Factors associated with food choice among long-term weight loss maintainers

Journal of Human Nutrition and Dietetics Notes

My Editor’s Pick for October 2022 is this paper by Jacob Young, Suzanne Phelan, Noemi Alarcon, James Roake, Chad Rethorst and Gary Foster.

One of the biggest problems associated with weight loss protocols for individuals living with obesity is the difficulty of maintaining the lost weight loss. Weight regain is frequently observed following weight loss assisted by pharmacological agents, or dietary change alone. Among individuals who successfully maintain weight loss, success appears to be associated with consistency of intake across all days of the week and a strong ability to consciously control overeating.

In this study the authors accessed weight stable individuals living with obesity following a commercial weight loss programme, and weight loss maintainers (WLM) via the WW Success Registry. The WLM group had all reported a weight loss that was greater than or equal to 9.1 kg for more than a year. 8047 individuals were approached to complete…

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The State of Obesity 2021

Oklahoma tied for 9th

Nationally, 16 states now have adult obesity rates at or above 35 percent.  Reaching the 35 percent or higher level this year were Delaware, Iowa, Ohio, and Texas. The twelve states that continue to have adult rates above 35 percent are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia.  (See rates chart for data on all 50 states and the District of Columbia).

State of Obesity 2021: Better Policies for a Healthier America — https://www.tfah.org/report-details/state-of-obesity-2021/

In 2012, no state had an adult obesity rate above 35 percent.

In 2000, no state had an adult obesity rate above 25 percent.

The full report can be downloaded from the link above. My post on the 2020 report is here: The State of Obesity 2020

As a former 370 pound human my experience and knowledge can help those struggling with their weight.

Meanwhile work continues on my Future Best Seller.

New Weight Loss Treatment Is Marked by Heavy Marketing and Modest Results – Kaiser Health News

By Julie Appleby June 22, 2022

First came the “edible billboard,” which appeared last year during the holidays in New York’s East Village loaded with cake treats. Then, in late January, came the national marketing campaign, with TV and digital media promoting the idea that trying to lose weight doesn’t mean a person can’t enjoy eating.

Those advertising messages are pushing a product named Plenity as a potential liberation from dieters’ woes. It’s a $98-a-month weight loss treatment that looks like a drug: Patients take three capsules twice a day. But it isn’t a drug. And its success in racking up lost pounds, on average, is modest.

Plenity is FDA-approved as a device, one that contains sugar-sized grains of a plant-based, absorbent hydrogel. Each grain swells to 100 times its size, cumulatively filling about a quarter of a person’s stomach. The three capsules containing them must be taken with two cups of water at least 20 minutes before eating. The gel is not absorbed and eventually exits the body in stool.

The treatment is also generally not covered by insurance.

“We thought we would price it low enough that most consumers can pay out-of-pocket,” said Dr. Harry Leider, chief medical officer and executive vice president of Gelesis, the maker of Plenity.

Although far less costly than some other prescription weight loss treatments, it still “isn’t affordable for someone in the low-income bracket,” said Jena Shaw Tronieri, an assistant professor and director of clinical services at the University of Pennsylvania’s Center for Weight and Eating Disorders.

Plenity is designed to help patients who want to eat less, and taking it is comparable to consuming a big salad before lunch and dinner, without the actual raw vegetables.

It joins a growing selection of prescription weight loss and obesity treatments, from old-school oral medications that are often low-cost generics to far pricier brand-name injectable diabetes drugs newly repurposed as weight loss treatments. Results varied widely among trial participants; 59% of those who got Plenity lost at least 5% of their body weight, although the rest did not meet that threshold.

Plenity, whose active ingredient is a form of cellulose, embraces a strategy that has been used for decades by some people: to feel full before eating a main meal, thus reducing the calories they take in. Studies have shown that “if you fill up on broth-based soup or vegetables before a meal, you will feel fuller and eat less,” said Tronieri. She noted that filling up with water doesn’t produce the same satiating effect.

Still, some patients say that they “hate vegetables” and that “capsules are a lot easier,” said Dr. Christina Nguyen, medical director of obesity medicine at Northeast Georgia Health System. She is not affiliated with Gelesis but has been prescribing Plenity since its soft launch in late 2020.

So far, Gelesis credits the marketing campaign with helping it pick up 40,000 new customers in the first three months of the year, adding $7.5 million in revenue, although the company still lost money in the first quarter.

So where does this latest treatment fit as a potential weight loss tool for the more than 70% of American adults who are overweight or obese?

“I’m glad to see it on the market, but I tend to want more weight loss in patients than what I’m looking at with this device,” said W. Timothy Garvey, professor at the University of Alabama at Birmingham and director of the university’s Diabetes Research Center.

Gelesis reported that participants in its clinical trial who used Plenity lost on average 6.4% of body weight — above the 5% that many physicians say is a good target threshold. For a 200-pound person, that would equal almost 13 pounds. Still, that’s only a bit better than the 4.4% weight loss, on average, that people given a placeboin the six-month trial experienced. All 436 participants were put on diets that averaged 300 calories a day less than they needed to maintain their weight.

Nguyen said she tells her patients they must change their eating and exercise habits or Plenity won’t work. “You have to be realistic and set expectations,” she said. “What I’ve seen with Plenity is weight loss of about 5%.”

She noted it has relatively few side effects — mainly gastrointestinal, such as bloating, nausea, constipation, or flatulence — and the FDA has approved it for use in people with lower body mass index numbers than required for many other prescription products.

Plenity’s average weight loss is comparable to or below that of some other oral medications and is far less than that of the much more expensive new additions to the market such as Novo Nordisk’s Wegovy, a once-a-week injection that costs $1,300 a month. Wegovy helped patients lose nearly 15% of their body weight over 17 months, on average, according to clinical trials. In April, Eli Lilly said an injectable drug it is testing helped patients achieve an average weight loss of 22.5%. More details were released June 4.

“We don’t see Wegovy as a competitor,” said Leider, of Gelesis.

Nor does Leider view the weight loss products available without a prescription as competitors.

Leider said Gelesis sought FDA prescription approval for the treatment, rather than over-the-counter status, because “there’s a whole wall of nutritional supplements and products” and “we felt it was absolutely important to do the study and prove it scientifically works.” Down the road, “once we’ve built the brand,” Gelesis could seek over-the-counter status, he added.

As with other treatments, weight loss with Plenity can vary widely, he noted. Study data shows 27% of those given the treatment were considered “super responders,” losing an average of 14% of their weight. Patients with diabetes or prediabetes may respond better than those with normal blood sugar levels.

Still, it didn’t work for 40% of participants in the trial.

“If you take it for two months and you’re not losing weight, it may not be the therapy for you,” Leider said.

Patients can request Plenity from their physicians. In a move aimed at setting it apart from other treatments, Gelesis offers potential patients another choice: skipping an in-office visit entirely by requesting the treatment online. It has partnered with Ro, a direct-to-patient platform, which provides its network of affiliated physicians for online health assessments and delivers the treatment to eligible customers. Ro is also alarge purchaser of Plenity, placing a $30 million prepaid order in late 2021.

Ro, originally named Roman, launched in 2017 and initially focused on men’s health concerns, including erectile dysfunction and hair loss. It has since expanded to cover other conditions.

Online visits with physicians through Ro are free, including those for weight loss. Patients must answer questions about their health and experiences trying to lose weight.Pregnant patients, people younger than 22, and those allergic to Plenity’s ingredients should not take it.

Information provided to Ro is not protected under the federal privacy law called the Health Insurance Portability and Accountability Act, or HIPAA, but CEO Zachariah Reitano said all data is stored in “HIPAA-compliant” ways.

Ro added Plenity to its offerings because of the clinical trial results and because it saw a business opportunity with weight loss. Help for “challenges with weight management” was one of the top items his customers requested, Reitano said.

Even though it’s not covered by his insurance plan, patient Rene Morales said the $98 a month he spends is worth it. “If I spend that [much] on coffee, I can spend it to benefit my health,” said the 51-year-old, who is president of a skateboard company in Montclair, California, and was made available for an interview by Gelesis.

He started taking Plenity in late January after his doctor brought it up during his annual physical. Morales said he has lost 15 pounds from his original weight of nearly 280 pounds and wants to stay on the treatment until he has dropped 30.

Morales said the treatment is also helping him reshape his view of food and focus on smaller portions: “I’ve come to [the] realization that you don’t have to pile your plate up to enjoy your food.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. <h1>New Weight Loss Treatment Is Marked by Heavy Marketing and Modest Results

Some elements may be removed from this article due to republishing restrictions. If you have questions about available photos or other content, please contact khnweb@kff.org.

Childhood Obesity Impacts Midlife Cognition

A new study of the impact of childhood fitness and obesity on cognition in middle age, followed over 1200 people who were children in 1985 for over 30 years, has found that better performance on physical tests is related to better cognition later in life and may protect against dementia in later years.

Monash University. “30-year study links childhood obesity and fitness to midlife cognition.” ScienceDaily. http://www.sciencedaily.com/releases/2022/06/220616121556.htm (accessed June 17, 2022)

We’re doomed.

You Want Fries With That?

Yes I would like fries with my double bacon cheeseburger.

The findings are from an analysis of 8015 emerging adults aged 18-25 in the cross-sectional National Health and Nutrition Examination Survey (NHANES), including NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES cycles from 1999 through 2018. The prevalence of obesity (BMI 30.0 kg/m2 or higher) in the emerging adult age group soared from 6.2% between 1976-1980 to 32.7% in 2017-2018 (P = .007).

Obesity Rates Soar in Early Adulthood in the US – Medscape – Nov 23, 2021. — https://www.medscape.com/viewarticle/963511?src=rss#vp_1

Original article – JAMA. Published online November 23, 2021. Abstract

I really need to finish writing my Future Best Seller.

Metabolic Adaptation in Obesity

Awareness of Metabolic Adaptation

When patients lose weight, the body desires to regain it via metabolic adaptation that decreases energy use, enhances metabolic efficiency, and prompts increased energy intake. With metabolic adaptation, a person recognizes that as they try a particular therapy, whether lifestyle, medication, surgery, or an endoscopic therapy, it initially feels relatively easy to do and maybe their weight responds. However, over time on therapy, continued weight loss becomes more and more challenging due to the alteration in hormone levels such as ghrelin, leptin, and glucagon-like peptide-1 (GLP-1). For example, increasing ghrelin levels stimulate a person to eat more, and falling GLP-1 levels cause a person to not feel as full.

Key Considerations for Maintaining a Healthy Weight to Reduce the Risk of Cardiometabolic Complications in Patients With Obesity Fatima Cody Stanford, MD, MPH, MPA, MBA — https://www.clinicaloptions.com/diabetes/programs/2021/obesityprimarycare2021

Because of my social media activities my name and email address have found their way into some interesting email marketing lists. This quote comes from an email I got a few days ago. I actually went to the website, was granted guest access and downloaded the slide deck. Most of the information in the presentation was WAY above my pay grade.

Author Disclosure – I am not a medical doctor. I’m an insurance guy.

Showing Cajones in the Obesity Wars

In Mexico obesity reached epidemic proportions after it joined NAFTA with the United States and Canada in the early 1990s, making processed food more easily available. Diets quickly changed as many people, particularly those on lower incomes, replaced largely healthy traditional staples (corn tortilla, frijoles, Jamaica Water) with highly processed alternatives (hotdogs, nuggets, sodas). Sugar consumption soared and waistlines exploded. In the past 20 years the number of obese and overweight people has tripled, with 75% of the population now overweight.

Mexico also has the sixth highest mortality rate from Covid-19, which has spurred the government to escalate its war against obesity.

Mexico’s War on Obesity Sends Global Junk-Food & Sugary-Drink Giants Scrambling — https://wolfstreet.com/2021/04/13/mexicos-war-on-obesity-sends-global-junk-food-sugary-drink-giants-scrambling/#comments

The State of Obesity 2020

Obesity rates vary considerably between states and regions of the country. Mississippi has the highest adult obesity rate in the country at 40.8 percent and Colorado has the lowest at 23.8 percent. Twelve states have adult rates above 35 percent, they are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia. As recently as 2012, no state had an adult obesity rate above 35 percent; in 2000 no state had an adult obesity rate above 25 percent.

The State of Obesity 2020: Better Policies for a Healthier America — https://www.tfah.org/report-details/state-of-obesity-2020/

Meanwhile in Oklahoma we are ranked #4 in the nation with an obesity rate of 36.8% — (SOURCE: Behavioral Risk Factor Surveillance System (BRFSS) data, CDC).

I seem to recall being ranked #5 in the nation in another report on Covid-19 — Meanwhile in Oklahoma – 09.17.20.

Interesting comparison don’t ya think?

People of any age with the following conditions are at increased risk of severe illness from COVID-19:

Cancer

Chronic kidney disease

COPD (chronic obstructive pulmonary disease)

Immunocompromised state (weakened immune system) from solid organ transplant

Obesity (body mass index [BMI] of 30 or higher)

Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies

Sickle cell disease

Type 2 diabetes mellitus

CDC website accessed 08.25.20 https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Nutrition and Obesity in Covid-19

USCOVID19_IMAGE

NEJM

A healthy diet, rich in fruits and vegetables and low in sugar and calorie-dense processed foods, is essential to health. The ability to eat a healthy diet is largely determined by one’s access to affordable, healthy foods — a consequence of the conditions and environment in which one lives. In the United States, poor diet is the leading underlying cause of death, having surpassed tobacco use in related mortality.2 A study of dietary trends among U.S. adults between 1999 and 2012 showed overall improvement in the American diet, with the proportion of people who reported having a poor-quality diet decreasing from 55.9% to 45.6%; additional analyses, however, revealed persistent or worsening disparities in nutrition based on race or ethnicity, education, and income level.3

Covid-19 and Disparities in Nutrition and Obesity

Screenshot_2020-07-19 Covid-19 and Disparities in Nutrition and Obesity NEJM

The BMJ

Global efforts to develop treatments for covid-19 have focused on drug repurposing, immunotherapies including convalescent plasma and monoclonal antibodies, and vaccines. Despite obesity prevalence rates of 40% in the United States, 29% in England, and 13% globally, to our knowledge none of the several thousand clinical studies of covid-19 in international clinical trial registries proactively recruit participants with obesity. On the contrary, several studies consider overweight or obesity as exclusion criteria. We call for proportional representation of people with obesity in clinical trials of drugs and vaccines, including dose finding studies.

Obesity and covid-19: the unseen risks

More from The BMJ

Covid-19: What we eat matters all the more now

our food systems are making us ill.11 The covid-19 outbreaks at meat packing plants have focused minds on the meat industry as a driver for acute and chronic disease.12 Last month Monique Tan and colleagues wrote that the food industry should be held partly accountable “not only for the obesity pandemic but also for the severity of covid-19 disease and its devastating consequences.”13 The government must do more to hold the industry to account.

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2840

Lose weight.  Make better food choices.  Wear a mask.

 

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Visceral fat delivers signal to the brain that hurts cognition

“We have identified a specific signal that is generated in visceral fat, released into the blood that gets through the blood brain barrier and into the brain where it activates microglia and impairs cognition.”

Visceral fat delivers signal to the brain that hurts cognition

Quote and article link presented without the usual sarcasm.

Molecule found in oranges could reduce obesity and prevent heart disease and diabetes

In mice, so don’t start gorging on oranges.

Sorry, sarcasm restriction didn’t last long.

Early studies on the diet suggested red wine was a major contributor to the health benefits of the Mediterranean diet because it contains a compound called resveratrol, which activated a certain pathway in cells known to increase lifespan and prevent aging-related diseases. However, work in Mashek’s lab suggests that it is the fat in olive oil, another component of the Mediterranean diet, that is actually activating this pathway.

Olive oil in the diet may also help mitigate aging-related diseases