News and Trends: April 2017

| April 1, 2017

An Update on the Treat and Reduce Obesity Act of 2017

The Obesity Society Optimistic of the Passage of the Treat and Reduce Obesity Act of 2017
Washington, D.C.–The Treat and Reduce Obesity Act of 2017 was introduced this month in both the Senate and House with bi-partisan support. The Obesity Society acknowledges the support and perseverance of Senators Bill Cassidy (R-LA) and Tom Carper (D-DE) and Representatives Erik Paulsen (R-MN) and Ron Kind (D-WI) in their ongoing efforts to ensure passage of this important piece of legislation.

The Treat and Reduce Obesity Act is a critical step in addressing the obesity epidemic in the United States by providing more funding and better treatment options for healthcare professionals including intervention, counseling, and drug treatment. This Act will also provide valuable assistance for seniors battling obesity by covering medications through Medicare part D designed for weight loss management. “This commonsense fix to Medicare Part D is an important step in helping seniors treat and reduce obesity as well as the chronic conditions caused as a result of this disease,” said Congressman Paulsen. “Access to these drugs will reduce health care costs across the board, improve seniors’ quality of life, and help curb the obesity crisis.”

In the United States, over 90 million individuals—35% of adults and 17% of children—have obesity. Obesity in America has steadily risen since 1960 and is one of the greatest public health challenges of our time. As a leading cause of U.S. mortality, morbidity, disability, healthcare utilization and healthcare costs—reaching $200 billion per year—obesity is a pervasive, chronic disease in need of new strategies for medical treatment and prevention. “Obesity accounts for nearly 10 percent of all annual medical spending in the United States. Unless we do something to address the obesity epidemic, the costs and harm to public health will only continue to rise,” said Representative Kind. “The Treat and Reduce Obesity Act of 2017 is a critical step to improving health outcomes for our aging population, as well as reining in out-of-control health care spending.”
As obesity continues to rise, ranking among major global health problems, it’s urgent that the Treat and Reduce Obesity Act be enacted. Obesity needs to be approached as a disease with comprehensive, multi-pronged treatment. “As a doctor, I’ve seen obesity’s effect on a person’s physical and mental wellness,” said Dr. Cassidy. “We must work together to make effective treatment of obesity a priority. This bipartisan legislation will lower health costs and give patients access to proper tools for better health.”

“Passing this Act sends a powerful message to the America public that Washington understands what’s at stake and is willing to invest in our health.” – The Obesity Society President Dr. Allen S. Levine

About The Obesity Society. The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org.

Obesity Action Coalition (OAC) Applauds U.S. Lawmakers for Introducing the Treat and Reduce Obesity Act of 2017
Tampa, Florida—The Obesity Action Coalition (OAC) applauded Senators Bill Cassidy (R-LA) and Tom Carper (D-DE) and Representatives Erik Paulsen (R-MN) and Ron Kind (D-WI) for introducing the Treat and Reduce Obesity Act (TROA) of 2017 (S830) (HR1953). This critical legislation will provide Medicare beneficiaries with additional treatment tools to help seniors address their overweight and obesity.

Specifically, the Treat and Reduce Obesity Act will:
This legislation would provide CMS with the authority to expand the Medicare benefit for intensive behavioral counseling by allowing additional types of healthcare providers to offer these services.

It also allows the agency to expand Medicare Part D to provide coverage of FDA-approved prescription drugs for chronic weight management.

“The Treat and Reduce Obesity Act of 2017 will provide Medicare recipients and their healthcare providers with meaningful tools to treat and reduce obesity by improving access to obesity screening and counseling services, and new prescription drugs for chronic weight management. Studies suggest that even a 5 to 10 percent weight-loss produces clinically significant reductions in risk factors for chronic diseases such as diabetes, heart disease and others,” said Joe Nadglowski, OAC President and CEO.

The TROA was first introduced in 2013 during the 113th Congress and reintroduced in 2015 during the 114th and received strong bipartisan support in both the House and Senate, with more than 175 co-sponsors. The 2017 version has already secured 22 co-sponsors in the House of Representatives and six in the Senate. The OAC strongly hopes to see passage of the TROA this year, as it will help millions of individuals impacted by the disease of obesity.

To learn more about the Treat and Reduce Obesity Act of 2017, please visit www.obesityaction.org/advocacy/legislative-action-center.
About the Obesity Action Coalition. The Obesity Action Coalition (OAC), a more than 56,000 member-strong National non-profit organization, is dedicated to improving the lives of individuals affected by the disease of obesity through education, advocacy and support.

Body Weight Fluctuations Linked to More Deaths in People with Coronary Artery Disease
NEW YORK, New York—Repeated cycles of weight loss and gain may be linked to higher risk for stroke, heart attack, and death in people with pre-existing coronary artery disease, according to a study published online this month in the New England Journal of Medicine.

Led by researchers at NYU Langone Medical Center, the study was the first to measure the effect of “weight cycling” on health outcomes in people with pre-existing heart disease. People with the largest weight changes were found to experience 136 percent more strokes, 117 percent more heart attacks, and 124 percent more deaths than those with the smallest shifts in weight.

Those in the high-fluctuation group had weight changes as large as 3.9 kilograms (or roughly 8.6 pounds), while weight varied by around 0.9 kilograms (just under 2 pounds) in the group with the smallest shifts in weight.

“Our findings suggest that we need to be concerned about weight fluctuation in this group that is already at high risk due to coronary disease,” says lead study author Sripal Bangalore, MD, director of the cardiovascular outcomes group in the Cardiovascular Clinical Research Center at NYU Langone.

“Even though this analysis was not designed to find out the causes of increased risk with body weight fluctuations, we need to examine how we can help Americans keep weight off, rather than having it go up and down,” says Bangalore, an associate professor of medicine in the Leon H. Charney Division of Cardiology.

The research team reviewed data on 9,509 men and women with coronary artery disease (CAD) who participated in the Treating to New Targets trial, which originally concluded in 2005. Study participants were between the ages of 35 and 75. All had coronary artery disease, high cholesterol levels, and some history of heart problems. Half were being treated with cholesterol-lowering drugs in intensive (versus standard) doses to see if this resulted in fewer deaths. All were monitored for a median of 4.7 years.

The analysis linked shifts in body weight to statistically significant differences in outcomes only in people who were overweight or obese at the beginning of the study, but not for people who started with normal weight. Body weight changes were also strongly linked to an increase in newly diagnosed diabetes, and associations persisted regardless of patients’ average body weight and traditional risk factors for heart disease.

The researchers caution that their re-analysis does not show a cause-and-effect relationship between weight cycling and poor outcomes, but only an association. The authors also recognize that they were unable to tell if people lost weight intentionally, unintentionally, or due to illness, or if any eventual heart problems resulted directly from the weight loss, change in weight, or illness.

Dr. Bangalore hopes that the current findings will lead to further study of weight fluctuation in people with coronary artery disease and to the development of related practice guidelines once all the evidence is in.

In the United States, more than 36 percent of American adults are obese, according to the Centers for Disease Control and Prevention. Additionally, about half of Americans report they are trying to lose weight, and weight cycling is frequent. Obesity is known to increase the risk for high blood pressure, high cholesterol, and diabetes, as well as for coronary heart disease.

For the full press release, visit http://www.prnewswire.com/news-releases/body-weight-fluctuations-linked-to-more-deaths-in-people-with-coronary-artery-disease-300435083.html. To access the article abstract, visit http://www.nejm.org/doi/full/10.1056/NEJMoa1606148

Intestinal Bacteria may Protect Against Diabetes
HELSINKI, Finland—A high concentration of indolepropionic acid in the serum protects against type 2 diabetes, shows a new study from the University of Eastern Finland. Indolepropionic acid is a metabolite produced by intestinal bacteria, and its production is boosted by a fibre-rich diet. According to the researchers, the discovery provides additional insight into the role of intestinal bacteria in the interplay between diet, metabolism and health.

The findings were published in Scientific Reports. The study was carried out in the LC-MS Metabolomics Centre of the University of Eastern Finland together with a large number of partners from Finnish and Swedish research institutes.
The study compared two groups participating in the Finnish Diabetes Prevention Study, DPS. At the onset of the study, all participants were overweight and had impaired glucose tolerance. The researchers investigated the serum metabolite profile of 200 participants with impaired glucose tolerance, who either developed type 2 diabetes within the first 5 years, or did not convert to type 2 diabetes within a 15-year follow-up. The differences between the groups were analysed by non-targeted metabolomics analysis. Instead of focusing on just a few pre-defined markers, metabolomics analysis allows for the determination of the study participants’ metabolic profile, i.e. the concentrations of several metabolites.

The greatest differences in the metabolic profiles of those who developed type 2 diabetes and those who didn’t were observed in the concentrations of indolepropionic acid and certain lipid metabolites.

A high concentration of indolepropionic acid in the serum was discovered to protect against diabetes. Indolepropionic acid is a metabolite produced by intestinal bacteria. A diet rich in whole grain products and dietary fibre increased the indolepropionic acid concentration. A higher concentration of indolepropionic acid also seemed to promote insulin secretion by pancreatic beta cells, which may explain the protective effect.

In addition to the DPS data, the association of indolepropionic acid with the risk of diabetes was also studied in two other population-based datasets: in the Finnish Metabolic Syndrome In Men Study, METSIM, and in the Swedish Västerbotten Intervention Project, VIP. In these datasets too, indolepropionic acid was discovered to protect against diabetes.

The study also identified several new lipid metabolites whose high concentrations were associated with improved insulin resistance and reduced risk of diabetes. The concentrations of these metabolites were also associated with dietary fat: the lower the amount of saturated fat in the diet, the higher the concentrations of these metabolites. Similarly to indolepropionic acid, high concentrations of these lipid metabolites also seemed to protect against low-grade inflammation.

“Earlier studies, too, have linked intestinal bacteria with the risk of disease in overweight people. Our findings suggest that indolepropionic acid may be one factor that mediates the protective effect of diet and intestinal bacteria,” Academy Research Fellow Kati Hanhineva from the University of Eastern Finland says.

A direct identification of intestinal bacteria is a complex process, which is why identifying the metabolites produced by intestinal bacteria may be a more feasible method for analysing the role of intestinal bacteria in the pathogenesis of, for example, diabetes.

The Finnish Diabetes Prevention Study was the first randomised, controlled lifestyle intervention study to show that in persons with impaired glucose tolerance, type 2 diabetes can be prevented by lifestyle changes. The most important lifestyle changes included weight loss, more exercise and dietary adjustments to include more whole grain products, fruits and vegetables.
To access the full article, visit https://www.nature.com/articles/srep46337

Can Childhood Obesity be Prevented Before Conception?
First-ever Exercise, Nutrition Program Will Seek Answers by Focusing on Cleveland Mothers
Cleveland, Ohio—A Case Western Reserve University School of Medicine and MetroHealth System researcher, along with Cleveland Clinic’s director of metabolic research, have received federal funding to determine if childhood obesity can be prevented before women become pregnant.

The first-ever Cleveland-based study will explore whether an exercise and nutrition program designed for mothers before they conceive will result in less childhood obesity.

“Until now, similar intervention programs, which have only had limited success, were introduced after women became pregnant,” said co-principal investigator Patrick M. Catalano, MD, professor of reproductive biology at Case Western Reserve and director of Reproductive Health and Clinical Research at MetroHealth. “To our knowledge, this is the first study that seeks to prevent childhood obesity before a planned pregnancy. Our hypothesis is that interventions after women become pregnant are too late to see the kinds of meaningful improvements in child and maternal health everyone is looking for.”
Through nutrition, exercise, and education, the Lifestyle Intervention in Preparation for Pregnancy program (LIPP) will seek to reduce body fat and improve glucose and lipid metabolism in overweight and mildly obese women who plan on becoming pregnant, with an aim of ultimately reducing obesity and obesity-related health problems in women and their children.

The study comes at a time when a growing number of experts believe that such adult-onset chronic conditions as heart disease, type 2 diabetes, and obesity may, at least in part, be a result of poor in utero nutrition resulting from maternal consumption of high-sugar, high-fat foods and little or no exercise before and during pregnancy.

“LIPP stands in dramatic contrast to the patients’ usual care, which for the vast majority is no lifestyle intervention at all,” said co-principal investigator, John Kirwan, Ph.D., director of the Metabolic Translational Research Center at Cleveland Clinic and Professor of Nutrition and of Physiology at Case Western Reserve University.

LIPP will be based in Cleveland neighborhoods and include investigators from a number of disciplines: obstetrics, internal medicine, nutrition, molecular biology, and exercise physiology. Participating institutions are Case Western Reserve University, MetroHealth, and Cleveland Clinic.
Under a five-year, $5.5M grant from the National Institute of Child Health and Human Development of the National Institutes of Health, 200 women will be randomly assigned to two groups: usual care and the LIPP intervention. LIPP participants will be sub-divided into classes of 8-10 and receive intensive nutrition education, an exercise program, and support-group programming before and during pregnancy.

The research team will seek funds to continue to follow the women and their children after the formal study is completed in order to ensure long-term adherence to a healthy lifestyle.

“We anticipate that, if successful, this project will serve as the proof-of-principle that childhood obesity can indeed be prevented – not simply treated after the fact,” said Dr. Catalano. Longer term plans include a similar proposal on a larger scale, possibly supported by Centers for Medicare & Medicaid Services on a county-wide level.

Dr. Catalano was one of the first investigators to show that overweight and obese women are at greater risk of having babies who become obese and suffer metabolic complications in later life.

To learn more about Case Western Reserve University School of Medicine, please visit our website: case.edu/medicine.

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