How many times have you, after a particularly hard day, reached for some chocolate or ice cream? It’s common for many people, but for those trying to lose weight, it can be detrimental to their long term success, and most weight-loss programs never even address it.

They focus on choosing healthier foods and exercising more, but they never answer a key question: how can people who have eaten to cope with emotions change their eating habits, when they haven’t learned other ways of coping with emotions?

Researchers at Temple’s Center for Obesity Research are trying to figure out the answer as part of a new, NIH-funded weight loss study. The new treatment incorporates skills that directly address the emotional eating, and essentially adds those skills to a state-of-the art behavioral weight loss treatment.

“The problem that we’re trying to address is that the success rates for long-term weight loss are not as good as we would like them to be,” said Edie Goldbacher, a postdoctoral fellow at CORE. “Emotional eating may be one reason why people don’t do as well in behavioral weight loss groups, because these groups don’t address emotional eating or any of its contributing factors.”

The study has already had one wave of participants come through, and many participants have seen some success in the short term, but have also learned the skills to help them achieve long term success.

Janet Williams, part of that first cohort, said she lost about 17 pounds over 22 weeks, and still uses some of the techniques she learned in the study to help maintain her weight, which has not fluctuated.

“The program doesn’t just help you identify when you eat,” said Williams. “It helps you recognize triggers that make you eat, to help you break that cycle of reaching for food every time you feel bored, or frustrated, or sad.”

Williams said that the program teaches various techniques to help break that cycle, such as the “conveyor belt,” in which participants, when overcome with a specific emotion, can recognize it and take a step back, before reaching for chips or cookies, and put those feelings on their mental “conveyor belt” and watch them go away.

“I still use the skills I learned in the study,” she said. “I’ve learned to say, ‘I will not allow this emotional episode to control my eating habits.’”

Healthy food choices alone are not enough to maintain your weight; exercise is a much-needed companion to those fruits, veggies, and whole grains. In fact, a study released yesterday online in the journal of the American Medical Association, suggests that women need 60 minutes of exercise per day, 7 days a week to stay fit and keep the scale from inching up over time.

The study focuses on women who do not diet but want to remain at their present weight. Lead author Dr. I-Min Lee of Brigham and Women’s Hospital in Boston said, “We wanted to see in regular folks—people not on any particular diet—what level of physical activity do you need to prevent weight gain over time. It’s a large amount of activity. If you’re not willing to do a high amount of activity, you need to curtail your calories a lot.”

The fifteen-year analysis included over 34,000 women—participants in the federal Women’s Health Study—about weight, physical activity, dietary habits, smoking, and other health factors. The goal was to look at women who weren’t dieting and were consuming a normal diet to see what impact physical activity has on weight, according to Dr. Lee. The women, with an average age of 54, filled out a questionnaire at the start of the study and at three-year intervals about the amount of exercise or activity they engaged in per week. Their activity was tracked for an average of thirteen years while weight changes were tracked over a three-year period. The average weight gain of the women in the study was 5.4 pounds, however those women with a normal weight and BMI under 25 who exercised 60 minutes a day were able to maintain their weight.

While this isn’t a particularly new idea, exercise or diet is usually required to keep one’s weight in check, it is the amount of recommended exercise that will alarm people. Currently, the federal government recommends 150 minutes per week (30 minutes day/5 days a week or 2.5 hours per week) to keep your health in check and lower the risk of chronic ailments. While this seems reasonable and attainable for most people with busy lives, giving up an hour a day, even in the interest of health, may be out of the realm of possibility for many.

To be specific, the study does recommend an hour a day of moderate intensity exercise for those who do not want to diet, but who want to maintain their weight. Should you choose to lower your calorie consumption, you can correspondingly lower your exercise time to achieve the same result. But if you like to eat, and are comfortable with your current calorie intake, engaging in activities such as walking, jogging, cycling, aerobic exercise or dance, yoga, tennis, swimming, or working out at the gym should keep those fat pads at bay.

The study conducted on mice showed that the juice of the blood orange stopped them from piling on weight when fed a high-fat diet.

However, those fed with sweeter oranges gained significant amounts of fat.

The research team from University of Milan believe the fat-busting powers of the fruit, grown in Italy and the US, may be partly due to its high levels of anthocyanin.

This red pigment that gives the orange its deep colour is a type of antioxidant, a natural chemical that helps ward off disease., reports dailymail.co.uk.

The juice damages the ability of cells called adipocytes to accumulate fat. Adipocytes are found mostly around the waistline and absorb fat from food to store as energy.

The study appears in International Journal of Obesity.

Extreme obesity is affecting more children at younger ages, with 12 percent of black teenage girls, 11.2 percent of Hispanic teenage boys, 7.3 percent of boys and 5.5 percent of girls now classified as extremely obese, according to a Kaiser Permanente study of 710,949 children and teens that appears online in the Journal of Pediatrics.

This is the first study to provide a snapshot of the prevalence of extreme obesity in a contemporary cohort of children ages 2 – 19 years from a large racially and ethnically diverse population using the recent 2009 U.S. Centers for Disease Control and Prevention extreme obesity definition. Previous research was based on recent National Health and Nutrition Examination Survey (NHANES) data and included information on obesity but not extreme obesity.

“Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children’s futures. Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their twenties that we typically see in 40 – 60 year olds,” said study lead author Corinna Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena, Calif. “For example, children who are extremely obese are at higher risk for heart disease, type 2 diabetes, fatty liver disease and joint problems, just to name a few.”

Researchers used measured height and weight in electronic health records to conduct a cross-sectional study of 710,949 children ages 2 – 19 years in the Kaiser Permanente Southern California integrated health plan in 2007 and 2008. Children in the study had an average of 2.6 medical visits per year where height and weight were measured.

The study found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, translating into more than 45,000 extremely obese children in this cohort. The percentage of extreme obesity peaked at 10 years in boys and at 12 years in girls. The heaviest children were black teenage girls and Hispanic boys. The percentage of extreme obesity was lowest in Asian-Pacific Islanders and non-Hispanic white children.

According to the recent CDC recommendations, extreme obesity is defined as more than 1.2 times the 95th percentile, or a body mass index (BMI) of more than 35 kilograms/meter squared. Obesity is defined as more than the 95th percentile or a BMI of more than 30 kg/m(2). Overweight is defined as more than the 85th percentile or a BMI of more than 25 kg/m(2). The BMI is a reliable indicator of body fatness and calculated based on height and weight. For children, BMI percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age.

“Our focus and concern is all about health and not about appearance. Children who are morbidly obese can do anything they want — they can be judges, lawyers, doctors — but the one thing they cannot be is healthy,” said study co-author Amy Porter, MD, a Kaiser Permanente Baldwin Park pediatrician who leads the Pediatric Weight Management Initiative for Kaiser Permanente’s Southern California Region.

“The most important advice to parents of extremely obese children is that this has to be addressed as a family issue. There is rarely one extremely obese kid in a house where everyone else is extremely healthy. It’s important that everyone in the family is invested in achieving a healthier lifestyle,” Porter said.

“This publication is only the beginning. Now we are trying to quantify the health risks and long-term effects associated with extreme obesity, determine which groups are affected most, and develop strategies for population care management to reduce these health risks. Children’s health is important and we have a long way to go,” Koebnick said.
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Getting children involved in finding ways to become more physically active can not only make them more aware of local recreational opportunities, but can even help increase their own physical activity.

That’s the result of a study examining the role of seven national parks in contributing to the health of today’s youth. The study was conducted by researchers from a variety of disciplines at North Carolina State University and other U.S. universities and funded by the National Park Service.

The researchers developed pilot programs aimed at increasing the awareness of health benefits from participating in recreational activities at national parks and increasing physical activity by park visitors.

Dr. Myron Floyd, professor of parks, recreation and tourism management at NC State, specifically examined the use of Cuyahoga Valley National Park in Ohio by studying area middle-school students.

“We decided early on that engaging the community in activities the park had to offer would be crucial in developing this pilot program,” Floyd said. “We had local 6th and 7th graders actually create the tagline to promote the program: Get Up, Get Out and Go!. The students also helped us determine what types of activities would get them interested enough to head out to the park.”

The program comprised a series of events at Cuyahoga Valley National Park that began with a kickoff event, featured weekly activities such as scavenger hunts and fishing lessons, and concluded with a festival. Advertisements of the program and its events – designed by the students themselves – were placed in local papers, on bus boards and at health fairs.

Floyd’s team compared awareness levels before and after the program and found out that the Get Up, Get Out and Go! worked. The study showed a significant increase in the level of awareness of Cuyahoga Valley National Park and its different offerings – 31 percent before the program was implemented versus 65 percent after the program – among the targeted youth population, with a reported increase in the percentage of participants who intended to visit a national park in the future – 18 percent before the program versus 51 percent after the program. Researchers also reported evidence of an increase in physical activity that was associated with the program’s activities.

“This study was important because it showed that engaging kids early on in the program planning process was important. A lot of the ideas we had for park activities, we quickly found out were not of interest to the children,” Floyd said. “It is imperative that we engage children in finding solutions that get them to be more physically active – whatever environment that may be in.”

Diabetics, under the gun to better manage their disease by controlling their food intake and weight, may find themselves in the sticky wicket of needing treatment that makes them hungry, researchers said.

Attempts to maintain healthy blood sugar levels and prevent weight gain may suggest an eating disorder when the disease and its treatment are to blame, said Dr. Deborah Young-Hyman, pediatric psychologist at the Medical College of Georgia’s Georgia Prevention Institute.

“You can’t use the same criteria to diagnose eating disorders that you use in non-diabetic populations because what we actually prescribe as part of diabetes treatment is part of disordered eating behavior. Food preoccupation is one example,” she said.

Preoccupation with food, in fact, is required for optimal disease management. Questions like “What are you putting in your mouth? Did you know that was going to raise your blood sugar?” are a part of life, Dr. Young-Hyman said. Young women, and increasingly young men, also are not immune from societal pressures to be thin, she noted.

Side-by-side comparisons of young people with and without diabetes are needed to answer fundamentals such as the incidence of eating disorders among diabetics, who is at risk and whether treatment can be modified to reduce the risk, researchers report in a review article in the March issue of Diabetes Care.

Answers could include better methods of insulin delivery and new therapies that address hunger-related hormones, which also become dysregulated in type 1 diabetes.

Dr. Young-Hyman and her colleagues extensively reviewed related literature enabling them to connect the dots between the disordered eating behavior reported by some diabetics with the dysregulation of hunger-related hormones and/or inadequate management of insulin therapy.

In type 1 diabetes, the immune system attacks the insulin producing cells of the pancreas complicating food metabolism. The treatment – insulin by injection or pump – spurs hunger. If the insulin dose isn’t exactly calibrated with food intake, blood sugar levels rise and require more insulin which could drop the blood sugar levels and increase hunger even more.

The cycle of inexact insulin dosing can cause weight gain which increases insulin requirements and resistance.

And there’s another factor at work: the insulin producing-cells attacked by the disease also make amylin which works with other appetite regulating hormones such as leptin to regulate the sensation of fullness. The resulting difficulty of diabetics to determine whether they are full has been documented in anorexia.

Interestingly, most type 1 diabetics lose a lot of weight before diagnosis because they excrete rather than metabolize calories. For a period of months, they may be able to eat large amounts of food and not gain weight. When they start taking insulin to “control” their disease, they can gain a lot of weight quickly. “It’s not hard to see how the treatment of the disease can lead to disordered eating behavior to control weight gain,” Dr. Young-Hyman said.

As a psychologist, Dr. Young-Hyman has treated many type 1 diabetics diagnosed with an eating disorder. In fact, one patient she describes as accomplished, funny and discouraged by her inability to control how much she ate and her subsequent weight gain, helped inspire Dr. Young-Hyman to learn more about eating disorders in patients with diabetes.

The conundrum expressed by this patient can lead, particularly for young women, to unhealthy behavior such as skipping or reducing insulin doses or binging-purging in an effort to avoid weight gain. The behaviors create immediate risks such as hypoglycemia or extreme high blood sugar levels, and are associated with long-term complications of diabetes such as eye, nerve and heart damage.

Controversy persists about whether type 1 patients have increased rates of diagnosable eating disorders or disordered eating behavior; incidence projections range from as low as 3.8 percent to up to 40 percent in young females when skipping or reducing an insulin dose is considered.

“We need to document that these patients are experiencing dysregulation in satiety and that it’s not only connected with factors one usually associates with disordered eating behaviors such as societal pressure, anxiety and depression,” Dr. Young-Hyman said. “It’s also associated with having diabetes.”

Obesity and alcohol act together to increase the risk of liver disease in both men and women according to two studies published on bmj.com today. These findings have significant clinical and public health implications.

In the UK, rates of liver disease and obesity are increasing. Alcohol is a major cause of liver cirrhosis. In addition, recent evidence indicates that excess body weight may also play a role.

Researchers from the University of Oxford examined in the first study the link between body mass index (BMI) and liver cirrhosis. A total of 1.2 million middle-aged UK women took part in the Million Women Study.

Each participant was monitored for an average of 6.2 years. Risks were modified according to age, alcohol consumption, smoking, socioeconomic status and physical activity.

Women who were overweight or obese had an increased relative risk of liver cirrhosis compared to women of a healthy weight. This relative risk did not differ considerably by alcohol consumption, but the absolute risk did.

For instance, among women who reported drinking an average of about a third to half a drink a day, 0.8 in 1,000 will be admitted to hospital with, or will die from, liver cirrhosis over five years if they are of healthy weight. This compares with 1 in 1,000 women who are obese.

However, among women who reported drinking an average of two and a half drinks a day, 2.7 in 1,000 will be admitted to hospital with or will die from liver cirrhosis over five years if they are of healthy weight. This compares with 5 in 1,000 women who are obese.

Researchers from the Universities of Glasgow and Bristol investigated in the second study the joint effects of BMI and alcohol consumption on liver disease in more than 9,000 men in Scotland. Participants were monitored for an average of 29 years.

Both factors were related to liver disease. Significantly, the combination of high BMI and alcohol consumption was greater than the additive effect of the two separate factors.

For instance, obese men who reported drinking 15 or more units per week had the greatest risk of liver disease: almost 19 times higher than underweight or normal weight non-drinkers. The researchers observe that lower, BMI specific “safe” limits of alcohol consumption may need to be defined for people who are overweight. They explain that in addition preventive efforts are required to limit the affordability and availability of alcohol and to increase physical activity.

From a public health standpoint, both studies conclude that strategies to reduce both excessive alcohol consumption and excessive body weight should result in a decline in the prevalence of liver disease.

In an associated editorial, Professor Christopher Byrne at the University of Southampton and Dr Sarah Wild from the University of Edinburgh comment that upcoming research must center on improved diagnosis and treatment of non-alcoholic fatty liver disease. This is a build-up of fat in the liver caused by obesity, high alcohol intake and diabetes and which can lead to cirrhosis.

They write that, for now, the old proverb of “prevention is better than cure” remains relevant. “Reducing alcohol consumption and obesity are, at present, our only weapons against non-viral liver disease. The progression of non-alcoholic fatty liver disease to end stage liver disease can now be added to the list of the undesirable consequences of modern lifestyles.”

“Body mass index and risk of liver cirrhosis in middle aged women in UK: prospective study”

Normal-weight women who drink a light to moderate amount of alcohol appear to gain less weight and have a lower risk of becoming overweight and obese than non-drinkers, according to a report in the March 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

More than half of American adults drink alcoholic beverages, according to background information in the article. Alcohol contains about 7 calories per gram (with approximately 28 grams per ounce) and alcohol drinking may possibly lead to weight gain through an imbalance of energy consumed and energy burned. However, research has not consistently provided evidence that consuming alcohol is a risk factor for obesity.

Lu Wang, M.D., Ph.D., of Brigham and Women’s Hospital, Boston, and colleagues studied 19,220 U.S. women age 39 or older who had a body mass index (BMI) in the range classified as normal (18.5 to 25). On an initial questionnaire, participants reported how many alcoholic beverages they typically drank per day. A total of 7,346 (38.2 percent) reported drinking no alcohol; 6,312 (32.8 percent) drank less than 5 grams; 3,865 (20.1 percent) drank 5 to less than 15 grams; 1,129 (5.9 percent) drank 15 to less than 30 grams; and 568 (3 percent) drank 30 grams per day or more.

Over an average of 13 years of follow-up, women on average gained weight progressively. Women who did not drink alcohol at all gained the most weight, with weight gain decreasing as alcohol intake increased. A total of 7,942 (41.3 percent) women who initially had normal weight become overweight or obese (BMI of 25 or higher), including 732 (3.8 percent) who become obese (BMI of 30 or higher). Compared with women who did not drink at all, those who consumed some but less than 40 grams per day of alcohol were less likely to become overweight or obese. Women who drank 15 to less than 30 grams per day had the lowest risk, which was almost 30 percent lower than that of non-drinkers.

“An inverse association between alcohol intake and risk of becoming overweight or obese was noted for all four types of alcoholic beverages [red wine, white wine, beer and liquor], with the strongest association found for red wine and a weak yet significant association for white wine after multivariate adjustment,” the authors write.

The authors caution that, given potential medical and psychosocial problems related to drinking alcohol, its beneficial and adverse effects for each individual must be considered before making any recommendation about its use. “Further investigations are warranted to elucidate the role of alcohol intake and alcohol metabolism in energy balance and to identify behavioral, physiological and genetic factors that may modify the alcohol effects,” they conclude.

A new study from the US found that normal weight women in their 40s and older who drank a light to moderate amount of alcohol gained less weight and had a lower risk of becoming obese and overweight compared to their non-drinking counterparts.

The researchers, from the Brigham and Women’s Hospital, and the Harvard School of Public Health in Boston, Massachusetts, have written about their study in a paper published online in the 8 March issue of Archives of Internal Medicine.

At 7 calories per gram (equivalent to 199 calories per ounce), alcohol is potentially a significant source of dietary calories, and more than half of adult Americans are alcohol drinkers. Meanwhile obesity is approaching epidemic proportions in the US, yet evidence on the extent to which alcohol consumption contributes to this public health crisis is patchy, suggested the authors.

For their prospective cohort study, which was sponsored by grants from the National Institutes of Health, lead author Dr Lu Wang, of Brigham and Women’s Hospital, and colleagues examined data from 19,220 women living in the US who were aged 39 and over, had no traces of cardiovascular disease, cancer, or diabetes, and whose body mass index (BMI) was in the range classified as normal (18.5 to less than 25). BMI is calculated as weight in kilograms divided by height in meters squared.

At the start of the study the women filled in a questionnaire that asked them about their daily alcohol consumption. After that they filled in questionnaires about their weight every year for an average of 13 years.

The results showed that:

* At the start of the study, 38.2 per cent reported drinking no alcohol, 32.8 per cent reported drinking less than 5 grams a day, 20.1 per cent reported drinking 5 to less than 15 grams, 5.9 per cent reported drinking 15 to less than 30 grams, and 3 per cent reported drinking 30 or more grams of alcohol a day.

* Over the 13 years of follow up, the women’s average weight went up steadily.

* 41.3 per cent of the women became overweight (BMI of 25 or more), and 3.8 per cent became obese (BMI of 30 or more).

* After adjusting for potential confounders like baseline BMI, smoking, other calorie sources, exercise, and other lifestyle and dietary factors, there was an inverse association between the amount of daily alcohol the women said they drank in their initial questionnaires and the weight gained over the follow up.

* Compared with women who did not drink at all, those who consumed some but less than 40 grams of alcohol a day had a lower risk of becoming overweight or obese.

* Women who drank 15 to less than 30 grams of alcohol per day had the lowest risk, which was nearly 30 percent lower than that of their non-drinking counterparts.

The authors also looked at four types of alcoholic beverages and found the links to be the same for all, with perhaps the strongest being for red wine.

They concluded that:

“Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.”

However, the authors stressed that given the potential medical and psychosocial problems of alcohol consumption, recommendations about its use should be made on an individual by individual basis.

They also suggested more studies are needed to find out the biological mechanisms of the role played by alcohol in energy metabolism, and whether any physiological and genetic factors are involved.

“Alcohol Consumption, Weight Gain, and Risk of Becoming Overweight in Middle-aged and Older Women.”

People who have gastric band surgery to lose weight are at risk of low self-esteem, relationship problems and being dissatisfied with their body image, according to new research being presented at the Diabetes UK Annual Professional Conference (APC).

Researchers from the University of the West of England and Southmead Hospital, Bristol, followed 25 patients aged from 30 to 58 years and recorded their experience 12 months after receiving a post-laparoscopic gastric banding operation. 64 per cent of the participants had Type 2 diabetes.

Health benefits versus negative psychological effects

Although the people who took part in the study reported significant health benefits such as improved blood glucose levels and lower cholesterol and blood pressure levels, they also found that living with the gastric band had a strong, negative psychological impact on their daily lives.

The majority reported that having a gastric band was as hard as having to diet and that losing the opportunity to eat as a coping strategy left them struggling to cope with distressing life events.

“Losing weight not only reduces your risk of developing Type 2 diabetes but also significantly improves management in people who have the condition,” said Simon O’Neill, Director of Care, Information and Advocacy Services at Diabetes UK.

“We always advise people wanting to lose weight to try to do so by following a healthy, balanced diet high in fruit and vegetables and low in fat, sugar and salt, combined with physical activity.”

“Weight-loss surgery can be a way of losing significant amounts of weight for people who are obese. However, surgery does have serious associated risks and should only be considered if sustained attempts to lose weight through diet and lifestyle changes have been unsuccessful.

“This new research also shows that there might be psychological consequences to having the procedure and patients should be made aware of these when considering the surgery.”

Not the easy option

Lead researcher Dr Andrew Johnson from Southmead Hospital said “Our findings show that having a gastric band fitted should not be seen as the easy option when it comes to losing weight.

“This operation has a strong psychological impact as well as a physical one, and we found that regular psychological support is needed to help people cope with the realities of having the device fitted.”

55 per cent jump in weight-loss operations

The NHS Information Centre recently released figures showing a 55 per cent increase in the number of people having weight-loss surgery, such as stomach stapling or having a gastric band fitted, between 2006/07 and 2008/09, from 1,950 to 4,220.