Monday, 23 June 2008

Big breakfast 'aids weight loss'

The easy way to lose weight?

Breakfast really could be the most important meal of the day when it comes to losing weight, claims a researcher.

Over several months, obese women who ate half their daily calories first thing fared better than those eating a much smaller amount.

US researcher Dr Daniela Jakubowicz told a San Francisco conference having a small breakfast could actually boost food cravings.

A UK expert said a big breakfast diet might simply be less boring.

It could be that it is simply easier for people on a higher-carbohydrate diet to comply with it over a longer period
Dr Alex Johnstone
Rowett Research Institute, Aberdeen

Dr Jakubowicz, from Virginia Commonwealth University, has been recommending a hearty breakfast to her patients for 15 years.

She tested it against a low carbohydrate diet in a study of 96 obese and physically inactive women.

This diet involved 1,085 calories a day - the majority of these coming from protein and fat.

Breakfast here was the smallest meal of the day - just 290 calories, with just seven grams of carbohydrates.

Her "big breakfast" diet involved more calories - 1,240 - with a lower proportion of fat and more carbohydrates and protein.

Breakfast here was 610 calories, with 58 grams of carbohydrates, while lunch and dinner were 395 and 235 calories respectively.

Four months on, the low-carb dieters appeared to be doing better, losing an average of 28 pounds to the 23 shed on the "big breakfast" diet.

However, after eight months, the situation had reversed, with the low-carb dieters putting an average of 18 of those pounds back on, while the big breakfasters continued to lose weight, on average 16.5 pounds each.

They lost a fifth of their total body weight on average, compared with less than 5% for the low-carb dieters.

Slower metabolism

Dr Jakubowicz reported that the big breakfasters said they felt less hungry, particularly in the mornings.

She said: "Most weight loss studies have determined that a very low carbohydrate diet is not a good method to reduce weight.

"It exacerbates the craving for carbohydrates and slows metabolism - as a result, after a short period of weight loss, there is a quick return to obesity."

She said that the bigger breakfast helped by making people feel fuller during the day, and was healthier, because it allowed more fibre and fruit to be included.

Dr Alex Johnstone, from the Rowett Research Institute in Aberdeen, said that other studies had shown that

while low-carb diets were a "good tool" to reduce weight quickly, they were not a "diet for life".

She said that the regaining of lost weight by these dieters could be more a sign of the relative monotony of the two diets, rather than their ability to necessarily reduce cravings.

"It could be that it is simply easier for people on a higher-carbohydrate diet to comply with it over a longer period."

A spokesman for the British Nutrition Foundation said there was evidence that a good-sized breakfast could help dieters.

She said: "Research shows that eating breakfast can actually help people control their weight.

"This is probably because

when we don't have breakfast we're more likely to get hungry before lunch and snack on foods that are high in fat and sugar, such as biscuits, doughnuts or pastries."

Wednesday, 18 June 2008

Cholesterol genes 'protect heart'

Cholesterol appears to play a key role in heart disease

A third of the population have genes that could help them in the fight against heart disease, say scientists.

A study of 147,000 patients suggests that

certain types of the CETP gene might increase the levels of so-called "good" cholesterol.

UK and Dutch research, published in the Journal of the American Heart Association, found a 5% cut in heart attacks for those with the key types.

A UK geneticist said it could point to drugs which help many more people.

What it does provide are important insights into the 'cause and effect' relationship, and if you understand this better, you can develop drugs which target it
Dr Aroon Hingorani
University College London

Scientists already know that cutting the levels of "bad" cholesterol in the bloodstream protects your heart, and well-established drugs such as statins aim to do precisely this.

The relationship between the levels of "good", or HDL, cholesterol, and heart health are less clear, although there is some evidence that raising these levels is good for you.

The team from Cambridge and Newcastle universities, and the University of Groningen in the Netherlands, merged the results of almost 100 other studies, involving 147,000 people worldwide.

They looked for the effect of having one of six different variations of the CETP gene.

The most popular three all seemed to carry a modest positive effect, raising HDL cholesterol levels by between 3% and 5%, and people with them were less likely to have a heart attack.

Cause and effect

Professor John Danesh, who led the study, said that

the findings added weight to the idea that heart disease could be prevented by raising HDL levels, perhaps by drugs that blocked CETP.

A trial into a drug which raised HDL cholesterol by influencing CETP was abandoned in 2006 due to an increase in heart disease and deaths, but some scientists believe it may still be possible to target the gene effectively and safely.

Professor Peter Weissberg, of the British Heart Foundation, which funded the study, said: "Researchers are questioning whether approaches that raise HDL cholesterol could further prevent heart disease.

"This suggests that it may have benefits, but that more studies are needed to determine how much might be derived."

Dr Aroon Hingorani, a lecturer in genetics from University College London, said that the relatively small decrease in risk meant that the presence of a particular variant of the CETP gene could not help predict with any accuracy the risk of an individual falling prey to heart disease.

She said: "What it does provide are important insights into the 'cause and effect' relationship, and if you understand this better, you can develop drugs which target it."

Fat versus fiction by Vivienne Parry

Fat versus fiction

The moral panic about the obesity epidemic was always hard to swallow, says Vivienne Parry. Now, a new study says we may have been wrong all along

There is an epidemic of obesity. We are all going prematurely to hell in a heavily reinforced handcart, the victims of our own self-indulgence and laziness. And a tsunami of diabetes, osteoarthritis, heart disease and cancers is about to hit us. Bring on the lettuce leaves and five-mile runs.

That's the orthodoxy, but a number of scholars are now accusing obesity researchers, the media and public health officials of exaggeration.
This week sees the publication of yet another of these dissenting views. The Obesity Epidemic: science, morality and ideology (Routledge 2005) is the work of two Australian academics, Michael Gard and Jan Wright, experts in physical education and education respectively. I can hear the sniffs of disapproval already.

They are outside the medical community, but that doesn't mean they have nothing of value to say.

Scientists talk about fat as if it had a clear cause. Too much energy in and not enough out. The reality, these authors claim, is that there are many aspects of both the causes and the consequences of being overweight or obese which are not explained by this simplistic model.

The authors do not dispute that the proportion of those who are obese in the population has roughly doubled in the US and many parts of Europe since 1980. Nor do they dispute the increase in cases of Type 2 diabetes.

In the US, 55% of adults with diabetes are obese, compared with 31% in the general population, which surely links obesity and diabetes.

It is said that 365,000 Americans die prematurely each year because of obesity. This figure became written in stone almost as soon as it appeared in 1999. But it was derived from 10-year- old data, taken in part from self- reported weights and heights.
In April, research published in the Journal of the American Medical Association by Katherine Flegal, a scientist at the Centres for Disease Control, which used newer data, showed that
it is far from certain that there is measurable excess mortality among obese or moderately overweight Americans.

Many will say that this is because of better drug treatments. But 30-50% of prescription drugs are not taken as directed, and many lower income Americans don't have health insurance and can't afford drugs, so this doesn't ring true. If it was, one would think the pharmaceutical industry would have been shouting it from the rooftops, yet Flegal's findings did not make the front pages like the 1999 study. But given the $46bn weight loss industry dependent on scaring stouter citizens, that is hardly surprising.

You could regard all this in the same vein as global warming dissent - to be trashed either because you think it wrong, or think there is truth to the argument but it shouldn't be made because it encourages complacency.

But Gard and Wright have some points on the ideology surrounding obesity and also the way body mass index (weight divided by the square of height) is used as a measure.

In the past, only those whose BMI was in excess of 30 were deemed overweight or obese. That value has now been changed to 25 and above, instantly exploding the number of obese people, labelling them as "abnormal" and in need of medical treatment.

This arbitrary definition of fatties vs thinnies has meant constant exhortation to get to your "ideal weight", within the magic 20-24 BMI band. Since there are naturally a range of weights within a population, many are trying to achieve the impossible. When they fail, they are told they are "weak-willed".

Obesity is one of those areas where science meets culture full on. Science has always been used by some as a church to which they retreat for factual underpinning of their moral beliefs. Fat people are bad, fat people are lazy, fat people are symptomatic of our moral decline.

To be overweight is said to be the product of a breakdown in family values and of slothful kids. Low-income groups are more likely to be obese, and so it is assumed that children living in poverty must watch more TV than rich children. But telling parents to restrict TV viewing is easier than dealing with health inequalities caused by poverty, a more likely cause of obesity than daytime TV, no matter how damaging that might seem.

We are right to be concerned about the rising levels of Type 2 diabetes but should we be worrying about the health futures of people with a BMI of 26 or 28 who are taking regular exercise? Probably not, but we will continue to tell these people that they are porky slobs who ought to try harder.
In doing so, it is likely that we are condemning them to the sort of yo-yo dieting that results in weight gain, not weight loss.