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    A City Refurbished for Health

    January 20th, 2017

    chesapeake-boathouse

    Childhood Obesity News has been following along with the story of Oklahoma City’s transformation, as described by Ian Birrell for MosaicScience.com. Mayor Mike Cornett led the people to undertake what was described as a war on fat. Local corporations and institutions pitched in to help with such cornerstones as the website ambitiously titled, “This City is Going on a Diet.”

    First, Cornett challenged the locals to lose a million pounds. Apparently, the combat paradigm makes sense in this neck of the woods, because it recruited tens of thousands of residents who joined groups according to their family ties, neighborhood affiliations, clubs, churches, or whatever.

    Wellness classes were held in libraries and businesses set up friendly fat-shedding competitions. The website dispensed weight-loss advice, information on recreational activities, the opportunity to pair up with an accountability partner, and much more.

    Rather than try to tax particular substances like sugar-sweetened beverages, the mayor took the bold step of asking the populace for an across-the-board 1% sales tax hike, and they voted it in. With this annual extra $100 million, and some other available funds, the city was able to start making changes. The concept was to provide more recreational opportunities and green spaces and in general, anything that would make the car-friendly cityscape more appealing to humans.

    Things looked up

    The positive activity encouraged businesses to invest in upgrading their buildings and surroundings. Developers built new hotels and other projects that gratifyingly lowered the unemployment rate. All those employed people spent their paychecks buying things and contributing to funds that the sales tax amassed.

    But aside from launching that tax, at the beginning there really was no “grand plan.” Birrell wrote:

    The mayor began to look afresh at the culture and infrastructure of his city… This unleashed an incredible range of initiatives, including the creation of parks, sidewalks, bike lanes and landscaped walking trails across the city. Every school is getting a gym.

    An incredibly ambitious and costly project turned the urban eyesore of a dried-up river into a three-mile-long water feature “fringed with lush landscaping, futuristic-looking boathouses, bike lanes and floodlights” and, best of all, created “the world’s finest rowing and kayaking centre in a Midwest town with no tradition of the sport beforehand.”

    The exertion of rowing will strip the pounds right off a person. The journalist wrote:

    People on paddleboards and school parties on dragon boats share the water with US Olympic teams in training under the searing sun. Efforts are made to attract people from across society: 50 firms have joined a corporate rowing league, while eight local high schools have their own boats.

    The first of a series of “Wellness Campuses” was built in an mostly African-American neighborhood:

    The slick new building — filled with medical clinics, communal meeting rooms and kitchens for cooking demonstrations — sits in verdant grounds dotted with walking and bike trails. Patients at the private–public partnership can see specialists in everything from nutrition to domestic violence, taking home prescriptions for food boxes and soon even for running shoes and vests.

    When enough time had gone by to assess the progress, health professionals confirmed that the obesity rate was growing more slowly, having dropped from a yearly 6% increase to a mere 1%. Other vital statistics improved noticeably too, including a measurable decrease in the overall mortality rate. If other cities haven’t already done so, it would be an excellent idea for them to take a close look at what OKC did and continues to do.

    Your responses and feedback are welcome!

    Source: “The fat city that declared war on obesity,” MosaicScience.com, 10/13/15
    Photo credit: Allison Meier via Visualhunt/CC BY-SA

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    Oklahoma City and the Combat Paradigm

    January 19th, 2017

    bricktown-oklahoma

    In Oklahoma City, Mayor Mike Cornett led the people to undertake what was described as a war on fat. Before looking at more of the fascinating information collected by journalist Ian Birrell about the nuts and bolts of that campaign, let’s digress for a moment and reflect on semantics.

    Some Americans are tired of all the Wars on Everything, and wish that activists and the press could branch out and employ some other metaphor to name things. A sentence in this article illustrates the problem:

    The battle is being done with, rather than against, the fast food industry and soft drinks manufacturers…

    Despite some objections of the “sleeping with the enemy” variety, the city leaders seem able to elicit cooperation and sponsorship from businesses, which is great, but does it have to be that they are allies in a war? Even a sentence that begins with a more neutral framing, finishes up with bellicose terminology:

    The experiment is unusual in terms of its ambition, breadth and cost, all of which take it beyond anything being attempted by other American cities in the fight against fat.

    Also like a war, there has to be triage, which practices the art of resource allocation to accomplish the greatest possible amount of good. In a makeshift hospital next to a battlefield, someone has to decide whether to pour copious time and energy into saving a few badly wounded victims, or to use the supplies and the staff’s time to patch up a larger number of troops who are less seriously hurt.

    These practical aspects have to be sorted out, to get the most bang for the available buck. In OKC, some municipal districts needed more help than others, as explained by Birrell:

    Six years ago the city started poring over all available data to find its least healthy zip codes, discovering that some disadvantaged parts suffer five times as many deaths from strokes and cardiovascular conditions as wealthier areas. This led to the redirection of funds to places most in need.

    Here is another example of how closely the combat paradigm is followed:

    Overweight people are targeted at home and at work to alter their lifestyles…

    Why “targeted”? Targeting is what the advertising industry rudely does to demographic groups it has researched, and maybe the good guys would do better to think in terms of addressing people, instead. Although, to be fair, the writer also describes the program as “relying largely on persuasion instead of coercion.”

    For more depth on the persuasion angle, Birrell consulted the City-County Health Department’s Alicia Meadows, who held the office of Director of Planning and Development. She described the outreach team of eight people who go out and mingle with the crowds at events where ordinary city residents tend to show up.

    In the overwhelmed neighborhoods where the data show that help is most clearly needed, the department understands the importance of meeting people where they are. An outreach worker from the same ethnic community may even go door to door distributing information and asking people about their needs. Meadows told the reporter:

    We make it clear we don’t want to see their papers; we know many are undocumented. But their health impacts on the city’s health… If you direct significant resources into areas of greatest health inequalities, we think you make the biggest difference.

    Next: More about the amazing transformation of Oklahoma’s capital city.

    Your responses and feedback are welcome!

    Source: “The fat city that declared war on obesity,” MosaicScience.com, 10/13/15
    Photo credit: Raymond Bucko, SJ (kiszka king) via Visualhunt/CC BY

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    When a City Goes on a Diet

    January 18th, 2017

    oklahoma-city-mayor-mick-cornett

    For MosaicScience.com, Ian Birrell paints the picture of a concerted effort by many people, encompassing an entire city, and led by a public official who is “hailed as an urban visionary.” The journalist describes what he calls “a remarkable attempt to tackle obesity.” The place is Oklahoma City, located in what some coastal snobs call a “flyover state.” Considerably more than 600,000 people live there, spread out over a spacious 620 square miles, so of course the automobile reigned supreme for decades.

    In 2004 when Mick Cornett first became mayor, there were no bike lanes, and maybe not that many sidewalks. The urban environment was ultra pragmatic and alienating. As time passed, a number of factors coalesced and inspired Cornett to become the prime mover of a renaissance. https://mosaicscience.com/story/fat-city

    There were troubling reports from the medical sector, of high cholesterol counts in children too young to start school, and of older kids with orthopedic problems more usually found in the middle-aged. Sugar consumption, especially in the form of soft drinks, was off the charts.

    Enter the media

    At one point, it came to the mayor’s attention that a fitness magazine declared his city to have the worst eating habits in America, along with the highest density of fast food joints. In national obesity statistics, the citizens made a poor showing. Also, Cornett realized that he himself was obese. The job entailed constantly showing up for breakfast or lunch meetings, and all kinds of other events where food and drink are served and consumed.

    The obligations attached to his position in life made many demands, and provided an excuse to carelessly eat the wrong things, and too much of them. In this way, the mayor was just like anybody else. As a human facing an obese future, he was no different from a typical OKC resident the writer introduced for contrast.

    Velveth Monterroso moved to the capital of Oklahoma as an adult, and eventually noticed that her weight had increased by 50%. Only 34 years old, she weighed one and a half times as much as when she arrived, and was diagnosed as pre-diabetic. She and her husband worked long hours and were too exhausted to prepare healthy meals although, ironically, they were both employed as cooks. “The shoemaker’s children go barefoot” is a cliche for a reason.

    Even when their second child was born and Monterroso became a stay-at-home mom:

    She was tired and her family encouraged her to drink lots of atole — a heavily sweetened corn-based drink popular in central America — to aid the breastfeeding of her new daughter…

    Obesity is a menace that cuts across lines of gender, class, race, and economic status, in every American city. But this place had something different — a mayor who left behind a 20-year career as an on-air television personality. Mick Cornett had been a professional sportscaster, and was a past master of the art of public relations. He challenged the citizens to collectively lose a million pounds.

    A total of 47,000 people signed up, who in January of 2012 were found to have lost around 20 pounds each. The million-pound win was decreed in January of 2012 — and that was only the beginning of the story, which will continue next time.

    Your responses and feedback are welcome!

    Source: “The fat city that declared war on obesity,” MosaicScience.com, 10/13/15
    Photo credit: Michigan Municipal League (MML) via Visualhunt/CC BY-ND

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    The Amazing Placebo Effect

    January 17th, 2017

    acupuncture-session

    Last time, Childhood Obesity News looked at research indicating that in the pursuit of weight loss, “soft science” factors like a human support system and attention from a caring professional might be more effective than calorie counting. This is all part of the phenomenon called the placebo effect, explained as the generic term for good outcomes that stem from the context of the doctor-patient encounter and the “ritual of treatment.”

    The placebo effect […] is characterized as representing the interpersonal component of healing, as distinct from spontaneous natural healing and technological healing dependent on physiologically active pharmaceuticals or procedures.

    The communicative interaction of practitioners with patients, both verbal and nonverbal, may produce placebo effects even without the use of discrete treatments.

    Those sentences are quoted from a 2009 publication with three authors (Dr. Franklin G. Miller of NIH, Dr. Luana Colloca of Turin’s National Institute of Neuroscience, and Dr. Ted J. Kaptchuk of Harvard’s Osher Research Center) who emphasize the importance of the doctor-patient relationship. They go further than that, and assert that research such as theirs “has the potential to revitalize the art of medicine.”

    The paper discusses at great length the difference between disease (biological dysfunction that affects the organism) and illness (the lived experience of the person affected by the disease). The authors emphasize that the placebo effect does not kill germs or knit bones, which are in the realm of biological dysfunction. The placebo effect operates on illness, to alleviate such symptoms as pain, anxiety, and fatigue, and it does a heck of a job.

    Sham and verum acupuncture

    For instance, one trial recruited more than 1,000 subjects with chronic low back pain, and divided them into three groups. Some were treated with genuine — or “verum” — acupuncture. Some were treated with fake — or “sham” — acupuncture, which they believed to be the real thing. Those groups both had 10 treatments (or “treatments”) of 30 minutes each, over a five-week period.

    The third group got traditional physiotherapy, and pain meds as needed. The improvement rates were 48% for the real acupuncture, 42% for the fake acupuncture, and a measly 27% for the “usual care” group.

    The authors go on to say that over the past 30 years, lab research has shown that “placebo interventions can elicit quantifiable changes in neurotransmitters, hormones, and immune regulators.” Brain imaging has shown that neurobiological mechanisms are at work and “placebo analgesia is mediated by release of endogenous opioids.”

    This will blow your mind

    The paper reports in great detail on another experiment in which subjects with Irritable Bowel Syndrome (known as a “difficult-to-treat patient population”) were divided into three groups. In one group, the participants received no treatment at all, but were included and followed under the pretext of being on a waiting list. The other two groups both received sham acupuncture — that is, the simulated or fake kind — twice a week for three weeks.

    In other words, it was not a question of whether acupuncture works or not, because nobody had real or “verum” acupuncture. The researchers wanted to know what would happen when IBS patients believed they were being treated with genuine acupuncture.

    So, why two groups of sham acupuncture recipients? This is the interesting part. The two categories were treated differently in terms of social intervention. In the group called “limited,” the interactions between patient and practitioner started with only a five-minute talk at the first session, and remained brief and business-like throughout. The other group, called “augmented,” had a lot of attention lavished upon them, beginning with a generous 45-minute initial interview “structured to be supportive and empathic and to promote positive expectations…”

    The subjects were questioned at the end of the three-week treatment course, and again at a follow-up three weeks later. The results? Adequate symptom relief was reported by 62% of the “augmented” group — the ones who got fake acupuncture and plenty of attention.

    Adequate symptom relief was also reported by 44% of the “limited group” — who also got fake acupuncture, but minimal attention. Even in the waiting list group, 28% of the subjects felt better. They experienced therapeutic benefit from nothing but anticipation, and knowing that somebody cared.

    Your responses and feedback are welcome!

    Source: “The placebo effect: illness and interpersonal healing,” NIH.gov, Autumn 2009
    Photo credit: Wonderlane via Visualhunt/CC BY

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    Happy Martin Luther King Day!

    January 16th, 2017

    martin luther king day text on usa flag background

    Happy Martin Luther King Jr. Day!

    We will return with our regular post tomorrow, Tuesday, January 17.

    Image by belchonock/123RF Stock Photo.

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    “Dieting” for Weight Loss

    January 13th, 2017

    ballet-class

    Childhood Obesity News mentioned a meta-study on the long-term effects of dieting. The trio of researchers, from UCLA and the University of Minnesota, wrote that their intention was to “evaluate whether weight loss improves health.”

    Just a moment, please! With rare exceptions like anorexia, isn’t it pretty much universally accepted, that weight loss improves health?

    Academic productions like this might be where the Fat Acceptance movement found some of its ideology. One paragraph of the article, first published by Social & Personality Psychology Compass, reads:

    The objective of this review is to assess the long-term health outcomes of weight-loss diets…

    Our review of randomized controlled trials of the effects of dieting on health finds very little evidence of success in achieving this goal.

    If diets do not lead to longterm weight loss or long-term health benefits, it is difficult to justify encouraging individuals to endure them.

    Believing that the ultimate goal should be not weight loss, but health improvement, these authors address the possibility that the reducing diet accomplishes neither weight loss nor anything else except frustration and feelings of inadequacy and failure.

    As is the custom, the researchers pored over a large number of publications to choose the 21 studies that fulfilled their criteria. They specified five particular lab-measurable health outcomes to track: cholesterol, triglycerides, systolic and diastolic blood pressure, and fasting blood glucose.

    Did weight loss lead to those looked-for improvements? Not really. The improvements were minimal, and not correlated with weight change. Weight loss did correlate with less diabetes and fewer strokes, and allowed some patients with diabetes or hypertension to cut down on their medications.

    Motion to the rescue

    The researchers found that exercise itself seems to be responsible for many health benefits — just the exercise, not the consequent loss of weight due to exercise. In other words, it “leads to health benefits in the absence of weight change.” While the reducing diet does not seem to count for much — nor the shedding of pounds — what makes the difference, apparently, is activity alone. Interestingly, and although this was not tested, they suspect that such factors as social support and engagement with the health care system may count for more than calorie reduction.

    Only people who do research can comprehend the mountain of detail involved in such chores as, for instance, determining that dozens or scores of studies have enough essential commonalities to justify matching them against each other, or combining the evidence they contain. Imagine how difficult it must be to compare studies with non-conforming timeframes.

    And yet, for some reason, the various practitioners of science don’t always make things easy for each other. The paper includes an intriguing paragraph, worth lengthy consideration, about what the authors call an “odd convention” of their field:

    The most widely accepted standard for a “successful diet” is that set by the Institute of Medicine (1995), which states that an individual must maintain weight loss for a year. Although our focus is on long-term health outcomes rather than on weight loss, we use the same timeframe of assessing outcomes at least one year post-diet. The Institute of Medicine, however, counts the one year as beginning when the diet begins, rather than when the target weight is reached.

    Social science researchers have discovered that life situations can improve just because a person has signed up for a program, and not even done anything yet. Often, finding kinship in a support group or receiving attention from a counselor can help a person heal through the beneficent effects of connection. Even though it does not involve pills or other physical intervention, this phenomenon is a type of placebo effect, which we will talk about next time.

    Your responses and feedback are welcome!

    Source: “Long-term Effects of Dieting: Is Weight Loss Related to Health?,” DishLab.org, 2013
    Photo credit: Flavio~ via Visualhunt/CC BY

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    Another Look at Long-Term Weight Loss

    January 12th, 2017

    person-on-phone-against-the-wall

    As we have seen, when a person intentionally loses 5% of their original body weight, and maintains that loss, this is considered a success, and 10% is an epic win. In certain cases, even 3% can be declared a victory.

    Of course, no 300-pound person should be discouraged from making the attempt, but how much better is it, really, to end up 9, 15, or even 30 pounds lighter? That’s still 270, which is considered to be in the healthy range only if the person is seven feet tall, which few are.

    Even to achieve modest results, the cost is unmanageable for many people, and not just the price in cash for nutrition classes, gym memberships, and special delivered meals. Mental stress takes a toll. A person listens to a friend who swears it’s all in what you eat; and to another friend who affirms that you must sweat for at least an hour a day; and another who advises you to get your gut bugs squared away; and the one who says to forget all that other stuff because the only answer is meditation.

    It gets worse

    Of course, if a person needs more reason to be discouraged, there is always the set-point theory, which says if the body wants to be a certain size, the human will can do nothing about it. If all else fails, a person can embrace obesity from the vantage point of identity politics, and turn it into a matter of pride.

    Some obese people are overwhelmed by conflicting advice and, even worse, so destructively influenced by advertising that they spend thousands of dollars on equipment they will never use. Everything is just too much of a hassle. Consequently, many people give up before even starting a weight-loss journey.

    Clarification

    One reason to appreciate a paper titled “Long-term Effects of Dieting: Is Weight Loss Related to Health?” is the authors’ generosity of spirit. A. Janet Tomiyama, Britt Ahlstrom, and Traci Mann assume that their report will be read by people who are not medical or science professionals, so they clarify:

    The word “diet” has numerous meanings, which include both “weight-loss diets” and “healthy diets” with no intent of weight loss.

    When a certain eating regimen is prescribed, the intent could be a number of different things. For a hospitalized patient, the doctor orders up a clear liquid diet, a diabetic diet, or whatever. Some hyperactive children respond well to a restricted diet.

    Also, diet may be faith-based, with a whole different set of rules. In the broadest sense, a creature’s diet is whatever that creature eats. But somehow, in the popular imagination, the word has been whittled down to where “on a diet” means you want to reclaim your true bikini body that is hiding in there somewhere.

    Whenever people say that more education is needed, they are both right and wrong. As Dr. Pretlow has learned, most American kids feel that they know enough about calories and vitamins. They don’t need more education about those things.

    There is, however, an urgent need for more education about such practical aspects as how to find reputable answers on the Internet, and how to recognize advertising claims for what they are. Especially, people need to know more about the inner workings of their own minds, and how to use their energy for self-betterment rather than self-destruction.

    Your responses and feedback are welcome!

    Source: “Long-term Effects of Dieting: Is Weight Loss Related to Health?,” Dishlab.org, 2013
    Photo credit: Leonard J Matthews via Visualhunt/CC BY-ND

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    The Discouraging Root of Much Despair

    January 11th, 2017

    depressed-person-on-bed

    Five years ago, in a New York Times article, Tara Parker-Pope called the sobering reality, and it hasn’t changed since then:

    Once we become fat, most of us, despite our best efforts, will probably stay fat.

    These are indeed discouraging words, the kind that actually steal our courage. We become disheartened, dispirited, disinclined, and experience a slew of other negative mindsets. What has caused such a loss of hope?

    For a clue to all the discouragement, let’s look even further back at a meta-study from 2001, conducted by University of Kentucky researchers and published by The American Journal of Clinical Nutrition. Studies of studies are useful, of course, especially when new research is restricted by limits, whether financial, humanitarian, or otherwise.

    These authors summed it up:

    Meta-analysis of observational studies is appropriate in the absence of randomized controlled studies.

    Their stated purpose was to examine the “current perception,” or assumption that participants in structured weight-loss programs would regain all the lost weight within five years. As meta-studies do, this one correlated the results of 29 previous studies. It only drew from investigations where the subjects were enrolled in structured weight-loss programs, with no do-it-yourself weight losers involved.

    Some of the subjects followed VLEDS, or very-low-energy diets, defined by the National Institutes of Health as under 800 calories per day, and at the same time containing “daily allowances of all essential nutritional requirements.” Typically, the VLED is liquid and comes in a can. The patient stays on the VLED for two to four months with, if the plan is correctly followed, no other food intake.

    It is possible to lose a lot of weight in a short time by this method, but the recommendation comes with a big caveat, and an equally important warning that a low-calorie liquid diet alone is not the entire answer:

    In randomized controlled trials VLED-based programs have not achieved significantly better long-term maintenance than conventional programs…

    To facilitate maintenance, cognitive behavioral counselling should always be included in a weight reduction programme using a very low energy diet.

    Then, there is the HBD, or hypoenergetic balanced diet, which is regular food consumed at the rate of 1,200-1500 calories per day. The Kentucky researchers found that people who wanted to lose weight who started with the VLED were better at maintaining the loss than those who started with the HBD.

    But apparently that doesn’t mean much, because “long-term maintenance of weight loss after VLEDs is no better than after other forms of obesity treatment.” The combination of VLEDs with behavior modification therapy was seen as “an important advance.”

    They also found that, in the long run, men and women fared equally well or badly, and six of the studies reported that “groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less.” Wait a minute — how could it be that only six our of the 29 examined studies indicated that exercise helps?

    It seems that the other studies did not include information on physical exertion. The conclusion was:

    Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3 kg and a reduced weight of >3% of initial body weight.

    Every little bit helps, but still, 3% of initial body weight does not seem very noteworthy. As the authors of meta-studies invariably do, the Kentucky team included a paragraph explaining any vagueness or seeming contradictions that might be found in their analysis.

    In particular, the greatest limitation of these studies is the absence of an accurate estimation of weight changes in an identical untreated population. Thus, weight changes can only be compared with baseline body weights… Predictors of long-term weight-loss maintenance have not been clearly identified because, in large part, there is a paucity of long-term data to test hypotheses.

    Your responses and feedback are welcome!

    Source: “The Fat Trap,” NYTimes.com, 12/28/11
    Source: “Long-term weight-loss maintenance: a meta-analysis of US studies,” Nutrition.org, 2001
    Source: “Very low energy diets in the treatment of obesity,” NIH.gov, 2001
    Photo credit: Alex Bellink via Visualhunt/CC BY

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    More Fat Pharmacy

    January 10th, 2017

    colorful-pills-white-background

    Childhood Obesity News has been tracing the recent history of weight-loss drugs, of which Vyvanse is an example. A company called Shire paid $2.6 billion to acquire the Vyvanse patent. As someone once said, “A billion here, a billion there, and pretty soon you’re talking about real money.”

    But they surely have recouped their investment by now. Vyvanse had been around for a while, as a treatment for ADHD (attention-deficit hyperactivity disorder). In all likelihood, someone accidentally noticed its helpfulness in another way, and spread the word about using it “off-label” to alleviate binge-eating disorder (BED).

    While the algorithm for making such a guess must be very complicated, someone arrived at 2.8 million as the estimated number of Americans who have BED. So, when in 2013 the American Psychiatric Association recognized binge-eating disorder as an official disease, it was a like manna from heaven to Shire.

    Vyvanse was christened the go-to (if not yet officially recognized) prescription for BED. For The New York Times, Katie Thomas collected background facts:

    A spokeswoman for the F.D.A. said Vyvanse was granted priority approval because there was no other drug treatment available for the disorder…

    And it did not ask an advisory committee to review the issue because Vyvanse is already sold as an A.D.H.D. drug and its safety profile is well known.

    Easy-peasy! But wait, there’s more, as Thomas takes readers back to the year 2011, when the FDA charged Shire with improper promotion of Vyvanse, Adderall and other products. As its punishment, the company paid the government a settlement of $56.5 million. Within months, the government granted the company permission to sell Vyvanse to treat BED.

    So a whole new market opened up, despite strenuous objections from some quarters, because just like lots of other pills that have since become disallowed, this one is basically amphetamine, and Thomas wrote a great article about the history of legal “speed.”

    She describes a website whose connection with the company is not obvious. It exists to help people who think they have BED, by providing a symptom checklist and suggested lines of dialogue for talking with a doctor. One might even think that it encourages patients to pester their doctors into prescribing a potentially troublesome drug. The hints are also useful for anyone who just likes the effects of speed, and needs a convincing story to tell the doctor.

    Thomas writes:

    The marketing strategy for Vyvanse, like that of Adderall, sheds light on how pharmaceutical companies seek to influence the diagnosis and treatment of a medical condition — in an effort to make billions of dollars in sales — even in the face of concerns about potential dangers of a drug.

    On the opposite side of the coin, a fear exists that drug companies will fight against the further development and repurposing of BCG, a vaccine that has been used for decades to prevent tuberculosis. It looks like it might also halt the development of type 1 diabetes, and even reverse the disease. This would be quite amazing, but it would cause the makers of insulin to suffer a loss of sales.

    Permission for human testing has been granted, and the first study will be a five-year trial. If that goes well, it will still take many more years to discover if BCG is really capable of performing the expected miracle.

    Your responses and feedback are welcome!

    Source: “Shire, Maker of Binge-Eating Drug Vyvanse, First Marketed the Disease,” NYTimes.com, 02/24/15
    Source: “FDA approves mid-stage trial of vaccine to reverse type 1 diabetes,” FoxNews.com, 06/08/15
    Photo credit: Victor Casale via Visualhunt/CC BY

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    The Fat Pharmacy

    January 9th, 2017

    pill-stilllife

    Six years ago, the anti-obesity medicine scene was not encouraging. There was only one specifically weight loss-oriented drug, Xenical (generic name Orlistat), which inhibits fat absorption.

    For any proposed drug or combination that pharmaceutical companies came up with, the test results were strewn with reports of hypertension or stroke risk or heart attack risk. Of course, the hopeful manufacturers countered with seductive arguments that boiled down to, “Yes, but being overweight is risky also, so choose the lesser of two evils, namely our pills.”

    Actually, they explained it a bit more eloquently, citing studies showing that even a 10% weight reduction could lesson a person’s risk for Type 2 diabetes and other problems. Also, even if a person only takes pills for a little while, the thrill of seeing the pounds drop away could inspire all kinds of lifestyle changes, and ultimately lead to a normal weight.

    And, while weight loss programs have proven to work as well as pills, not everybody can afford the delivery of pre-measured meals or the services of a personal trainer, but, one way or another, almost everybody can afford pills.

    FDA reluctant

    Still, the Food and Drug Administration put up staunch resistance, and the chance of some startling new discovery seemed unlikely. Critics pointed out that what we really need is not a drug to start us off along the weight loss trail, but a solution to what happens a year or two down the road, when those banished pounds inevitably start sneaking back.

    Experts wanted to be shown an answer to that problem, and then maybe there would be some basis for discussion. Observers feared that the drug makers would simply give up on the quest for a silver bullet. Jeannine Stein and Shari Roan wrote:

    The last year has been so bleak on the research front that some experts are questioning whether a long-desired safe and effective diet pill can be found.

    Then, about three years ago, the aforementioned Xenical was joined by two newcomers, Belviq and Qsymia, effectively tripling the number of weight-loss drugs on the market.

    A New York Times article emphasized the serious difficulty with trying out these types of medications, which is that animal testing can’t really replicate what goes on with humans. Kevin Corbit said of testing that it is limited to “highly formulaic rodent models.”

    According to the article:

    These laboratory animals are genetically and environmentally manipulated to mimic human weight gain, and do not reproduce certain adverse drug events… The result is a plethora of mice and rats that are metabolically healthy thanks to the drugs, while about a fifth of the world’s population and more than a third of Americans stay overweight.

    Meanwhile, a drug called Metformin was shown to be useful in lowering the fasting glucose levels of obese children. It did better than a placebo, in reducing their BMI and sustaining that improvement for six months.

    Metformin had been used for years to slow down the onset of type 2 diabetes in adults, who used to be the only kind of people who got type 2 diabetes. Now children also get it, but it will be years before anyone can know whether the drug also delays diabetes in the young.

    (To be continued…)

    Your responses and feedback are welcome!

    Source: “A Big Fat Problem,” Kansas.com, 01/11/11
    Source: “A Grizzly Answer for Obesity,” NYTimes.com, 02/12/14
    Source: “Metformin improves blood glucose levels and BMI in very obese children,” MedicalXpress.com, 12/10/12
    Photo credit: Jamiesrabbits via Visualhunt/CC BY

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Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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