Medical Center. "Weight loss in old folks is just understood to be a bad prognostic sign. The data that people have been using has been unable to separate the cause and effect of the weight loss, however, and our study suggests that the weight loss they've been studying may be the result of other health problems and not of intentional weight loss."

The participants in this study had a constellation of common health problems occurring in aging adults, Kritchevsky added.

"These were the seniors living out in the community, getting around and doing their daily tasks just like your neighbor," he said. "All were overweight and dealing with the signs of aging when the study started."

When the researchers evaluated the effect of weight loss in the oldest of the participants - 75 and older - they found the same reduction in mortality as they saw in the younger group - those 60 and older - who lost weight.

Weight loss in older adults has been shown to help several medical problems, Kritchevsky said, such as high blood pressure, high cholesterol and high fasting glucose levels. However, physicians have been hesitant to recommend weight loss in older adults because of a concern for mortality based on previous research.

"This study puts to rest a lot of unfounded concerns about how to address the epidemic of obesity among our older adults," Kritchevsky said.

He cautioned that the study was relatively small and the results should be confirmed in other trials, but that the data gathered from this analysis are sufficient enough to rule out any significant excess risk due to intentional weight loss and to suggest that there may be a mortality benefit to losing the weight, as well.

In addition to Shea and Kritchevsky, Wake Forest Baptist co-authors included Denise K. Houston, Ph.D., Barbara J. Nicklas, Ph.D., Dalane W. Kitzman, M.D., and Kimberly Kennedy, B.A., all of the J. Paul Sticht Center on Aging; Cralen C. Davis, M.S. and Michael E. Miller, Ph.D., both of the Department of Public Health Sciences; Stephen P. Messier, Ph.D., of Wake Forest University; and Tamara B. Harris, M.D., of the National Institute on Aging.

Source
Wake Forest University Baptist Medical Center

Low-Carb and Mediterranean Diets May Equal Watching Fat Intake

By Crystal Phend

BEER-SHEVA, Israel, 17july 2008--
Weight loss with both a low-carbohydrate and a Mediterranean diet may have advantages over a low-fat diet, researchers found.
The mean weight loss was greater with the low-carb diet (4.7 kg) and a Mediterranean diet (4.4 kg) than with the low-fat diet (2.9 kg, P<0.001 for interaction), reported Iris Shai, R.D., Ph.D., of Ben-Gurion University of the Negev here, and colleagues in the July 17 issue of the New England Journal of Medicine.
In the two-year randomized trial, the low-carb diet was the clear winner in lowering lipids with a 20% relative reduction in total-to-HDL cholesterol compared with 12% in the low-fat group (P=0.01).
Among diabetic patients, the Mediterranean diet held the greatest benefits for fasting plasma glucose compared with the low-fat diet (P<0.001 for interaction).
"In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects," they wrote, "a result suggesting that … diets might be individualized according to personal preferences and metabolic needs."
For example, patients who find it difficult to cut calories might do best on a low-carb diet, which achieved a similar caloric deficit as the other diets in the study without restricting calories directly, they said.
Their Dietary Intervention Randomized Controlled Trial (DIRECT) included 322 moderately obese adults (mean BMI 31 kg/m2) at an isolated workplace in Israel with an on-site medical clinic and a cafeteria that provided lunch in accordance with diet groups.
Participants were mostly middle age men (86%, average age 52).
Registered dietitians met with patients in groups several times over the first two months and at six-week intervals thereafter, for a total of 18 90-minute sessions.
The low-fat, low-calorie diet based on American Heart Association guidelines aimed at 1,500 to 1,800 kcal a day with 30% of calories from fat, 10% of calories from saturated fat, and an intake of 300 mg of cholesterol per day.
The Mediterranean diet emphasized vegetable, poultry, and fish intake with daily calories restricted to 1,500 to 1,800 kcal and olive oil and nuts as the main sources of added fat.
The low-carbohydrate diet was based on the Atkins diet and did not limit calorie, protein, or fat intake, although vegetarian sources of fat and protein were suggested.
Adherence to these diets was high, with an average of 95.4% at 12 months and 84.6% at 24 months, whereas most diet trials have high dropout rates of 15% to 50% within the first year.
Dieters in all three groups significantly reduced daily energy intake (P<0.001) and increased physical activity compared with baseline without differences between groups.
Weight loss peaked at six months followed by partial rebound and then a plateau during the maintenance phase from seven to 24 months.
Overall at 24 months, the average weight loss compared with baseline was:
-2.9 kg for the low-fat group
-4.4 kg for the Mediterranean diet group
-4.7 kg for the low-carbohydrate group
Weight changes were even greater among the 272 participants who stuck with the diet for the full 24 months (-3.3, -4.6, and -5.5 kg in the diet groups, respectively, P=0.03 low-fat versus low-carb).
Although relatively few in number, the 45 women participants tended to lose more weight on the Mediterranean diet than on the other diets over 24 months (-6.2 kg versus -0.1 on low-fat and -2.4 kg on low-carb diets, P<0.001 for interaction).
"This possible sex-specific difference should be explored in further studies," the researchers said.
Whereas no effects were seen on LDL cholesterol, HDL cholesterol increased in all groups, particularly the low-carbohydrate versus the low-fat group (8.4 versus 6.3 mg/dl, P<0.01 for interaction).
Those on the low-carb diet likewise showed the most improvements in triglyceride levels compared with the low-fat diet (23.7 versus 2.7 mg/dl, P=0.03 for interaction).
The Mediterranean diet, though, came out ahead on most glucose control measures.
Among the 36 participants with diabetes, fasting plasma glucose fell only in the Mediterranean-diet group (32.8 mg/dl, P<0.001 versus low-fat diet).
Insulin resistance decreased as measured by HOMA-IR at 24 months with the Mediterranean diet compared with the low-fat diet (2.3 versus 0.3, P=0.02), although the authors acknowledged that HOMA-IR is not an optimal test.
Glycosylated hemoglobin decreased most with the low-carb diet (0.9% versus 0.4% low-fat and 0.5% Mediterranean diet, P<0.05 for low-carb).
The study was limited by the high proportion of male subjects and its setting in a restricted workplace. Although the workplace-based intervention may make it difficult to generalize the results to other populations, the researchers said they believed "similar strategies to maintain adherence could be applied elsewhere."
The study was supported by the Nuclear Research Center Negev, the Dr. Robert C. and Veronica Atkins Research Foundation, and the S. Daniel Abraham International Center for Health and Nutrition of Ben-Gurion University. The researchers reported no potential conflict of interest.

Primary source: New England Journal of MedicineSource reference:Shai I, et al "Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet" N Engl J Med 2008; 359: 229-41.

A nervy approach to weight loss

By Chandra Shekhar
15 june 2008-- WEIGHT loss surgery works, but is so invasive and has such unpleasant long-term side effects that it's recommended for only a fraction of the obese population, and even many in that group are reluctant to undergo the surgery. In hunting for a simpler and safer alternative, researchers have zeroed in on a nerve that carries much of the communication between brain and gut.Disrupting this communication, they believe, could lead to safe, effective and sustained weight loss -- mainly by cutting off signals from the gut that tell the brain it's time to eat. The concept still has to be validated, says Dr. Philip Schauer, immediate past president of the American Society for Metabolic and Bariatric Surgery, a Gainesville, Fla.-based association of U.S. weight loss surgeons, "But if it gives even a modest amount of weight loss, it could be a winner."Two different methods of disrupting the vagus nerve are now in clinical trials. One method, vagotomy, simply cuts the nerve and permanently disables it. The other, vagal nerve blocking, uses an electric current to periodically confuse the nerve and prevent it from transmitting signals. Preliminary results suggest that both methods help to safely reduce excess body weight by about 20% on average within six months of therapy.Amid the complex set of muscles, nerves and organs that team up to regulate body weight, one anatomical feature stands out: the vagus nerve. Running from the brain through the esophagus and branching out to reach nearly every part of the digestive system, this nerve plays a key role in weight gain.When the stomach is empty, the vagus nerve informs the brain and triggers the feeling of hunger. When the stomach contains food, the vagus tells the brain and relays back the brain's commands to secrete stomach acid to help digest the food. The brain's control of the passage of food through the digestive system also relies on the vagus nerve. In short, without the vagus, we would get less hungry, and food would stay longer in the stomach.The vagus nerve does even more than that. While food is being digested, the brain tells the pancreas to make insulin, a hormone that helps store energy from food in fat tissues. That command passes through the vagus nerve. So too does another that instructs fat tissues to grow by absorbing more nutrients. "Everything this nerve does is designed to make you take up energy and put it into your fat," says Dr. Robert Lustig, a pediatric endocrinologist at UC San Francisco and one of the lead investigators in a 30-patient clinical trial of vagotomy for weight loss. "It's your energy storage nerve."First noticed in the 1940sThe vagus nerve's pivotal role in weight gain would appear to make it a prime target of obesity therapy. But this potential was discovered almost by accident in the 1940s, when surgeons treating intractable ulcers tried vagotomy to help reduce stomach acidity. The method worked, and soon became widely used (drug therapy eventually superseded it). But the operation had an unexpected side effect: It made obese patients lose weight.Early vagotomy surgeries cut the entire vagus nerve as well as some stomach muscles. This drastic method caused undigested food to be dumped into the intestines, leading to a range of unpleasant side effects, such as diarrhea, vomiting, flushing and dizziness.The modern form of the procedure is much more refined: It cuts only the parts of the vagus that control hunger and weight gain, leaving the stomach muscles and the rest of the nerve intact. As a result, the side effects of vagotomy are now much milder and tend to disappear after a few months, Lustig says.Launched in 2005, the trial Lustig is involved in is taking place at UC San Francisco and the University of Rochester. About 80% of the 30 subjects in the trial lost an average of about 30% of their excess body weight in the first six months, Lustig says. The trial is sponsored by EndoVx, a Napa-based company that is developing a device to simplify the vagotomy procedure.One of Lustig's patients, 57-year-old Garth Michaels of Walnut Creek, says he lost about 40 pounds within months of surgery. He got rid of 60 pounds more over the next year after starting a regular exercise program, and is down to a manageable 220 pounds."It's harder for extra weight to come on to me, and it's easier for it to fall off than it used to be," he says. In fact, he adds, he feels that his whole attitude toward food has changed for the better after his vagotomy. "I eat less food, eat it more slowly and enjoy it more."Once the vagus nerve is cut, it can't be restored -- a potential drawback, because the reduced appetite and slowed digestion may no longer be required or even desirable once a patient attains a healthy body weight. And so some researchers are testing whether it's possible to achieve the weight loss effects of vagotomy while keeping the vagus nerve intact.The technique they are using is called vagal nerve blocking, which has been developed by St. Paul, Minn.-based EnteroMedics. A surgeon implants a matchbox-sized device in the patient's side that sends a high-frequency electrical signal to the vagus nerve. The electrical signal effectively blocks the nerve, causing the same effect on appetite and digestion as a vagotomy, says Mark Knudson, the company's chief executive. Turning off the signal restores vagus function, he adds.This procedure is now being evaluated in a 300-patient placebo-controlled study underway at several U.S. research centers. Patients in both arms of the EnteroMedics-sponsored trial are implanted with the device. But it is not turned on in the placebo group."Vagal nerve blocking gets to the root of the problem to inhibit the hunger pains these patients have," says Dr. Ninh Nguyen, a gastrointestinal surgeon who is leading the trial at the UC Irvine Medical Center.One of Nguyen's subjects, San Juan Capistrano resident Jeff Collins, 25, says he has lost about 20 pounds since he joined the trial in December at more than 300 pounds. Wearing the VBLOC device causes only mild discomfort, he says. And judging by the result, he thinks he is getting the therapy, not the placebo."I still love food, and still get hungry," he says. "But I am eating healthier, and eating a lot less than I used to."Each has its downsideBoth vagotomy and vagal nerve blocking have advantages and drawbacks. "With vagotomy, they snip something, and your anatomy is permanently altered," Knudson says. "With our method, you are living a more normal life.""With the EnteroMedics approach, you carry a foreign object in your body that needs constant attention and could cause infection," Lustig says. "Vagotomy doesn't have those problems."Both treatments are done using a technique called laparoscopic surgery, which is much less invasive than most weight loss surgeries. Knudson estimates that VBLOC therapy will cost about as much as gastric bypass surgery (about $25,000, according to the National Institutes of Health). Vagotomy as it is done now would cost about $9,000, Lustig estimates. But costs could come down if an experimental technique for snipping the vagus nerve using sound waves, developed by EndoVx, turns vagotomy into a simple outpatient procedure. This has been tested on animals and will be tried on human patients next year, says William Aldrich, the company's chief executive.It isn't yet known whether either procedure will have a lasting effect on body weight. The body's ability to adapt to a weight loss therapy and find other ways to gain weight has doomed many initially promising anti-obesity drugs. VBLOC tries to prevent the body from adapting to it by using intermittent, rather than constant, blocking of the nerve, Knudson says. Since vagotomy can't do this, obesity researchers such as Dr. Samuel Klein of the Washington University School of Medicine in St. Louis predict it may produce only temporary weight loss.Lustig, however, cites earlier studies that found that weight loss from vagotomy was sustained for up to 25 years and says that most of his patients have not regained lost weight after 18 months.Both approaches are being conducted only in clinical trials for now. If the VBLOC study goes well, the device is likely to get Food and Drug Administration approval within two to three years, Knudson says. Vagotomy, since it is a surgical procedure, does not need FDA approval, but the EndoVx device for snipping the vagus nerve would need to be approved, and this could take several years, Lustig says.For now, the only really effective therapy for severe obesity is weight loss surgery, Schauer says. "But perhaps in five or 10 years we may have a minimally invasive procedure that is just as effective."

New drug makes weight loss safer

Dr. Nir Barak of TAU University has created a new diet drug with fewer side effects

TEL AVIV – More than 60 percent of American women are overweight, with nearly a third falling into the category of obese and at greater risk of cancer, heart disease and diabetes. Until now, there has been no safe, long-term medical remedy that tackles unwanted weight gain.
Dr. Nir Barak of Tel Aviv University’s Sackler School of Medicine has developed what could be a new weight-loss wonder drug. In conjunction with the drug company Obecure, Dr. Barak developed a new formulation called HistaleanTM, based on betahistine, an approved drug marketed worldwide for the treatment of vertigo. Betahistine has been available to health authorities for over 30 years.
Betahistine is believed to block receptors in the brain – the H1 and H3 receptors – which are connected to one’s sense of fullness and desire to eat fatty foods. It has an excellent safety profile and has been used for treatment by more than 100 million patients suffering from vertigo and dizziness in Canada and Europe.
The repurposed pill, Histalean, has been found to quell the desire to consume fatty foods, and the effects have been most pronounced in women.
According to the U.S. Center for Disease Control, about 32% of adult American women under 54 (about 25 million women) suffer from obesity. “Our new results suggest a strong gender-and-age-effect and support the potential of the drug as a breakthrough anti-obesity agent in women 50 years old or less,” confirmed Dr. Yaffa Beck, Obecure’s CEO.
According to some estimates, obesity results in thousands of deaths a year and accounts for $117 billion in U.S. health care expenses annually. Clearly, a breakthrough in this area will not only make women look and feel better, but it could save their lives as well.
A recent Phase II clinical trial of the new drug in the U.S. suggests that women under the age of 50 who took Histalean for 12 weeks lost 7 times the weight of those taking a placebo. What’s most important to the researchers involved is that none of the 281 patients, males and females aged 18-65, complained of any serious side effects.
The trial, completed this August, was supervised by U.S. weight-loss guru Dr. Robert Kushner. The women who took the pill reported, “It wasn't hard.” “I wasn't thinking about food.” “I was content.”
Dr. Barak explains why this is good news, “All the drugs in the diet pill market today have serious side effects. They may help a woman lose weight, but with that weight loss comes all sorts of bad things like depression and even suicide. Safety issues are a real concern for the FDA. But because this new drug has already been proven safe for other indications, we think Histalean has real blockbuster potential.”
The recent results were based on a double-blind, placebo-controlled study on people with a Body Mass Index ranging from 30 to 40. (A BMI of 30 and above indicate obesity.) The study was conducted at 19 investigation sites across the U.S. over a 12 week treatment period. The subgroup of high-dose Histalean-treated women lost an average of 2.91% of their weight versus placebo group which lost only 0.4 %.
Dr. Barak’s drug is also expected to compete for the $28 billion market of cholesterol-reducing drugs such as Lipitor. It could also be used in parallel with anti-psychotic drugs, which have unwanted side effects of extreme weight gain among mental health patients.

Weight Loss Comes Before a Cognitive Fall

ROCHESTER, Minn., Aug. 20 -- A decade before women develop dementia, they may begin to have an unexplained loss of weight, according to investigators here.
Women who went on to develop dementia weighed an average of 12 pounds less at the time of diagnosis than non-demented age-matched controls, reported David Knopman, M.D., of the Mayo Clinic, and colleagues, in a retrospective case-control study.
Weight loss did not predict dementia in men, however, the authors reported in the Aug. 21 issue of Neurology.
"One explanation for the weight loss is that, in the very early stages of dementia, people develop apathy, a loss of initiative, and also losses in the sense of smell," Dr. Knopman said. "When you can't smell your food, it won't have much taste, and you might be less inclined to eat it. And apathy and loss of initiative may make women less likely to prepare meals and more likely to skip meals."
In contrast, men are more likely to have their meals prepared for them, "which would lessen the effect of the apathy, loss of initiative and loss of sense of smell," Dr. Knopman added.
The authors identified patients who were diagnosed with dementia from 1990 through 1994, using records linked through the Rochester Epidemiology Project. They defined dementia according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.
Each case was matched by gender and age to a patient from the same population. Controls were free of dementia in the year of dementia diagnosis of their matched cases. The weights of cases and controls were drawn from medical records.
The investigators identified a total of 481 patients who had been diagnosed with primary dementia of presumed vascular or degenerative origin during the study period and who had suitable matches. Information on weight for matched pairs was available for 295 female pairs and 76 male pairs.
The authors found that although there were no significant differences in weight between cases and controls from 21 to 30 years before the onset, women who developed dementia weighed significantly less than controls starting 11 to 20 years before the index year (the year of dementia onset), and that prior to the index year, and that this difference increased over time.
"We found a trend of increasing risk of dementia with decreasing weight in women both at the index year (test for linear trend, P<0.001) and nine to 10 years before the index year (test for linear trend, P<0.001)," they wrote.
Among men, however, there were no significant differences in weight at any time point, including the index year.
The authors suggested that the association between weight loss and dementia only in women may be attributable to hormonal factors.
"Women with lesser amounts of adipose tissue may have lower circulating levels of estrogen because the adipose tissue participates in the conversion of endogenous steroids to estrogen," they wrote. "Lower levels of estrogen in early menopause may increase the risk of neurodegenerative or vascular brain lesions. Similarly, the lack of association between weight loss and risk of dementia in men may be related to hormonal factors such as testosterone levels; however, a social explanation seems equally plausible."
Weight loss that precedes dementia might also be caused by dementia-related changes in limbic and hypothalamic function, alterations in insulin sensitivity, or age-related changes in metabolic function, they added.
The authors acknowledged that the study was limited by the retrospective case-control design, difficulties in diagnosing dementia in its early stages, and missing weight data for many of the cases.
The study was supported by grants from the National Institute on Aging and by the Rochester Epidemiology Project. Dr. Knopman has been a consultant to GE HealthCare, GlaxoSmithKline, and Myriad Pharmaceuticals, served on a Data Safety monitoring board for Neurochem Pharmaceuticals and Sanofi-Aventis, and was an investigator for in a trial sponsored by Elan Pharmaceuticals. Co-author Ronald C. Petersen M.D., Ph.D., has been a consultant to GE HealthCare, Servier, and Elan Pharmaceuticals. The remaining authors reported no conflicts of interest.Primary source: NeurologySource reference: Knopman DS et al. "Incident dementia in women is preceded by weight loss by at least a decade." Neurology 2007;69:739-746.

Weight Loss with Dietary Counseling Fizzles Over Time

BOSTON, July 2 -- Dietary counseling produces modest weight loss, but the effect disappears within about five years, a meta-analysis showed.
On average, weight loss programs that use group or individual counseling, or both, helped participants drop 6% of their body weight after one year, found Michael L. Dansinger, M.D., of Tufts-New England Medical Center here, and colleagues.
At three years, however, half of the weight lost was regained, and at about 5.5 years participants were back to baseline, they reported in the July 3 issue of Annals of Internal Medicine.
Nonetheless, "even small, relatively short-term weight loss may have an important clinical effect," they wrote.
"As many of the included studies show," they added, "dietary and lifestyle changes resulting in modest weight loss consistently reduce such cardiovascular risk factors as hyperglycemia, hypercholesterolemia, and hypertension."
Although weight loss programs with a counseling component have long been known to produce modest, transient effects, the magnitude and persistence of the weight loss across clinical trials was less clear.
So the researchers gathered the relevant studies from a prior systematic review covering 1980 to 1997 and searched the literature for randomized trials published from 1997 through 2006.
The 46 trials included reported original data comparing dietary counseling interventions with control, either usual care or minimal counseling (general verbal or written advice). Participants had to be adults with a body mass index of 25 kg/m2 or greater at baseline.
Overall, about 6,386 people underwent dietary counseling and 5,467 received usual care or minimal counseling. Mean age ranged from 27 to 68, and mean BMI ranged from 25 to 40 kg/m2. Participants were healthy in 12 trials, but had hypertension in another 12 trials, type 2 diabetes in 10, impaired glucose tolerance in five, heart disease in three, dyslipidemia in two, and other conditions in six.
Nearly all of the trials promoted exercise, but interventions varied. Seventeen targeted calorie intake, 25 restricted fat intake, and others individualized dietary recommendations to achieve a specific weight loss goal. Group meetings were used in 18 trials, individual meeting in 13 trials, a combination in 11, and three trials used the Internet.
Dr. Dansinger and colleagues found no studies of low-carb diets that included a control group, so none of were included in their review.
Active intervention ranged from 2.5 to 48 months. Although about two-thirds of the trials were of at least fair quality, 28% were poor quality, the researchers said.
They found the expected pattern of weight loss during the active phase of trials and weight regain during the maintenance phase.
On average during active intervention, BMI dropped by 0.12 units per month during months three to six and 0.04 units per month from months three to 12. Meta-regression suggested an overall loss of 0.08 units per month to one year (P=0.007).
The net weight loss effect was about two BMI units at one year (6% of baseline weight, or about 11 lbs).
Diet and exercise showed no consistent benefit over diet alone, although the difference significantly favored exercise with diet at 12 months. The rate of weight loss with diet and exercise was 0.23 BMI units per month from months three to 12 averaged across three trials compared with essentially no change in the diet groups alone (P=0.009).
Studies of people with diabetes showed that dietary counseling intervention was half as effective as in studies of nondiabetics (P<0.001).
During maintenance, the average weight regain increased with time: 0.01 BMI units per month from months six to 12, 0.02 to 0.03 units per month from 12 to 18 months, and 0.04 units per month from 24 to 30 months.
About half the initial weight loss was regained at three years, Dr. Dansinger and colleagues noted.
Meta-regression suggested, "patients would return to their baseline weights after approximately 5.5 years," they wrote.
Independent predictors of greater weight loss were:
A lower daily caloric intake target (P=0.009).
More frequent support meetings (P<0.001).
Absence of diabetes (P<0.001).
Notably, whether the intervention included exercise was not a significant factor (P=0.50).
Predictors of slower weight regain were lower calorie targets (P=0.011) and the absence of diabetes (P=0.012), but not type of intervention (P=0.62).
Only a third of the studies reported recommended daily caloric intake, however, and the predictive findings can only be considered hypothesis generating because of the retrospective nature of the meta-analysis and lack of patient-level data.
The study was also limited by differences between interventions studied, "although such heterogeneity may enhance the generalizability of our findings," the investigators wrote.
Long-term trials are needed to confirm the findings, the researchers concluded.
The study was funded by the Agency for Healthcare Research and Quality. Dr. Dansinger reported support by a grant from the National Institutes of Health. The researchers disclosed no potential financial conflicts of interest. Primary source: Annals of Internal MedicineSource reference: Dansinger ML, et al "Meta-analysis: The effect of dietary counseling for weight loss" Ann Int Med 2007;147:41-50.