News from the latest research

Lose More Weight

With obesity contributing to “presenteeism,” a lack of productivity while at work due to health problems, employers are looking for ways to combat this costly problem. A new study shows that one way they could save money is by paying their employees to lose weight.

Jeffrey Kullgren, MD, MS, MPH, at the University of Michigan, and his team of researchers divided 105 obese dieters (body mass index 30–40 kg/m2 ) into three groups: a control group given links to an online weight-loss network to participate in monthly weigh-ins; a second group who were additionally offered a monthly $100 incentive to meet their individual weight-loss goal; and a third, who were subdivided into groups of five to split $500 among only those group members who met their goals (thus building in the possibility of a bigger payout if not all five met goals). In their paper, to be published soon in the Annals of Internal Medicine, the researchers report that the third group lost on average 4.4 kg more weight than the non-incentivized control group and 3.2 kg more than the individually incentivized group after 24 weeks of dieting. However, 12 weeks post-incentive, the individual-incentive group had kept off an average of 2.7 kg more weight than the group-incentive group.

The researchers conclude that the prospect of a bigger cash reward among the group-incentive participants was the strongest motivator to lose weight. Maintaining that loss over the long term might also be more successful if the incentive plan is likewise continued.

with No Likely Benefit

Statins cost the healthcare system more than $20 billion a year and may be overprescribed to patients who are not at high risk for coronary heart disease (CHD).

Michael E. Johansen, MD, at the University of Michigan, Ann Arbor, and his team of scientists anonymously surveyed 202 family and internal medicine and cardiology physicians on their treatment choices in six clinical vignettes, each concerning a hypothetical patient ranging from age 40 to 75 years with various baseline risk factors for hyperlipidemia (e.g., high “bad” cholesterol or blood pressure level, diabetes, smoking), but none with existing CHD. In their paper, to be published soon in the Journal of the American Medical Association: Internal Medicine, the researchers report that most physicians (70%) would have prescribed a statin to even the patients with very low risk for developing CHD anytime soon yet fewer than half would have prescribed a statin for the diabetic patient who may have benefited most.

The researchers conclude that physicians prescribe statins almost reflexively, focusing solely on cholesterol levels and without adequately weighing the risk–benefit ratio. Lifestyle modification (e.g., quitting smoking, eating well, and exercising) is most effective in many patients with high cholesterol but no other CHD risk factors, they add.

Group Clinics Improve Outcomes, KEEP COSTS DOWN

With chronic diseases such as diabetes requiring constant management and never-ending medical bills, group medical clinics (GMCs) have been shown to be eff ective at managing diabetes. Are they also cost effective?

George L. Jackson, PhD, MHA, at the Durham Center for Health Services Research in Primary Care in North Carolina, and his team of scientists recently studied 239 people with poorly controlled diabetes receiving either usual care or attending GMCs every two months for one year. GMC attendance included education and structured interactions among the up to eight group members, and the care team comprised registered nurses, certified diabetes educators, pharmacists, and general internists. Diabetes in the GMC group was more successfully managed, with lower systolic blood pressure and cholesterol levels. In their follow-up paper, to be published soon in the Journal of the American Medical Association: Internal Medicine, the researchers report that having better controlled disease, the GMC group required fewer emergency room and primary care visits, thereby off setting the annual $460 GMC fee. Moreover, GMC participants reported greater satisfaction with the group experience than with conventional oneon-one care.

The researchers conclude that cost-effective and clinically beneficial GMCs could be the new face of long-term care for certain chronic diseases in the United States.

Among Older Adults

Eating fish and seafood, foods that are unique in containing long-chain polyunsaturated omega-3 fatty acids, can improve cardiovascular and brain health. A new study examines for the first time whether these benefits might help us live longer.

Darius Mozafarrian, MD, DrPH, at the Harvard School of Public Health, Massachusetts, and his team of researchers analyzed blood level data of three types of omega-3 fatty acid from 2,692 healthy U.S. adults ages 69–79 years who participated in the National Heart, Lung, and Blood Institute’s 1992–2008 Cardiovascular Health Study. In their paper, to be published soon in the Annals of Internal Medicine, the researchers report that docosahexaenoic acid lowered risk of coronary heart disease (CHD) death by 40%, eicosapentaenoic acid lowered risk of nonfatal heart attack, and docosapentaenoic acid lowered risk of stroke death. Although none of the three omega-3 acids was strongly related to reducing noncardiovascular causes of death, those participants with the highest circulating levels of all three types had an overall 27% lower risk of mortality due to all causes.

The researchers say that the biggest benefit comes from increasing fish intake to about two servings a week. The gain is well worth it—on average, this amount increased lifespan by 2.2 years.

for Healthy Metabolism

For years, scientists have wondered why roux-en-Y gastric bypass (RYGB), the most widely done form of gastric bypass surgery, results not only in rapid weight loss but also in an even faster return to normal glucose metabolism, suggesting that the latter effect is not due strictly to decreased caloric intake or absorption. A new study tests whether the changes RYGB causes in the makeup of gut microbes accounts for the additional effects.

Doctors Lee Kaplan, MD, PhD, at the Harvard Medical School, Massachusetts, and Peter Turnbaugh, PhD, at Harvard’s Center for Systems Biology, and their team of researchers divided 23 mice into an RYGB group, a sham surgery group, and a sham surgery coupled with caloric restriction group, analyzing their fecal samples before surgery and then weekly for 12 weeks. In their paper, published in Science Translational Medicine, the researchers report increases in proteobacteria and verrucomicrobia and a decrease in firmicutes in the RYGB and the dieting groups, with more dramatic and rapid changes among the RYGB group. When proteobacteria and verrucomicrobia were transferred to mice guts in the sham surgery group, rapid weight loss resulted.

The researchers conclude that the changes in gut bacteria account for the metabolic benefits seen after RYGB, possibly by increasing levels of short-chain fatty acids, which speed up metabolism. Manipulating the gut microbiota without surgery could be a potential new therapy to address obesity in humans, they add.

— Kelly Horvath

Time Leads to More Neurological Issues

Couples who take longer to conceive may be at higher risk of having children born with mild neurological problems, according to new research.

Babies born through in vitro fertilization (IVF) have an increased risk of being born prematurely or having a low birth weight, possibly leading to a developmental disorder. But what has been previously linked to the IVF treatments, the developmental problems actually may be connected to what initially caused the couples’ infertility.

In an article appearing in Archives of Disease in Childhood: Fetal & Neonatal edition, researchers from Th e Netherlands examined 209 two-year-old children who were born to subfertile parents. The couples had taken between 1.6 and 13.2 years to conceive. More than half of the couples had undergone IVF.

The study, led by Jorien Seggers of the University of Groningen, assessed the children’s neurological development by testing their movement, muscle tone, reflexes, gross and fine motor function, and handeye coordination.

Results showed that minor neurological dysfunction (MND) was present in 16 children (7.7%). In the children with MND, couples took an average of 4.1 years to become pregnant compared with an average of 2.8 years in couples with children born without MND. Taking longer to get pregnant was linked with a 30% higher risk of having a baby with MND.

— Glenda Fauntleroy

Adolescent Bariatric Surgeries Decline While

With childhood obesity at an alltime high — one in three kids is overweight or obese — effective strategies to combat this epidemic and its comorbid diseases are vital. Is adolescent bariatric surgery one such strategy?

Deirdre C. Kelleher, MD, at the Children’s National Medical Center, Washington, D.C., and her team of scientists retrospectively analyzed data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database for the decade 2000–2009 to determine rate of bariatric surgery in adolescents (ages 10–19 years) and characterize related trends. In their paper, to be published soon in the Journal of the American Medical Association: Pediatrics, the researchers report that procedure rates increased considerably during the first three years ( from 328 to 987) but subsequently plateaued. Type of procedure, length of hospital stay, and complication rates also changed: Minimally invasive (i.e., laparoscopic) procedures are now more likely to be done than open procedures, reducing both hospital stay and complications.

The researchers also found that males and younger adolescents are less likely to undergo the surgery than females age 17 years and older with private insurance. Those with low socioeconomic status and on Medicaid are also in the minority. Their data underscore the disparity between obesity rates and use of lowrisk, minimally invasive bariatric surgery that could improve or even save many lives.

— Kelly Horvath

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