US 'medical tourists' seek cheap health care abroad

When Veronica Merrill decided to undergo stomach surgery for weight loss, she found two options: pay $12,000 at home in the United States, or have it done in Mexico for $4,000. 

She packed her suitcase.

Her insurance would only cover the operation if she was morbidly obese and suffering from diabetes and hypertension.

This was not the case for the 50-year-old, who weighs 210 pounds (95 kilos) but aspires to slim down to 160 -- precisely because she wants to avoid ending up with those medical conditions.

"It's sad that I have to come to another country" for the procedure, said Merrill, who drives a school bus in rural Arizona and is highly critical of the US health system -- the most expensive in the world.

"We shouldn't have to do that. That's crazy. And we're the only ones (with this system), and that is depressing."

After researching medical tourism options, she saved up the money and contacted a specialist agency to organize her trip over the border to Tijuana, where weight-loss operations and dental treatments are popular.

Others travel to the Mexican city for treatment of cardiovascular conditions or cancer, orthopedic work and fertility care, as well as to buy medications.

"If I only could have done it in the US... (but) I can't pay that much money," she told AFP. "I just want to be healthy."

No price regulation

Each year, an estimated 20 million "medical tourists" seek treatment around the world, according to Patients Beyond Borders. 

About 1.9 million of those people are Americans.

Mexico and Colombia -- which many Americans associate more with drug trafficking than health care -- are among the most popular destinations, along with Costa Rica and the Dominican Republic.

They all offer lower costs and high-quality infrastructure.

Bernie Sanders and Elizabeth Warren, two prominent Democratic candidates for the 2020 presidential election, have proposed universal health coverage -- an idea that Merrill considers "logical."

For now, Merrill turned to a company called Medical Tourism Corporation to organize every detail of her trip -- including her flight from Phoenix to San Diego, the driver who took her across the border and a luxury hotel.

Altogether, the tickets, hotel and surgery -- at the Oasis of Hope hospital, right by the border -- cost her $3,880. She paid in cash.

"We do the coordination... (we) have a destination manager in those cities who would help a patient with the language, the local logistics and things like that," said Deepak Datta, who founded Medical Tourism Corporation 13 years ago.

The company sends 60-70 people abroad each month to countries around the world, mainly Mexico.

"I operate on two or more foreigners every day," said surgeon Luis Cazares, who removed 80 percent of Merrill's stomach.

He said his greatest flow of patients is during the tax refund season in the United States, after April.

According to Gerald Kominski, a professor of health policy at UCLA in Los Angeles, the US does "little to regulate prices, in contrast to all other high-income nations."

"Medical tourism from a high-income nation like the US is indicative of a problem with affordability, as opposed to quality," he added.

Universal coverage

But even if "Medicare for All" were introduced as Sanders and Warren have urged, Americans likely would not stop seeking cheaper care abroad, says Medical Tourism Association CEO Jonathan Edelheit. 

After President Barack Obama's health care reforms in 2010, which required all adults to have insurance plans whether through work or the government, medical tourism by Americans expanded, he said.

Some employers whose medical costs "almost doubled since Obamacare was in place" sent staff abroad, he said, citing a company that saved $20 million in five years by sending employees for orthopedic and weight-loss operations outside the US.

Under universal care proposals, the US would likely end up with a system where, like in Canada and Europe, non-urgent procedures such as stomach operations require years on a waiting list.

"Wait times... will push people to go for medical tourism" to get treatment earlier, he predicted.

Indeed, many of the foreign patients at Oasis of Hope hospital are Canadian.

Europe is a sought-after destination for US medical tourists, though it does little to attract them, unlike emerging economies such as Singapore, Thailand and the Philippines.

The United States itself receives health tourists -- its highly advanced health care system appeals to patients with massive purchasing power from Arab and Asian countries.

But that is a luxury Merrill cannot afford. 

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Overweight people more likely to have overweight dogs: study

COPENHAGEN, Denmark - Overweight people are more likely to have overweight dogs, partly because they are more likely to feed them treats, Danish researchers said Wednesday.

The study by the University of Copenhagen lends credence to the saying "like owner, like dog", the scientists wrote in the journal Preventive Veterinary Medicine.

"The prevalence of heavy or obese dogs is more than twice as large among overweight or obese owners (35 percent) than among owners who are slim or of a normal weight (14 percent)," the researchers said.

Of the 268 dogs studied, 20 percent were overweight.

Average-weight owners tend to use treats for training purposes while overweight owners prefer to provide treats in convivial situations, "for example, when a person is relaxing on the couch and shares the last bites of a sandwich or a cookie with their dog," the study's main author, Charlotte Bjornvad, said.

In developed countries, 34 to 59 percent of dogs are overweight or obese, which can reduce their life expectancy and mobility or cause diabetes and cardiac disease just like in humans, another international team of researchers found in 2016.

On average, overweight dogs live 1.3 years less than dogs on restrictive diets.

The University of Copenhagen study also showed that castration tripled the risk of being heavy or obese.

"Castration seems to decrease the ability to regulate the appetite in male dogs and at the same time, it might also decrease the incentive to exercise which results in an increased risk of becoming overweight," Bjornvad said.

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Why so many of us don’t lose weight when we exercise

People hoping to lose weight with exercise often wind up being their own worst enemies, according to the latest, large-scale study of workouts, weight loss and their frustrating interaction. The study, which carefully tracked how much people ate and moved after starting to exercise, found that many of them failed to lose or even gained weight while exercising, because they also reflexively changed their lives in other, subtle ways. But a few people in the study did drop pounds, and their success could have lessons for the rest of us.

In a just and cogent universe, of course, exercise would make us thin. Physical activity consumes calories, and if we burn calories without replacing them or reducing our overall energy expenditure, we enter negative energy balance. In that condition, we utilize our internal energy stores, which most of us would call our flab, and shed weight.

But human metabolisms are not always just and cogent, and multiple past studies have shown that most men and women who begin new exercise routines drop only about 30 percent or 40 percent as much weight as would be expected, given how many additional calories they are expending with exercise.

Why exercise underwhelms for weight reduction remains an open question, though. Scientists studying the issue agree that most of us compensate for the calories lost to exercise by eating more, moving less, or both. Our resting metabolic rates may also decline if we start to lose pounds. All of this shifts us back toward positive energy balance, otherwise known as weight gain.

It has not been clear, however, whether we tend primarily to overeat or under-move as compensation, and the issue matters. To avoid compensating, we need to know how we are doing it.

So, for the new study, which was published last month in the American Journal of Clinical Nutrition, researchers with the Pennington Biomedical Research Center in Baton Rouge, Louisiana, and other institutions decided to exhort a large group of inactive people into exercising and closely track how their waistlines and daily habits changed.

They began by recruiting 171 sedentary, overweight men and women ages 18 to 65, measured their weight, resting metabolic rates, typical levels of hunger, aerobic fitness and, using complex, liquid energy tracers, daily food intake and energy expenditure. With standardized psychological questionnaires, they also explored whether the volunteers felt that virtuous, healthy actions now justified less-desirable ones later.

They then randomly assigned some to continue their normal lives as a control, while others began supervised exercise programs. In one, people exercised three times a week on treadmills or exercise bikes until they had burned eight calories for every kilogram of their body weight, or about 700 calories a week for most of them. The other program upped the exercise to 20 calories for every kilogram of body weight, or about 1,760 calories a week.

Both routines lasted for six months. Throughout, the volunteers wore activity monitors, and the researchers periodically checked their metabolic rates, energy intake and fitness. The volunteers could eat as they chose.

Afterward, everyone returned to the lab for comprehensive remeasurements. As expected, the control group’s numbers, including their weights and resting metabolic rates, had not budged. But neither had those of most of the exercisers. A few had dropped pounds, but about two-thirds of those in the shorter-workout group and 90 percent of those in the longer-workout group had lost less weight than would have been expected.

They had compensated for their extra calorie burn.

But not by moving less, the scientists found. Almost everyone’s activity-monitor readouts had remained steady. Instead, the exercisers were eating more, other measurements and calculations showed. The extra calories were slight — about 90 additional calories each day for the some-exercise group, and 125 a day for the most-exercise set. But this noshing was sufficient to undercut weight loss.

Interestingly, the researchers also found that those exercisers who had compensated the most and lost the least weight tended to be those who had reported at the start that they thought some good health habits gave people license for other, insalubrious ones.

“In effect, they felt that it’s OK to trade behaviors,” says Timothy Church, an adjunct professor at Pennington who led the new study. “It’s the ‘if I jog now, I deserve that doughnut’ idea.”

In consequence, they lost little if any weight with exercise.

But the study produced other, more encouraging data, he says. For one thing, almost everyone’s resting metabolic rates remained unchanged; slowed metabolisms would encourage pounds to creep back. And those few exercisers who avoided an extra cookie or handful of crackers did lose weight.

“There was only a small difference, overall,” between those who compensated and those who did not, Church says. “We’re talking about barely 100 calories. That’s about four bites of most food.”

So, people hoping to lose weight with exercise should pay close attention to what they eat, he says, and skip those last four bites, no matter how tempting.


2019 New York Times News Service

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Genes, yes, but obesity pandemic mostly down to diet: study

PARIS - A three-fold jump since 1975 in the percentage of adults worldwide who are obese has been driven mainly by a shift in diet and lack of exercise, but genes do play a role as well, according a large-scale study published Thursday.

For people genetically predisposed to a wider girth, these unhealthy lifestyles compounded the problem, resulting in an even higher rate of weight gain, researchers reported in The BMJ, a peer-reviewed medical journal.

The standard measure for obesity, the Body-Mass Index (BMI), is calculated on the basis of weight and height.

A BMI of 25 up to 30 means that one is overweight. Thirty and above corresponds to obesity, a major risk factor for heart attacks, stroke, diabetes and some cancers.

About four percent of adults in the mid-1970s had a BMI of 30 or higher. By 2016, that share had risen to 13 percent (11 for men and 15 for women), according to the World Health Organization.

There are currently about two billion people 18 and older -- 39 percent of all adults -- with a BMI above the "overweight" threshold of 25, and 700 million of them are clinically obese.

The prevalence of excess weight has risen even more dramatically among children, from four percent in 1975 to over 18 percent in 2016.

To tease out the relative impact of environment and genes on obesity, scientists led by Maria Brandkvist at the Norwegian University of Science and Technology combed through data on nearly 120,000 people in Norway whose height and weight were regularly measured between 1963 and 2008.

Adults began tipping the scales at significantly higher weights in the 1980s and 1990s, they found.

Those born after 1970 were far more likely to have a substantially higher BMI as young adults than earlier generations.

- 'Obesogenic' environment -
Half of the people monitored were divided into five groups depending on their genetic susceptibility to obesity.

Comparing the two groups at the extremes, the researchers found, for example, that 35-year-old men with genetic variants known to favour weight gain were already heavier in the mid-1960s than men the same age without those fat-inducing genes.

Four decades later -- even as obesity rates increased across the board -- that gap nearly doubled.

Women showed the same trend, though the increase over time was somewhat smaller.

"Genetic predisposition would make a 35-year old man of average height 3.9 kilos heavier than his genetically protected peers in the 1960s," explained Brandkvist.

"In Norway today, his vulnerable genes would make him more than 6.8 kg heavier."

In addition, he will have gained an extra 7.1 kilos "simply as a result of living in our 'obesogenic' environment," she added.

"This man's 13.9 kg excess weight is caused mostly by today's unhealthy lifestyle, but also by how his genes interplay with the environment."

While the correlation between the genetic profiles and degree of obesity was strong, the study -- by its nature -- cannot determine a direct cause-and-effect relationship, the authors caution.

Only clinical trials can highlight causal relationships, but for many areas of interest such experiments are not possible with humans, for both practical and ethical reasons.

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40 percent of cancers in U.S. linked to excess weight

About 40 percent of all cancers in the United States -- more than 630,000 in all -- are associated with excess weight, health officials said Tuesday, urging a renewed focus on prevention.

In a nation where 71 percent of adults are either overweight or obese, the findings by the U.S. Centers for Disease Control and Prevention "are a cause for concern," said the agency's director Brenda Fitzgerald.

"A majority of American adults weigh more than recommended -– and being overweight or obese puts people at higher risk for a number of cancers," she said in a statement.


"By getting to and keeping a healthy weight, we all can play a role in cancer prevention."

Carrying excess weight has been shown to boost the risk of 13 types of tumors, including cancers of the esophagus, thyroid, postmenopausal breast, gallbladder, stomach, liver, pancreas, kidney, ovaries, uterus, colon and rectum.

The rates of these overweight- and obesity-related cancers are rising, in contrast to the overall rate of new cancer cases which has dropped since the 1990s.

Colorectal cancer was the only weight-associated cancer that decreased from 2005-2014 -- falling 23 percent, due in large part to screening, said the report.

All other cancers linked to weight rose seven percent in that decade.

About two-thirds of the 630,000 weight-associated cancers diagnosed in 2014 occurred in people aged 50 to 74.

Women were particularly susceptible, with 55 percent of all cancers diagnosed in women associated with weight, compared to 24 percent of those diagnosed in men.

According to the latest CDC data, 32.8 percent of people in the United States are overweight, and 37.9 percent are obese.

Being overweight is defined as having a body mass index of 25-29.9 kg/m2, while obesity means a BMI of 30 or above.

BMI is calculated by taking a person's weight in kilograms divided by the square of the person's height in meters.

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World's heaviest man undergoes bypass surgery

GUADALAJARA, Mexico - The man believed to be the world's heaviest is recovering from biliopancreatic bypass surgery in Mexico, after doctors recommended the procedure amidst fears for the patient's health.

According to local media, thirty-three-year-old Juan Pedro Franco - who has weighed up to 595 kilos (1,311 pounds) - has been largely bed-ridden for the last seven years due to his large size. He was recently put on a diet to help shed some weight but not enough to allay concerns for his life.

The surgery took place on May 09, after Franco dropped 175 kilograms (385 pounds) over the last couple of months, making surgery possible.

Speaking to Reuters after the surgery in a clinic in Guadalajara, Franco said he would do his best to make his bypass surgery a success.

Franco has battled obesity all of his life, but the problem took a turn for the worse following an injury at age 17. After this time a dramatic increase in weight gain was observed.

His medical team told media they are awaiting to see how much of a loss in weight his body will make from the surgery, but due to Franco's delicate health they are keeping a close eye over the patient.

Threats to Franco's health from his obesity ranges from diabetes to organ failure.

Franco's doctor, Jose Castaneda, operated on Franco together with other specialists. Two anaesthesiologists and a cardiologist watched over Franco's vital signs during the 20 -minute surgery.

According to the World Health Organisation, Mexico is a global leader in obesity with 35 percent of its adolescents overweight or obese.

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Trump downshifts Michelle Obama's healthy school food scheme

WASHINGTON - US President Donald Trump's administration on Monday put the brakes on a scheme championed by former first lady Michelle Obama meant to ensure healthier meals in schools through lower salt, fats and sugar.

The Agriculture Department said in a statement the change would give American schools "greater flexibility" and stop kids from throwing out the less appetizing food mandated under the scheme.

Forcing schools to adopt better nutritional standards under the 2012 Healthy, Hunger-Free Kids Act if they wanted federal subsidies for meals was one of Michelle Obama's key achievements.

Lauded by supporters in the US as crucial in the fight against childhood obesity, the initiative put restrictions on sodium and sweetened milks, and required school lunches to increase the amount of whole-grain foods they contained.

The Trump administration's backtrack on the measure came the same day as a study suggesting that if American children exercised more, tens of billions of dollars in medical costs could be saved over their lifetimes.

The finding was made by researchers at Johns Hopkins University's Bloomberg School of Public Health. According to the US Centers for Disease Control and Prevention, about one in six American children are overweight or obese.

The Agriculture Department said the nutritional requirements imposed on schools in the past five years had added $1.2 billion in costs to school districts and to states.

It said easing those rules would decrease costs, give back greater control to local authorities, and see children eating more enthusiastically.

"If kids aren't eating the food, and it's ending up in the trash, they aren't getting any nutrition –- thus undermining the intent of the program," Agriculture Secretary Sonny Perdue said.

At the same time, the Trump administration discontinued another signature program by Michelle Obama and her husband Barack Obama.

The 2015 scheme designed to promote educational opportunities for adolescent girls in developing countries, called "Let Girls Learn," was being immediately scrapped, CNN reported on the basis of an internal email it had obtained.

The email, sent to members of the US Peace Corps, a US government overseas volunteer program, said some parts of "Let Girls Learn" would continue, but the name was being dropped along with its standalone status.

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FTO gene not an obesity life sentence: study

People who carry a variant in the so-called obesity gene, FTO, react just as well to diet and exercise as those without it, a research paper said Wednesday.

This means that people with the variant, which appears to be linked to a higher risk for being overweight, are not necessarily doomed to remain so, according to a meta-analysis published in The BMJ medical journal.

"Individuals carrying the (variant) respond equally well to dietary, physical activity, or drug based weight loss interventions," wrote the authors of the review of eight studies involving some 10,000 people.

This meant that genetic predisposition to obesity "can be at least partly counteracted through such interventions."

Scientists have previously shown an association between a variant of the FTO gene and surplus body fat, but little is understood about how the link works.

The relative contribution of genetics and lifestyle to the global obesity epidemic is still very much in dispute.

The latest review showed that participants in weight loss programs who had the FTO variant started out almost a kilo (about two pounds) heavier on average than those without it.

But changes in weight were similar in people with the variant and those without it, regardless of other factors such as ethnicity or gender, the authors said.

In 2014, according to the World Health Organization, more than 1.9 billion adults globally were overweight. Of those, more than 600 million were obese.

Carrying excess weight has been linked to heart disease, stroke and certain cancers.

Commenting on the latest research, Public Health England agency chief nutritionist Alison Tedstone said the causes of the obesity epidemic may have little to do with genes.

The study, she said, "adds to the evidence suggesting that environmental factors might dominate over at least common obesity linked genes".

Such factors could include a high-sugar diet or insufficient physical exercise.

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Obesity, heart disease linked to childhood bullying

Victims of childhood bullying are more likely to be overweight or obese as adults and have a higher risk of developing heart disease, diabetes and other illnesses, according to a study by British psychiatrists.

Researchers found that just over a quarter of women who were occasionally or frequently bullied as children were obese at age 45, compared to 19 percent of those who had never been bullied.

And both men and women who were bullied as children had higher levels of fat around their middle -- a known risk factor for heart disease.

"Bullying is bad for your physical health, whether you're a man or a woman," said Andrea Danese, who worked on the study at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London.

Louise Arseneault, who led the research, said its findings should remind teachers, parents and carers to think about the victims, not just worry about how to stop the bullies.

Bullying is characterized by repeated hurtful actions by other children, against which the victims find it difficult to defend themselves, she told reporters. Unfortunately, bullying was "part of growing up for many children", she said.

"We tend to neglect the victims and their suffering," she added. "(Yet) for some children, they will be marked for the rest of their lives."

Arseneault's findings, published on Wednesday in the journal Psychological Medicine, come from the British National Child Development Study which has data on all children born in England, Scotland and Wales during one week in 1958.

It included 7,102 children whose parents gave information on their child's exposure to bullying at age 7 and 11. Some 28 percent had been bullied occasionally and 15 percent were bullied frequently. The children were then followed up at age 45, when measures of blood inflammation and obesity were recorded.

Besides obesity, the results showed that being bullied also led to higher levels of blood inflammation by the age 45.

Some 20 percent of those who were frequently bullied had high levels of a substance called C-reactive protein (CRP). High CRP raises heart disease risk by increasing atherosclerosis, where arteries get clogged up with fatty deposits.

Danese said the effects of childhood bullying on the risk of poor health in adulthood are relatively small compared to factors such as smoking, diet and exercise, but stressed that because obesity and bullying are both common, tackling them could have a significant health impact.

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How grocery lists may help lower body weight

Heading to the grocery store armed with a list may make it easier to follow a healthy diet, a study of shoppers in Pittsburgh suggests.

Researchers surveyed more than 1,300 mostly overweight and obese residents in two poor, primarily African American communities and found that shoppers who regularly made grocery lists also made higher quality food choices and had lower body weights.

"We don't know whether people who are healthier pay more attention to what they eat and pay more attention to their weight and are also people who do more planning, or if people who do more planning are more able to avoid impulse purchases and the less healthy options presented to them at the supermarket," lead study author Tamara Dubowitz said.

"We can say there is a link but we can't say what causes it," Dubowitz, a researcher at RAND Corporation in Pittsburgh, told Reuters Health.

More than one-third of U.S. adults are obese, putting them at increased risk of heart disease, stroke, type 2 diabetes and certain cancers, according to the Centers for Disease Control and Prevention. Among all adults nationwide, nearly half of African-Americans and more than 40 percent of Hispanics are obese, as are about a third of Caucasians.

While many factors can contribute to obesity, poverty and lack of quality grocery stores close to home are two important contributors, Dubowitz said.

Dubowitz and colleagues surveyed a population with 80 percent of participants reporting household income of less than $20,000 a year. Just 33 percent were employed. They lived in what's known as a food desert, an area with limited access to healthy foods.

Just under one third of the participants said they “always” shopped with a grocery list, while another 17 percent did so often and 26 percent did so occasionally.

People who used grocery lists all the time were more likely to be female and older, less likely to be employed, and more likely to be trying to eat fewer calories.

After controlling for these factors, the researchers found that dietary quality remained significantly higher among participants who always shopped with a list.

The study team also weighed participants and measured their heights to calculate body mass index (BMI), a ratio of weight to height. A BMI between 18.5 and 24.9 is considered healthy weight, 25 to 29.9 is considered overweight and 30 or above is obese.

Using a shopping list was also associated with having a BMI about one point lower compared to people who didn’t use lists. That amounts to a weight difference of about five pounds for somebody whose height is 5' 5" (1.65 meters).

The researchers acknowledge in the Journal of Nutrition Education and Behavior that the study isn't designed to show shopping lists cause people to be healthier, only that there is a link between the two.

They are also following residents over a longer period of time to see if the opening of a new grocery store in the community changes people's dietary habits or makes a dent in obesity rates, Dubowitz said.

"Shoppers don't have control over the availability of healthy produce or their pricing; those problems will require structural interventions to fix them such as attracting grocery stores to move into food deserts," Dr. Ichiro Kawachi, chair of social and behavioral sciences at Harvard School of Public Health in Boston, said by email.

Given the lack of groceries and other structural problems encountered by the study participants, the findings "suggest that there are things that people can do for themselves" to pursue healthy eating habits, said Kawachi, who wasn't involved in the study.

It's possible that some things people did to eat healthier food and maintain a lower weight had nothing to do with shopping lists, said Dr. Jason Block, associate director of the obesity prevention program in the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.

He noted that the modest one-point difference in BMI linked to grocery lists makes it more likely that some other behavior not measured in the study may have explained the change.

"It's quite likely that using a list is a behavior linked to other healthful behaviors," Block, who wasn't involved in the study, said by email.

Still, it points to the power of advance planning to help improve impulse control, Kawachi said.

"The typical supermarket these days is carefully engineered so that they are constantly tempting customers to make impulse purchases and unwise food choices (e.g. placing candies at the checkout)," Kawachi said. "Having a plan and sticking to it is a good start to pre-committing yourself to a healthy purchase pattern."

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PH, India lead nations with highest obesity levels

MANILA, Philippines - While the world is focusing on global hunger and malnutrition, another ugly “monster” has emerged.

Obesity, a new form of malnutrition, has surfaced as an urgent challenge affecting several countries.

According to the United Nations Food and Agriculture Organization (FAO), the Philippines and India are among the developing countries with high levels of obesity and under-nutrition.

Obesity as a form of malnutrition often coexists with under-nutrition and results from shifts from local and traditional diets to foods that are increasingly heavy in salt, sugar and fat or processed foods.

The shift to a steady diet of processed food is due to the increasing cost of nutritious and natural food, the FAO said.

The global prevalence of combined overweight and obesity has risen in all regions, increasing among adults from 24 percent to 34 percent between 1980 and 2008.

The FAO said the prevalence of obesity among children has increased even faster, doubling from six percent to 12 percent over the same period.

“Overweight can co-occur with underweight within the same household, and is on the rise in countries with a high level of under-nutrition,” the FAO added in the report.

A 2011 survey by the Food and Nutrition Research Institute (FNRI) showed that 22.3 percent of Filipino adults are overweight and 6.1 percent are obese.

The prevalence of overweight Filipinos is expected to increase significantly by 2015.

“If this trend continues, it is highly likely that more will suffer from high-risk diseases that could lead to death,” the FNRI report said.

The factors leading to obesity in developing countries like the Philippines are numerous.

One leading factor is increasing world and domestic food prices, forcing increased purchase of unhealthy processed food over healthy and staple but expensive food.

Price increases threaten food security for poor households. For example, the 2011 increase in the price of basic grains meant that, in many developing countries, the cost of a kilogram of wheat doubled from about $.15 to $.30, a critical difference for people who live on little more than a dollar a day.

Food represents a substantial portion of the expenditure of poor households in poor countries.

For countries in Asia and Africa, expenditure on food was generally over 50 percent in the early 2000s, prior to the 2007-2008 crisis. In the Philippines, expenditures on food amount to 63 percent of a person’s income.

Biggest risk

Obesity is the biggest risk factor for type 2 diabetes mellitus. It likewise aggravates hypertension and raises blood cholesterol levels, which are major predisposing factors to the development of heart attacks and strokes.

In overweight men, the occurrence of impotence and sterility is higher than average while in obese women, there is a higher than average incidence of menstrual disorders, infertility and complicated pregnancies.

In both sexes, obesity increases the risk for gallbladder stones.

Obesity is likewise associated with cancers of the breast, uterus, cervix, ovary and gallbladder among women, and colon, rectum, prostate, pancreas and stomach among men.

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Pollution, smoking, roads, obesity kill 4.7m Chinese a year

PARIS - Air pollution, smoking, obesity and accidents, especially on the road, kill at least 4.7 million Chinese a year and cost the country tens of billions of dollars, researchers said on Friday.

In an overview published in The Lancet, they said China had in some respects made great strides in health, boosting the average lifespan from 40 years in 1950 to 76 years in 2011 and rolling back many infectious diseases.

On the other hand, the risk of premature death and sickness from pollution, smoking, road crashes and "lifestyle" ailments is worse than before.

The trio of Chinese and US experts said China had the chance of learning from rich countries which had already been down this path, a by-product of rising prosperity.

"Many of these risks can be lowered by interventions with shown effectiveness," they said.

"China has the opportunity to avoid repetition of the full toll of preventable disease burdens suffered by high-income countries from non-communicable diseases."

The research, led by Jeffrey Koplan, a professor at Emory University in Atlanta, provides the following snapshot, which includes figures that have been published previously:

-- Air pollution: A million deaths annually are attributable to inhaling indoor smoke from solid fuels, and another 1.2 million from inhaling fine particulate matter outdoors.

The economic cost from particulate air pollution among urban dwellers was 341 billion yuan ($55 billion, 42 billion euros) in 2006, according to the paper.

-- Smoking: 1.4 million premature deaths each year, costing 41 billion yuan annually on the basis of values for 2000.

-- Road fatalities: China has more than 800,000 deaths annually from accidents, which are "mainly" accounted for by road accidents, according to the report. (Separately, the United Nations estimated 275,000 road deaths in China in 2010).

Accidents of all kinds are the leading cause of death in the 1-39 age group and cost 65 billion yuan in medical expenses alone, said the study.

-- Obesity: 363,000 fatalities each year attributable to high body-mass index, a condition linked to heart disease, diabetes and other ailments. The cost -- in 2003 -- was 21 billion yuan.

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Diet and exercise may help maintain weight loss

NEW YORK - Programs focused on both diet and exercise may help people who have lost weight keep the pounds from creeping back on, according to a new analysis of past studies.

Orlistat, an obesity drug, may also be effective when taken at higher doses, researchers found.

More than one third of US adults are obese, and obesity raises the risk of heart disease, type 2 diabetes and some types of cancer. Losing weight - and keeping it off - can reduce those risks.

“Long term weight loss through changes in eating and physical activity is possible, even in adults who have already acquired obesity related illness, and effective weight loss programs are now available,” researchers led by Stephan Dombrowski of Newcastle University in the UK write.

They pooled data from 45 studies that included a total of 7,788 adults who had lost at least 5% of their body weight. The studies looked at people’s ability to keep the weight off for a minimum of one year.

Forty-two of the studies included an initial phase meant to produce weight loss. The participants in those studies lost an average of about 24 pounds.

The studies all looked at medication or lifestyle changes such as diet, physical activity and meal replacements, either alone or in combination, to help with weight loss maintenance.

The researchers found that people participating in programs that combined diet and exercise gained back 3.4 fewer pounds after one year compared to people receiving no extra help with weight maintenance or standard treatment only.

They also found that combining Orlistat with behavioral changes resulted in 4 fewer pounds regained after one year compared to participants who took a drug-free placebo.

Orlistat appeared to be more effective at larger doses, according to results published in the British medical journal BMJ. But the drug also came with gastrointestinal side effects.

Lori Rosenthal said the findings echo previous research and that it was “interesting” that the authors included data from so many studies.

Rosenthal is a dietician at Montefiore Medical Center in Bronx, New York. She was not involved in the new review.

“I think it’s great that they covered so many different studies but there’s also so much variety and the long-term research isn’t there, you know - going beyond 24 months,” she told Reuters Health.

Still, “We know that interventions like diet and physical activity are really important in preventing weight regain after losing,” she said.

Rosenthal noted that participants who had dropped out of the programs were not always included in the findings, and that could affect the review’s results.

“Weight management is hard,” she said. “People have to realize that it’s not just the losing it - it’s for life, and if you don’t like what you’re doing, if it doesn’t work for you, you’re not going to stick with it.”

Support during the weight management phase is important, Rosenthal added. There are support groups and dietitians who can give people tricks and tools to help make it easier, she said.

She offered some advice for people who have lost weight and are moving into a maintenance phase.

“It’s really important to remember that weight management is a mind and a stomach game,” she said. “You have to feel good about what you’re having.”

“Really make sure you find foods you like - that you’re choosing foods not because you’re on a diet but because you like them,” Rosenthal said. “You have to like them more than the other things you were eating before.”

Rosenthal said that if people don’t like the new foods they eat or their new routine, they will be more likely to go right back to old habits.

She said being mindful and chewing slowly also allows people to enjoy their food and eat less.

source: www.abs-cbnnews.com

Calling girls 'fat' may result in weight gain

NEW YORK - Young girls who have been called “too fat” are more likely to be obese as young adults, according to a new research letter.

The early stigma of being labeled that way may worsen the problem rather than encouraging girls to become healthier, but more research is needed to be sure, the study authors say.

“This study is one step closer to being able to draw that conclusion, but of course we can't definitively say that calling a girl "too fat" will make her obese,” said senior author A. Janet Tomiyama of the University of California, Los Angeles.

“This study recruited girls when they were age 10 and followed them over nine years, so we know it's more than just a one-time connection, which makes me believe that it's an important question to continue researching,” Tomiyama told Reuters Health in an email.

She and her coauthor examined data from an existing study that followed girls through their teen years. At age 10, the girls answered the question, “have any of these people told you that you were too fat: father, mother, brother, sister, best girlfriend, boy you like best, any other girl, any other boy, or teacher?”

Out of just over 2,000 girls, a total of 1,188 answered “yes” to any of the choices.

Those girls were more likely to have a body mass index (BMI) – a measure of weight relative to height - in the obese range ten years later than girls who answered “no,” according to the results in JAMA Pediatrics.

“We know from considerable evidence that youth who feel stigmatized or shamed about their weight are vulnerable to a range of negative psychological and physical health consequences,” said Rebecca Puhl, deputy director of the Rudd Center for Food Policy & Obesity at Yale University in New Haven, Connecticut.

“This study suggests that negative weight labels may contribute to these experiences and have a lasting and potentially damaging impact for girls,” said Puhl, who was not part of the study.

Girls who had been labeled “fat” were still at higher risk of obesity even when researchers accounted for their BMIs at age 10, household income, race and parental education level.

The effect seemed to be strongest when the labels came from family members, which increased the risk of obesity later by 60 percent, compared to 40 percent when the comments came from friends or teachers. But it’s not wise to make too much out of the difference between those numbers, since this was only an exploratory study, Tomiyama said.

She was not at all surprised that over half of girls had been labeled “fat.”

“The pressure to be thin in our society is intense, and other research shows that people label both themselves and others as 'overweight' even if their objective body mass index is in the 'normal weight' range,” she said.

Females are exposed to weight stigma more often, but the connection may be present for boys as well, she noted.

There are ways for parents to address weight and health issues with their children that don’t involve labeling, Tomiyama said.

“There's no need to say the ‘f’ word at all if you want to improve your child's health,” she said.

Parents could instead focus on the health of the family as a whole, said Angelina Sutin, who was not involved in the new study.

Sutin studies psychological wellbeing and health disparities at Florida State University College Of Medicine in Tallahassee.

“The best approach would be to start kids early on a path toward healthy living by eating healthy food and being physically active,” Sutin told Reuters Health in an email.

“This applies equally to parents as it does to kids – children model their parents’ behavior, so if kids see their parents making healthy choices, they are more likely to also make healthy choices,” she said.

Parents could identify activities the child enjoys and work on ways to do more of them, she added.

“I think the focus of the conversation needs to change,” Tomiyama said. “Right now, we have a laser focus on weight instead of health, but many studies show that weight is a really imprecise indicator of actual health.”

“Parents can talk to their child about adopting healthy behaviors without once mentioning weight,” she said.

source: www.abs-cbnnews.com

No profits for companies chasing obesity business

KALUNDBORG, Denmark - Steam rises from pipes at a giant industrial complex on the edge of the Baltic Sea whose success is a testament to the world's diabetes and obesity epidemic.

Novo Nordisk's Kalundborg factory, 100 km west of Copenhagen, makes half the planet's insulin for diabetics, putting it on a list of global sites the United States sees as vital to its interests, according to a WikiLeaks cable in 2010.

Soaring diabetes rates, driven by increasing obesity, have fuelled profits at the Danish company for two decades.

But now the company wants to tackle obesity head on by launching a treatment specifically to help patients lose weight.

It would seem to be a no-brainer. Obesity rates suggest a booming market. Yet it is proving surprisingly difficult for both drugmakers and food companies to develop businesses directly addressing the problem.

In a global economic downturn, modestly effective weight-loss drugs and special diet foods are turning out to be a tough sell when a cheaper alternative is to eat less - or do nothing.

The first new prescription diet drugs to hit the U.S. market in more than a decade, from Vivus and Arena Pharmaceuticals, have registered disappointing sales and food companies' diet lines are struggling.

Switzerland's Nestle has all but given up on the diet business, agreeing to sell the bulk of its Jenny Craig weight-loss unit last week to U.S. private equity firm North Castle Partners.

And as Unilever reviews its portfolio of underperforming food assets, analysts say its Slim-Fast brand is one that could come up for sale. Bernstein Research estimates Slim-Fast had 2012 sales of 300 million euros ($402 million), 34 percent lower than when Unilever agreed to buy it in 2000 for $2.3 billion.

"The need for the services is increasing, unfortunately, but there are a lot of companies that have not done well," said Jon Canarick of North Castle, which also bought the firm behind the Atkins diet from its post-bankruptcy lenders in 2007. "I credit most of that to a combination of the economy and the influx of competition."

Weak economies have curbed demand for pricey, specialist dieting schemes just as competition has exploded from a host of electronic apps that count calories for free - and securing insurance reimbursement has been an uphill fight for new drugs that cost around $160-$200 a month in the United States.

BURDEN OF DISEASE

Obesity prevalence has increased by more than 40 percent across the OECD industrialised countries and half of U.S. adults are now forecast to be obese by 2030 unless Americans change their ways.

The condition is a major risk factor for heart disease, certain cancers and diabetes, with the latter alone expected to kill more than 5 million people this year.

Lars Sorensen, Novo Nordisk's veteran chief executive, hopes the clear medical need will help his firm's move into obesity, although he acknowledges it will not be easy.

"It is going to be challenging. We need to convince employers and insurers in the United States, which is the biggest market, that this is a problem that can be addressed," he said in an interview.

"It's been very disappointing in terms of pharmaceutical interventions up to now, but I see that changing."

Certainly, the medical community is taking more notice.

The American Medical Association classified obesity as a disease for the first time this year, while new guidelines from the American College of Cardiology and American Heart Association back more aggressive therapy.

Binge eating disorder, a related problem, has also entered the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the reference book for psychiatry, opening a new opportunity for a drug from Shire.

Europe, however, is lagging behind in recognising obesity and approving new drugs, according to Euan Woodward, executive director of the European Association for the Study of Obesity.

"The U.S. is way ahead. We haven't had the same discussion in Europe yet," he said.

Yet U.S.-approved diet drugs like Vivus' Qsymia and Arena's Belviq are being held back by cost and the modest weight loss they can offer, with safety problems linked to earlier products also making doctors cautious.

The popular fen-phen drug combination was taken off the market in 1997 for causing heart damage, while Sanofi's Acomplia was withdrawn in Europe in 2008 after being linked to suicidal thoughts - it never won U.S. approval - and Abbott's Meridia was pulled in 2010 on heart worries.

As a result, global sales of obesity drugs have halved in the last five years, and even though they are expected to climb again they will remain dwarfed by therapies to treat diabetes, as rates of type 2 disease - the kind linked to obesity - soar.

Consensus analysts forecasts suggest obesity drug sales may grow from $300 million to $3.8 billion by 2018, while the diabetes market, worth some $37 billion at present, will reach more than $57 billion, according to Thomson Reuters Pharma.

Novo Nordisk hopes a high dose of its injectable medicine liraglutide - the active ingredient in its diabetes treatment Victoza - will take pharmacological interventions to a new level, by mimicking the action of a natural hormone.

So far, though, clinical trials have underwhelmed analysts and Matthias Tschoep, head of the Institute for Diabetes and Obesity at the Helmholtz Zentrum in Munich, believes a truly effective medicine will need to combine the effects of multiple hormones to achieve reductions in body weight beyond the 5-10 percent seen with current drugs. That could be a long haul.

"We need to close the gap between existing drug treatments and a gastric bypass surgery, which makes you lose 35 percent of body weight," he said. "I firmly believe that within the next 10 to 20 years, we will have very efficient drugs."

The big problem for dieters and drug designers alike is the fact that human evolution makes it very hard for people to curb their appetite and cut calorie consumption.

A predisposition to gain weight is hard-wired, with animal experiments showing that consumption of sugary food triggers the brain to release dopamine, a neurotransmitter also linked to drug addiction.

THREATENED BY BROCCOLI, MOBILE APPS

Weight Watchers, the leading weight loss company in the United States, is finding the going increasingly tough. Revenue has been roughly flat or down during six of the last seven quarters and the outlook for the next four is even worse.

Last month, the company said that despite progress on cost-cutting, it expected full-year revenue to fall at a low double-digit percentage rate if recruitment trends failed to improve.

Weight Watchers is battling a declining membership base, growing membership at rivals, and the rise of cheap or free smartphone applications and activity monitors such as MyFitnessPal and the Jawbone UP wristband.

There are nearly 2,000 weight-loss apps now available on the iPhone, and Berlin-based market research firm research2guidance estimates that by 2015, 500 million people will be using mobile health applications which cost much less than the packaged meal plans sold by Jenny Craig, Nutrisystem and Medifast that usually cost hundreds of dollars a month in up-front purchases.

Analysts say the lion's share of the world's dieters use a "do-it-yourself" approach.

"Broccoli and lettuce are good competition for weight-loss shakes," said Imperial Capital analyst Mitchell Pinheiro. "Dieting is fickle to begin with and trends are fleeting. While the addressable market is enormous and continues to grow, how dieters choose to diet is not consistent and it's not sustainable."

Meanwhile, the retail market for meal replacement products such as Slim-Fast bars and Herbalife shakes, is estimated at $7.76 billion worldwide, according to data tracker Euromonitor, up from $5.51 billion in 2008.

In a very competitive market, Euromonitor analyst Ildiko Szalai sees the key to success as transcending the natural stigma and impermanence of dieting. She cited Kellogg's Special K cereal bars, protein shakes and diet plan, which has briskly moved in as Slim-Fast has retreated.

"They made it very successful, positioning the product as a lifestyle and not just something for six weeks so you lose weight," Szalai said. "You eat it forever."

source: www.abs-cbnnews.com

'Lifestyle diseases' are new threat to Asia

MANILA - Asia-Pacific countries face serious challenges from "lifestyle" diseases and ageing populations even as they overcome more traditional illnesses, the World Health Organisation's regional director said Monday.

Western Pacific WHO director Shin Young-soo said such ailments, often arising from a change in diets and less exercise, were sharply rising in Asian nations.

He said recent studies showed that as many as 12 percent of Chinese adults had diabetes, while as many as 50 percent had a "pre-diabetes" condition, meaning they were on the borderline of developing the illness.

This was a huge jump from the estimated 3-4 percent diabetics in China's adult population in the 1990s.

About 10 percent of adults in countries like South Korea, Japan and even Vietnam also had diabetes, Shin told reporters at a WHO regional meeting in the Philippine capital.

"It is because of the big change in our diets in the last 30-40 years' time. There is also a very interesting observation that Asian people... tend to have more diabetes than Western people," he said.

"We must have behaviour change. The whole society must tackle the issue," Shin said.

Other non-communicable ailments like hypertension and high cholesterol were also on the increase despite the fact that they could all be prevented, he said.

Shin said countries such as some Pacific island nations were experiencing diabetes among 40 percent of adults while 75 to 80 percent were suffering from obesity.

"Over many years, this will lead to huge health care costs. Societies will lose this productive labour power," he warned.

Shin also said ageing populations in some Asia-Pacific countries like Australia, Japan and China would force these nation to spend more on caring for the elderly.

Other problems facing the region like relatively high rates of blindness and the spread of drug-resistant diseases will also be discussed at the WHO meeting being held in Manila this week.

source: www.abs-cbnnews.com

Children with psoriasis may also be obese

Children with the skin disease psoriasis are about twice as likely to be overweight or obese as children who don't have the disease, U.S. researchers said.

Lead author Dr. Amy Paller of Northwestern University's Feinberg School of Medicine and pediatric dermatologist at the Ann and Robert H. Lurie Children's Hospital of Chicago said U.S. children with psoriasis have much higher odds than psoriatic children in other countries of being obese or overweight.

The study, published in the Archives of Dermatology, found U.S. children with psoriasis had four times the odds of being overweight or obese as healthy controls.

"Within this U.S. population, Hispanics and African-American children had significantly greater rates of being obese and overweight than whites and Asians," the study authors wrote in the study. "The odds ratio of being obese were particularly high for U.S. children with more severe psoriasis."

source: upi.com

Children with the skin disease psoriasis are about twice as likely to be overweight or obese as children who don't have the disease, U.S. researchers said.
Lead author Dr. Amy Paller of Northwestern University's Feinberg School of Medicine and pediatric dermatologist at the Ann and Robert H. Lurie Children's Hospital of Chicago said U.S. children with psoriasis have much higher odds than psoriatic children in other countries of being obese or overweight.
The study, published in the Archives of Dermatology, found U.S. children with psoriasis had four times the odds of being overweight or obese as healthy controls.
"Within this U.S. population, Hispanics and African-American children had significantly greater rates of being obese and overweight than whites and Asians," the study authors wrote in the study. "The odds ratio of being obese were particularly high for U.S. children with more severe psoriasis."


Read more: http://www.upi.com/Health_News/2012/11/28/Children-with-psoriasis-may-also-be-obese/UPI-12631354085676/#ixzz2DWbNsNIu

Japanese scientists confirm fat-burning protein

OSAKA, Japan - A team of researchers of Japan's Kyoto University has found a protein that helps the body burn fat following an intake of fatty meals, Japanese public broadcaster NHK reported Monday.

The researchers at the Kyoto University's Institute of Chemical Research compared mice with protein called GPR120 with those that do not have the protein, and provided them with high-fat feeds, the report said.

They confirmed that the mice without the protein were heavier than those who had it by an average of 15 percent, and accumulated twice as much fat in their bodies, it said.

The Japanese scientists also analyzed the genetic sequence of about 20,000 people in Europe, including the French and the British, and found that people with mutant GPR120 genes were 1.6 times more likely to be obese.

Based on the result of the research, the Japanese scientists concluded the protein is capable of detecting fat, and also plays a role in prompting the body to burn the fat.

Professor Gozo Tsujimoto, head of the researcher team, was quoted by NHK as saying that the development of drugs that activate the protein will help prevent obesity.

source: interaksyon.com