Overweight women should slim down and have counselling before they get pregnant because being fat poses such a serious risk of them having a premature baby, doctors warn today.

Women carrying excess weight have up to a 30% greater chance of having a baby before it reaches 37 weeks gestation, medical researchers in Canada write in todays British Medical Journal. Premature babies are at much higher risk of dying or suffering a range of illnesses and impairments.

Those who are overweight or obese have an extra 30% risk of having their child induced before 37 weeks, and have a 26% chance of delivering their baby prematurely before it reaches 32 weeks, according to a team of researchers led by Sarah McDonald, an associate professor in the maternal-fetal medicine department at McMaster University in Hamilton, Ontario.

“Ideally, overweight or obese women should have pregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy,” the authors say.”

Unlike many causes of pre-term birth, maternal overweight and obesity represent a potentially preventable cause of the leading source of neonatal mortality and morbidity and morbidity through childhood,” they add.British doctors who look after pregnant women, mothers and children said they backed the proposals.Professor Sir Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said:

“Maternal obesity is a public health concern as there are consequences for both mother and baby. For the mother, it could lead to cardiac disease, diabetes and pre-eclampsia as pregnancy can aggravate these conditions. These women should therefore receive obstetric care

.”Health professionals, including family doctors, need to work with overweight women to help them slim down before conceiving, added Arulkumaran, the leader of Britains 5,500 maternity care doctors.”We have said in our Maternity Standards document that pre-pregnancy counselling and support, both opportunistic and planned, should be provided to women of childbearing age with serious existing medical conditions including obesity BMI > 30″, he said.”This requires a multi-disciplinary approach with GPs and midwives to encourage women to achieve an appropriate weight level during the pre-conception stage.

It is something which needs to be handled sensitively but we need to point out to women the long-term benefits of a healthy lifestyle for them and their children.”However, the Royal College of Midwives suggested that mere exhortation of would-be mothers to keep their weight in check may not work.Janet Fyle, the unions professional policy advisor, said:

“There is a public health message that needs to be conveyed to women considering becoming pregnant, of the potential impact of being overweight when pregnant.”Of course midwives know that they need to provide women with the information and support about eating healthily and exercise in pregnancy. We can tell women about the right diet and exercise, but this has to be done within the context of their lives.”Can they afford the right food? Can they get access to gyms or swimming pools? There are social contexts to consider and one size does not fit all.”Tam Fry, of the National Obesity Forum, said: “It is absolutely crucial that a woman who is serious about childbirth gets herself into shape before conception. If she doesnt, she is running the risk not only of endangering her own health but also that of her intended child.

“Not only is it a tragedy to have to have a Caesarean section delivery if you are a very overweight woman, because its the safest way of getting the baby out, but it could adversely affect the childs health and be crippling to NHS maternity services.”

via Obese women should slim before conceiving | Life and style | The Guardian.

The New York Times, Roni Caryn Rabin, May 31, 2010

Obesity increases the risk of Type 2 diabetes, heart disease and other illnesses, but a surprising new finding suggests it may not affect one’s health until after age 40.

The study compared medications taken by normal weight, overweight and obese Americans ages 25 to 70 who participated in National Health and Nutrition Examination Surveys from 1988-1994 and 2003-6. The surveys included 8,880 men and 9,071 women.

While obese people of all ages took slightly more medications than those of normal weight, the differences were mainly among adults 40 and older, according to the study, published in the International Journal of Obesity.

For example, 28.7 percent of obese men and 25.2 percent of normal weight men ages 25 to 39 took medications. But among those 40 to 54, 60 percent of obese men were on medication, compared with 39.3 percent of men of average weight.

The differences in medications taken by normal weight adults and those considered merely overweight were small at all ages, the researchers found.

Brant Jarrett, a graduate student who was the study’s lead author, said one message from the paper was that body mass index, the formula used to assess weight status, is an imperfect measure. “It’s not the best measure in terms of risk factors or current health,” he said

Vital Signs – Risks – Obesity Is Found to Take Toll After Age 40 – NYTimes.com.

San Fransisco Chronicle, Susanne Leigh, May 24, 2010

Like many midlife adults, Ken Holmes noticed that the toned abs of his 20s had billowed into a fistful of flab. He blamed long drives from his Sunset District home to jobs as a program consultant in Silicon Valley and the East Bay, together with extended workdays spent deskbound tinkering with software. In his childless days, Holmes would have offset these sedentary periods with frequent punishing workouts. But now with two elementary-school-age children, the gym was relegated to the back burner.

Still, Holmes was taken aback to discover that his weight had gone from being comfortably centered in the “normal weight” zone of the government’s weight charts to nudging the “overweight” section. “In my mind I wasn’t that fat guy,” he says.

In the same way as anorexics may have a distorted self-perception of being fat, some overweight and obese people fail to see their true plus-size selves, believing instead that they are a healthy weight, says British author Sara Bird, whose book documenting her experience with “fatorexia” was published in March.

Like Holmes, Bird, who lives in Nottinghamshire, England, with her domestic partner and two daughters, ages 10 and 9, was shocked to discover she was overweight. Unlike Holmes, at 5 feet 10 and 238 pounds, she was seriously overweight.

“When I looked in the mirror, I saw a confident thin person, when in fact I was obese,” says Bird, 44, who weighed 140 pounds as a teen model and gradually grew heavier as she segued into a new career and later had children. A routine visit to her doctor where she was weighed and pronounced “obese,” together with a long hard look at some “cruelly revealing” party pictures razed Bird’s wall of self-denial. For the first time in years, she forced herself to examine her naked frame in a full-length mirror. At 240 pounds, she looked like the Pillsbury Doughboy with a head that appeared much too small for her body, she says.

In an era of “skinny jeans,” T-shirts that skim the navel and hemlines that brush mid-thigh, it might be hard to imagine how an obese woman can con herself, but Bird says that she developed a magician’s menu of optical illusions. These included wearing generously cut clothing with elastic waistbands, looking at hand mirrors to check her appearance, rather than full-length ones and favoring ornate jewelry and fabrics to draw the eye away from the expanded flesh beneath. When her thighs started rubbing together, Bird used talc to avoid chafing, rather than stepping on the scales for a reality check.

Now Bird, who owns an optical practice, is on a one-woman mission to convince the world a fatorexic epidemic abounds. Since the release of her self-published book “Fatorexia: What Do You See When You Look in the Mirror?” Bird has been deluged with thousands of e-mails from men and women saying they share the same size delusions.

“I’ve said for ages that I suffer from the opposite of anorexia,” reads one. “My friends are sizes 10 to 14. I’m a 20, but when I’m with them, I think that I’m the same size as they are, until I see photos of us together. Then I have an almighty shock to see that I’m huge compared to them.”

The new normal

While her message, which makes for eyebrow-elevating sound bites, might invite cynicism, it’s hard to dismiss statistics and studies that lend credibility to her claims.

Put simply, government figures show that overweight has become the new normal. A sample of adults from 2007 to 2008 in the National Health and Nutrition Examination Survey showed that 68 percent were overweight or obese, compared with 46 percent from 1976 to 1980. A 2008 study published in the British Medical Journal found that one-quarter of obese or overweight adults did not view themselves as fat. Earlier this year, a Dutch study reported that 75 percent of mothers thought their overweight child was a normal weight. And last year, research presented to the American Heart Association confirmed that almost 1 in 10 obese individuals was satisfied with their size and did not think they needed to lose weight.

Experts say our self-delusions about weight appear to be fed by the apparel industry with its prevalence of “vanity sizing.” Stores repeatedly come under fire in the blogosphere for cutting garments more lavishly, all the while whittling sizes down to “0″ and “00.”

Shedding 20 pounds

The problem with being in denial about our weight, Bird says, is that it keeps us fat. Her humiliation in the doctor’s office was just the shove she needed to take stock of her eating habits. She has since shed 20 pounds by making minor lifestyle changes, a no-diets approach she recommends for fellow fatorexics. She has maintained this weight loss for two years and says she is healthy.

Having accepted her fatorexia, Bird says she makes a point of looking at herself in full-length mirrors and although she doesn’t “go to the gym for endless hours,” she exercises by walking her dog and is more aware of eating healthfully. “I’ll never be thin,” she says, “but I won’t allow myself to get any bigger.”

While never seriously overweight, Ken Holmes says he shared his own version of Bird’s epiphany. After discovering he had gained weight, he resolved to get more exercise, running at least once a week, and he underwent his first physical in several years to learn his cholesterol level and blood pressure.

To Andrea Garber, assistant professor of pediatrics and chief nutritionist for WATCH, a program for obese teens and children at UCSF, cases like Bird’s in which an overweight person is able to maintain even a modest weight loss and increase daily exercise are “fantastic.” This is especially true, she says, if the individual is able to sidestep the co-morbidities of obesity, like high blood pressure, diabetes and orthopedic issues that can compromise mobility – a complication she sees in some patients who struggle to walk even short distances.

“Studies show that if an obese person exercises and eats healthfully, their cardiovascular risk is lower than the thin-appearing person who is sedentary and lives on junk food,” says Garber, who believes obese adults are best served by programs providing social support, stress management, exercise and nutrition counseling.

It’s in their heads

She is less convinced that obese people perceive themselves as thin, as Bird claims she did.

“Many patients are not ready to acknowledge their weight has become a problem, which is enabled by the normative nature of obesity and the camaraderie associated with overeating and under-exercising. They are busy and stressed, and we don’t offer adequate support and resources,” she says.

But Bird’s fans say that fatorexia is the crux of their girth. Responding a recent TV appearance by Bird, one viewer commented: “I’m only three stone [42 pounds] overweight, but I can’t see what the problem is. I have trouble losing weight because in my head I am not fat.”

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/05/24/DDLE1DAK88.DTL#ixzz0p6hLg4IB

Fat people who deny their plus size.

WHEN most people think of hunger in America, the images that leap to mind are of ragged toddlers in Appalachia or rail-thin children in dingy apartments reaching for empty bottles of milk.

But a recent survey found that the most severe hunger-related problems in the nation are in the South Bronx, long one of the country’s capitals ofobesity. Experts say these are not parallel problems persisting in side-by-side neighborhoods, but plagues often seen in the same households, even the same person: the hungriest people in America today, statistically speaking, may well be not sickly skinny, but excessively fat.

Call it the Bronx Paradox.

“Hunger and obesity are often flip sides to the same malnutrition coin,” said Joel Berg, executive director of the New York City Coalition Against Hunger. “Hunger is certainly almost an exclusive symptom of poverty. And extra obesity is one of the symptoms of poverty.”

The Bronx has the city’s highest rate of obesity, with residents facing an estimated 85 percent higher risk of being obese than people in Manhattan, according to Andrew G. Rundle, an epidemiologist at the Mailman School of Public Health at Columbia University.

But the Bronx also faces stubborn hunger problems. According to a survey released in January by the Food Research and Action Center, an antihunger group, nearly 37 percent of residents in the 16th Congressional District, which encompasses the South Bronx, said they lacked money to buy food at some point in the past 12 months. That is more than any other Congressional district in the country and twice the national average, 18.5 percent, in the fourth quarter of 2009.

Such studies present a different way to look at hunger: not starving, but “food insecure,” as the researchers call it (the Department of Agriculture in 2006 stopped using the word “hunger” in its reports). This might mean simply being unable to afford the basics, unable to get to the grocery or unable to find fresh produce among the pizza shops, doughnut stores and fried-everything restaurants of East Fordham Road.

Precious, the character at the center of the Academy Award-winning movie by the same name, would probably count as food insecure even though she is severely obese (her home, Harlem, ranks 49th on the survey’s list, with 24.1 percent of residents saying they lacked money for food in the previous year). There she is stealing a family-size bucket of fried chicken from a fast-food restaurant. For breakfast.

That it is greasy chicken, and that she vomits it up in a subsequent scene, points to the problem that experts call a key bridge between hunger and obesity: the scarcity of healthful options in low-income neighborhoods and the unlikelihood that poor, food-insecure people like Precious would choose them.

Full-service, reasonably priced supermarkets are rare in impoverished neighborhoods, and the ones that are there tend to carry more processed foods than seasonal fruits and vegetables. A 2008 study by the city government showed that 9 of the Bronx’s 12 community districts had too few supermarkets, forcing huge swaths of the borough to rely largely on unhealthful, but cheap, food.

“When you’re just trying to get your calorie intake, you’re going to get what fills your belly,” said Mr. Berg, the author of “All You Can Eat: How Hungry Is America?” “And that may make you heavier even as you’re really struggling to secure enough food.”

For the center’s survey, Gallup asked more than 530,000 people across the nation a single question: “Have there been times in the past 12 months when you did not have enough money to buy food that you or your family needed?”

The unusually large sample size allowed researchers to zero in on trouble spots like the South Bronx.

New York’s 10th Congressional District, which zigzags across Brooklyn and includes neighborhoods like East New York and Bedford-Stuyvesant, ranked sixth in the survey, and Newark ranked ninth, both with about 31 percent of residents showing food hardship. (At the state level, the South is the hungriest: Mississippi tops the list at 26 percent, followed by Arkansas, Alabama, Tennessee, Kentucky, Louisiana, the Carolinas and Oklahoma. New York ranks 27th, with 17.4 percent; New Jersey is 41st, with 15.5 percent; and Connecticut is 47th, with 14.6 percent.)

The survey, conducted over the past two years, showed that food hardship peaked at 19.5 percent nationwide in the fourth quarter of 2008, as the economic crisis gripped the nation. It dropped to 17.9 percent by the summer of 2009, then rose to 18.5 percent.

Though this was the first year that the center did such a survey, it used a question similar to one the Department of Agriculture has been asking for years. The most recent survey by the agency, from 2008, found that 14.6 percent of Americans had low to very low food security.

Bloomberg administration officials see hunger and obesity as linked problems that can be addressed in part by making healthful food more affordable.

“It’s a subtle, complicated link, but they’re very much linked, so the strategic response needs to be linked in various ways,” said Linda I. Gibbs, the deputy mayor for health and human services. “We tackle the challenge on three fronts — providing income supports, increasing healthy options and encouraging nutritious behavior.”

To that end, the city offers a Health Bucks program that encourages people to spend their food stamps at farmers’ markets by giving them an extra $2 coupon for every $5 spent there.

The city has also created initiatives to send carts selling fresh fruits and vegetables to poor neighborhoods, and to draw grocery stores carrying fresh fruit and produce to low-income areas by offering them tax credits and other incentives. The city last month announced the first recipients of those incentives: a Foodtown store that burned down last year will be rebuilt and expanded in the Norwood section of the Bronx, and a Western Beef store near the Tremont subway station will be expanded.

But the Bronx’s hunger and obesity problems are not simply related to the lack of fresh food. Experts point to a swirling combination of factors that are tied to, and exacerbated by, poverty.

Poor people “often work longer hours and work multiple jobs, so they tend to eat on the run,” said Dr. Rundle of Columbia. “They have less time to work out or exercise, so the deck is really stacked against them.”

Indeed, the food insecurity study is hardly the first statistical measure in which the Bronx lands on the top — or, in reality, the bottom. The borough’s 14.1 percent unemployment rate is the highest in the state. It is one of the poorest counties in the nation. And it was recently ranked the unhealthiest of New York’s 62 counties.

“If you look at rates of obesity, diabetes, poor access to grocery stores, poverty rates, unemployment and hunger measures, the Bronx lights up on all of those,” said Triada Stampas of the Food Bank for New York City. “They’re all very much interconnected.”

The South Bronx, Plagued by Obesity, Tops a Hunger Survey – NYTimes.com.

Childhood obesity in the United States has tripled since 1980. A recent report from the Centers for Disease Control and Prevention (CDC) indicates that 16% of children (9 million), ages 6-19 years old, are overweight or obese in the U.S. This startling statistic, when analyzed by age, reveals some very troubling trends. Over the past 30 years, obesity rates for preschool children (aged 2-5) and adolescents (aged 12-19) has doubled and for elementary children aged 6-11, have risen three-fold. These trends also have significant long-term impacts. Overweight adolescents have a 70% chance of becoming obese adults. If one or more parent is overweight or obese, that number jumps to 80%. If this trajectory is not changed, one in three children born today will develop Type 2 diabetes as well as other obesity related illnesses, and as a result, this generation of children may become the first that is less healthy than their parents.

Why has this happened? The answer lies in the American lifestyle and environment. While more than fifty genes have been identified linked to obesity, our genes have not changed over the past three decades, but our lifestyles have. The simple fact is that most Americans are consuming far too many calories and are not getting enough physical activity.

The number of calories consumed by Americans has increased over the past several decades, contributing to significant weight gain in the population. Behavioral and environmental changes in the American way of life as well as media influences and alterations in the diet of people are all factors that have contributed to the 25% increase in the average daily caloric intake (roughly 530 more calories) per person between 1970 and 2000 in the U.S. Increased calorie consumption has occurred partially as a result of the proliferation of “fast-food” eating venues as well as increases in portion sizes in the United States. Additionally, the food industry spends approximately $33 billion annually on advertising to market food products to the public. American children are especially vulnerable targets. Every year, children are exposed to over 40,000 advertisements, of which 72% are for candy, cereal, and fast foods.

The second major contributing factor to the spike in obesity rates is the decreased physical activity of Americans, in part, as a result of increased reliance upon technology such as cars, television and computers as well as reduced physical education in schools. Only 31% of children walk to school if the distance is one mile or less, and only 2.4% bicycle when the distance is less than two miles. Furthermore, children spend, on average, 7.5 hours daily using media including television, computers and video games. Recent studies have found that reducing television-viewing actually resulted in a lower body fat percentage in the children studied as a result of a combination of factors including increased participation in physical activity, decreased food intake because of reduced snacking and less exposure to food advertising.

If we don’t act now to prevent obesity, the costs associated with this condition will devastate the health of Americans, as well as our nation’s economy. In 2008, medical costs and those related to lost productivity associated with obesity were $147 billion, 9% of all medical spending. Fast forward 10 years where predictions are that 43% of the U.S. population will be obese with costs more than doubling to $344 billion or 21% of all medical expenditures.

That’s why recent actions taken by President Obama, First Lady Michelle Obama and Surgeon General Benjamin to promote health and prevent obesity are so important. A Presidential Memorandum issued in February, 2010 has mobilized all federal agencies in the fight against childhood obesity, by establishing the first ever Task Force on Childhood Obesity Prevention emphasizing “health in all policies” of government including the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, and the U.S. Department of Transportation, among others.

via Susan Blumenthal, M.D.: Weighing in on Childhood Obesity Prevention.

Excess weight increases stroke risk, a new study including nearly 2.3 million people confirms. And the heavier a person is, the greater their risk.

“Being obese (but indeed even just overweight) puts an individual at significantly higher risk of ischemic stroke, with a serious possibility of permanent disability and reduced life expectancy,” Dr. Pasquale Strazzullo of Frederico II University of Naples Medical School in Naples, Italy, one of the study’s authors, told Reuters Health.

Ischemic strokes occur when blood vessels supplying the brain are blocked. Hemorrhagic strokes, caused by bleeding in the brain, are less common.

While being overweight increases a person’s likelihood of having stroke risk factors such as high blood pressure, the question of whether being overweight or obese directly ups stroke risk has not been answered adequately; evidence from past research has been “controversial,” Strazzullo noted.

To investigate, he and his colleagues searched the medical literature for studies with at least four years of follow-up that looked at stroke risk based on body mass index, or BMI, a standard measure of weight in relation to height used to gauge how fat or thin a person is. They found 25 studies including 2,274,961 people, who had a total of 30,757 strokes.

People who were overweight were 22 percent more likely to suffer an ischemic stroke than normal weight people, while the risk for obese people was 64 percent higher, the researchers found. Hemorrhagic stroke risk wasn’t higher for overweight people, but it was 24 percent higher for obese people.

A person’s risk of having a stroke within the next 10 years can be estimated based on their gender, blood pressure, whether or not they smoke, and whether or not they have diabetes, Strazullo explained.

For example, a 62-year-old man whose systolic blood pressure (the top number) is 125, doesn’t smoke, and does not have diabetes or other cardiovascular problems, would have a 4 percent risk of stroke over the following decade; if the same man had a systolic blood pressure of 160 (140 and above is too high) and wasn’t receiving treatment for high blood pressure, his risk of stroke within the next 10 years would be 15 percent.

Therefore, obesity would raise the risk of stroke to nearly 6 percent for the man with normal blood pressure, and to 25 percent for the man with untreated high blood pressure.

Strazzullo and his team also found that once they accounted for lifestyle risk factors like smoking, age, and cardiovascular risk factors, overweight and obesity independently affected stroke risk. One possible reason for this, the researcher noted, is that fat cells secrete several substances that have “unfavorable effects” on the body, for example promoting inflammation, hardening of the arteries, or blood clotting.

Given the difficulty of treating obesity, the researcher said, the best approach to preventing related complications like stroke is for people to avoid packing on the pounds in the first place.

“All of us should keep tight control of our weight and take immediate action in case of weight gain, reducing calories and increasing physical exercise,” he advised.

via Being overweight ups stroke risk, study confirms | Reuters .

If there is any reason for hope among the data on national obesity rates in the U.S. (the numbers should be familiar by now: two-thirds of adults and nearly one-third of children are overweight or obese in the country), it is that they finally seem to be leveling off. According to the most recently published reports by epidemiologists at the Centers for Disease Control and Prevention (CDC), long-term federal obesity data suggest that after decades of ballooning in size, American adults and children may have gotten about as fat as they’re ever going to get.

Of course that still means that the majority of Americans are currently overweight and at high risk of chronic health problems, such as heart disease, diabetes and certain cancers. These risks continue to propel several national campaigns aimed at preventing obesity, particularly in children, including those spearheaded by First Lady Michelle Obama and former President Bill Clinton. But some researchers say such programs, which involve school-age children, may begin too late to benefit all children.

Increasingly, evidence suggests that obesity-prevention measures need to be taken earlier, in infancy or even before birth. According to the CDC’s National Health and Nutrition Examination Survey, rates of obesity in youngsters ages 2 to 5 have more than doubled since 1980, from 5.0% to 12.4%. And once a child sets down the road to an unhealthy weight, it becomes increasingly difficult for him to change course: according to one study, 80% of children who are overweight between ages 10 and 15 grow up to become obese 25-year-olds.

In November 2009, with funding from the Robert Wood Johnson Foundation, the Institute of Medicine (IOM) formed the Committee on Obesity Prevention Policies for Young Children, whose members will for the first time review evidence on obesity risk factors and health effects in children from birth to 5 years old and identify potential opportunities for intervention in this age group. The committee’s first report is expected in early 2011.

Early Warning Signs

In a recent study of more than 1,800 children, who were tracked from before birth to age 4, Harvard researchers identified several risk factors for obesity that began in pregnancy or early childhood. They included pre-pregnancy obesity; gestational diabetes; low birth weight and rapid weight gain in infancy; stopping breast-feeding early; introducing solid foods before 4 months; short sleep in infancy; TV in children’s bedrooms; and higher consumption of fast food and sugary beverages in childhood. In many cases, these early risk factors were more common in black or Hispanic families than in white families, regardless of income.

The findings, first published online on March 1 by the journal Pediatrics, help explain why minority children are at higher risk for obesity early on: 16.7% of Mexican-American children ages 2 to 5 are obese, compared with 14.9% of black children and 10.7% of white children, according to CDC data. The authors emphasize that obesity prevention must not only begin early, but also address cultural issues and include education targeted to specific groups. The good news, says study author Dr. Elsie Taveras, an assistant professor of pediatrics and prevention at Harvard Medical School and a member of the IOM obesity committee, is that many risk factors involve behaviors than can be modified and are not due only to socioeconomic inequalities. “As a pediatrician, it’s frustrating for me to think, How am I going to change this person’s household income? But what a hopeful message to know that it’s actually not that in many cases,” she says.

(See a slideshow about obesity rehab for teens.)

A Tipping Point for Obesity?

How early in life that prevention efforts need to target children is quickly becoming a central question to childhood-obesity research. One intriguing notion is that there exists an obesity threshold — or tipping point — in infancy, before which a chubby child may be safely steered away from a lifetime of obesity. A small study led by Dr. John Harrington, an associate professor of pediatrics at Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters, analyzed childhood medical records of 111 obese children and adolescents — those with a body mass index (BMI) equal to or higher than 85% of their same-age peers — in order to determine the age at which children first became overweight

via Is There an Obesity Tipping Point in Infancy? – Overcoming Obesity – TIME.

In Norwood, Massachusetts, 14-year-old Maria Caprigno no longer wants to be one of those statistics.

Maria has been overweight since she was about 3 years old and as she got older, she just got heavier. She told CNN her eating habits were to blame.

“I’m a junk-food person and because I’m a couch potato I don’t like to get off the couch,” she said. “It’s also kind of just like my genes: Both my parents are heavy and that’s just the environment I was raised in.”

Maria said people have stared at her all her life because of her weight.

“The first thing that goes through their mind is, ‘Why is she so fat?’ And, ‘Oh my god, she’s so fat. Why doesn’t she just hop on a treadmill?’ And I think people don’t really understand that it’s not just exercising … it’s extremely hard.

See Maria growing up in pictures

“I get self-conscious,” she said. “I don’t like to go to crowded places — like if a mall’s crowded, I’ll sit in the car.”

The CDC says obesity rates for Maria’s age group, those 12 to 19 years old, have tripled since 1980. Maria pleaded with her mother to find a doctor who would perform weight-loss surgery on teenagers.

Dr. Evan Nadler, who started a program for adolescent surgery at National Children’s Hospital in Washington, said he felt “compelled” to help Maria.

“Her BMI [body mass index], which is a measurement we use to determine how obese someone is, put her in the highest risk category. Not just morbidly obese but two categories higher than that,” Nadler said. “So I felt that withholding a known therapy that works based on her age alone was really almost unethical.”

Between 2000 and 2003, some 800 teenagers went under the knife to lose weight, Nadler said.

Before she was approved for surgery, Maria had to meet with a nutritionist, a pediatric cardiologist and a psychologist. In the end, Maria was approved for an experimental procedure known as a “gastrectomy,” during which about 80 percent of the stomach is removed, including the part of the stomach that controls appetite.

Nadler said the procedure “basically restricts the amount of food that can come into the stomach at any one time and it really makes the patient have a sense of fullness or a lack of hunger.”

Maria had the “gastrectomy” last month and already has lost about 45 pounds. Today she weighs 400 pounds and is down to a size 32. Maria said she would like one day to be a size 12 but isn’t trying to reach a specific weight.

“It’s not about the numbers; I want to be at a healthy size,” she said.

“I want to be able to go into a normal store and buy something and be able to wear it. I want to be able to run. I haven’t been able to run since I was 5 years old. I want to be able wear a bathing suit without feeling embarrassed.

“I just want to be normal.”

via Obese teen credits surgery for weight loss – CNN.com.

Packing on the pounds gets a well-deserved bad rap. Most Americans understand that excess weight contributes to heart disease and diabetes, not to mention the urge to hide behind the kids in family photos. But obesity as a risk factor for cancer?

That seems to be the case. An increasing number of studies are finding that overweight and obese people are more likely to develop cancer of various kinds. At least half a dozen types of cancer are believed to be directly affected by weight.

“As time goes on, we’re realizing that obesity is related to more cancers than we originally suspected,” said Dr. Donald Hensrud, an associate professor of preventive medicine and nutrition at the Mayo Clinic College of Medicine.

Researchers are unable to prove that obesity actually causes cancer because requiring people to either gain weight or keep their weight down in clinical trials would be impossible. Most of the data come from observational studies, in which people who are thinner are probably doing many things differently than their heavier counterparts. Any number of those factors might be responsible for the difference in cancer rates.

Still, the evidence is “convincing” for a cause-and-effect relationship between obesity and postmenopausal breast, colon, endometrial, esophageal, kidney and pancreas cancer, according to a 2007 report from the World Cancer Research Fund and the American Institute for Cancer Research. The report also cited obesity as a “probable” cause of gallbladder cancer.

Scientists aren’t sure how obesity might affect cancer risk, but “there are some plausible biological mechanisms by which this may occur,” said Dr. Patricia Ganz, director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center.

One popular explanation is that extra weight boosts the body’s production of hormones such as estrogen, insulin and insulin-like growth factor 1 — all of which have the potential to promote the growth of certain tumors. Another possibility is that fatness contributes to cancer growth by causing cells to divide more rapidly.

Mechanical factors may play a role in certain types of cancer. In the case of esophageal cancer, the culprit seems to be acid reflux. People who are overweight are more likely to experience chronic reflux, which can lead to precancerous changes by eroding the lining of the esophagus.

The suspected higher risk of gallbladder cancer might be explained by the increased tendency of obese people to develop gallstones. These stones cause inflammation that could promote cancer.

Putting a number on it

Rates of obesity have steadily increased over the past few decades, more than doubling from 15% of adults in the early 1970s to 34% of adults in 2005-06, according to data from the National Health and Nutrition Examination Survey. Cancer rates also increased somewhat during this period, from a rate of 4 in 1,000 in 1975 to 4.56 per 1,000 in 2006 —although rates peaked in 1992 and have since been on the decline.

Scientists don’t know how much of this increase in cancer is real. Much of it appears to reflect the fact that we now regularly go looking for cancer with mammograms and prostate specific antigen tests, which is one more reason why the relationship between obesity and cancer is so difficult to study.

The World Cancer Research Fund and the American Institute for Cancer Research made an attempt to quantify the relationship in a 2009 policy report. The report concluded that excess body weight has the largest effect on endometrial cancer, causing an estimated 49% of cases. This translates into an extra 20,700 people with endometrial cancer per year.

The policy report also calculated that being overweight or obese causes 35% of esophageal cancers (5,800 people per year), 28% of pancreatic cancers (11,900 people per year), 24% of kidney cancers (13,900 people per year), 21% of gallbladder cancers (2,000 people per year), 17% of breast cancers (33,000 people per year) and 9% of colon cancers (13,200 people per year) .

Dr. Moshe Shike, an attending physician at Memorial Sloan-Kettering Cancer Center whose research focuses on cancer prevention, said he was skeptical about the idea of putting a number on something so slippery, saying that this implies accuracy where none exists. “We don’t know the magnitude of the effect,” he said.

Dr. Michael Thun, head of epidemiologic research for the American Cancer Society, agreed that the percentages are imprecise, but pointed out that numbers are often the best way to get results. “Numbers carry a strong message, just as estimates of death caused by smoking were very important to tobacco control,” he said.

Most of the studies on weight and cancer risk define obesity using body mass index (BMI), a number that accounts for weight in relation to height. Someone who stands 5-foot-7 is considered “overweight” at 159 pounds and “obese” at 191 pounds. A third of Americans are overweight, and another third are obese.

But the real culprit is fat, not weight, so a football player-type with lots of muscle and little flab would not be at increased risk even if his BMI fell into the “overweight” category.

The effects of weight loss

If excess weight increases the risk of cancer, can losing weight reduce the risk? Preliminary research suggests that it might. At least two large, published studies have found that people who undergo gastric bypass surgery are significantly less likely to develop cancer or die from it than severely obese people who don’t undergo the weight-loss procedure.

READ MORE  Overweight, obese people more likely to get certain kinds of cancer – latimes.com.