For those few without other risk factors such as high blood pressure or high cholesterol, being obese doesn’t raise their risk of cardiovascular trouble.

“Metabolically healthy obese persons do not have the elevated cardiovascular risk of obesity, but represent only a small subset of the total obese population,” said lead researcher Dr. Andre van Beek, from the University Medical Center in Groningen. “It’s the metabolic risk profile that counts, and not the weight itself.”

He was to present the findings Saturday at the Endocrine Society’s annual meeting in San Diego.

For the study, van Beek’s group collected data on 1,325 obese people from among 8,356 people who participated in a large Dutch study.

Among the obese people, only 90 (6.8 percent) were metabolically healthy, the researchers found. That meant they had no history of heart disease, stroke, diabetes or high blood pressure, or high cholesterol or triglycerides. In addition, none of the 90 were taking cholesterol-lowering drugs.

Over more than seven years of follow-up, only one of these people developed cardiovascular disease. As a percentage (1.1 percent) this was not significantly higher than heart disease seen in metabolically healthy people who were overweight (1.3 percent) or normal weight (0.6 percent), van Beek’s team found.

To see whether you are at risk for heart disease, check your metabolic risk profile, van Beek advised. “If this is normal, be reassured that there is no excess cardiovascular risk independent of weight class,” he said.

At least one expert is not convinced that obesity itself does not lead to an increased risk for heart disease.

Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said that “while this study did not find increased risk associated with obesity if no metabolic abnormalities were present, it is important to note that other studies with longer-term follow-up have shown there is an increased risk of cardiovascular events in these individuals.”

“The balance of evidence suggests that, over the long-term, obesity imparts higher cardiovascular risk, even if metabolic abnormalities are not present at baseline,” he said.

A researcher specializing in diabetes and metabolic syndrome also thinks the follow-up period in the study is too short to draw firm conclusions about whether certain obese people are protected from heart disease.

Dr. Tae-Hwa Chun, an assistant professor of internal medicine at the University of Michigan, said that “clearly we need to know why some overweight and obese individuals are protected from metabolic deterioration and increased cardiovascular risk.”

This study suggests that identifying the genetic and molecular mechanism that underlies the deadly link between obesity and cardiovascular risk, which is selectively found in a subset of individuals, is more important than simply measuring body-mass index, Chun said.

“There is a caveat in this study, however, as the cardiovascular event rate is so low in the short follow-up period, the study may not possess enough statistical power to detect a potential difference in cardiovascular risk,” he said.

The rate of unplanned pregnancy among obese women is four times that of normal-weight women, despite the former having fewer partners, the report found.

For men, being obese greatly raised the odds for impotence and their risk of contracting a sexually transmitted disease.

“Being obese has a strong influence on people’s sexual life,” said lead researcher Nathalie Bajos, an associate professor at the London School of Hygiene and Tropical Medicine and research director at the National Institute of Health and Medical Research, in Paris.

She believes obesity affects the sex lives of women particularly hard.

“Because of social pressure or social stigmatization, obese women are less likely to engage in sexual intercourse and more likely to find sexual partners via the Internet,” Bajos said. “Because of their obesity, they are not comfortable meeting men through friends, through work, through parties,” she reasoned.

Obese women are also more likely than thinner women to be in a relationship with a partner who is also obese or overweight, Bajos said.

A lot of these problems are driven by the stigmatization of obese women, she said, and “these women are more likely to have low self-esteem.”

The report is published in the June 16 online edition of the BMJ.

For the study, Bajos and colleagues collected data on the sexual behavior of more than 12,000 French men and women. Among this group, 3,651 women and 2,725 men were normal weight, 1,010 women and 1,488 men were overweight, and 411 women and 350 men were obese.

Putting on excess pounds did take a toll on sex lives, the study found.

Compared with normal-weight women and men, obese women were 30 percent less likely to have had a sex partner in the past year, while obese men were 70 percent less likely to have had more than one sex partner over the same time, the researchers found.

Obese men were also 2.5 times more likely to experience erectile dysfunction than normal-weight men, and obese men under 30 were more likely to have had a sexually transmitted disease, the researchers found.

Obese women under 30 often didn’t seek contraceptive advice or use oral contraceptives, and were more likely to have an unintended pregnancy, the researchers found, and they were also less likely to visit a gynecologist, Bajos said. Due to being overweight, “they do not [always] feel comfortable seeing a gynecologist for contraception issues,” she said.

In addition, gynecologists and general practitioners are less likely to prescribe contraception to obese women, Bajos noted. “It could be that they believe these women are less likely to have a sexual life,” she said.

The study also found that obese women were five times more likely to meet sex partners on the Internet and more likely to watch pornography. Yet they were less likely to view sex as important in their lives, Bajos said.

Dr. Sandy Goldbeck-Wood is associate specialist in psychosexual medicine at Camden and Islington Mental Health Trust in the U.K., and author of an accompanying editorial. She said that “the differing sexual experiences of obese and non-obese people need cautious interpretation.”

“We need to understand more about how obese people feel about their sex lives, and what drives the observed behaviors and attitudes. In particular, we need to know why obese women use less contraception and have more unwanted pregnancies despite having fewer sexual partners,” Goldbeck-Wood said. “The answers are likely to be complex, with biological, psychological and social aspects that will require a qualitative research approach,” she added.

Doctors must also develop the courage, skill and sensitivity to speak to patients directly about their sex lives and their weight, Goldbeck-Wood noted. “Doctors in primary care and sexual and reproductive health need to pay particular attention to the complex contraceptive needs of obese women,” she suggested.

Dr. Robert Schwartz, professor and chairman of family medicine at the University of Miami Miller School of Medicine agreed that, right now, “a lot of physicians don’t pay much attention to obese patients’ sexuality.”

His advice to doctors: “Don’t make the assumption that your obese patients are not as sexually active as the rest of the population, and they need to be counseled appropriately.”

In fact, the quality of care for the obese may actually be higher and more aggressive than that given to normal-weight people, the study authors said.

“Contrary to our expectations, we found that in certain measures overweight patients were actually slightly more likely to get recommend care,” said lead researcher Dr. Virginia W. Chang, an assistant professor of medicine and sociology at the University of Pennsylvania.

The study findings are published in the April 7 issue of the Journal of the American Medical Association.

Chang said the study was motivated by surveys that found many doctors and health-care professionals “openly admit having negative attitudes towards obese patients. They say they are dissatisfied in caring for obese patients. They find it uncomfortable, unpleasant and not professionally rewarding.”

Obese patients are sensitive to this, she added. “A lot of obese patients will say they experience weight-related stigma from a doctor or they will name doctors as the primary source of weight-related bias,” Chang said.

These attitudes left Chang wondering if stigma might somehow lower the quality of care obese patients receive.

To find out, her team tracked eight common measures of quality of medical care, including diabetes care, pneumococcal vaccination, influenza vaccination, and screenings for breast, colorectal and cervical cancers.

The researchers evaluated these quality measures for more than 36,000 Medicare patients and 33,550 Veterans Administration patients.

Across all the quality measures in both groups of patients there was no indication that obese or overweight patients had lower odds of getting the recommended care, compared with normal-weight patients, Chang’s team found.

In many cases, obese and overweight patients had better chances of getting optimal care compared to normal-weight patients, the researchers found.

More aggressive treatment for obese patients was seen most among the Medicare group, where many more overweight and obese patients had their cholesterol levels and blood sugar screened.

In addition, a slightly higher number of obese and overweight patients in both groups received vaccinations against the flu and pneumococcal viruses. In the Medicare population there were also slightly higher rates of breast cancer screening, and among VA patients a higher rate of colorectal and cervical cancer screening versus that experienced by normal-weight patients.

“While it may be true that physicians and other health-care providers harbor negative attitudes towards obesity is does not seem to be borne out in lower quality of care. They are actually doing a good job,” Chang said.

Another expert agreed.

“I think our obese patients sometimes get better care than the people who are not because of their known risk factors,” said Dr. Robert Schwartz, professor and chair of the department of family medicine and community health at the University of Miami Miller School of Medicine. “So when an obese patient comes into the office we are probably hyper-vigilant rather than less vigilant.”

Schwartz noted that obese patients may feel they have more difficulty with the health-care system because the usual recommendation from doctors is often to diet and lose weight.

“Many obese patients are sensitive about their conditions,” he noted. But health problems associated with obesity, such as diabetes and heart disease, mean these patients will need more medical attention.

Obese patients also need a lot of support to optimize their care, Schwartz said.

“They need a team approach. They need to see a nutritionist. They need to get into a physical therapy program. They need to make sure they don’t have diabetes and if they do that needs to be taken care of,” he said. “It’s a much more complex problem than the way we used to look at obesity.”

But what if it were a big part of the solution?

One expert believes it can be. In fact, in just six months, the Mayo Clinic’s Dr. James A. Levine and colleagues helped 18 Minneapolis office workers lose a total of 156 pounds, just by redesigning the office and the office workday.

“By harnessing a little creativity, one can infuse the workday with movement. And in so doing — while adjusting the way we think about food — the pounds will simply start melting off,” said Levine, who is a professor of medicine in Mayo’s department of endocrinology in Rochester, Minn.

“Patients have tried everything to lose weight and get healthy, and nothing works,” Levine said. “Many have become despondent and feel it’s hopeless. But it’s not a hopeless situation at all.”

Levine’s “healthy office” approach is rooted in what experts call “non-exercise activity thermogenesis” (NEAT).

NEAT happens naturally, as humans burn off energy with everyday movements such as standing up, fidgeting, turning, bending and walking.

According to Levine, NEAT is distinct from the other primary forms of energy-expending processes, including active exercise, at-rest metabolism, or digestion.

For most sedentary Americans, the amount of energy burnt off by active exercise is actually “negligible” compared to what’s lost via NEAT, Levine said. In fact, NEAT accounts for between 15 percent (for very sedentary people) to about 50 percent (among the very active) of daily energy expenditure. And even minor lifestyle changes can boost one’s daily NEAT by about 20 percent, he said.

So that was the kernel of Levine’s idea: Make the office a more NEAT-inducing place.

To try it out, in 2007 he and his colleagues launched a six-month experiment targeting 18 office employees at a small financial staffing business in Minneapolis.

First, the research team “re-engineered” the firm’s offices. Chairs and traditional desk-seating were replaced with desks that came pre-attached to treadmills, and walking tracks were installed around the circumference of the office to facilitate “walking meetings.”

This wasn’t exercise, Levine stressed. “You don’t run at work, you walk. And what we are trying to do in fact is to get people to walk at the office while they work at a pace of 1.1 miles an hour,” Levine said. That pace falls within the NEAT category of energy use.

Other changes subtly encouraged more movement. The office’s landline phones were replaced with mobile sets; spaces for games such as Wii and foosball were made available, and employees were also outfitted with high-tech activity monitors. Staff was also offered nutrition counseling.

The result: A half-year later the 18 study participants had lost a total of 156 pounds, of which 143 pounds were pure body fat.

On average, employees lost nearly nine pounds each, 90 percent of it in fat, and their triglyceride (blood fat) levels plunged by an average of 37 percent.

Among the nine staffers who specifically indicated a desire to lose weight when the study began, average weight loss was even higher: nearly 15-and-a-half pounds.

Weight loss did not come at the price of workplace productivity. In fact, after only three months in the reconfigured office, staffers had boosted corporate revenue by almost 10 percent. Halfway through the study, the firm registered its highest monthly gross to-date.

“This was a small study,” Levine acknowledged. “But when people who are really suffering with weight and health problems see the results it’s a very, very powerful ‘eureka moment.’ Because the trick here is that we’re not asking them to think about weight loss. We’re asking them to simply live their day in a dynamic and positive way.”

The study, which is awaiting publication, “shows that you do not have to have a gym membership to do that,” he noted. “In fact, for most people the energy burnt off at the gym is a lot lower than you might think. When you average it out over three times a week at the gym, most people are only burning off about 70 calories a day.”

“But you can achieve much more than that by infusing your day at the office with a steady level of movement without going anywhere,” Levine noted. “By taking a phone call standing up, by having a meeting walking around — slowly, a shopping pace, at maybe one mile an hour — and by taking the elevator to the third floor and walking up the other three, you will burn an extra 100 to 150 calories an hour. That’s an extra 400 to 500 calories a day. And that’s a big number.”

“If, in addition, you philosophically change the way you look at food, using food as a fuel rather than as a comfort, all of a sudden you have a weight-loss program that is available and amenable to everybody,” he added.

One expert applauded Levine’s approach, but wondered how accessible it might be for most workers.

“Yes, non-intentional exercise such as just standing instead of sitting burns more calories than if you were sitting by your computer all day. Little changes like that add up, burn calories, and make a difference,” said Lona Sandon, a registered dietician and assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas.

“But for an individual to make this kind of office place activity change they need a work environment that strongly promotes the habit,” she added. “An individual employee cannot make it happen all by himself. So unless an organization decides it’s worth putting the effort towards a remodeling it’s probably not going to happen.”

But another expert said he’s experienced the benefits of the “healthy office” firsthand.

“I’ve probably employed this approach for about twenty years, myself,” said Cedric X. Bryant, chief science officer at the non-profit San Diego-based American Council on Exercise. “People used to think I was nuts, but I do all of my editing of books and article and manuals while exercising on a step-mill — a revolving staircase type of stair climber — that I have set up, so my material is on a reading stand while I move at a very low intensity.”

“I can certainly tell when I’m working on a particularly heavy project,” Bryant chuckled, “because I lose all that much more weight.”

“And it also helps me have greater focus and mental clarity,” he added, “which makes my editing process so much easier and productive. I would say that I am probably a good 30-40 percent more productive while exercising than while sitting at my desk.”

“We need to get people to not think that the only way to get fit is through a structured experience at a prescribed intensity at the gym,” Bryant said. “We need to think of an active lifestyle being throughout the entire day, and not just during workout sessions. And if you simply move more while you work you will get the benefit you want.”

Mrs. Obama visited the Fairhill Elementary School in North Philadelphia on Friday afternoon as part of her campaign to curb childhood obesity.

She announced plans for more than $400 million in funding to help bring healthy food retailers to underserved communities.

Obama says Philadelphia and the state of Pennsylvania have done great work to increase access to fresh foods and combat obesity.

She says six years ago, the state invested $30 million in fresh food initiatives that helped fund 83 supermarkets statewide.

She also stopped by a North Philadelphia grocery story earlier Friday.

In a new study, the researchers report that using a standard 1-inch needle to immunize obese adolescents against hepatitis B virus produced a much weaker effect than using a longer needle.

“As obesity rises in the U.S., we need to be aware that the standard of care may have to change to protect obese youth,” study co-author Dr. Amy Middleman of Baylor College of Medicine in Houston told Reuters Health.

Over three years her team vaccinated 22 young women and two young men in the shoulder, randomly assigning them to be injected with either a 1-inch or a 1.5-inch needle.

Once injected, vaccines trigger production of small molecules called antibodies, which kick-start our immune system if we are ever attacked by the virus again.

The two groups turned out to have different antibody counts depending on the needle used. In those injected with the short one, the number was almost halved.

Although everyone in the study had enough antibodies to be considered protected against hepatitis B, a lower count generally means a less robust response.

“It gives us more evidence of the importance of choosing the right needle length,” said Middleman, “because we just don’t know what the impact could be in other vaccines.”

The results are no surprise, said Dr. Gregory Poland, who studies vaccines at the Mayo Clinic in Rochester, Minnesota. For years, doctors have known that vaccines tend not to work as well in heavy people. Whether the obese have weaker immune systems, or fat keeps shorter needles from reaching muscles, where the vaccines can affect immune cells, was unclear.

The introduction of the hepatitis B vaccine in the 1980s offered some clues. Soon after doctors began using the vaccine, they realized that it was failing to protect some female nurses.

At the time, the shot was given in the buttock, Poland told Reuters Health, and was thwarted by the padding there.

Instead of entering the muscle as it was supposed to, the vaccine apparently was broken down in the fat tissue, where it had little chance to affect immune cells. So doctors began giving the shot in the less-padded shoulder.

With the obesity epidemic now adding extra insulation to the shoulder, “our needles are going to have to be longer,” Poland said.

And those long needles aren’t as unpleasant as they sound. In fact, Poland said, “they turn out to be less painful and have fewer side effects.”

The Centers for Disease Control and Prevention recommends longer needles in obese patients, but it is unclear how many doctors follow these guidelines, or even know about them.

Women are more affected by needle length than men, because their fat distribution is different. But even obese women shouldn’t be overly concerned until more research has been done, Middleman cautioned.

“Should you go back and get all your immunizations repeated?” she said, “No, I don’t think so.”

SOURCE: Pediatrics, March 2010 (published online February 8, 2010).

Everyone is familiar with scents that arouse the appetite, as well as odors that turn the stomach. But apparently molecules that make up a food’s aroma can also activate areas of the brain that trigger the feeling of fullness.

As people chew food, scents wafting up to the back of the nose from inside the mouth help quench the sensation of hunger, food technologist Rianne Ruijschop at NIZO Food Research in Ede, The Netherlands, and her colleagues found.

“These were quite unexpected results,” Ruijschop told LiveScience. “Everyone was quite astonished and very energetic about them.”

Variety of findings

Certain aromas, flavors and textures were especially effective at making people feel full.

• Solid foods that required chewing and swallowing - thus offering a lingering release of aromas - proved more satiating than liquid foods.
• When odors linked either with fat, carbohydrates or proteins were tested, adding scents linked with carbohydrates or protein significantly increased the feeling of fullness, perhaps because they suggest food is high in energy.
• Complex aromas with multiple components were more filling than others with just one component. Complex aromas might tell the brain it’s eating a variety of food and thus a large meal.
• The size of food samples had an impact, as smaller bite sizes prolonged the amount of time in which odors could have an effect.

In experiments, the researchers could modify how filling various foods were. For instance, making a beverage release aromas much like solid foods would significantly increased the feeling of fullness.

Feeling full

These findings could help researchers develop a new generation of foods that release aromas that help people feel full, therefore fighting overeating and obesity. Scientists might add capsules that boost or prolong aftertaste or release of aromas. They might also introduce chewy ingredients, or reduce bite size to increase the amount of chewing people have to do. Complex odors could be added, as well as scents that suggest the food is rich in energy.

In recent, as-yet unpublished work, Ruijschop said that by controlling aroma, they could in fact lower the amount of food people consumed by roughly 10 percent. They are now conducting long-term studies to see what effects months of changes in aromas can have on people.

Although aromas could contribute to the fight against obesity, “they’re not really the solution by itself,” Ruijschop noted. “It’s also very much about changes in lifestyle.”

Ruijschop and her colleagues detailed their findings in the November 11 issue of the Journal of Agricultural and Food Chemistry.

Original Story: Anti-Hunger Smells Could Battle Obesity

The paper, written by doctors in Britain and Sweden, seeks to finetune a well-known tool — the body mass index (BMI) — which is used to measure obesity and ill-health.

BMI entails taking one’s weight in kilos and dividing it by the square of one’s height, in metres. A BMI of 25-30 is generally considered overweight. while a figure of above 30 indicates obesity.

Previous studies have already found a big link between BMI and higher risk of death from cardiovascular disease, diabetes and some cancers.

In contrast, a low BMI — in other words, people who are very skinny — is associated with increased mortality from respiratory disease and lung cancer.

But many experts have questioned the findings about low BMI, arguing that the figures could be skewed by something called reverse causality.

For instance, diseases such as lung cancer, which cause weight loss, are being factored in as low BMI, they argue. And smoking and poor socioeconomic circumstances may also cause bias.

Seeking to find out more, specialists from Britain’s University of Bristol and the Karolinska Institute in Sweden set out to get a wider view of the BMI benchmark.

They measured BMI and mortality among more than a million pairs of Swedes, comprising mother-and-son pairs and father-and-son pairs, over 50 years.

They found strong patterns of mortality and BMI.

The link was especially noticeable in cardiovascular disease — for which prevailing estimates may be “substantially underestimated” — as well as diabetes and kidney cancer.

But there was no evidence of an association between low BMI and an increased risk of respiratory disease and lung cancer mortality.

The findings are important, because they imply that obesity programs could yield major health benefits, says the study.

“Suggestions to the contrary are probably misguided,” it adds.

Even though the study participants ate whatever they wanted on their non-fasting days, they lost an average of 5.6 kilograms (about 12 pounds) after eight weeks, Dr. Krista A. Varady of the University of Illinois at Chicago and her colleagues found.

What’s more, their total and “bad” LDL cholesterol levels dropped, and their blood pressure fell.

“People lost anywhere from about 7 pounds to about 30 pounds and that was in a very short amount of time,” Varady said. And, she added, the program was pretty easy for the study participants to follow.

People typically try to lose weight by cutting their calorie intake every day, Varady and her team note in the American Journal of Clinical Nutrition. A much rarer approach, they add, is to have people alternate “feed days” with “fast days.” Studies in normal and overweight people have shown that this strategy can indeed help people lose weight and improve their cholesterol levels.

To test alternate-day fasting in obese adults, Varady and her colleagues had 12 obese women and 4 obese men begin by eating normally for a two-week control period. Then, for eight weeks, they ate just 25 percent of the calories they needed to maintain their weight, between noon and 2 p.m., every other day.

For the first four weeks, the researchers provided study participants with their fasting day meal, while for the next four, study participants met with a dietitian every week and prepared the meal themselves.

Study participants lost about 0.7 kilograms (1.5 pounds) every week. At the end of the eight-week diet, their total cholesterol had dropped by 21 percent, on average, while their LDL cholesterol had dropped 25 percent. Moreover, their systolic blood pressure (the upper number in a blood pressure reading) had fallen by an average of five points.

While Varady and her team had thought people might overeat on their non-fasting day in order to compensate, this turned out not to be true; people typically ate between 100 percent or 125 percent of their calorie needs on their all-you-can eat days.

“I think it’s probably because their stomachs kind of shrunk,” she said.

The next step, the researcher said, will be to figure out if people can maintain the on-off approach for a longer period of time, to continue to lose weight or to maintain a healthy weight.

Anyone who wants to give the diet a try, she added, should meet with their doctor or a dietitian first.

SOURCE: American Journal of Clinical Nutrition, November 2009.

The group, which funds research on the link between diet and the disease, said 49 percent of endrometrial cancers, which originate in the womb, and 35 percent of esophageal cancers are linked to excess body fat.

“It’s clearer than ever that obesity’s impact is felt before, during and after cancer, it increases risk, makes treatment more difficult and shortens survival,” said Laurence Kolonel of the Cancer Research Center of Hawaii.

Scientists have long seen a link between obesity and certain types of cancer, but the study — extrapolated from US cancer incidence data — is among the first to conclude the link exists on such a scale.

Researchers have yet to pin down the exact link between obesity and cancer, but some have suggested that fat tissue may produce heightened levels of sex hormones that spur cancer growth or that fat lowers immune function.

If the link is proven to be true, cancers could be expected to expected to balloon in tandem with US body sizes.

According to the government-backed Centers for Disease Control, 34 percent of American adults aged 20 and over are obese.