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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Merits of Subtyping Obesity:  One Size Does Not Fit All

Merits of Subtyping Obesity:  One Size Does Not Fit All | Heart and Vascular Health | Scoop.it

 Within the obesity field there has been increasing recognition that prevention and treatment programs should be culturally sensitive and that the prevalence of risk factors and obesity may vary by race or ethnicity, but the same basic recommendations for prevention and treatment are given in all settings. An important question is whether this is one reason for not achieving better treatment outcomes.

Currently many obesity treatment studies have overall small effects, but substantial variability in results, with some individuals having a large amount of weight loss and others gaining weight. The focus on mean overall effects may preclude identifying an effective treatment program for a specific subtype of obesity, but not others.

High insulin secretion low responsiveness to internal satiety signals, high responsiveness to external food cues; learned patterns and preference for foods high in calories, fat, sugar, and salt; binge eating or food addiction; and low reinforcing value of activity or high reinforcing value of being sedentary. However, these are only several possible subtypes but others may exist.

Currently, major advances are being made in statistical methods to understand the development of obesity, the neuroscience of eating behaviors, use of sensors to better measure exposures, and exploration into the functional role of genetic polymorphisms associated with obesity. Additional advances are needed in how to conceptualize and phenotype the outcome of obesity. The one-size-fits-all approach is yielding small average weight losses. 

The molecular pathological epidemiology model has recently emerged to help address the heterogeneity of disease. Obesity is a heterogeneous and complex disease influenced by exogenous and endogenous exposures. Stratifying obesity into meaningful subtypes could provide a better understanding its causes and enable the design and delivery of more effective prevention and treatment interventions.

Seth Bilazarian, MD's insight:

Generalization is sometimes useful, but in medicine often results form intellectual laziness or pharmaceutical companies attempting to have broad commercial applications for their therapies.  This editorial on the need to sub-type different types of obesity so different treatment strategies can be tested and tailored for best outcomes for patients affiliated with obesity makes a lot of sense.  It would also have significant impact on the cost of treatment from a public health standpoint since therapies could be used when most effective and avoided when they are unlikely to be effective..  This may be why there are so many commercially successful diet programs iand books because some of the programs DO work fro some of the people who try them.

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Important facts about quitting smoking and weight gain

Important facts about quitting smoking and weight gain | Heart and Vascular Health | Scoop.it

Quitting smoking is arguably the most important step that smokers can take to improve their health and prevent premature death. Smoking cessation greatly reduces the risk of multiple types of cancer, cardiovascular disease (CVD), and chronic obstructive pulmonary disease (COPD) complications and has other health benefits such as improved wound healing and reduced risk of hip fractures and cataracts.

Patients should not be concerned about the health effects of cessation-related weight gain. About 50% of female smokers and about 25% of male smokers are “weight concerned,” which may discourage quit attempts and quitting success. Even though no treatments have been shown to reliably prevent cessation-related weight gain, exercise regimens may be beneficial, and use of nicotine replacement medications can suppress weight gain during their use.

The most important message of two articles in the 3/13/2013 JAMA is that every smoker should be encouraged to quit smoking and given support to do so.

Seth Bilazarian, MD's insight:

Patients worry about weight gain with smoking cessation.  It may be an excuse to not want to tackle this tough addicition.

Weight gain is a frequent side effect when people quit smoking.  But the health benefits of stopping smoking far outweigh the cardiovascular hazard of weight gain.

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