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Obesity Beats Adiposity For Cardiovascular Risk

Obesity contributes to cardiovascular risk no matter where a person carries the weight, concluded researchers after looking at outcomes for nearly a quarter-million people worldwide.

Body mass index, (BMI) waist circumference, and waist-to-hip ratio do not predict cardiovascular disease risk any better when physicians recorded systolic blood pressure, history of diabetes and cholesterol levels, researchers reported in The Lancet.

The research group used individual records from 58 prospective studies with at least one year of follow up. In each study, participants were not selected on the basis of having previous vascular disease. Each study provided baseline for weight, height, and waist and hip circumference. Cause-specific mortality or vascular morbidity were recorded according to well defined criteria.

Individual records included 221,934 people in 17 countries. In people with BMI of 20 kg/m2 or higher, hazard ratios for cardiovascular disease were 1.23 (95 percent CI, 1.17 to 1.29) with BMI, 1.27 (95 percent CI, 1.20 to 1.33) with waist circumference, and 1.25 (95 percent CI, 1.19 to 1.31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After adjusting for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding hazard rations were 1.07 (95 percent CI, 1.03 to 1.11) with BMI, 1.10 (95 percent CI, 1.05 to 1.14) with waist circumference, and 1.12 (95 percent CI, 1.08 to 1.15) with waist-to-hip ratio.

BMI, waist circumference, or waist-to-hip ratio did not importantly improve risk discrimination or predicted 10-year risk, and the findings remained the same when adiposity — the carrying of adipose tissue (fat) — measures were considered. Read more »

*This blog post was originally published at ACP Internist*

Avoid Weight Gain By Using Brain Tricks To Master Portion Control

When I was growing up, my parents had a simple rule when it came to food: “Finish everything on your plate.” We had to sit at the table until we did.

They meant well. They wanted us to understand that food should not go to waste. The problem with this advice — and I’m sure I’m not the only American who grew up with it — is that we learned early on to eat everything put in front of us when we sat down to meals. Then the size of the plates grew — and so did the amount of food we consumed.

Portion inflationIt’s called portion inflation. Take a look at the illustration at left. It’s based on an analysis published in the Journal of the American Dietetic Association which found that typical restaurant portion sizes today are two to eight times as large as those in 1955. Back then, people who consumed a typical American meal (a hamburger, French fries, and a soda) had only one portion size to pick from. Today we can choose from multiple portion sizes: reasonable, big, bigger, and ridiculous (as I’ve come to think of the sizes listed in that last column).

Portion size matters. The bigger the portion, the more calories you can consume. An example using a table of calorie information available online in the nutrition section at McDonald’s: By choosing the largest size in each category, you’ll end up consuming nearly triple the number of calories in a meal as you would if you chose the smallest portions.

Food Smallest size/calories Largest size/calories
Hamburger 3.5 oz/250 calories 11.1 oz/750 calories
French fries 2.5 oz/230 calories 5.4 oz/500 calories
Coca Cola 12 oz/110 calories 32 oz/310 calories
Total calories 590 calories 1,560 calories

Partly as a result of portion inflation, we’re eating more. Dietary surveys indicate that, on a per capita basis, Americans consumed 200 calories more per day in the 1990s than they did in the 1970s. That may not sound like a lot, but over time extra calories translate into extra pounds. Some experts calculate that people who add 150 calories a day to their diets, without increasing physical activity to burn those calories off, will gain as many as 15 pounds in a year. Read more »

*This blog post was originally published at Harvard Health Blog*

Military Plastic Surgery: Using Liposuction To Make The Weight Cut

The Orange County Register blog posted on military plastic surgery and mentioned liposuction:

Army Times reports that soldiers are turning to liposuction to remove fat if extreme dieting, laxatives and other methods fail to get them under the Army’s weight limit for their height, age and gender.

“Liposuction saved my career. Laxatives and starvation before an [Army Physical Fitness Test] sustains my career,” a soldier told the periodical. “Soldiers are using liposuction, laxatives and starvation to meet height and weight standards. I did, do and still do.”

I am well aware of the military patient looking to stay within military parameters to stay in the service as my San Clemente office is quite close to Camp Pendleton, and I give military discounts. I have seen several of these patients in my decade in San Clemente. Surgery for wives still outnumbers surgery for soldiers, though.

As some of these clients have explained, the Marine administration requires active duty soldiers to have certain measurements at a certain weight. Those who do not fall within these expected norms are first warned and then penalized. Liposuction has worked at times to keep some of these soldiers in the service.

- John Di Saia, M.D.

*This blog post was originally published at Truth in Cosmetic Surgery*

Lose Weight And Save Your Heart

On location at the American Heart Association’s “Scientific Sessions“ meeting in Chicago, Andrew Schorr discusses lowering your risk of heart disease and how weight affects your risk:

Lower Obesity and Save Your Heart from Patient Power® on Vimeo.

*This blog post was originally published at Andrew's Blog*

Mayo Clinic’s Dr. Jim Levine On How “NEAT” Good Health Can Be

Dr. Jim Levine at his treadmill deskObesity doesn’t stand a chance against Dr. Jim Levine, one of the prestigious presenters at Mayo Clinic’s Transform 2010 conference last week. Dr. Levine’s fascinating research focuses on helping people understand obesity, weight reduction, and Non-Exercise Activity Thermogenesis (NEAT) — the idea that expending calories through the activities of daily living is more important for calorie burning than exercise is.

Dr. Levine’s ”Treadmill Desk” has won more than 50 national and international awards in science, including the Judson Daland prize from the American Philosophical Society, the Invention of the Future Award from NASA, and the Innovation Award at the World Fair. The “Walkstation” is now a product of Steelcase.

Dr. Levine’s work has been highlighted nationally around the world, and he has produced documentary films with the BBC, ABC, and CNN. His Walkstation has been featured in The New York Times, his vision of a future where office people walk at work in USA Today, and his Treadmill Desk tested live on Good Morning America. Read more »

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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