Roundup of the latest information
The 'Big 3' Conference - Wednesday 10th November 2010, Glasgow
The ‘Big 3’ Conference on Obesity, Diabetes and CHD brings together leading experts who will keep you up to date with the latest evidence, knowledge and best practice – an essential learning opportunity for the busy health professional. The day will take the format of presentations, lively Q &A sessions, discussion and case studies to make your learning informative and enjoyable too.
Why You Should Attend
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Who Should AttendThe ‘Big 3’ Conference is particularly aimed at professionals working in the primary care settings although others with an interest are very welcome to attend –
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Conference Details |
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Date:Wednesday 10th November 2010 Venue:The Hilton Grosvenor, 1-9 Grosvenor Terrace, Great Western Road, Glasgow G12 0TA, United Kingdom. Telephone: 0141 339 8811 Registration:To register for this conference, please fill in the registration form on the back of the leaflet, detach and return no later than Friday 29th October 2010. It is advisable to return the form ASAP as places are restricted. Further information will be sent to each delegate on receipt of the completed registration form. |
Time:The conference will start promptly at 10.00am and close at 4.35pm approx. Registration will be from 9.15 - to 10.00am Registration fee:The registration fee is £197 including lunch and refreshments. Accommodation:Glasgow has a wide range of accommodation to suit every budget. For further information and ideas please visit - www.seeglasgow.com |
Exercise after bariatric surgery
Not much is known for sure about exercise programmes in obese individuals who have undergone bariatric surgery. Livhits and co-authors from Los Angeles have now published a systematic review in the journal Obesity Surgery. They found 14 articles which reported exercise and weight loss in this setting, all but one reported the amount of post-op weight loss as well. The 13 studies with specific information contained 4108 patients. Most patients had undergone laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass (open or laparoscopic); vertical banded gastroplasty (VBG) and duodenal switch (DS) were included in one study each.
Meta-analysis of 3 studies which provided 1-year data with Body Mass Index (BMI) values showed that at 1 year there was a significantly greater weight loss of 4.2% of the BMI with exercise.
In general, physical activity was defined as at least 30 minutes of exercise, on 3 or more days per week. The Baecke Physical Activity Questionnaire and the International Physical Activity Questionnaire were frequently used, but there were also a number of non-standard measurement tools.
The authors, while careful to point out that this is only an association, conclude that this information supports exercise following bariatric surgery, but also note that more research is needed before activity guidelines can be formulated.
Additional information - please also see the paper in Obesity Reviews: Jacobi D, et al. Physical activity and weight loss following bariatric surgery. Published online 14 March 2010.
Sibutramine suspension in Europe
On 21st January 2010, the European Medicines Agency (EMA) issued a press release recommending the suspension of marketing authorisations for sibutramine in all markets in the European Union for the time being. The EMA's Committee for Medicinal Products for Human Use (CHMP) made this recommendation based on data from the Sibutramine Cardiovascular Outcome Trial (SCOUT), which is a trial conducted by Abbott, the manufacturares of Sibutramine.
What's the reason for the ban?
Preliminary results from the SCOUT trial (more info below) suggest an increased risk of cardiovascular events in patients already known to have cardiovascular disease. Most of the patients enrolled in the trial would not have met the current license terms for the use of sibutramine, which has always been contraindicated in people with cardiovascular diease or risk factors such as uncontrolled hypertension.
While acknowledging that the SCOUT study data did not represent the patients who met the current license terms for sibutramine, the EMA CHMP also noted that the weight loss benefits of sibutramine were modest (weight loss 2 to 4 kg more than placebo). As a result, they have recommended suspension of this drug until information is available to identify a group of patients who are likely to benefit from this treatment.
The EMA's press release is available as a pdf from their website. They have also issued a Q&A release, also available as a pdf.
What is the FDA doing?
The US Food and Drug Administration (FDA) has taken a different approach to the new data. They state: "The sibutramine drug label already includes warnings against the use of sibutramine in patients with cardiovascular disease. However, based on the serious nature of the review findings, FDA requested and the manufacturer agreed to add a new contraindication to the sibutramine drug label. The contraindication will state that sibutramine is not to be used in patients with a history of cardiovascular disease, including: History of coronary artery disease (e.g., heart attack, angina); History of stroke or transient ischemic attack (TIA); History of heart arrhythmias; History of congestive heart failure; History of peripheral arterial disease; and Uncontrolled hypertension (e.g., > 145/90 mmHg).
The FDA statement is available online.
SCOUT (Sibutramine Cardiovascular Outcomes Trial)
The SCOUT trial enrolled 10,742 patients over the age of 55 years with cardiovascular disease or risk factors for cardiovascular disease, and followed up over 9700 over 6 years. Patients included in the study were 55 years of age or older, overweight or obese, with: a history of cardiovascular disease; or Type II diabetes and one additional cardiovascular risk factor. Patients who had recently had a heart attack or stroke, or had congestive cardiac failure were not included in the study.
Some of the recent data are shown in the table below (information obtained from the FDA):
| Group | Placebo: events | Sibutramine: events | Hazard Ratio | p-value |
| Diabetes only (n=2385) |
6.5% | 6.5% | 1.010 (0.737-1.383) |
0.951 |
| CV disease only (n=1552) |
8.3% | 10.1% | 1.274 (0.915-1.774) |
0.151 |
| CV + diabetes (n=5807) |
11.9% | 13.9% | 1.182 (1.024-1.354) |
0.023* |
(* = statistically significant)
Sibutramine trade names (all trade marks):
Reductil, Meridia
Other names: Afibon, Ectiva, Lindaxa, Meissa, Minimacin, Minimectil, Obesan, Sibutral, Siluton, Sitrane, Redoxade, Zelixa, Zelium.
References:
EMA press release, 21 January 2010 (pdf)
EMA questions and answers, 21 January 2010 (pdf)
FDA statement, 21 January 2010
RSS feed of papers in PubMed related to sibutramine SCOUT can be accessed here:
http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1XMgV6jli...
Where is obesity research published?
A paper published in the International Journal of Obesity in December raises an interesting issue - where should obesity clinicians and researchers look for published work on obesity? Unlike specialised areas in medicine, obesity is linked with virtually every medical system and condition, whether as cause, contributor, effect or affecting diagnosis and management.
It it therefore not surprising that the authors, from McMaster University in Canada, found that the three "top" obesity journals published only 19.2% of the research. More that four-fifths of the published work was to be found in a variety of journals (the authors counted 249).
Interestingly, the paper reports that only 11% of the articles they found were about clinical obesity care.
Identifying Unhealthy Lifestyle Patterns
Unhealthy lifestyle patterns are conventionally regarded as central to the problem of overweight and obesity. However, the complex interactions between weight, eating behaviour, physical activity and emotional health (to name but a few factors) mean that evaluation of lifestyle is a complex issue.
Kushner and Choi have published the results of a survey into unhealthy lifestyle patterns in the Behavior and Psychology section of Obesity (published online 29 Oct 2009). They collected responses to a 53-item lifestyle questionnaire which was filled-in by 446,608 adults (18-65 years old, average age 32) on the website of a commercial weight-loss programme. About a quarter of the respondents were healthy weight, 29% were overweight, 34% were class I/II obese, and almost 12% were BMI > 40 kg/m2. The prevalence of 21 lifestyle patterns was estimated, and these were found to correlate with increasing body mass index (BMI).
The authors also comment on the use of pattern recognition to analyse clustered behaviour, attitudes and traits. The 21 patterns mentioned were divided into 3 categories: eating, exercise and coping. These are grouped as follows:
Eating patterns:
Meal skipper | Night-time nibbler | Convenient diner | Fruitless feaster | Steady snacker | Hearty portioner | Swing eater
Exercise patterns:
Couch champion | Uneasy participant | Fresh starter | All-or-nothing doer | Set-routine repeater | Tender bender | Rain-check athlete
Coping patterns:
Emotional eater | Self-scrutiniser | Persistent procrastinator | People-pleaser | Fast-pacer | Doubtful dieter | Overreaching achiever
Some of these factors have been incorporated into a commercial programme online at www.diet.com, of which the medical director is the lead author of this Obesity paper, R Kushner.
Gut hormones and obesity
Gastrointestinal hormones are being recognised as increasingly important parts of the weight regulation mechanisms in health. Glucagon-like peptide (GLP-1) agonists are the first interventional agents to be marketed which target these hormone mechanisms. The diabetes control agents exenatide and liraglutide have been shown to cause some weight loss as well, but more research is needed. There is also the likelihood that weight-control doses could be different from the doses required for diabetes management. A study reported in the Lancet of 7 Nov 2009 reports efficacy and tolerability of liraglutide in non-diabetic obese individuals. There is an accompanying comment as well.
Parental perceptions of child obesity prevention
Qualitative research regarding parental perceptions about childhood obesity prevention is presented in a systematic review published online by Obesity Reviews. Six themes were identified among 21 studies: child factors, family dynamics, parenting, knowlegde & beliefs, extra-family influences, and resources & environment. The researchers note that many parents' views were about perceived barriers; the authors suggest these may be targets for intervention. They also note that there was widespread belief that healthy weight promotion should start early in life.
Web-based interventions for weight loss
Web-based weight loss interventions have been promoted recently as a convenient, accessible way of providing information, support and interactive features to aid weight loss. However, the effectiveness of such an approach is not clearly known yet, and there is uncertainity about which components of such interventions are central to success/failure.
A systematic review with meta-analysis has been published in Obesity Reviews, covering the period 1995 to 2008. 13 studies aimed for weight loss, and 4 targeted weight maintenance. Some positive associations were identified, but there is limited evidence for meaningful conclusions.
Primary care obesity treatment: lessons from the US?
A meta-analysis of randomised controlled trials of behavioral weight loss interventions, with or without medication, appears in the Journal of General Internal Medicine (September 2009). The studies selected were based in primary care settings in the USA. 10 trials met the criteria. Low-to-moderate intensity counselling by primary care physicians was not found to be useful as a stand-alone intervention. Pharmacotherapy along with physician counselling, or intensive dietitian/nurse counselling with meal replacements seemed to be more beneficial.
Fit or Fat, which is better? A systematic review.
Dr Fogelholm from Helsinki performed a systematic review of health risks in normal-weight individuals with poor fitness vs obese individuals with good fitness levels. There were 36 publications afetr 1990 which met the inclusion criteria. The results were:
- All-cause and cardiovascular mortality was lower in obese fit people than in unfit normal-BMI people
- Risk of Type 2 diabetes and cardiovascular risk factors were worse in obese individuaks, though.
The data suppoprted these conclusions at BMI <35 mainly
