Sunday, October 9, 2011

Weight loss,benefits and the obesity paradox

This first light reading article offers a little bit of hope for all of us struggling to lose a few pounds.
Incremental weight loss improves cardiometabolic risk in extremely obese adults. The American Journal of Medicine (2011) 124,931-938

This study involved 208 obese ( BMI 40 to 60 ) people with and without type 2 diabetes. The study demonstrated that cardiovascular risk factors begin to improve with almost any weight loss and continued to improve with each incremental decrease in weight.

Weight loss -------- ----------- 2 to 4.9%---------5 to 9.9 %---------10 to 19 % ------>20 %

blood pressure reduced ---- - 4.9 % ------------ 8.3 % ------------- 4.7 % ----------- 10 mmhg

Fasting glucose reduced ----- none -------------10.5 % ------------18.2 %----------- 25%

Triglycerides reduced -------- 2.4%-------------- 22 %----------------19%--------------37.7%

LDL Cholesterol increased ---2.6% -------------------------------------------------------------
LDL cholesterol reduced --------------------------3.6 %---------------.7%---------------.6 %

HDL increased ------------------------------------------------------------6.9 %------------20%

This article basically demonstrate that improved risk factors for cardiovascular disease occur with almost any weight loss and then gets better for each additional few pounds lost. I think we can celebrate each pound lost as one victory in our battle with diabetes.

I weigh 187 pounds on a good day. Trying to lose 10 % of my body weight (18.7 pounds ) is a big challenge that I have not mentally decided to do . Losing 5% of my body weight( 9.3 pounds) looks possible and I will still gain some benefit according to this article. That is good news even with the fact that this study was done in very obese individuals.

Another article in the same journal, The obesity Paradox and weight loss , is interesting.

Being overweight ( BMI > 25 to 29.5) or obese ( BMI > 30) is associated with numerous risk including hypertension, diabetes, lipid disorders and increased cardiovascular disease. Despite the association between obesity and these conditions, a number of studies have shown that overweight and obese individuals have a better prognosis than the normal weight individuals.

This is the "obesity Paradox"

This study followed 3834 men with established cardiovascular disease for 7 years and found that death rates were higher in the men who lost weight compared to the men who gained weight . A closer look at the causes for death in each group revealed that the men in the weight loss group had other diseases such as cancer, heart failure and others that could explain the difference.. This "unintentional" weight loss resulting from occult disease may be the answer to this paradox.

I think that we can still believe that " intentional " weight loss is associated with a marked reduction in the metabolic syndrome, inflammatory markers, lipids, Blood Pressure , glucose levels and a lower risk of developing cardiovascular disease . Dr Calder

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Your comments and questions are appreciated. David Calder,MD