Obesity creeps up in US

Obesity continued to creep up in the United States last year and now affects more than one in four US adults, a US government report showed Friday.In 2005, 23.9 percent of adults in the United States were obese, or had a body mass index greater than 30, while in 2007, the percentage had grown to 25.6 percent, data issued by the Centers for Disease Control (CDC) showed.

Body mass index is calculated by dividing a person's weight in kilos by his or her height squared in meters.

In three states -- Alabama, Mississippi and Tennessee -- nearly one in three adults was obese.

Mississippi, which is also the poorest US state, had the highest rate of obesity in the United States, at 32 percent. Colorado had the lowest rate of obesity at 18.7 percent and was the only state in which obesity was running at less than 19 percent.

No state has achieved the official target to bring obesity down to 15 percent of the adult population by 2010, the report showed.

Obesity was highest for non-Hispanic black women, nearly four in 10 of whom were obese.

University graduates were the least likely to be obese -- around 22 percent compared with 29 percent of people who only obtained a high school diploma.

A report issued last year by the Trust for America's Health (TFAH) said the percentage of obsese adults more than doubled in the past 25 years across the United States, growing from 15 percent in 1978-80 to 32 percent in 2003-04.

ADHD children have greater risk of being overweight

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for being overweight, regardless of whether or not they are currently receiving medications for the condition.The results of prior research has suggested that the impulsivity and poor behavioral regulation that is common in children with ADHD may promote certain eating patterns that increase the risk of obesity, co-authors Molly E. Waring and Dr. Kate L. Lapane, from Brown Medical School in Providence, Rhode Island, note.

To investigate further, the researchers analyzed data from 62,887 children and adolescents included in the 2003-2004 National Survey of Children's Health.

Children with ADHD were identified based the response of the parent to the question: "Has a doctor or health professional ever told you that your child has attention-deficit disorder or attention-deficit/hyperactivity disorder, that is, ADD or ADHD?"

The prevalence of ADD or ADHD was 8.8 percent, the authors report in the journal Pediatrics, and approximately half the affected children were taking medication for the condition.

After accounting for demographic factors as well as depression and anxiety, ADHD patients who were not being treated with medication were 1.5-times more likely to be overweight than children without the disorder. The risk for ADHD among those who were currently receiving medications was only about 0.5-times higher than children without ADHD.

"Future work is needed to better understand the longitudinal and pharmacologic factors that influence the relationship between ADD/ADHD and weight status in children and adolescents," the investigators conclude.

Studies show exercise boon for obesity, diabetes

Walking a bit more each day can help people control their Type 2 diabetes but obese people trying to keep weight off may need to exercise harder than they had thought, according to a studies published on Monday.Simply walking 45 minutes more each day helped people with diabetes use blood sugar better, Michael Trenell of Britain's Newcastle University and colleagues wrote in the journal Diabetes Care.

"People often find the thought of going to the gym quite daunting, but what we've found is that nearly everyone with diabetes is able to become more active through walking," Trenell said.

The Newcastle team paired 10 Type 2 diabetes patients with people without the condition of similar height, weight and age and asked everybody to walk more than 10,000 steps each day.

Magnetic resonance imaging or MRI scans showed that people who walked 45 minutes more each day burned about 20 percent more fat -- increasing the ability of the muscles to store sugar and help control diabetes, the researchers said.

"What is exciting about this study is that it provides an immediate way to help control diabetes without any additional drugs," Trenell said.

Diabetes affects an estimated 246 million adults worldwide and accounts for 6 percent of all global deaths. Type 2 diabetes accounts for about 90 percent of all diabetes cases and is closely linked to obesity and physical inactivity.

Obesity and diabetes both are growing problems as more developing nations adopt a Western lifestyle, something the International Diabetes Federation estimates will propel the number of people with diabetes to 380 million by 2025.

But current exercise guidelines calling for people to get 150 minutes -- 2.5 hours -- each week may not be enough to help the obese keep weight off, John Jakicic of the University of Pittsburgh and colleagues wrote in the Archives of Internal Medicine.

To determine an optimal amount of exercise, the U.S. team enrolled 201 overweight and obese women in a weight loss programme between 1999 and 2003 and assigned them to one of four exercise groups.

After six months, women in all four groups had lost an average of 8 to 10 percent of their weight but many gained it back.

Women assigned to exercise for about an extra hour each day did not gain the weight back, the researchers said. These women were also more likely to stick to healthy diets.

Jakicic recommended that people who want to lose weight and keep it off get at least 4-1/2 hours of exercise a week.

"There is a growing consensus that more exercise may be necessary to enhance long-term weight loss," Jakicic and colleagues wrote.

Obesity not a contraindication to knee replacement

Obese individuals with arthritic knees should not be denied knee replacement surgery, researchers conclude, based on a new study showing that obese patients benefit from the surgery almost as much as their normal-weight peers.Roughly 55,000 knee replacements are performed every year in England to relieve the pain and disability of knee arthritis, according to the British research team that conducted the study. But in some parts of the country the surgery is offered only to people who are not obese, on the grounds that obesity is itself a risk factor for knee arthritis.

Dr. Cyrus Cooper, at the University of Southampton, and associates monitored the progress of 325 patients for around six years after they had had knee replacement surgery. Their progress was compared with that of 363 "control" patients seen in general medical practices, matched for age and sex, who had not had knee replacements.

At the outset, physical function was markedly worse in the knee replacement patient group than in the control group. However, at follow-up, physical function had improved in the knee replacement patients, while that of controls had worsened.

When the researchers restricted their analysis to participants who were obese, the improvements with knee surgery persisted. In obese patients, physical function increased in surgery patients and deteriorated in controls.

"The long term improvement in physical function that we observed in patients who have undergone (knee replacement surgery) is striking when set against the decline that occurred in (the control group)," Cooper and colleagues say. "These benefits extend to patients who are obese."

"There seems no justification for withholding (knee replacement surgery) from patients who are obese," they conclude.

SOURCE: Annals of the Rheumatic Diseases, online July 24, 2008

Childcare before kindergarten may promote obesity

Participation in a childcare program appears to increase the likelihood that a child will be obese when he or she shows up for the first day of kindergarten, researchers report in the journal Pediatrics.Moreover, the report indicates that the type of childcare makes a difference. For instance, children who receive care from a relative, friend, or neighbor, held at least occasionally in the child's own home, were more prone to obesity than those who received care at a daycare center or nursery school.

Latino children, however, seemed to be the exception. While they were found to be at greater risk for obesity than kids of other races, they were less likely to become obese when enrolled in a childcare program rather than spending the week with a parent.

The study, conducted by Dr. Erin J. Maher, from Casey Family Programs in Seattle, and colleagues, involved nearly 16,000 first-time kindergartners who had or had not been enrolled in childcare, defined as spending at least 10 hours per week in care not provided by a parent.

Childcare was subdivided into four types: 1) paid or unpaid care by a relative, friend, or neighbor, held at least occasionally at the child's home; 2) paid care by a non-relative family outside the child's home; 3) Head Start; and 4) care at daycare center, nursery school, preschool, or pre-kindergarten. Children were considered to be obese if their weight was in the 95th or higher percentile for height.

Overall, kids in childcare were more likely to obese than children not in childcare. Of the various childcare types, care by a relative, friend, or neighbor was most strongly linked to obesity. Compared with other racial groups, white children were less likely and Latino children more likely to be obese.

"Our research points to the need to better understand how the specific features of childcare environments may promote or protect against the development of obesity," Dr. Maher's team concludes. "This understanding can then lead to the development of targeted interventions to reach children and families in childcare settings."

SOURCE: Pediatrics, August 2008.

Lack of REM sleep may raise obesity risk in kids

Studies have shown that children and teens who fail to get the proper amount of sleep each night are more prone to obesity, and researchers now think it may be linked to a particular stage of sleep.
They said not spending enough time in rapid eye movement, or REM, sleep -- the type that is normally associated with dreaming -- significantly increased the odds of obesity in children and teens.

"Our results demonstrated that the short sleep-obesity association may be attributed to reduced REM sleep," said Dr. Xianchen Liu of Western Psychiatric Institute and Clinic in Pittsburgh reported on Monday in the Archives of General Psychiatry.

Ultimately, obesity is the byproduct of taking in more calories than the body needs. But Liu and colleagues wanted to see if they could identify any stage of sleep that appeared especially important.

The researchers studied 335 children and adolescents aged 7 to 17 for three consecutive nights. Their sleep was monitored through polysomnography, which measures sleep cycles and stages by recording brain waves, electrical activity of muscles, eye movement, breathing rate, blood pressure, and other variables.

Weight and height were measured to calculate body mass index, a measure of obesity. They found 15 percent were at risk for becoming overweight and 13 were overweight.

When they compared the sleep patterns among these groups, they found children who were overweight slept about 22 minutes less per night than normal-weight children. They also had shorter REM sleep, less eye activity during REM sleep and a longer wait before the first REM period.

After adjusting for other factors, they found one hour less of total sleep doubled the odds of being overweight, and one-hour less of REM sleep tripled the odds.

"Although the precise mechanisms are currently under investigation, the association between short sleep duration and overweight may be attributed to the interaction of behavioral and biological changes as a result of sleep deprivation," Liu and colleagues wrote.

They said sleep loss causes changes in hormone levels that may affect hunger. It also gives a person more time in which to eat, and makes a person sleepy during the day, which may make them less likely to exercise.

Liu said more research is needed to understand changes in the metabolism that occur when children and teens get too little sleep.

They noted that the obesity rate has more than tripled among children aged 6 to 11 years in the past 30 years, and about 17 percent of U.S. adolescents are now overweight or obese.

Given this, the researchers think doctors, schools and families should step in to ensure that children get enough sleep.

Liu suggests parents establish regular bedtime and wake up times at both weekdays and weekends, improve the sleep environment and address any sleep disorders such as sleep apnea that may be keeping children from getting the sleep they need.

Kids Who Sleep Poorly at Risk for Being Overweight

Getting too little sleep or not spending enough time in rapid eye movement (REM) sleep is associated with being overweight among children and teens, a new U.S. study.For three consecutive nights, researchers assessed the sleep patterns of 335 youngsters, aged 7 to 17. They looked at total sleep time, time spent in REM, and time it took to fall asleep. Body-mass index was checked at the start of the study, and 45 participants (13.4 percent) were overweight, while 49 (14.6 percent) were at risk for becoming overweight.

Compared to normal-weight children, those who were overweight slept about 22 minutes less per night and had lower sleep efficiency (percentage of time in bed that a person is asleep), shorter REM sleep, less eye activity during REM sleep, and a longer wait before the first REM period.

After they adjusted for other factors, the researchers concluded that one hour less of total sleep was associated with a twofold increased risk of being overweight. One hour less of REM sleep was associated with a threefold increased risk.

Although the precise mechanisms are currently under investigation, the association between short sleep duration and overweight may be attributed to the interaction of behavioral and biological changes as a result of sleep deprivation, wrote Dr. Xianchen Liu, of the Western Psychiatric Institute and Clinic in Pittsburgh, and colleagues.

They explained that sleep loss causes changes in hormone levels that may affect hunger, and less sleep also means a person has more waking hours in which to eat. Sleep loss also contributes to fatigue the following day, which may lead to less physical activity and fewer calories burned.

Given the fact that the prevalence of overweight among children and adolescents continues to increase and chronic sleep insufficiency becomes more prevalent in modern society, family- and school-based sleep interventions that aim to enhance sleep hygiene and increase sleep duration may have important public health implications for the prevention and intervention of obesity and type 2 diabetes in children, the authors concluded.

"Furthermore, our results demonstrate an important relationship between REM sleep and high BMI and obesity, suggesting that the short sleep-obesity association may be attributed to reduced REM sleep time and decreased activity during REM sleep," they wrote.

The study was published in the August issue of the Archives of General Psychiatry.

Obesity seen protective in cases of heart failure

Overweight and obese patients with heart failure seem to have a lower risk of dying than their normal-weight counterparts, according to a review of published studies involving more than 28,000 heart failure patients who were followed for an average of nearly three years.There is evidence, Dr. Antigone Oreopoulos told Reuters Health, that a normal body mass index (BMI) "is likely not the ideal BMI" in people with heart failure, which occurs when the heart loses its ability to pump blood efficiently.

Oreopoulos, from University of Alberta, Edmonton, Canada, and associates reviewed nine studies that examined the impact of BMI on mortality. They pooled the data to estimate the risk of death in patients who are underweight, overweight or obese compared to patients with a normal body weight.

According to the researchers, patients who were overweight or obese were less likely to die during follow up compared to their normal-weight peers. Being overweight or obese "remained protective" against death in a "risk-adjusted" analysis.

Heart failure patients who had a normal weight or who were underweight had the highest death rates. "It remains unknown, however, if higher body fat levels are actually the cause of better outcomes in patients with heart failure," the researchers note in the American Heart Journal.

"We believe there is a need for prospective studies to confirm these findings and elucidate potential mechanisms" for the potentially protective effect of increased body weight on heart failure, Oreopoulos and colleagues conclude.

"Our findings," they point out, "are consistent with evidence in other chronic disease populations," including survivors of heart attack and chronic hemodialysis patients, demonstrating lower death rates with higher BMI levels.

SOURCE: American Heart Journal, July 2008.

Britain and France grapple with child obesity problem

To combat the growing problem of child obesity, a French report Tuesday suggested imposing an anti-obesity tax on sweet and fatty foods, while British health officials want to avoid the label "obese" for very overweight children.The French plan would target foods such as pizzas and hamburgers as well as sodas and alcohol.

Drawn up jointly by the French tax and social affairs inspectorates, the report was handed to Budget Minister Eric Woerth and his counterpart for health Roselyne Bachelot late last month, ministry officials said Tuesday.

According to Les Echos newspaper, it calls for the VAT sales tax rate to be lifted from 5.5 percent to 19.6 percent on all food stuffs considered "too rich, too sweet, too salty and which are not strictly necessary."

Meanwhile, health authorities in Britain rejected criticism of plans to use the word "very overweight" instead of "obese" in letters to the parents of schoolchildren.

Officials said research showed the term obese "shuts people down" and was regarded as "highly offensive."

Instead they have recommended that the alternative term be used for children whose body mass index (BMI) exceeds 30.

The National Obesity Forum accused the government of being "prissy" and "namby pamby" by avoiding the word.

The proposals are designed to tackle the growing problem in Britain of overweight children, but the letters will put the onus on parents to contact their doctors or school nurse if they want further information.

Parents will be informed of the child's height and weight and say whether they are underweight, a healthy weight, overweight or very overweight.

Will Cavendish, director of health and wellbeing at the Department of Health, said there was a danger that parents would not react to the information at all if they received a letter containing the word "obese".

"We have not banned (the word obese) but we have chosen not to use it," he said. "There's no point giving them a letter that doesn't have any impact on their behaviour."

Tam Fry, a board member of the National Obesity Forum, however, said experts in the United States had also suggested banning the term obese but had now decided the word was necessary.

"The Americans have gone back to using the term because it's the kind of shock word that makes parents sit up and take notice. It's a nasty word but by God it should sound alarm bells in parents' minds.

"I find this whole approach from the Department of Health a bit prissy and namby pamby."

Two thirds of French men and half of all women aged 35 to 74 are thought to be overweight, according to a study released in June, while one fifth of all adults are obese.

France has taken steps to combat obesity in children with vending machines banned in schools since 2005.

A national programme in Britain now aims to weigh and measure children at age four to five and again aged 10 to 11, but parents can opt out of the process

Overweight problems seen even in infants

New research indicates that problems associated with being overweight occur at a much younger age than previously thought.In a study reported in the journal Pediatrics, overweight infants were at increased risk for developmental delays and possibly breathing problems, such as asthma. Moreover, in most cases, parents were unaware of their child's weight problem.

"Although the consequences of infant and childhood excess body weight may seem to manifest in later years, this perception is inaccurate," Dr. Ron Shaoul, from Bnai Zion Medical Center in Haifa, Israel, and colleagues warn.

"Our findings indicate a need to intervene during these critical years by adopting proper eating habits and active lifestyles," they add.

The findings are based on two studies. The first involved 2139 infants not older than age 2 who were admitted for any reason to the Bnai Zion Medical Center in 2004 and 2005. The second study was community-based and used parental interviews to assess the problems seen in 79 overweight infants and 144 normal-weight infants.

The infants were considered overweight if they had a body mass index (BMI) above the 85th weight-for-height percentile on 2 or more measurements taken at least 3 months part. This means that 85 percent of children their age and gender have a lower BMI, which is a measure of weight in relation to height.

In the first study, the researchers found that infants between the 85th and 94th weight-for-height percentiles actually had fewer hospital admissions and repeat admissions than normal-weight infants. However, higher than expected admission rates were seen in the most overweight infants (95th or higher percentile).

In the second study, overweight infants were more likely than their normal-weight peers to have developmental delays and snoring. There was also evidence that asthma and other breathing problems were more common in overweight infants.

When surveyed, only about 32 percent of mothers with an overweight child believed that their child was overweight.

Parents need to be aware that even infants are at risk for problems related to excess body weight and, therefore, should strive to achieve a normal weight in their young children, Shaoul and colleagues conclude.

SOURCE: Pediatrics, August 2008.

Clinton honors 43 schools for anti-obesity efforts

Former President Clinton is honoring 43 schools for their anti-obesity efforts, including one that banished candy from its building and another that offers a student fitness club.In a ceremony Wednesday at his presidential library in Little Rock, the former president planned to recognize the schools from a dozen states for their participation in the Healthy Schools Program, a joint initiative of the William J. Clinton Foundation and the American Heart Association.

"Despite the rising food prices and constrained budgets impacting programs nationally, these schools are using innovative approaches to curb the country's alarming rates of childhood obesity," Clinton said. "Schools around the country are stepping up and making progress."

The schools being honored include Kenly Elementary School in Tampa, Fla., which banished candy from its building.

A fitness club is offered to students at the Pine Hill Middle School in New Jersey, and the staff does yoga twice a week.

The Healthy Schools Program started in 2006 and now includes nearly 3,000 schools and more than 1.66 million students. It provides in-person support to 1,364 schools and aims to boost that number to 8,000 by 2010.

All U.S. adults could be overweight in 40 years

If the trends of the past three decades continue, it's possible that every American adult could be overweight 40 years from now, a government-funded study projects.The figure might sound alarming, or impossible, but researchers say that even if the actual rate never reaches the 100-percent mark, any upward movement is worrying; two-thirds of the population is already overweight.

"Genetically and physiologically, it should be impossible" for all U.S. adults to become overweight, said Dr. Lan Liang of the federal government's Agency for Healthcare Research and Quality, one of the researchers on the study.

However, she told Reuters Health, the data suggest that if the trends of the past 30 years persist, "that is the direction we're going."

Already, she and her colleagues point out, some groups of U.S. adults have extremely high rates of overweight and obesity; among African- American women, for instance, 78 percent are currently overweight or obese.

The new projections, published in the journal Obesity, are based on government survey data collected between the 1970s and 2004.

If the trends of those years continue, the researchers estimate that 86 percent of American adults will be overweight by 2030, with an obesity rate of 51 percent. By 2048, all U.S. adults could be at least mildly overweight.

Weight problems will be most acute among African-Americans and Mexican- Americans, the study projects. All black women could be overweight by 2034, according to the researchers, as could more than 90 percent of Mexican-American men.

All of this rests on the "big assumption" that the trends of recent decades will march on unabated, Liang acknowledged.

"This is really intended as a wake-up call to show what could happen if nothing changes," she said.

Waistlines aren't the only thing poised to balloon in the future, according to Liang and her colleagues. They estimate that the healthcare costs directly related to excess pounds will double each decade, reaching $957 billion in 2030 -- accounting for one of every six healthcare dollars spent in the

U.S.

Those financial projections are based on Census data and published estimates of the current healthcare costs attributed to excess weight -- and they are probably a "huge underestimate" of what the actual costs will be, Liang said.

The findings highlight a need for widespread efforts to improve Americans' lifestyles and keep their weight in check, according to the researchers. Simply telling people to eat less and exercise more is not enough, Liang noted.

Broader social changes are needed as well, she said -- such as making communities more pedestrian-friendly so that people can walk regularly, or getting the food industry to offer healthier, calorie-conscious choices.

"It really needs to be more than an individual effort," Liang said. "It needs to be a societal effort."

SOURCE: Obesity, online July 24, 2008.

Prostate cancer prognosis worse in obese men

Prostate cancer diagnosis tends to be delayed and surgical treatment more difficult in obese men than in lean men, according to two studies published Friday.The primary reason for the later diagnosis, and consequently poorer prognosis, seems to be that the PSA test used to screen for prostate cancer is "biased" against obese men, according to researchers.

The problem, they explain, may stem from obese men's larger blood volume, which dilutes their PSA levels. High blood levels of PSA -- or prostate specific antigen - can signal the presence of a prostate tumor.

"We know that obese men tend to have lower PSA values than their normal-weight counterparts, possibly caused by larger blood volumes which dilute their readings," Dr. Stephen J. Freedland, who led the studies, said in a written statement.

"Now we know some of the real implications of this -- that these men are at a disadvantage in terms of prognosis compared to normal-weight men."

Freedland, of Duke University Medical Center in Durham, North Carolina, and his colleagues report their findings online in the journal BJU International.

In one study, the researchers looked at the outcomes of nearly 3,400 prostate cancer patients who had undergone surgical removal of the prostate between 1988 and 2007. Some had had their cancer detected by PSA, while the rest had had it discovered during a digital rectal exam.

Overall, Freedland's team found, obese men were more likely to have more-aggressive tumors and to suffer a cancer recurrence after surgery.

However, the link between weight and disease progression was limited to men treated since 2000, when PSA screening had become the norm.

By contrast, obesity had no effect on the risk of progression for cancers detected by digital rectal exam. The findings support the notion that PSA testing, in particular, confers a bias against obese men, according to Freedland.

In the second study, the researchers found that obese prostate cancer patients tend to have a higher rate of "positive surgical margins" after prostate removal -- which means the odds are higher that some tumor cells were left behind.

"The aggressiveness of obese men's tumors, coupled with the fact that they may be more difficult to remove, is like a double whammy for being obese," Dr. Jayakrishnan Jayachandran, another researcher on the studies, said in a statement.

The findings of both studies, according to Freedland, build up the case for developing alternative prostate cancer screening methods for obese men -- or for lowering the PSA threshold for these patients.

"The least we can do is find a way to level the playing field when it comes to diagnostic tools," Freedland said.

SOURCE: BJU International, online August 8, 2008.

Obese Men Face Twin Threat From Prostate Cancer

The standard screening test for prostate cancer may not be accurate for obese men, leaving them more vulnerable to the disease, and surgery is less likely to be effective for them, a new pair of studies found."Obese men are more likely to be diagnosed with an aggressive form of the disease," said Dr. Stephen Freedland, an associate professor of urology and pathology at the Duke University Prostate Center, and an author of one of the studies.

The reason: The blood test that looks for elevated levels of the protein prostate-specific antigen (PSA), indicating a heightened cancer risk, doesn't seem as reliable for obese men, Freedland said.

"Our assumption is that these men have more blood volume, so PSA gets diluted, he said. "By the time obese men get to elevated levels, the cancer is more advanced."

The study, published online Friday in the journal BJU International included nearly 3,400 men who had PSA tests. The researchers found that the risk of an aggressive cancer was doubled in obese men diagnosed because of high PSA levels. No such association was found for obese men diagnosed by a digital rectal examination, in which the physician feels for an abnormally large prostate gland.

Prostate cancer is suspected when the PSA reading is 4 or higher. The current recommendation is for men aged 50 and older to be offered an annual PSA test, with explanations of its possible risks and benefits. A federal preventive medicine committee this week said that PSA screening should not be done for men aged 75 and older because the risks outweigh the benefits.

"I'm not sure that we should check obese men more often," Freedland said. "But we should have a higher [PSA] index of suspicion of what is not normal -- 3.4 rather than 4; for really obese men, 3.2."

The Duke study measured obesity using body-mass index, which is a ratio of weight to height. Obesity is defined as a BMI of 30 or more.

A second report from Duke in the same issue of the journal found that excess weight influenced the outcome of surgery for prostate cancer. Men with a BMI of 35 or higher were nearly 60 percent more likely to have a recurrence of the cancer than thinner men, the study of 1,434 men found.

One reason is "the difficulty of operating on obese men in general," said study author Dr. Jayakrishnan Jayachandran, a urology oncology fellow at the Duke Prostate Cancer Center. "The prostate is a narrow thing to operate on, and when there is a big wad of fat in your way, if the abdominal wall is thick, it becomes a technical issue."

The result is that not all the cancer may be removed, which means a recurrence after time, Jayachandran said. "The only thing we can think of is that when you operate on obese people, you have to be more careful," he said.

The studies results apply to men who might not regard themselves as obese, Freedland said. "We can't forget that when we use the term, we are not just talking about very large men," he said. "A man who is 5 foot 9 and weighs 203 pounds would be considered obese."

Jayachandran added, "We are not screening these obese men effectively and are not doing as good a job surgically as could be done."

Fit and fat: Study shows it's possible

It may be possible to be both fat and healthy, researchers reported on Monday, for at least half of overweight adults, and close to a third of obese men and women, have normal blood pressure, cholesterol and other measures of heart health.And being lean does not necessarily protect people, either. Close to a quarter of normal-weight U.S. adults in one study had risk factors for heart disease or diabetes.

"We really don't know as much about obesity as we think we do," Judith Wylie-Rosett of the Albert Einstein College of Medicine in New York, who oversaw the study, said in a telephone interview.

"A considerable proportion of overweight and obese U.S. adults are metabolically healthy, whereas a considerable proportion of normal-weight adults express a clustering of cardiometabolic abnormalities," Wylie-Rosett and Rachel Wildman and colleagues wrote in their report, published in the journal Archives of Internal Medicine.

Wylie-Rosett's team looked at data on 5,440 men and women who were examined and filled out questionnaires for the National Health and Nutritional Examination Surveys between 1999 and 2004. Most did not exercise very much.

They found just over 51 percent of those who were overweight, and 31.7 percent of those who were obese, had healthy levels of cholesterol, blood sugar, blood pressure and other measures linked to heart disease.

These measures have been shown in many other studies to predict heart attacks, strokes, diabetes and other heart disease, although this particular study did not look at whether people suffered any of these problems.

OBESE YET HEALTHY

More than 23 percent of those who were at a healthy weight, as measured by body mass index, had two or more unhealthy readings, the researchers found.

"Our study shows you can still be healthy even if you are obese," Wylie-Rosett said.

Her team did not look at people's diets, but she believes the location of body fat is as important as how much there is. Many studies have shown that having visceral fat, in and among the internal organs, may be more dangerous than having fat thighs or buttocks.

But when Wylie-Rosett's team measured waist circumference, a common way to estimate visceral fat, more than 36 percent of the obese people with what should have been dangerously large waists had healthy blood test results.

A second study suggested that the liver may be the key.

Dr. Norbert Stefan and colleagues at the University of Tubingen in Germany closely examined 314 people, using magnetic resonance imaging to look at precisely how much body fat they had and where it was.

They also found that obese men and women could have healthy hearts and arteries and suggested that having fat on the liver may be what makes the difference.

"Altogether, 10 percent of the study population and 25 percent of the obese subjects had a high insulin sensitivity phenotype or 'metabolically benign obesity,"' they wrote in their Archives report.

"Our data suggest that ectopic fat accumulation in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity," they wrote.

"That's an area that we are very intrigued with as well," Wylie-Rosett said," adding: "If you start stuffing people with calories, it is very much like making pate from goose liver."

Geese are often force-fed to make their livers fatty and thus more suitable for pate-making.

Scientists Create Mice Resistant to Obesity

Researchers have developed a strain of mice resistant to diet-induced obesity.The findings could one day lead to possible drug treatments for obesity in people. They also shed light on the brain circuitry that controls energy homeostasis -- the balance between how much energy (i.e., food) an animal takes in and how quickly it burns that energy.

Dr. Julio Licinio, a professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, called the research a "technological tour de force."

Dr. Bradford Lowell, associate professor of medicine at Harvard Medical School, led the study, which was published online Aug. 10 in the journal Nature Neuroscience.

According to lead study author Qingchun Tong, most research into energy homeostasis has involved what scientists call genetically encoded neuropeptides, rather than small molecule neurotransmitters.

Neurotransmitters "have been postulated to play a very important role in neurocommunication, but in this field, essentially no critical studies have been performed to address this issue," Tong said. "So I set up an experiment to create an animal model in which a particular group of neurons in the brain couldn't release a small neurotransmitter, and by examining those animal models, I could know the function of those molecules."

Tong and Lowell focused on one neurotrasmitter in particular, called GABA (gamma-aminobutyric acid). They developed transgenic, or mutant, mice that lacked the ability to release GABA in a subset of brain cells in the hypothalamus -- the brain region that controls processes such as hunger, thirst and body temperature.

On a normal diet, the normal and mutant mice weighed roughly the same, with mutant mice weighing slightly less. On a high fat diet, however, the mutant mice gained far less weight than the normal mice, even though the two groups ate approximately the same amount of food. The reason: The mutant mice were burning energy at a faster rate, the researchers said.

"We found that the mice without GABA release from AgRP neurons have increased energy expenditure and are resistant to diet-induced obesity," Tong said.

These transgenic mice were also resistant to the effects of the hormone ghrelin, which governs hunger. When normal mice were given ghrelin, their food intake increased. In the mutant mice, however, that effect was dampened, Tong said.

Finally, the researchers shed some light on the brain cell networks controlling energy homeostasis. They found that another group of neurons in the hypothalamus, called pro-opiomelanocortin (POMC) neurons, receive the GABA signal from AgRP neurons.

"The function of AgRP neurons is probably to reserve the energy for maintaining life," Tong said. "So if the animal doesn't have enough food, the animal should have some strategy to preserve energy, and this group of neurons, by releasing GABA, restrains energy expenditure to maintain enough energy to survive under the conditions in which food is not readily available."

According to Licinio, these findings underscore the importance of the GABA neurotransmitter in regulating the relationship between food consumed and energy expended. "I think it makes the role of GABA in obesity much more relevant than previously thought," he said.

Of course, as with all animal studies, it remains to be seen whether the findings can be repeated in humans.

Half of overweight adults may be heart-healthy

You can look great in a swimsuit and still be a heart attack waiting to happen. And you can also be overweight and otherwise healthy. A new study suggests that a surprising number of overweight people — about half — have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity.The first national estimate of its kind bolsters the argument that you can be hefty but still healthy, or at least healthier than has been believed.

The results also show that stereotypes about body size can be misleading, and that even "less voluptuous" people can have risk factors commonly associated with obesity, said study author MaryFran Sowers, a University of Michigan obesity researcher.

"We're really talking about taking a look with a very different lens" at weight and health risks, Sowers said.

In the study, about 51 percent of overweight adults, or roughly 36 million people nationwide, had mostly normal levels of blood pressure, cholesterol, blood fats called triglycerides and blood sugar.

Almost one-third of obese adults, or nearly 20 million people, also were in this healthy range, meaning that none or only one of those measures was abnormal.

Yet about a fourth of adults in the recommended-weight range had unhealthy levels of at least two of these measures. That means some 16 million of them are at risk for heart problems.

It's no secret that thin people can develop heart-related problems and that fat people often do not. But that millions defy the stereotypes will come as a surprise to many people, Sowers said.

Even so, there's growing debate about the accuracy of the standard method of calculating whether someone is overweight. Health officials rely on the body mass index, a weight-height ratio that does not distinguish between fat and lean tissue. The limits of that method were highlighted a few years ago when it was reported that the system would put nearly half of NBA players in the overweight category.

A number of experts say waist size is a more accurate way of determining someone's health risks, and the study results support that argument.

Dr. Robert Eckel, a former American Heart Association president and professor of medicine at the University of Colorado, said the new research may help dismiss some of the generalizations that are sometimes made about weight and health.

Study co-author Judith Wylie-Rosett emphasized that the study shouldn't send the message "that we don't need to worry about weight." That's because half of overweight people do face elevated risks for heart disease, explained Wylie-Rosett, a nutrition researcher at Albert Einstein College of Medicine in New York.

But, for those without elevated risks, losing weight "might be important only from a cosmetic perspective," she said.

To arrive at the estimates, scientists analyzed nationally representative government surveys involving 5,440 people age 20 and over, and extrapolated to calculate nationwide figures.

The new study, appearing in Monday's Archives of Internal Medicine, used government surveys from 1999 to 2004 that included lab tests and height and weight measurements. Participants reported on habits including smoking and physical activity.

In all weight categories, risk factors for heart problems were generally more common in older people, smokers and inactive people. Among obese people who were 50 to 64, just 20 percent were considered healthy compared with half of younger obese people.

The results underscore how important exercise is for staying healthy, even for people of healthy weight, Wylie-Rosett said.

The authors noted that fat tissue releases hormones and other substances that affect things like blood vessels, cholesterol and blood sugar. The results suggest this interaction varies among overweight and obese people, the authors said.

The results also add to mounting evidence that thick waists are linked with heart risks.

Among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies. This often signals internal fat deposits surrounding abdominal organs, which previous research has shown can be especially risky.

Similarly, among overweight and obese adults, those in the "healthy" category tended to have smaller waists than those with at least two risk factors.

Dr. Lewis Landsberg, a Northwestern University obesity expert, noted that the research didn't look at heart disease, and that not everyone with high risk factors develops heart problems.

Still, he said, the study shows that waist measurements can help assess health.

Obese people can be healthy: study

Some obese people are in good health and are not predisposed to heart ailments, according to a surprise study published in the Archives of Internal Medicine.And yet another study showed that being slim doesn't automatically protect you from heart-related illnesses such as high blood pressure and cholestrol, and diabetes.

In the first study, conducted by Norbert Stefan and a team at the University of Tubingen in Germany, the researchers studied the fat around the internal organs and under the skin of 314 individuals with an average age of 45.

The obese individuals in the study were divided into two groups: those who were resistant to insulin and those who were not. Insulin resistance is a pre-diabetic condition, meaning some symptoms of diabetes are present and progression to full-blown diabetes is likely.

Those who were obese and resistant to insulin had more muscle fat, fat in their livers and thicker carotid-artery walls -- an early sign of artery narrowing, which is a heart-disease risk factor -- than obese individuals without insulin resistance, the study found.

In addition, obese individuals who were not insulin-resistant had no differences in artery-wall thickness from the normal-weight group.

"We provide evidence that a metabolically benign obesity can be identified and that it may protect from insulin resistance and atherosclerosis," the researchers wrote.

The second study carried out by Rachel Wildman at the Albert Einstein College of Medicine in New York examined body weight and cardio-metabolic abnormalities -- including high blood pressure, elevated triglycerides and low levels of so-called good cholesterol -- in 5,440 individuals between 1999 and 2004.

The study found that some obese people are metabolically healthy.

"Obese individuals with no metabolic abnormalities were more likely to be younger, black, more physically active and have smaller waists than those with metabolic risk factors," the authors wrote.

Those of normal weight with health risks were older, less active and had a larger waist than the average population.

Among the US population aged 20 and older, some 23 percent (16 million adults) of normal weight have metabolic abnormalities, while 51 percent (36 million) of overweight adults and 32 percent (19.5 million) of obese adults "were metabolically healthy," the authors wrote.

Clumsy children more likely to become obese adults

Children with poor hand control and coordination are more likely to become obese adults, researchers said on Wednesday.The finding adds to a growing body of evidence linking poorer cognitive function in childhood to obesity and type 2 diabetes in adults.

A study of thousands of British children found those with the worst cognitive and physical function at the ages of seven and 11 years were far more likely to be obese in later life.

"It's not a question of people who are already overweight becoming clumsy because the majority of these children weren't any heavier than their peers," researcher Scott Montgomery said in a telephone interview.

"It was assumed that all the neurological complications associated with obesity were consequences of obesity itself. This suggests that's not the case."

The findings held true even after adjusting for factors likely to influence the results, such as childhood body mass and family social class, he noted.

What lies behind the link is unclear but Montgomery believes it could be a function of factors such as maternal smoking during pregnancy or lack of exercise in childhood. The latter is important for developing fine motor control.

The new study by experts from Sweden's Karolinska Institute and London's Imperial College is based on more than 11,000 individuals participating in Britain's ongoing National Child Development Study, which began in 1958.

Around 8,000 of them were assessed by teachers at age seven years to identify hand control and clumsiness, and just under 7,000 were tested for hand control and coordination at age 11 by a doctor.

The results were published in the British Medical Journal.

Scientists are finding a surprising number of connections between neurological problems and obesity. Earlier this week, U.S. researchers reported that running reduced the risk not only of heart disease but also of neurological diseases such as Alzheimer's -- as well as cancer.

Poor Coordination in Childhood Tied to Adult Obesity

A lack of physical control and coordination in childhood may be tied to an increased risk of obesity in later life, a new study says.The research, published online at BMJ.com Wednesday, adds to previous studies that found poorer cognitive function in childhood may be linked to obesity and type 2 diabetes in adults.

The findings, based on 11,041 individuals in the ongoing National Child Development Study in Great Britain, showed that children who showed poor hand control, poor coordination, and clumsiness at age 7 in testing were more likely to be obese adults. Those with poorer functioning motor skills at age 11 also tended to be obese at age 33.

Adjusting for factors that may influence the results, such as childhood body mass and family social class, did not change the results. However, the study did not delve into specific biological processes that may explain poorer physical control and coordination in childhood with adult obesity.

"Some early life exposures (such as maternal smoking during pregnancy) or personal characteristics may impair the development of physical control and coordination, as well as increasing the risk of obesity in later life," the authors, from Imperial College London and Orebro University Hospital & Karolinska Institute in Stockholm, wrote.

"Rather than being explained by a single factor, an accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function," they concluded.