Inflammation causal to obesity?
   Inflammation may be implicated in weight gain, reports a University of Minnesota study that measured the presence of fibrinogen and other putative markers of inflammation. Over a 3-year period in a biethnic cohort of 13,017 men and women, age 45 to 64, the study found that middle-age adults in the highest quartile of fibrinogen gained one-half pound more each year (0.23 kg) than those in the lowest quartile. Adjusted odds of a large weight gain for those in the highest quartile of fibrinogen were 1.65 times those in the lowest quartile.
   Inflammatory mediators are known to be strongly associated with the metabolic syndrome (risk factors for chronic disease), and weight gain is an important risk factor in the syndrome's development. The researchers concluded that inflammatory processes do play a role in the development of the metabolic syndrome and cardiovascular disease in part through stimulation of weight gain.. (Duncan B, Schmidt M, Chambless L, et al. Fibrinogen, other putative markers of inflammation and weight gain in middle-aged adults -- the ARIC Study. Obes Res 2000;8:279-286) 
 

Weight cycling increases risk
   Women who have dieted their way through repeated cycles of weight gain and loss tend to have lower levels of high-density lipoprotein cholesterol (HDL, the "good cholesterol"), associated with increased risk of cardiovascular disease. This report comes from the Women's Ischemic Syndrome Evaluation (WISE) multicenter study of 485 women who had coronary risk factors, funded by the National Heart, Lung, and Blood Institute. Overall, 27 percent of the women reported weight cycling, defined as intentionally losing at least 10 pounds at least three times during one's life. Among these women, regardless of their weight, HDL levels were 7 percent lower than in women with no history of weight cycling. Total cholesterol levels were also 8 percent higher. HDL was directly associated with the amount of weight lost and gained, independent of other known factors such as smoking or lack of exercise. Women who lost and gained 50 pounds or more during cycling had HDL levels 27 percent below those of noncyclers. The researchers urge an end to dieting and more attention to exercise and sound nutritional practices. (Weight cycling appears to lower levels of HDL-C in women. Westport, CT, Reuters Health 11/1/00; J Am Coll Cardiol 2000;36:1565-1571)  
 

Fertility events link to women's weight gain
   Three high-risk times for excess weight gain in a woman's life are all related to fertility events, according to several studies presented at the annual meeting of the North American Association for the Study of Obesity in Long Beach, CA. The key times are when menstruation begins, with pregnancy, and with menopause.
   Studies at Tufts University, Boston, show that early menarche may be an intermediate on the pathway to later obesity and also contribute independently to increased risk of later obesity. The researchers suggest that early menarche, if established as a critical period, could be targeted for obesity prevention. Weight retention after pregnancy, long established as a risk factor for obesity, is shown to be a greater risk for African-American women than Caucasian. The Women's Healthy Lifestyle Project, a 5-year randomized clinical trial of 535 initially premenopausal women funded by the National Institutes of Health, shows that postmenopausal women have higher levels of body fat and central adiposity than other women the same age. Four and a half years into the study, women in the control group gained an average of 5.2 pounds. In the intervention group, which made lifestyle changes, twice as many women were at or below their original weight. (Women have high-risk periods for weight gain. MedscapeWire 11/6/00)  
 

American Indian heart disease not linked to obesity
   More than 75 percent of middle-aged and older American Indians are overweight or obese (body mass index [BMI] of 25 or over) in recent research on risk factors for heart disease in the Strong Hearty Study of Arizona, Oklahoma, and South/North Dakota. BMI is higher in women than men, in younger than older people, and in those with diabetes versus nondiabetic persons. The majority have central obesity, and percent body fat is extremely high. Yet, paradoxically, increasing obesity had only a modest influence on risk factors for coronary heart disease, and waist circumference had no special effect over BMI on these risk factors. Except for insulin, the changes in risk factors with increasing obesity were not large. Thus, the relations among obesity, body fat distribution, and heart disease risk may differ for American indians. The authors cite a large population study of Pima Indians that shows little relation between obesity and death rates.
   The study included 4,549 men and women age 45 to 74 in the three areas. For both men and women, all measures of weight, waist, BMI, and percent body fat were lower in the Dakotas and higher in Arizona, where lifestyles may be more sedentary. (Gray R, Fabsitz R, Cowan L, et al. Relation of generalized and central obesity to cardiovascular risk factors and CHD in American Indians: the Strong Heart Study. Int J Obes 2000;24:849-860) 
 

Warning issued on PPA
   The US Food and Drug Administration (FDA) has issues a warning to remove phenylpropanolamine (PPA) from all diet and drug products. PPA is use in many over-the-counter weight loss products, as well as in cough and cold medications. 
   The concern is for the risk of hemorrhagic stroke, or bleeding into the brain, associated with phenylpropanolamine hydrochloride. Following up on adverse events reports, FDA worked with the manufacturers and scientists at Yale University School of Medicine to investigate. The first warnings on PPA came in the 1980s when medical journals cited several dozen young women who suddenly had strokes soon after taking their first diet pill. The researchers found increased risk of hemorrhagic stroke among women within 3 days of taking the diet pills. Men may also be at risk. FDA concluded that PPA cannot be considered safe for continued use, and although the risk of hemorrhagic stroke is low, the conditions for which these products are used do not warrant an increased risk of the serious event. (FDA issues warning on phenylpropanolamine. Broadcast Media 11/6/00. FDA: 888-INFO-FDA, website www.fda.gov or  ww.fda.gov/cder/drug/infopage/ppa/default.htm)  
 

Excess fat, not BMI, the risk for mortality
Higher mortality is associated with higher body fat in a linear direction, in Swedish studies of 735 men born in 1913 and followed up for 22 years after age 60. The relative risk of death was 1.5 for men in the highest fifth of percentage body fat, compared with 1.0 for men in the lowest fifth. Also, men with the highest percent of fat-free mass had the lowest risk. This research indicates it is high body fat rather than high body mass index (weight) that is associated with risk. Unlike body fat, BMI data showed a U-shaped risk: men in the middle fifth of BMI had the lowest mortality risk (1.0), with a risk of 1.3 at the lowest fifth, and 1.5 at the highest. Waist circumference was not statistically associated with mortaltiy.
   The reserchers explain that persons who are lean and muscular are often misclassified as overweight or obese, because BMI is used as a proxy for body fat. Similarly, less than half of the Swedish men with low BMIs were actually lean. They warn that BMI cannot give an accurate indication of body fat, and even less so for older persons. (Healthy Weight Journal 2000:14:5;67 / Heitmann BL, Erikson H, Ellsinger BM, et al. Mortality associated with body fat, fat-free mass and body mass index among 60-year-old Swedish men. Int J Obes 2000;24:33-37)
 

Elderly women's mortality risk
rises with weight loss
   Older women who are underweight or who lose weight may be at greater risk of dying than women who maintain an average weight or gain a few pounds. In a University of Maryland study, 648 women, age 65 to 99, were interviewed and weighed once a year for 3 years, then followed for an additional 3 years. Women with a low body mass index (BMI) were most likely to die. Of these, 22 percent of women died, compared with 18 percent of women with a high BMI and 13 percent of women with an average weight. Losing weight, regardless of initial BMI, also increased the risk of dying. For example, in women with an average weight, those who lost weight were almost four times as likely to die as women who either maintained that weight or gained a  few pounds. The researchers caution that extra medical attention should be paid to older women who lose weight. (Healthy Weight Journal 2000:14:2;18 / McKinney M. Weight loss hikes elderly women's risk of dying. Reuters Health, NY, 12/3/99; J Am Geriatrics Soc 1999; 47:1409-1414.)

Weight loss brings risk, unlike fat loss
   Most large studies show an increased risk of death with weight loss. Yet fat loss seems beneficial. 
Perhaps the harm of losing lean body mass during weight loss overrides any benefits that might come from fat loss. Testing this theory, researchers at the Obesity Research Center in New York analyzed two large longitudinal cohort studies, the Framingham Heart Study, and the Tecumseh Community Health Study. 
 Results were remarkably similar in both samples. Weight loss was associated with higher death rates, but fat loss with lower death rates. In the Framingham sample, weight loss of 1 standard deviation or 6.7 kg resulted in a 39 percent increase in mortality risk, and fat loss of 1 standard deviation or 4.8 mm resulted in a 17 percent decrease in risk. In the Tecumseh sample weight loss of 1 sd (4.6 kg) resulted in a 29 percent increase in mortality risk, and fat loss of 1 sd (10 mm) resulted  in a 15 percent decrease in risk. Controlling for smoking, baseline values of weight and fat, and using different analyses, basically reached the same outcome and confirmed these results. Whether male or female made little difference, nor did age. Essentially weight loss was revealing a loss of lean body mass, said the researchers.
 They suggested this may also imply the opposite: that weight gain is associated with lower death rates and fat gain with higher death rates, but this needs further study.
 Implications of the study are clear and profound. Whether weight loss is healthy or not may depend on the amount of fat that is lost and lean that is preserved. The optimal percentage is not clear. It may make a difference how much body fat the person has. It is important to begin measuring fat loss in weight loss programs, they said. (Healthy Weight Journal 1999:13:5;66 / Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. I J Obesity 1999;23:603-611.)

Death rate lowest at BMI of 34
   Disputing guidelines that say health risks begin at a body mass index of 25, the Panel Study of Income Dynamics, which looked at women age 50 and over, found the point of lowest risk to be much higher than this. The four-year study of 1,355 women found a broad U-shaped relationship between BMI and mortality, suggesting that a broad range of weight is well tolerated by older women. Mortality risk was lowest among both smoking and nonsmoking women at a BMI of around 34. High risk at lower weights did not appear to be explained by smoking, as the effect remained when controlled for smoking. (Healthy Weight Journal 1999:13:5;66 / Fontaine KR, Heo M, Cheskin LJ, Allison DB. Body mass index, smoking, and mortality among older American women. J Women's Health 1998;7:1257-1261.)

Dentists warned of fen-phen risk
   Dentists are urged to ask if their patients have a history of fen-phen or dexfenfluramine use. If so, they should be refered to their physician for evaluation and treatment before dental work that may cause considerable bleeding. This is advised in the 1997 guidelines "Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association and A Statement for theDental Profession," recently approved by the American Dental Association's Council on Scientific Affairs. The guidelines suggest that antibiotics may be prescribed prior to such procedures as tooth extractions, periodontal surgery, and root canal treatment. (Healthy Weight Journal 1998;12:4:50 / Dentists should ask about fen-phen use, Dentistry Today 1997; 17:32).

Steroid alternative is dangerous
   After dozens of reports of injuries and three deaths linked in the last year to gammahydroxybutyric acid (GHB) abuse, the Food and Drug Administration again warned that this chemical is unapproved and potentially dangerous. It is illegal to produce or sell GHB, promoted as a steroid alternative for bodybuilding and muscle building, in the United States. In 1990, after receiving reports of illness, including vomiting, dizziness, tremors, and seizures resulting in hopsitalization and some deaths related to GHB use, the FDA began to investigate. The agency's action against firms involved in producing, distributing, and promoting the chemical, an embargo on imports, and a public information campaign were effective for a time. But clandestine laboratories operate today and the FDA reports a recent resurgence of injuries. (Healthy Weight Journal 1998;12:4:50 / Injuries, deaths linked again to GHB abuse. FDA Consumer 1997; 31:4:2).

Deaths shock college wrestling
 Three college wrestlers died during workouts in the 6 weeks between November 9 and mid-December 1997, as they tried to lose weight to meet the requirements of their weight classes. Jeff Reese, 21, of the University of Michigan, was wearing a rubber suit and riding a stationary bike trying to lose 6 lbs over a 3-hour period to compete in the 153-lb weight class the next day when he had difficulty breathing, became incommunicative, his legs became unsteady, and he collapsed with cardiorespiratory arrest. Resuscitation was unsuccessful. His preseason weight was 180 lbs. Joseph LaRosa, 22, of the University of Wisconsin-La Crosse also was riding an exercise bike in a rubber suit trying to shed the last 4 pounds to compete in the 153-lb weight class when he died (preseason weight, 178). Billy Saylor, 19, or North Carolina's Campbell University died while attempting to lose 15 lbs over a 12-hour period, to compete in the 195-lb weight class (preseason weight, 33). They were under the supervision of athletic staff when they died. 
 All three engaged in a similar rapid weight-loss regimen that restricted food and fluid intake and promoted dehydration through perspiration, according to a Centers of Disease Control report. They attempted to maximize sweat losses by wearing vapor-impermeable suits under cotton warm-up suits and exercising vigorously in hot environments, which resulted in hyperthermia. 
 These were the first identified deaths associated with weight loss in interscholastic or collegiate wrestling since national record keeping began in the United States in 1982. As a result of the deaths, the National Collegiate Athletic Association revised the guidelines governing weight-loss practices and weigh-in procedures and added penalties for noncompliance. They now prohibit use of laxatives, emetics, diuretics, excessive food and fluid restriction, self-induced vomiting, hot rooms greater than 79 degrees F (26 degrees C), hot boxes, saunas, steam rooms, vapor-impermeable suits, and artificial rehydration techniques such as intravenous hydration before competition. In addition, NCAA temporarily added a 7-lb weight allowance to each weight class, required all wrestlers to compete only in the weight class they were in on January 7, and stipulated that all weigh-ins be held no more than 2 hours before the beginning of competition. (Healthy Weight Journal 1998:12:3;34 / Hyperthermia and dehydration-related deaths in three collegiate wrestlers. Centers of Disease Control and Prevention, MMWR February 20, 1998; 47;105-108); Wrestling training deaths, AP December 20, 1997)

Weight effect on breast cancer minimal
 Among women who use hormone therapy, weight makes little difference in risk for breast cancer, in the latest Nurse's Health Study report. 
 The relationship between weight, weight change, menopause, hormone use and breast cancer is complex, and associations are often weak. As in other studies, a lower weight before menopause was associated with higher risk of breast cancer. After menopause, higher weight meant risk increased, but only minimally. Higher weight at age 18 was associated with lower breast cancer both before and after menopause. 
 It took a large weight change of 45 pounds or over to increase risk. Yet there was no negative effect of weight gain after menopause, a reassuring finding since weight gain is common at this time. 
  Hormone use had a stronger effect. Breast cancer risk was increased in heavier women after menopause only among those who had never used hormone therapy — women whose estrogen levels would be low if it were not for body fat. (Healthy Weight Journal 1998:12:2;19 / Huang Z, et al. Dual effects of weight on breast cancer risk. JAMA 1997;278:1407-1411)

Risks less than expected
 Premature mortality associated with obesity was less than expected in a German study at Heinrich-Heine University in Dusseldorf. 
 For 6,053 obese patients followed for an average of 14 years there was no significantly increased mortality up to a body mass index of 32, and only moderate risk up to 36. Even in the heaviest group with a BMI of 40 or more, the risk was only double for women; it was triple for men in this group. 
 Relative risks were: BMI 25 up to 32, women 1.00, men 1.26; BMI 32 to 36, women 1.20, men 1.26; BMI 36 to 40, women 1.27, men 1.92; BMI 40 and over, women 2.31, men 3.05. Mortality ratios were compared with reference populations in the same locations. (Healthy Weight Journal 1998:12:1;2 / Spraul M, et al. Mortality in Obesity. I J Obesity 1997;21:S2:49:S24)

Deaths reveal liposuction risks 
Three liposuction deaths being investigated in California may be just the tip of the iceberg, experts say, in a burgeoning, unmonitored field driven by advertising and quests for the perfect body.
Judy Fernandez, 47, of Irvine, underwent 12 hours of surgery at a cost of $20,000 and died March 17 from what the Medical Board of California called an overdose of anesthesia, fluid overload and a fatal dilution of the blood. Rosemarie Mondeck, 39, of San Diego, died June 21, 1994, from cardiac arrest after stomach liposuction at a La Jolla dermatologist's office. Tammaria Cotton, a 43-year-old court clerk from Los Angeles, suffered massive blood loss and died of cardiac arrest on June 22, 1996, after having fat removed from her stomach, bottom and thighs.   Liposuction incidents are not tracked. But Richard Ruffalo, MD, past chair of the department of anesthesia at Hoag Memorial Hospital in Newport Beach, says that for every death there are "at least 15 to 20 cases where severe injury has occurred." 
Tumescent liposcution may seem routine. The area is made taut by a combination injection of saline solution, a local anesthetic like lidocaine, and epinephrine to reduce bleeding. Then the doctor makes a small incision and inserts a tubelike device called a cannula to suction out fat. The problem is that more doctors in a variety of specialties are offering the procedures, some pushing the margins of safety, often in private, outpatient surgical suites hidden from scrutiny.
Frederick Grazer, MD, a Newport Beach plastic surgeon, says the money is drawing more untrained doctors to liposuction. "Many doctors who were never interested in plastic surgery... take a weekend course and become interested in things they can bill upfront without insurance." (Healthy Weight Journal 1997:11:6;106 / AP, Los Angeles, Bismarck Tribune 8-25-97)
 

Low weight predicts fractures for older women
   Thin elderly women suffer more fractures than larger women, according to Minnesota researchers working with the Study of Osteoporotic Fractures. In a 6.4-year follow-up of 8,059 women age 65 and older, women in the lowest quartile of weight had 2 to 2.4 times the risk of hip, pelvic, and rib fractures as women in the highest quartile. They conclude that in recommendations for screening and treatment decisions, low weight should be considered a risk factor for these fractures. Weight did not predict fractures of the humerus, elbow, wrist, ankle, or foot. (Healthy Weight Journal 2000:14:6;82 / Low body weight increases risk of some fractures in elderly women. Reuters Medical News, Westport 7/18/00. Ann Inten Med 2000;133:123-127)