William Petit Joins Company Developing Diabetes Device

Dr. William Petit is a partner in a company that’s developing a new device for testing diabetes.

Petit is one of four principals in Quick LLC, a Farmington-based company that announced Thursday the start of a fundraising campaign to raise money for developing a prototype of the device and testing it.

Petit said he got involved with the company because it’s an opportunity to be involved with something that could solve the long-discussed problem of how to make it easier to measure glucose levels in diabetes patients. He is friends with Scott Fox, the president and CEO of the company.

“Over the course of a number of rounds of golf, he told me about what was going on,” Petit said.

David Mucci and Ron Clark, both doctors at the Hospital of Central Connecticut who developed the device, demonstrated it to Petit.

Instead of using a finger prick to test blood, the device measures glucose levels in saliva. It’s easier and less painful, Petit said, especially for people who need to test themselves several times each day. Some people don’t test themselves as often as they should, Petit said, because of the pain and inconvenience.

“It’s a fascinating idea and I give credit to Dave Mucci and Ron Clark,” he said in a telephone interview. “People have been looking for ways to measure glucose levels for some time.”

The device also connects to smartphones so that parents can track their children’s tests.

A former medical director of the Joslin Diabetes Center at the Hospital of Central Connecticut, Petit hasn’t practiced medicine since 2007, when his wife and two daughters were killed in a brutal attack in their home. Since that ordeal, he has worked for the Petit Family Foundation, which has raised and donated more than $1 million to causes that match the interests of his wife and daughters.

He has also advocated for reforming the state’s death penalty law and has served with the Hartford County Medical Association and the Connecticut State Medical Society.

The new device, called the iQuickIt Saliva Analyzer, has been in development for about 18 months, Fox said. The company hopes to raise $100,000 over the next two months on the crowdsourcing website Indiegogo.com, which allows people to raise money for specific goals with contributions from many people.

Fox, Mucci and Clark are the founders of the company. They brought Petit onto the management team to serve as the diabetes advisor. Among other tasks, he’ll oversee the clinical trials when the device gets to that stage.

In a best-case scenario, Fox said, the device could be on the market in about two years.

Petit made news earlier this month when he confirmed that he was considering running for Congress. Petit said Thursday he was still considering a run for the Republican candidacy in the 5th District, and is weighing the time it requires to other commitments, including the foundation, his work with Quick LLC and the fact that he and his new wife are expecting a baby in six weeks.

Obesity experts appalled by EU move to approve health claim for …

Obesity experts say they are appalled by an EU decision to allow a “health claim” for fructose, the sweetener implicated in the disastrous upsurge in weight in the US.

Fructose, the sugar found in fruit, is used in Coca-Cola, Pepsi and other sweetened US drinks. Many believe the use of high-fructose corn syrup caused obesity to rise faster in the US than elsewhere in the world. Europe has largely used cane and beet sugar instead.

But the EU has now ruled that food and drink manufacturers can claim their sweetened products are healthier if they replace more than 30% of the glucose and sucrose they contain with fructose.

The decision was taken on the advice of the European Food Safety Authority (Efsa), on the grounds that fructose has a lower glycaemic index (GI) – it does not cause as high and rapid a blood sugar spike as sucrose or glucose.

But, say obesity experts, fructose is metabolised differently from other sugars – it goes straight to the liver and unprocessed excess is stored there as fat, building up deposits that can cause life-threatening disease.

There is potential for products high in sugar including soft drinks, cereal bars and low-fat yoghurts to make health claims by using fructose. Lucozade Original contains 33g of sugar in a 380ml bottle, Sprite has 21.8g of sugar in 330ml cans and Dr  Pepper 34.1g per 330ml.

Kellogg’s Nutri-Grain Elevenses bars have 18g of sugar in a 45g bar – so are more than a third sugar.

Barry Popkin – distinguished professor in the department of public health at the University of North Carolina at Chapel Hill, in the US, who co-authored the groundbreaking paper linking high-fructose corn syrup to obesity in 2003 – said the ruling would lead to claims from food and drink firms that would mislead consumers.

“This claim is so narrow and it will confuse a whole lot of people,” he said. “That’s what the industry does an awful lot of. People see it and think, ‘ah maybe it’s healthy.’

“It brings into question the whole area of health claims. They are made on such short-term effects.”

Drinking pomegranate juice might give you all the vitamin C and antioxidants you need that day, but six months of regular drinking could raise the risk of diabetes, he said.

A health claim relating to a lower glycaemic index ignored the wider and more important public health issue, he said: that we should all consume less fructose and other sugars.

George Bray, head of the division of clinical obesity and metabolism at the Pennington biomedical research centre in Louisiana and co-author of the fructose paper, said he could see no rational reason for adding pure fructose to the diet.

“Assuming that it is correct that manufacturers can substitute up to 30% fructose for glucose or sucrose, it would be a very sad commentary on their review of the literature,” he said.

“The quantity of fructose appearing in the diet is already excessive in my view. [Focusing on the fact that] fructose does not raise glucose as much ignores all of the detrimental effects of fructose from whatever source.”

Michael Goran, director of childhood obesity research at the University of Southern California, said that although it had a lower GI, “in the long term, excess fructose is more damaging metabolically for the body than other sugars”.

He added: “This opens the door for the beverage and food industry to start replacing sucrose with fructose, which is presumably cheaper.”

More people in Europe will be consuming more fructose as a result, he said. “This is a dangerous and problematic issue. There is going to be a big increase in fructose exposure.”

The European Heart Network raised concerns with DG Sanco, the European commission’s health department, and asked it to share its views with member states. Its director, Susanne Logstrup, warned that replacing glucose and sucrose with “healthier” fructose might make people think a drink or food was less fattening.

“If the replacement of glucose/sucrose is not isocaloric, replacement could lead to a higher caloric content. In the EU, the intake of sugar-sweetened beverages is generally too high and it would not be in the interest of public health if intake were to increase,” she said.

Professor Mike Rayner, director of the British Heart Foundation health promotion research group at Oxford University and an adviser to the European Heart Network, said it was important the EU looked at nutritional health claims – and that it had in recent years taken a tougher stance.

“But here is an example in fructose of a claim that is technically probably true but has no public health benefit,” he said.

Industry is delighted by the EU ruling. Galam Group, an Israeli fructose manufacturer, called the move “a game-changing step” in comments to the trade journal Nutra Ingredients. It said it expected a surge in sales from 2 January, when the ruling takes effect.

Examining the link between bacteria and obesity

We have, it seems, moved on from acknowledging it takes a village to raise a human being. We are well into the realm of realization that it takes a village just to be one. More and more studies are demonstrating the importance of the germs that outnumber our cells by an order of magnitude at least, to virtually every aspect of physiology. But while epiphanies of this sort are redolent with promise, they can be dizzying as well, and pose a threat of disequilibrium and distraction. If we can miss the forest for the trees, there is, I think, a comparable risk of missing the importance of lifestyle for the Lactobacilli. My motivation here is the hope that we will not.

While I can no longer readily recall what life was like before email, I certainly do recall medical practice before the widespread popularity of probiotics. Only very recently did the use of ingestible bacteria transition from the realm of far-fetched to all-but-standard, and from “you must be kidding!” to “where to do I get mine?” Not all that long ago, the only good germ was a dead germ.

Progress since the initial uptake of the probiotic concept has been astounding. The now well-established potential to prevent and treat C. difficile colitis, a dire complication of antibiotic therapy, with probiotics is a considerable advance all by itself.

The more we’ve learned about the importance of our resident microbes, the more we’ve learned about the need and opportunity to learn more. The process may be likened to climbing a hill, and then gaining a view of the higher hills and mountains beyond. There is a lot of climbing left to do.

One peak now within view involves the important relationships among our immune system, cohabiting bacteria, and other organisms. In An Epidemic of Absence, Moises Velaszquez-Manoff makes a thorough and compelling case for the unintended consequences of sanitizing our environments and the eradication of parasites. How best to apply such lessons to the management of allergy and autoimmune disease is a work in progress, but that it’s vitally important work now seems abundantly clear.

The other peak before us is the one that worries me a bit. It beckons with tantalizing new findings related to weight control.

We have known for quite some time that commensal microbes play a vital role in digestion. In fact, we surmised this about bacteria living in our guts before we knew much else about them; after all, what else would they be doing there? More recently, we have come to learn that bacterial colony counts influence our energy efficiency and the number of calories we can extract from food. Differences in the microbiome can make it harder or easier to lose weight, and may account for more flagrant cases of weight loss resistance. In some instances, when all else fails, the wholesale transplantation of gut microbes may allow for weight control.

This provocative tale is further embellished by a cluster of recent papers in preeminent scientific journals. An article published in Nature Reviews in early August explores the causal pathway from intestinal microbes to obesity risk. A study published in late August in Nature compared the microbiota in 123 lean and 169 obese Danish adults. The authors report greater genetic variety among gut microbes in lean individuals than obese. A brief report of an intervention in the same issue of the journal reported an increase in the genetic richness of gut microbes when obese and overweight individuals were put on a weight-reducing diet. And even more of Nature’s rarefied real estate has been allocated to this topic to accommodate commentaries and editorials.

And a report in Science indicated that the gut microbes from obese adult twins could make germ-free mice get fat, while the gut microbes from their lean siblings had the opposite effect.

Why does this all worry me?

I fully acknowledge the almost certain importance of our microbial diversity to energy balance and weight regulation. I accept that indelible links are being forged among genes, germs, and resultant girth.

But we are all too easily distracted from the accessible means of both losing weight and finding health, by new and exotic theories. Excessive preoccupation with the microbiome could lead us into our next great boondoggle.

Consider that behaviors we control directly, as opposed to microbial colonies we may not, explain 80 percent of the variation in the risk for all major chronic diseases. Consider that overwhelmingly, when people eat well and exercise, they lose weight — and if the behaviors persist, so does the weight loss. Consider that obesity was rather uncommon a half century ago in the days before drive-through fast-food restaurants, a vast proliferation of junk foods, and a comparable proliferation of labor-saving technologies.

In other words, while scrutiny of our microbes may help account for enigmatic cases of weight gain, they are, for most of us, the trees that may cause us to overlook the forest. The fixable causes of obesity and chronic disease are on prominent display, all around us. Most of us will gain weight when we take in too many calories, even if from wholesome sources. Most of us will lose weight if we restrict calories enough, even if those calories come from Twinkies. Energy balance does not seem to require a bacterial referendum.

For the most part, people who exercise diligently and eat very well are both leaner and healthier than others who don’t. What a remarkable coincidence it would be if those who best attended to calories in and calories out just happened to be those with the genes and germs conducive to trim guts.

This does not mean the germs and genes in our guts are not germane to weight and health; they clearly are. But the available evidence suggests they are at least as much effects as causes.

In other words, the same adverse exposures that tend to make us sick and fat appear to do much the same to our resident bugs. It doesn’t much change the relevance of junky diets and physical inactivity to poor health and weight gain to note that along with all of the other adverse effects of such behaviors, they disrupt and distort the microbiome. All this really means as that we, and our germs, are in this together — we flourish, or founder, together.

For a quick analogy, imagine if we had just discovered atherosclerosis and reached the conclusion that it is the “real” cause of heart disease. That would be true, but it would be a serious mistake to toss out what we knew about tobacco, physical activity, and diet as a result. Those factors influence atherosclerosis, which in turn influences the likelihood of heart attack. Similarly, shifts in our bacterial colonies may be part of the pathway by which behaviors translate into changes in both weight, and health. This is in no way an invitation to jettison anything we already knew about the importance of those behaviors.

There may well be some opportunities to address the microbiome directly, from probiotics to fecal transplant. There are, analogously, ways to address atherosclerotic plaque directly with angioplasty and coronary bypass surgery. But just as lifestyle can keep arteries healthy in the first place, or even restore them to health, so too, it seems, can the very same lifestyle practices that protect our health do the same for our inner menagerie.

Over the years, we have heard about many “obesity genes.” But these genes were around long before obesity was a salient public health concern. Genes that haven’t changed recently can’t really account for recent changes in epidemiology. Similarly, while our understanding of our intimate codependence on gut microbes is fairly recent, the codependence is not. The bugs were there all along. If they have suddenly become complicit in epidemic obesity, it might be tempting to pass the buck to the bugs, but it begs the question: What changed them?

This, in turn, offers the silver lining of insight within the dark clouds of potential diversion. One of the prevailing mistakes about obesity is to pin it all on personal responsibility. There is, clearly, a case for personal responsibility; but the choices we make are in turn governed by the choices we have. It never made sense to presume that the current generation of 7-year-olds was less endowed with personal responsibility than every prior generation of 7-year-olds; but they sure are fatter! It makes even less sense to ascribe less personal responsibility to the current generation of Saccharomyces.

Of course, the “fault” lies not in our Saccharomyces! The explanations for what is awry within us are all around us; the very factors of lifestyle, environment and culture that have changed us have changed our resident flora as well. The behaviors that lead to better health and healthier weight may do so in part by moderating the expression of genes, and favorably shifting the populations of gut microbes.

It takes a healthy village within, it seems, to be a healthy human being. It still takes healthy choices by that human being to tend the village.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center. He is the author of Disease-Proof: The Remarkable Truth About What Makes Us Well.

Childhood obesity: A problem of will and money

The American Heart Association recently published a sobering “scientific statement” on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria, between 4 percent and 6 percent of our kids between the ages of 2 and 19 have severe obesity.

Those percentages probably don’t fully convey how common that makes this ominous condition. Consider that if a typical classroom held roughly 20 kids, there would be one “severely” obese child, on average, in every such classroom in the country. That is stunning, and extremely alarming — particularly given the current trends. Those trends, also noted in the report, indicate that severe obesity is “the fastest growing subcategory of obesity in youth.” Even where overall rates of obesity are leveling off, rates of severe obesity are rising briskly.

Our problems begin with our apparent inability to keep our eye on this ball. All too often, and at our collective peril, we treat scientific research like a Ping-Pong ball, diverting our attention first this way, then that. Media uptake of any given study often gives the impression that it represents the new, final word — replacing all we thought we knew before. But, of course, science is incremental; studies don’t replace one another, they contribute to the gradually accumulating weight of evidence. When we learn that rates of childhood obesity may be dipping slightly in some places, or leveling off among adults, it does not refute everything we knew about the outrageously high prevalence, the grave metabolic consequences, or the run-away increases in the most severe forms.

If virtually all of those vulnerable to obesity — adults and children alike — are already there, we can count on rates stabilizing. But if we are failing to help those who are already there from succumbing ever more fully,we can count on weights rising. It may no longer characterize the toll of epidemic obesity adequately to determine how many of us are overweight; that number may be relatively fixed now. We may need to ask: How overweight are the many of us? The American Heart Association gives us this answer about our kids: very.

This may explain why diabetes rates are rising on a truly ominous trajectory, even as overall obesity rates level off. More severe degrees of obesity are more predictive of metabolic complications and chronic disease, the details of just such associations occupying much of the new report’s verbiage.

But with the pages devoted to the new solutions we need, welcome and appropriate as this attention is, the AHA authors were far too conventional in my view. One of Albert Einstein’s famous witticisms is brought to mind: “We cannot solve our problems with the same thinking we used when we created them.”

We created the problem of epidemic obesity in children, and now hyper-endemic obesity in adults, over the past half century while propagating its causes in our culture and seeking its remedies in our clinics. But scalpels may be a very sorry substitute for the good that might be done in schools; pharmacotherapy may compare quite unfavorably to empowering better use of feet and forks.

Imagine looking at us from without, and assessing causes and cures of severe obesity informed by a dispassionate view from altitude. There would be a role for clinicians, clearly, but much of the relevant medicine would be cultural. Is it symptomatic of our inability to see outside the donut box that there is no mention in the new report, for instance, of aggressive food marketing to children?

The causes of obesity are not so much within us, as all around us. We and our kids are put together much the same ways we ever were, of course; yet the epidemiology of severe obesity is as it never was before. It takes change to produce change, and while our genes and physiologies are fairly constant, our culture is awash in obesigenic changes. Our plight is the predictable consequence.

There is a correspondingly predictable emphasis on drugs and surgery in the new report, and on models of clinical counseling. These are, indeed, appropriate for severe obesity — but they have severe liabilities.Drugs don’t tend to work very well. Surgery does, at least in the short term. But the costs are high; recidivism may be high as well. And surgery is something of a “deus ex machina” approach to obesity, doing nothing to address the factors that caused it in the first place. Surgery requires the skills of a surgeon but imparts no skills to the patient. Benefits we acquire under general anesthesia, whatever their duration, cannot be paid forward.

As for clinical counseling, consider its challenges. A child who is severely obese is generally caught up in a difficult dynamic at the family level. For a clinician to provide family counseling, appointments need to be scheduled for the whole family — a logistical challenge. If these appointments are during business hours, they pull adults away from work (assuming they are employed), and kids away from school. At best, the frequency of such encounters will be modest compared to the scope of the problem, and ill-suited to address some very practical concerns — such as no one in the home having the time, or skills, to prepare a meal.

Such challenges are further compounded by something we likely all know from personal experience, if not from the abundant research literature on the topic: Severely-obese kids are severely persecuted by their peers. When we were young, the “chubby” kid was the object of schoolyard bullying, to the regret of those of us victimized by it, and the shame of those of us who perpetrated it. Now, among kids who are chubbier in general than we were, it’s the severely “fat” kid who gets that daily dose of derision. That addition of insult to injury can lead to depression and despair, putting the behavior change needed for a remedy hopelessly out of reach. Can we really expect a doctor visit, even as often as once a month, to fix all of this?

There is something that can. We can embed solutions to severe obesity into the existing infrastructure of our lives and routines.

So, for instance, just as we have boarding schools to cultivate the talents of the academically gifted, or remediate the difficulties of the behaviorally challenged, so, too, could we have boarding schools for the severely obese, that blend academic rigor with comprehensive weight management. The appeal of such a concept, nowhere mentioned in the AHA report, is that severely-obese kids could get the intensity of treatment they need without stepping out of their lives to do so.

That treatment would almost certainly include behavioral, and psychological counseling. Depression and despair would need to be recognized and addressed by qualified professionals.

It would also include an emphasis on the relevant skills, such as identifying nutritious foods, learning how to choose and prefer them, and learning how to cook. It would include physical education and training, with an emphasis on strategies to fit fitness into every kind of daily routine. And by providing this and more in an environment where all the kids have run the same gauntlet, such a program could offer the therapeutic benefits of community, and compassion, and understanding.

And finally, if we could “fix” severe obesity in kids by empowering them with skills for healthy living, the kids could pay such benefits forward — to family members, and peers. Imagine re-integrating such kids into their public schools of origin, where their success at not just losing weight, but finding health — could inspire hope in others. Imagine such kids acting as peer mentors with a unique fund of knowledge and experience on which to draw.

And then stop imagining, because at least one such program exists. I have been privileged to serve as senior medical advisor to Mindstream Academy, which is the very model I’m describing. The results to date are stunning — with kids losing an average of nearly 50 pounds per semester, and some losing closer to 100. More important still is what the kids find: hope, self-esteem, and a renewed capacity to believe in themselves, and dream. And all of this is achieved by teaching a set of sustainable skills, not with any quick-fix gimmickry.

Why is the Mindstream model not more widely known, not mentioned in Circulation, and not accessible to the hundreds of thousands of kids who need it? In a word: money.

The families of severely-obese children tend to be the very families least able to afford treatment of any kind. Third-party payers can fix this, but they are accustomed to looking only at “medical” treatments. We tend to be rather blind to the possibility of lifestyle, or culture, as the medicine we need. But these are, in fact, the best medicines we’ve got – and with the potential to save us dollars along with lives.

Admittedly, we need to prove it. The Mindstream experience to date, for instance, needs to be published in the peer-reviewed literature; that’s in the works. We need to know more about the overall cost-effectiveness of such an approach, its sustainability, and how the program might be modified and still work. But we have routinely reimbursed for “medical” treatments before having such data. Even now, we know little about the long-term effects of bariatric surgery in tweens and teens. We might at the very least give school the same benefit of doubt we give scalpels.

There are many reasons why a problem that is hard but not truly complex, and amenable to remedies involving better use of feet and forks, has defied us for so long. We are inclined to medicalize obesity to legitimize it. But obesity as a “disease” implies a need for treatments of a clinical nature, drugs and surgery in particular. There are many good reasons why we do not have, and are unlikely to have, good drugs for obesity treatment. Surgery works, although just how long and how well for children, we really don’t know. But even if it worked well and sustainably, would we really want to sanction sending our sons and daughters through the operating room doors, to reorganize their gastrointestinal tracts, because we couldn’t manage to find ways to keep them from passing under the Golden Arches quite so often?

Even as we tear our proverbial beards, and gnash our teeth, we manage to turn a blind eye. Obesity is a cultural problem and requires a cultural solution we have the knowledge and means to administer. That we fail to apply those means — that we can watch television shows telling us of this threat to our kids, while our kids watching television are bombarded with intensive marketing of the very products that propagate the problem — bespeaks our ambivalence at best, our profit-driven hypocrisies at worst. Are we truly willing to mortgage the health of our children to fortify the corporate bottom line?

This is largely a problem of will, and money. Money, too, figures in the new report. The authors note that access to effective treatments for severe obesity is limited by lack of insurance coverage. In fact, the closing line of the article closes with a focus on dollars: “The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it.”

Given the dire consequences of severe obesity left unaddressed, pecuniary neglect is at best penny-wise and pound-foolish. But given the prospects for losing far more than pennies as the pounds accumulate to rob our vulnerable daughters and sons of both years of life, and life in years, it is far worse than that. It is a colossal, collective cultural failure of the first order.

The new report speaks to the grave threat of severe obesity among our children and hints at the solutions we need. The solutions exist; the will to cultivate them seems to be in question. So, the words in this report are just a start. The question now is this: Will we put the needed money where these erudite mouths are?

David L. Katz is the founding director, Yale-Griffin Prevention Research Center.

Does the process of diseasification hold any promise in obesity?

In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: does the process of diseasification hold any promise at all in obesity? And are there downsides to this approach that should cause us concern?

Diseasification is a funny and not entirely real word, but I didn’t make it up. Sure, if you look for it in an online dictionary, you won’t find it — but if you Google it, you’ll find over 6,000 hits. Most seem to focus on one of the most problematic aspects of diseasification: that of classifying all sorts of mental states and psychological issues as diseases, a tendency that has arguably contributed to our nation’s overreliance on pharmacology to ease the vicissitudes of daily living. But some of these Google hits refer to issues in prevention, including obesity. While I didn’t coin the term, I think its meaning is self-evident: labeling as a “disease” a condition that is typically not so construed. Clearly, the AMA’s action would fit under this intuitive definition.

Of course, this begs the question: what is a disease? A typical definition of disease provides guidance, if not absolute clarity: “any deviation from or interruption of the normal structure or function of any body part, organ or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis may be known or unknown.”

In holding obesity up to this standard, its appropriateness could hinge on whether a body with a body mass index (BMI) greater than 30 would be considered a normal structure; this in turn depends on how we define normal. Ironically, if we refer to a standard statistical concept of outliers — usually, the most extreme 5 percent or so of a population — then the more widespread our so-called national obesity epidemic, the more “normal” obesity becomes. Currently, more than a third of the entire U.S. population is obese; in certain states and in some ethnic/racial groups, the proportion is closer to half. Clearly, these are not outliers.

But I think the annals of preventive medicine have demonstrated that diseasification has its place. Let us look at a reasonably successful story of diseasification: that of hypertension. Some readers might be surprised that I’m considering this diseasification: after all, isn’t hypertension clearly a disease? Well, no, it’s not. There are no symptoms, illnesses or dysfunctions related to hypertension per se. Hypertension refers to an elevated blood pressure, where elevated was established in a discretionary (though certainly not arbitrary) manner. Coincidentally, about a third of all Americans fit the definition of people with hypertension, so these are also not outliers in the traditional sense. But what we do know is that high blood pressure is a major, modifiable risk factor for things that are diseases — important ones, such cardiovascular diseases, of stroke and heart attack. Moreover, we know that pharmacological efforts to lower blood pressure below established cutpoints leads to a reduction in the risk of such diseases. So diseasifying hypertension has led to helpful treatments and to a reduction in disease outcomes.

Obesity, however, is a wholly different animal. First, while obesity has been shown to be a risk factor for certain diseases — indeed, many of the same diseases predicted by high blood pressure — its association with those diseases is neither so strong nor so direct as that with hypertension. Moreover, healthcare practitioners do not have the sorts of treatments in their toolkits to treat obesity that they do for high blood pressure, and even more significantly, there is no direct evidence that using treatments to lower BMI will in turn reduce the risk of the real diseases that are associated with obesity — the ones we really care about.

Thus, the presumed upsides of this new AMA-endorsed classification are hard to imagine. Given the lack of effective and proven therapies, what benefit do we seek? Prevention, as Dr. Ayoob indicated, is key — but our rapidly exploding national obesity prevalence isn’t caused by lack of adequate medical care; rather, it is due to wholesale changes in diet and lifestyle, largely promoted by corporate marketing, governmental policies, new technologies and changing norms of behavior. These are amenable (alas, not easily) to public health interventions and policy change, but not to increased doctor visits.

An open question is: if this relabeling of obesity has an impact on the stigmatization of the overweight, will it be for good or ill? On the good side, perhaps, is recognizing that it isn’t necessarily a sign of sloth or weakness of will, but something that may be beyond volitional control, much as classification as disease may have improved the situation for alcoholics or substance abusers. On the other side — do we really want to equate obesity with such things? I think we ought to heed lessons from the fat acceptance movement, and consider that the overweight seem to be the last social group that it is deemed acceptable to malign.

Certainly, there are many fat people comfortable in their own bodies; do we really want to say to them, “Sorry, it doesn’t matter what you think, you’re sick”? Not a necessary corollary of diseasification, I think, but a cause for concern.

Paul Marantz is associate dean, clinical research education and director, Center for Public Health Sciences, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.

Grandpa Rules in Coca-Cola Ad Addressing Obesity Issue …

<!– Embed Title: Coca-Cola (UK): Grandfather –>

Life was much simpler back then, wasn’t it? Coke looks back on olden times in this new one-minute spot, out of David. “Grandfather” presents a day in two men’s lives using a familiar split screen approach. But this time, the left-hand sepia-toned frame shows the routine of a young 1950’s married man, while on the right the same actor portrays his modern-day counterpart. In the end, the generations merge together seamlessly when we discover the two men are grandfather and grandson.

The old-timer’s life emerges as the simpler one in which time moves slower, food portions are smaller, snacks are healthier and physical exertion is a given in his daily routine. Another noticeable difference is his happier demeanor — none of his lifestyle choices seem to put a strain on him and, hey, he gets to enjoy a guilt-free cold cola at the end. The spot, which is backed by Tom Jones’ “It’s Not Unusual,” began airing in the U.K. today as a part of Coke’s continuing efforts to raise awareness about balanced diets and active healthy living. It also strategically presents the brand’s zero-calorie and zero-sugar option, Coca-Cola Zero. You know, because that’s what grandpa would have chosen, if he could have, back in the day.

Coca-Cola also took a more lighthearted, animated approach to promoting the active lifestyle in another spot created out of The Cyranos and directed by Johnny Kelly of Nexus, who also was behind Chipotle’s celebrated “Back to the Start.” Check out his director’s cut below.

For more exciting ideas in brand creativity, tune in to Creativity-Online.com, follow @creativitymag on Twitter or sign up for the Creativity newsletter.

Obesity is much more like drowning than a disease

There is a certain irony in the nearly immediate juxtaposition of the rare introduction of a new FDA-approved drug for weight loss (Belviq) to the marketplace and the recognition of obesity as a “disease” by the AMA. A line from the movie Jerry Maguire comes to mind: “You complete me!” Drugs need diseases; diseases need drugs.

And that’s part of what has me completely worried. The notion that obesity is a disease will inevitably invite a reliance on pharmacotherapy and surgery to fix what is best addressed through improvements in the use of our feet and forks, and in our Farm Bill.

Why is the medicalization of obesity concerning? Cost is an obvious factor. If obesity is a disease, some 80 percent of adults in the U.S. have it or its precursor: overweight. Legions of kids have it as well. Do we all need pharmacotherapy, and if so, for life? We might be inclined to say no, but wouldn’t we then be leaving a “disease” untreated? Is that even ethical?

On the other hand, if we are thinking lifelong pharmacotherapy for all, is that really the solution to such problems as food deserts? We know that poverty and limited access to high quality food are associated with increased obesity rates. So do we skip right past concerns about access to produce and just make sure everyone has access to a pharmacy? Instead of helping people on SNAP find and afford broccoli, do we just pay for their Belviq and bariatric surgery?

If so, this, presumably, requires that everyone also have access to someone qualified to write a prescription or wield a scalpel in the first place, and insurance coverage to pay for it. We can’t expect people who can’t afford broccoli to buy their own Belviq, clearly.

There is, of course, some potential upside to the recognition of obesity as a disease. Diseases get respect in our society, unlike syndromes, which are all too readily blamed on the quirks of any given patient and other conditions attributed to aspects of character. Historically, obesity has been in that latter character, inviting castigation of willpower and personal responsibility and invocation of gluttony, sloth, or the combination. Respecting obesity as a disease is much better.

And, as a disease, obesity will warrant more consistent attention by health professionals, including doctors. This, in turn, may motivate more doctors to learn how to address this challenge constructively and compassionately.

But overall, I see more liabilities than benefits in designating obesity a disease. For starters, there is the simple fact that obesity, per se, isn’t a disease. Some people are healthy at almost any given BMI. BMI correlates with disease, certainly, but far from perfectly.

The urge to label obesity a disease, and embrace the liabilities attached to doing so, seems to be a price the medical profession is willing to pay to legitimize the condition. It may also be an attempt to own it (and the profits that come along with treating it), whereas that right and responsibility should really redound to our entire culture. Is it necessary for obesity to be a disease for it to be medically legitimate? I think not.

Carbon monoxide poisoning is medically legitimate, but it is not a disease — and there’s a good reason for that. It is poisoning, so the fault lies not with our lungs, but with what is being drawn into them. Your lungs can be working just fine, and carbon monoxide can kill you just the same. Perfectly healthy, disease-free bodies can be poisoned.

None would contest the medical legitimacy of drowning. If you drown, assuming you are found in time, you will receive urgent medical care — no matter your ability to pay for it. If you have insurance, your insurance will certainly pay for that care.

But drowning is not a disease. Perfectly healthy bodies can drown. Drowning is a result of a human body spending a bit too much time in an environment — under water — to which it is poorly adapted.

And so is obesity. Our bodies, physiology, and genes are much the same as they ever were. Certainly these have not changed much in the decades over which obesity went from rare to pandemic. What has changed is the environment.

We are awash in highly-processed, hyper-palatable, glow-in-the-dark foods. We are afloat in constant currents of aggressive food marketing. We are deluged with ever more labor-saving technological advances, while opportunities for daily physical activity dry up.

We are drowning in calories. And that’s how, in my opinion, we should make obesity medically legitimate: as a form of drowning, not as a disease.

With drowning, we don’t rely on advances from pharmaceutical companies. No one is expecting a drug to “fix” our capacity to drown. Our capacity to drown is part of the normal physiology of terrestrial species.

Our capacity to get fat is also part of normal physiology. Obesity begins with the accumulation of body fat, and that in turn begins with the conversion of a surplus of daily calories into an energy reserve. That’s exactly what a healthy body is supposed to do with today’s surplus calories: store them against the advent of a rainy (i.e., hungry) day tomorrow. The problem that leads to obesity is that the surplus of calories extends to every day, and tomorrow never comes.

Thinking of obesity as a form of drowning offers valuable analogies for treatment. We don’t wait for people to drown and devote our focus to resuscitation; we do everything we can to prevent drowning in the first place. We put fences around pools, station lifeguards at the beaches, get our kids to swimming lessons at the first opportunity, and keep a close eye on one another. People still do drown, and so we need medical intervention as well. But that is a last resort, far less good than prevention, and applied far less commonly.

There is an exact, corresponding array of approaches to obesity prevention and control; I have spelled them out before.

Disease is when the body malfunctions. Bodies functioning normally asphyxiate when breathing carbon monoxide, drown when under water for too long, and convert surplus daily calories into body fat. Perfectly healthy bodies can get obese. They may not remain healthy when they do so, but that is a tale of effects, not causes.

The most important reasons for rampant obesity are dysfunction not within our individual bodies, but at the level of the body politic. We do need medicine to treat obesity, but more often than not, it is lifestyle medicine.Lifestyle is the best medicine we’ve got — but it is cultural medicine, not clinical.

That’s where our attention and corrective actions should be directed. If calling obesity a disease makes us treat the condition with more respect, and those who have it with more compassion, and if it directs more resources to the provision of skill-power to adults and kids alike, it’s all for the good. But if, as I predict, it causes us to think more about pharmacotherapy and less about opportunities to make better use of our feet and our forks, it will do net harm. If we look more to clinics and less to culture for definitive remedies, it will do net harm. If we fail to consider the power we each have over our own medical destiny, and wait for salvation at the cutting edge of biomedical advance, it will do net harm.

Long before labeling obesity a disease, the AMA lent the full measure of its support to the Hippocratic Oath and medicine’s prime directive: First, do no harm. Obesity is much more like drowning than a disease. Calling it a disease has potential in my opinion to do harm. And so it is that I vote: No.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center.

Multitasking against obesity | Harvard Gazette

Five specialists in obesity came together at Cambridge’s Royal Sonesta Hotel on Friday for a forum called “Why Is Weight Loss So Hard?” The event was part of the four-day Blackburn Course in Obesity Medicine, sponsored by Harvard Medical School (HMS) and Massachusetts General Hospital (MGH), during which experts from across the globe gathered to discuss one of America’s fastest-growing and most important health issues — the country’s increasing levels of obesity.

Complex causes

The panelists agreed on the complexity and interacting issues that underlie the crisis. Genetics and environment are just two of the many factors involved.

“The world is getting heavier,” said moderator-panelist Lee M. Kaplan, an associate professor at HMS and director of the MGH Weight Center, “and this is not a personal problem of slovenliness or laziness by the patient.”

Nadia Ahmad, former HMS instructor of medicine, now director of the Dubai Obesity Medicine Center, agreed: “There’s a lot of research to show obesity is actually a biological problem,” she said.

The causes and consequences of obesity are different in every case, Kaplan said. “Obesity isn’t the same disease in everybody. Our bodies have 20,000 genes and 4,000 are involved in weight regulation.”

W. Scott Butsch, an instructor of medicine at HMS and a doctor at MGH, and Caroline Apovian, an associate professor of medicine and pediatrics at Boston University School of Medicine, pointed to the roles of age and gender.

“As we get older our bodies change: We gain fat and lose muscle mass, which can impact health,” said Butsch.

Apovian moved from the physical — “men and women are very different about where they distribute weight” — to the psychological. Additional social pressure on women to be thin, she said, “can create psychological issues” as well as weight issues.

Environmental factors

Increases in obesity stem in part from “all the prescription medications that cause weight gain,” said Louis Aronne, clinical professor of medicine at Weill Cornell Medical College. In addition, today’s stressed person “sleeps an hour less today than 100 years ago.”

Ahmad said, “The obesity epidemic is absolutely environmentally driven,” pointing to “more processed food and people working longer hours.” Kaplan described all these factors as “a perfect storm” pushing obesity: “We work too hard; we play too little; we eat too much; our circadian rhythms are disrupted; there have been big changes in our food.” It all adds up to more weight.

Can we change our environment and lifestyle to reduce obesity? Lifestyle changes in isolation have little chance of fixing the problem, Ahmad said. “Just getting rid of sugar-sweetened beverages won’t work,” she said. We need to make better food choices, but also “reduce stress and promote more sleep,” she continued.

Kaplan agreed that there’s no “one-size fits all” remedy, but “we can decide what we eat and how much we exercise and the amount of sleep we get and how much stress we have.”

Weight management

Prescribing a weight-management program is maddeningly complex and highly individualized, said Aronne. “In some cases, it’s just trial and error.”

Diets don’t have a great track record, the panelists agreed. “No one diet has been shown to cause more weight loss than any other diet,” said Kaplan. Physicians and researchers have to do more to address the obesity epidemic, he said: “We need to do a lot more with research, with community-based care,” and other treatment options.

Ahmad was optimistic that more treatments are in the pipeline: “We’re going to have more drugs and treatments, but what you do in your lifestyle” is important too, she emphasized.

Pfizer holds diabetes awareness workshops

Pfizer holds diabetes awareness workshops

Dubai, 4 hours, 36 minutes

Pfizer, the leading pharmaceutical company, organised diabetic foot awareness workshops in association with Dubai Health Authority (DHA) and local and international experts in Sharjah, Dubai and Abu Dhabi.

Globally, 40 per cent to 60 per cent of all lower extremity amputations are performed in patients with diabetes. The peripheral neuropathy comes on top of many components leading to the Diabetic Foot ulceration which makes the early examination of the Diabetic Foot the key of protecting it from complications such as ulcerations and amputations especially that the prevalence of diabetes in UAE could exceed 18.7 per cent.

It is recommended globally that every diabetic patient should be screened annually for DPN using the simple examination tools.

Dr Ahmad Ibrahim Kalban, CEO of the Primary Health Care Sector at the DHA: “DHA welcomes the initiatives which are aimed to fight and reduce the burden of chronic diseases. Patients with diabetes may be at risk of developing foot problems as Diabetic foot poses significant health economic and social problems and can lead to serious complications in its later stages leading to foot ulcer and amputation in diabetic patients.”

“In collaboration with Pfizer we are here today to focus on the diabetic foot and to enlighten doctors about the significance of early screening. It is imperative that foot risk-status is identified and discussed with patients to ensure their full understanding of its implication and potential complications.

“Due to the comprehensive plans as well as the awareness and treatment programs that have been implemented across the UAE as part of strong strategies, the UAE has succeeded to be excluded from the top 10 list of highest diabetes prevalence countries around the world where it was before the second,” he added.

Dr Muna Al Kuwari, director of Primary Health Care at the Ministry of Health (MOH), said: “Diabetes prevalence in UAE is considerably high. The diabetic foot is very sensitive and the awareness program about the early screening of the diabetic foot falls in accordance with our strategies in UAE which aim to educate doctors about diseases, and even health providers and educators, according to their specialty.

“The social partnership with Pfizer brought in the niche speakers who have held educational workshops across Sharjah, Dubai and Abu Dhabi with an objective to educate the majority of hospitals and doctors about the diabetic foot. The results would definitely reduce the socio-economic impact of this disease.”

Dr Mohamed Farghaly, acting director Health Affair Sector at the DHA said: “The Emirates is among the highest prevalence of diabetes countries in the world. The burden of this disease is alarming with some physicians not observing certain disease impacts such as on the diabetic foot.

“The early diagnosis is imperative to ensure a much more effective treatment and Pfizer awareness program provides an opportunity for diabetes experts to meet and share experiences and best plans for patients and society care.”

Dr Yasser El Dershaby, medical director of Pfizer in the Gulf Levant markets said: “The awareness workshops about the Diabetic Foot are another initiative from Pfizer to reiterate the company’s commitment to its values of quality and collaboration with the local Emirati community.”

“Among the causes that interact and ultimately result in diabetic foot ulceration are the neuropathy, vascular impairment and trauma.

“In order to identify those patients at risk of foot problems and to prevent such complications, it is essential to know and implement simple practical tools for foot examination for every diabetic patient; this fits well the purpose of organizing the Diabetic Foot workshops in UAE. It is important to emphasize the vitality of early examination and diagnosis of neuropathic pain in each diabetic patient,” he concluded. – TradeArabia News Service

abu dhabi | Dubai | Sharjah | Pfizer |

Madonna New Film and She Still Denies Surgery – It’s the Kabbalah Apparently.

Doesn’t Madonna look fresh-faced these days all of a sudden, as if by magic? At the Venice Film Festival, the 53-year-old pitched up looking no more than five years older than the so-called chubby Madonna so desperate to be famous no matter what it took back in the early- to mid-eighties.

Her desperate need for attention has been unremitting, although she lost a pound or few from her frame along the years, but piled them onto her ego.

[adsense]Madonna is back in the public eye – which means she must want something from us. Oh yes, she is promoting her new film based on the relationship between Edward and Mrs Simpson called W.E. Which probably stands for ‘weak ending’, although it would certainly be on no surprise if it also had a W.B. and a W.M.

She arrived on a speedboat (LOL) wearing a gray frock with red butterflies on that some designer had made just for little old her, and teamed it with red shoes and red sunglasses (even though it was dark – the tit). All very newsworthy stuff.

But if us in our pedestrian gray office jobs didn’t have stars like Madonna and Lady Gaga to false idolize, imagine how insipid our pointless little lives would be. I don’t know about you, but if I don’t get my weekly fix of Hello! Magazine (which should be renamed ‘Why?’), the week just seems to drag on. I like nothing more than to look at all the pictures of glamorous people I don’t know wearing different outfits in foreign locations I’ve never heard of and will definitely never be able to afford to go, whilst I gorge myself on cheap custard creams and a fat coke before I start processing invoices. I mean… what a life!

Madonna before and after no surgery

Madonna before and after no surgery. I can't wait to look younger than I do now in ten years time.

Since the music industry spat Lady Gaga out through its disgusting and smelly vagina, giving egotistic celebrity haters a new false idol to anti-worship, it’s been easy to forget all about Madonna. And then she brought out another film, (we all know that Madonna and films is a bad mix) and up she pops again in the media, looking like she spent more time directing her own face than she did on the film itself.

Why people are surprised when a squillionaire who can only function when they are in the public eye looks good, when they have access to the world’s best cosmetic surgeons et al, is beyond me and my ilk. People shouldn’t say ‘doesn’t she look good for her age’, they should be saying ‘didn’t they do a good job on Madonna?’

Of course, Madonna knows that her fanbase consists of undereducated know-nothings who wouldn’t know a great piece of music if it got up and gave them liposuction sans anaesthetic, so she vehemently denies having had any surgery done at all. Instead she blames her stupid religion of choice – the kabbalah – for saving her skin and making her wrinkle free despite galloping towards 60 with a ten-year-old boyfriend.

Apparently the kabbalah teaches beauty from within. LOL. Kabbollocks more like. This coming from possibly the vainest woman on the planet (Lady Gaga [always happy to emulate Madonna] comes close second.) who has spent the last 25 years or more rubbing her desperate celebrity minge in the general public’s face and screaming ‘Look at me! Love me!’ (Possibly due to her diminutive size. Short asses are known for their massive compensatory egos and for not being able to reach the cookie shelf.)

Cosmetic surgeons generally concur that the material girl has had extensive surgery performed on her face. And photos abound on the internet that make face lifts look highly likely. In fact, she’s probably undergone more ops than Michael Jackson. Not that it matters. If she wants to spend all her money on kabbalah surgery that’s up to her.  Easy come, easy go,

Madonna has not had surgery.

Madonna Denies Having Surgery to Make her Look like Peter Cushing.

Madonna has a lot to prove with this second stab at writing and direction. Her first film ‘Filth and Wisdom’ was shit. But then Madonna and films have always been a mismatch. Her past acting attempts made Pinnochio look like he’d spent forty years under Stanislavsky’s wing. She must shudder as she remembers the awful Desperately Seeking Susan, the pathetic Who’s That Girl, and the utterly dreadful Body of Evidence. Oh and Shanghai Surprise which almost put an end to Sean Penn’s career. But she likes to try her hands at stuff does Madge – like a bored rich kid playing with her toys: Hollywood and the music industry. I imagine that Madonna has always wanted to capture the one thing she can’t have – an intelligent audience. Something she will never achieve with a back catalog of songs akin to aural Haribo.

I hope that this next foray into theatrics will pay off, purely because W.E. features the wonderful Andrea Riseborough (star of The Devil’s Whore). I hope she doesn’t become soiled by Hollywood and all its wretched demons. People with genuine talent should stay away from the pop music industry and Hollywood.

Has Madonna had more surgery than a patchwork quilt? Maybe she was born with it. Or maybe it’s the kabbalah.

Peter Cushing.

Personally, if I was really rich and intelligent, I’d avoid any organised religion that made me look like I’d just come around from an anaesthetic having just had extensive facial surgery.

If you would like to make a comment on this article, you can jolly well do so using the commenty box below. It loves comments. You could also ‘like’ it or share it using the social networking buttons below. You choose.

Images: posh24.com, viciousmomma.blogspot.com, fresnobeehive.com, awfulplasticsurgery.com