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#OW2016 Research Spotlight: A functioning circadian clock may help maximize weight loss following bariatric surgery
TOS
A newly released basic science study of Roux-en-Y gastric bypass (RYGB) suggests that a functioning circadian clock, or sleeping at night and being awake during the day, can help patients achieve a higher amount of weight loss following the surgery. The study conducted in a mouse model is one of the first to shed light on how researchers and clinicians might continue to improve the outcomes following RYGB by correcting disruptions to the circadian clock. The findings were unveiled during a poster presentation at The Obesity Society Annual Meeting at ObesityWeek℠ 2016 in New Orleans.

Prior research observations suggest that appropriate timing of calorie consumption and minimal disruption of the light/dark cycle set by the environment are crucial for a healthy energy balance and metabolism. However, little is known about the potential role of this molecular clock on maximizing the beneficial metabolic effects of bariatric surgery—one of the most effective therapies available for obesity.

“Our findings from this mouse study suggest that patients with a disrupted circadian rhythm—such as night-shift workers and those with night-eating syndrome—may not be able to achieve the maximum amount of weight loss resulting from bariatric surgery,” said the study’s lead researcher Mohamad A. Mokadem, MD, ABOM, of the University of Iowa. “Our research shows that it could be important for patients to have a normal circadian clock pre-surgery to maximize weight loss following surgery.”

The research implications for patients are drawn from a study conducted in mice, which is one of the first steps toward designing and replicating such a study in humans. Study authors say that more research is needed to better understand the role of circadian rhythm regulators or “clock genes” in the reversal of obesity, including research conducted in a patient population.

“Bariatric surgery has long been recognized as one of the most effective treatments for severe obesity,” said Samer Mattar, MD, spokesperson for TOS and Professor of Surgery at Oregon Health and Science University. “This study is a step toward better understanding the underlying mechanisms affecting bariatric surgery outcomes, enabling us to continue to improve upon this form of treatment.”

Read more in the press release here.
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Integrated Health Keynote connects obesity to broader food system and policy issues
Rajiv Narayan
Though Kelly Brownell, PhD, wasn't originally taught to think in terms of the food system, he said during the ASMBS Integrated Health Keynote on Wednesday that it is without a doubt a lens necessary to conjuring major change. Brownell, Dean of the Sanford School of Public Policy at Duke University, began his lecture by connecting hunger and obesity, what many know as the “Double Burden,” but the thrust of his talk was reserved for the narrative invoking the food system, agricultural production, climate change, water depletion and defense policy.

Agricultural production accounts for 70 to 90 percent of global water, said Brownell, and this figure is itself hardly monolithic. For example, while 1 kg of corn requires 172 gallons of irrigated water, the same amount of beef requires 11,380 gallons. While water use is stabilizing in the United States, it has skyrocketed beyond those levels in China. Concern over water depletion stokes fears — and as Dr. Brownell suggests, present realities — of climate change, wars over water and mass hunger. Those working in obesity may find natural allies among those who have a similar stake in issues such as environmental sustainability, defense policy and economic development.

The talk ended with a meditation on the question: Who’s watching the store? To Dr. Brownell, there’s no one organization among government entities, researchers or private foundations that keeps watch over each of the four areas he outlined as constituents of the food system: hunger and food insecurity, obesity, environmental impact of agriculture, and food safety and security. This motivated him to create the World Food Policy Center at Duke University, which will be utilized as a meeting point for stakeholders in the food system.

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Lessons learned from the Childhood Obesity Research Demonstration (CORD) projects
Rajiv Narayan
Three researchers shared their experiences from CDC-funded Childhood Obesity Research Demonstration (CORD) projects during a Symposium at ObesityWeek on Thursday. CORD sites are funded for four years to provide a systems approach to interventions delivered in primary and public health settings. Kirsten Davison, PhD, of the Harvard School of Public Health presented school-site findings from Massachusetts CORD; Deanna M. Hoelscher, PhD, RD, Director of the Michael & Susan Dell Center for Healthy Living, showed results from Texas CORD; and Leticia Ibarra, PhD, from Clínicas de Salud Del Pueblo presented on California CORD.

With modest findings across sites, each presentation lent itself to reflections on intervention design and best practices for implementation. In particular, TX-CORD demonstrated the challenge of combining multisector interventions in a large urban setting; Dr. Hoelscher observed that a coordinator or convener could be instrumental in such a complex environment. She and Dr. Ibarra both shared insights about the role of Community Health Workers (CHW). In TX-CORD, CHWs were key to developing relationships with the intervention families and were instrumental in bridging the cultural competency gap. CHW-led intervention sessions differed from clinic-led sessions in CA-CORD, which potentially calls for separating their effects in future studies.

Last, both the Texas and California talks presented data on intervention dosage that indicate a direct relationship between dosage intensity and intervention efficacy. As CORD builds on the evolving field of complex, systems-level interventions, it is clear that promising results will lead to further investigation.

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Don't miss today's Ethan Sims Award session
TOS
Each year at The Obesity Society Annual Meeting at ObesityWeek, five finalists are selected to compete for the Ethan Sims Award, created to recognize excellence in research by young investigators based on their science submitted to and presented at the meeting. Each finalist receives a $1,000 travel award and competes for an additional $1,000 cash prize.

Congratulations to the 2016 finalists who will present their research today at 1:30pm in EMCC Room 215-216:
  • BMI-Related Alterations in Intrinsic Brain Activity and Connectivity in Reward and Interoceptive Regions – Sex Commonalities and Differences, Arpana Gupta, PhD
  • Six Months of Omega-3 Fatty Acid Supplements Does not Improve Adipose Tissue Functions, Kazanna C. Hames, PhD
  • Extended Calorie Restriction Suppresses Overall and Specific Food Cravings: A Systematic Review and Meta-Analysis, Chanaka N. Kahathuduwa, MD
  • Maternal Low-Dose Aspartame Consumption During Gestation and Lactation May Compromise Metabolic Profile, Body Composition and Alter Central Pathways in Offspring, Jodi E. Nettleton
  • TAp63 in POMC Neurons Regulates Energy and Glucose Homeostasis by Regulating POMC Neuron Activity, Chunmei Wang
This session will also honor the winners of the 2016 Thomas A. Wadden Award for Distinguished Mentorship, Harvey Grill, PhD, and the 2016 Lilly Scientific Achievement Award, Marian Tanofsky-Kraff, PhD.

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Live Surgery Session, today at 7:30 a.m.
ASMBS
Experience live surgery from around the world. This session will feature 12 cases via live telecast and then will be followed by discussion by moderators. For more information, visit obesityweek.com/session/live-surgery-session/.
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Last chance to check out the Early Career Poster Education Theater at ObesityWeek
TOS
Come watch and vote on early career presenters competing in a live oral poster pitch competition in the Exhibit Hall today at 12:15-12:45pm. Top-ranked abstracts being presented in the traditional poster area will also be presented on stage using a four-minute, three-slide, oral format, and prizes will be awarded to the presentations receiving the most votes.

Vote for the winner each day at WWW.POLLEV.COM/OBESITYSOCIETY

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TOS vs. ASMBS debate, today at 11:00 am
TOS and ASMBS
Mark your calendar for an inaugural keynote debate on surgery and weight regain/loss, created to engage the full spectrum of ObesityWeek attendees: basic scientists, neuroscientists, clinicians, surgeons, population researchers and policy makers.

This session will include a panel of leading scientists and clinicians from ASMBS and TOS who will discuss a controversial case study with audience participation. The case will also discuss complex issues related to insurance coverage of several different treatment modalities.

Don't miss this exciting keynote discussion in EMCC Great Hall A-D open to all ObesityWeek attendees, as well as these other spirited discussions and debates:

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Introducing: Obesity App for the iPhone® and iPad®
TOS
The Obesity Society is proud to introduce the new Obesity app, which launched during ObesityWeek and gives readers a new way to keep up with the most important developments in the field.

Enjoy an entirely new, optimized browsing and reading experience featuring:
  • Readable, print-like articles enhanced with dynamic figures, tables and references
  • Rapid access to breaking research — Early View articles updated as they publish
  • Adjustable text and table sizing with “pinch and zoom”
  • Ability to download issues to read offline
  • Email and social media sharing tools
  • Convenient alerts when new issues are available
Download Obesity’s iPad® and iPhone® App from the Apple App Store today.
Apple and iPad are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc.

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Bench to Bedside and Beyond early career travel grant winners announced
TOS
Addressing obesity requires an integrated, multipronged approach from all areas — including clinical, public health, policy and research. With that in mind, The Obesity Society Secretary-Treasurer Martin Binks, PhD, FTOS, created a new path to fund travel for early career members to The Obesity Society Annual Meeting at ObesityWeek with the creation of the Bench to Bedside & Beyond travel grants in 2014. These two annual travel grants in the amount of $1,000 each recognize and provide opportunities for any TOS early career member in attendance at ObesityWeek. Recipients are chosen on-site based on a simple lottery.

This year's winners are:
  • Sara Kovacs, student at University of Pittsburgh
  • Carrie Nelson, student at North Dakota State University

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Journal Symposium winners exemplify diversity of research at ObesityWeek
Andy Pool
It was standing room only at Wednesday’s Obesity Journal Symposium, where five investigators presented their exciting new studies chosen as winners of the annual competition sponsored by The Obesity Society’s official journal. This year’s top papers addressed the full complexity of obesity, from a basic science level to the population level.

Ken Fujioka, MD, kicked off the Symposium by examining the early response criterion for predicting clinically meaningful weight loss with liraglutide 3.0 at 56 weeks of treatment and comparing efficacy outcomes for early responders and nonresponders. His research team determined that a ≥4% weight loss at week 16 was the best predictor for clinically meaningful weight loss at 56 weeks. Further, they identified that early responders experienced greater mean weight losses and improved cardiometabolic outcomes and health-related quality of life compared to early nonresponders.

Next Kevin Hall, PhD, presented research showing that appetite increases by 100 calories per day for each kilogram of lost weight. Diets high in monounsaturated fatty acids may benefit adults at risk for the metabolic syndrome, according to a feeding study by Xiaoran Liu, PhD. In a randomized controlled trial, Patrick O’Neil, PhD, determined that a Weight Watchers program improves outcomes for adults with type 2 diabetes. Finally, Dr. Paul von Hippel, PhD, presented his noteworthy research on the summertime increase in obesity prevalence among children. With talks from a range of disciplines, this symposium truly exemplified the research diversity present at ObesityWeek 2016.

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Symposium confronts weight biases in health care
Rajiv Narayan
At The Obesity Society Symposium on Reducing Weight Bias in Healthcare on Wednesday, Nanette Adams, MEd, LPC, set the tone for the session by reflecting on the complicated nature of her frequent contact with the healthcare system: "I know how it feels to be in providers’ offices and have every visit end in tears.” Because providers bring a unique and privileged perspective to their patients, the New Orleans native said it is imperative to interrogate where their biases are. Some tips that may help include: using people-first language, immersing oneself in the literature and trusting your instincts and the patient. Nanette put the spotlight on the Obesity Action Coalition, sharing a stirring video of patient perspectives.

Kimberly Gudzune, MD, MPH, expanded on this introduction, offering evidence that speaks to providers' and patients’ experiences. While 50 percent of primary care providers view patients with obesity as awkward, unattractive or ugly, 55 percent of patients with obesity report canceling an appointment due to anxieties about being weighed in the clinic. Better research into bias reduction interventions is needed, but Dr. Gudzune pointed to some promising practices, such as perspective-taking classes and meditation, increased awareness of implicit and explicit bias, education on the causes of obesity and emphasizing improved health and well-being over body weight.

Trina M. Histon, PhD, FTOS, of Kaiser Permanente offered a final perspective on the role of health plan leadership in reducing weight bias. Kaiser has been facilitating the uptake of more sensitive clinic designs with practices, chairs, beds, scales and discreet layouts that respect the dignity of larger body sizes. Beyond physical spaces, Kaiser has invested in messaging campaigns, visual media and research that attempt to move the needle on weight bias.

Concluding the panel’s talks, Nanette returned to the podium with a vigorous call for ObesityWeek attendees to check out National Obesity Care Week and its Take 5 Challenge.

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OBESITY IN THE NEWS


Health plans often stand in the way of obesity care
PR Newswire
New research in two separate studies presented at ObesityWeek demonstrates that health plans often stand in the way of obesity care. In one study, researchers from Harvard, ConscienHealth, and the Obesity Action Coalition found that Americans report they don't have health insurance that will pay for obesity care recommended in evidence-based guidelines, including dietary counseling, medical obesity treatment and bariatric surgery. Even for people with employers targeting obesity in their wellness programs, people do not believe that their health insurance will even cover dietary counseling by a registered dietitian. Reported coverage for medical obesity treatment, obesity medicines, and bariatric surgery is even lower. Theodore Kyle, RPh, MBA, Immediate-Past OAC Chairman, presented the results.
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Weight loss in untreated spouses tied to interventions in partners
Healio
The effects of weight loss in adults randomly assigned to Weight Watchers or self-guided weight loss may have an impact on untreated spouses' weight loss. "We actually know quite a bit of about different relationships and how weight might function within certain relationships," Amy Gorin, PhD, associate professor at the University of Connecticut, said during her presentation.
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Study reveals long-term survival benefits of gastric bypass surgery in patients with severe obesity
American Society for Metabolic and Bariatric Surgery via The Medical News
Patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48 percent up to 10 years after surgery, compared to similar patients who do not undergo the procedure, according to new research presented today at ObesityWeek 2016, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery and The Obesity Society.
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Weight shaming falls as medical view of obesity grows
ConscienHealth
New research to be presented at ObesityWeek 2016 indicates that weight shaming may be easing a bit. At the same time, the public increasingly understands that obesity is a medical condition. Between 2013 and 2016, public perception of obesity as a "personal problem of bad choices" has dropped from 44 to 34 percent. On top of that, public agreement that people with obesity need medical help increased significantly over the last year.
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Obesity, bias and stigma in the doctor's office: Take 5 for better care
The Huffington Post
William Dietz writes: "My friend and colleague, Patty Nece, has described an experience that’s exemplary of how people with obesity often do not get appropriate care from doctors, nurses or other providers. An orthopedist, without ever conducting an exam, quickly decided that Patty’s hip discomfort was 'obesity pain,' that she needed to lose weight, and suggested she consider weight-loss surgery. In fact, Patty had recently lost 70 pounds and later discovered that her hip pain was due to progressive scoliosis, which is not obesity-related. Patty’s experience shows how weight bias persists even in the doctor’s office, a place we’d expect everyone to receive comprehensive care."
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New quality improvement program reduces hospital readmission rates for weight-loss surgery patients
American Society for Metabolic and Bariatric Surgery via The Medical News
While the average hospital saw 30-day readmission rates for weight-loss surgery patients drop by about 14 percent, some hospitals had reductions as much as 32 percent after implementing a new quality improvement program, according to new research presented today at ObesityWeek 2016, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery and The Obesity Society.
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Researchers: Having trouble losing weight? Obesity is due to genetics – Not lack of willpower
People
Most Americans think lack of willpower is to blame for obesity, according to a new survey conducted by the American Society for Metabolic and Bariatric Surgery and NORC at the University of Chicago. “A lack of individual willpower is cited as the biggest barrier to weight loss, and a majority of people with obesity attempt to lose weight without the help of medical professionals,” reads the survey.
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Avoid judgement when making prediction of patient's weight loss outcomes
Healio
Because clinicians are poor predictors of weight-loss outcomes after gastric banding, it is imperative that physicians take a nonjudgmental approach when interacting with their patients preoperatively and postoperatively, according to a presenter here. “‘I knew he wouldn’t do well at all.’ ‘They just aren’t complying’ are not valid observations for predicting,” John Dixon, MBBS, MD, PhD, Baker IDI Heart and Diabetes Institute, said.
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Genes play a major role in weight gain
Healio
In this video exclusive, ObesityWeek keynote speaker Sadaf Farooqi, PhD, FRCP, professor in the department of clinical biochemistry at University of Cambridge, describes how researchers are using genetics to understand weight regulation. Although all weight gain is the result of calories consumed and calories expended, some people gain weight more easily than others.
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Responsive parenting reduces high energy-density food intake in infants
Healio
In infants with a negative temperament, a responsive parenting intervention may help reduce the intake of high energy-density foods, especially sweets and fried foods, according to a presenter. "Negative temperament has previously been recognized as a risk factor for childhood obesity," Emily E. Hohman, PhD, of the department of human biology, nutritional biochemistry, nutrition and dietetics at Pennsylvania State University said during her presentation.
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