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.

Over 60 per cent of Canadians are classified as overweight or obese. This epidemic is a concern for experts around the world. One of the major problems is high levels of lipids in the blood, which can lead to cardiovascular disease, fatty liver disease and Type 2 diabetes. But a University of Alberta researcher has taken a major step in protecting people against these diseases.

Richard Lehner and his research group found that decreasing the activity of an enzyme called triacylglycerol hydrolase, or TGH, in an animal model results in lowering the amount of fat in the blood and improves glucose metabolism. It also appears to keep fat from being deposited into organs that aren’t meant to store fat, like the liver.

A lack of TGH also showed to protect the beta cells in the pancreas that produce insulin and this can potentially protect from the development of diabetes in obese patients.

The benefits don’t end there. Animal models that lack the enzyme also showed to burn more fat and were more physically active compared to those who had the enzyme.

This discovery shows that TGH could eventually be used as a target for pharmaceuticals to combat metabolic complications associated with obesity.

A study in the March 1 issue of the journal SLEEP shows that African-American and Hispanic young adults with short or long sleep durations had greater increases in belly fat over a five-year period compared with those who reported sleeping six to seven hours a night.

Results show that in participants younger than 40 years of age, both short and long sleep durations were associated with significant increases in body mass index (BMI), as well as in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) fat accumulation. Compared with people who reported a nightly sleep duration of six to seven hours, those with a self-reported sleep duration of five hours or less per night had an average BMI increase over a five-year period that was 1.8 kg/m2 higher, and greater accumulations of SAT (42 cm2) and VAT (13 cm2); and those who reported sleeping eight hours or more had a BMI increase that was 0.8 kg/m2 higher, as well as greater accumulations of SAT (20cm2) and VAT (6 cm2). No significant relationship existed between sleep duration and abdominal fat change in participants older than 40 years of age.

Lead author Kristen G. Hairston, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, N.C., said that obtaining a sufficient amount of sleep is important for people of all races and ethnicities. However, ethnic minorities disproportionately report extremes in sleep duration, putting them at risk for negative metabolic outcomes such as obesity and type 2 diabetes.

“Appropriate amounts of sleep are important for maintenance of healthy weight,” said Hairston. “In a group of African-American and Hispanic participants, those who slept less than this had greater increases in belly fat over a five-year period.”

Information was obtained from 1,107 people in the IRAS Family Study, an extension of the Insulin Resistance Atherosclerosis Study (IRAS). Data were collected from 332 African-Americans and 775 Hispanics with a mean age of 41.7 years at baseline and an age range from 18 to 81 years. Sixty-two percent of participants were female. Mean sleep duration at baseline was 6.7 hours in response to the question, “On average, about how many hours of sleep do you get a night?” Seventeen percent of the sample reported sleeping five hours or less per night, 55 percent slept six to seven hours per night and 28 percent averaged eight or more hours of sleep per night.

Abdominal computed tomography (CT) scans and BMI were obtained at a five-year interval. Dietary intake was assessed using a short, retrospective, one-year, semi-quantitative food-frequency interview. An estimate of usual frequency of participation in vigorous activities also was obtained. Generalized estimating equations using linear regression models assessed the association between sleep duration and five-year fat accumulation with adjustment for age, race, gender, study site, baseline fat measure, physical activity, total calorie intake, smoking status and education.

In those younger than 40 years old, a short sleep duration of five hours or less was most frequently reported by Hispanic men (30 percent), and a long sleep duration of eight or more hours was most frequently reported by Hispanic women (53 percent). Participants reporting five hours of sleep or less consumed more total calories (2,224 kcal) than those reporting six to seven hours (1,920 kcal) or eight or more hours (2,199 kcal).

The authors proposed that short sleep may impact fat accumulation by promoting increased caloric intake via increased hunger, or by reducing energy expenditure via altered thermoregulation and increased fatigue. Both increased caloric intake and decreased vigorous activity were observed in the short sleep group.

The authors also suggested that it is just as important for doctors to encourage patients to get adequate sleep as it is for them to promote a healthy diet and physical activity. This is particularly relevant when young adults make transitions involving college, marriage and childbearing, because these life stages often are associated with sleep deprivation.

According to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), obese teenage girls with a greater ratio of visceral fat (fat around internal organs) to subcutaneous fat (fat found just beneath the skin) are likely to have lower bone density than peers with a lower ratio of visceral to subcutaneous fat.

“Visceral fat is known to increase the risk of diabetes and heart disease in obese people,” said Madhusmita Misra, MD, of Massachusetts General Hospital and senior author of the study. “Our study suggests that visceral fat may also have an impact on bone health. This finding is particularly relevant given the rising prevalence of obesity and recent studies suggesting a higher risk of fractures in some obese individuals.”

In this study, researchers examined 30 adolescent girls (15 obese/15 normal weight) between the ages of 12 and 18 years. After measuring weight and height, researchers used magnetic resonance imaging (MRI) to measure subcutaneous and visceral fat tissue and dual energy x-ray absorptiometry (DXA) to assess bone density at the spine, hip and whole body. They found that subcutaneous fat and visceral fat had reciprocal associations with bone density measures, with subcutaneous fat demonstrating positive associations and visceral fat demonstrating inverse associations.

“We do not yet fully understand the chemical mediators of the associations between regional fat and bone health,” said Misra. “It is possible that inflammatory cytokines, types of signaling molecules used in cellular communication, or hormones like adiponectin or leptin are potential mediators of these associations between fat and bone, but further studies are needed to determine their true impact on bone metabolism.”

Hormone Helps to Regulate Energy Homeostasis, Neuroendocrine Function, and Metabolism

Leptin is a hormone that plays a central role in fat metabolism. Patients with genetic leptin deficiency are obese, and treatment with leptin leads to dramatic weight loss through decreased food intake and possible increased energy expenditure. However, most obese people who produce leptin normally are resistant to the weight-loss effects of the hormone. Leptin deficiency is a clinical syndrome associated with distinct conditions such as recent weight loss, diet- or exercise-induced hypothalamic amenorrhea, and lipoatrophy.

Recombinant human leptin is an emerging potential therapy for these leptin-deficient conditions because in replacement doses, it normalizes energy homeostasis, neuroendocrine function, and metabolism.

Replacement of leptin in physiologic doses may help people who have recently lost weight because relative leptin deficiency may drive them to eat more, expend less energy, and regain weight. Leptin also restores ovulatory menstruation in women with hypothalalmic amenorrhea and improves metabolic dysfunction in patients with lipoatrophy, including lipoatrophy associated with HIV or highly active antiretroviral therapy.

In an issue of the British Journal of Sports Medicine, specialists argue that prolonged periods of sitting are truly detrimental. In addition, we should focus on the harms caused by daily inactivity rather than on the lack of regular exercise alone.

The term “sedentary behavior” has come to mean “taking no exercise” according to doctors from the Karolinska Institute and the Swedish School of Sport and Health Sciences in Stockholm, Sweden.

They say it should be more correctly used to describe “muscular inactivity.”

Recent research indicates that prolonged periods of sitting and lack of whole body muscular movement are strongly linked to obesity, diabetes, heart disease, cancer, and an overall higher risk of death. This is regardless of whether moderate to vigorous exercise is taken.

An Australian study suggested that for every additional hour a woman sits in front of the TV, her risk of metabolic syndrome which is a precursor to diabetes and cardiovascular disease, increases by 26 percent. This is irrespective of how much moderate exercise she does.

The authors explain that the health of people who already do too little exercise will suffer even more if combined with extended bouts of sitting.

The researchers remark that further investigation is needed to establish a causal effect between prolonged sitting and ill health. However, some underlying mechanisms have already been identified. These include an enzyme known as lipoprotein lipase. It has an essential role in the regulation of key blood fats.

Consequently, the authors put forward a new model or paradigm of “inactivity physiology”. It establishes that sitting and non-muscular activity may independently boost the risk of ill health, and that sedentary behavior is a separate class of behavior with specific consequences for ill health. These are different than those caused by taking too little exercise.

The authors explain that the molecular and physiological responses of the body provoked by too much sitting cannot simply be eliminated by taking additional exercise.

They add: “In the future, the focus in clinical practice and guidelines should not only be to promote and prescribe exercise, but also to encourage people to maintain their intermittent levels of daily activities [that involve movement]. Climbing the stairs, rather than using elevators and escalators, five minutes of break during sedentary work, or walking to the store rather than taking the car will be as important as exercise.”

The Preventive Services Task Force which makes medical-care recommendations based on the latest research has stated that medical professionals warn that children 6 and older should be screened for obesity and be referred to comprehensive weight-management programs.

The team reviewed dozens studies and concluded that obese children who were involved in moderate to high weight-management programs for 25 or more hours over a six-month period could show improvements in their weight. Some of these programs include direction from dietitians, psychologists, exercise trainers and physicians.

The problem seems to be that there are not enough weight-management programs for parents to get their children involved with and it appears it is not a benefit most insurance companies care to pay for. Ned Calonge, chairman of task force and chief medical officer of the Colorado Department of Public Health and Environment. “But now that there is evidence of effectiveness and this new recommendation — that may change.”

Government statistics show that 32% of children and adolescents are obese or overweight and almost 20% of kids ages 6 to 11 and 18% of those ages 12 to 19 are obese. It is important to remember that obese children are at a greater risk of health problems that are related to their obesity such as high cholesterol, blood pressure and diabetes. These children also run a large risk of becoming obese as adults.

Today’s children are thought to be overweight if they fall between the 85th and 94th percentile on body-mass index growth charts. Medical personal who work with overweight kids believe that this currently recommendation is way overdue and that even more options are needed.

“There are millions of obese kids but probably only several hundred centers nationwide offering quality programs that meet the standards outlined in these recommendations,” says Melinda Sothern, director of pediatric obesity research at Louisiana State University Health Sciences Center. “Most of these are affiliated with universities or big hospitals. The programs are expensive if delivered by professionals, but they are less expensive than bariatric surgery later during adolescence.”

She also believes that caregivers and parents need to carefully look at programs to be certain that professionals are educated and trained to work with obese children. “What works for adults doesn’t necessarily work for kids. They have developmental nutritional needs, and exercise has to be fun for them. It can’t be a boot-camp mentality.”

“Part of the problem is that where there are obese children, there are often obese parents,” says Keith Ayoob, associate professor of pediatrics at the Albert Einstein College of Medicine. He believes parents must be involved if they want change to not only happen, but last. “Parents often have to take a hard look at their own eating styles and how they may have morphed into less-than-healthy role models.” If the entire family makes improvements, the payoff is huge, Ayoob says. “A whole family can get healthier when one child does.”

Pediatrician Sandra Hassink, A chair of the American Academy of Pediatrics Obesity Leadership Work Group states, “If a child is obese, parents need to get the child to the doctor to identify weight-related medical conditions such as sleep apnea, diabetes, liver disease, hip and knee problems and depression.”

Obesity is a condition that often follows family lines, but bariatric surgery offers hope for breaking this generational pattern.

“Bariatric surgery is part of a transformational lifestyle change,” said Christopher Still, D.O., director of the Geisinger Center for Nutrition and Weight Management. “Patients who are most successful after bariatric surgery must adapt to healthy diet and exercise, and many times this new lifestyle will rub off on family members, resulting in a healthier family unit.”

While genetics can play a role in obesity, other familial factors can be major contributors to this health issue, said Dr. Still. A 2008 study in the American Journal of Sociology concluded that a family’s lifestyle has a major impact on whether teenagers will end up overweight, and according to the Center for Disease Control (CDC), a person’s environment and behavior play a large role in obesity.

“Oftentimes, obesity is caused by preventable factors such as poor eating habits or a lack of physical activity,” said Dr. Still. “These tendencies are strongly influenced by the people around us. After bariatric surgery, a patient who begins exercising and eating healthier can impart new, healthy habits on their family and help break unhealthy behaviors and ultimately obesity.”

Evidence has also shown that women who undergo bariatric surgery before becoming pregnant are less likely to have children that become obese. According to a recent study in the Journal of Clinical Endocrinology & Metabolism, the intrauterine environment is crucial in a child’s development, and after bariatric surgery, a woman’s uterus is less likely to contain substances within the amniotic fluid that can contribute to a child’s likelihood of becoming obese.

The study observed 49 mothers who had children both before and after surgery, as well as their 111 children, who were between the ages of 2.5 and 25. Children born after the mother’s weight loss surgery had lower birth weights and were three times less likely to become obese than children born before the mother’s surgery. Children born after surgery also had better blood sugar resistance and lower cholesterol.

“Bariatric surgery has effects far beyond simply helping a patient lose weight, and some of the changes in their bodies can be life-altering,” Dr. Still said. “The changes that women go through can lessen the likelihood that they have a child who will become obese, presenting another way that bariatric surgery can help break the cycle of obesity.”