Extreme Obesity, And What You Can Do About It

Too much weight can take a toll on your body, especially your heart. The good news is that there are steps you can take to get healthier — and even losing a little body weight can start you on the right path.

Why lose weight?
If you’re extremely obese, losing weight can mean “less heart disease, less diabetes and less cancer,” said Robert Eckel, M.D., past president of the American Heart Association. “Metabolic improvements start to occur when people with extreme obesity lose about 10 percent of their body weight.”

Losing weight can reduce your risk of heart disease and stroke; risk factors like high blood pressure, plasma glucose and sleep apnea. It can also help lower your total cholesterol, triglycerides and raise “good” cholesterol — HDL.

Understanding Extreme Obesity
A healthy BMI ranges from 17.5 – 25 kg/m2. If your body mass index is 40 or higher, you are considered extremely obese (or morbidly obese.) Check out the American Heart Association’s BMI calculator for adults to determine if your weight is in a healthy range. (Note: BMI in children is determined using a different BMI calendar from the CDC.)

A woman is extremely obese if she’s 5 feet, 4 inches tall and weighs 235 pounds, making her BMI 40.3 kg/m2. To reach a healthy BMI of 24.8, she would have to lose 90 pounds to reach a weight of 145 pounds.

A man is extremely obese if he’s 6 feet, 2 inches tall and weighs 315 pounds, making his BMI 40.4 kg/m2. To reach a healthy BMI of 25.0, he would need to lose 120 pounds to reach a weight of 195 pounds.

Doctors use BMI to define severe obesity rather than a certain number of pounds or a set weight limit, because BMI factors weight in relation to height.

How to Get Healthier
If you’re extremely obese, taking action to lose weight and improve your health may seem overwhelming. You may have had trouble losing weight or maintaining your weight loss, been diagnosed with medical problems and endured the social stigma of obesity.

“The key to getting started is to find a compassionate doctor with expertise in treating extreme obesity,” said Dr. Eckel, who is also professor of medicine and Charles A. Boettcher II Chair in Atherosclerosis at the University of Colorado Anschutz Medical Campus in Aurora, Colo. “Bonding with your physician is the best way to get past first base and on the path to better health.”

If you’re extremely obese, Dr. Eckel recommends that you become more active, but not to start a vigorous workout program without getting physician advice and not until you’ve lost about 10 percent of your body weight.
“You can continue the level of physical activity that you’re already doing, but check with your physician before increasing it,” Dr. Eckel said. “Some people with extreme obesity may have health issues like arthritis or heart disease that could limit or even be worsened by exercise.”

Treatment Options
Talk to your doctor about the health benefits and the risks of treatment options for extreme obesity:

  1. Change your diet. You may be referred to a dietician who can help you with a plan to lose one to two pounds per week. To lose weight, you have to reduce the number of calories you consume. Start by tracking everything you eat.

    “You have to become a good record-keeper,” Dr. Eckel said. “Reduce calories by 500 calories per day to lose about a one pound a week, or cut 1,000 calories a day to lose about two pounds a week.”
     

  2. Consider adding physical activity after reaching a minimum of 10 percent weight-loss goal.
     
  3. Medication. Some people can benefit from medication to help with weight loss for extreme obesity. Keep in mind that medication can be expensive and have side effects.
     
  4. Surgery. If changing your diet, getting more physical activity and taking medication haven’t helped you lose enough weight, bariatric or “metabolic” surgery may be an option. The American Heart Association recommends surgery for those who are healthy enough for the procedure and have been unsuccessful with lifestyle changes and medication. Risks can include infections and potentially dangerous blood clots soon after the operation, and concerns about getting the right amount of vitamins and minerals long-term.

Get The Social Or Medical Support You Need
Although some people can modify their lifestyle and lose weight on their own, many need extra help. A social support system can help encourage your progress and keep you on track. Decide what support best fits your needs — either a weight-loss support group or one-on-one therapy.

Some people with extreme obesity suffer from depression. Talk to your doctor about the best treatment, as some anti-depressant medications can cause weight gain.

Learn more:

  • BMI Calculator
  • BMI in Children
  • 5 Goals to Losing Weight
  • Losing Weight With Life’s Simple 7 Infographic
  • Preventing Childhood Obesity: Tips for Parents and Caretakers
     

Qsymia and Belviq Drugs for Obesity, Weight Loss | Psych Central

Qsymia and Belviq Drugs for Obesity, Weight LossIf you’re obese and are at the end of your ropes looking for weight loss help, there’s good news from the U.S. Food and Drug Administration (FDA). The FDA in the past few months has approved two new weight loss drugs for people who struggle with obesity — Qsymia and Belviq.

It should be noted up-front that these drugs are meant for people who are obese — those with a BMI number 30 or greater. While doctors often prescribe drugs for conditions not specifically approved by the FDA (called “off-label” use), doctors are likely to be more conservative in prescribing these two drugs when they first become available because of their unfamiliarity with them.

Both drugs can also be prescribed to people who are overweight, with a BMI of 27 or more and at least one weight-related condition such as type 2 diabetes, high blood pressure, or high cholesterol.

Qsymia (pronounced kyoo-sim-EE-uh and manufactured by Vivus Pharmaceuticals) and Belviq (pronounced bel-VEEK and manufactured by Arena Pharmaceuticals) have been shown to be effective in their clinical trials to help people lose significant amounts of weight.

Qsymia appears to be the more effective weight loss medication. People taking Qsymia for up to one year had an average weight loss of nearly 9 percent over those taking an inactive placebo. Over 70 percent of people taking Qsymia lost at least 5 percent of their body weight (only 20 percent of patients taking an inactive placebo lost this much weight).

People taking Belviq had an average weight loss that was 3 to 3.7 percent greater than people taking placebo. After taking Belviq for one or two years, some 47 percent of people without diabetes lost at least 5% of their body weight (only 23 percent of patients taking an inactive placebo lost this much weight.)

Although likely to be expensive, both weight loss drugs will likely be approved by insurance companies for treatment of obesity or being overweight with other health conditions. Why? Because obesity is a serious chronic health problem affecting more than one-third of U.S. adults (35.7 percent), according to the U.S. Centers for Disease Control and Prevention. As such, it costs insurers a lot of money. In 2008, medical costs associated with obesity were estimated at $147 billion. Anything to bring those costs down is likely to become approved for payment by insurance companies.

How Do Qsymia and Belviq Work?

Qsymia combines two generic drugs in a new formulation. One half the drug is composed of the seizure and migraine medication called topiramate. Topiramate causes weight loss in several ways, including increasing feelings of fullness, making foods taste less appealing, and increasing calorie burning. The other half of Qsymia is the appetite-suppressant called phentermine. Phentermine is thought to suppress appetite by triggering release of a brain chemical that increases blood concentrations of the appetite-regulating hormone leptin.

Belviq, on the other hand, appears to work by turning on a specific chemical “switch” in the brain that increases levels of serotonin. It’s not clear exactly why this helps a person lose weight.

Who Can’t Take These Drugs?

As with all medications, certain people cannot take these medications.

  • Pregnant or nursing women should not take either Belviq or Qsymia.
  • Qsymia:
    • People with glaucoma
    • People who have been told they have an overactive thyroid
    • People taking a type of antidepressant called a MAOI
    • People allergic to phentermine or topiramate
  • Belviq:
      People taking drugs linked to valvular heart disease, such as cabergoline (Dostinex)

    • People taking certain medicines for depression; migraine; the common cold; or mood, anxiety, psychotic, or thought disorders
    • Men with conditions that predispose them to erections lasting more than four hours. These conditions include sickle cell anemia, multiple myeloma, and leukemia
    • Men with a deformed penis

When Can I Get Them?

Qsymia will be available sometime after September 2012, while Belviq won’t be available until early-to-mid 2013.

As with any medication, talk to your doctor to see if this medication may be right for you. Tell your doctor if you are on any other medications, nutritional supplements (including vitamins), pregnant, nursing, or have any other health condition.


 

John Grohol, PsyDDr. John Grohol is the founder CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues — as well as the intersection of technology and human behavior — since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.

 

Deep Brain Stimulation Studied as Last-Ditch Obesity Treatment …

Deep Brain Stimulation Studied as Last-Ditch Obesity Treatment

By Amy Norton

HealthDay Reporter

THURSDAY, June 13 (HealthDay News) — For the first time, researchers have shown that implanting electrodes in the brain’s “feeding center” can be safely done — in a bid to develop a new treatment option for severely obese people who fail to shed pounds even after weight-loss surgery.

In a preliminary study with three patients, researchers found that they could safely use the therapy, known as deep brain stimulation (DBS). Over almost three years, none of the patients had any serious side effects, and two even lost some weight — but it was temporary.

“The first thing we needed to do was to see if this is safe,” said lead researcher Dr. Donald Whiting, vice chairman of neurosurgery at Allegheny General Hospital in Pittsburgh. “We’re at the point now where it looks like it is.”

The study, reported in the Journal of Neurosurgery and at a meeting this week of the International Neuromodulation Society in Berlin, Germany, was not meant to test effectiveness.

So the big remaining question is, can deep brain stimulation actually promote lasting weight loss?

“Nobody should get the idea that this has been shown to be effective,” Whiting said. “This is not something you can go ask your doctor about.”

Right now, deep brain stimulation is sometimes used for tough-to-treat cases of Parkinson’s disease, a movement disorder that causes tremors, stiff muscles, and balance and coordination problems. A surgeon implants electrodes into specific movement-related areas of the brain, then attaches those electrodes to a neurostimulator placed under the skin near the collarbone.

The neurostimulator continually sends tiny electrical pulses to the brain, which in turn interferes with the abnormal activity that causes tremors and other symptoms.

What does that have to do with obesity? In theory, Whiting explained, deep brain stimulation might be able to “override” brain signaling involved in eating, metabolism or feelings of fullness. Research in animals has shown that electrical stimulation of a particular area of the brain — the lateral hypothalamic area — can spur weight loss even if calorie intake stays the same.

The new study marks the first time that deep brain stimulation has been tried in that brain region. And it’s an important first step to show that not only could these three severely obese people get through the surgery, but they also seemed to have no serious effects from the brain stimulation, said Dr. Casey Halpern, a neurosurgeon at the University of Pennsylvania who was not involved in the research.

“That shows us this is a therapy that should be studied further in a larger trial,” said Halpern, who has done animal research exploring the idea of using deep brain stimulation for obesity.

“Obesity is a major problem,” Halpern said, “and current therapies, even gastric bypass surgery, don’t always work. There is a medical need for new therapies.”

Government Org Photoshops Little Girl, Makes Her Fat to Fight Obesity

This unsettling ad campaign for First 5, a government-run “healthy kids” program, depicts a heavily (literally) photoshopped little girl drinking from a paper bag (?) of sugar. Ugh, so many problems here.

On bus stop billboards, the words under the ad say:

“Less sugar” still has too much sugar. Sugary drinks like juice, sports drinks and soda can cause obesity. Choose milk* and water instead.

First, I get that they’re trying to show that soda/fruit juice/all of the delicious drink are filled with evil sugar, but it just looks like she’s trying to drink dry sugar out of a xxl maxi pad. And HELLO, obviously you can’t drink sugar out of a bag — First 5 clearly didn’t consult any fat kids — or any kids, period — or they would’ve known that this is how you eat sugar out of a container. Jesus.

Second, that has to be the worst photoshop botch job in a LOOOONG time. The (originally adorable) girl looks like Gwyneth Paltrow in Shallow Hal or Tracy Jordan in Fat Bitch. I wouldn’t exactly call her fat, and I wouldn’t call her wouldn’t human-looking either. She looks like a future graphic design dropout was blindfolded and then told to draw an obese chipmunk. Plus, WTF is up with the darkening of her skin? It’s all bad.

But perhaps most importantly, this. shit. doesn’t. work.**

More specifically:

A review of 55 international studies of programs aimed at reducing childhood obesity found that although most programs were able to reduce adiposity to some degree, not all interventions were effective, reported Elizabeth Waters, PhD, from the University of Melbourne, and colleagues in the Cochrane Database of Systemic Reviews. Children in an intervention group had a standardized mean difference in body mass index (BMI) of -0.15 kg/m2 (95% CI -0.21 to -0.09).

That’s a one pound weight loss, on average. Is that enough? Is it enough of a weight loss to torture kids with this shit? Because I’ll tell you what it’s like to be standing with a parent, friend, or bully when you see an ad like that — it’s humiliating, shameful, and sometimes dangerous. We know the physical toll of these tactics is a one pound weight loss, but what is the mental toll? And what are the ramifications of that stress on a young child’s body And regardless of how it makes fat kids feel — is the one pound weight loss enough to justify the time, cost, and effort put into this campaign?

Because I don’t think so. These government and school sanctioned weight loss programs just makes it that much harder for kids today. Don’t the adults who come up with these campaigns have any memory of what it was like to be a kid? If they did, I find it hard to believe that these are the tactics they would take. But then, they clearly have no idea what it’s like to be a responsible adult either, because they would’ve evaluated the stats and made a course correction by now. I just don’t understand what’s going on over there? Are they stubborn? Lazy? Stupid? What’s the deal?

Perhaps the worst part is that, if the website is any indication, the program appears to be defunct or barely operational. So, say you were an adult or kid who saw that ad and was like “Yes, I’d like to stop drinking dry sugar out of a maxi-pad! Show me the skinny light!” and actually visited First 5’s site, you’d be greeted with little information. Some of their programs haven’t been updated since 2009, and others have “Page Information – Coming Soon” placeholders.

Seriously, you guys? If you’re gonna go out of your way to pay for ads that belittle and humiliate children, at least pretend to offer a solution. Or maybe their terrible, incomplete, unhelpful website is the most honest thing about this whole shitshow.

*Milk is pretty high in sugar, and its health benefits are highly debatable — especially if we’re talking in black people, as seventy-five percent of African Americans are thought to be lactose intolerant.
**And maybe we don’t REALLY want them to, either? But that’s a whole ‘nother conversation…

Via national treasure Marilyn Wann; special thanks to Elizabeth Tamny, Cary Webb, and Kirby R. Michelle.

Battling Obesity in the Mentally Ill

Laura Ward, who has major depression, was able to lose more than 30 pounds in a study of weight loss programs for people with mental illness. She exercised regularly and attended counseling sessions on improving nutrition.Matt Roth for The New York Times Laura Ward, who has major depression, was able to lose more than 30 pounds in a study of weight loss programs for people with mental illness. She exercised regularly and attended counseling sessions on improving nutrition.

Laura Ward, 41, had always attributed her excess pounds to the drugs she takes for major depression. So Ms. Ward, who is 5-foot-6 and once weighed 220 pounds, didn’t try to slim down or avoid dietary pitfalls like fried chicken.

But in a clinical trial, Ms. Ward managed to lose more than 30 pounds doing low-impact aerobics three times a week. During the 18-month experiment, she was introduced to cauliflower and post-workout soreness for the first time. She and the other participants attended counseling sessions where they practiced refusing junk food and choosing smaller portions. She drank two liters of Diet Dr Pepper daily instead of eight.

Eventually, Ms. Ward, who lives in Baltimore, realized her waistline wasn’t simply a drug side effect. “If it was only the medications, I would have never lost all that weight,” she said.

People with serious mental illnesses, like schizophrenia, bipolar disorder or major depression, are at least 50 percent more likely to be overweight or obese than the general population. They die earlier, too, with the primary cause heart disease.

Yet diet and exercise usually take a back seat to the treatment of their illnesses. The drugs used, like antidepressants and antipsychotics, can increase appetite and weight.

“Treatment contributes to the problem of obesity,” said Dr. Thomas R. Insel, the director of the National Institute of Mental Health. “Not every drug does, but that has made the problem of obesity greater in the last decade.”

It has been a difficult issue for mental health experts. A 2012 review of health promotion programs for those with serious mental illness by Dartmouth researchers concluded that of 24 well-designed studies, most achieved statistically significant weight loss, but very few achieved “clinically significant weight loss.”

But now a trial published online in The New England Journal of Medicine in March has provided the most comprehensive evidence yet that people with serious mental illness can lose weight, despite the challenges. Nearly 300 people with schizophrenia, bipolar disorder, schizoaffective disorder or major depression — including Ms. Ward — were assigned to either a control group given basic nutrition and exercise information or one whose members exercised together and attended weight-management sessions.

The mean difference between the groups at 18 months was a modest seven pounds, but studies have shown that it is enough to reduce cardiovascular risks, the researchers noted. Nearly 38 percent of participants in the intervention group lost 5 percent or more of their initial weight, compared with only 22.7 percent of members of the control group. The difference between the groups could have been bigger, as the control group benefited from one aspect of the intervention: healthier dietary choices offered at the 10 psychiatric programs where the study took place, like baked fish instead of fried.

“This population can make a change,” said Dr. Gail L. Daumit, the study’s lead author and an internist at Johns Hopkins University School of Medicine. “There’s been a lot of stigma that they can’t do it.”

Most other trials had “a narrowly defined population that excluded people with lots of co-morbidities,” said Dr. Caroline Richardson, at Veterans Affairs Ann Arbor Healthcare System in Michigan. But this study “applies to a lot of people.”

The study suggests that weight loss may take a different trajectory for those with mental illness. Weight loss in the intervention group didn’t “peak early” and then rebound a bit, as sometimes happens in programs targeted to people without mental illness, Dr. Daumit said. Instead, it “progressed over the course of the trial.”

Since the study, Ms. Ward said she had regained at least 15 pounds. Still, every other day she walks for 20 minutes.

Dr. Stephen J. Bartels, a professor of psychiatry at Dartmouth and co-author of the 2012 review, said the more effective interventions for people with mental illness combined education and structured activity, focusing on both exercise and diet.

Classes and exercise programs seem to work better when they are available where mental health services are provided. And these programs should probably run six months or longer, he said.

Losing weight is challenging for anyone, let alone people with problems with executive function and memory. In Dr. Daumit’s trial, researchers gave cards to carry in wallets and purses that emphasized messages like avoiding sugary drinks.

One of the few widely tried health-promotion programs for people with mental illnesses is InShape, available at 10 sites in New Hampshire and 9 programs in 5 other states. One of its tenets is to have patients set their own goals, with the help of a health “mentor” who also sometimes accompanies them to the gym to get them past any feelings of discomfort.

In a randomized controlled yearlong intervention using InShape, to be published in Psychiatric Services next month, almost half of the 133 participants had either clinically significant weight loss (5 percent or more of body weight) or clinically significant improvements on a six-minute walk, said Dr. Bartels, the lead author.

“Many of them come to feel helpless about how they will avoid gaining weight,” Ken Jue, who started InShape at Monadnock Family Services in Keene, N.H., in 2003. “We try to encourage people and say, ‘You do have some control in this.’ ”

A version of this article appeared in print on 04/16/2013, on page D5 of the NewYork edition with the headline: A Battle Plan to Lose Weight.

Breath Test Might Predict Obesity Risk – WebMD

Breath Test Might Predict Obesity Risk

By Denise Mann

HealthDay Reporter

TUESDAY, March 26 (HealthDay News) — A simple breath test may be able to tell if you are overweight or will be in the future, a new study suggests.

According to the findings, results from a standard breath test used to assess bacterial overgrowth in the gut can also tell doctors if you have a high percentage of body fat.

The microbiome, or the trillions of good and bad bugs that line your gut, can get out of balance. When bad bacteria overwhelm good bacteria, symptoms such as bloating, constipation and diarrhea may occur. The new study, appearing in the April issue of the Journal of Clinical Endocrinology Metabolism, suggests that this scenario may also set someone up for obesity.

For the study, individuals drank a sugary lactulose syrup. Breath samples were then collected every 15 minutes for two hours. Participants also had their body fat measured in two ways. One was body mass index (BMI), which takes height and weight into account. The other method uses low-wattage electrical conductivity, which differentiates between lean and fatty tissue.

Those participants whose breath samples showed higher levels of two gases — methane and hydrogen — had higher BMIs and more body fat than participants who had normal breath or a higher concentration of only one of the two gases, the study showed. This pattern suggests that the gut is loaded with a bug called Methanobrevibacter smithii, the researchers explained.

It’s possible that when this type of bacteria takes over, people may be more likely to gain weight and accumulate fat, said lead study author Dr. Ruchi Mathur, director of the outpatient diabetes treatment center at Cedars-Sinai Medical Center in Los Angeles.

Although there are other ways to measure body fat and BMI, the researchers suggested that individuals with higher methane and hydrogen content in their breath may be more likely to respond to specific weight loss methods down the line. “Obesity is not a one-size-fits-all disease,” Mathur said.

If the study findings are confirmed, certain weight-loss treatments could be matched to people who have this breath pattern. One possibility, for instance, might be that probiotics, which help restore and maintain the natural balance of organisms in the gut, could have a role in treating or preventing obesity.

But the science is not there yet, experts cautioned.

“This is an important study looking at bacteria in the intestine and how they are related to BMI,” said Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. “The more methane and hydrogen in the breath, the higher the body fat.” But, “we need more studies to figure out how bacteria is related to the growing obesity epidemic and what happens if we modify it,” Mezitis said.

UPDATE 1-Novo Nordisk obesity drug results underwhelm investors

* High-dose liraglutide only slightly better than 1.8 mg

* Placebo-adjusted weight loss 4 pct at 3 mg dose

* Shares fall 4 pct on worries over obesity potential

(Adds analyst comments, latest shares)

COPENHAGEN, March 18 (Reuters) – Overweight and obese diabetes patients given high doses of Novo Nordisk’s drug liraglutide achieved 6 percent weight loss in a clinical trial, only slightly above the loss seen in those on a lower dose.

The Danish group, the world’s biggest insulin producer, said on Monday it was pleased with the results. But investors worried about where it left Novo’s strategy for a premium-priced high-dose obesity treatment and shares in the company fell 4 percent.

Novo Nordisk said subjects with Type 2 diabetes achieved 6 percent weight loss with 3 milligrams of liraglutide in the advanced Phase III trial compared to 5 percent in those on 1.8 mg.

Patients given a placebo also lost 2 percent of their weight, so the placebo-adjusted loss for the higher dose was 4 percent, analysts noted.

“Five and 6 percent is on the low side in efficacy, but it is important to note that it is enough to be approved by the FDA (U.S. Food and Drug Administration),” said Michael Friis Jorgensen, senior analyst at Alm Brand.

He said the share price reaction was harsh but reflected broader uncertainty about Novo’s prospects, following an earlier setback for new diabetes drug Tresiba in the key U.S. market.

“We are pleased about the outcome of this trial and look forward to getting the results from the two remaining trials in the SCALE programme,” said Mads Krogsgaard Thomsen, chief science officer at Novo.

Soren Lontoft Hansen, an analyst at Sydbank, endorsed Thomsen’s view, arguing the results were “robust” – but an analyst at a major bank, who asked not to be quoted before he published on the subject, said the results were only “so so”.

The fact there was just a marginal benefit from using the highest dose was a particular concern for the company’s high-price strategy, he added.

Novo wants to turn the injected drug – already on the market as a treatment for Type 2 diabetes under the brand name Victoza – into a multibillion-dollar-a-year product for the seriously obese.

While some in the industry are sceptical about using so-called GLP-1 diabetes drugs such as liraglutide to fight obesity, Thomsen believes the approach can offer cost-effective benefits.

Glucagon-like peptide-1, or GLP-1, drugs work by stimulating insulin release when glucose levels become too high. Their ability to induce weight loss is an added benefit, since type-2 diabetes is linked to obesity.

Novo Nordisk expects to complete the two remaining Phase III

trials in the so-called SCALE clinical trial programme by mid-2013.

When used in diabetes as Victoza, liraglutide is given at daily doses of either 1.2 or 1.8 mg. Novo, however, has been betting on a higher dose to produce greater weight-loss in the obese.

Novo Nordisk shares were down 4.2 percent at 1245 GMT, underperforming a 0.4 percent fall in a European drugs sector index .

(Reporting by Johan Ahlander, Stine Jacobsen and Ben Hirschler; Editing by Tom Pfeiffer)

((johan.ahlander@thomsonreuters.com)(+46 707 211027)(Reuters Messaging: johan.ahlander.reuters.com@reuters.net))

Keywords: NOVONORDISK/

UPDATE 1-Novo Nordisk obesity drug results underwhelm investors

* High-dose liraglutide only slightly better than 1.8 mg

* Placebo-adjusted weight loss 4 pct at 3 mg dose

* Shares fall 4 pct on worries over obesity potential

(Adds analyst comments, latest shares)

COPENHAGEN, March 18 (Reuters) – Overweight and obese diabetes patients given high doses of Novo Nordisk’s drug liraglutide achieved 6 percent weight loss in a clinical trial, only slightly above the loss seen in those on a lower dose.

The Danish group, the world’s biggest insulin producer, said on Monday it was pleased with the results. But investors worried about where it left Novo’s strategy for a premium-priced high-dose obesity treatment and shares in the company fell 4 percent.

Novo Nordisk said subjects with Type 2 diabetes achieved 6 percent weight loss with 3 milligrams of liraglutide in the advanced Phase III trial compared to 5 percent in those on 1.8 mg.

Patients given a placebo also lost 2 percent of their weight, so the placebo-adjusted loss for the higher dose was 4 percent, analysts noted.

“Five and 6 percent is on the low side in efficacy, but it is important to note that it is enough to be approved by the FDA (U.S. Food and Drug Administration),” said Michael Friis Jorgensen, senior analyst at Alm Brand.

He said the share price reaction was harsh but reflected broader uncertainty about Novo’s prospects, following an earlier setback for new diabetes drug Tresiba in the key U.S. market.

“We are pleased about the outcome of this trial and look forward to getting the results from the two remaining trials in the SCALE programme,” said Mads Krogsgaard Thomsen, chief science officer at Novo.

Soren Lontoft Hansen, an analyst at Sydbank, endorsed Thomsen’s view, arguing the results were “robust” – but an analyst at a major bank, who asked not to be quoted before he published on the subject, said the results were only “so so”.

The fact there was just a marginal benefit from using the highest dose was a particular concern for the company’s high-price strategy, he added.

Novo wants to turn the injected drug – already on the market as a treatment for Type 2 diabetes under the brand name Victoza – into a multibillion-dollar-a-year product for the seriously obese.

While some in the industry are sceptical about using so-called GLP-1 diabetes drugs such as liraglutide to fight obesity, Thomsen believes the approach can offer cost-effective benefits.

Glucagon-like peptide-1, or GLP-1, drugs work by stimulating insulin release when glucose levels become too high. Their ability to induce weight loss is an added benefit, since type-2 diabetes is linked to obesity.

Novo Nordisk expects to complete the two remaining Phase III

trials in the so-called SCALE clinical trial programme by mid-2013.

When used in diabetes as Victoza, liraglutide is given at daily doses of either 1.2 or 1.8 mg. Novo, however, has been betting on a higher dose to produce greater weight-loss in the obese.

Novo Nordisk shares were down 4.2 percent at 1245 GMT, underperforming a 0.4 percent fall in a European drugs sector index .

(Reporting by Johan Ahlander, Stine Jacobsen and Ben Hirschler; Editing by Tom Pfeiffer)

((johan.ahlander@thomsonreuters.com)(+46 707 211027)(Reuters Messaging: johan.ahlander.reuters.com@reuters.net))

Keywords: NOVONORDISK/

neo-neocon » Blog Archive » What we don't know about obesity …

The New England Journal of Medicine has published an article that sounds both interesting and brave, about obesity’s myths vs. what we actually know.

I write “sounds” because the article itself is behind a firewall, and I’ve only read this NY Times piece describing it. But it’s a rare thing for a medical article to try to explode the common “wisdoms” about obesity that are not based on much of anything except some correlations.

Here’s the gist of the article:

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Personally, I’ve long been impressed by how much garbage is out there about weight loss. My own observations?

(1) There’s a difference between overweight and obesity, and it’s not even clear that the first has negative health consequences.

(2) The path to overweight and/or obesity is different for different people, and there is no universal remedy.

(3) In fact, remedies are very difficult to come by, and it’s not because of some moral weakness or lack of willpower in overweight people. Losing weight and keeping it off is very, very hard for most overweight or obese people.

(4) Nevertheless, it’s easier for men than for women, and for young people than for the middle-aged. This is for physiological, not psychological, reasons.

(5) Many people who are overweight do not eat more than many thin people, or exercise less.

Could brown fat cure obesity? – The Blogs at HowStuffWorks

No, this kind of brown fat certainly won't accelerate weight loss. (© David Brabyn/Corbis)

No, this isn’t the kind of brown fat we’re talking about. (© David Brabyn/Corbis)

In my previous blog post on thermal dieting, I discussed how exposure to cold temperatures can potentially ramp up fat metabolism. In figuring out what makes this possible physiologically, scientists have pinpointed brown fat as the gatekeeper. Distinct from white fat, the stuff that gym memberships are made of, brown adipose tissue is chock-full of energy-chomping mitochondria (these iron-packed structures give the tissues its brown color, in fact) that kick into gear when the body’s internal temperature drops in order to generate heat. In short, when the mercury plummets, brown fat chows down on calories and fat cells. Rather cannibalistic, eh?

Babies are born with brown fat deposits to help keep them toasty, and rodents are rich in brown fat as well since their bodies don’t shiver when temperatures drop. Only recently, scientists also figured out that many adults retain pockets of brown fat in small quantities even as they age. Grownups don’t tote a lot of it around, though; a couple shot glasses-worth of the stuff is on the high end comparatively, as Wired’s Steven Leckhart reported. Even in those minimal doses, brown fat delivers a serious punch, tearing through around 80 more calories-per-hour  than a body normally would.

Now that brown fat’s presence is known in adults, scientists are furiously attempting to untangle how it can yield accelerated weight loss results in the face of rising obesity rates in the United States and abroad, keeping in mind that different people carry around different amounts of brown fat, along with the myriad variables associated with metabolism and weight loss.

To that end, some scientists have tried turning white fat brown. In 2010, a group of European scientists published a headline-generating study in which they were able to tinker with an enzyme in the white fat cells of mice and effectively convert it to brown fat. The results? A 20 percent drop in mouse weight. But the study authors also highlighted some not-so-fantastic possible impacts of rejiggering that COX-2 enzyme. TIME reported, “revving up its activity may lead to some serious side effects such as clotting problems, increased sensitivity to pain and even muscle abnormalities.”

Others are seeking to develop brown fat transplants, which have been shown to effectively spur weight loss and curb the risk of type 2 diabetes in mice. And there’s even a patriotic bent to this strand of research. The military has awarded a grant to a company developing “transferable brown fat cells,” Wired reports in hopes to trimming down troops.

And brown fat isn’t the only promising adipose tissue on the block. In 2012, researchers discovered another fat-burning fat they termed “beige fat,” which has similarly been hailed as a possible obesity remedy.

Whether these sepia-toned tissues can work their magic in humans remains to be seen, however. As diabetes and physiology professor Andre Carpentier cautioned WedMD in late 2012, additional brown fat still won’t be a substitute for overweight adults adjusting their daily health regimens. “You may end up burning a little bit more calories at the end of your day, but it’s not going to be anything close to what you can achieve by doing exercise and diet,” Carpentier said.