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    <recommendedItem id="20100101_19_466"
                     title="Surgery Trumps Lifestyle Change for Teen Weight Loss (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18397?impressionId=1265805019470"
                     
      &lt;p&gt;Gastric banding resulted in significantly greater weight loss in obese teens than an intensive lifestyle modification program, a randomized trial showed.&lt;/p&gt;
&lt;p&gt;In the two-year study, 84% of patients in the surgery group lost at least half of their excess weight, compared with 12% who underwent the lifestyle intervention (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Paul O&apos;Brien, MD, of Monash University in Melbourne, Australia, and colleagues.&lt;/p&gt;
&lt;p&gt;None of the teens who had surgery had metabolic syndrome at the end of follow-up, compared with 22% in the control group (&lt;em&gt;P&lt;/em&gt;=0.025), the researchers reported in the Feb. 10 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Although the improvements were substantial, O&apos;Brien and his colleagues stressed that &quot;the gastric banding approach to weight loss is not a quick fix.&quot;&lt;/p&gt;
&lt;p&gt;&quot;For optimal effectiveness,&quot; they wrote, &quot;it requires long-term supportive follow-up by trained health professionals.&quot;&lt;/p&gt;
&lt;p&gt;They also noted that the study demonstrates that lifestyle interventions can be effective for some teens and should remain the first option.&lt;/p&gt;
&lt;p&gt;Surgeons contacted for comment on the study unanimously touted the results as evidence that bariatric surgery can be a safe and effective means of weight loss for obese adolescents, a topic that remains controversial.&lt;/p&gt;
&lt;p&gt;J. Christopher Eagon, MD, a bariatric surgeon at Washington University in St. Louis, noted in an e-mail that the significance of the study lies in the fact that participants were randomized between surgery and medical management of weight.&lt;/p&gt;
&lt;p&gt;&quot;This helps to eliminate biases that may have been present in other studies of the effectiveness of bariatric surgery and should make the case for the benefits of surgery more compelling,&quot; Eagon wrote.&lt;/p&gt;
&lt;p&gt;There are more than five million obese adolescents in the U.S., according to O&apos;Brien and his colleagues, and obesity-related complications, once rare in pediatric populations, are becoming more common.&lt;/p&gt;
&lt;p&gt;Because of the generally disappointing results of lifestyle programs aimed at improving diet, increasing exercise, and modifying unhealthy behaviors, bariatric surgery, widely used in adults, has been explored as a strategy for reducing weight in these patients.&lt;/p&gt;
&lt;p&gt;But no randomized trials of bariatric surgery had been conducted in adolescents.&lt;/p&gt;
&lt;p&gt;So O&apos;Brien&apos;s group randomized 50 obese teens ages 14 to 18 (mean 16.5) to laparoscopic adjustable gastric banding or an intensive, supervised lifestyle modification program.&lt;/p&gt;
&lt;p&gt;The participants all had a body mass index of at least 35 kg/m&lt;sup&gt;2&lt;/sup&gt; and had obesity-related complications, such as hypertension, metabolic syndrome, asthma, back pain, physical limitations, and psychosocial difficulties.&lt;/p&gt;
&lt;p&gt;All had previously failed to lose weight through lifestyle changes.&lt;/p&gt;
&lt;p&gt;Before the study began, prospective participants attended a two-month program teaching them about healthy eating and the importance of physical activity.&lt;/p&gt;
&lt;p&gt;Those randomized to the lifestyle intervention were on a diet of 800 to 2,000 calories a day, and were instructed to increase activity and decrease sedentary behavior at regular visits with a physician, dietitian, exercise coordinator, nurse, and sports medicine physician. The program included six weeks with a personal trainer.&lt;/p&gt;
&lt;p&gt;Teens in the surgery group were given instructions on correct eating and exercising at regular visits.&lt;/p&gt;
&lt;p&gt;Through two years, all but one of the teens in the surgery group completed the study; 18 of 25 in the lifestyle group completed.&lt;/p&gt;
&lt;p&gt;The mean weight loss was significantly greater in the surgery group (76.3 pounds versus 6.6), which equated to a significantly greater percentage of excess weight lost (78.8% versus 13.2%).&lt;/p&gt;
&lt;p&gt;The mean decrease in BMI was 12.7 kg/m&lt;sup&gt;2&lt;/sup&gt; in the surgery group and 1.3 kg/m&lt;sup&gt;2&lt;/sup&gt; in the lifestyle modification group.&lt;/p&gt;
&lt;p&gt;All differences were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;Insulin sensitivity improved in both groups, but to a larger extent in the surgery group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Quality of life was also improved in the surgery group.&lt;/p&gt;
&lt;p&gt;Overall, adverse events occurred at similar rates in the surgery (48%) and lifestyle modification (44%) groups.&lt;/p&gt;
&lt;p&gt;There were no perioperative adverse events in the surgery group, but seven patients required revisional procedures during follow-up, for proximal pouch dilatation or tubing injury.&lt;/p&gt;
&lt;p&gt;The researchers said eating small meals slowly is an important way to avoid these problems.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Edward Livingston, MD, a surgeon at the University of Texas Southwestern Medical Center in Dallas, said the high rate of revisional procedures is significant because the study authors &quot;are among the most experienced group in the world with these operations, suggesting that these complication rates will probably be higher in actual community practice.&quot;&lt;/p&gt;
&lt;p&gt;Added Jonathan Schoen, MD, a bariatric surgeon at the University of Colorado Hospital in Denver, in an e-mail: &quot;One thing to keep in mind is that the results they get in Australia with the band are the best in the world and are not uniformly reproducible.&quot;&lt;/p&gt;
&lt;p&gt;In addition to the uncertain generalizability to other settings, the researchers said the study may be limited by its length, which may not be long enough to assess outcomes from the surgery over time.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a grant from the National Health and Medical Research Council. The laparoscopic adjustable gastric bands used in the study were provided by the manufacturer, Allergan. The Center for Obesity Research and Education receives an unrestricted research support grant from Allergan.&lt;/p&gt;&lt;p&gt;O&apos;Brien did not make any financial disclosures. One of his co-authors reported having relationships with Allergan, Bariatric Advantage, Scientific Intake, SP Health Co., Optifast, Abbott Australasia, Eli Lilly Australia, Merck Sharp &amp;amp; Dohme Australia, Nestle Australia, and Roche Products Australia.&lt;/p&gt;&lt;p&gt;Livingston did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_378"
                     title="First Lady and Lawmakers Discuss Childhood Obesity"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18270?impressionId=1265805019470"
                     
      &lt;p&gt;WASHINGTON  --  Still engaged in an intensely partisan debate over healthcare reform, the White House is ready to launch an initiative that&apos;s likely to have widespread backing: a push to combat obesity.&lt;/p&gt;
&lt;p&gt;First Lady Michelle Obama has announced a four-pronged assault on childhood obesity that focuses on increasing the number of &quot;healthy schools,&quot; adding more physical activity to youngsters&apos; lives, encouraging consumers to make smart food choices, and improving access to healthy foods, which she calls a major barrier to healthy eating.&lt;/p&gt;
&lt;p&gt;She invited a bipartisan group of lawmakers and leaders to the Old Family Dining Room of the White House Tuesday to ask for suggestions on dealing with the epidemic.&lt;/p&gt;
&lt;p&gt;&quot;One of the tougher challenges that we need to look at is improving the accessibility and affordability of foods because there are many food deserts in this nation, which makes it difficult for families trying to access good options,&quot; Obama told Senate leaders who oversee agriculture and health, as well as the Secretaries of Agriculture, Education, and Health and Human Services.&lt;/p&gt;
&lt;p&gt;By that she referred to low income areas of many cities where there are no supermarkets, and the only food outlets are neighborhood convenience stores whose inventories are high on snacks but almost devoid of fresh fruit, vegetables, protein, and other healthy foodstuffs.&lt;/p&gt;
&lt;p&gt;She said childhood obesity is a problem that is &quot;eminently solvable,&quot; adding, &quot;Anyone who has access to children in their lives is going to have to work together. And one of the things that&apos;s also very clear is that this problem won&apos;t be solved by any single federal solution. This is going to require national action.&quot;&lt;/p&gt;
&lt;p&gt;Revising federal child nutrition programs, which include school lunch guidelines, will be part the initiative, Obama said, offering &quot;an opportunity to impact more than 30 million kids.&quot;&lt;/p&gt;
&lt;p&gt;Congressional leaders pledged their support.&lt;/p&gt;
&lt;p&gt;&quot;Together with the First Lady, the secretaries of Education, Agriculture, and Health and their congressional counterparts, we are starting a dialogue to combat childhood obesity, one that holds the promise of making real progress toward addressing this public health crisis,&quot; Sen. Tom Harkin (D-Iowa) told reporters after the meeting.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_360"
                     title="Metformin Cuts Obese Teens&apos; Weight (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18243?impressionId=1265805019470"
                     
      The diabetes drug metformin can help obese teenagers lose weight even if they don&apos;t have the disease, researchers said.&lt;br&gt;
&lt;br&gt;In a randomized, placebo-controlled study that combined nearly two years of treatment and follow-up, the drug was associated with a statistically significant drop in body mass index, according to Darrell Wilson, MD, of Stanford University, and colleagues.&lt;br&gt;
&lt;br&gt;But the drug appeared to have no effect on many other aspects of obesity, including fat distribution and insulin resistance, Wilson and colleagues reported in the February &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The study is the longest and largest to test the effect of the drug, Wilson told &lt;em&gt;MedPage Today&lt;/em&gt;. Treatment lasted 48 weeks, with another 48 weeks of follow-up, for 77 randomized volunteers.&lt;br&gt;
&lt;br&gt;The researchers enrolled the teens (ages 13 to 17) at six pediatric centers in the U.S. After a one-month run-in, they were randomized to 2,000 milligrams of extended-release metformin or to a placebo.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;All participants also took part in a lifestyle modification program that included diet and exercise.&lt;/p&gt;
&lt;p&gt;To be eligible, the participants had to be in the 95th percentile or higher for their age and sex and could not have diabetes, Wilson said.&lt;/p&gt;
&lt;p&gt;The primary goal was to see if the drug had any effect on body mass index, but Wilson and colleagues also measured body fat using dual-emission X-ray absorptiometry and computer tomography (CT) scanning, and measured insulin resistance using an oral glucose tolerance test.&lt;/p&gt;
&lt;p&gt;After 48 weeks, they found, those in the metformin group had experienced on average a 0.9-point drop in body mass index, compared with a 0.2-point gain in the control group. The difference was significant at &lt;em&gt;P&lt;/em&gt;=0.03.&lt;/p&gt;
&lt;p&gt;The weight loss is roughly equivalent to three kilograms (6.6 pounds) for a 5&apos; 5&quot; adolescent, Wilson and colleagues said.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s not a 20-pound weight loss, it&apos;s not what the world is looking for in a weight-loss drug,&quot; he said. &quot;It was a meaningful weight loss, just not a spectacular one.&quot;&lt;/p&gt;
&lt;p&gt;On the other hand, the researcher reported significant differences in body composition, abdominal fat, or insulin indices.&lt;/p&gt;
&lt;p&gt;The loss of weight lasted between 12 and 24 weeks after stopping the drug, the researchers reported. After that, the BMI of participants in the active group trended back toward levels of the placebo group.&lt;/p&gt;
&lt;p&gt;There were no significant differences between the groups in adverse events, which were mostly mild or moderate. Two cases of nausea in metformin-treated volunteers were considered probably related to the study drug. One participant stopped the drug because of the nausea.&lt;/p&gt;
&lt;p&gt;For clinicians, the study suggests that the drug might be useful in treating some obese adolescents, Wilson said.&lt;/p&gt;
&lt;p&gt;&quot;We&apos;ve certainly started some of our patients on it, but it has not unleashed us on a campaign of getting everybody on it,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Elizabeth Glaser Pediatric Research Foundation and the NIH. Bristol-Myers Squibb provided the active drug (Glucophage XR) and both placebos. The researchers did not report any conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_315"
                     title="A Few Extra Pounds May Benefit Older People (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/tb/18183?impressionId=1265805019470"
                     
      &lt;p&gt;A little excess weight after age 70 could do the body some good, according to results of a study involving 9,000 older patients.&lt;/p&gt;
&lt;p&gt;Overweight participants in the cohort study had the lowest 10-year mortality. Normal-weight and obese participants ages 70 to 75 had a similar and slightly higher risk of death, Leon Flicker, PhD, of the Western Australian Center for Health and Aging in Perth, and colleagues found.&lt;/p&gt;
&lt;p&gt;The findings add to evidence suggesting that being overweight in older age is not such a bad thing and might even be beneficial.&lt;/p&gt;
&lt;p&gt;&quot;These results lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people,&quot; the researchers concluded in an article in the &lt;em&gt;Journal of the American Geriatrics Society&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The authors also found that a sedentary lifestyle doubled the mortality risk for older women but did not affect survival of older men.&lt;/p&gt;
&lt;p&gt;The World Health Organization has established four BMI thresholds to characterize body weight: &lt;ul&gt; &lt;li&gt;&amp;lt;18.5 kg/m&lt;sup&gt;2&lt;/sup&gt;, underweight&lt;/li&gt; &lt;li&gt;18.5 to 24.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, normal weight&lt;/li&gt; &lt;li&gt;25 to 29.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, overweight&lt;/li&gt; &lt;li&gt;&amp;#8805;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, obese&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors noted that the thresholds were derived primarily from studies of younger and middle-age adults. Whether the cut points for overweight and obese are appropriate for older individuals has remained unclear.&lt;/p&gt;
&lt;p&gt;Two systematic reviews and a meta-analysis showed no increased mortality risk associated with a BMI in the overweight range for older people (&lt;em&gt;Arch Intern Med&lt;/em&gt; 2001; 161: 1194-1203, &lt;em&gt;Obesity Rev&lt;/em&gt; 2007; 8: 41-59). However, methodologic differences complicated the comparison of different studies, Flicker and colleagues wrote.&lt;/p&gt;
&lt;p&gt;So they sought to address some of the uncertainty by analyzing data from two large Australian cohort studies involving more than 9,000 individuals ages 70 to 75 (4,677 men, 4,563 women).&lt;/p&gt;
&lt;p&gt;The principal objectives were to determine the BMI threshold associated with the lowest mortality in older people and to determine whether the relationship between BMI and mortality differed between men and women.&lt;/p&gt;
&lt;p&gt;Data for the analysis came from self-reported measures of height and weight, which the authors used to calculate BMI for the study participants. Participants also provided demographic, lifestyle, and health information.&lt;/p&gt;
&lt;p&gt;Using the WHO criteria for BMI, the authors found that 1.3% of men and 3.1% of women were underweight; 43.5% of men and 50.3% of women were normal weight; 44.3% of men and 33.5% of women were overweight; and 11% of men and 13.1% of women were obese.&lt;/p&gt;
&lt;p&gt;During 10 years of follow-up, overweight study participants had a 13% lower risk of death compared with normal-weight participants (HR 0.87, 95% CI 0.78 to 0.94). Obese participants had a mortality risk similar to that of normal-weight participants (HR 0.98, 95% CI 0.85 to 1.11).&lt;/p&gt;
&lt;p&gt;Self-reported sedentary lifestyle doubled the mortality risk for women across all BMI categories (HR 2.08, 95% CI 1.79 to 2.41). In contrast, sedentary lifestyle increased the mortality risk for men by 28% (HR 1.28, 95% CI 1.14 to 1.44).&lt;/p&gt;
&lt;p&gt;Separate analyses involving common causes of death, such as cardiovascular disease and cancer, showed similar relationships between BMI and mortality risk.&lt;/p&gt;
&lt;p&gt;&quot;Even after removing the effects of early mortality, those who were overweight were still at lowest risk, a finding consistent with the observation that weight loss in older age groups is associated with greater mortality,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Overweight older people are not at greater mortality risk, and there is little evidence that dieting in this age group confers any benefit,&quot; they added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_10_674"
                     title="New Obesity Treatment Guidelines Issued to Doctors"
                     score="-0.005"
                     href="