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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_370"
                     title="Blocking Enzyme in Mice Reduces Fat (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/PrimaryCare/Obesity/tb/18259?impressionId=1265772935868"
                     
      &lt;p&gt;Blocking a single enzyme leads to increased energy expenditure and loss of body fat  --  at least in mice, researchers said.&lt;/p&gt;
&lt;p&gt;Mice treated with a compound that blocks the so-called Fyn kinase expended 14% more energy than animals treated with an inert compound, according to Claire Bastie, PhD, and colleagues at Albert Einstein College of Medicine in New York City.&lt;/p&gt;
&lt;p&gt;They also displayed a significant weight loss within 12 hours of receiving the compound, compared with animals given the inert substance, Bastie and colleagues reported in the Feb. 3 issue of &lt;em&gt;Cell Metabolism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;This is a new mechanism to help the body to burn extra energy,&quot; Bastie said in a statement.&lt;/p&gt;
&lt;p&gt;The Fyn kinase has previously been linked to energy use: animals with the enzyme blocked burn more fatty acids and are leaner than their normal littermates, Bastie and colleagues noted.&lt;/p&gt;
&lt;p&gt;Those animals also had increased insulin sensitivity, the researchers said, but the absence of the enzyme did not block the normal anabolic processes of protein synthesis and muscle growth during the feeding cycle.&lt;/p&gt;
&lt;p&gt;The findings suggested that drugs blocking the enzyme might have a significant effect on energy balance and weight, they theorized.&lt;/p&gt;
&lt;p&gt;To test the idea, they turned to wild-type mice and a compound called SU6656, a known inhibitor of the Src family of tyrosine kinases, of which Fyn is a member.&lt;/p&gt;
&lt;p&gt;The mice spent spent 48 hours getting used to a so-called metabolic chamber, which allows researchers to monitor energy intake and expenditure. Then the compound was administered via intraperitoneal injection.&lt;/p&gt;
&lt;p&gt;Control animals got injections of an inert substance, the researchers said. The shots were given at the beginning of the light cycle, when the animals are least active.&lt;/p&gt;
&lt;p&gt;Both groups showed identical carbohydrate use during the dark cycle (when they are most active) that preceded the injection.&lt;/p&gt;
&lt;p&gt;After the injection, the control animals reduced energy use as their bodies switched to the normal lipid production seen during the light cycle.&lt;/p&gt;
&lt;p&gt;The treated animals, on the other hand, continued to expend energy at a rate that was significantly greater (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0098) than the controls, although there was no significant difference in physical activity.&lt;/p&gt;
&lt;p&gt;Because mice eat 80% of their calories during the dark cycle, they have a daily pattern of weight loss and gain, Bastie and colleagues noted, so that 12 hours after the start of the light cycle  --  when they had been given the shots  --  their weight was lowest.&lt;/p&gt;
&lt;p&gt;But the SU6656-treated mice had a 40% greater weight loss than the control group, a difference that was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.003.&lt;/p&gt;
&lt;p&gt;Lean mass was slightly reduced in all the animals, Bastie and colleagues said, but without significant differences between groups. On the other hand, fat mass was significantly reduced (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) in the SU6656-treated mice, they found.&lt;/p&gt;
&lt;p&gt;The metabolic effect of the inhibitor appears to be specific to Fyn, because it had no effect on mice lacking the enzyme, the researchers noted.&lt;/p&gt;
&lt;p&gt;Unfortunately, SU6656 itself isn&apos;t a good choice for clinical trials of the idea in humans, Bastie said, because the Fyn kinase affects the brain, as well as muscle and fat tissue.&lt;/p&gt;
&lt;p&gt;&quot;Our next goal,&quot; she said, &quot;is to design something extremely specific to muscle and adipose.&quot;&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 Ellison Medical Foundation, the NIH, the American Diabetes Association, and the NY Obesity Research Center.&lt;/p&gt;&lt;p&gt;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_341"
                     title="Doctor&apos;s Orders: Brain&apos;s Wiring Makes Change Hard"
                     score="0.009"
                     href="http://www.medpagetoday.com/Psychiatry/Addictions/tb/18207?impressionId=1265772935868"
                     
      &lt;p&gt;Doctor&apos;s Orders&lt;em&gt; is a feature in the collaboration between &lt;/em&gt;MedPage Today &lt;em&gt;and&lt;/em&gt; ABC News&lt;em&gt;. In this monthly segment we explore medical issues of interest to physicians and their patients alike. This month, we look at addiction and addictive behaviors, and what neuroimaging studies have revealed about why it&apos;s so hard to break bad habits. &lt;/em&gt;&lt;/p&gt;&lt;hr&gt;

&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

&lt;p&gt;By the end of January, many New Year&apos;s resolutions have been tossed out with the leftover holiday cookies. That&apos;s because change is hard  --  and neuroscientists are learning why.&lt;br&gt;
&lt;br&gt;Advances in neuroimaging have enabled researchers to peer inside the brains of addicts and patients with addictive behaviors. They can see in real-time what gets patients hooked: how the brain&apos;s reward system  --  based largely on the neurotransmitter dopamine  --  thirsts for more, while inhibitory control centers experience a system failure.&lt;br&gt;
&lt;br&gt;The pattern is similar across all kinds of behaviors  --  from cocaine and tobacco addiction to overeating. That&apos;s why changing your mind may be the first step toward breaking a habit, but altering the brain&apos;s neural machinery is the real challenge.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Hijacked Pathways&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Drug-taking and other addictive behaviors &quot;hijack&quot; the brain&apos;s reward system, says Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke&apos;s and Roosevelt Hospitals in Manhattan.&lt;/p&gt;
&lt;p&gt;In normal patients, dopamine plays a major role in motivation and reward, surging before and during a pleasurable activity  --  say, eating or sex  --  to make patients want to repeat a behavior that&apos;s crucial to the survival of the species.&lt;/p&gt;
&lt;p&gt;Dopaminergic pathways connect the limbic system, responsible for emotion, with the hippocampus, etching rewarding behaviors into the brain by creating strong, salient memories.&lt;/p&gt;
&lt;p&gt;The problem arises when the memory and the craving to recapture it takes over a person&apos;s life.&lt;/p&gt;
&lt;p&gt;&quot;Imagine what a strong hold these hijacked reward pathways take on our brains and our whole existence when they&apos;re so closely connected, geographically and anatomically speaking, with our memories and our emotions,&quot; Levounis says.&lt;/p&gt;
&lt;p&gt;As the dopamine surge repeats and repeats, it gains speed, but the brakes begin to fail: Normal function in the brain&apos;s frontal lobes, responsible for inhibitory control and executive functioning (read: willpower), tends to decrease in addicts.&lt;/p&gt;
&lt;p&gt;&quot;Ultimately,&quot; Levounis says, &quot;the war on drugs is a war between the hijacked reward pathways that push the person to want to use, and the frontal lobes, which try to keep the beast at bay. That is the essence of addiction.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Similar Patterns&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;These neural pathways have been well studied in the brains of hardcore addicts. Now, researchers say they see similar pathways involved in other bad behaviors.&lt;/p&gt;
&lt;p&gt;Gene-Jack Wang, MD, of Brookhaven National Laboratory on New York&apos;s Long Island, has conducted several brain imaging studies of obese patients using PET-CT scans.&lt;/p&gt;
&lt;p&gt;The scans have revealed similarities in brain activity  --  or a lack thereof  --  between patients addicted to cocaine or alcohol, and those &quot;addicted&quot; to eating. Normally, the PET scan lights up when a contrast of radioactive glucose is metabolized, revealing an area of red activity in the center of the brain.&lt;/p&gt;
&lt;p&gt;But in both drug-addicted and obese patients, the scans show very little red activity, because there aren&apos;t enough receptors to which the radioactive glucose can bind. Wang says the decreased availability of dopamine receptors is the brain&apos;s way of coping with a constant dopamine overload.&lt;/p&gt;
&lt;p&gt;&quot;If a person constantly has an excess of dopamine, the brain will down-regulate,&quot; Wang says, explaining the principle commonly referred to as tolerance. &quot;Once the system is down-regulated, we have to do more in order to get the same amount of feeling in our normal state.&quot;&lt;/p&gt;
&lt;p&gt;Thus, obese patients &quot;will want to eat more in order to compensate for their down-regulated system.&quot;&lt;/p&gt;
&lt;p&gt;In other experiments, Wang and his colleagues have also found that a higher body mass index (BMI) correlated with lower prefrontal cortex function  --  the area associated with inhibitory control.&lt;/p&gt;
&lt;p&gt;&quot;If they&apos;re obese,&quot; Wang said, &quot;they have a problem controlling their eating behaviors.&quot;&lt;/p&gt;
&lt;p&gt;Those studies also revealed that a higher BMI was linked to a decrease in memory and executive functioning.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Out of Control&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Ed Susman was 293 pounds when he decided to join a clinical trial for an investigational weight-loss drug and chronicle his year-long experience for &lt;em&gt;MedPage Today&lt;/em&gt;. (See &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Diabetes/8125&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Diabetes/8125&quot; target=&quot;_blank&quot;&gt;Journalist Participant to Present Insider View of Weight-Loss Trial&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Eating, to him, was a &quot;compulsion&quot;  --  as was biting his nails, a habit he picked up at age 4.&lt;/p&gt;
&lt;p&gt;Over the course of the trial, not only did Susman lose 52 pounds, he also stopped his nail-biting.&lt;/p&gt;
&lt;p&gt;He doesn&apos;t yet know if he was in the drug arm of the trial, but he strongly suspects he wasn&apos;t experiencing a placebo effect.&lt;/p&gt;
&lt;p&gt;&quot;I believe I was on the drug because it controlled a compulsion that I had had for 50 years,&quot; Susman says of the nail-biting. &quot;This stopped it cold.&quot;&lt;/p&gt;
&lt;p&gt;Unfortunately, he says, the same didn&apos;t happen with his eating habits, but he&apos;s gained back only 10 of those 52 pounds in the year since his participation in the trial ended.&lt;/p&gt;
&lt;p&gt;The still-investigational drug is lorcaserin  --  a combination of benzazepine and hydrochloride, two neurological agents. Susman says it is &quot;supposed to improve your willpower, your ability to overcome compulsions.&quot;&lt;/p&gt;
&lt;p&gt;Lorcaserin is a selective 5-HT&lt;sub&gt;2C&lt;/sub&gt; receptor agonist, working through the serotonin system, which regulates appetite, mood, and motor behavior.&lt;/p&gt;
&lt;p&gt;Two other investigational obesity drugs target the dopamine reward system  --  Contrave, which is a combination of bupropion and naltrexone, and Qnexa, which combines phentermine and topiramate.&lt;/p&gt;
&lt;p&gt;&quot;Some medications that have used similar dopamine modulation, until now, have failed,&quot; Wang said. &quot;These two companies are using the command of the modulation of the dopamine system with other neurological systems, such as the opiate or norepinephrine system. According to the trials, they&apos;ve been very effective.&quot;&lt;/p&gt;
&lt;p&gt;Wang called the new medications &quot;a bright light for the treatment of obesity.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;Kicking the Habit&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Basically, the idea of medications that act on the dopamine system is &quot;to cool down those reward pathways,&quot; Levounis says. There are two strategies for doing so: an agonist strategy, or an antagonist strategy.&lt;/p&gt;
&lt;p&gt;The agonist strategy is &quot;feeding the beast, providing activity in the cell so that the cravings go down,&quot; Levounis said. Classic examples are nicotine patches, or methadone for opioid dependence.&lt;/p&gt;
&lt;p&gt;On the other hand, the antagonist strategy is to block the receptors. Naltrexone, for example, will block opioid receptors so that the drug addict won&apos;t feel anything if he or she attempts to get high.&lt;/p&gt;
&lt;p&gt;&quot;After a while, you say, &apos;This is not worth my time, my money, my trouble,&apos; so you stop using,&quot; Levounis explains.&lt;/p&gt;
&lt;p&gt;These have been the two main strategies in addiction pharmacotherapy, but there&apos;s now a &quot;third avenue&quot;  --  the partial agonist approach.&lt;/p&gt;
&lt;p&gt;The partial agonist is one molecule that blocks most receptors while still providing just a little bit of an &quot;oomph&quot; to calm cravings. That&apos;s how varenicline (Chantix) helps smokers quit, and how buprenorphine gets junkies off heroin or other opioids.&lt;/p&gt;
&lt;p&gt;But what about inhibitory control? What if medications could ramp up will power?&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s an area of active research,&quot; Levounis says. &quot;There are some medications proposed, but nothing to write home about.&quot;&lt;/p&gt;
&lt;p&gt;He said treatment is typically twofold. For addicts, psychiatrists will try to &quot;cool down&quot; the reward pathways, often with medication. Then, they target the diminished frontal lobes.&lt;/p&gt;
&lt;p&gt;&quot;We try to beef up the frontal lobes as much as we can, and we do that with psychotherapy,&quot; Levounis said.&lt;/p&gt;
&lt;p&gt;Researchers agree that psychotherapy is key to regaining self-control, and it&apos;s the predominant treatment used in patients with addictive behaviors.&lt;/p&gt;
&lt;p&gt;Mark Smaller, PhD, a psychoanalyst in private practice in Chicago, said psychotherapy often reveals an underlying cause for an addiction or compulsive behavior. Usually, it&apos;s anxiety or depression.&lt;/p&gt;
&lt;p&gt;Acknowledging those problems may help change behaviors. Once they&apos;re realized, a patient can start working against them, with the help of the brain&apos;s own neuroplasticity. Essentially, neurons can disconnect and reconnect, or loosen their connections and tighten them, which often manifests in noticeable change.&lt;/p&gt;
&lt;p&gt;&quot;[Psychological] insights can actually begin to change brain chemistry and diffuse compulsions,&quot; he said. &quot;If you address those issues, you can have a positive impact on your life that can change the chemistry of your brain.&quot;&lt;/p&gt;
&lt;p&gt;Smaller said it &quot;creates a new psychological  --  if not neurological  --  structure that can help regulate behavior.&quot;&lt;/p&gt;
&lt;p&gt;Although research on neuroplasticity is relatively young, the concept of &quot;rewiring&quot; the brain is not new.&lt;/p&gt;
&lt;p&gt;In fact, too often, the electrician metaphor has been employed as an excuse for indulging, an explanation for a New Year&apos;s resolution deferred: &quot;I can&apos;t stop eating chocolate, I&apos;m just not wired that way.&quot;&lt;/p&gt;

&lt;hr&gt;
&lt;p&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/30/16717.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/30/16717.jpg&quot; alt=&quot;&quot;&gt;&lt;em&gt; is a collaboration between &lt;/em&gt;MedPage Today &lt;em&gt;and&lt;/em&gt; ABC News&lt;em&gt;.&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_315"
                     title="A Few Extra Pounds May Benefit Older People (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/tb/18183?impressionId=1265772935868"
                     
      &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="20100101_19_279"
                     title="Low-Carb Diet Edges Low Fat Plus Weight-Loss Drug (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18131?impressionId=1265772935868"
                     
      Weight loss was the same and blood pressure control was more effective with a low-carbohydrate diet than a low-fat regimen supplemented by the diet drug orlistat (Xenical, Alli), a randomized trial found.&lt;br&gt;
&lt;br&gt;Among 146 overweight or obese outpatients, both treatment plans led to weight loss of about 10% after 48 weeks, with similar improvements in glycemic and blood lipid measures, according to William S. Yancy Jr., MD, MHS, of Duke University, and colleagues.&lt;br&gt;
&lt;br&gt;But mean systolic and diastolic blood pressure declined by 5.9 and 4.5 mm Hg, respectively, in the low-carb diet compared with a slight increase in patients on the low-fat diet plus orlistat (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both measures), the researchers reported in the Jan. 25 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Both interventions also included small-group sessions with a dietitian every two weeks for the first six months. Yancy and colleagues indicated that participants with the best attendance at these meetings seemed to benefit the most.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Mean weight loss was 14% to 15% among participants who attended at least 80% of the sessions.&lt;/p&gt;
&lt;p&gt;This latter finding &quot;may indicate the usefulness of these sessions, signify motivated participants, or both,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;&quot;How to identify these select individuals [with high attendance] a priori and how to move more individuals into this category is vital to reversing the obesity epidemic,&quot; they added.&lt;/p&gt;
&lt;p&gt;Yancy and colleagues indicated that the study was the first head-to-head, randomized trial comparing a low-carb diet with a low fat regimen plus orlistat (now readily available over-the-counter).&lt;/p&gt;
&lt;p&gt;Participants were recruited from outpatient clinics attached to the VA Medical Center in Durham. Their mean age was 52 and they had a mean body mass index of 39.3. Only slightly more than one-quarter of patients in each group were women.&lt;/p&gt;
&lt;p&gt;Low-carb dieters could eat as much meat and eggs as they liked, along with up to 112 g of hard cheese, 0.48 L of leafy greens and other low-carbohydrate vegetables, and half as much in other vegetables such as asparagus and broccoli. There was no specific caloric limit.&lt;/p&gt;
&lt;p&gt;Participants assigned to the low-fat diet were told to keep total fat to less than 30% of total caloric content and saturated fat less than 10%.&lt;/p&gt;
&lt;p&gt;Cholesterol intake was to be less than 300 mg/day. Patients in this group were encouraged to reduce total caloric intake by 500 to 1,000 kcal less than the estimated weight-maintenance level. Pocket guides, handouts, and individual assistance were provided to help patients meet these goals.&lt;/p&gt;
&lt;p&gt;Patients in the low-fat group also received orlistat at 120 mg before meals three times daily.&lt;/p&gt;
&lt;p&gt;Mean weight loss with the low-fat diet plus orlistat after 48 weeks was 8.5%, compared with 9.5% in the low-carb diet group (&lt;em&gt;P&lt;/em&gt;=0.60), Yancy and colleagues reported.&lt;/p&gt;
&lt;p&gt;Body weight in kilograms and waist circumference also declined slightly more with the low-carb diet but, again, the difference was not statistically significant.&lt;/p&gt;
&lt;p&gt;Total cholesterol declined by an average of 8.9 mg/dL with the low-fat diet plus orlistat, versus a decrease of 3.8 mg/dL in the low-carb group (&lt;em&gt;P&lt;/em&gt;=0.29). A similar but also nonsignificant difference was seen in LDL cholesterol. Triglyceride levels actually declined more with the low-carb diet but that, too, was not statistically significant.&lt;/p&gt;
&lt;p&gt;A nonsignificant trend was also seen for the low-carb diet to be associated with greater improvements in fasting glucose, fasting insulin, and glycated hemoglobin levels.&lt;/p&gt;
&lt;p&gt;The sole significant difference between outcomes, apart from blood pressure, was in serum urea nitrogen, which increased by a mean of 3.19 mg/dL with the low-carb diet and by 1.23 mg/dL with low fat plus orlistat (&lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;Both diets appeared to be successful in terms of adherence, on average. Those on the low-fat diet cut their saturated fat intake by half and total fat by 40%. Participants assigned to the low-carb diet reduced their mean daily carbohydrate intake from 262 g/day at baseline to just 62 g/day at their final evaluation at week 48.&lt;/p&gt;
&lt;p&gt;Total caloric intake declined by 29% in each group from baseline.&lt;/p&gt;
&lt;p&gt;Yancy and colleagues noted that participants were not paid or given food or access to exercise facilities. &quot;Our goal was to design the interventions so that they closely mimicked a weight-loss program that could be instituted in an outpatient clinic,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;But in an accompanying editorial, Robert F. Kushner, MD, of Northwestern University in Chicago, questioned whether either regimen was truly practical in ordinary practice.&lt;/p&gt;
&lt;p&gt;In particular, he pointed to the apparently considerable role of the dietitian-led counseling sessions. Currently, he noted, such sessions &quot;are not a covered benefit by most health plans for the treatment of obesity and most primary care practice offices do not have the resources to conduct group sessions.&quot;&lt;/p&gt;
&lt;p&gt;Kushner also observed that primary care physicians were not directly involved in the treatment plans.&lt;/p&gt;
&lt;p&gt;He suggested that more emphasis should be placed on engaging and empowering primary care physicians in treating obesity.&lt;/p&gt;
&lt;p&gt;&quot;Healthcare reform and training is needed to allow primary care physicians to tackle the obesity crisis,&quot; Kushner wrote.&lt;/p&gt;
&lt;p&gt;One limitation to the study, the authors noted, was that patients were not charged for orlistat. &quot;This could have increased dietary adherence, group session attendance, and/or participant retention compared with the [low-carb diet],&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Another limitation was the lack of blinding in the study, they 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;Funding for the study came from the Department of Veterans Affairs.&lt;/p&gt;&lt;p&gt;Yancy and another study author have received research funding from the Robert C. Atkins Foundation. Atkins developed the low-carbohydrate diet program that bears his name. No other potential conflicts of interest were reported by study authors or Kushner.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_233"
                     title="Obese Blacks at Higher Risk of Stroke (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/Neurology/Strokes/tb/18083?impressionId=1265772935868"
                     
      &lt;p&gt;Obesity raises the risk of stroke regardless of race or sex, according to a new study that is one of the first to show a link between obesity and stroke risk in blacks.&lt;/p&gt;
&lt;p&gt;The most obese black women were at 43% higher risk of stroke than the thinnest black women (95% CI 0.81 to 2.53; trend &lt;em&gt;P&lt;/em&gt;=0.016), while the fattest black men had more than three times the stroke risk of their thin counterparts (95% CI 1.53 to 6.67; trend &lt;em&gt;P&lt;/em&gt;=0.0026), depending on the measure of obesity used, researchers reported online Jan. 21 in &lt;em&gt;Stroke&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Based on the fact that we consistently found positive associations between obesity measures and ischemic stroke incidence in blacks in the present study, we believe that obesity, however it is measured, significantly increases ischemic stroke risk in blacks as well as in whites,&quot; Hiroshi Yatsuya, MD, of the University of Minnesota, and colleagues concluded.&lt;/p&gt;
&lt;p&gt;Stroke is the third leading cause of death in the U.S., and incidence of stroke among blacks is about twice that of whites. But while research has established that being overweight raises risk of stroke in whites, it was not clear whether obesity put blacks at higher risk of stroke, too.&lt;/p&gt;
&lt;p&gt;&quot;We tested the hypothesis that there are differences in the association for black versus white men and women,&quot; Yatsuya and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The researchers analyzed records of 13,549 middle-age black and white men and women in four U.S. communities who participated in the Atherosclerosis Risk in Communities Study (ARIC).&lt;/p&gt;
&lt;p&gt;The data included measurements of the subjects&apos; body mass index (BMI), waist circumference, and waist-to-hip ratio taken between 1987 and 2005. The participants started the study free of cancer and cardiovascular disease, but during the two decades of the study, 598 suffered ischemic strokes, based on hospital records.&lt;/p&gt;
&lt;p&gt;Relatively speaking, blacks suffered two to three times the number of strokes of their white counterparts.&lt;/p&gt;
&lt;p&gt;The thinnest white women suffered about 1.2 strokes per 1,000 person-years on average, while their black counterparts suffered 4.3 per 1,000 person-years. The difference was more dramatic when comparing the heaviest white women (2.2 strokes per 1,000 person years) with the heavy black men (8.0 strokes&lt;strong&gt; &lt;/strong&gt;per 1,000 person years).&lt;/p&gt;
&lt;p&gt;While their findings agreed with previous research that linked obesity to stroke risk in whites, Yatsuya and colleagues found stronger evidence than most previous studies for such an association in blacks.&lt;/p&gt;
&lt;p&gt;They generally found a linear relationship between obesity and stroke risk for both whites and blacks, with a person&apos;s risk increasing as they grew heavier. &quot;Higher disease burden of stroke in blacks exists, and is at least partly due to their higher obesity level compared to whites,&quot; Yatsuya said.&lt;/p&gt;
&lt;p&gt;Hypertension and diabetes attenuated the effect of obesity on the risk of stroke.&lt;/p&gt;
&lt;p&gt;&quot;Given the strong association between obesity and hypertension and other risk factors, including diabetes mellitus, obesity would be an important target for the prevention of ischemic stroke,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;The authors noted that most of the black subjects were from one region and the whites mostly from three other areas, which limits the ability to generalize the results to other settings and socioeconomic groups.&lt;/p&gt;
&lt;p&gt;&quot;Strictly speaking, clinical trials are now needed to determine whether obesity prevention or control would actually decrease stroke incidence,&quot; Yatsuya said. &quot;However, it would be reasonable to say we can prevent stroke targeting at obesity control and prevention.&quot;&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 the National Heart, Lung, and Blood Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>