Study: Weight-loss surgery cuts cancer risk in women

Weight-loss surgery can sometimes reverse type 2 diabetes and ease other obesity-related conditions. Now, new research suggests that obese women who undergo bariatric surgery experience a 42 percent drop in their cancer risk.

Exactly why this occurs and whether it's also true for obese men is not yet clear. Obesity is a known risk factor for colon, breast, endometrial, kidney and esophageal cancers. However, the researchers found that the surgery-related weight loss and drop in caloric intake did not seem to be solely responsible for the decline in the women's cancer risk, according to the report in the July issue of Lancet Oncology.

"Evidently, one or several risk factors for cancer are favorably influenced by bariatric surgery in women," said lead study author Dr. Lars Sjöström, a professor of medicine at Sahlgrenska University Hospital, in Gothenburg, Sweden.

In the study, researchers followed two groups for an average of 10.9 years -- 2,010 men and women who had weight-loss surgery and 2,037 obese people who did not undergo surgery. Those who had the surgery lost roughly 44 pounds, compared to just 3 pounds in those who did not. During the 10-year period, 117 people who had surgery developed cancer, as did 169 of their counterparts who tried to lose weight nonsurgically. Health.com: 20 little ways to drop pounds and keep them off

There were 79 cancers diagnosed in women who had surgery, compared with 130 cancers in the other women; a wide variety of cancer types were lower in women who had bariatric surgery. Still, the researchers did not find a statistical link specifically between weight loss or caloric intake after surgery and the reduction in cancer risk. They also found no cancer risk reduction for men who had surgery.

However, there were more women than men in the study. A larger study might detect an effect in men, too, the researchers note. Still, this is not the first study to suggest that weight-loss surgery does not reduce cancer risk in men, and it's possible that hormonal differences between the sexes may play a role.

For example, higher levels of the female sex hormone estrogen can stimulate the growth of breast and endometrial cancers, and fat cells are known to produce estrogen.

"Women are more sensitive to estrogen, so you might expect to see a major difference in estrogen-related cancers after surgical weight loss," said Dr. Neil Hutcher, the director of bariatric surgery at St. Mary's Bon Secours Hospital, in Richmond, Virginia.

It's also possible that obesity-related cancers that are more common in men -- such as colon, rectal, and kidney cancers -- may simply take longer to manifest than weight-related cancers in women, according to an editorial by Dr. Andrew G. Renehan of the University of Manchester, in the United Kingdom. Therefore, a longer study may show an advantage for men.

"I think the message here is that obesity increases the risk of cancer, [so] more aggressive screening for those cancers in obese people is indicated, especially breast, uterine, and colon cancers," said Dr. Gregg H. Jossart, of Laparoscopic Associates of San Francisco, who was not involved in the study. "Finally, sustained weight loss through obesity surgery probably does decrease the risk of death from colon cancer-- men are most at risk for this-- but the study population is simply not large enough to determine this." Health.com: Easy weight-loss recipes

The weight-loss surgery techniques used in the study may also partly explain the findings. The majority of participants had vertical banded gastroplasty (commonly known as stomach stapling), in which the upper stomach is stapled to create a smaller pouch; some had adjustable gastric banding, in which a silicone band is placed around the top of the upper part of the stomach to restrict food intake. Health.com: Raising the salad bar: How to keep greens diet-friendly and delicious

Fewer than 300 people in the study had gastric bypass surgery, a more dramatic technique in which the surgeon creates a golf-ball-shaped pouch to curb food intake. Although a reduction in cancer risk was seen with all three techniques, some experts believe that gastric bypass surgery may one day be shown to be more effective than the other two.

In gastric bypass surgery, a portion of the stomach is stapled to create the pouch and the intestines are rerouted to the new, smaller stomach. Surgeons rearrange the anatomy and that may change the hormonal milieu and affect cancer risk, Hutcher explained.

Rearranging the anatomy is thought to have an unknown effect on the body; some people with type 2 diabetes who undergo this type of surgery experience a drop in insulin resistance and other diabetes-related problems before they even lose weight. (However, this is not true for everyone; many people who undergo weight-loss surgery still have type 2 diabetes even after they lose weight.) Health.com: How two women with type 2 diabetes fared after weight-loss surgery

Weight-loss surgery safe, but sleep apnea increases risk

Weight-loss surgery isn't risk-free, but a new study suggests that in the hands of a skilled surgeon, it may be safer than previously thought. However, some people -- including those with sleep apnea or a history of blood clots -- are more likely to have problems with surgery than others, according to a study published this week in the New England Journal of Medicine.

"The overall conclusion that we reached is that bariatric-surgery safety is actually quite good," said Dr. Bruce Wolfe, a professor of surgery at the Oregon Health and Science University.

In the past, bariatric procedures have been associated with death rates of 2 to 3 percent and complication rates of up to 24 percent. However, the obesity epidemic is fueling a rise in such surgeries, prompting concerns about their safety. In 2005, 171,000 people underwent bariatric surgery, more than 10 times the number that had the procedure in 1994.

To assess the safety of such operations, Wolfe and his colleagues looked at 4,776 patients in the first month after having a bariatric procedure. They found that 4.3 percent of patients had a serious problem, such as a blood clot or needing another operation, and 0.3 percent, or 15 patients, died within a month after surgery -- a complication rate similar to other types of surgery.

Four main factors seemed to increase the risk of complications, including sleep apnea, severe obesity, a history of blood clots, and an inability to walk at least 200 feet prior to surgery. Health.com: 10 easy food swaps cut cholesterol, not Taste

Sleep apnea is a common disorder in the obese (about half of the patients in the study had the condition). Excess weight in the neck region can contribute to sleep apnea, which is characterized by snoring and the collapse of the upper airway during sleep, sometimes hundreds of times a night.

Is the fat acceptance movement bad for our health?

Deb Lemire has always been "short and square," a figure she inherited from her grandmother and passed on to her child. So when Lemire took her daughter in for a wellness visit and the well-meaning pediatrician pulled her aside to talk about her daughter's weight, the 47-year-old burst into tears "because I was the 10-year-old being told I was overweight."

She took her daughter to a nutritionist, who said her dietary habits were good. So Lemire decided not to push the issue. "I have spent my whole entire life dieting and feeling like my worth was attached to my weight," says Lemire. "I wasn't going to tell her she has to change who she is. But we're going to encourage healthy behaviors [and] not worry about translating that into a size that's 'OK.' That message is not going to come from me -- she'll get that enough from other people."

Lemire also happens to be president of the Association for Size Diversity and Health, a group that advocates that people can be healthy at any size. Her group is just one of several in a growing trend sometimes called the fat acceptance movement.

From the Dove Campaign for Real Beauty, which portrays underwear-clad women who tend to be larger than the average model, to the National Association to Advance Fat Acceptance, which fights size discrimination, many organizations and businesses are championing a new definition of beauty -- one that is not dictated by waist size.

Although most people agree that promoting super-skinny models as the feminine (or masculine) ideal isn't healthy, will the opposite -- accepting that being overweight or obese is fine -- undermine the progress being made toward heart health?

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In fact, experts have recently found that the decades-long efforts to limit one serious heart risk -- smoking -- is expected to pay off with longer life spans. Unfortunately, the rise in obesity will likely undercut that progress.

Can you be fat and fit?

Expert opinion is pretty much unanimous: Being overweight is bad for your health, particularly for your heart.

"Obesity is probably the only risk factor that has such a global negative impact on so many risk factors for the heart," says Barry Franklin, Ph.D., the director of the Cardiac Rehab Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan.

Obesity's heart disease risk factors include high blood pressure, inflammation, metabolic syndrome, and trouble with blood-fat levels, such as higher triglycerides, low HDL (good cholesterol), and high LDL (bad cholesterol). Obesity is also associated with sleep apnea.

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However, research conducted by Steven N. Blair, a professor at the Arnold School of Public Health at the University of South Carolina, suggests that some people can be overweight and healthy. In a 2007 study, he and colleagues found that unfit people over age 60 who were of normal weight had higher mortality rates during the 12-year study than people the same age with higher body-mass indexes (BMIs) who were fit (as measured by a treadmill test).

And a 2008 study found that the location of fat deposits on the body is a big factor in the health risks associated with being overweight. (Belly fat and fat deposits in the liver are bad news.)

Franklin says that studies have indeed shown that fit overweight or obese people have cardiovascular mortality rates that are lower than thin, unfit people.

Michelle May, M.D., the author of "Eat What You Love; Love What You Eat: How To Break Your Eat-Repent-Repeat Cycle," says, "We use obesity as a marker of whether someone is practicing a healthy lifestyle, but that is not a way of determining if they are making healthy eating choices, are physically active, or have economic, emotional, and social stability, which is important to longevity."

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May, who is a member of the Association for Size Diversity and Health, says, "It is easy to use a BMI and place everyone in the same box, but it is too simplistic and is not always an accurate description of someone's health."

But are such studies just an excuse for overweight people -- most of whom aren't fit -- to remain complacent about excess weight? There remains concern on the part of physicians that the rise in fat acceptance is an unhealthy trend.

Franklin says that people who are overweight or obese already have one strike against them in terms of heart health, and need to compensate by monitoring other factors like exercise, blood pressure, and blood sugar.

"I don't want to take on any specific organization...but a social movement that would suggest healthy at any size in many respects can be misleading," Franklin says. "We can't say that every overweight person is healthy."

Is body image as important as health?

But for Lemire and others, it is important to balance a healthy body image with a healthy body.

"Health at any size is helping people be as healthy as they choose to be, want to be, need to be -- as healthy as they are," Lemire says. "Everyone at any size can take care of the body they have and support their well-being."

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May says she is concerned about contributing to fear and shame within a group for which the medical community has few available solutions.

"Where else in medicine do we offer a solution -- dieting -- that is going to fail and then point to the end user and say, 'You are weak-willed; you don't have enough willpower'?" she asks. "I know many thin people who don't exercise and follow unhealthy diets."

Part of the problem is that even when people -- or their kids -- are overweight or obese, they don't think they are. In fact, 8 percent of obese people think they are healthy and don't need to lose weight (even though 35 percent of those people have high blood pressure, 15 percent high cholesterol, and 14 percent diabetes), according to a study of nearly 6,000 people presented in November 2009 at the American Heart Association meeting.

It's not clear why there's a disconnect. But with the rise in obesity, people may have a skewed perception of a "normal" weight. Right now, more than 60 percent of American adults are obese or overweight. (This map shows the states with the highest percentage of overweight people.)

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Lemire and May believe that the focus should be placed on an individual's health as much as his or her weight, and that people can make great strides just by taking small steps toward improvement.

"I think it's a given that we understand physical activity is good for your body," Lemire says. "Most people find that when they are more physically active, it makes us feel better and makes the machine run better. But we shouldn't be promoting it just on the backs of fat people."

However, people who don't think they have a health problem may be less likely to exercise, visit a physician, or talk about dietary changes with their doctor.

Stephen Nicholls, M.D., the clinical director of the Cleveland Clinic Center for Cardiovascular Diagnostics and Prevention, says it's never too late to improve your health by eating better, becoming physically active, quitting smoking, and seeing a doctor for checkups.

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However, Nicholls is still concerned that fat acceptance may send the message that being overweight isn't a health issue.

"As a population, we have moved the yardstick ourselves as what we consider to be a problem and what we don't consider to be a problem," Nicholls says. "We consume processed, high-fat, easily available food and reduce the amount of exercise and activity we perform on a daily basis. There is complacency about developing obesity, and it could suggest that we underestimate what its implications might be."

He adds, "Obesity is the single greatest public health problem we face in the U.S. today and is now spreading beyond the developed world into developing countries."

Can neck measure indicate body fat better than BMI?

Flawed, limited and inaccurate. The complaints against the body mass index are many.

Among them: The BMI, which measures weight relative to height, doesn't accurately calculate body fat. It deems athletes or muscular people to be obese and underestimates body fat in older people.

But it's inexpensive and simple, so the BMI continues to be the public health agencies' standard for assessing for obesity.

A study published Monday in the journal Pediatrics suggests another simple, straightforward measurement could be used to supplement the BMI: neck circumference.

A wide neck circumference is associated with obesity-related conditions such as sleep apnea, diabetes and hypertension, according to research. Neck circumference has been explored in studies for potential obesity and heart problems in adults.

Lead author Dr. Olubukola Nafiu and his colleagues examined 1,102 children and recorded their heights, weights and neck circumferences to determine whether this measurement could be another way to assess obesity in children.

They measured necks using a flexible tape at the most prominent part of the neck. For older males, that area was the Adam's apple.

The authors found that a 6-year-old boy with a neck circumference greater than 11.2 inches was 3.6 times more likely to be overweight or obese than a peer below that level. Using the data, they devised neck measurements at which children could be at higher association with overweight and obesity.

Taking such a measurement is inexpensive, easy and could be predictive of health problems such as sleep apnea, Nafiu wrote in the article. He's an assistant professor of pediatric anesthesia at the University of Michigan School of Medicine Health, Ann Arbor.

One of BMI's shortcomings is that it "does not accurately define central body fatness," Nafiu said. Neck circumference could give better clues to body fat composition, he said.

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Studies have shown that regional adiposity, which is fat collected around the midsection, is often a good indicator for obesity-related complications, including hypertension, diabetes and heart disease. The correlation between regional adiposity and a high neck circumference is strong, said Nafiu. This could give doctors more information than BMI alone.

"We've been using BMI to advise parents and patients for making healthy choices," he said. "Unfortunately, often we tell someone their BMI is 27 or 30, most of the time it doesn't mean much. To tell you that your neck is wide, these are some of the risks associated to it -- that we feel people would be able to relate to it better than BMI."

The idea of using circumferences of various body parts has been around for awhile, said Jim Pivarnik, director of the Center for Physical Activity and Health at Michigan State University.

"It's not widely used," he said. "It doesn't mean it's not correct, but it's not widely used."

One of the challenges is the difficulty of accurate measurements. Waist circumference "is harder to measure than you might think," said Dr. Cora Lewis, a professor of medicine and public health at the University of Alabama at Birmingham.

"There's the issue of figuring out where you measure," she said. "If someone is obese, should the waist measurement come under or over the fold?"

Despite its flaws, Lewis said the BMI still gives information.

"It's a good place to start," she said. "Lots of people bash it, but what else are we going to use?"

The alternatives, such as air chambers that measure a person's mass and volume to calculate the composition of muscle and fat and underwater scales, are expensive and impractical, Pivarnik said.

The neck circumference could an initial screening tool someday, Nafiu said. But he wrote additional studies are needed to evaluate how useful it is in detecting abdominal fat.

"If a neck circumference is above what you regularly see, that raises a red flag," he said. "You want to ask further questions, then see other indices of body fat -- BMI, abdominal circumference and other parameters."

Is it baby fat -- or obesity?

Desani Marshall was never really overweight, but she was always a little big for her age. During a checkup at age 4, her doctor pointed out to her mother that Desani was gaining weight more rapidly than he thought was normal. Six months later, she was still putting on pounds at a rapid pace -- a strong predictor of future obesity.

"I didn't take it seriously; I didn't think it was that bad," says Desani's mother, Caryl Marshall, of New York City. "But then he showed me the growth chart. At the rate she was gaining, what really made me take it more seriously was what the future could be."

Now 7, Desani is gaining weight at a normal pace, thanks in part to dietary changes, such as cutting out soda, that Marshall has implemented. "Everybody would look at her and say, 'She's so skinny. Why?'" Marshall says of her daughter's regimen.

In some ways, Desani's success story is an exception. Across the country, childhood obesity has only gotten worse. More than 20 years after it was first described as an epidemic, 17 percent of American children and adolescents are obese, triple the rate in 1980, and nearly one-third are overweight, according to the latest government data.

Alarming statistics such as these have prompted government agencies, schools, and nonprofit organizations to launch a barrage of anti-obesity programs in recent years.

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Their sense of urgency is not shared by all parents, however. In fact, studies have consistently shown that parents tend to underestimate their child's weight and the health risks associated with being too heavy.

In a 2006 study that surveyed the parents of obese children, only one-half recognized that their child was overweight, and less than one-third said they were "worried" about their child's weight. In another survey, only 38 percent of parents had taken steps, or were planning to take them, to help their obese child lose weight.

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Several factors may be contributing to this indifference among parents, experts say. Some parents believe their child's excess weight is just "baby fat," for instance, and some may simply be in denial. Or it could be that parents have concluded their kid is normal after eyeballing his or her overweight peers.

"Because so many children are overweight and obese ... they don't stand out as much as they would have 20 or 30 years ago," says nutritionist Elisa Zied, a registered dietitian and spokesperson for the American Dietetic Association. "I almost see a lack of concern with some parents."

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Parents should be concerned. Although some overweight kids do outgrow their baby fat, roughly two out of three are likely to grow up to be obese adults, according to a 2009 study by the U.S. Centers for Disease Control and Prevention (CDC). Childhood obesity, moreover, is associated with a slew of serious health problems, including diabetes, asthma, heart disease, and depression.

How do you know if your child's chubbiness is baby fat or a serious health problem? You can't always tell just by looking, and you can't always count on pediatricians to broach the subject. But you can take matters into your own hands and adopt habits that will keep your child as healthy as possible.

You can't trust your eyes

Most parents probably feel pretty confident that they know whether their child is overweight or not. The research tells a different story: A large proportion of the parents of overweight children -- and especially mothers, who are surveyed more often -- do not perceive their children as overweight. In some studies, the percentage of parents who don't realize (or won't admit) that their child is overweight has been reported to be as high as 80 percent to 90 percent.

It's not entirely clear what accounts for this disconnect. For starters, many parents define obesity differently than health professionals do, and distrust the growth charts used by pediatricians.

In a focus group discussion that was excerpted in the journal Pediatrics in 2001, one mother of a preschooler defined an obese person as someone who "can barely walk." Other mothers denied that their children were fat or overweight, and instead used words like "big-boned," "chunky," and "solid" to describe them.

Susan Carnell, Ph.D., a research fellow and childhood obesity expert at the New York Obesity Research Center, attributes the failure of parents to accurately assess their child's weight to changing social norms. Not only are kids heavier than ever before, but roughly two-thirds of adults are also overweight, and parents who are overweight themselves are less likely to identify their children as overweight, Carnell notes.

"We gain many of our perceptions from comparison with peers," she says. "So if we compare a healthy-weight child with their overweight classmates, we may even think they are too skinny and try to feed them up."

Social values and beliefs may also distort a parent's perception. Parents are more likely to overestimate the weight of their daughters, for instance, perhaps because they feel it is less acceptable for girls to be heavy. Similarly, some studies suggest that parents of different ethnicities and cultural backgrounds have different conceptions of body type and overweight.

The doctor may not bring it up

If you're waiting for your child's pediatrician to tell you that your child is a bit heavy, don't hold your breath. In spite of the myriad health risks associated with childhood obesity, pediatricians often fail to screen for it during annual checkups and office visits.

In a recently published survey of its members conducted by the American Academy of Pediatrics (AAP), virtually every pediatrician said they measured height and weight during checkups.

But just 52 percent use those figures to calculate body mass index (BMI), a simple ratio of height-to-weight that provides a rough yet useful snapshot of whether a child is overweight for his or her age. (The CDC defines overweight as a BMI in the 85th percentile or above, and obesity as the 95th percentile or above.)

Even if they do feel that a child is overweight, many pediatricians are hesitant to say so, perhaps because they think it's a touchy subject. In the AAP survey, only 59 percent of pediatricians said they believe that families want to discuss weight.

"I think some doctors are reluctant to bring up weight because they are not trained to deal with it sensitively," says Carnell. Discussing a child's weight with parents in the wrong way -- by implying that they are to blame, for instance -- can make parents "feel guilty and defensive," she adds.

Doctors may also adopt a hands-off approach to weight because they feel there's little they can do. Less than one-quarter of the pediatricians in the AAP survey believed that there are effective treatment strategies for overweight and obesity.

"We all have strategies we use that can make a difference with a certain proportion of kids," says Eugene Dinkevich, MD, the division chief of general pediatrics at SUNY Downstate Medical School, in Brooklyn. "But it's not like an ear infection where you can give someone an antibiotic and they're better."

Pediatricians only set aside about 15 minutes for a regular checkup, Dr. Dinkevich says, and they have to pick and choose which topics to discuss with parents in that time. Doctors must ask themselves, "What am I competent to talk about, and if I talk about it, will it make a difference?" he says. For far too many doctors, he adds, obesity treatment and prevention don't fall into that category.

New guidelines for childhood obesity screening might help reassure pediatricians. In January, the U.S. Preventive Services Task Force, an independent panel of experts that advises the federal government on preventive care, released new guidelines that urge doctors to routinely calculate the BMI of children between the ages of 6 and 18. The guidelines also say that children who qualify as obese should be referred to various interventions, such as nutritional counseling or physical activity programs.

"In 2005, we said you can screen kids, but we had insufficient evidence of any effective therapy for weight loss," says task force chairman Ned Calonge, MD, referring to the previous guidelines. "Now we have evidence that shows you can get modest weight loss through these intensive programs."

Too few docs tell patients they're overweight

Many people who are overweight and obese either don't realize it or are in denial -- and too few doctors are setting them straight, according to a new study in the Archives of Internal Medicine.

Researchers analyzed data on roughly 5,500 people who took part in government health surveys between 2005 and 2008. One-third of the obese participants and 55% of overweight participants had never been told by a doctor that they were overweight, the study found.

If a doctor did comment on a patient's weight, it seemed to make an impression. Nearly 20% of obese people whose doctors hadn't brought up their weight described themselves as "not overweight," compared with just 3% of those whose doctors had addressed their weight. Obese and overweight patients who discussed the issue with doctors were also more than twice as likely to have tried to lose weight in the previous year.

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"If people are told by their doctor that they are overweight, it corrects their perception," says the lead author of the study, Robert Post, M.D., research director of the Virtua Family Medicine Residency in Voorhees, New Jersey.

Overweight is defined as having a body mass index between 25 and 29, and obesity is defined as a BMI of 30 and up. (BMI is a rough estimate of body fat based on the ratio of a person's height and weight.)

Doctors may be reluctant to broach the subject of weight for a number of reasons, Post says. For instance, busy physicians might not want to fall behind schedule by adding another topic to their list of things to discuss during an appointment. And many doctors have negative attitudes toward their heavier patients, whom they see as unlikely to stick to a diet and exercise program, he adds.

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The researchers weren't surprised by the high percentage of overweight people who thought their weight was normal, as several studies in recent years have found comparable -- or higher -- rates. A study published last year that used similar data from government surveys showed that 23% of overweight women and 48% of overweight men considered their weight to be just right.

Post and his colleagues chalk this up to what they call the "'norming up' of society." Roughly two-thirds of U.S. adults are now overweight or obese, and as Americans have grown heavier, the perception of what constitutes a normal weight has changed as well, Post says.

In fact, most of the overweight study participants accurately estimated their BMI. But many didn't see their weight as unhealthy or recognize the need to shed some pounds.

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Although it might seem obvious that excess weight is unhealthy, being reminded of this by a doctor can be an effective wake-up call, says Robert B. Baron, M.D., director of the weight management program at the University of California San Francisco.

In an editorial accompanying the study, Baron notes that studies have shown that smokers whose doctors remind them of how unhealthy the habit is and encourage them to quit are more likely to do so successfully than those whose doctors stay mum. Simple reminders and encouragement to lose weight could have a similar effect on overweight and obese patients, he says.

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Baron proposes calculating BMI and entering it on a patient's chart at every doctor's office visit, as is done with blood pressure and other vital signs. "This is very, very easy to do," Baron says. "If it were required or strongly suggested, it would not be very onerous.... We need to be as aggressive as we were with smoking cessation."

Study: Most obese moms, kids underestimate their weight

Roughly two-thirds of adults and one-third of children in the U.S. are now overweight or obese. Aside from contributing to rising rates of diabetes and other chronic illnesses, this widespread weight problem also appears to be changing our perception of what's considered heavy.

As overweight and obesity have become more common, those who are carrying unhealthy extra pounds are increasingly likely to see their weight as normal, and are therefore unlikely to feel the need to shed some of those pounds.

The latest evidence for this trend was presented Wednesday at an American Heart Association conference in Atlanta, where Columbia University researchers reported the preliminary results of a study that found that overweight mothers and children tend to underestimate their own -- and each other's -- weight.

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"A lot of their misperception has to do with the fact that overweight and obesity is becoming the norm," says the lead author of the study, Nicole E. Dumas, M.D., an internal medicine resident at Columbia University Medical Center, in New York.

The study included 222 mostly Latino mothers and children who were recruited at a children's health clinic in an urban setting. The research team interviewed the participants about their medical history and social background, and also measured their height, weight, and body mass index.

Just under two-thirds of the mothers were overweight or obese, as were nearly 40% of the children, who ranged in age from 7 to 13. The vast majority of the overweight people weighed more than they thought they did -- and the heavier they were, the more likely they were to underestimate their weight.

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Eighty-two percent of the obese women underestimated their weight, compared with 43% of overweight and 13% of normal-weight women. Likewise, 86% of overweight or obese children failed to correctly estimate their weight, compared with just 15% of normal-weight children.

"There was a trend that showed that as women became more and more overweight, and then obese, the larger the misperception of true body weight was," says Dumas. "Unfortunately, we found this was the case with the children as well."

The participants' misperceptions were not limited to how they viewed themselves: Nearly half of the mothers who had an overweight child believed their child's weight to be normal. And even though more than 80% of the women were overweight, only 41% of the children thought their moms needed to lose weight.

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Moreover, when the children were presented with a series of cards bearing silhouette images of body types and were asked to select the "ideal" or "healthy" size for their mother, they tended to pick body types that were, in fact, unhealthily large.

Robert Eckel, M.D., a cardiologist and professor of medicine at the University of Colorado Denver, says the study was too small and too ethnically homogenous to support any firm conclusions. "With this fairly small sample, it's hard to weed out any information that is generalizable," says Eckel, who was not involved in the research. "However, it's clear that perception was skewed."

Dumas acknowledges that her findings may not apply to the U.S. population as a whole, although she points out that other studies have found similar trends among African Americans and Caucasians. The study does, however, shed much-needed light on how weight perception functions across generations, she says.

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"In order to target the obesity epidemic, we need to improve perceptions of body weight and create healthy image goals," Dumas says. "But how do we change perceptions? That's the big question."

Dumas presented her findings at the American Heart Association's annual conference on nutrition, physical activity, and metabolism. Unlike the studies published in medical journals, the research presented at the meeting has not been thoroughly vetted by other experts.

Why isn't there a safe weight-loss pill?

Obesity can't be cured by pills, shots or even surgery.

If only it were that easy.

Despite centuries of supposed weight-loss remedies from anti-obesity soaps, crash diets based on vinegar to even amphetamines, fads have failed.

Over the years, Americans have become more obsessed with weight loss, but not much healthier as more than one-third of U.S. adults are obese.

Drugs have not effectively answered the problem, despite billions of dollars spent in research.

Obesity has more factors than just eating too much, according to research. The reasons why people gain excess weight vary -- and one drug isn't likely to address all these factors including lifestyle, food access and environment.

Our brains have a natural tendency to desire eating beyond need, to store in case of scarcity and famine, scientists say. That doesn't work well in the modern day when calorie-dense foods are readily available.

"We might not have any magic bullet," for obesity said Dr. Gene-Jack Wang, chair of medical research at Brookhaven National Laboratory. "We might have to use a bomb. You have to be very comprehensive."

Dr. Sidney Wolfe, director of the Health Research Group -- part of the nonprofit consumer advocacy organization Public Citizen -- isn't hopeful about the development of an effective and safe weight-loss drug.

"The possibility that the drug will only do the good things like lose weight and not have myriad effects on the body -- is zero," he said.

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Weight-loss stimulants speed up metabolism but can cause strokes, heart attacks and cardiovascular problems. Medications that block the body from absorbing fat cause really unpleasant side effects like diarrhea, oily spotting and the notorious anal leakage.

On Thursday, the Public Citizen Health Research Group petitioned the U.S. Food and Drug Administration to ban the only approved long-term weight-loss drug, orlistat.

The group said that orlistat, sold in prescription form as Xenical and over-the-counter as Alli, causes serious side effects such as liver injury and kidney failure.

Genentech, maker of Xenical, said it had not yet thoroughly reviewed the petition. The company said the efficacy and safety of the drug "is based on more than 10 years of clinical experience and more than 38.7 million patients worldwide have received Xenical."

GlaxoSmithKline which owns Alli announced on Thursday that it would put the weight-loss drug for sale along with other products, because these "lacked sufficient critical mass."

Obesity treatment "is high priority" among drug research, said Dr. Mark Gold, chair of psychiatry at University of Florida who focuses on addiction and eating habits. "They've failed most of the time before."

The weight-loss busts are plenty: Meridia (heart attacks, strokes), Fen-phen (heart risk), Rimonabant (suicidal thoughts), ephedra (heart attacks, strokes).

Last year, the FDA rejected three proposed weight-loss drugs, Qnexa, lorcaserin and Contrave because of safety concerns ranging from heart to psychiatric issues.

Weight-loss combo pill shows promise

So why can't an effective weight-loss drug be made without awful side effects?

The causes of weight gain can be emotional, biological, social, psychological, environmental -- and these multiple factors don't fit into a neat capsule.

While lifestyle, diet and exercise matter, our biological wiring combined with the modern environment make it difficult, researchers said.

"A lot of people say the reason for obesity is because of personal responsibility," said Wang, a senior scientist. "As a physician, I don't think it's necessarily true."

Researchers are rethinking how to tackle weight loss because the traditional approach of blaming the patient isn't working, he said.

Our brains crave calories to store for hard times, said Gold, an obesity researcher.

Why eating a lot feels so darn good

"Unfortunately for us, that worked very well when we had little food and we needed incentive to hunt. Right now, with abundant food, it's very easy to get food and fast food," he said.

Today, calorie-dense food loaded with salt, sugar and fat is everywhere. Advertisements and social cues bombard consumers to eat.

"The global obesity epidemic is due to food being widely available," Gold said. "The food has evolved, but our brains haven't really changed from the time that we had to hunt and grow our own food."

Many of our brains' pathways are linked to appetite, he said. It's hard to create a drug to suppress appetite when there could be many unknown factors involved in this instinct.

Drugs given to suppress appetites have had disastrous results such as psychotic episodes, depression and suicidal thoughts, according to experts.

Dr. Patricia Powell, clinical assistant professor for the clinical pharmacy at the University of South Carolina said "the problem with those stimulants are side effects -- cardiovascular risk, stroke, heart attack, high blood pressure. They're causing you extra work on the heart."

The risk of a heart attack or stroke "outweighs any small benefit of weight loss," she said.

Another side effect is that some people turn to new addictions such as drugs or alcohol, after their appetites have been suppressed, said experts. That's why overeating has been likened to drug addiction.

"There can be no more basic drive for people than to eat," said Wolfe, who is critical of weight-loss drugs. "It is embedded in the whole body and whether you're suppressing appetite or affecting absorption of fat, there are going to be other systems affected."

He added flatly: "The point is there is no magic."

With family life as goal, man drops 177 pounds

At his heaviest, Brent Schmitt weighed 419 pounds. Even at 6 feet 3 inches tall, that was very overweight and he had high blood pressure.

Many people in his family -- aunts, uncles and grandparents --suffered from diabetes, high cholesterol, heart disease and high blood pressure.

The iReporter's life-changing moment came during an intense family discussion back in 2009 about his relatives' ailments.

It finally clicked for him: It was time for him to take a different path.

"If I didn't do something about my health, then I was concerned I'd never live long enough to get married and have children or be healthy enough to spend quality time with my future family," the Evansville, Indiana, man said.

And in 15 months, he dropped 177 pounds, more than 40 percent of his body weight.

View Brent Schmitt's iReport

Starting a family is important to this 27-year-old civil engineer and he didn't want to miss out on this opportunity, or the chance to lead a healthy life. 

Schmitt jump-started the first six months of his weight loss journey back in July 2009 by reducing his food portions. He would use a smaller dinner plate than in the past and fill it with what he wanted to eat. Once he had done this, he would take half the food off his plate and just consume that portion.

As part of his diet, Schmitt avoided processed foods.

"I tried to buy fresh fruit and vegetables every three days, along with lunch meat sliced from the deli section of my local grocery store," he noted.

Schmitt focused on moving more, too. During the first six months of his weight loss plan, he made the daily choice of moving his body more than he had in the past. He would do little things like take the stairs rather than the elevator - or head to the copy machine after printing a work document, instead of letting his copies stack up.

Once he hit the six-month mark of his lifestyle change, he added more rigorous activity to his daily routine, like using the treadmill. At first, he just walked on the treadmill, but over time he picked up his pace and started to run.

In October 2010, he reached a milestone, running the Evansville half-marathon in less than two hours. 

"At first I was in disbelief that I finished, and then I was relieved and proud of myself for achieving a difficult goal," he said.

He now makes a point to take the longest route possible when walking somewhere in order to get more exercise.

"It's everyday choices like these that help me lose weight," he added.

It took Schmitt about six and a half months to lose his first 100 pounds and then he shed the last 77 pounds over the next eight and a half months. He hopes to eventually reach his goal weight of 230 pounds.

Dr. Melina Jampolis, CNNHealth's Diet and Fitness expert who's a physician nutrition specialist who practices in Los Angeles and San Francisco, California, said Schmitt has shed his weight in a safe and effective manner and she salutes him for making smart choices.

"He didn't do any crazy diets or jump into a crazy exercise schedule - and he focused on proper nutrition," Jampolis said. "His story just proves that in real life, if you make small choices like these day after day, it can end with tremendous results."

Schmitt's family doctor, Dr. Michael Allen, said he was comfortable with the pace of the weight loss, since he was a young male and didn't have major health issues, beyond his high blood pressure. Allen noted if Schmitt hadn't dropped the pounds, he would have been on his way to bigger health problems, including diabetes or possible knee replacement surgery.

Many people who have not seen Schmitt in a long time often do not recognize him, since his looks have dramatically changed. Many will ask him which diet plan he used or if he had bariatric surgery.

"I have to constantly reinforce the fact that it was a lifestyle change for me, and not a fad diet or surgery that caused me to lose so much weight," he added. 

Schmitt credits his family and friends for supporting him through his "lifestyle change." He says on days when he felt like he was struggling, they would remind him of his progress and how proud they were of him.

"They encouraged me to keep going," he said.

Schmitt said his family members, with their various health issues, have closely watched his transformation, and he hopes his new healthy life will inspire them to make their own changes one day.

Schmitt's goal of starting his own family is on track, too. In mid-June, he became engaged and plans to marry his fiancée in November 2012.

"Life is good for me right now and the future is bright," said Schmitt. "I feel healthier, have more energy, more self-confidence and feel as though I have accomplished something really great."

Erectile dysfunction? Try losing weight

Viagra gets the job done, but it's a quick fix. For many men, weaning themselves off the little blue pill and finding a longer-lasting solution to their sexual dysfunction may require hitting the gym and putting down the doughnuts.

A new Australian study, published Friday in the "Journal of Sexual Medicine," found that losing just 5% to 10% of body weight over a two-month period improved the erectile function -- and revved up the sex drives -- of obese men with diabetes.

The study was very small (it included just 31 men), so the results should be taken with a grain of salt. But the findings are yet another reminder that obesity and erectile dysfunction (ED) often go hand in hand.

Health.com: 7 ways to treat erectile dysfunction

Excess weight -- especially excess belly fat -- can affect sexual function in many ways; it can interfere with the body's ability to supply blood to the penis, for instance, and it can cause testosterone production to plummet.

And though the research on weight loss and sexual dysfunction is still emerging, there's growing evidence that men who get active, eat healthier foods, and pare a few pounds will see their sex lives improve -- not to mention their overall health.

In fact, doctors express hope that the promise of an improved sex life will finally get through to all the overweight and obese men who haven't responded to dire warnings about heart disease, diabetes and stroke.

Health.com: The worst habits for your heart

"You talk all the prevention you want," says Kevin Billups, M.D., an associate professor of urology at the University of Minnesota, in Minneapolis. "When I talk about restoring penile health, I have their attention."

When a patient comes to see him about ED, one of the first things Billups tells him to do is to stand up and look at his belly. "If you can't see your penis," he says, "that's a problem."

How obesity hits below the belt

The most important way that excess weight drags down a man's sex life is by affecting the health of his blood vessels.

An erection occurs when the blood vessels leading to the penis dilate, causing it to fill with blood. This process begins when the inner lining of the vessels (known as the endothelium) releases nitric oxide, a molecule that signals the surrounding muscles to relax. (Viagra and similar drugs work by increasing the amount of nitric oxide in the endothelium.)

Health.com: 10 reasons why you're not having sex

Although experts aren't exactly sure why, obesity appears to damage the endothelium. And when the endothelium doesn't work properly, the penis may not get enough blood to produce or sustain an erection.

"An erection is basically a cardiovascular event," says Robert A. Kloner, M.D., a cardiologist and professor of medicine at the University of Southern California's Keck School of Medicine, in Los Angeles. "If blood flow cannot increase because the blood vessels can't dilate normally, then there's a decrease in erectile function."

Sure enough, in the new study, endothelial function improved in the men who lost weight. (Function was measured using two different laboratory tests.)

Poor heart health can cause ED in another way. The fatty foods and lack of exercise that cause weight gain also contribute to the narrowing and hardening of arteries (atherosclerosis), in which cholesterol and other substances build up in the artery wall.

Health.com: Supplements for high cholesterol: what works?

Atherosclerosis, which can lead to heart attacks if it occurs in major arteries near the heart, can happen just as easily in the small blood vessels leading to the penis.

In fact, atherosclerosis may hit those small blood vessels first, which is why ED is increasingly seen as an early warning sign of heart disease, Kloner says.

The role of testosterone

Blood vessel problems are responsible for the vast majority of ED cases in obese men over 40, experts say, but another common culprit is low testosterone, which is also linked to obesity. Adequate levels of this male sex hormone are necessary to maintain sex drive and get erections.

Low testosterone is "very much underdiagnosed," says Ronald Tamler, M.D., co-director of the men's health program at the Mount Sinai Medical Center, in New York. "And as we are all getting fatter, it's becoming an increasing problem."

Health.com: Make over your sex drive

Those big bellies Billups warns his patients about are especially worrisome when it comes to testosterone. Belly fat, a strong predictor of heart risk, seems to have a greater effect on the hormone than excess fat distributed in other parts of the body.

"That's the bad actor that causes all sorts of inflammatory mediators and different substances to be emitted into the body that will lower testosterone," says Billups, who studies the relationship between heart health and sexual dysfunction.

Losing even a little weight can improve blood vessel function (as the new study shows), but the effect of weight loss on testosterone levels may not be as rapid or as direct. Men who have persistently low testosterone levels and ED despite losing weight may need to consider testosterone gels, shots or patches, Tamler says.

Health.com: Should "male menopause" be treated with testosterone?

Weight loss can turn things around

Being overweight doesn't seem to affect a man's self-esteem as much as it does a woman's, says Joel Block, Ph.D., a psychologist on Long Island who specializes in couples therapy and sex therapy. ED, on the other hand, can trigger a cycle of shame and doubt in even the most confident men.

"Once [ED] happens it becomes self-perpetuating," says Block, an assistant clinical professor at the Albert Einstein College of Medicine, in New York City. "The more he fails, the more difficulty he has."

Eventually, Block says, a man will begin to avoid sex. And his condition may plunge him into depression.

"Even if you have clear cut medical reasons -- diabetes, obesity -- when you're having erectile dysfunction...it is depressing," Billups says. "A lot of these men [are] down in the dumps."

Health.com: 25 ways to cut 500 calories a day

Losing weight can help with the plumbing aspect of ED, but it can also provide an ego boost that carries over into the bedroom, says Stephen Josephson, Ph.D., a psychologist at New York-Presbyterian Hospital.

"People need to feel good about themselves [to] overcome performance anxiety and other things in the sex arena, and sometimes it's as simple as getting into shape," Josephson says.

Some men who have relied on pills like Viagra or Cialis to get erections can toss them once they start exercising, eating right and losing weight, Billups says.

These men may see their morning erections return, he adds, and their wives have been known to say they're acting "friskier."

"They'll come in and tell me, 'Wow, doc, things are really turned around,'" he says.

Should all obese people lose weight?

You may be obese, but does that automatically mean you're unhealthy?

The conventional wisdom is that if you're overweight or obese, you're in mortal danger because that extra weight is like a ticking time bomb ready to unleash diabetes, heart disease and other health complications.

But doctors have known for years that obesity doesn't affect all people the same way. An obese person could lead a healthy life while another person with the same body mass index, or BMI, could have severe medical problems.

Two studies published Monday suggest reframing the way medical practitioners look at overweight and obese patients. The studies question the notion that BMI and weight determine health -- even when someone is severely obese.

"Our study challenges the idea that all obese individuals need to lose weight," said Dr. Jennifer Kuk, assistant professor in York University's School of Kinesiology & Health Science in Toronto. One in five obese people may not have medical problems, the authors estimated.

The challenge is determining who are the "healthy obese" and those who may not have complications now but may develop them in the future.

The studies appear in two publications, the Canadian Medical Association Journal and Applied Physiology, Nutrition and Metabolism.

The first study analyzed data from 8,000 people in the National Health and Human Nutrition Examination Surveys, a cross section of the U.S. population.

The main question was whether BMI alone could determine who dies early, said Dr. Arya Sharma, the lead author.

The BMI measures weight relative to height but does not calculate body fat. A person who has a BMI between 25 and 29 qualifies as overweight; a BMI greater than 30 is obese. This measurement has been used as an indicator for obesity since the 1980s.

In the Canadian research, each person who qualified as overweight was given a ranking based on the Edmonton Obesity Staging System, which Sharma designed.

A person can be ranked from zero, which indicates no apparent medical risk, although his or her weight is considered obese. As the stages progress, the symptoms become more serious.

Stage one is borderline hypertension and elevated blood pressure. The person may have elevated glucose levels and mild physical symptoms such as pain and aches. The person does not have a clinical disease at this point.

Stage two is classified with obesity-related diseases such as hypertension, diabetes and sleep apnea. The person may face limitations on daily activities.

Stage three means the person has organ damage such as heart failure, diabetic complications and debilitating arthritis. The person may also be suicidal and depressed.

Stage four is the most severe, with end-stage chronic diseases, severe disabilities and functional limitations.

This method of ranking risk more accurately predicted someone's death in 20 years than using BMI.

"What the study clearly shows is you can't make that call based on BMI," Sharma said. "You're going to have to look at additional risk factors."

But the study looked at mortality -- not quality of life.

"Their study was largely mortality in the outcome," said Dr. Steven Heymsfield, executive director of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, who was not involved in the research. "It doesn't mean your knees and hips don't have to be replaced. I still think that's an issue. You suffer certain social and employment stigma."

Researchers predictably found a correlation between health complications and heavier weight. But they also found "people who are out there, who are pretty healthy despite being large," Sharma said.

"Of course, people at a high BMI are more likely to have these problems, but 20% may be doing OK," he said.

In the other article published in Applied Physiology, Nutrition and Metabolism, Canadian researchers found similar results. Although higher BMI was associated with increased death risk, there was "considerable variation in the health risk profile" in the obese population, according to the report.

The study used data from the Aerobics Center Longitudinal Study consisting of 29,533 individuals and assessed their mortality 16 years later.

They found no difference in death risks between normal-weight individuals and obese individuals who were in stages zero or one of the Edmonton Obesity Staging System.

They "are at no greater risk of dying than normal weight individuals," said Kuk, the Toronto professor. "It challenges the notion all obese individuals need to lose weight"

Who are the 'healthy obese'?

Why are some people considered the "healthy obese" versus others who might be less overweight but have more obesity-related complications?

Genetics could play a role. A person's chances of getting diabetes, high blood pressure or arthritis with weight gain are stronger if he or she has parents or grandparents who also had the conditions.

Another factor is the quality of diet and level of fitness. These factors lower a person's risks even though his or her weight may qualify as obese. But other factors remain unclear.

Rather than focus on weight, Sharma suggests checking for chronic disease risk such as blood pressure and other factors in obese patients.

"The key message is I can't tell you how healthy someone is if you tell me height or weight on a scale," said Sharma, chair for obesity research and management at the University of Alberta. "I have to do additional tests for other health problems."

He designed the ranking system because of long waiting lists for obesity treatment on Canadian public health care. Doctors had to decide who should be treated first.

The ranking system shows not everyone is the same and helps "to identify who should actually lose weight and who are we torturing for no reason," Kuk said.

"It's a bad thing to have a sweeping brush for everybody," she said.

While doctors who treat obesity agree that BMI is not a good solitary measure of health, they said the papers have limitations.

Dr. Allen Rader, a member of the American Society of Bariatric Physicians, noted that a patient could need weight loss intervention even in the early stages of disease risk to "prevent or delay progression."

Dr. Howard Eisenson, executive director of the Duke Diet & Fitness Center, echoed the same concern.

If he had a 25-year-old patient, Eisenson said, he wouldn't tell the person, "You're fine. Don't worry because you don't have any chronic diseases."

"If we don't intervene now, by the time the person is 35 ... maybe some damage has been done and the unhealthy habits are more established," Eisenson said.

Doctors agreed that there should be a more sophisticated method of assessing risk in obese patients, rather than just weight or BMI.

Health groups such as the World Health Organization and the U.S. Food and Drug Administration have been using BMI as measure of obesity, which also determines whether people qualify for drugs or bariatric surgery.

While calling the proposed ranking system intriguing, Eisenson said, "It's not quite clear what the average physician should do."

Distracted eating may add to weight gain

If you are worried about your weight, paying more attention to what you eat, not less, could help keep you from overeating. Multitasking—like eating while watching television or working—and distracted or hurried eating can prompt you to eat more. Slowing down and savoring your food can help you control your intake.
That’s the bottom line from a report published in the April issue of the American Journal of Clinical Nutrition. A team from the University of Birmingham in the United Kingdom scoured the medical literature for studies that have looked at how attention and memory affect food intake. All of these studies had at least two groups, such as one group that ate a particular meal while watching television and another that ate the same meal without television.
These studies point to two key conclusions:

• Being distracted or not paying attention to a meal tended to make people eat more at that meal
• Paying attention to a meal was linked to eating less later on.

These results make good sense. Hunger isn’t the only thing that influences how much we eat during the day. Attention and memory also play roles. For example, after you start eating, it takes 20 minutes or so before the brain begins to start sending out “I’m full” or “I’m not hungry anymore” signals that turn off appetite. If you are hurrying or not paying attention, it’s easy to take in many more calories than you need in 20 minutes.
If you aren’t mindful of what’s going into your mouth, you don’t process that information. That means it doesn’t get stored in your memory bank. And without a memory of having eaten, you are more likely to eat again sooner than you might have if you ate mindfully.

Mindful eating

Mindful eating is an application of a broader approach to living called mindfulness. It involves being fully aware of what is happening within and around you at the moment. You can practice mindfulness during any daily activity—including eating.
Applied to eating, mindfulness includes noticing the colors, smells, flavors, and textures of your food. It also means getting rid of distractions like television or reading or working on your computer.
If mindful eating is a new concept for you, start gradually. Eat one meal a day or week in a slower, more attentive manner. Here are some tips that may help you get started:

• Set your kitchen timer to 20 minutes, and take that time to eat a normal-sized meal.
• Try eating with your non-dominant hand; if you’re a righty, hold your fork in your left hand when lifting food to your mouth.
• Use chopsticks if you don’t normally use them.
• Eat silently for five minutes, thinking about what it took to produce that meal, from the sun’s rays to the farmer to the grocer to the cook.
• Take small bites and chew well.
• Before opening the fridge or cabinet, take a breath and ask yourself, “Am I really hungry?” Do something else, like reading or going on a short walk.

Mindful eating can reduce your daily calorie intake. By paying attention to what you are putting into your mouth, you are more likely to make healthier food choices. And you will enjoy meals and snacks more fully. That’s a pretty good three-fer!

A good day to check your medications

Patrick J. Skerrett, Executive Editor, Harvard Health

For many people, medications are a mainstay for preventing and treating disease. Managing multiple conditions and multiple medications can be confusing, especially if you store some of your pills in the medicine cabinet and others in a kitchen cabinet or pill drawer. Every once in a while, it’s a good idea to take inventory of all of your medications. As a reminder to do just that, the American College of Endocrinology has declared April 15th as National Check Your Meds Day. Here’s what the college recommends:

• Look everywhere you may store medications—medicine cabinet, bathroom counter, toiletry bag, refrigerator, purse, sock drawer, etc.
• Check the label for the name of the prescription and the dosage. Confirm that what you got from the pharmacy matches what your doctor prescribed. Contact your pharmacy if they don’t match exactly.

One reason the American College of Endocrinology recommends this kind of inventory is that insurance companies or pharmacies may substitute one brand-name or generic medication with another one without notifying you. Although this usually doesn’t make a difference, it’s good to know exactly what medication and what formulation of it you are taking. (If you aren’t 100% sure what a particular pill is, you can look it up at the Pill identifier on Drugs.com.)
Another reason is that it’s important to check expiration dates. For most medications, going a few months beyond the expiration date is okay. Beyond that, it’s time for a new prescription.
If you have expired medicines, don’t just toss them in the garbage. They could pose a safety hazard to children or animals if they somehow get out of the trash. Medicines in dumps and landfills are also making their way into our drinking water. Some pharmacies take back expired medications. The Boston Police Department and some other local law enforcement agencies offer collection boxes for out-of-date medications. If you can’t find a take-back program, here’s what the FDA recommends for most drugs:

• Take the medication out of its original container, mix it with used coffee grounds, kitty litter, or dirt, and put this unappetizing blend in a plastic container with a tight-fitting lid or in a sealable plastic bag. Put the container or bag into your regular garbage.
• Scratch off the prescription label and any identifying information from the original container to protect your identity and the privacy of your health record, and recycle or dispose of the container.

The FDA’s Web site provides a list of the 25 “flush-only” drugs as well as more information on disposing unwanted medications.

New study links L-carnitine in red meat to heart disease

Daniel Pendick, Executive Editor, Harvard Men's Health Watch

Is red meat bad for your heart? A new study suggests it is, but not for the reasons you might expect.

There’s long been a perception—not necessarily backed by strong evidence—that eating steak, hamburger, lamb, and other red meat ups the risk of heart disease. The saturated fat and cholesterol they deliver have been cited as key culprits. A team from a half dozen U.S. medical centers says the offending ingredient is L-carnitine, a compound that is abundant in red meat.

According to this work, published online in the journal Nature Medicine, eating red meat delivers L-carnitine to bacteria that live in the human gut. These bacteria digest L-carnitine and turn it into a compound called trimethylamine-N-oxide (TMAO). In studies in mice, TMAO has been shown to cause atherosclerosis, the disease process that leads to cholesterol-clogged arteries. We know that clogged coronary arteries can lead to heart attacks.

So, case closed—don’t eat red meat? Sorry, nutritional science isn’t that simple.

“The studies of red meat and heart disease in humans are conflicting,” says Dr. Dariush Mozaffarian, associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital. “This new research was well-done and compelling, but it’s too early to decide that this molecule, TMAO, causes atherosclerosis in humans or that this is responsible for some of the associations of meat intake and risk.”

Dr. Mozaffarian, a cardiologist and epidemiologist, studies the health effects of dietary habits and other lifestyle factors in large populations. His team has previously pooled the findings of the best studies available on red meat and health and found that people who eat unprocessed red meat regularly have, at worst, only a slightly higher risk of developing heart disease. Unprocessed red meat includes virtually all fresh cuts of beef, pork, lamb, and the like.

“If you look at people who eat unprocessed red meat, there is a relatively weak association with heart disease,” Dr. Mozaffarian says. “It’s not protective—and healthier dietary choices exist—but major harms are also not seen.”

In the bigger picture, we do have pretty damning evidence about the harms of eating a particular type of meat. “Processed red meats—bacon, sausage, salami, deli meats—are associated with much higher risk of heart disease,” Dr. Mozaffarian says.

Research at the Harvard School of Public Health has shown that people who eat the most processed meats have a higher overall risk of death. The ultimate reason for this is not yet clear, says Dr. Mozaffarian, but it may be the huge doses of sodium delivered by all those low-fat deli sandwiches and salami-festooned platters.

And here comes other spoilers against the L-carnitine study: Processed meats generally contain less L-carnitine than does fresh red meat. Heart-healthy fish and chicken also contain L-carnitine, Dr. Mozaffarian points out—although five to 10 times less of it than red meat. “TMAO needs to be studied more in humans to understand the implications for public health,” Dr. Mozaffarian says. “This new research is very interesting but is not yet the final word.”

To further complicate matters, a study published online today in the Mayo Clinic Proceedings suggests that supplements of L-carnitine may help heart attack survivors reduce the chances of dying prematurely or reduce symptoms of angina (chest pain with exertion or stress).

L-carnitine supplements: “Think three times before taking”

There’s still a long way to go before we know the full story about L-carnitine and heart disease. Even so, the Nature Medicine report is very important, Mozaffarian says. It suggests that regularly eating red meat boosts the number of L-carnitine-loving bacteria in your gut. “It’s the best demonstration so far of two-way communication between ourselves and the bacteria in out gut: what we eat affects the bacteria, and what they do with what we eat can influence health.”

“Based on the Nature Medicine study, I’d be concerned about taking L-carnitine supplements,” Dr. Mozaffarian says. “There was no strong reason to take such supplements before the study, and now this well-done study suggests there may be harm. I would definitely think three times before taking an L-carnitine supplement.” The studies in the Mayo report were mostly small with short follow-up, and included only heart attack survivors.

Of course, there are reasons to avoid eating red meat that aren’t directly related to individual health. Cattle farming has devastating environmental effects, including production of greenhouse gases, water pollution, and deforestation. “Health effects in humans aside, red meat consumption is clearly bad for the health of our planet,” says Mozaffarian.

Benefit to improving diet and exercise at the same time

Daniel DeNoon, Executive Editor, Harvard Heart Letter

When you decide it’s time to live a healthier lifestyle, you’re likely to get better long-term results if you start improving your diet and increasing physical activity at the same time.
It may seem better to improve just one thing at a time.  But while you don’t have to make drastic changes overnight, a new study suggests that it’s best to begin by bettering both your nutrition and your activity level.
“This gives me hope that making two changes at the same time can work,” says Kathy McManus, director of the nutrition department at Harvard-affiliated Brigham and Women’s Hospital.

Counseling Advice for Lifestyle Management: The CALM Study

The study, from Stanford University researcher Abby King and colleagues, enrolled 200 people over age 44 whose diets and physical-activity levels were well below healthy standards. They were hoping to improve their lifestyles, but were not specifically trying to lose weight.
Study participants were randomly assigned to one of four groups:

• The diet-first group began with four months of counseling about improving nutrition, then received both nutrition and exercise counseling for eight months.
• The exercise-first group began with four months of counseling about increasing their activity level, then received both nutrition and exercise counseling for eight months.
• The simultaneous group got 12 months of both nutrition and exercise counseling.
• The control group got 12 months of stress-reduction counseling.

For all groups, the exercise goal was to increase moderate-to-vigorous physical activity to 150 minutes (two and a half hours) each week. The diet goal was to get five to nine daily servings of fruits and vegetables and to reduce saturated fats to 10% of total calories consumed.
What happened? The control group met none of these goals. Those in the diet-first group met their dietary goals.  Those in the exercise-first group met their activity goal. But only those in the simultaneous group met both goals.
On the other hand, nobody lost significant weight.  “Many of us are trying to do that, also,” McManus says. “We don’t know how this would play out if the focus of lifestyle change were on weight loss.”

How To Change Your Lifestyle

Lifestyle change is very hard to do by oneself. Most people need counseling and encouragement. McManus praises the Stanford study for providing much-needed data on how healthcare providers can help people achieve lifestyle change.  However, she notes that every individual has his or her own lifestyle and needs an individualized approach to changing it.
“The patient is really the expert in his or her own self-change. We are experts in medicine, but patients are experts on their own behavior,” McManus says. “We elicit dialog around that, building on any successful changes they’ve made in the past. And we develop connections about what matters to them and why it matters, understanding and empathizing with what they will miss if they leave out, say, the high-sodium snacks they’ve been eating.”
It doesn’t work merely to tell people what they must do, what they need to do, or what they should do.
“We use phrases such as, ‘Other folks have found,’ ‘Some have benefitted from,’ and ‘You might consider,’” she says. “Once patients feel listened to they are more open to what you have to say.”
Over time, McManus says, people place more importance on healthy behaviors and become more confident in their ability to make changes.
“Without confidence, behavior change chances are slim,” she says. “We go from that, to where the individual is driving his or her own intervention and behavior change.”

Tai chi improves balance and motor control in Parkinson’s disease

It isn’t every day that an effective new treatment for some Parkinson’s disease symptoms comes along. Especially one that is safe, causes no adverse side effects, and may also benefit the rest of the body and the mind. That’s why I read with excitement and interest a report in the New England Journal of Medicine showing that tai chi may improve balance and prevent falls among people with Parkinson’s disease.

This degenerative condition can cause many vexing problems. These range from tremors and stiffness to a slowing or freezing of movement, sleep problems, anxiety, and more. Parkinson’s disease may also disrupt balance, which can lead to frightening and damaging falls.

A team from the Oregon Research Institute recruited 195 men and women with mild to moderate Parkinson’s disease. They were randomly assigned to twice-weekly sessions of either tai chi, strength-building exercises, or stretching. After six months, those who did tai chi were stronger and had much better balance than those in the other two groups. In fact, their balance was about two times better than those in the resistance-training group and four times better than those in the stretching group. The tai chi group also had significantly fewer falls, and slower rates of decline in overall motor control. In addition, tai chi was safe, with little risk of Parkinson’s disease patients coming to harm.

Other smaller studies have reported that tai chi can improve quality of life for both people with Parkinson’s disease and their support partners.

These studies are significant because they suggest that tai chi can be used as an add-on to current physical therapies and medications to ease some of the key problems faced by people with Parkinson’s disease.

Into the clinic

Parkinson’s disease affects more than one million Americans. This brain disorder interferes with muscle control, leading to trembling; stiffness and inflexibility of the arms, legs, neck, and trunk; loss of facial expression; trouble swallowing; and a variety of other symptoms, include changes in memory and thinking skills. These changes can greatly reduce the ability to carry out everyday activities and reduce quality of life. Medications can help, but they sometimes have unwanted side effects.

Since the appearance of the New England Journal of Medicine study, tai chi classes specifically for Parkinson’s disease patients have sprung up across the country, and the benefits of tai chi for Parkinson’s disease have been endorsed by the National Parkinson’s Foundation. (You can see a video of a tai chi class at Brigham and Women’s Hospital for people with Parkinson’s disease at the bottom of this post.)

Several colleagues and I have developed a tai chi program for people with Parkinson’s disease. It brings together Harvard Medical School doctors and other clinicians with tai chi experts. The 12-week program uses the traditional tai chi principles that I describe in my newly released book, The Harvard Medical School Guide to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart & Sharp Mind. This program is jointly sponsored by the Parkinson’s Disease and Movement Disorders Center at Beth Israel Deaconess Medical Center and the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School. So far, about 50 people have completed the program.

We have also begun a small, preliminary study across multiple Harvard Medical School hospitals focused on understanding the interactions between cognitive function, mobility, and motor function in early stage Parkinson’s disease. The idea is to examine how the mind-body connection of tai chi slows the loss of mobility and cognitive function in individuals recently diagnosed with Parkinson’s disease. The results of this pilot study will be used to guide randomized trials to further test the impact of tai chi.

I foresee a growing number of hospitals in the country developing similar tai chi programs for individuals with Parkinson’s disease. In addition to easing balance problems, and possibly other symptoms, tai chi can help ease stress and anxiety and strengthen all parts of the body, with few if any harmful side effects. I look forward to the day when evidence-based tai chi programs become widely available and used by individuals with Parkinson’s disease world-wide.