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Mar 13

Experimental weight loss pill seems to be more potent than Ozempic – New Scientist

An oral weight loss drug could help people with obesity who dislike needles

Kseniya Ovchinnikova/Getty Images

An experimental pill looks set to cause more weight loss than existing injectable treatments such as Ozempic, Wegovy and Mounjaro, based on early trial results reported on 7 March.

The medicine, called amycretin, caused people to lose 13 per cent of their weight over three months, more than twice the amount seen with Ozempic and Wegovy specifically. This approach seems to be a little bit more exciting, from the limited data that we have, says Daniel Drucker at the University of Toronto in Canada.

The results are from a placebo-controlled trial lasting three months, so it is too soon to know how amycretin stacks up against the other medicines for long-term effectiveness and safety, says Drucker, who wasnt involved in the trial but has consulted for the manufacturer Novo Nordisk, as well as other pharmaceutical firms.

The diabetes drug Ozempic and the weight loss drug Wegovy are two brand names for the compound semaglutide. They work by mimicking a gut hormone called GLP-1 that is normally released after eating. This makes people feel full, reduces their appetite and boosts the release of the blood-sugar-regulating hormone insulin.

Semaglutide leads to the loss of about 15 per cent of body weight after it has been taken for one year, although weight then plateaus and people need to continue the injections long term or it tends to creep back up.

Another weight loss injection was launched last year, called Mounjaro, also known as tirzepatide or Zepbound. This mimics GLP-1 and an additional gut hormone called GIP. Mounjaro seems to lead to people losing about 21 per cent of their weight over the first year and five months of use, before their weight loss plateaus.

Amycretin, however, mimics GLP-1 and a different hormone called amylin, which seems to make it more potent still at least over the first three months of treatment. People taking amycretin lost 13 per cent of their weight in this period, Novo Nordisk announced today, according to a report by Reuters. Those taking placebo pills lost 1 per cent.This is more than the equivalent figures for Wegovy and Ozempic, of 6 per cent, and for Mounjaro, of about 7.5 per cent.

However, we can only know for sure how the drugs measure up long term when they are compared under exactly the same circumstances in a single study, says Drucker. These are not head-to-head trials.

Another caveat is that medicines that work by mimicking GLP-1 have been used for more than a decade to treat type 2 diabetes and so their safety profile is well understood, which isnt the case for an amylin mimic.

Novo Nordisk has also said that amycretins side effects were similar to those of Wegovy, which tend to be nausea, vomiting and diarrhoea, especially for people who increase the dose too quickly.

Being available in tablet form would be a great advantage for people who dont like injections, says Daniel Chancellor at global pharmaceutical business analysts Citeline. An oral pill is very attractive.

As well as these three medicines, other weight loss drugs that mimic other gut hormones are also in development.

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Experimental weight loss pill seems to be more potent than Ozempic - New Scientist


Mar 13

Running may not help lose weight but it’s very good for you long-term – ZME Science

After the January rush of motivation, most people simply give up on their new-year-new-me fitness goals. But those that persist and stick with it are likely to see some noticeable results.

Take running, for instance. When someone whos unfit or overweight starts running and keeps up with it for a little time, they may see some quick results. But after a few months, most people start to hit a plateau both in performance, and in physical improvement. In fact, a new study suggests that running doesnt help you lose a lot of weight long term. However, it does keep you healthy and prevents you from gaining fat long-term.

Our data clearly shows that lifelong running exercise, be it long-distance or repeated short-distance sprinting, maintains lower fat mass levels than a typical physically active lifestyle and also more than participating in competitive strength sports. says Dr. Simon Walker, a Docent in Exercise Physiology from the Faculty of Sport and Health Sciences.

The researcher added that this is excellent motivation for himself as a runner.

Absolutely this result motivates me to continue running. Id certainly be happy with a fat percentage of 1618% when Im in my 70s and 80s, continues Dr. Walker.

The study involved 109 participants aged 20-39, 147 participants competitive male athletes aged 70-89, as well as 147 healthy age-matched controls. The athletes were separated by their focus (on strength, sprint, and long-distance running). Researchers assessed the body composition of all participants (fat mass, muscle mass, etc).

The study made several important findings. For starters, individuals participating in lifelong resistance training maintained their muscle mass much better than those participating sprinting. In addition, the older strength trainers had a similar amount of muscle mass as their young counterparts. Also, people who engaged in lifelong running had less fat than other participants.

So, if you want to get the best of both worlds, you need to get involved in both worlds. Essentially, in order to maintain a higher muscle mass and a lower fat mass, the best approach is doing both strength and resistance training.

In terms of enhancing body composition through both heightened muscle mass and maintenance of a non-health affecting fat mass, it seems that a combined approach is recommendable.

We know that both tissues, fat and muscle, influence overall health and function opposingly. Therefore, the best strategy would be to optimize both.

However, there are limits to what exercise alone can achieve. All older athlete groups showed higher average fat mass than the young groups, suggesting that you need more than just exercise to keep fat under control.

Nevertheless, this research shows just how much physical activity matters in remaining healthy as one ages.

The key is perhaps to prevent a rise in fat mass or loss in muscle mass in the first place and maintain exercise throughout the lifespan. Thus, lifelong engagement in regular exercise does help to maintain a healthy body composition. That is no myth.

There are some limitations to the study. For starters, its a pretty small sample size. All the study participants were also all males, although Walker says he expects the findings to carry over to everyone just as well.

While we studied males only, I see no reason why our results would not be applicable for females too, especially considering the effects of menopause and other age-related effects.

Plenty of different studies have highlighted the beneficial effect of endurance and strength training. Different types of exercise help in different ways, but the overarching theme is clear: a balanced approach to physical activity is crucial for long-term health and fitness. Incorporating a mix of endurance and strength training can help individuals achieve a healthier body composition, improve cardiovascular health, and maintain mobility as they age.

The study was published in Frontiers in Sports and Active Living.

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Running may not help lose weight but it's very good for you long-term - ZME Science


Mar 13

Weight-loss drugs like Wegovy are meant for long-term use. Some patients want to stop – Herald Palladium

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Weight-loss drugs like Wegovy are meant for long-term use. Some patients want to stop - Herald Palladium


Feb 29

Exercise helps keep pounds off after taking a weight-loss drug, study shows – The Washington Post

The new weight-loss drugs that suppress appetite and reduce food cravings can be quite effective at helping people drop pounds, with many losing at least 10 or 20 percent of their body weight while they take the medications.

But in the real world and despite the drugs effectiveness, as many as half of users quit the drugs within a year, studies show, because of their expense, side effects or for other reasons.

Afterward, the pounds almost invariably creep back, and, almost as worrying, the weight people regain tends to be almost exclusively fat, with little muscle. The result is that they are often metabolically less healthy than before theyd begun the drugs.

But an important, new, long-term study of people who used and then quit one of the weight-loss drugs suggests there may be a simple, accessible way to stave off unhealthy weight regain after stopping the drugs: exercise.

In the study, people who exercised while using a weight-loss drug kept off far more of their weight after quitting the medication than people who didnt work out, and they maintained more muscle.

Signe Srensen Torekov, a professor of biomedical sciences at the University of Copenhagen in Denmark and senior author of the new study, said the results strongly indicate that people using the drugs may be able to preserve a healthy weight, even after they quit the medication. But they do need to do exercise.

Most obesity experts agree that the holy grail of healthy, long-term weight loss is maintenance. Shedding pounds is possible for many people, in the short term. Keeping it off can seem almost impossible.

The new class of GLP-1 diabetes or weight-loss drugs, with brand names such as Ozempic, Wegovy, Zepbound and Mounjaro, seem to be intensifying that dynamic. GLP-1 is short for glucagon-like peptide 1 agonist; these drugs mimic the effects of the substance GLP-1.

Most people lose substantial weight rapidly on these drugs. But if they stop, the pounds typically return almost as quickly.

But is this rebound inevitable?

Torekov and her colleagues devised a multiyear, multipronged effort to find out.

It began with 195 Danish adults with obesity but no other major illnesses. They were put on an extremely low-calorie diet, under the supervision of the scientists, to rapidly lose about 30 pounds. Since this was to be a weight-maintenance study, the scientists wanted them to drop pounds fast, and then move to the maintenance phase.

For that phase, the researchers assigned some of the volunteers to start taking Saxenda, known generically as liraglutide, an early GLP-1 medication, to see if the drug would help them maintain and even augment their dieting weight loss. Saxenda is made by Novo Nordisk, the company that also makes two similar drugs the diabetes drug Ozempic and the weight-loss drug Wegovy.

(The study was funded in part by the Novo Nordisk Foundation, a charitable organization affiliated with Saxendas maker. The pharmaceutical company itself had no oversight of the study or its results, a company spokesperson said.)

A separate group of volunteers started the same drug, but also a supervised exercise program, with twice-weekly, half-hour group spinning classes and 15 minutes of high-intensity, full-body resistance training, along with two at-home jogs or similar workouts. The exercise was mostly vigorous, meaning strenuous enough that people could barely talk while they were working out.

A control group didnt exercise and received a placebo, instead of liraglutide. (Although the prescribing information for Saxenda says it should be used in conjunction with a low-calorie diet and increased physical activity, that recommendation is often ignored.)

After a year, almost everyone who took the drug had maintained the lower weight or lost more weight.

Those combining the drug and exercise had lost the most, though. Theyd dropped about six pounds more than those on the drug alone, and more of those pounds consisted of fat, instead of muscle.

The researchers published those results in 2021 in the New England Journal of Medicine. Then they began the most revelatory aspect of their study. They ended the medications and exercise sessions for everyone, leaving people to maintain or regain their weight-loss completely on their own.

After a year passed, the researchers invited all the volunteers back to the lab. One hundred and nine returned and researchers checked their body weight, body composition and current exercise habits.

For some, the year had been discouraging. Those whod earlier taken the weight-loss drug without exercise regained about 70 percent or more of all the weight theyd lost since the start of the study. Most of these regained pounds were in the form of fat, not muscle, so they wound up with relatively higher percentages of body fat than before starting the drug.

Theyd gained weight in an unhealthy manner, Torekov said.

But those whod exercised while taking the drug had maintained considerably more of their weight-loss during this phase. Many remained at least 10 percent lighter than at the studys start, and at least some of the weight theyd regained was muscle, leaving them with a healthier body composition than the other groups.

Its easy to understand why the exercisers added fewer pounds after stopping the drug, Torekov said. They were still exercising, even without supervision or nudging from the scientists. According to questionnaires and activity trackers, they generally continued to work out for several hours a week, voluntarily.

These findings suggest about two hours a week of vigorous exercise, may be a good goal for staving off weight regain after ceasing a weight-loss drug, she continued. Mixing aerobic and resistance exercise is probably best.

Meanwhile, those whod taken the drug without exercise were almost completely sedentary now, averaging fewer than 30 minutes of exercise a week.

More of the ones who had not exercised while medicated had complained of fatigue during treatment and afterward, Torekov said, which may have contributed to their inactivity now.

Overall, the results make a strong case for the importance of adding exercise to a regimen that includes a GLP-1 medication, said Daniel Drucker, a diabetes expert and senior investigator at the Lunenfeld-Tanenbaum Research Institute in Toronto, whose research helped pave the way for the GLP-1 drugs. He wasnt involved with the new study.

The results are very encouraging, agreed Robert Kushner, an endocrinologist and professor at Northwestern University Feinberg School of Medicine, who specializes in weight loss. But further studies will need to be performed to see if a less intense exercise routine has similar effects on weight maintenance when people stop a GLP-1 drug.

The study has other limitations. It used liraglutide, which is not as potent as more-recent obesity drugs. But I would expect the results to be directionally similar with the newer GLP-1 drugs, Drucker said.

It also involved relatively healthy Danes, who may not be typical of other people hoping to lose weight. And the studys exercise routine wasnt merely vigorous, which can be challenging. It was also free and closely supervised during the first year, a luxury unavailable to many of us.

Still, for now, the study tells us that to stave off weight regain and hold onto muscle during and after treatment with an obesity drug, its really important you have an exercise program, Torekov said.

Do you have a fitness question? Email YourMove@washpost.com and we may answer your question in a future column.

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Exercise helps keep pounds off after taking a weight-loss drug, study shows - The Washington Post


Feb 29

Weight loss surgery has long-term benefits for people with diabetes, study finds – WVTM13 Birmingham

Bariatric surgery, also called weight loss surgery, leads to better blood sugar control and less medication use long-term in people with type 2 diabetes than non-surgical management with medications such as insulin and metformin, a new study found.Related video above: Am I a candidate for weight loss surgery?The study, published Tuesday in the journal JAMA, compared the blood sugar levels and medication regimens of 262 people who were randomly assigned to undergo weight loss surgery or non-surgical medical management, such as medication and lifestyle changes, for type 2 diabetes after seven to 12 years.Participants who had weight loss surgery had significantly lower blood sugar levels and were on fewer diabetes medications than those who did not undergo surgery, the researchers, from the University of Pittsburgh and other institutions, wrote. They were also more likely to achieve diabetes remission, which is defined as having non-diabetic blood sugar levels for at least three months without medication.This research "provides the most robust evidence to date of the long-term efficacy of bariatric surgery for improving control of type 2 diabetes," Dr. Thomas A. Wadden, a professor of psychology and former director of the Center for Weight and Eating Disorders at the Perelman School of Medicine at the University of Pennsylvania, wrote in an editorial that was published along with the research.Weight loss surgery is a procedure in which the digestive tract is altered typically, the size of the stomach is reduced to help a person lose weight, according to the National Institute of Diabetes and Digestive and Kidney Diseases.The resulting reduction in food intake and neurohormonal changes also lower blood sugar and thereby treat type 2 diabetes, Dr. Marilyn Tan, chief of the Endocrinology Clinic at Stanford Health Care, who was not involved with the research, wrote in an email to CNN."Though it's a more invasive option than traditional diabetes medications and is a large commitment, it's also an investment in long-term health," Tan said.Most health-care providers don't currently recommend weight loss surgery for type 2 diabetes unless a person has a body mass index (BMI) of 35 or higher, and less than 1% of those people end up pursuing surgical treatment, according to the study.However, Wadden said in an email to CNN that the new findings support the expanded use of bariatric surgery for those with a BMI less than 35 who have trouble controlling their blood sugar with medical management alone."I hope these results will encourage more insurers and payers to cover bariatric surgery for patients with type 2 diabetes and a BMI of 30 to 34.9," he said. "It is a highly effective, long-term therapy for these individuals."Non-surgical medical management for type 2 diabetes involves lifestyle changes like reducing carbohydrate intake and increasing exercise, and using medications like metformin and occasionally insulin, Tan said. The goal is to lower hemoglobin A1c, the measure of average blood sugar levels over three months, below 7%."I've had multiple patients where despite hundreds of units of insulin a day, and despite their best efforts, they are unable to get their A1cs below 10%," Tan said. "Then, after bariatric surgery, they can maintain A1c levels below the diabetes range without any medications. They also note that with the weight loss, they can be more active."Further research is needed to compare the clinical outcomes and cost efficacy of weight loss surgery and the new generation of anti-diabetes medications, such as Ozempic and Mounjaro, the editorial says.The weight loss people have after surgery is key to improving diabetes outcomes as well as heart health, Tan said. Weight loss improves the body's response to insulin, reduces inflammation and helps lower blood pressure and cholesterol. It can also improve arthritis so people can exercise more, she added.The findings from this study also support the heart health benefits of weight loss surgery. People in the surgery group had significantly higher HDL or "good" cholesterol and lower triglycerides, a type of fat that can raise the risk of heart disease and stroke.Despite the benefits, people are often hesitant to have weight loss surgery because it is invasive and comes with some risks, Tan said.The study found that anemia (a lack of healthy red blood cells), bone fractures and gastrointestinal complications such as abdominal pain, nausea and vomiting were more common in people who had weight loss surgery.These known complications result from nutritional deficiencies that can happen when the digestive tract is surgically altered. People who have surgery must change their diet and take vitamins regularly to avoid these problems, Tan said.People who have the surgery can also gain back any weight lost, Tan added."Despite having the surgery, weight regain is possible if patients revert back to prior eating habits and quantities," she said.The study found that 51% of surgically treated participants achieved full remission of type 2 diabetes one year later, but only 18% maintained remission at seven years. This reduction in remission after surgery, which has been observed in previous research, is probably due to a combination of weight regain and the loss of insulin-producing cells over time, according to the editorial.Even short-term diabetes remission has benefits in terms of reducing diabetes-related complications, such as eye, kidney and peripheral blood vessel disease, the editorial says.Although bariatric surgery has a higher upfront cost than medical management about $33,000 before insurance coverage it is considered to be more cost-effective about five years after surgery, according to the editorial.

Bariatric surgery, also called weight loss surgery, leads to better blood sugar control and less medication use long-term in people with type 2 diabetes than non-surgical management with medications such as insulin and metformin, a new study found.

Related video above: Am I a candidate for weight loss surgery?

The study, published Tuesday in the journal JAMA, compared the blood sugar levels and medication regimens of 262 people who were randomly assigned to undergo weight loss surgery or non-surgical medical management, such as medication and lifestyle changes, for type 2 diabetes after seven to 12 years.

Participants who had weight loss surgery had significantly lower blood sugar levels and were on fewer diabetes medications than those who did not undergo surgery, the researchers, from the University of Pittsburgh and other institutions, wrote. They were also more likely to achieve diabetes remission, which is defined as having non-diabetic blood sugar levels for at least three months without medication.

This research "provides the most robust evidence to date of the long-term efficacy of bariatric surgery for improving control of type 2 diabetes," Dr. Thomas A. Wadden, a professor of psychology and former director of the Center for Weight and Eating Disorders at the Perelman School of Medicine at the University of Pennsylvania, wrote in an editorial that was published along with the research.

Weight loss surgery is a procedure in which the digestive tract is altered typically, the size of the stomach is reduced to help a person lose weight, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

The resulting reduction in food intake and neurohormonal changes also lower blood sugar and thereby treat type 2 diabetes, Dr. Marilyn Tan, chief of the Endocrinology Clinic at Stanford Health Care, who was not involved with the research, wrote in an email to CNN.

"Though it's a more invasive option than traditional diabetes medications and is a large commitment, it's also an investment in long-term health," Tan said.

Most health-care providers don't currently recommend weight loss surgery for type 2 diabetes unless a person has a body mass index (BMI) of 35 or higher, and less than 1% of those people end up pursuing surgical treatment, according to the study.

However, Wadden said in an email to CNN that the new findings support the expanded use of bariatric surgery for those with a BMI less than 35 who have trouble controlling their blood sugar with medical management alone.

"I hope these results will encourage more insurers and payers to cover bariatric surgery for patients with type 2 diabetes and a BMI of 30 to 34.9," he said. "It is a highly effective, long-term therapy for these individuals."

Non-surgical medical management for type 2 diabetes involves lifestyle changes like reducing carbohydrate intake and increasing exercise, and using medications like metformin and occasionally insulin, Tan said. The goal is to lower hemoglobin A1c, the measure of average blood sugar levels over three months, below 7%.

"I've had multiple patients where despite hundreds of units of insulin a day, and despite their best efforts, they are unable to get their A1cs below 10%," Tan said. "Then, after bariatric surgery, they can maintain A1c levels below the diabetes range without any medications. They also note that with the weight loss, they can be more active."

Further research is needed to compare the clinical outcomes and cost efficacy of weight loss surgery and the new generation of anti-diabetes medications, such as Ozempic and Mounjaro, the editorial says.

The weight loss people have after surgery is key to improving diabetes outcomes as well as heart health, Tan said. Weight loss improves the body's response to insulin, reduces inflammation and helps lower blood pressure and cholesterol. It can also improve arthritis so people can exercise more, she added.

The findings from this study also support the heart health benefits of weight loss surgery. People in the surgery group had significantly higher HDL or "good" cholesterol and lower triglycerides, a type of fat that can raise the risk of heart disease and stroke.

Despite the benefits, people are often hesitant to have weight loss surgery because it is invasive and comes with some risks, Tan said.

The study found that anemia (a lack of healthy red blood cells), bone fractures and gastrointestinal complications such as abdominal pain, nausea and vomiting were more common in people who had weight loss surgery.

These known complications result from nutritional deficiencies that can happen when the digestive tract is surgically altered. People who have surgery must change their diet and take vitamins regularly to avoid these problems, Tan said.

People who have the surgery can also gain back any weight lost, Tan added.

"Despite having the surgery, weight regain is possible if patients revert back to prior eating habits and quantities," she said.

The study found that 51% of surgically treated participants achieved full remission of type 2 diabetes one year later, but only 18% maintained remission at seven years. This reduction in remission after surgery, which has been observed in previous research, is probably due to a combination of weight regain and the loss of insulin-producing cells over time, according to the editorial.

Even short-term diabetes remission has benefits in terms of reducing diabetes-related complications, such as eye, kidney and peripheral blood vessel disease, the editorial says.

Although bariatric surgery has a higher upfront cost than medical management about $33,000 before insurance coverage it is considered to be more cost-effective about five years after surgery, according to the editorial.

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Weight loss surgery has long-term benefits for people with diabetes, study finds - WVTM13 Birmingham


Feb 29

The Morning Banana Diet is the latest weight-loss craze, but what is it? – South China Morning Post

The diets appeal lies in its flexibility and simplicity. The official website says followers can start their day by eating as many bananas as they like for breakfast, and drinking room-temperature water.

The diet also allows one snack a day, preferably Japanese confectionery or chocolates.

There are no recommended strict meal plans; for lunch and dinner, followers can eat what they like apart from the restricted items.

Want to live longer? 10 diet secrets of people living longest and healthiest

However, it is advised not to eat anything after 8pm, and not to have alcoholic or caffeinated drinks. Water is the suggested beverage of choice.

Those following the diet should stop eating when they are 80 per cent full a principle in keeping with the ancient Japanese concept of hara hachi bun me.

Residents of Okinawa one of the worlds five Blue Zones, where residents are known to live to 100 years or beyond practise this.

Indian sages living in the Himalayas were known to live a long, disease-free life in cold climes by following this discipline.

Nutritionists say the heart of the morning banana diet is healthy eating habits such as portion control, and eating nutritious foods while avoiding unhealthy ones.

Can a juice cleanse really reset your body? Experts weigh in

The diet is premised purely on common sense and a traditional Japanese lifestyle, which is considered healthy, says Delhi-based nutritionist Ruchika Sodhi.

Like any other diet, its success depends on an individuals overall lifestyle, metabolism and physical activity levels.

While it might be a good kick-start to a weight-loss journey, long-term success necessitates a more inclusive approach, like the inclusion of regular exercise and a balanced and diverse diet for optimal benefits, Sodhi adds.

As bananas are rich in fibre and nutrients, they offer a healthy morning boost of energy while contributing to a sustained feeling of fullness potentially curbing excessive food consumption, she says.

Bananas are a good source of potassium and soluble and insoluble fibre, which regulates body fat, fights toxins and energises the body. The fruit is also very low in cholesterol, sodium and saturated fats, she adds.

The fruits fibre, she explains, bulks up in the stomach, triggering a longer feeling of satiety. Bananas also have resistant starch, which begins to ferment in the digestive tract, she says, and accelerates fat burning.

Freeze your nuts, eat green bananas: 10 ways to max out nutrients in food

Sodhi recommends consulting a healthcare professional before making significant changes to ones diet and eating bananas daily.

Follow the diet only after this, to ensure that your weight-loss journey is safe, sustainable, and customised to your individual needs and health requirements.

Since bananas are also loaded with sugar, diabetics should avoid the diet, Sodhi says. An average banana has about 120 calories, so overindulging may result in weight gain instead of loss.

New Delhi-based homemaker Sushma Gupta, 33, who lost 8.5 kilograms (18.7 pounds) in a year by following the banana diet after her second pregnancy, says that it worked wonders for her.

Adopting the diet not only helped her lose weight, she says, but also helped improve her overall lifestyle, which had lacked discipline.

Inspired by her weight-loss success, two of Guptas friends also started following the banana diet but could not maintain it.

They gave up after two weeks. The diet seems simple, but what it actually entails is a lifestyle modification, which some people find tough to adhere to, Gupta says.

Short, intense workouts can be as healthy as 30 minutes of daily exercise

However, those who persevere are richly rewarded.

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The Morning Banana Diet is the latest weight-loss craze, but what is it? - South China Morning Post


Feb 29

Bariatric surgery outperforms traditional treatments for long-term diabetes control – News-Medical.Net

In a recent study published in the Journal of American Medical Association (JAMA), researchers from the United States of America (US) compared the safety, efficacy, and long-term outcomes of bariatric surgery and medical and lifestyle management in patients with type 2 diabetes mellitus (T2DM). They found that patients undergoing bariatric surgery had better glycemic control and higher remission rates at 712 years compared to medical management.

Study: Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. Image Credit:Terelyuk/ Shutterstock

T2DM affects over 500 million adults globally, presenting significant economic burdens. Although bariatric surgery has shown superiority over medical and lifestyle therapies in treating the condition, limited randomized controlled trials (RCTs) with constraints in sample size and follow-up duration have hindered widespread recommendations. This has led to less than 1% of individuals with a body mass index (BMI) of 35 kg/m2 or higher considering surgical treatment. Despite advances in weight loss medications, their cost, uncertain long-term efficacy, and the need for prolonged use pose challenges.

The Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) consortium conducted the most extensive pooled analysis to date, combining long-term observational data from four US single-center randomized trials. It aimed to assess bariatric surgery's safety, durability, and efficacy compared to medical/lifestyle treatment for T2DM. At three years, the study revealed the superior and sustained effectiveness of bariatric surgery over medical/lifestyle intervention, even in individuals with a BMI of 2535 kg/m2. In the present study, researchers report the extended follow-up results at 712 years after randomization.

The study included 262 T2DM patients with a BMI of 2745 kg/m2. The mean age was 49.9 years, and 68.3% of them were female. Patients were randomized to undergo intensive medical and lifestyle management (n = 96), or bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding), and postoperative care (n =166). Based on self-reported racial information, about 31% of patients were Black, and 67.2% were White. While the study was conducted between 2007 and 2013, the observational follow-up was conducted until 2022.

The study's primary outcome was a between-group difference in the change (%) in glycated hemoglobin (HbA1c) from baseline to seven years, with extended data up to 12 years. The secondary outcomes were changes in HbA1c, changes in various metabolic and cardiovascular parameters, and diabetes remission, with a hypothesis favoring bariatric surgery over medical/lifestyle treatment. Adverse events were systematically collected, covering serious events and complications up to 12 years. The statistical methods involved the use of a linear mixed-effect model, inverse probability weighting, sensitivity analysis, and exploratory analyses.

In spite of higher baseline values, the bariatric surgery group consistently maintained significantly lower HbA1c levels than the medical group, with a difference of -1.4% and -1.1% at seven years and 12 years, respectively. At seven years, HbA1c improvements were similar between Roux-en-Y gastric bypass and sleeve gastrectomy, while adjustable gastric banding showed less improvement than sleeve gastrectomy (P = .007) and Roux-en-Y gastric bypass (P = .03). As 25% of patients switched from medical management to surgery during the study, a per-protocol sensitivity analysis was conducted, which confirmed the main results.

At one year, diabetes remission was achieved by 0.5% of patients in the medical group as compared to 50.8% in the surgery group. At seven years, remission rates were 6.2% vs. 18.2% in the medical group and surgery group, respectively, and the difference persisted at 12 years. HbA1c was found to be < 7% in 26.7% of patients in the medical group vs. 54.1% of those in the surgery group. Additionally, bariatric surgery resulted in significantly higher weight loss and rates of non-obesity at 7 and 12 years. The surgery group also experienced significantly reduced medication and insulin use as compared to the medical group. Further, the bariatric group showed significantly higher high-density lipoprotein (HDL) and lower triglycerides. No significant differences were observed for systolic blood pressure, low-density lipoprotein (LDL), serum creatinine, or urine albumin-to-creatinine ratio in the two groups at seven years. Adverse events were found to be similar between the groups, with increased gastrointestinal events in the surgery group.

The study is strengthened by its larger sample size, diversity in sampling, inclusion of data on the most common surgical procedures, and longer follow-up compared to previous studies. However, the study is limited by its open-label design, heterogeneous treatments, missing data, lack of power for procedure-specific outcomes, and changes in surgical procedures and medication use during follow-up.

In conclusion, after 7 to 12 years, patients assigned to bariatric surgery demonstrated better glycemic control, reduced diabetes medication usage, and higher rates of diabetes remission compared to those on medical/lifestyle intervention. The findings endorse the employment of bariatric surgery as a viable treatment option for T2DM in individuals with obesity.

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Bariatric surgery outperforms traditional treatments for long-term diabetes control - News-Medical.Net


Feb 29

Bariatric surgery provides long-term blood glucose control, type 2 diabetes remission – National Institutes of Health (NIH) (.gov)

News Release

Tuesday, February 27, 2024

NIH-supported study shows long-term benefits of surgery compared to medication and lifestyle change.

People with type 2 diabetes who underwent bariatric surgery achieved better long-term blood glucose control compared to people who received medical management plus lifestyle interventions, according to a new study supported by the National Institutes of Health. The participants who underwent bariatric surgery, also called metabolic or weight-loss surgery, were also more likely to stop needing diabetes medications and had higher rates of diabetes remission up to 12 years post-surgery. Results of the study were published in JAMA and funded by the National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK), part of NIH.

While there are many factors involved, and not all of them are completely understood, bariatric surgery typically results in greater weight loss that affects a persons metabolic hormones, which improves the bodys response to insulin and ability to maintain healthy blood glucose levels, said Dr. Jean Lawrence, NIDDK project scientist. These results show that people with overweight or obesity and type 2 diabetes can make long-termimprovements in their health and change the trajectory of their diabetes through surgery.

The current study is a follow-up that combined data from four independent single-center randomized trials conducted at clinical sites in the United States. The original trials, which were conducted between May 2007 and August 2013, evaluated the effectiveness of bariatric surgery compared to intensive lifestyle and medication therapy involving oral and injectable diabetes medications including insulin, for adults with type 2 diabetes and overweight or obesity. While some participants in the study were prescribed GLP-1 agonists as part of their medical management of diabetes, these drugs were not specifically examined in the study. The investigators from the four individual studies pooled their data to provide a larger and more geographically diverse data set to evaluate efficacy, durability, and safety of bariatric surgery to treat type 2 diabetes. Follow-up data were collected through July 2022.

In total, 262 participants from the four original studies enrolled in the current study. Of these, 166 were randomized to surgery and had undergone one of three bariatric surgery procedures. The remaining 96 participants were randomized to the medical/lifestyle management group. The medical/lifestyle interventions have previously been shown effective for weight loss. All participants were between the ages 18 and 65 and had overweight or obesity as measured by body mass index, or BMI. Primary endpoint results were measured at seven years, with continued follow-up through 12 years.

At seven years, participants in the surgery group experienced an average 20% weight loss compared to 8% in the medical/lifestyle group. The surgery group had greater improvements in blood glucose control, measured by HbA1c, with 54% of participants in the surgery group achieving an HbA1c less than 7% compared to only 27% of participants in the medical/lifestyle group. More participants with surgery achieved diabetes remission compared to participants in the medication/lifestyle group, and the percent of participants using medications to treat diabetes in the surgery group decreased from 98% to 61%, yet remained largely unchanged in the medication/lifestyle group.

The results and differences between groups remained significant at 12 years.

Additional exploratory analyses in this study showed that bariatric surgery had important, beneficial effects on HbA1c and weight loss among participants with a BMI between 27 and 34 (within overweight and lower obesity ranges). These findings lend important information about the benefit of surgery in people with type 2 diabetes who fall short of the traditional, higher BMI threshold of 35 for bariatric surgery, said Dr. Anita P. Courcoulas, chief of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center and lead author of the study.

No differences in major adverse events occurred between the two groups, but there was a higher number of fractures, anemia, low iron, and gastrointestinal events in the surgery group. Nutritional deficiencies may explain fractures and anemia, underscoring the importance of continued monitoring of people who have bariatric surgery.

Obesity and type 2 diabetes are complex conditions with many common risk factors and long-term complications, said NIDDK Director Dr. Griffin P. Rodgers. This study exemplifies how public investments in obesity and diabetes research can lead to real clinical advances and long-term health benefits for millions of Americans experiencing these conditions.

The study, known as the Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is supported by cooperative agreement U01DK114156 from NIDDK.

The NIDDK, part of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see https://www.niddk.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

Courcoulas AP, Patti ME, Hu B, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes. JAMA. 2024; doi:10.1001/jama.2024.0318.

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Bariatric surgery provides long-term blood glucose control, type 2 diabetes remission - National Institutes of Health (NIH) (.gov)


Feb 29

Q&A: Why Project HEAL Believes No One Really Needs to Lose Weight – Everyday Health

Does anyone really need to lose weight?

Project HEAL, an organization focused on equitable access to treatment for eating disorders, believes intentional weight loss is not healthy for anyone.

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Project HEAL promotes body acceptance, or accepting ones body exactly as it is, regardless of weight, size, or shape.

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Body acceptance can improve body image (the thoughts and feelings someone has about their body) and reduce a person's risk of developing an eating disorder, says Stephanie Albers, PhD, a clinical assessment program manager at Project HEAL. A positive body image can also help people realize they do not need to participate in disordered eating behaviors for their body to be good, Dr. Albers explains.

Everyday Health sat down with Albers to talk about body acceptance, why Project HEAL does not promote intentional weight loss for health, and how to make treatment for eating disorders more accessible.

Everyday Health: Why does Project HEAL believe no one really needs to lose weight?

Stephanie Albers: Project HEAL does not support intentional weight loss because efforts aimed at weight loss far too rarely produce the desired result and far too often lead to eating disorders. If the goal is health, not only is weight a poor indicator, but we have to include mental health in that equation. When it comes to dieting as the kids say, the math simply doesnt math.

EH: What research backs this up linking attempted weight loss to poorer mental health, including eating disorders?

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RELATED: Why Arent We Paying More Attention to Eating Disorders in People With Larger Bodies?

EH: Are there other potential health consequences of intentional weight loss?

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The demonstrated physical and psychological risks of intentional weight loss, including the likelihood of developing eating disorders, are too concerning to ignore.

EH: Given that people at higher weights tend to have an increased risk of complications like heart disease, how can doctors help people in bigger bodies address their health while still looking out for potential issues?

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No matter what an individuals weight is, they should receive a comprehensive physical exam, be asked to provide a complete medical history, and undergo necessary tests to determine risk for any medical condition or receive an official diagnosis.

It is simply not okay to assume a patient in a larger body is at risk for certain medical conditions based on weight alone. Discussing all known risk factors not exclusively weight provides a more inclusive approach to health issues that have been solely attributed to weight in the past.

EH: Why is body acceptance (as a means of achieving health) so important to Project HEALs mission?

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EH: There are many misconceptions about eating disorders, including that someone has to be thin to have one. Whats the solution to helping more people realize that myth is not true and help people in larger bodies recognize when they do have disordered eating behaviors?

SA: Body acceptance helps us understand that it's detrimental to have a disordered relationship with food, no matter our size. This helps us recognize harmful and eating disordered behavior because we know that it can occur in anyone. Rather than believing that dieting, weight cycling, and eating disorders are acceptable due to society's unrealistic ideals, we can identify how others in our community are struggling and support them.

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EH: What are some other barriers to better prevention and treatment of eating disorders for people in bodies of all sizes?

SA: Depending on their diagnosis and whether they meet certain weight criteria (like having a higher BMI), some people may not be eligible for their insurance to pay for the cost of inpatient care. We are working toward getting equitable access to care for all no matter what type of body you are in.

Project HEAL does this through a couple of different avenues. We have our treatment placement program, which we have made up of ourHEALers circle (treatment providers and centers who donate pro bono care to certain Project HEAL beneficiaries each year), which is used to help place folks with treatment if their insurance does not afford it.

We offer a virtual meal support program for folks over 16 at the outpatient level of care to drop in and attend as well. We haveinsurance navigation, meaning we offer services to help if you're trying to navigate insurance difficulties, or even signing up for insurance that can help cover some of your care.

Within my role, I work on theclinical assessment, which is providing a diagnosis and level-of-care recommendation for someone with an eating disorder, regardless of their background.

EH: How can talking about body acceptance help buffer some of the harms of diet culture, especially when it comes to conversations with young people?

SA: Talking about body acceptance, particularly for people with kids and teens around them, is important because it helps rewrite the narrative about what bodies are considered valuable in our society. It is important to discuss body diversity when these questions come up. For instance, you can emphasize that, "Bodies aren't all meant to look alike. That is the beauty in having a body.

The book Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith has a lot of great information on talking to your children about bodies and weight. Its also important to be a role model to others in the ways that you talk about your body, movement, and food.

EH: What are some body acceptance-friendly phrases people can use in their own lives?

SA: Some examples are:

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Q&A: Why Project HEAL Believes No One Really Needs to Lose Weight - Everyday Health


Feb 29

Resistant starch diet proves a game changer for weight loss and diabetes control – News-Medical.Net

In a recent study published in the journal Nature Metabolism, a team of scientists investigated whether modulation of the gut microbiome using dietary fiber supplementation in the form of resistant starch could help with insulin resistance and weight loss and offer a potential treatment avenue for metabolic disorders.

Study: Resistant starch intake facilitates weight loss in humans by reshaping the gut microbiota. Image Credit:Sokor Space/ Shutterstock

Obesity has been classified as a global epidemic, with substantial research being conducted on strategies to reduce weight and prevent obesity. It contributes significantly to the global mortality rates by increasing the risk of metabolic diseases such as diabetes, as well as cardiovascular disease risk. Weight management and effective weight loss can lower the risk of these diseases.

Increasing evidence indicates that the gut microbiome plays a pivotal role in the regulation of human physiology and development of various diseases. Gut microbiome composition and diversity are intricately linked to the metabolism of glucose and fat and inflammation.

Furthermore, while fecal microbiome transplantation has been used to establish healthy gut microbiome communities, the procedure has not yielded effective or long-term results. However, diet can be used to modulate the gut microbiome, and dietary interventions, either alone or in conjunction with fecal microbiome transplantation, could potentially improve the clinical outcomes.

In the present study, the team conducted a randomized, crossover clinical trial involving overweight individuals to determine whether dietary supplementation with resistant starch positively impacted obesity and metabolic phenotypes. They also conducted metagenomic and metabolomic analyses to understand how the resistant starch affected the composition of the gut microbiome and its function.

Furthermore, they studied antibiotic-treated mice that had received gut microbiomes from human donors that had already been modified through resistant starch supplementation to understand how gut microbiomes modified through supplementation with resistant starch influence glucose metabolism and adiposity. The metabolomic advantages offered by the gut microbiome modified through resistant starch supplements were also explored.

Resistant starch cannot be broken down by the amylase enzymes produced in humans, functioning as a dietary fiber. During digestion, resistant starch does not get broken down in the stomach or small intestine but moves into the large intestine or colon, where the gut microbiome ferments this dietary fiber. Rodent model studies have shown a decrease in body fat and better metabolic outcomes when the carbohydrate portion of their diet consists mainly of resistant starch.

The present clinical trial included participants with excess body weight who did not have any chronic disorders, were not using any probiotics or antibiotics, and were not undergoing any treatments that would impact their glucose metabolism. The participants were randomly assigned to the treatment or control group, with the treatment group receiving resistant starch in the form of high-amylose maize and the control group receiving amylopectin with no resistant starch.

The starch was provided in sachets in powdered form, and all the participants in the treatment and control groups consumed one packet of the appropriate starch twice a day before a balanced, isoenergetic meal that was provided thrice a day. Since this was a crossover clinical trial, all the participants underwent two eight-week-long interventions, one for the resistant starch treatment and the other for the control treatment.

The results showed that supplementation with resistant starch helped achieve a mean weight loss of about 2.8 kg and improved insulin resistance in overweight participants. The study also found that the beneficial effects of resistant starch supplementation were associated largely with gut microbiome composition changes.

The bacterium Bifidobacterium adolescentis was found to be associated with resistant starch supplementation in humans, and the monocolonization of mice with this bacterium protected them from diet-induced obesity. Resistance starch impacted lipid and fat metabolism by reducing inflammation, restoring the intestinal barrier, and altering the bile acid profile.

The gut microbiota impacts the host physiology through signaling metabolites, of which bile acids play a significant role. Secondary bile acids, such as glycodesoxycholic acid, deoxycholic acid, glycocholic acid, and taurodeoxycholic acid, are important in improving insulin sensitivity and ameliorating hepatic steatosis. The enzyme bile salt hydrolase carries out the deconjugation of secondary bile acids.

The study found that resistant starch supplementation decreased the production of bile salt hydrolase and increased the levels of secondary bile acids. The results were reciprocated in the mice after they were monocolonized with B. adolescentis from humans who underwent resistant starch supplementation.

Resistant starch (RS, 40g d-1) accompanied with isoenergetic and balanced diets led to an obvious reduction in body weight and improvement of insulin sensitivity, as well as alteration in metagenomics and metabolomics. Faecal microbiota transplantation (FMT) showed benefits of RS were associated with the reshaped gut microbiota composition. Monocolonization of mice withB. adolescentis, which was closely correlated with the benefits of RS in human protected mice from diet-induced obesity. Mechanistically, the RS-induced changes in the gut microbiota influenced metabolites of gut microbiome, reduced chronic low-grade inflammation by improving intestinal integrity, inhibited lipid absorption by modulating angiopoietin-like 4 (ANGPTL4), and improved the sensitivity of fibroblast growth factor 21 (FGF21) in adipose tissue. SPF, specific-pathogen-free; LPS, lipopolysaccharide; BCAAs, branched-chain amino acids; Erk1/2, extracellular signal-regulated kinase 1/2; FGFR1, fibroblast growth factor receptor 1. Created with BioRender.com.

To summarize, the study found that supplementation with resistant starch can facilitate weight loss by increasing the abundance of B. adolescentis in the gut microbiome. It can also help improve insulin sensitivity through gut microbiome-induced changes in the levels of secondary bile acids and lowering of inflammation.

Journal reference:

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Resistant starch diet proves a game changer for weight loss and diabetes control - News-Medical.Net



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