ORLANDO, Fla. — Fighting fat on all fronts, more than 2,000 scientists and educators convened at the Obesity Society conference this week in Orlando, Fla. The annual meeting drew experts from around the world who shared the latest findings on a growing epidemic that affects one in three American adults.
Though the society has been meeting for 29 years, the problem of obesity is outpacing the progress. Sessions were filled with practitioners eager to learn the latest findings, which included new surgical therapies, promising hormone treatments, ideas for changing the food environment and more.
Among the blue-sky and big-picture presentations were these that offered actionable insights for consumers.
TAKE THIS STANDING UP
The average American sits nine to 10 hours a day, said Dr. Marc Hamilton, professor of inactivity at Pennington Biomedical Research Center in Baton Rouge, La. Most people underestimate how much they sit until they add up time spent sitting while driving, eating, working at a computer or desk and watching television.
In a study of 17,000 men and women comparing those who sat hardly ever to those who sat almost all the time, those who sat most had a much higher rate of death from all causes than those who hardly sat, said Dr. Peter Katzmarzyk, an epidemiologist from Pennington who also specializes in inactivity.
Exercisers aren’t immune. Even if you exercise regularly and vigorously, that doesn’t offset the hours a day spent sitting.
The findings were so consistent, and convincing, that researchers think sedentary behavior, which for a long time has been linked to cardiovascular disease, should be classified as an independent risk factor.
Diet and exercise are still important, but they’re not the antidote for sitting, Hamilton said. “Low intensity physical activity for as many hours a day as possible is the prescription.”
MEDS THAT MAKE YOU FAT
Doctors can make patients fat just by the medications they prescribe.
Many medications that treat hypertension, bipolar disorder, epilepsy and migraines also are linked to weight gain, said Dr. Luis Aronne, an obesity expert from Weill Cornell University Medical Center. So are beta blockers, antidepressants, steroids, antihistamines and insulin.
Sometimes physicians get so focused on treating one problem — such as cancer or depression or migraines — they fail to note that in resolving one medical issue, they’re creating another.
Kids undergoing cancer treatment, specifically for leukemia and brain tumors, are at long-term risk for becoming obese because of their treatments, said Dr. Paul Nathan, a pediatric oncologist and professor at the University of Toronto. Radiation to treat brain tumors in children often damages the hypothalamus, which governs feelings of appetite and fullness.
Aronne suggests doctors consult with pharmacologists to find a way to either change medications, change doses or add a medication has been shown to help patients lose weight or stay weight-neutral.
“Don’t wait till it gets out of hand,” he said. “Stop the gaining when it starts.”
Acknowledging that losing weight is hard enough, but keeping it off is even harder, experts shared long-term studies that revealed what works best to keep weight off.
A trio of behaviors showed the best results: attending regular weight-loss meetings; frequently using meal-replacement products; and doing regular and frequent exercise, said Dr. Rena Wing, professor of psychiatry at Brown University, where she’s director of the Weight Control and Diabetes Center.
In a study of how genes influence weight regain, researchers found that genetics could only account for about 1 percent of the rebound, Wing said.
The most successful dieters from the National Weight Control Registry — which has 10,000 members who have lost at least 70 pounds and kept it off for five years — counted calories, stuck with low-calorie diets, exercised, limited television, weighed themselves daily and limited their dietary variety, Wing said.
In addition, 60 percent say they were just as strict on weekends as on weekdays, while 78 percent ate breakfast most days or daily, and most limited fast-food meals to less than once a week.
“Maintaining weight loss for the long term is possible,” Wing said, “but it requires vigilance in the face of the current toxic food environment in which we live.”
When handing out advice, one size does not fit all. For doctors, that means tailoring their message to fit the culture of each obese patient.
When working with Hispanics, three cultural qualities can be used to direct conversations about adopting healthy eating and weight-loss programs, said Dr. Elizabeth Parks Prout, a pediatrician at Children’s Hospital of Philadelphia.
One is a strong family ethic. Rather than discuss how much weight loss will benefit the individual, she suggests, frame it in terms of how the mother’s or child’s health affects the whole family.
She also said that the culture promotes a strong respect for authority, which can fool providers.
“Patients may nod and show agreement when in fact they are not yet in a place where they’re ready to change,” she warned.
Prout also pointed out that in Hispanic families males tend to be lead decision makers, whereas in African-American families the women tend to be.
“Eliciting information about a patient’s culture, history and beliefs about obesity can be very useful in establishing what will motivate them to adopt healthy behaviors,” Prout said. “If you know what their concerns are, based on their cultural backgrounds, you can address BMI issues in that context.”