Obesity: Blame It On Your Friends?

Yesterday I was searching the New York Times for a particular article and I came across this headline: "Find Yourself Packing It On? Blame Friends." This is a fascinating new look at the Framingham Heart Study and how a reanalysis of their data led to the conclusion that if an individual has an overweight friend, then he or she is more likely to gain weight.

Staff Photo

According to this analysis, when one person in a social network gains weight, his or her friends are also likely to gain weight, creating a viral-like spread of obesity. In fact, when one's close friend gains weight, an individual has a 57% chance of gaining weight! Compared to friends, neighbors weight gain apparently had no affect on individual's chance of weight gain, and family members weight gain had less influence than that of close friends.

The researchers think that once your close friend becomes overweight, you will be more likely to view being overweight as socially acceptable, and you will tend to become less conscientious about your own weight management. The investigators are quick to point out that obese friends aren't the only reason we gain weight; there is a strong genetic predisposition to weight gain as well. Previous research has suggested that we all have a range of weight that can vary by about 30 pounds, but this new study may help us to understand why an individual tends toward the top or bottom of their individual weight range.

Critics of the study suggest that blaming growing obesity levels on the overweight individuals is a bit of blaming the victim; Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University said that he was concerned that there is a great deal of risk involved in "blaming obese people even more for things that are caused by a terrible environment."

Other researchers are concerned that this is a unique data set that cannot be "replicated" to prove the outcome again. This is because the Framingham data is a complex collection of data from interrelated individuals from a single town, and their friends and family who have spread out across the country. There is no other set of study data that is like it. Most scientists consider replication of data as necessary to prove a theory to be "truth."

Nonetheless, this study gives researchers a new window into the social complexity of obesity, and gives all of us who are concerned about the health of our patients more information about ways to assist how they think about being overweight. For example, the researchers suggest that the data may point to a reason for individuals to lose weight: gaining friends who are not overweight may cause an individual to become more conscious of their eating and exercise habits.

As you may have guessed from my previous posts here, I am pretty passionate about the duel epidemics of obesity and type 2 diabetes, and I spend much of my part-time office practice working with individuals with these health problems. The article that I was searching for yesterday appears here and is about a company that I have been helping a fabulous team of individuals to grow over the last year. David Weingard, who is featured in this article that discusses training for athletic events when one has type 1 diabetes, founded our company, called Fitness4Diabetics. Fitness4Diabetics provides free monthly web seminars on the topics of interest to those living with diabetes as a part of our commitment to providing self-management education to people living with the diabetes. We have also partnered with the American Diabetes Association and the Juvenile Diabetes Research Foundation to provide free web seminars for those training to participate in one of these organizations fund raising walks or bike rides.

Unfortunately obesity and type 2 diabetes go hand-in-hand; I am very happy to see a piece of social research that helps us to gain insight into weight gain, and I hope this information will help you. Get together with one of your thinner friends and inspire one another to eat in a healthy way and exercise more. Your friendship and your body will be happier and healthier for it!

Take care, Laurie

New Thoughts on Coronary Artery Stenting

The Wall Street Journal is reporting (July 20, 2007) that the implantation of drug eluting stents has decreased significantly; fewer of the devices were placed in June of this year than in any other month in the last year.

It has been reported since November 2006 that the drug releasing stents have an increased risk of developing blood clots for as long as three years after implantation, especially in certain higher-risk individuals. Ironically the drug-coated stents were made for the very purpose of preventing clot formation within stents, a problem noted with the first devices. When a stent is implanted in an artery the body attaches it to the arterial wall by putting down a layer of new cells, forming a seal that holds the stent in place. Unfortunately the body can go overboard, and in treating the stent like a foreign object, it can form scar tissue and inflammation. This can lead to clotting within the stent, resulting in a recurrence of the problem it was designed to prevent-lack of blood flow through the artery. The drug-coated stents slowly release medication that is designed to prevent scar formation, but they don't always work as designed.

The drug-coated stents were originally tested in a group of individuals with basic, stable coronary artery disease; they were individuals with small blockages in one or two arteries, who did not have other complications to their disease, such as uncontrolled diabetes or hypertension. This was done specifically to control for factors that might make the stents fail such as the body's tendency toward inflammation that is inherent in type 2 diabetes. Gradually interventional cardiologists began placing the drug eluting stents in individuals for whom the stents had not actually been cleared, such as individuals with diabetes or those in acute coronary syndrome (ACS), who were actively having chest pains. Individuals in ACS have dynamic clotting and inflammation going on, placing them at higher risk of clot formation. Analysis of data from post marketing use have indicated that both these higher-risk individuals and others who would not seem to have an obvious risk for clotting are getting clots in their stents, some as long as 3 years after they are placed.

Deepak L. Bhatt, MD, associate director of The Cleveland Clinic's heart center reported to Web MD on his analysis of the clinical studies of the drug releasing stents that those individuals who have them have a 0.5% risk of developing serious blood clots than those who have the bare metal stents implanted. "The absolute risk to an individual patient is less than one in 200," Bhatt says. But "with a million stents going in each year in the U.S. and twice that number worldwide, this is not trivial."

This reanalysis of the data has caused physicians to rethink all stent use, and to seriously consider whether or not a plain, bare-metal stent will be more appropriate than the drug-coated stents in a given individual. In March the New England Journal of Medicine reported on a study that showed that for patients with mild chest pains it might be more appropriate to delay stenting in favor of treatment with medications. Should those medications fail to control chest pain then those individuals could be scheduled for stenting. If stenting is required, cardiologists are recommending that a conscious decision be made between the use of a bare metal versus a drug-coated stent. This represents a major shift in the approach to managing cardiac chest pain, and is good news for the companies who manufacture the plain, bare-metal stents. These devices had essentially been overlooked in favor of the newer drug coated devices when they arrived on the market.

Researchers don't know for certain what all of the risks factors are that may increase individuals' chances of developing a clot in a stent, but a few factors are known. Individuals with diabetes, those with acute coronary syndrome, and those who would not be able to take medications to prevent clotting for more than a year might be better candidates for the bare metal devices. Individuals in the latter group would include those who are at increased risk bleeding on blood thinners, such as the elderly, those with liver disease, and those with a history of bleeding disorders and health problems such as a stomach ulcer or diverticulitis.

Doctors point out that if you have a drug releasing stent it is important to discuss with your provider your risks of clot formation, and to question whether or not you should remain on blood thinners for longer than the typical year that was originally indicated for stent placement. If you are going to have a stenting procedure done, ask the cardiologist to explain their choice of stent type, and be certain that the risk of one type or the other is chosen with your situation in mind.

The process of medical device (and medication) development occurs over many evolutions. Each time the researcher looks at problems with the current device and tries to overcome them. The original stents helped to prevent the recurrence of coronary artery blockages. The next generation of stents that released medications to prevent clot formation within the stents for some individuals, but not others. Like all clinical situations, we learned this information only after they began to be widely implanted, sometimes in individuals for whom this device had not been specifically cleared for use.

Fortunately it appears that several generations of new stents are on the horizon; one version has a drug coating that dissolves and disappears when it is no longer helpful and may be coming to the harmful point that we are now seeing. Another stent is placed but dissolves completely over time. For physicians and patients dealing with coronary heart disease, these developments are eagerly awaited.

Take care,
Laurie

The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them.
Sir William Bragg (1862 - 1942)

Related Topics:

• WebMD Video: Heart Angioplasty and Bypass - Combining Procedures
• WebMD Video: Stent Treatment for Stroke Patients

Technorati Tags: stents, angioplasty, coronary disease, heart disease, health and wellness

Are You Getting Your Fruits and Veggies?

I read with interest an article from CDC researchers who concludes that Americans don't eat enough fruits and vegetables. The authors pointed out that unless we find a way to incorporate more of them into our diets, we won't meet the goals set for us by the US Government's "Healthy People 2010."

Staff Photo

According to government nutritionists we're supposed to eat fruits two or more times per day, and vegetables three or more times per day. Only about 1/3 of us eat that much fruit and slightly more of us eat the number of vegetables that we should. The results of this CDC study were published in a March edition of the Morbidity and Mortality Weekly Report. "U.S. adults have a way to go if they are to achieve the 'Healthy People 2010' goals," wrote Heidi M. Blanck, Ph.D. and colleagues of the CDC.

These goals include increasing to 75% the percentage of persons two years or older who eat at least two daily servings of fruit, and to 50% the number who eat at least three daily servings of vegetables. At least 1/3 of those vegetable servings are supposed to be dark or orange colored ones.

The data collection took place among 305,504 people from all 50 states and Washington, DC, during the 2005 Behavioral Risk Factor Surveillance. At the time of the data collection approximately 32.6% of the U.S. adult population surveyed consumed fruit two or more times a day and 27.2% ate vegetables three or more times a day. One finding that I thought interesting was that fruit consumption was higher among men (36%) that women (29%). I expected women to do a better job!

People over 65 years of age were better fruit eaters (46%) than people in the 35-44 year old age group (28%). Individuals with a college education ate more fruit (37%), as did those who earn $50,000 a year or more. Considering the current cost of fruit that's no surprise! Nor does it surprise me that people who were not overweight ate fruit twice a day (36%), and only 28% of those are obese (BMI over 30) ate fruit that often. Although the actual numbers were different, the overall trends were the same regarding the consumption of vegetables.

In expanding on their findings, MMWR editors wrote that to meet the 2010 objectives, a more continuous and effective public health program is needed, including the identification of barriers to individuals eating more fruits and vegetables, and changes such as increasing the amount of fruits and vegetables available in vending machines and school lunches.

They also recommend improving on advertising that promotes eating healthy, real food, rather than convenience foods. They point out that there have been successful educational programs that include school-based interventions, programs for preschoolers, and church programs serving the African-American community. They also point to CDC programs that provide nutritional education and access to fruits and vegetables through community gardens, farmers markets, and restaurants. The writers conclude that "nutritional interventions should go beyond increasing individual awareness," and should "target the family, local community, and overall society to eliminate barriers to healthy eating."

Sounds good doesn't it? Except as I see it there's just one small problem. No one cooks any more. When I talk to my patients about what they eat, it's frequently fast food, or "prepared" foods from the market. They don't know what I mean when I say they need to eat "real" food. My town has two places that will create a whole meal to go for one or a whole family; one only need to call in the morning and order it to be picked up on the way home, or pop in for instant gratification on their drive.

I feel blessed; my mom cooked in a healthy manner, with more vegetables and less meat, and more vegetarian options before it was cool to do so. Every summer we had a garden, and we ate from it through the winter, because she canned and froze things.

Photo Credit: Laurie Anderson

I too have a garden now, and I am sharing my love of vegetable gardening with my neighbors. Several other families on my street have garden space of their own on my property this year, and it has been a joy to watch individuals from ages 5 to nearly 80 work to develop their plots, plant seeds and vegetable plants, and drop off their household compost.

Today the 5 year old twins were instructed by their older sister on what is needed for plants to grow ("water, sunshine, and food"). They all looked to me for an how to answer the question, "how do we feed the garden?" We turned the compost together and talked about how the "big, fat, juicy worms," helped us to make the food the plants needed.

We're just starting to harvest squash, and we've had herbs, lettuces, and radishes for weeks. The cucumbers are nearly ready, as are the tomatoes and peppers. We even planted a "row for the hungry," a row of zucchini to be donated to the local food bank. When our harvest really gets going I plan to fire up the grill and have a cook out, so we can share our bounty with those who helped us to till the soil, but decided not to plant this year. We'll have them on board next year after that feast, I guarantee it!

All the plans of the CDC and our Nation are grand, but to me, it's this kind of grass roots effort that will change how future generations eat, one person at a time.

Related Topics:

• Quick Meals for Busy Families
• WebMD Video: Vegetarian Vacation

Technorati Tags: diet, nutrition, garden