“Rex went public with his band surgery about 2 years ago. Now, the benefits of his decision to have a band are easily seen. He’s gone from 340 lbs to 256 lbs, and is still losing weight. There are many ways to lose weight, most of them fads, and most doomed to failure in the long term. Every day, a new miracle cure pops up on TV and in magazines. Weight loss surgery, or bariatric surgery, has been around for a long time, and has stood the test of time. It’s certainly no miracle. It’s hard work. It’s a choice patients make after they’ve tried and failed many times to lose weight and keep it off, are often getting sick, and have deteriorating quality of life.

Dr. Fielding emphasized: “Weight loss after bariatric surgery is a journey. It’s not a race. It’s not what happens in game one: it’s whether you get to the superbowl, and whether you are still there the next year fighting for the next one. It’s completely expected that a large man like Rex will lose about 120-130 lbs, then keep it off. He’s on track to do this. He will definitely be a slimmer Rex than most fans are used to seeing, when the season opens later this year. I told Rex all this 2 years ago – like I tell all our patients: The keys to success with the band are simple – keep attending follow-up to adjust the band as necessary to control hunger, then, once the band is tight, eat slowly, and eat as healthy food as possible. I have had a Lap Band myself for 12 years, and have been the same weight for the last 10 years. I just eat slowly, which can be the hardest part for a big guy – and I get full and I stop, because I’m not hungry. It can be frustrating at times, especially if patients don’t think they are losing weight fast enough. But everyone has to remember it’s not a race.”

Stay tuned for an upcoming article where Rex Ryan & Carnie Wilson’s surgeons speak to us about myths and perceptions of weight loss surgery, and what they’d like people to understand about their patients. You can sign up for our weekly newsletter, with the latest research and news on obesity and weight loss here.

Some of the weight trends that were captured in the projection include the transition into adulthood of a population of obese children, the growing population of Latinos, among whom obesity is a growing problem, and the aging of overweight and obese adults, who are far more likely to put on more weight than to lose weight as they age. On a positive note, the study found that the growth rate of obesity in women is projected to be fairly flat.  Additionally, earlier predictions based on the soaring rates of the 1980s ,1990s and 2000’s had projected a 51 percent rise in obesity, while this study expects a 33 percent increase.

The growth in obesity would spur additional health care spending, with the additional obese Americans estimated at costing $549.5 billion in health care cost over the next two decades. Even small successes in anti-obesity initiatives could substantially reduce this figure, though, as it represents the difference between providing healthcare for a population with 34 percent obesity and a population whose obesity prevalence has grown to 42 percent.

The forecast accounted for several factors associated with eating and exercise habits: the density of restaurants, the cost of groceries, rates of unemployment, internet access and the price of gas. The key factor, according to the CDC, was the aging of the population, which pushes many overweight adults into the obese category, as well as many already obese adults into the “severely obese” category.  The study authors caution that predicting obesity rates is “tricky business”, despite the best models.  While exercise habits, accessibility of healthy food and convenience of fast food restaurants all influence a population’s tendency to put on the pounds, such factors stand alongside more powerful influences, such as genetics.

Genetics are believed to play an important role in one’s propensity toward weight gain.  A personalized approach may be the future of treatment of severe obesity, taking into account an individual’s DNA, combined with a personalized, in-depth understanding of physical fitness and clinical well-being. You can read more about this approach to obesity treatment here.

The researchers found that vagotomy significantly reduced total body fat, as well as visceral abdominal fat, known as the “beer belly” fat. The volume of visceral fat a person has is a marker of obesity, and obesity-related diseases. While vagal de-afferentation reduced these fats to a lesser extent, the researchers still describe the reduction as “remarkable”.  Being able to target dangerous visceral fat makes these procedures especially appealing. Of the two procedures, vagal de-afferentation has fewer side effects, as it does not completely destroy the vagus nerve; while the capsaicin destroys the nerve fibers that move signals from the gut to the brain, it leaves the fibers that send signals in the opposite direction intact.

The findings of this study are early and further research is needed to determine if capsaicin could be applied directly to human vagal fibers.  Procedures such as these that show promising results for weight loss in a less invasive fashion will become more important as the demand for weight loss surgery increases, say the study authors. Additionally, as diabetes rates continue to climb, more and more people will need effective therapy options to fight the epidemic. In fighting the battle against visceral fat, soluble fiber has proven to be an effective weapon. A study last year showed the positive effects of soluble fiber, which is found in beans, oats, peas, apples, carrots, and barley. You can read more about the study here.

Another recent study found fat-fighting promise in another “spicy” ingredient–black pepper.  Researchers pinpointed that  piperine, the pungent-tasting substance that gives black pepper its characteristic taste, can block the formation of new fat cells. Lab studies and computer models found that piperine interferes with the activity of genes that control the formation of new fat cells, and in doing so, it may also set off a metabolic chain reaction that helps keep fat in check in other ways. You can read more about the black pepper study here.

The findings of this study greatly enhance the potential to generate drugs which can both block and stimulate the receptor for the obesity hormone leptin.  It is an exciting prospect, as the United States has not had an obesity drug approved by the FDA in more than 13 years. In the past year, the weight loss drug QNEXA, a low-dose combination of phentermine and topiramate, has had good traction with the FDA; however last month the FDA decided that it will be pushing back its decision on whether to approve the weight loss drug until July 17, 2012. The FDA’s original deadline was April 17, 2012. You can read more about the decision to approve QNEXA here.

By measuring the activity of thousands of genes at once – called a global gene expression analysis – UC researchers found that perivascular (outer) fat tissue is different from the fat tissues in other parts of the body. It has been proposed that dysfunctional perivascular fat is to blame in the onset of coronary artery disease; research has shown that in people with coronary artery disease, the fat tissue is highly inflamed.

The researchers replicated the inflammation in an animal model. They found that the closeness of the perivascular fat to the artery easily influences the function of the coronary blood vessel wall. Lead researcher Tapan Chatterjee, PhD, explained that the findings showed that perivascular fat is especially sensitive to a high-fat diet, and induced inflammatory changes in their animal models. Specifically, when they transplanted perivascular fat from obese mice to the carotid artery of lean mice, the tissue was detrimental to the blood vessel wall and quickly led to disease formation. “We believe this cross-talk between perivascular fat and the coronary artery is very important in triggering coronary artery diseases,” said Chatterjee.

Next, the team plans to identify various secreted factors, or signals, from perivascular fat tissue of obese mice that could negatively influence the functions of the blood vessel wall. Their goal is to be able to use this research to treat patients before they experience the onset of coronary artery disease. This new research was presented at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology Annual Meeting last month.

Related Reading: Earlier in 2012, a study of 4,000 obese adults was published, showing that there are fewer heart attacks after bariatric surgery. You can read about that study here.

Nearly one out of three adults in America has fatty liver disease, and many of them are not symptomatic and may not even realize they have the condition.  Obese people are at an increased risk of developing fatty liver disease.  With obesity, the transport of fat to adipose tissue can slow down to the point at which the liver becomes essentially, a “dumping ground” for excess fat. When this happens in an organ that is not supposed to store fat, such as the liver, the organ’s vital function can be dangerously compromised and in the case of fatty liver disease, it can lead to liver failure.  The study findings suggest that by partially restoring the function of a key signaling pathway, called Wnt/β-catenin, soy protein could help reduce liver fat accumulation in obese people.

It has been known for decades that fat production by the liver runs on a 24-hour cycle, known as the circadian rhythm. It is similar to the sleep-wake cycle.  Last year, a study found that the molecules that protect the liver from fat work as “shift workers” during the day. You can read more about the study here.

The researchers found that at age 5, 21 percent of the children were obese, and 25 percent of those followed to age 7 were obese. After adjusting for a number of factors including sex, ethnicity, age, birth weight, and the mother’s acceptance of public assistance, the higher prenatal PAH exposures were significantly associated with higher childhood body mass index (BMI). The results showed that compared with children of mothers with lower levels of PAH exposure during pregnancy, children of mothers with high levels of exposure were almost twice as likely to be obese at age 5, and more than twice as likely to be obese at age 7. Further, not only did the children of high exposure have higher BMIs, but also more body fat, with an average of 2.4 pounds more fat mass than the other children.

Earlier research by the same team found that the pollutants can also negatively affect childhood IQs and is linked to anxiety, depression and attention problems in young children.  Additionally, PAHs interfere with the body’s endocrine system and are known to cause cancer.  Also of note, the study did not find that the pollutants risk of obesity was influenced by household income or neighborhood poverty, nor cigarette smoke in the household or proximity to highly trafficked roads.

We spoke with Dr. Daniel Cottam, expert weight loss surgeon in Utah, about the study. He said: “This article again proves that obesity is a multifactorial disease.  Too many people assume that obesity is only due to slothfulness.  This shows that not only does high inactivity in inner city produce higher weight children, but literally the air they breath in urban centers affects the rates of obesity,” Dr. Cottam concluded.

The study authors explained that aside from moving away from the city, there are a few ways to reduce PAH exposure;  Some fuels release more of the chemicals than others and efforts in New York City to take diesel buses off the streets and retrofit oil furnaces so they burn cleaner fuel is already starting improve air quality.

The research demonstrates that both smoking and obesity lead to substantially higher health care costs, and with employers looking for ways of reducing health care costs, the findings support programs designed to help smoking cessation and encourage weight loss. Another recent report assessing the cost of obesity found that obesity now accounts for 21 percent of all health care spending in the United States. The report estimates that an obese person’s medical costs are even higher than what the Mayo Clinic study found, with obese people spending $2,741 more annually than someone who is not obese.

Dr. Vafa Shayani, expert bariatric surgeon in Chicago, commented on the study. He said “Many of us perceive obesity and smoking as variations of substance abuse.  Accordingly, to overcome each condition, patients might benefit from life-long behavioral modification strategies.  Thanks to the abundant support for adverse effects of second-hand smoke, smoking at public places, including places of employment, has long been banned.  It is hard to imagine that we will ever impose similar restrictions for food intake.  However, studies like this one clearly demonstrate the significant economic impact of obesity, not just for the obese individual, but the society in general.  At the very least, employers might consider incentivising their employees for healthier life-styles, which should include better eating habits,” Dr. Shayani concluded.

For severely obese people, bariatric surgery is often an effective weight loss treatment. A 2011 study found that not only is bariatric surgery cost-effective, but it ultimately saves money in healthcare costs for the most severely obese patients that suffer from diseases related to their weight, including heart disease, high blood pressure and Type 2 diabetes. You can read more about that study here.

The first study involved 30 physically-fit adults in their 20’s.  Researchers from California Polytechnic State University studied responses in the regions of the brain known as the ‘food-reward system’ by attaching magnetic resonance imaging (MRI) coils to the participants’ heads. The food-reward system controls whether we like and want food. In general, the more cells firing in the region, the higher the desire to eat.  The participants first either spent an hour riding a stationary bike or sat quietly for an hour before being tested. They then swapped activities for a second MRI session. After performing the activities, the participants viewed a series of images of food, varying from healthy fruit and vegetables to cheeseburgers and ice cream. There were also a few non-food images in the series.  The food-reward system consistently lit up in the participants after they had been sitting for an hour, especially when they saw the high fat or sugary images.  However, after these same participants had exercised vigorously on the bike for the hour before, their brain scans displayed much less interest in food. Portions of the food-reward system remained fairly quiet, even when viewing ice cream and burgers. The reduction in response was spread over many areas of the brain, including those that are related to liking and wanting food, as well as the motivation to seek out food. The participants indicated on questionnaires that they felt much less interested in seeking out food after the exercise than after resting for an hour.

Dr. Bob Michaelson - a bariatric surgeon and avid cyclist

The article pointed out that these results may not be typical, however, since the participants were all physically fit and in their 20’s. In fact, previous research, has found that some overweight, sedentary people respond to exercise by revving their food-reward systems, not dampening them. In a study published last year, 34 overweight people were put on a supervised exercise routine, designed to burn around 500 calories each workout. The participants were allowed to eat as they chose throughout the study.  After 12 weeks, 20 people had shed considerable weight– 11 pounds, on average. The other 14 had lost at most a pound or two. These 14 were called  ‘nonresponders’, and had the highest brain responses to food cues following exercise when the study began. After 12 weeks, they still had the highest brain responses with their food-reward systems lighting up after exercise at the sight of food.  The nonresponders actually showed more enthusiasm when viewing food at 12 weeks than at the beginning.

The study author suggests that these findings indicate that exercise may influence appetite differently based on the individual’s body as well as the length and vigor of the exercise.  For physical activity to noticeably to decrease appetite, it may be important to exercise for an hour or more and it may help to be already lean and in shape.  They encourage everyone to exercise, as even if exercise makes you ravenous, being active can have psychological effects, perhaps increasing your desire to eat a better diet and ultimately lose weight in the long term.

Dr. Bob Michaelson, expert weight loss surgeon in Washington State, spoke with us about the findings. He said: “Our brains allow us to adapt to our environment in ways that ensure not just our individual survival, but the survival of the human race. Our skin and sensory organs are obvious interfaces between our bodies and the environment, and signals between these organs communicate information to the brain about the environment. Is it hot or cold; wet or dry; painful or pleasant; friend or foe?” Dr. Michaelson explained that similarly, our digestive tracts are in constant communication with the environment through what we eat and drink – the products of our environment. “Subtle signals between these organs and the brain communicate to subconsciously direct our food choices”, he said. “It is not surprising that these recent findings demonstrate that the brain plays a central role in our food choices based on our fitness level.”

Dr. Michaelson pointed out that these studies highlight some findings we have known for years, but have yet to work out how all of the pieces of the puzzle fit together. “For instance, there are more nerve cells in the gastrointestinal tract than there are in the brain, and almost all of the neurochemicals present in the brain are also found in the GI tract,” Michaelson explained. “We also know that weight loss surgery is a tool that allows people to lose weight, in part, by appetite suppression, through communication between the brain and gastrointestinal tract. At some point, we will eventually solve the puzzle and understand exactly how the brain and GI tract interact to control hunger and weight.” Dr. Michaelson concluded that “until then, continue to exercise!”

Related Reading:

Addicted to Food – a 2011 study suggests that compulsive food eating may be driven in part by an enhanced anticipation of the rewarding properties of food, similar to how drug addicted individuals react to substance-related cues.

One of the key findings of the study was that during the sleep deprivation and circadian rhythm disruption period, the participants’ resting metabolic rate decreased while their blood sugar levels increased after meals, at times even reaching a level considered pre-diabetic. This was caused by the pancreas not producing enough insulin. These changes seen in the participants were severe enough to amount to a 10 pound weight gain over the course of a year. After the recovery period, these metabolic changes returned to normal.

A recent study of more than 2000 nurses found that those who work long hours were significantly more likely to be obese. You can read about the study here.