Archive for the ‘obesity prevention’ Category

OBESITY AND CARDIOVASCULAR DISEASE

Monday, April 25th, 2011

While weight gain and obesity adversely affect the heart and the entire cardiovascular system in many ways, I think it is important to point out a few of the ways doctors and researchers can actually measure that negative impact. One simple method is to measure the blood pressure in people of different weights, and in the same person over time as his or her weight changes. Such studies find that weight gain is associated with elevated blood pressure increasing the body weight by 22 pounds or more (10 kg) is associated with a 3 mm of Mercury higher systolic blood pressure and a 2.3 mm higher diastolic blood pressure.  This is rather significant and increases the incidence of coronary heart disease and stroke.

By contrast, weight loss translates into reduced blood pressure and reduced risk.  In more than half of individuals, decreasing even one 1 kg, or a mere 2.2 pounds of body weight reduced the systolic blood pressure 1-4 mm of Mercury and the diastolic 1-2 mm of Mercury according to several studies.  While these are not huge numbers, they represent a tangible improvement in health and measurable reduction in risk of heart attack.

The ability of the heart muscle to squeeze and pump blood is also adversely affected by weight gain. A 2006 study in the Journal of the American College of Cardiology demonstrates that right ventricular function suffers as body mass index rises.  This association remained present when the right ventricular function changes were adjusted for age, for diabetes and insulin usage and blood pressure.  This cardiac function is measured using several techniques – images with ultrasound, images with nuclear isotope labeling, and with inserted catheters that use measuring instruments. In all of these measurement methods, heart performance suffers when body weight rises. This means less energy, less blood available to the tissues that need it most during exertion, and more chance of fatigue or loss of vital blood supply to organs thirsty for it, like the kidneys.

CHILDHOOD OBESITY PREVENTION TAKES A GROUP EFFORT

Sunday, March 27th, 2011

So far our Obesity Prevention Foundation has worked to bring messages of healthy eating and nutritional awareness to schools including students, teachers and parents.  We had the great pleasure of working together side by side with Wendy Damonte and the Lace ‘Em Up team to also bring the message of fun exercise and activity.  So far the programs in the schools have met with great support and enthusiasm and have been a lot of fun.

TREATMENT AND PREVENTION

Tuesday, January 4th, 2011

Modern epidemics and health crises have demanded vigorous and sweeping responses from healthcare practitioners.  But, they have also required vigorous responses from many other segments of society including everyone from teachers to political leaders.  Think of the complexity and relative effectiveness of the response to the AIDS epidemic.  Health researchers would now generally agree that the most effective response to the deadly virus has come from a combination of efforts that involve policy changes to enhance prevention efforts, combined with effective treatments for those already afflicted.

As horrific as the AIDS epidemic has been and continues to be on a worldwide basis, it is dwarfed by the obesity epidemic by any measure including the measure of premature deaths.  So how can we best formulate a response to the obesity epidemic that will minimize needless suffering, premature disease and premature deaths?

Clearly the lessons from the last major health crises are that we must respond with vigorous and sweeping efforts at all levels including those aimed at prevention and those aimed at treatment for those already afflicted.

Just like other major health crises, many factors in the obesity epidemic serve as distractions and undermine positive efforts toward prevention and treatment.  For example, debates about the degree to which obesity is a self-inflicted disease serve to undermine research efforts, treatment efforts and prevention efforts.  Although the complex nature of obesity is one that requires solutions that draw from many disciplines including those associated with mental health, the complex social, psychological and cultural aspects of obesity must not stand in the way of logical research, prevention programs and effective treatments.  At the end of the day, our response as healthcare providers, community leaders and stewards of our future generations must focus on health, wellness and longevity and nothing less.

Ultimately, the successful eradication of such a complex disease will need to happen through sweeping obesity prevention efforts.  We see the initiation of such efforts at many levels including public and private awareness campaigns, emphases on fitness and physical activity, community movements toward locally grown and produce based diets, school district efforts aimed at replacing high calorie meals for kids, legislative efforts that focus on calories, carbohydrates or fats and many more.  Undoubtedly during this process there will be measures that help the prevention cause and there will be missteps that hinder the cause and obfuscate the solutions or drown us in polemic.  Nonetheless, the driving force must be to prevent more kids from acquiring what is indisputably a deadly disease.

Treatment must also be a twin priority with prevention.  While the National Institutes of Health and the CMS have exhibited objectivity and fairness in endorsing bariatric surgery as early as 1991, many other advisory policies from professional societies and governmental agencies lag far behind the currently available data and they fail to appreciate the seriousness of obesity as a disease.  Newer and better treatments will continue to become available and these treatments are likely to include a mixture of medications, surgical procedures and implanted devices.  Eventually, a select number of these treatments will be excepted as superior interventions, which can help induce increasing correction of obesity and durable weight loss results.

To date, modest success has been achieved with structured medically supervised programs utilizing evidence based tools such as meal replacement, diet formulations low in sugar, psychological and dietary counseling, diet logs, support groups and regular exercise such as walking.  Surgical programs have achieved markedly greater success and increasingly, the most successful programs employ each of the proven elements from the non-surgical experience to boost outcomes and maintain their durability.

In the past, rather arbitrary guidelines have arisen from specialty societies that recommended very stingy use of obesity treatments only in the most severe of cases.  For example, many specialty societies and currently available references will recommend the use of the appetite suppressive drug, Phentermine or its analog, Tenuate only at certain body mass index thresholds.  Working on the theory that these “conservative recommendations” will be better for patient safety, they have served to deter practitioners from prescribing much needed obesity therapy and overemphasized the risk of very safe drugs while markedly underemphasizing the risks of the disease of obesity.

Our hope is that as we move forward such miscalculations will be eliminated and the seriousness of obesity as a health crisis will be appreciated, and the treatment and prevention efforts evaluated in their proper light.


Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

Copyright © 2007-2010 Kent Sasse, M.D. All Rights Reserved.

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