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Time-restricted eating, also called intermittent fasting, has become an extremely popular weight loss method over the past several years. About 10% of Americans over 18 have tried intermittent fasting for some period of time, according to the International Food Information Council.

The simplicity of this diet method is part of its appeal. Intermittent fasting involves eating only during a shortened window of time each day, forcing the body into a quasi-fasting state where it burns more fat for fuel. The diet has been found to be effective for weight loss in many studies, while others have pointed to health benefits including lower cholesterol and blood pressure, improved insulin sensitivity and more.

But the news about intermittent fasting is not all good. A recently published long-term analysis of more than 20,000 U.S. adults found that those who fasted for 16 hours or more per day were more likely to die of cardiovascular disease than peers who ate normally over the course of 12-16 hours per day.

Key findings of the analysis, which spanned a period of between eight and 17 years, included:

People who followed a pattern of eating all of their food across less than 8 hours per day had a 91% higher risk of death due to cardiovascular disease.

Among people with existing cardiovascular disease, an eating duration of 8-10 hours per day was also associated with a 66% higher risk of death from heart disease or stroke.

Time-restricted eating did not reduce the overall risk of death.

We were surprised to find that people who followed an 8-hour, time-restricted eating schedule were more likely to die from cardiovascular disease. Even though this type of diet has been popular due to its potential short-term benefits, our research clearly shows that, compared with a typical eating time range of 12-16 hours per day, a shorter eating duration was not associated with living longer, said senior study author Victor Wenze Zhong, Ph.D.

Zhong noted that, although the study noted a long-term relationship between intermittent fasting and cardiovascular death, this doesnt mean that time-restricted eating was the cause. He said its findings should encourage a more cautious, personalized approach to dieting.

Lisa Russell covers health and aging for both West Newsmagazine and Mid Rivers Newsmagazine. She is a West St. Louis County native [Parkway South, class of 1979] and graduate of Mizzous journalism school. She and her husband have three grown children.

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Long-term intermittent fasting could harm the heart - WestNewsMagazine.com

Full details of the study design and outcomes from the parent study have been described elsewhere26. Here we briefly describe methods relevant to this analysis.

The parent study was a 22 design assessing the effectiveness of a LF versus LC diet among insulin resistant (IR) and insulin sensitive (IS) adults who were overweight or obese26. We suggest the terms insulin resistance and insulin sensitivity here be interpreted cautiously because we used a proxy measure for this, rather than a direct measure (expanded discussion is provided elsewhere26). Briefly, insulin resistance status was assessed by calculating an area under the curve of insulin concentrations from four blood samples taken during an oral glucose tolerance test (OGTT) (time: 0, 30, 60, and 120min)26. Individuals above the median (separately for men and women) were considered more IR and individuals below the median were considered more IS. Participants were then assigned to either their first diet assignment (LF or LC) via a random number generator in Microsoft Excel.

Participants were recruited from the local Palo Alto, CA community primarily through media advertisements. Premenopausal women and men aged 1850years were invited to enroll if their BMI was 2840kg/m2, body weight was stable over the previous 2months, and medications were stable for3months. Potential participants were excluded if they self-reported hypertension (except for those stable on antihypertension medications); type 1 or 2 diabetes mellitus; heart, renal, or liver disease; cancer or active neoplasms; hyperthyroidism unless treated and under control; taking any medications known to affect weight/energy expenditure or blood lipids; smoking; alcohol intake3 drinks/day; pregnancy, lactation, no menstruation for the previous 12months, or plans to become pregnant within the next year. All study participants provided written informed consent. Procedures for this study were followed in accordance with the ethical standards from the Declaration of Helsinki. The study was approved by the Stanford University Human Subjects Committee (Protocol ID: 23438, approved: 2013.12.17).

The intervention consisted of two 6-month phases. Participants ate an assigned diet (healthy LF or LC) for 6months then switched to the opposite diet for an additional 6months. During each phase, participants received 14 1-h nutrition education classes led by a health educator. Classes were delivered in-person once a week for the first 8weeks, every other week for the next 8weeks, and once a month for the last 8weeks.

The curriculum of the nutrition education classes emphasized the Limbo-Titrate-Quality approach for defining a healthy LF and LC diet. There were three components of this approach. The first component was Limbo, or How low can you go? This involved participants in the LF group reducing their total daily fat intake to 20g/day or less and participants in the LC group reducing their total daily carbohydrate intake to 20/g a day or less for the first 8weeks. The second component, Titrate, involved participants incrementally adding back 5g of fat or carbohydrates per day to their assigned diet for 14weeks (e.g., going from 20g of total fat to 25g of total fat for the LF group). An important part of the second component was for participants to identify the lowest level of daily fat or carbohydrates they felt that they could maintain long term. The third component was Quality, which emphasized diet quality. Participants were encouraged to consume nutrient dense foods, fresh vegetables and fruits, and to prepare meals at home while avoiding heavily processed foods, foods with added sugars, refined white flour products, and foods with trans fats. In summary, the Limbo-Titrate-Quality approach was designed to motivate participants to achieve the lowest possible level of fat or carbohydrate intake, that is, an approach that was equally ambitious with maximal overall nutritional quality and a dietary pattern that could be continued for a lifetime.

There were no caloric restriction requirements for this dietary intervention. Nutrition education classes also addressed mindful eating, body acceptance, sugar addiction, getting adequate sleep, and maintaining healthy levels of physical activity. Participants were encouraged to track their dietary intake using daily food journals. Participants were also encouraged to be physically active and were provided with pedometers (Omron HJ-112 Digital Pocket Pedometer) to track their activity.

Self-reported sociodemographic data on age, gender, race/ethnicity, marital status, education, and employment status were collected at baseline.

Participants current body weight was measured to the nearest 0.1kg at each time point (baseline, 3, 6, 9, and 12months) using a calibrated scale (Scaletronix). Participants height was measured at baseline to the nearest millimeter using a standard wall-mounted stadiometer. Average daily energy expenditure was assessed using the Stanford 7-day physical activity recall39.

Dietary intake data was collected via 3 unannounced, 24-h dietary recalls within a 2-week time window at each time point (baseline, 3, 6, 9, and 12months) using the Nutrition Data System for Research (NDS-R) software [Nutrition Coordinating Center (NCC), University of Minnesota, versions 4.05.33 (2011) and 4.06.34 (2012)]. Recalls were conducted on two weekdays and one weekend day, nonconsecutive whenever possible.

Blood samples for analysis of plasma lipids (including high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and triglycerides), and insulin and glucose were collected after participants fasted for10h. Insulin was collected at baseline, 6, and 12months. All other outcomes were collected at baseline, 3, 6, 9 and 12months. HDL-C was measured by liquid selective detergent followed by enzymatic determination of cholesterol40. LDL-C was calculated according to Friedewald et al. equation41. Total plasma insulin in serum was measured by radioimmunoassay42, and blood glucose was measured using a modification of the glucose oxidase/peroxidase method (Diabetes Research Center, Washington University, St Louis, MO)43,44.

Participant demographics and baseline clinical characteristics were summarized overall and by arm (diet order) as mean (standard deviation) or n (percent) for continuous and categorical variables, respectively.

For the primary analysis, we characterized percent weight change (PWC) before and after introducing the second diet in the crossover. The primary outcome is percent weight change at 36months versus the percent weight change at 69months. Absolute weight change is presented for visual observation. As prespecified in the statistical analysis plan, the primary analysis includes all available data. We fit a linear mixed model with fixed effects: categorical time (3, 6, 9, 12months with 6months as the reference since it is the end of the first diet and occurs before starting the new diet), order (e.g., study arm), insulin status (resistance vs sensitive), gender; and with a random effect to account for the correlated observations over time of each participant. We performed visual inspections for the model assumptions: normality of residuals and homogeneity of variance, using Q-Q plots and scatterplots, respectively. We provide model estimates for the difference in percent weight change at each time period (relative to the 6-month timepoint) along with 95% confidence intervals (CIs). These estimates account for the cross-over design and stratification randomization variables: insulin status and gender. Additionally, we also presented crude estimates for each time period, i.e., average percent weight change (95% CI). In a stratified analysis, we fit a similar linear mixed model by diet order (excluding study arm as a fixed effect) and present model estimates with 95% CIs. Additionally, we present mean percent weight change (95% CI) by diet order and insulin status.

For the secondary outcomes of LDL-C, HDL-C, triglycerides, fasting glucose, and fasting insulin, we fit a linear mixed model similar to the primary model and present model and crude estimates with 95% CIs, stratified by diet order. For blood lipids, a log transform was used on the outcome in the model to resolve departures from normality.

In a subgroup analysis, we fit a linear mixed model similar to the primary model, but included only those participants that were weight stable or gaining before the diet change at 6months (i.e., those that can re-start weight loss). We considered participants to be weight stable or gaining if their percent weight change at the end of phase 1 (6month timepoint) was greater than or equal to 2 percent (weight loss) relative to the weight change at the 3-month timepoint. Estimates overall and by diet order are provided. Also, we presented crude estimates with 95% CI using only weight stable or gaining participants for the secondary outcomes.

Last, we characterized the percent weight change observed in this study (i.e., 12-month trial comparing low-fat to low-carbohydrate with a diet crossover at 6months) and the percent weight change data from the DIETFITS dietary clinical trial (i.e., 12-month trial comparing low-fat to low-carbohydrate with the same diet for the entire study duration).

Data were analyzed in RStudio (Version 1.2.5042, RStudio Team, 2020, PBC, Boston, MA, USA).

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Switching diets after 6-months does not result in renewed weight loss: a secondary analysis of a 12-month crossover ... - Nature.com

Deep in the basement of Target Center under the court where the Minnesota Timberwolves have staged an impressive playoff run, Life Time is quietly testing the next offshoot of its business.

The part spa, part health clinic called Miora, where members can enjoy IV drips as well as a session in a hyperbaric oxygen chamber, may sound niche, but Life Time has proved its expansion from a gym into a high-end wellness destination with amenities such as co-working and pickleball can bring big business.

Life Time has reached a record level of retention with members who on average visit the company's facilities more than 130 times a year, a metric that continues to improve month to month, the Chanhassen-based company said in its first-quarter earnings report. Membership dues and fees have increased almost 20% from a year ago.

"Our focus is always to deliver the best member experience and a long, long-lasting enduring business," said Life Time founder and CEO Bahram Akradi in a call with analysts. "We reinvented this business over the last four or five years with a clear vision that the business is not going to be going forward the same as it was before."

Just a few years ago, Life Time was in survival mode. The pandemic forced its clubs to shut down and then reopen with COVID-19 restrictions. In fall 2021, Akradi took the former private company public for the second time in its history in an effort to generate funds. After that tumultuous time, Life Time is now focused on growth with Akradi expecting Life Time to generate a cash surplus in the second quarter of this year.

"This year looks great. Retention is great. Top line is great," he said in an interview on Wednesday. "I'm just thrilled."

In addition to recovery equipment and skin treatments, Miora also offers hormone and peptide therapy such as the GLP-1 drugs that are typically used to treat diabetes but have gained popularity as a weight-loss aid, sparking debates about their intended use and possible side effects.

Many who might seek out the services of Miora, which opened late last year and sometimes has a waitlist for popular equipment such as the red light bed and infrared sauna, have tried traditional solutions for health ailments but their results plateaued, said Ali Yanez, senior vice president for LifeSpa and Miora.

At Miora, which is staffed by healthcare professionals like physician assistants, members can get their blood drawn to provide them with a health assessment that breaks down what is called an individual's metabolic code to analyze areas like their hormones, thyroid health and the immune system.

"When you have the tangible data to say my lifestyle behaviors are causing my chemistry to manifest this way, driving me to feel this way, I now can create some ownership," said Cliff Edberg, senior director of Miora.

The goal over the next few years is to roll out Miora into other major markets, Akradi said.

People are visiting Life Time clubs more often as they improve group and personal training opportunities and add programming for older members, the company said.

Another game-changer driving member visits has been Life Time's more than 600 pickleball courts. In April, Life Time opened its first pickleball facility that was built from the ground-up on its Chanhassen campus next to its offices and athletic club. From January of 2022 to last December, Life Time saw an increase of almost 900% in terms of the number of participants at its Life Time pickleball locations.

Life Time Work, Life Time's co-working arm it launched in 2018, has also seen some success like in Edina where the layout changed to accommodate more workers. Another opportunity Akradi sees in the future is for Life Time to manage and operate athletic clubs and possibly co-working offices in vacant office space as building amenities to help landlords reinvigorate their holdings.

"We could help the office owners substantially in certain locations," he said.

Life Time's luxury apartment complexes have worked in certain locations such as in Green Valley, Nev., not far from the Las Vegas strip. The rental rate in those locations is about 50% higher than the market average. There are more projects in the works in other parts of the country including Paradise Valley, Ariz.

However, plans for a Life Time Living complex in Edina near the Southdale Center still haven't been solidified.

At many apartments, the gym is just a workout room, said Parham Javaheri, Life Time's chief property development officer and president of club operations. But with a Life Time center across the parking lot, "it's your way of life."

That doesn't mean that everything Life Time tries is a success. Akradi had dreams of opening Life Time Sports facilities where young people could learn soccer, but it never financially panned out. The Life Time soccer fields at Southdale Center's campus were eventually converted into pickleball courts. He had also thought of creating hotels he dubbed Life Time Stay, but the current model is just a handful of long-term vacation rentals.

Another challenge is that as Life Time continues to upgrade its clubs and offer better services, its costs also increase. In the first quarter of this year, Life Time's profit dipped more than 9% as center operations and rent grew pricier. However, Akradi attributed the drop to the fact the first quarter of 2023 was benefited by a few one-time deals such as the sale of two of Life Time's triathlon events.

"I would be lying if I told you everything's running perfectly," Akradi told analysts this week. "There's always opportunities to improve."

Continued here:
Life Time adds spa that offers weight loss management including Ozempic. - Star Tribune

Although body mass index (BMI)has been criticized by some experts, it is still the most commonly used measure for determining whether someone has obesity. BMI is calculated by dividing your weight in kilograms by the square of your height in meters, but there are resources online that can help as well, such as the CDC's adult BMI calculator or the National Heart, Lung, and Blood Institute's BMI index chart. BMI does not, however, provide information about the distribution of body fat.

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If you have obesity, you may be at risk for other health problems. It cannot be stressed enough that obesity is a disease, and the disease is associated with a higher risk of certain conditions, compared with people who are considered a healthier weight, says Samantha Cassetty, RD, a registered dietitian based in New York City and the coauthor of Sugar Shock.

Obesity has been shown to increase the risk of other health issues, including:

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Weight Loss Surgery vs. Medication: What's the Best Treatment Option for Obesity? - Everyday Health

Wilmington Healths Jayme Stokes recently successfully performed the first SADI-S procedure in the region, according to the practice.

Stokes, a board-certified general and bariatric surgeon, performed a Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S).

SADI-S represents a significant advancement in bariatric surgery, offering patients a comprehensive solution for long-term weight management, Stokes said in a news release.

The procedure requires making one intestinal bypass instead of two as part of the patients weight-loss surgery, reducing surgical time and minimizing the risk of intestinal leakage.

The two-step laparoscopic surgery begins with the removal of a substantial portion of the stomach, transforming it into a slender sleeve structure, the release stated. This sleeve restricts food intake and diminishes the production of the appetite-stimulating hormone ghrelin, aiding in appetite suppression.

SADI-S was introduced in 2007 as a modification of the more traditional duodenal switch operation, officials said, adding that the procedure has shown enhanced outcomes and reduced postoperative complications.

"Unlike the duodenal switch,SADI-S preserves a greater portion of the intestine, enabling improved nutrient absorption and minimizing the need for lifelong supplementation," the release stated. "Additionally, the single intestinal connection in SADI-S reduces the risk of leakage and future bowel obstruction, enhancing patient safety and long-term surgical success."

SADI-S represents a significant advancement in bariatric surgery," Stokes said, "offering patients a comprehensive solution for long-term weight management."

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Surgeon performs newer type of bariatric surgery - Greater Wilmington Business Journal

Obesity is defined as a BMI greater than or equal to 30 by the CDC and is currently among the most prevalent diseases in the world, in addition to being an important risk factor for many other diseases. It has high rates of morbidity and mortality21,22 and, in this context, weight loss can bring countless positive impacts to the individual. Currently, there are several treatments for obesity, and we can divide them into non-surgical or surgical.

Non-surgical treatments include non-drug and drug treatments. Among the non-medicated, we can highlight the change in eating habits, regular physical exercise, and cognitive behavioral therapy8. Ideally, these measures should be implemented for all patients living with obesity, even for those who will undergo drug or surgical treatment. Recently, in addition to lifestyle change, neuromodulation with deep transcranial stimulation has also been studied and has shown effectiveness in weight loss reduction23.

A systematic review carried out in 2021, which analyzed 64 articles concluded that among the most effective non-surgical interventions are low-carbohydrate or low-fat diets and combined therapies. This study also showed that non-drug interventions, such as physical exercise, when used alone, are not very effective in reducing the weight of these patients Therefore, a combination of two or more therapies should be chosen24.

Pharmacological treatment must be chosen together with the patient. One or more drugs can be used, the main ones used being: Liraglutide, Semaglutide, Tirzepatide, Orlistat, Phentermine and Sibutramine25.

Liraglutide was recently approved for the treatment of obesity and is now one of the most widely used drugs. It acts as a GLP-1 receptor agonist26,27,28, enhancing its effects. This group of drugs is already known in the treatment of Type 2 Diabetes Mellitus, a condition that can often be associated with obesity29,30, since its pathophysiology involves increased insulin resistance. The main actions of this drug are: increased satiety due to a reduction in the speed of gastric emptying, increased insulin release and decreased glucagon release. Semaglutide is a drug with a similar mechanism of action who demonstrated not only a substantial weight loss31, but was also associated with a lower 10-year T2D risk in people with overweight or obesity after 2years of follow up32. More recently, a new drug that combines GLP-1 and GIP receptor agonist, Tirzepatide, has shown even better results in the short term33.

Orlistat, in turn, reversibly inhibits the lipase enzyme34, which has the function of breaking down fat from food for its absorption, as well as inhibiting the absorption of ingested triglycerides. Thus, there is elimination of fat in the feces35. The main adverse effects are gastrointestinal symptoms, however this can be beneficial as it leads to a change in behavior, for example causing a lower consumption of foods rich in fat36.

Phentermine, an amphetamine analogue, can be used in conjunction with topiramate for the treatment of obesity. The mechanism of action of the drugs is not yet known, however, significant weight loss has already been observed, in addition to a reduction in the consumption of hypercaloric foods and a decrease in the speed of gastric emptying with the use of this combination of drugs37,38.

Sibutramine, widely used in the 1990s, acts to inhibit the reuptake of serotonin, norepinephrine, and dopamine34. Serotonin, in turn, activates POMC system neurons and inhibits NPY neurons, thereby promoting reduced appetite and increased satiety. Despite generating weight reduction39, some data show increased cardiovascular risk40, and therefore, it is no longer used as a first-line drug.

Among the possible surgeries, the most performed today are: Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic diversion (BPD), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB). According to the NIH and the American Bariatric Society41,42, some indications for performing bariatric surgery are adults with BMI greater than or equal to 40 and adults with BMI greater than 35 accompanied by some comorbidity such as type 2 diabetes mellitus, obstructive sleep apnea or hypertension.

RYGB is one of the best-known procedures and its complications vary according to the surgical technique used. Some complications include gastric distention, ulcers, cholelithiasis, hernias, dumping syndrome, and hyperammonaemia encephalopathy.

BPD presents long-term nutritional complications, such as anemia, bone diseases and fat-soluble vitamin deficiency. This technique has high mortality rates, mainly due to the complexity of the technique.

Among the procedures described, LSG is the one with the fewest complications, being described in the literature bleeding or stenosis of the stoma. An alternative technique using endoscopy for sleeve gastroplasty has shown to be safe and efficient for weight loss after 104weeks, with important improvements in metabolic comorbidities43.

The procedure with the lowest mortality rate is the LAGB44. Despite this, it can present complications such as obstruction, band erosion, band slippage and gastric prolapse, esophagitis, hernia, in addition to having a high rate of reoperation, reaching 50% of patients who underwent this surgery45.

In this article, we compare data on weight loss through intensive drug treatment, which includes changes in eating habits, physical exercise, and medications, and through surgical treatment. Both treatments showed that weight loss caused an improvement in the lipid panel, with a reduction in total cholesterol, triglycerides and LDL, an increase in HDL, improvement in systolic and diastolic blood pressure, decrease in glycated hemoglobin and insulin resistance (accessed through HOMA), in addition to reducing the risk for cardiovascular diseases.

Our systematic review confirmed the findings of individual studies that bariatric surgery has a greater potential for weight reduction, BMI and waist circumference, as already described in individual articles and widely in the literature. It should be noted that even in the long term, this difference remained. Similarly, a 2014 Cochrane systematic review46 comparing RCT with more than 1year of follow-up showed that all 7 articles included demonstrated an advantage of the surgical group. An article47 on the use of pharmacological treatment for obesity showed that even recent drugs approved, including GLP 1 agonists, are not able to reduce weight to levels similar to those of bariatric surgery to date, despite the emergence of new drugs still in initial phase48. It is worth mentioning that in these studies the comparison time is relatively short (12months) and that we do not have data on the long-term impact. Thus, in relation to long term weight loss, bariatric surgery is still the best option.

Most articles were not able to individually demonstrate that surgical treatment is superior to non-surgical in terms of pressure reduction. However, the result of the meta-analysis showed a superiority of the surgical group in relation to both systolic and diastolic pressure, more pronounced in the BPD group. Wang49 performed a systematic review focused on the impact on pressure and demonstrated that there was a reduction in systolic and diastolic values, but the subgroup analysis showed that this occurs only in the RYGB groups for systolic pressure. Similarly, Schiavon also demonstrated a significant reduction in the need of blood pressure medication after 3years in the RYGB group when compared intensive medical treatment for obesity50. This difference found in only one subtype of surgery seems to be just a reflection of the sample size, which can be interpreted that surgical treatment in general tends to reduce pressure to a greater extent than non-surgical treatment. The fact that different types of surgery are significant may reflect the studies selected in our meta-analysis, which have longer follow-ups.

In relation to both HOMA-IR and glycated Hb, there was a more significant improvement in the group that underwent surgery. The way in which the data on diabetes remission was reported in the articles did not allow a meta-analysis to be carried out with these data and, therefore, it was not included. However, individual data from the Mingrone 2015, Mingrone 2021 and Schauer articles showed that the surgery group had better results. A network meta-analysis from 202151 comparing the different types of metabolic surgery for the treatment of obesity and diabetes showed that RYGB was 20% more likely to result in remission of type 2 diabetes compared to SG. There was no significant difference between the other groups. Moreover, the effects of bariatric surgery on diabetes is not exclusive for patients with obesity, as shown by a study with patients with a BMI of 2732kg/m2 that had a better glycemic control when treated with RYGB20. Regarding the lipid profile, Schauer's study was not able to demonstrate superiority in relation to LDL and HDL parameters. However, by combining the data from Mingrone's articles, it is possible to demonstrate that surgical treatment is superior. Regarding cholesterol reduction, Mingrone's studies showed that although RYGB and BDP were better in relation to non-surgical treatment, the BDP technique had a statistically greater reduction in relation to RYGB. This can be explained by the greater intestinal exclusion in BDP and, therefore, having a greater impact on lipid absorption. Despite Sayeed's study52 et al. was not included in this meta-analysis due to the inadequate way of separating the groups for analysis, the results regarding the lipid profile showed that the group that received both interventions was superior to the exclusive non-surgical treatment. It is important to point out that despite a statistically significant difference between the groups, the effect size of this difference is probably not clinically significant.

The choice of treatment for obesity can also have an impact on several other patient comorbidities. Hossain et al.53 performed a systematic review with 26 studies that showed that bariatric surgery appears to be more effective in the treatment of asthma. Similarly, a study by Crawford et al.15 showed that there is a greater increase in bone turnover in groups undergoing bariatric surgery in relation to pharmacological treatment. Other than that, bariatric surgery is also demonstrated to be superior in the treatment of other obesity related pathologies, such as Non-Alcoholic Steatohepatitis (NASH), and in the treatment of obesity in adolescents54,55.

The effect of major cardiovascular adverse events (MACE) and mortality56 have also been promising for bariatric surgery. A recent cohort comparing bariatric surgery in patients with obesity and use of GLP1-agonists inpatients with diabetes showed a lower risk of MACE in the surgical group57. The surgical treatment has also shown superiority when compared to medical treatment regarding the prevention of diabetic kidney disease in 5years for patients with diabetes and obesity58. Boyers et al. evaluated the cost-effectiveness of surgical and pharmacological treatment in the treatment of obesity and found that RYGB should be the treatment of choice only if the optimization of health system costs is considered59.

Another important consideration is the fact that pharmacological and surgical treatment for obesity are not mutually exclusive. Most clinicians choose to combine both treatment modalities in practice to improve results. Weight gain after bariatric surgery is a known possibility, and for those patients, two-thirds of the weight regain can be safely lost with GLP1 agonist, providing clinicians with a therapeutic option for this clinical challenge.

Despite the large number of articles in the literature on the treatment of obesity, there are few RCTs comparing non-surgical and surgical treatment, and most of them only follow up in the short term. In addition, many articles do not adequately describe the strategy used in non-surgical treatment. This lack of data and standardization in this type of treatment can lead to bias and possibly the formation of extremely heterogeneous groups for analysis.

Most of the studies included in our systematic review have diabetes as an inclusion criteria. In this circumstance, our findings may not be generalized to patients with obesity without diabetes.

Another important limitation of our systematic review refers to pharmacological treatment in the non-surgical group. The use of GLP 1 agonists has great potential in the treatment of obesity, but they have only started to be used recently. As the purpose of our article is to assess the long-term impact, there are still few articles available that used this drug. The use of the most recent medications, such as Tirzepatide, could not be evaluated in our study, once there are no RCTs in the literature presenting its long-term effects. Those drugs proved to be very efficient and might have similar effect in the long term. Future systematic reviews may reveal a different results when including the new generation of weight loss medication.

Finally, choosing the most appropriate treatment often involves individual characteristics of each patient, and the impact on quality of life can be extremely subjective and difficult to assess.

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Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review ... - Nature.com

The carnivore diet, according to Cleveland Clinic, is as simple as it sounds: You eat meat or animal products for every meal, and mostly avoid every other food group.

Health has reported that the all-meat diet is attractive to those wanting to lose weight. Adherents keep their daily carbohydrate intake to a minimum and eat only small amounts of plant-based foods, such as low-carb vegetables. The bottom line is that people following a carnivore diet focus on getting calories strictly from meat and animal products.

But is the carnivore diet actually healthy? Healthline and other outlets have reported that the diet is too restrictive and not well-balanced, and that its not completely backed up by research.

According to Health, several researchers and health professionals have examined the meat-based diet over hundreds of years.

In 1797, Dr. John Rollo reportedly treated patients with Type 2 diabetes through a meat-and-fat based diet after studying the low-carb diet of indigenous people in St. Lucia. Low-carb diet treatments became widely adopted for managing diabetes until 1921 with the discovery of insulin, Health reported.

The carnivore diet enjoyed a surge in popularity in 2018 with the rise of The Carnivore Diet, a book by Dr. Shawn Baker, who recommended the complete version of the diet after claiming to benefit from it, per Health.

Healthline reported that aspects of a high-protein, low-carb diet may result in select benefits.

Protein can help you feel more full and simultaneously increase your metabolic rate, enabling you to not only reduce your calorie intake, but potentially burn more calories.

These aspects of following the carnivore diet promote weight loss, but they may not last, health experts say.

A 2021 study examining self-reports of the carnivore diet found that participants who followed the diet for nine to 20 months reported improvements in their overall health, physical and mental well-being, and some chronic medical conditions, according to Health.

These findings might have resulted from cutting out foods and drinks associated with poor physical and mental health, so health experts say more research is needed to see how the carnivore diet impacts long-term health.

According to CNBC, people following the carnivore diet do not get enough carotenoids, polyphenols and fiber, which are cancer-preventing substances abundant in fruits and vegetables.

Registered dietitian Kate Patton told Cleveland Clinic that the lack of fiber will cause a lot of constipation, and that the diet, which is potentially high in saturated fats and sodium, could lead to health complications.

Even if you have digestive issues, this diet can make things worse with all that protein and fat, which takes a lot longer to digest, Patton said.

In addition, the diet limits consumption of certain micronutrients and plant compounds. While meat does provide some micronutrients, the carnivore diet may result in the deficiency of some nutrients, and the overconsumption of others.

Diets rich in plant-based foods, unlike the carnivore diet, have been associated with lower risks of long-term conditions, such as heart disease and Alzheimers, per Healthline.

Walter Willett, a professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, said to CNBC, Its possible that some people who have been eating a lot of refined starch and sugar may get better in the short run. ... But this sounds like a diet that is going to be very unhealthy in the long run.

The rest is here:
Is the carnivore diet healthy? Here's what to know Deseret News - Deseret News

When will we see through the haze of drugs like Ozempic and Wegovy?

Hopefully soon. These drugs might reach 30 million U.S. users by 2030. Surging, off-label demand has come with unintentional overdoses, rising prices and medication shortages. Further expansion seems likely with the Food and Drug Administrations recent approval of another class of medications to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.

These medications, called GLP-1 receptor agonists or semaglutides, have gotten the attention of the New York City Council. One member has proposed a law requiring the city health department to release information on the consequences of off-label use of these medications for weight loss.

About 20% of patients taking GLP-1s for weight loss experience nausea and vomiting; 30% get diarrhea. Add headaches, swelling of nasal passages, allergic reactions, pancreatitis, and fatigue to the list, along with rare cases of thyroid cancer in laboratory animals.

Admittedly, bariatric surgery, my area of expertise, also poses risks, like any surgical procedure. Still, it remains a safe, long-term option offering better long-term control of weight and glucose levels than medical therapies for patients with Type 2 diabetes. Patients need accurate information about the risks and benefits of all options.

There is no denying: Semaglutides are a powerful class of drugs helping push back on the obesity epidemic. They offer weight loss, reduced appetite, and slower emptying of the stomach that makes patients feel full faster.

Ive also seen at my Great Neck-based practice what can happen when patients stop taking semaglutides. It can trigger weight (re)gain, a greater appetite, a surge of blood sugar, and lean muscle mass loss with body fat percentage gain. There can be withdrawal symptoms.

Data, physician awareness, and patient education can help us assess whats best for each patient, medication or bariatric surgery. The lack of knowledge translates into only about 200,000 patients per year pursuing weight-loss surgery about 1% of those who qualify for it.

Physicians need to share that bariatric surgery remains an effective, long-term tool that has become safer and less invasive. It can be highly effective for weight loss and management of obesity-induced complications, especially when surgeons use minimally invasive procedures. This approach, used in 90% of bariatric surgeries, results in shorter hospital stays, less blood loss during procedures, less postoperative pain, and fewer pulmonary complications and wound infections.

We need to review data comparing outcomes for patients who have undergone gastric bypass, sleeve gastrectomy, and intensive medical therapy alone. Of patients who underwent medical therapy, 12% achieved the desired diabetes targets after a year, but positive effects of metabolic surgery lasted longer and also improved cholesterol and triglyceride levels. Those advantages must be considered against potential post-surgical drawbacks like anemia or gastrointestinal problems.

Its clear semaglutides have tremendous potential, though we dont yet know their full impact. If we can find optimal ways to wean patients off those them, perhaps they might help patients maintain weight loss after bariatric surgery.

Semaglutides also have opened the door to reframing obesity as a medical condition without shame. When we can consider weight-loss options without stigma, patients are better positioned to receive information from their doctors and make decisions. The less starry-eyed we are, the better we can focus on the positive, long-term health outcomes each patient deserves.

THIS GUEST ESSAY reflects the views of Dr. Aurora Pryor, system director for bariatric surgery at Northwell Health and surgeon in chief at Long Island Jewish Medical Center.

See more here:
Given their side effects, weight-loss drugs might not be good for all - Newsday

Its that hold-your-breath moment, often at the start of the day: The numbers on the scale can have so much influence on your sense of self-worth. Each one of us is so much more than the figure that flashes upyet research has shown that consistently weighing yourself is one of the most effective ways to lose weight and subsequently keep it off.

But when can you take a step back from all that vigilance over your food intake, exercise, and weight? A study conducted by researchers from the University of Florida and the University of Virginia set out to determine how often an individual should weigh themselves to effectively keep weight off.

The results and analysis were published in March 2024 in the journal Obesity. Led by scholars of metabolism, cardiovascular health, and psychology, the study followed 74 adults who were overweight or obese with an average age of 50. The study tracked these participants throughout a nine-month maintenance period after completing a three-month-long weight loss plan, asking them to monitor their weight, food intake, and activity and to report on the days they tracked every week.

What Is Your Set Point Weight? Heres How To Gauge ItAnd Why a Doctor Says Youll Want To

The researchers found that weight re-gain correlated with the frequency per week that the participants monitored their weight. Those who continued monitoring their weight, diet, and activity at least three days per week were likelier to have maintained their weight at the end of the nine months. Participants who tracked their values for five days or more each week were more likely to continue losing weight. And interestingly, tracking for one to two days per week was associated with significant weight gain.

The researchers were encouraged by the results because in this study, maintenance was attainable with just three to four days of monitoring per week. These results provide support for using modified schedules of self-monitoring during maintenance, with the potential to lower self-monitoring burden and ultimately improve long-term adherence and weight-loss maintenance, they said.

Additionally, they note that the data support the idea that a slow and steady approach is more effective than bursts of weight monitoring. Also, consistently reporting metrics three to four days per week worked much better than reporting seven days one week and then only one day on another week.

This modified maintenance is encouraging for people who want to be a little more flexible, but still mindful, with their diets after weight loss.

Originally posted here:
The Best Way to Keep Weight Off? Weigh Yourself This Often, Says New Study - The Healthy

If you put a lab mouse on a diet, cutting the animals caloric intake by 30 to 40 percent, it will live, on average, about 30 percent longer. The calorie restriction, as the intervention is technically called, cant be so extreme that the animal is malnourished, but it should be aggressive enough to trigger some key biological changes.

Scientists first discovered this phenomenon in the 1930s, and over the past 90 years it has been replicated in species ranging from worms to monkeys. The subsequent studies also found that many of the calorie-restricted animals were less likely to develop cancer and other chronic diseases related to aging.

But despite all the research on animals, there remain a lot of unknowns. Experts are still debating how it works, and whether its the number of calories consumed or the window of time in which they are eaten (also known as intermittent fasting) that matters more.

And its still frustratingly uncertain whether eating less can help people live longer, as well. Aging experts are notorious for experimenting on themselves with different diet regimens, but actual longevity studies are scant and difficult to pull off because they take, well, a long time.

Heres a look at what scientists have learned so far, mostly through seminal animal studies, and what they think it might mean for humans.

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Link:
Could a Calorie-Restricted Diet or Fasting Help You Live Longer? - The New York Times

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