University of Virginia Health System

Staff Update

Winter 2005

What’s in the News?

NAASO 2005 Highlights

NAASO, the North American Association for the Study of Obesity, is one of the largest groups of obesity researchers and clinicians. They are active nationally on obesity-related issues, publish Obesity Research (journal) and are involved in many continuing medical education endeavors (online courses, conferences).  If you have never heard of them, check out their website at www.naaso.org.  I’d like to provide a few highlights from this year’s annual meeting:

• Brian Wansink PhD of Cornell University addressed the issue of “Environmental Factors that Influence the Intake of Unknowing Consumers”. He found that visual cues can increase food intake but that not being aware of these cues can lead to bias when they estimate their dietary intake.
• Rena Wing presented 18-month results from the STOP regain randomized controlled trial (NIH funded). To be eligible, participants had to have lost at least 10% of their body weight (mean loss was 44 pounds). They were randomly assigned to 1 of 3 treatment groups (internet, face-to-face, or newsletter (control). The internet and face-to-face were identical in content (self-monitoring, diet, physical activity) and meeting frequency (weekly for 4 weeks; monthly for 18 months). In both groups, participants submitted weekly weights and were counseled as if in the “red zone” (> 5 lb regain). At the time of presentation (at NAASO, 92% of the participants completed the 18-month assessment) the results were the following: 46.7% of face-to-face, 54.8% of internet and 72.4% of newsletter participants regained > 5 lbs (median regain: 2.5 lb in face-to-face, 6.0 lb in internet and, 10.4 lb in newsletter groups). A key strategy for success appears to be daily weighing.
• Paula Rhode presented the Role of Stress and Depression in Weight Regain. In this sample of primary care medical patients who had recently undergone a physician directed weight loss program, it was previously reported that psychosocial factors significantly contributed to weight gain. The present study sought to understand some of the dietary mechanisms by which this regain occurs. This 18 months study of 69 Afro-American women suggests that stress and depression was associated with higher intakes of fat and calories; fruit and vegetable intake was not consistently impacted.
• Jakicic’s group evaluated whether exercise capacity was associated with metabolic syndrome (see following page about metabolic syndrome definition) among 5145 overweight/obese people with diabetes (from the LookAhead trial).   Exercise capacity was determined during a treadmill graded exercise test to maximal effort (> 85% estimated HR max). The participants were activity involved in an intervention trial but the authors did not evaluate whether the exercise intervention was related to a change in metabolic syndrome status.  From this study they report that a higher exercise capacity was associated with a lower prevalence of metabolic syndrome. 
• Andres Digenio et al presented their study comparing 5 different methods of delivering a comprehensive non-pharmacological weight loss program in patients on Sibutramine (Meridia, a weight loss medication). The different methods varied by type of counseling (dietitian or no RD), counseling method (face-to-face, telephone, or email) and frequency of counseling. They reported that the two most effective methods were face-to-face with the RD using relatively high intensity (mean wt loss: 9.1%) and RD telephone counseling, high intensity (mean wt loss: 7.7%). RD face –to-face at low intensity resulted in similar weight loss as RD, email high intensity (5.7% and 5.8%).
• An evaluation of NHANES databases suggests that there is an inverse association between intake of caloric beverages and healthy diet patterns.
• An online interview with 5,279 adults reported the following trends:
  • Those actively engaged in the Atkins diet were down to 8% from 13% a year ago.
  • Exercise frequency has increased slightly with 52% of adults now reporting twice a week exercise up from 48% in 2004.
  • Away from home meal purchase frequency increased by over 27% for both breakfast and dinner, reaching 1.1 and 3.0 times per week.
• In a 2-year trial, Jakicic et al found that exercise of approximately 270 to 300 min/week, in addition to diet modification, was associated with the greatest amount of weight loss between groups studied (groups were based on dose and intensity of exercise level.

American Diabetes Position on Metabolic Syndrome.

Metabolic syndrome is a cluster of risk factors including obesity or visceral obesity, blood fat disorders, high blood pressure, insulin resistance or glucose intolerance, prothrombotic state and/or proinflammatory state that occur in one person.   The current definitions of metabolic syndrome (having 3 or more of the following risk factors) were developed in 1988; however, there is no consensus about the exact factors compromising metabolic syndrome (see tables below). 

Table 1. Comparison of WHO and ATP III definitions of Metabolic Syndrome

             The interest in metabolic syndrome has increased over the past five years due to its association with diabetes and cardiovascular morbidity and mortality. Despite peaked interest, the American Diabetes Association in conjunction with the European Association for the Study of Diabetes recently issued a joint statement that proclaimed that metabolic syndrome is not a “syndrome” because its presence does not increase risk for heart disease more than the risk posed by each of the individual health factors (triglycerides, impaired glucose tolerance, visceral adiposity). Interest and debate continue as this statement is at odds with the American Heart Association’s position. In addition, there is an established ICD-9 code for metabolic syndrome which from a policy/reimbursement perspective supports clinical treatment of it as a whole rather than each individual risk factor. Many in the fields of diabetes, obesity and cardiovascular disease disagree with the ADA/EASD position because of its usefulness clinically. Having a concept like metabolic syndrome, according to George Blackburn, places greater emphasis on the whole (the cluster of risk factors) rather than any one risk factor (like impaired glucose tolerance).   In addition, clinicians have become more attentive of the triad of high waist circumference, high triglyceride levels and low HDL-C levels at it relates to cardiovascular risk.  For some clinicians, the assessment of high waist circumference and triglyceride levels and low HDL-cholesterol levels are not only signals to prescribe lifestyle treatment (diet and physical activity) but are also important and simple indicators of high risk in patients who, because of normal LDL cholesterol, would otherwise go unidentified as high risk for cardiovascular disease.

HIC# 11143