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Another study finds that substantial weight loss can frequently reverse type 2 diabetes -  in 46% of people who had the disease 6 years or less. In the study (which was conducted in the United Kingdom) individuals were randomly assigned to different groups - either standard medical care for diabetes group or intense weight loss group (intense dieting in the first 4 months of the study), and then all were followed for 8 months (maintenance period). Those whose diabetes was reversed were all in the weight loss group and lost an average of 35 pounds during the weight loss (dieting) phase.

According to the researchers some of the non-responders (their diabetes did not reverse itself) just hadn't lost enough weight, but also tended to have diabetes a little longer (3.8 years) than the responder group (2.7 years).

Another similar earlier study also found that type 2 diabetes can be reversed in many after losing weight of about 31 pounds (600 to 700 calories a day) during an 8 week period. 40% of study participants overall reversed their diabetes, but 60% of those with short-duration of diabetes (under 10 years) reversed their diabetes. IN SUMMARY: Both of these studies had fantastic results in reversing type 2 diabetes after a large weight loss, which may lead to doctors suggesting weight loss as the number one thing to do after a type 2 diabetes diagnosis. From Science Daily:

Why weight loss produces remission of type 2 diabetes in some patients

A clinical trial recently showed that nearly half of individuals with type 2 diabetes achieved remission to a non-diabetic state after a weight-loss intervention delivered within 6 years of diagnosis. Now a study published August 2nd in the journal Cell Metabolism reveals that this successful response to weight loss is associated with the early and sustained improvement in the functioning of pancreatic beta cells. This finding challenges the previous paradigm that beta-cell function is irreversibly lost in patients with type 2 diabetes.  ...continue reading "Type 2 Diabetes May Be Reversed With Weight Loss"

So you finally lost weight by diligently dieting, but now the issue is how to keep the weight from creeping back up again. Keeping strict watch over what you eat (basically continuing to diet)? Or exercising? Or...? Another issue muddying the waters is that a big weight loss also lowers the metabolism rate - something that occurred to former participants of the reality TV show The Biggest Loser. They lost enormous amounts of weight during the 30 week competition (over 100 pounds on average), but 6 years later much of the weight was regained, and they were burning hundreds fewer calories each day at rest. So they had become metabolically much slower over time.

A study looking at 14 former participants of The Biggest Loser 6 years after the show found that a large persistent increase in physical activity was essential for long-term maintenance of weight loss. Those who regained the least weight were the most active, and vice versa. On the other hand, food intake (keeping calorie intake low) wasn't the most important. How much of an increase in physical activity was needed to maintain the weight loss? Researchers found that an increase of about 80 minutes of daily moderate activity (such as brisk walking) or 35 minutes of daily vigorous activity was needed. From Medscape:

The Biggest Loser: Physical Exertion Is Key to Keeping Weight Off

Persistent increased physical activity is likely essential for long-term maintenance of weight loss, new research from participants in the US TV reality show The Biggest Loser suggests.... Using objective measures for both energy intake and physical activity in 14 former Biggest Loser contestants 6 years after they participated in the competition, Dr Kerns and colleagues found that those who had regained the least weight were the most active, and vice versa. Food intake, on the other hand, had very little effect on long-term weight-loss maintenance.

Asked to comment, Eric Ravussin, PhD, Boyd Professor at Louisiana State University, Baton Rouge, and coeditor of Obesity, told Medscape Medical News that the data align with those of follow-ups to major trials — including the Diabetes Prevention Program and the Action for Health Diabetes (Look AHEAD) study as well as with the National Weight Control Registry — of thousands of people who have lost at least 30 pounds and kept them off for at least a year. "The successful losers…all report high levels of physical activity" for weight maintenance, in contrast to weight loss, for which caloric deficit plays a far greater role, Dr Ravussin noted.

The reason for the difference between what works for weight loss vs maintenance, he said, probably has a lot to do with metabolic adaptation. This was the subject of another Biggest Loser paper published in Obesity in 2016, in which a person's metabolism slows down in response to a large drop in weight, making weight-loss maintenance difficult without an extra "push" from exercise, he explained.

The subjects in the new study were 14 participants with class III obesity who participated in a single season of The Biggest Loser, during which they underwent an intensive 30-week diet and exercise program and lost an average of 60 kg. Most regained weight after the program ended, although the degree of regain was highly variable. The median weight loss after 6 years was 13%. Seven subjects above the median weighed 24.9% less than baseline (maintainers) while the seven below the line (regainers) weighed 1.1% above their baseline. The maintainers had significantly greater increases in physical activity from baseline compared with the regainers..... that 35 minutes a day of intensive exercise, or 80 minutes of moderate activity, would roughly approximate the calorie expenditures among the maintainers.

Why exercise alone won't get those pounds off - it's because the body adapts to higher exercise levels. We all suspected that, but it is depressing... From Medical Xpress:

Why you won't lose weight with exercise alone

Exercise by itself isn't always enough to take off the weight. Now, evidence reported in the Cell Press journal Current Biology on January 28 helps to explain why that is: our bodies adapt to higher activity levels, so that people don't necessarily burn extra calories even if they exercise more.

People who start exercise programs to lose weight often see a decline in weight loss (or even a reversal) after a few months. Large comparative studies have also shown that people with very active lifestyles have similar daily energy expenditure to people in more sedentary populations.

Pontzer says this really hit home for him when he was working among the Hadza, a population of traditional hunter-gatherers in northern Tanzania."The Hadza are incredibly active, walking long distances each day and doing a lot of hard physical work as part of their everyday life," Pontzer says. "Despite these high activity levels, we found that they had similar daily energy expenditures to people living more sedentary, modernized lifestyles in the United States and Europe. That was a real surprise, and it got me thinking about the link between activity and energy expenditure."

To explore this question further in the new study, Pontzer and his colleagues measured the daily energy expenditure and activity levels of more than 300 men and women over the course of a week.In the data they collected, they saw a weak but measurable effect of physical activity on daily energy expenditure.

But, further analysis showed that this pattern only held among subjects on the lower half of the physical activity spectrum. People with moderate activity levels had somewhat higher daily energy expenditures—about 200 calories higher—than the most sedentary people. But people who fell above moderate activity levels saw no effect of their extra work in terms of energy expenditure."The most physically active people expended the same amount of calories each day as people who were only moderately active," Pontzer says.

 The important thing learned from this study is that 10% of the obese women had precancerous uterine growths (remember that obesity results in inflammation which can lead to cancer) that regressed and disappeared after the weight loss. Along with weight loss (mean loss was over 100 pounds), there was an alteration of the their gut bacteria. It was a small group of women, but very, very interesting that precancerous growths could disappear simply with reducing weight. From Medical Xpress:

Preventing cancer: Study finds dramatic benefits of weight-loss surgery

A study evaluating the effects of bariatric surgery on obese women most at risk for cancer has found that the weight-loss surgery slashed participants' weight by a third and eliminated precancerous uterine growths in those that had them. Other effects included improving patients' physical quality of life, improving their insulin levels and ability to use glucose - which may reduce their risk for diabetes - and even altering the composition of their gut bacteria.

The study speaks both to the benefits of bariatric surgery and to the tremendous toll obesity takes on health. "If you look at cancers in women, about a fifth of all cancer deaths would be prevented if we had women at normal body weight in the U.S.," said Susan C. Modesitt, MD, of the University of Virginia Cancer Center. "When you're looking at obesity-related cancers, the biggest one is endometrial cancer, but also colon cancer, breast cancer, renal cancer and gall bladder cancer. We think about 40 [percent] to 50 percent of all endometrial cancer, which is in the lining of the uterus, is caused by obesity."

The study looked at 71 women with a mean age of 44.2 years and a mean body mass index (BMI) of 50.9. Women are considered obese at a BMI of 30 and morbidly obese at 40 (which is typically about 100 pounds over a woman's ideal body weight). The study looked at the effects of bariatric surgery in a relatively short time frame, one to three years after surgery. A total of 68 participants underwent the procedure; two opted out of the surgery, and another died of a heart condition prior to surgery. The effects of surgery on body weight were dramatic: Mean weight loss was more than 100 pounds.

Ten percent of study participants who had not had a hysterectomy showed precancerous changes in the lining of the uterus, and all of those resolved with weight loss. "We're talking about small numbers, really tiny numbers" of study participants, Modesitt said, noting one limitation of the study. "So I could never say that effect is definitive, but it is suggestive, given that we know already the incredibly strong link between endometrial cancer and obesity."

Modesitt, of the UVA's Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology, was most surprised by the dramatic changes seen in the patients' metabolic profiles derived from the gut microbiome, the population of microorganisms living inside us. "The study results demonstrate that there is a huge alteration, but I don't even know what to say about that, except it is really new and intriguing area to look at in the link between obesity and cancer.

Beware of big soda companies bearing gifts to scientists and their misleading messages to consumers. This time it is Coca-Cola that is trying to influence the research by funding scientists who shift blame for obesity to lack of exercise.There is a large body of evidence finding that what you eat is very important for health and weight control, and this does not mean a diet filled with highly processed foods, including soda.

Yes, exercise is important, but the overall diet is even more important. And we know that soda is not a beneficial food for the beneficial microbes within us (Feeding Your Gut Microbes). Coca Cola's sales of soda are really slipping and this Global Energy Balance Network is a major effort on their part to try to boost sales of sugary drinks. From NY Times:

Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets

Coca-Cola, the world’s largest producer of sugary beverages, is backing a new “science-based” solution to the obesity crisis: To maintain a healthy weight, get more exercise and worry less about cutting calories.The beverage giant has teamed up with influential scientists who are advancing this message in medical journals, at conferences and through social media. To help the scientists get the word out, Coke has provided financial and logistical support to a new nonprofit organization called the Global Energy Balance Network, which promotes the argument that weight-conscious Americans are overly fixated on how much they eat and drink while not paying enough attention to exercise.  ...continue reading "Ignore Big Soda’s Message"

For many years it was thought that yo-yo dieting resulted in higher cancer risk. So the findings of this study are a relief. Researchers looked at weight cycling (yo-yo dieting) and incidence for all cancer and 15 individual cancers among more than 132,000 participants during 17 years of study and found NO association with overall risk of cancer or any individual cancer. So feel free to diet and lose weight for the health benefits. From Science Daily:

Yo-yo dieting not associated with increased cancer risk

The first comprehensive study of its kind finds weight cycling, repeated cycles of intentional weight loss followed by regain, was not associated with overall risk of cancer in men or women. The study by American Cancer Society investigators is the largest to date to investigate weight cycling with cancer risk....Weight cycling was also not associated with any individual cancer investigated. The authors of the study say people trying to lose weight should be encouraged to do so even though they may regain it.

With almost half of American adults reporting they are trying to lose weight, and with most weight loss not maintained, weight cycling is very common. Previous studies in animals and humans had suggested that weight cycling may affect biological processes that could lead to cancer, such as increased T-cell accumulation, enhanced inflammatory responses in adipose tissue, and lowered natural killer cell cytotoxicity. However, many of these findings have not been replicated, and at least two previous studies showed no associations between weight cycling and cancer.

For the latest study, researchers led by Victoria Stevens, PhD, American Cancer Society Strategic Director, Laboratory Services, examined weight cycling and cancer among more than 132,000 men and women enrolled in the Cancer Prevention Study II Nutrition Cohort. Begun in 1992/1993, the Nutrition Cohort gathered detailed dietary information from men and women ages 50 to 74 participating in the Society's larger Cancer Prevention Study II, to explore nutrition's effect on and cancer incidence and mortality. Investigators looked at weight cycling and incidence for all cancer and 15 individual cancers. More than 25,000 participants developed cancer during 17 years of study.

One study points out the difficulty of weight loss in overweight adults, because so few actually are able to get down to a normal weight or even lose a mere 5% of body weight (for example. 10 pounds for a 200 pound person or 15 pounds for a 300 pound person). The annual chance of an obese person attaining normal body weight is only 1 in 210 for men and 1 in 124 for women,and the annual chance of obese patients achieving five per cent weight loss was 1 in 12 for men and 1 in 10 for women.  The second study highlights how well weight loss treats "fatty liver" (which is a problem in middle-aged overweight people). Fatty liver or nonalcoholic steatohepatitis (NASH), which affects 2 to 5 percent of Americans, can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.

After reading scientific studies nonstop for the last few years, it seems that the best, easiest way to lose weight is to have lifestyle changes rather than focusing just on a "weight-loss diet": increase activity levels (yes, walking counts) and switch to a more plant based diet or Mediterranean diet (lots of fruits, vegetables, whole grains, legumes, seeds, nuts, olive oil, some fish each week) and decrease the amount of typical Western style diet (highly processed foods. lots of meat and coldcuts, lots of fat, fast foods, soda). Try to only eat within 12 hours each day (for example, 8am to 8pm) and don't eat the other 12 hours. And of course eat fewer calories (it should be easier  to do if you substitute fruits and vegetables for high calorie processed foods such as ice cream, french fries, and sweets). And yes, of course it's really hard to lose weight, but the health benefits of weight loss are enormous. From Medical Xpress:

Low chance of recovering normal body weight highlights need for obesity prevention

The chance of an obese person attaining normal body weight is 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with severe obesity, according to a study of UK health records led by King's College London. The findings, published in the American Journal of Public Health, suggest that current weight management programmes focused on dieting and exercise are not effective in tackling obesity at population level.The research, funded by the National Institute for Health Research (NIHR), tracked the weight of 278,982 participants (129,194 men and 149,788) women using electronic health records from 2004 to 2014.

The annual chance of obese patients achieving five per cent weight loss was 1 in 12 for men and 1 in 10 for women. For those people who achieved five per cent weight loss, 53 per cent regained this weight within two years and 78 percent had regained the weight within five years.

Overall, only 1,283 men and 2,245 women with a BMI of 30-35 reached their normal body weight, equivalent to an annual probability of 1 in 210 for men and 1 in 124 for women; for those with a BMI above 40, the odds increased to 1 in 1,290 for men and 1 in 677 for women with severe obesity. Weight cycling, with both increases and decreases in body weight, was also observed in more than a third of patients. The study concludes that current obesity treatments are failing to achieve sustained weight loss for the majority of obese patients.

Dr Alison Fildes, first author from the Division of Health and Social Care Research at King's College London (and now based at UCL), said: 'Losing 5 to 10 per cent of your body weight has been shown to have meaningful health benefits and is often recommended as a weight loss target..... More importantly, priority needs to be placed on preventing weight gain in the first place.'

From Medical Xpress:  Weight loss for a healthy liver

Weight loss through both lifestyle modification and bariatric surgery can significantly reduce features of nonalcoholic steatohepatitis (NASH), a disease characterized by fat in the liver, according to two new studies published in Gastroenterology..."we most commonly see this condition in patients who are middle-aged and overweight or obese," said Giulio Marchesini, MD, from University of Bologna, Italy, and lead author of an editorial summarizing these two studies. "These two large prospective cohort studies strengthen the evidence that, no matter how you lose weight, weight loss improves liver health. Both bariatric surgery for morbidly obese patients or lifestyle modifications are viable options."

Lifestyle modifications: Eduardo Vilar-Gomez and colleagues from Cuba report in Gastroenterology that a weight reduction of 10 percent or more, induced by a comprehensive lifestyle program, is necessary to bring about NASH resolution and reverse scarring of the liver in overweight and obese patients. To a lesser degree, modest weight loss (7 to 10 percent) reduced disease severity in certain subsets of patients, including male patients and those without diabetes. Conversely, 93 percent of the patients with little or no weight reduction (less than 5 percent) experienced worsening of liver scarring....While promising, less than 50 percent of patients achieved the necessary weight loss goal of 7 to 10 percent, providing a stark reminder of the sustainability of weight loss interventions.

Bariatric surgery: For appropriate morbidly obese patients with NASH who have previously failed to lose weight through lifestyle modifications, bariatric surgery may be considered. In the second Gastroenterology study, Guillaume Lassailly and colleagues from France report that, one year after bariatric surgery, NASH had disappeared from 85 percent of patients and reduced the pathologic features of the disease after 1 year of follow-up. NASH disappeared from a higher proportion of patients with mild NASH before surgery (94 percent) than severe NASH (70 percent). More studies are needed to determine the long-term effects of bariatric surgeryin morbidly or severely obese patients with NASH.

Excerpts from an article by Jane Brody in the NY Times:

Beating Back the Risk of Diabetes

This year, nearly two million American adults and more than 5,000 children and adolescents will learn they have a potentially devastating, life-shortening, yet largely preventable disease: Type 2 diabetes. They will join 29.1 million Americans who already have diabetes.

Diabetes and its complications are responsible for nearly 200,000 deaths a year; the fatality rate among affected adults is 50 percent higher than among similar people without diabetes. Alarmingly, recent studies even have linked diabetes to an increased risk of dementia and Alzheimer's disease. Even people with above-average blood glucose levels, but not diabetes, have an elevated risk.

The Diabetes Prevention Program study, conducted among about 3,800 people who had pre-diabetes, found that moderate weight loss — an average of 12 pounds —  reduced the odds of progression to diabetes by nearly 50 percent.

An excellent discussion of what is known about the effect on diabetes of various foods and supplements appeared recently in Nutrition Action Healthletter at cspinet.org/iceberg.pdf. Some highlights:

Carbohydrates - breads, grains, cereals, sugary drinks and sweets of all kinds — are most problematic for people with diabetes or at risk of developing it. Carbohydrates are eventually metabolized to glucose, which raises the body’s demand for insulin. Consume less of them in general, and choose whole-grain versions whenever possible.

If you must have sweet drinks, select artificially sweetened ones. In two huge studies of nurses and other health professionals who were followed for 22 years, those who drank one or more sugary soft drinks a day had about a 30 percent higher risk of developing diabetes than those who rarely drank them, even after their weight was taken into account.

But there’s good news about coffee. Two or three cups of coffee (but not tea) a day, with or without caffeine, have been consistently linked to a lower risk of Type 2 diabetes. 

For protein, limit consumption of red meat, especially processed meats like sausages, hot dogs and luncheon meats, which are linked to a higher diabetes risk. Instead, choose fish, lean poultry (skinless and not fried), beans and nuts. Low-fat dairy products, including yogurt, and even fatty ones may lower the risk of diabetes; the reason is unclear.

Most protective are green, leafy vegetables — spinach, chard, kale, collards, mustard greens and even lettuce — as well as cruciferous vegetables like cabbage, broccoli and cauliflower. But all vegetables are good and should fill at least two-thirds of your dinner plate.

The nutrients magnesium and vitamin D are also potentially protective. In fact, the preventive value of leafy greens, whole grains, beans and nuts may lie in their high magnesium content. In a well-designed clinical trial of 32 overweight people with insulin resistance, the prelude to diabetes, blood glucose levels and insulin sensitivity improved in those who took a daily magnesium supplement for six months. Don’t go overboard: More than 350 milligrams of magnesium daily can cause diarrhea. 

Vitamin D, long known to be crucial to healthy bones, may also be helpful. In one study of 92 overweight or obese adults with prediabetes, those who took a supplement of 2,000 international units of vitamin D daily had better function of the pancreatic cells that produce insulin..

Of course, how much you weigh and what you eat are not the only concerns. Regular, preferably daily, physical exercise is a vital component of any prevention and treatment program for Type 2 diabetes, or most any chronic ailment. Weight loss can reduce diabetes risk by about 50 percent, but adding exercise to that can lower the odds by 70 percent, compared with people who remain overweight and inactive, according to a study that followed nearly 85,000 female nurses for 16 years. Women who were active for seven or more hours weekly had half the risk of developing diabetes as did women who exercised only a half-hour a week.

Two studies about blood pressure and how it can be easily changed without medications. From Science Daily:

Small weight gain can raise blood pressure in healthy adults

Gaining a few pounds can increase blood pressure in healthy adults, researchers report. Increased fat inside the abdomen led to even larger increases in blood pressure, their study results showed. Many people understand the health dangers of large amounts of extra body weight, but researchers in this study wanted to see the impact of a small weight gain of about five to 11 pounds.

At the beginning of the eight-week study, a 24-hour monitor tested the blood pressure of 16 normal weight people. Their results were compared to 10 normal weight, healthy people who maintained the same weight over the eight weeks. Researchers found: -Those who gained weight had a systolic blood pressure (top number) increase from an average 114 mm Hg to an average 118 mm Hg. -Those who gained more weight inside their abdomen had a greater blood pressure increase. -A five to 11 pound weight gain didn't change cholesterol, insulin or blood sugar levels. The study was conducted in healthy people ages 18-48. 

From Science Daily:

Restricting calories may improve sleep apnea, blood pressure in obese people

Restricting calories may improve sleep apnea and reduce blood pressure in obese adults. Those who restricted their calories had higher levels of oxygen in their blood and a greater reduction in body weight, a study has demonstrated.

 "Losing weight was most likely the key to all the benefits observed in the calorie-restricted group. A greater reduction in systolic blood pressure can be explained, at least partially, by the reduction in body weight that was associated with reduction in obstructive sleep apnea severity and sympathetic nervous system activity." Systolic blood pressure is the top number in a blood pressure reading, which measures the force of the blood in the arteries when the heart is contracted.

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Two write-ups about the same large study.The good news is that there is no one diet that works - the key is to stick with the diet. From Science Daily:

Comparison of named diet programs finds little difference in weight loss outcomes

In an analysis of data from nearly 50 trials including about 7,300 individuals, significant weight loss was observed with any low-carbohydrate or low-fat diet, with weight loss differences between diet programs small, findings that support the practice of recommending any diet that a patient will adhere to in order to lose weight.

Bradley C. Johnston, Ph.D., of the Hospital for Sick Children Research Institute, Toronto, and McMaster University, Hamilton, Ontario, and colleagues conducted a meta-analysis to assess the relative effectiveness of different popular diets in improving weight loss. 

The meta-analysis included 59 articles that reported 48 randomized clinical trials (7,286 individuals; median age, 46 years; median weight, 207.5 lbs.). In the diet-class analysis adjusted for exercise and behavioral support, all treatments were superior to no diet at 6-month follow-up. Compared with no diet, low-carbohydrate diets had a median difference in weight loss of 19.2 lbs. and low-fat diets had similar estimated effects (17.6 lbs.).

At 12-month follow-up, the estimated average weight losses of all diet classes compared with no diet were approximately 2.2 to 4.4 lbs. less than after 6-month follow-up. The diet classes of low fat (16 lbs.) and low carbohydrate (16 lbs.) continued to have the largest estimated treatment effects.

Weight loss differences between individual diets were minimal. "Our findings should be reassuring to clinicians and the public that there is no need for a one-size-fits­ all approach to dieting because many different diets appear to offer considerable weight loss benefits. 

From Medical Xpress:

Any diet works, if you stick to it, study finds

At six month follow-up, people on low-carbohydrate diets lost 19 more pounds than those who were not on a diet, while those on low-fat diets lost 17 more pounds than those on no diet. After 12 months about two to three pounds of that difference was gone, and there was no difference between low-carbohydrate and low-fat diets.

Behavioural support in a diet made a difference at six months, enhancing weight loss by about seven pounds, while exercise was significant at 12 months, improving weight loss by about four and half pounds.