Posted by on September 13, 2010 - 8:22am

Weight gain during menopause continues to be a challenge to women.  About 30% of women aged 50-59 are not just overweight, but obese.  This weight gain increases one's risk for high blood pressure, heart disease, and diabetes.    Just when we are getting used to the other symptoms often associated with menopause (hot flashes, insomnia, etc), we now have to worry about other serious chronic diseases!   It's hard not to say, "aging is not for sissies".

So why does menopause add those unwanted inches?  Scientists and physicians indicate that it is probably due to a number of factors related to both menopause and aging.

In animal studies, estrogen appears to help regulate body weight.  With lower estrogen levels, lab animals tend to eat more and be less physically active.  Reduced estrogen may also lower metabolic rate (rate at which the body converts stored energy into working energy).  It is possible that the same thing happens to women when their estrogen level drops at menopause.  There is some evidence that estrogen hormone therapy may increase one's resting metabolic rate, slowing weight gain.

Other factors for this weight gain are related to aging.  As we age, we exercise less.  This leads to increased loss of muscle mass, which decreases our resting metabolism even more!  This makes it easier to gain weight.   As we age, our aerobic capacity also declines (the rate we use up energy during exercise). To compensate for this, we may need to increase the amount of time we exercise in order to achieve the same weight loss we experienced while exercising when when we were younger.

To learn more how exercise can help control menopausal weight gain and some tips for ensuring success, click here.

Posted by on August 31, 2010 - 10:24am

In 2006, the Center for Disease Control and Prevention (CDC) reported that 21.6% of the US adult population reported arthritis, with significantly higher prevalence in women than in men (24.4% vs. 18.1%). Arthritis prevalence increased with age and was higher among women than men in every age group.    With the aging of the US population, the prevalence of doctor-diagnosed arthritis is expected to increase in the coming decades.   By 2030, it is estimated that 67 million adults age 18 and older will have arthritis, compared with the current 46 million.  Also, by 2030 an estimated 25 million adults will report arthritis-attributable activity limitations.

Functional limitations in routine activities are common among adults with arthrtis:   40% report it is "very difficult" or they "cannot do" at least 1 of 9 important daily functions which include their ability to stoop, bend, grasp, kneel or walk 1/4 mile.  Obesity is a known risk factor for the progression of knee osteoarthritis and possibly of other joints.   Reducing body weight may result in significant improvement in the health-related quality of life of people with arthritis.

Although physical activity and exercise have been shown to benefit people with arthritis by improving pain control, function, and mental health, many people with arthritis report no leisure time physical activity. Low levels of physical activity place individuals with arthritis at further risk of inactivity-associated conditions such as cardiovascular disease, diabetes, obesity, and functional limitations.

Some interesting research is currently taking place at Northwestern U. that is looking at knee alignment and its role in progression of knee osteoarthritis that could lead to earlier and novel interventions that could decrease or prevent arthritic disability in the future.  Many Illinois women who are part of the Illinois Women's Health Registry are participating in those studies.

In the meantime, women (and men) who have arthritis could benefit from keeping their weight down and keeping physically active!!!   As we age, it is even more important that we develop a lifestyle that includes healthy eating and exercise.


Posted by on August 20, 2010 - 10:04am

Benefits shown in middle-aged and elderly women

Middle-aged and elderly Swedish women who regularly ate a small amount of chocolate had lower risks of heart failure risks, in a study reported in Circulation: Heart Failure, a journal of the American Heart Association.  The nine-year study, conducted among 31,823 middle-aged and elderly Swedish women, looked at the relationship of the amount of high-quality chocolate the women ate, compared to their risk for heart failure. The quality of chocolate consumed by the women had a higher density cocoa content somewhat like dark chocolate by American standards. In this study, researchers found:

  • Women who ate an average of one to two servings of the high-quality chocolate per week had a 32 percent lower risk of developing heart failure.
  • Those who had one to three servings per month had a 26 percent lower risk.
  • Those who consumed at least one serving daily or more didn’t appear to benefit from a protective effect against heart failure.

The lack of a protective effect among women eating chocolate every day is probably due to the additional calories gained from eating chocolate instead of more nutritious foods, said Murrray Mittleman, M.D., Dr.P.H., lead researcher of the study.  “You can’t ignore that chocolate is a relatively calorie-dense food and large amounts of habitual consumption is going to raise your risks for weight gain,” said Mittleman, director of the Cardiovascular Epidemiology Research Unit at Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston. “But if you’re going to have a treat, dark chocolate is probably a good choice, as long as it’s in moderation.”

High concentration of compounds called “flavonoids” in chocolate may lower blood pressure, among other benefits, according to mostly short-term studies. However, this is the first study to show long-term outcomes related specifically to heart failure, which can result from ongoing untreated high blood pressure.   In the observational study, researchers analyzed self-reported food-frequency questionnaire responses from participants 48-to-83-years-old in the Swedish Mammography Cohort. Combining the results with data from national Swedish hospitalization and death registries between 1998 through 2006, the researchers used multiple forms of statistical modeling to reach their conclusions on heart failure and chocolate consumption.

Mittleman said differences in chocolate quality affect the study’s implications for Americans. Higher cocoa content is associated with greater heart benefits. In Sweden, even milk chocolate has a higher cocoa concentration than dark chocolate sold in the United States.    Although 90 percent of all chocolate eaten across Sweden during the study period was milk chocolate, it contained about 30 percent cocoa solids. U.S. standards only require 15 percent cocoa solids to qualify as dark chocolate. So, by comparison, American chocolate may have fewer heart benefits and more calories and fat per equivalent amounts of cocoa content compared to the chocolate eaten by the Swedish women in the study.   Also, the average serving size for Swedish women in the study ranged from 19 grams among those 62 and older, to 30 grams among those 61 and younger. In contrast, the standard American portion size is 20 grams.

“Those tempted to use these data as their rationale for eating large amounts of chocolate or engaging in more frequent chocolate consumption are not interpreting this study appropriately,” said Linda Van Horn, Ph.D., R.D., immediate past chair of the American Heart Association Nutrition Committee and professor in the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “This is not an ‘eat all you want’ take-home message, rather it’s that eating a little dark chocolate can be healthful, as long as other adverse behaviors do not occur, such as weight gain or excessive intake of non-nutrient dense ‘empty’ calories.”

Heart failure occurs among about 1 percent of Americans over age 65. A condition in which the heart can’t pump enough blood to the rest of the body, heart failure rates are increasing as our aging population grows.“Anything that helps to decrease heart failure is an important issue worth examining,” Mittleman said.

Co-authors are Elizabeth Mostofsky, M.P.H.; Emily Levitan, Sc.D.; and Alicja Wolk, Dr.Med.Sci. Author disclosures and funding support are on the manuscript.

Source: Press release prepared by the American Heart Association


Posted by on August 19, 2010 - 11:07am

The first study to compare the effectiveness of the birth control pill in women with marked weight differences has found that the pill works equally well in women with obesity and thinner women. This new finding by physician-scientists at NewYork-Presbyterian Hospital/Columbia University Medical Center refutes a long-held conviction among many doctors that the pill may not reliably prevent pregnancy in women who are overweight or obese. With obesity a significant health issue in the United States -- the U.S. government estimates that nearly 65 percent of adult women ages 20 and older are overweight or obese -- the reliability of the birth control pill in this population is critical, especially since pregnancy itself is riskier among women with obesity.

In the study, published in the August issue of the journal Obstetrics & Gynecology, principal investigator Dr. Carolyn Westhoff, and her colleagues did not rely, as previous studies had, on women's recollections of how much they may have weighed at a time when the pill had failed and they became pregnant."We wanted to study what was actually happening in the ovaries of women and not depend on memory, which is notoriously faulty," Dr. Westhoff says.

Dr. Westhoff and her colleagues designed a prospective study where 226 women of normal weight or who were overweight, and between the ages of 18 and 35, were randomly assigned to take either a lower- or higher-dose version of the pill. The researchers purposely used the different dose levels to assess whether heavier women required higher dosing, as has been previously believed.  After three or four months of using the oral contraceptives -- the time it usually takes for a woman's body to acclimate to the pill -- the women had multiple ultrasounds and blood tests to determine if ovulation was being suppressed. The goal of oral contraception is to suppress ovulation.

Of the 150 women who used the pill consistently, three of the 96 women with normal weight ovulated, as did one of the 54 women with obesity. The researchers also found that when women were not taking the pill regularly, they ovulated with greater frequency."Our findings strengthen the message to patients that the pill will only work if it is taken every day. Weight does not seem to have an impact on suppression of ovulation, but consistency of pill-taking does," Dr. Westhoff says.

Importantly, the lower-dose pill seemed to be as effective as the higher-dose pill in suppressing ovulation in women with obesity. This is a crucial finding because women with obesity are at greater risk for developing blood clots from taking either type of pill, although the overall risk is small. "For a woman to fear relying on her oral contraceptive to prevent an unwanted pregnancy is a huge burden. This study should put those fears to rest," Dr. Westhoff says.

Source:   New York Presbyterian Hospital/Columbia University Medical Center

Click here to see full press release.

Note from the Institute for Women's Health Research:   Expect debate on this issue until the findings are replicated by other researchers and further analyzed.   The Institute will continue to track this issue and put updates on this blog site.

Posted by on August 10, 2010 - 2:45pm

In July, a commentary in the journal Pediatrics discussed several new studies that have increased our knowledge of the  association between tobacco smoke exposure and childhood morbidity and mortality.  Collectively, these new reports demonstrate that in several categories of chronic childhood illness (asthma, obesity, and mental health disorders) there are small-to-moderate independent associations with tobacco smoke exposure either during pregnancy or in the postnatal period.   A moderate association with tobacco smoke and dental caries (cavities) in children was also reported.   One study found an association between smoke exposure of pregnant women and subsequent childhood overweight in offspring.   What was especially significant about the latter study was the fact that it was conducted in pregnant women who did NOT smoke but were exposed to smoke from the father.  Studies looking at mothers who smoke continue to show an association to their children's mental health status that affects their children's  ability to participate in social activities and make friends.

Posted by on July 28, 2010 - 4:00pm

I just received a FDA email about the safety of color additives in food.   What caught my eye was the subheading:  "Without color additives, colas wouldn't be brown, margarine wouldn't be yellow and mint ice cream wouldn't be green."   I  wonder if colorless food could help reduce the obesity epidemic!!!   Seriously, to read the article, click here.

Posted by on July 14, 2010 - 12:05pm

CHICAGO --- The more an older woman weighs, the worse her memory, according to new research from Northwestern Medicine. The effect is more pronounced in women who carry excess weight around their hips, known as pear shapes, than women who carry it around their waists, called apple shapes.  The study of 8,745 cognitively normal, post-menopausal women ages 65 to 79 from the Women's Health Initiative hormone trials is the first in the United States to link obesity to poorer memory and brain function in women and to identify the body-shape connection.

"The message is obesity and a higher Body Mass Index (BMI) are not good for your cognition and your memory," said lead author Diana Kerwin M.D., an assistant professor of medicine and a physician at Northwestern Medicine. "While the women's scores were still in the normal range, the added weight definitely had a detrimental effect."

For every one-point increase in a woman's BMI, her memory score dropped by one point. The women were scored on a 100-point memory test, called the Modified Mini-Mental Status Examination. The study controlled for such variables as diabetes, heart disease and stroke.   The study will be published July 14 in the Journal of the American Geriatric Society.

The reason pear-shaped women experienced more memory and brain function deterioration than apple-shaped women is likely related to the type of fat deposited around the hips versus the waist. "Obesity is bad, but its effects are worse depending on where the fat is located," Kerwin said.

Cytokines, hormones released by the predominant kind of fat in the body that can cause inflammation, likely affect cognition, Kerwin said. Scientists already know different kinds of fat release different cytokines and have different effects on insulin resistance, lipids and blood pressure.

"We need to find out if one kind of fat is more detrimental than the other, and how it affects brain function," she said. "The fat may contribute to the formation of plaques associated with Alzheimer's disease or a restricted blood flow to the brain."    In the meantime, the new findings provide guidance to physicians with overweight, older female patients.

"The study tells us if we have a woman in our office, and we know from her waist-to-hip ratio that she's carrying excess fat on her hips, we might be more aggressive with weight loss," Kerwin said. "We can't change where your fat is located, but having less of it is better."

Kerwin's research is funded by the T. Franklin Williams Award from Atlantic Philanthropies and Association of Specialty Professors and the Wisconsin Women's Health Foundation Faculty Scholar Award. The Women's Health Initiative was funded by a grant from the National Heart, Lung and Blood Institute.

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Posted by on April 14, 2010 - 9:31am

The Agency for Healthcare Research and Quality issued its 2009 National Healthcare Quality Report and National Healthcare Disparities Report on April 13.  The 2009 reports include a new section on lifestyle modifications because preventing or reducing obesity is a crucial national goal. The reports found:

  • One-third of obese adults have NEVER received advice from their doctor about exercise.
  • Obese adults who are black, Hispanic, poor or have less than a high school education are LESS likely to receive diet advice from their doctors.
  • Most overweight children and one-third of obese adults report that they have NOT been told by their doctor that they are overweight.
  • Most American children have NEVER received counseling from their health care provider about exercise, and almost half have NEVER received counseling about healthy eating.

The reports indicate that the lack of health insurance slows improvement in health care quality and reduction of disparities.  For many services, not having insurance is the single strongest predictor of poor quality care, exceeding the effects of race,  ethnicity, income or education.

So, the BIG question....will expanding health insurance to more people change some of these statistics????   Let's hope so.

Posted by on February 26, 2010 - 5:13pm

According to a study that was coordinated by investigators at Northwestern University's Feinberg School of Medicine, two to three times more pregnant women may soon be diagnosed and treated for gestational diabetes, based on new measurements for determining risky blood sugar levels for the mother and her unborn baby.

“As result of this study, more than 16 percent of the entire population of pregnant women qualified as having gestational diabetes,” said lead author Boyd Metzger, MD.  “Before, between 5 to 8 percent of pregnant women were diagnosed with this.”

Blood sugar levels that were once considered in the normal range are now seen as causing a sharp increase in the occurrence of overweight babies with high insulin levels, early deliveries, cesarean section deliveries and potentially life-threatening preeclampsia, a condition in which the mother has high blood pressure that affects her and the baby. Large babies, the result of fat accumulation, are defined as weighing in the upper 10 percent of babies in a particular ethnic group. Because large babies increase the risk of injury during vaginal delivery, many of the women in the study were more likely to have a cesarean section.  To view entire news report written by science writer, Marla Paul click here.

Posted by on November 2, 2009 - 10:42am

Diabetes mellitus is an endocrine disease affecting approximately 7% of the US population.  Diabetes is categorized into two classes: Type 1, or insulin dependent diabetes, and Type 2, or adult onset diabetes.

Type 1 Diabetes is a condition in which the pancreas produces little or no insulin, a hormone necessary for the metabolism of glucose.  Type 1 Diabetes is generally diagnosed in childhood or early adolescence and is considered to be primarily genetic in origin.  Symptoms include extreme hunger, fatigue, rapid weight loss and blurry vision.  There is no cure for Diabetes, but successful treatment includes insulin injections, blood sugar monitoring, a healthy diet, and regular exercise.

Type 2 Diabetes accounts for 90-95% of all Diabetes cases in the United States.  In Type 2 Diabetes, the body is either insulin resistant or the pancreas does not produce enough insulin.  This type is often preventable and is strongly linked to obesity.  Symptoms are similar to Type 1 Diabetes but, depending on the severity, treatment may only include blood sugar monitoring, a healthy diet, and regular exercise.  Severe or advanced cases may require medication and/or insulin injections.

Resources at Northwestern for Diabetes:

The Division of Endocrinology at Northwestern Memorial Hospital provides comprehensive diagnosis and treatment for a variety of endocrine related disorders.  Physicians in the department specialize in endocrine tumors, endocrine disease genetics, gestational diabetes, and offer specialized services in diagnosis and treatment of Type 1 and Type 2 Diabetes.  The department participates in a variety of NIH-sponsored research trials.  Results from NMH’s participation in the National Institute’s of Health 10-year study on prevention of type 2 diabetes can be found at http://www.feinberg.northwestern.edu/news/2009C-October/Diabetes.html.

Click to see physician finder:

http://nmhphysicians.photobooks.com/

Northwestern Physicians/ Researchers specializing in Diabetes treatment:

The Division of Endocrinology, Metabolism, and Molecular Medicine at Northwestern University features a diverse faculty, many of whom are leaders in their field.  The department, headed by Dr. Andrea Dunaif, is committed to clinical and basic science research development and training.  The research interests of the department are diverse and extend to multiple subfields of endocrinology.  Researchers studying diabetes include Dr. Franck Mauvais-Jarvis, who studies the role of estrogen receptors in pancreatic cells, Dr. M. Geoffrey Hayes, PhD, who studies the genetic components of diabetes, and Dr. Boyd E. Metzger, MD, whose research on gestational diabetes has been widely published.

IWHR Highlighted Researcher

Dr. Robert F Kushner, MD, MS is the Clinical Director of the Northwestern Comprehensive Center on Obesity and a Professor of Medicine at the Feinberg School of Medicine.  Dr. Kushner has published various books, book chapters, and articles and serves on the editorial board of various prestigious journals including Obesity, Obesity Management, and the Journal of the American Dietetic Association.  Popular publications include Dr. Kushner’s Personality Type Diet, Treatment of the Obese Patient and Fitness Unleashed: A Dog and Owner’s Guide to Losing Weight and Gaining Health Together.  Although Dr. Kushner’s research interests are in obesity and nutrition, his research and publications have implications for a diabetic population.  Recently he published a study in Obesity examining various lifestyle interventions for prevention of weight gain in type II diabetic patients taking the common diabetes medication pioglitazone (Actos®).  The study showed that the weight gain side effects commonly associated with this medication can be diminished or alleviated by lifestyle interventions such as medical nutrition therapy (MNT).  The greatest success was seen in patients who received intensive follow up MNT, which included lessons in meal planning, food preparation, goal-setting and exercise recommendations.

For information on Dr. Kushner or to purchase his books:

http://www.counselingoverweightadults.com/

Other Useful Links and Resources:

http://www.nlm.nih.gov/medlineplus/diabetes.html
http://www.cdc.gov/diabetes/
http://www.diabetes.org
http://www.dlife.com/

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