A retrospective review of over 1000 injured patients admitted to a level I trauma center presented at the recent Surgical Forum of the American College of Surgeons demonstrated that an elevated body mass index (BMI) was associated with a significant increase in the risk of hospital acquired infections. This risk increased steadily as BMI increased. The authors from the University of Toledo and Oakwood Medical Center in Michigan speculated that the chronic inflammatory state found in obese patients was behind the marked increase in risk of infections. -- 4.7X in obese patients and 6X morbidly obese patients. Dr. Blackshear?s comments: This study is yet another which confirms that obesity is a significant risk factor for complications of all sort in hospitalized patients. 30% of the patients in this study were obese as defined by BMI. Our own experience indicates that body fat percentage (BF %) is an even more accurate indicator of obesity. Re-analyzing the data using BF% might produce an even more striking risk.

An eight year Italian study of over 48,000 adults published in the Archives of Internal Medicine demonstrated that women who ate the most high glycemic index (GI) foods increased their risk of developing heart disease by 2.25 times compared to women who consumed the lowest number of high (GI)carbohydrates. Surprisingly, these differences were not as evident in men in the study. Dr. Blackshear's comment: This study adds yet another report to the many which illustrate that consumption of refined (high GI) sugars are much more of a health problem in our diet than fats consumed in moderate quantities.

Pre-pregnancy weight loss reduces risk of blood pressure disorders and diabetes during pregnancy. A recent retrospective study of 500 American women revealed that those who had lost a significant amount of weight during the four year period prior to delivery had only a 10% chance of pre-eclampsia (hypertension and kidney dysfunction) compared to a 31% incidence in obese women who did not lose weight before the delivery. Obese mothers also had twice the incidence of gestational diabetes (often a precursor of type II diabetes later in life) compared to with the mothers who lost significant weight before delivery.

Body fat percentage accurately predicts post operative surgical site infections. A study from Brigham and Women's hospital in Boston in the April issue of The Journal of the American College of Surgeons demonstrated that body fat percentage (BF %) as measured by bioelectrical impedance, markedly outperformed body mass index (BMI) as a predictor of postoperative surgical site infections. Obesity measured by BF% was associated with five times the risk of surgical site infections postoperatively compared to non-obese patients. BMI measurements of obesity were unable to accurately predict an increased risk of postoperative infections. BF% also identified almost twice as many patients as obese, therefore at greater risk, compared to BMI measurements.

Dr. Blackshear's comment: This study demonstrates once again that BF% is a much more sensitive clinical tool for identifying patients who are at increased risk from obesity. It has long been recognized that BMI can be elevated for reasons other than obesity. For example, individuals with significant muscularity may be identified as obese by BMI when in fact their body fat percentage is low. We have long relied upon BF%, as measured by bioelectrical impedance, to identify patients who will benefit from significant weight loss.

Genetic makeup may play an important role in successful dieting and/or weight maintenance. A recent Stanford University study of 133 overweight women surprisingly showed that genes which help regulate fat and carbohydrate metabolism radically influence the amount of weight lost on low fat or low carbohydrate regimens. Patients with a "low carb" genotype did much better on low carbohydrate diets. Conversely those with a "low fat" genotype were much more successful restricting fats. A currently available genetic test can be used as an outpatient to determine a patients "carb vs. fat" genotype. Preliminary data indicates that 45% of white females have a low carb genotype and 39% have a low fat genotype. Researchers, speculated that genotype testing, if it is confirmed in subsequent studies with larger groups including men and other racial groups, might be an important new consideration in weight control. Dr. Blackshear points out that these studies were not done in a medically supervised intensive weight loss program but only an outpatient, patient-controlled diet. Nevertheless the findings are interesting and may have significant long term implications for weight maintenance if the results prove valid in subsequent studies.

Fructose, a naturally occurring sugar present in fruits and in high concentrations in corn and corn syrups, was recently reported to influence the metabolic processes which lead to early onset diabetes and heart disease. In a ten week study of volunteers on a high fructose diet, University of California researchers demonstrated a significant increase in fat accumulation in the heart and other visceral organs--the type of fat accumulation which can often lead to metabolic disease. Abnormalities linked to diabetes and heart disease were also noted. A matched group of volunteers eating an identical diet but with glucose as a sugar instead of fructose did not demonstrate these same changes. Fructose is a common sweetener used in processed foods including cakes, cereals, salad dressing, yogurt and fruit drinks. The researchers speculated that high concentrations of fructose consumed at an early age might be a factor in the increasing incidence of childhood diabetes. "The message that we should take away from this report is to limit sugar consumption in any form," said Dr. Blackshear.

The Federal Trade Commission (FTC) doled out fines totaling $29.5 million to four manufacturers of the over-the-counter weight loss medications Cortislim, Xenadrine EFX, TrimSpa and One-A-Day WeightSmart for making false claims about their products. The FTC found that these products were primarily a combination of caffeine, herbs and vitamins and did little or nothing to induce weight loss, particularly of the magnitude claimed in advertising for the products. A study by the manufacturer of Xenadrine found that participants taking placebo lost more weight than those on Xenadrine, but this finding went unreported in their advertising. People who purchased these medications may qualify for reimbursement through the FTC web site.

The Centers for Disease Control & Prevention reports that new diabetes cases in America have doubled over the last ten years. An estimated 23 million Americans now suffer from diabetes and the incidence continues to rise.

Chicago researcher Adam Reppert at Swedish Covenant Hospital reported that in a study of 5,000 Illinois adults 30 minutes of daily exercise reduced the incidence of metabolic syndrome (central obesity, hypertension, diabetes, atherosclerosis, hyperlipidemia) by 85%. Furthermore, regular consumption of calcium rich foods lowered this risk by 61%.

Researchers in Boston and Louisiana reported on a two year study of overweight patients in the New England Journal of Medicine that trying to maintain weight loss by manipulating fat, carbohydrate and protein intake with various prescribed diets was not beneficial. Patients who ate foods of their choice and simply focused on calorie management were much more successful at weight maintenance. Epidemiologist Catherine Loria says that dieting is "much simpler" than we believed because "all you have to do is count your calories." Calorie management eating foods according to patient choice has been the basis of Dr. Blackshear's Prescription Weight Loss Clinic Weight Management Program.

In a thorough review of the medical literature published in the winter quarter of The Bariatrician , Michael Anchors, MD, PhD, found no credible evidence of any dangerous side effects of phentermine use as an appetite suppressant. Dr. Anchors' review was unable to document any instance of addition, significant hypertension, heart valve damage or serotonin syndrome in patients on prescribed doses of phentermine, although these problems are often cited by medical professionals as reasons not to take phentermine for appetite suppression. In addition, Dr. Anchors found no evidence that prolonged use of phentermine produced any ill effects.

Gnagnarella, et al., reported on a meta-analysis of 39 studies in the American Journal of Clinical Nutrition that subjects regularly consuming a diet ranked in the top 25% in glycemic index (GI) and glycemic load (GL) were 26% more likely to develop colorectal cancer when compared to subjects on the opposite end of the GI/GL scale.

Vitamin D is generating renewed interest as ongoing research demonstrates its crucial role in preventing a wide range of medical disorders, including coronary artery disease, many cancer, stroke, osteoporosis, insulin resistance, macular degeneration, depression, hypertension, diabetes, MS, rheumatoid arthritis, chronic back pain and impaired immune responses. Obesity increases the risk of clinical deficiency since vitamin D is deposited in body fat stores. Those with large amounts of body fat trap vitamin D in these stores of fat, making it less available for beneficial uses. Recommended daily requirements of vitamin D are increasing. Since it is difficult to ingest or synthesize (exposing skin to sunlight) sufficient D to meet these new standards, daily consumption of up to 10,000 International Units of vitamin D3 has been recommended.