Overweight children have higher risk of asthma

Children who are overweight or obese are more likely to develop asthma compared with children of a healthy weight, according to a study published in the American Journal of Epidemiology.

Researchers from Kaiser Permanente in California examined electronic health records of 623,358 children between the ages of 6 and 19.

 The children were divided into four groups based on their measured height and weight.:

- Normal weight
- Overweight
- Moderately obese
- Extremely obese

All children were monitored over the course of 1 year in order to analyze the prevalence of asthma.

The results of the study revealed that children who were overweight were 1.16 times more likely to develop asthma compared with children who were of a normal weight.

Moderately obese children were 1.23 times more likely to develop the condition, while extremely obese children were 1.37 times more at risk.

Of the children who developed asthma, it was found that moderately obese and extremely obese children were more likely to develop regular and aggressive forms of asthma compared with children of normal weight, resulting in hospital visits and treatment with oral corticosteroids - medication used to reduce inflammation and swelling in the airways.

Asthma risk dependent on age, race and sex

The research also revealed that the effects of body weight and asthma varied depending on race/ethnicity, age and sex.

Moderately obese girls between the ages of 6 and 10 had a 1.36 times higher risk of asthma than girls of normal weight the same age, while extremely obese girls had a 1.56 times higher risk.

Moderately obese Asian-Pacific Islander children had a 1.41 times higher risk of developing the condition, while extremely obese children of this race were at 1.67 times higher risk.

'Close monitoring' needed for asthmatic obese children

Mary Helen Black, lead study author, says:

"As a result of this research, we know that children who are overweight or obese - particularly young girls and Asian-Pacific Islander children - are more likely to develop asthma. With this knowledge, we can work to develop programs to prevent asthma in high-risk groups. Physicians might also monitor obese children with asthma more closely, since these children tend to have a more severe type of asthma."

According to the Centers for Disease Control and Prevention (CDC), there are currently 7.1 million children in the US suffering from asthma.

It is the most common chronic condition amongst children, and accounts for more than 13 million total missed days at school each year.

The researchers say that although other studies have acknowledged a link between childhood obesity and asthma, there have not been many large-scale studies in the US confirming this.

Therefore, the researchers at Kaiser Permanente plan to continue their ongoing work to better understand how body weight and body mass index in childhood can increase asthma risk.

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Clear evidence that long-term obesity can lead to heart disease

Researchers have tracked thousands of people in the three decades since the mid-1980s to see what effect getting obese might have on their heart risks. They say this is one of the few studies that can give proof of the consequences of long-term obesity.

Follow-up of the 3,275 adults - who were not obese at the start of the research in 1985-1986 - found that those who became obese were more likely to have coronary artery calcification (hardening of the arteries supplying the heart), a problem that can lead to a heart attack.

Of the people who became obese, the earlier they did - and the longer they stayed overweight - the more likely they were to be at risk of coronary artery disease. This risk was decided by computed tomography (CT), a form of X-ray scan that was used to pick up artery calcification.

The research participants were aged between 18 and 30 years at the beginning of the study, which has just been published in the Journal of the American Medical Association. They were almost equal in numbers of men and women, and in proportion of white and black people.

Study examined both "overall" and "abdominal" obesity

Two measures of obesity were made at specific points during the long-term study. Overall obesity was worked out by measuring body-mass index (BMI), and abdominal obesity was measured by waist circumference. These checks were done at 2, 5, 7, 10, 15, 20, and 25 years after baseline.

Being obese was defined as:
- Having overall obesity with a BMI of at least 30
- Having abdominal obesity with a waist circumference of more than 40.2 inches (102cm) in men, 34.6 inches (88cm) in women.

During follow-up, 40% and 41% of the subjects developed overall and abdominal obesity, respectively. The average duration of each type of obesity was 13 years and 12 years, respectively. The CT scans to check for hardening of the coronary artery were done at 15 years (in 2000-2001), 20 years (2005-2006), and 25 years (2010-2011).

There was an almost double chance of finding hardened coronary arteries in the people who were obese for 20 years or more, compared with the people who had never become obese.

The researchers - Jared Reis of the National Heart, Lung, and Blood Institute, Bethesda, MD, and colleagues - give percentage values for these results: "Approximately 38.2% and 39.3% of participants with more than 20 years of overall and abdominal obesity, respectively, had coronary artery calcification, compared with 24.9% and 24.7% of those who never developed overall or abdominal obesity."

Not only was the presence of artery hardening more likely in the obese people, but the longer people were too big, the greater the extent to which calcification got worse (disease "progression").

The authors conclude:

"These findings suggest that the longer duration of exposure to excess adiposity as a result of the obesity epidemic, and an earlier age at onset, will have important implications on the future burden of coronary atherosclerosis and potentially on the rates of clinical cardiovascular disease in the United States."

The study has been given the name CARDIA - Coronary Artery Risk Development in Young Adults. It is a large, multi-center, community-based study published in a world-renowned medical journal.

The design of the study, which set out to track future changes over time, means that the association between obesity and heart disease risk is a reliable one. This is because it was a "prospective" study as opposed to a "retrospective" one in which links are drawn from past data.

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Harvard Scientists Urge You to Stop Drinking Milk

Vegans may have had it right all along; while raw, organic milk offers numerous health benefits, a Harvard

researcher and pediatrician argues that conventional milk and dairy products alike are a detriment to your health – thanks to added health-compromising sweeteners.

As David Ludwig mentioned in his research, which was published in the Journal of the American Medical Association Pediatrics, there have been countless pieces of research concluding the ill effects of sugar-sweetened beverages. The over-consumption of sugar has been tied to obesity, diabetes, inflammatory-related pain, and much more. And because of sugar’s negative effects on our health, even the United States Department of Agriculture, the American Academy of Pediatrics, and other organizations are recommending against consuming calories from sugary drinks.

The one calorie-containing beverage they still heavily promote, however, is reduced-fat milk, where the organization recommends drinking 3 cups daily. This is where Ludwig questions the scientific rationale for such recommendations.

“This recommendation to drink three cups a day of milk – it’s perhaps the most prevailing advice given to the American public about diet in the last half century. As a result, Americans are consuming billions of gallons of milk a year, presumably under the assumption that their bones would crumble without them,” says David Ludwig.

As far as Ludwig is concerned, if the USDA is recommending to drink reduced-fat milk, it is also inadvertently encouraging the consumption of added sugars – a piece of advice that goes against all the research saying not to consume sugar and sugar-sweetened beverages. The idea of consuming low-fat milk or chocolate milk cancels out the whole reasoning for the recommendation in the first place since the fats are simply being replaced with dangerous sugars.

“The worst possible situation is reduced-fat chocolate milk: you take out the fat, it’s less tasty. So to get kids to drink 3 cups a day, you get this sugar-sweetened beverage,” Ludwig says. ”…we can get plenty of calcium from a whole range of foods. On a gram for gram basis, cooked kale has more calcium than milk. Sardines, nuts seeds beans, green leafy vegetables are all sources of calcium.”

The Case Against Low-Fat Dairy, and Other Dangers of Milk

Harvard researcher David Ludwig certainly has a point in analyzing and ultimately criticizing the USDA’s recommendations, but there is much more to the full-fat vs reduced-fat argument for milk and dairy products.

There are plenty of reasons to avoid certain fats such as trans-fats and refined polyunsaturated fats in vegetable oils (like corn, soy, sunflower, and canola), but the evidence for moderate consumption of saturated fat, which is found in milk, coconut oil, and grass-fed land animals, is coming to the surface. While saturated fat was villainized for decades, a 2010 analysis published in the American Journal of Clinical Nutrition concluded that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of [coronary heart disease or cardiovascular disease].”

Further, there are numerous benefits to drinking full-fat dairy products. In it’s most pure state (raw, organic, and coming from grass-fed cows), full-fat dairy has been found in research to potentially promote heart health, control diabetes, aid in vitamin absorption, lower bowel cancer risk, and even aid in weight loss. But while pure dairy could promote your health, conventional dairy may prove damaging.

Before you consume more conventional dairy, please educate yourself as to what’s in your dairy. You’d be surprised that there could be 20+ painkillers, antibiotics, and much more lurking in your milk.

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Expertos piden que la obesidad se declare enfermedad

La Sociedad Española para el Estudio de la Obesidad (SEEDO) defiende la necesidad de declarar la obesidad una enfermedad, siguiendo la decisión aprobada recientemente en EE.UU, y teniendo en cuenta que, según datos del Estudio de Nutrición y Riesgo Cardiovascular en España, ENRICA (2009-2011), se trata de un problema que padece el 62% de la población española.

"Reconocer la obesidad como una enfermedad ayudará a modificar la praxis clínica, a incrementar el nivel de compromiso de los médicos con esta afección y a potenciar la inversión económica y científica para mejorar su prevención y tratamiento", afirma el presidente de la SEEDO, el doctor Felipe F. Casanueva.

Desde la SEEDO el objetivo es incluir la obesidad en las enfermedades crónicas, y establecerlas como prioridad dentro de los presupuestos públicos del Sistema Nacional de Salud, ya que "tan sólo así se logrará que las personas que padecen exceso de peso puedan acceder a un tratamiento, evitando otras enfermedades relacionadas con la obesidad.

"La atención de una persona con obesidad llega a ser hasta tres veces más costosa que la de otra con peso correcto . Si a eso le sumamos el alto porcentaje de población de la tercera edad con sobrepeso y el crecimiento de obesidad infantil tenemos cifras alarmantes que ponen en riesgo la sostenibilidad de la sanidad de nuestro país porque no hay sistema que pueda soportar mucho tiempo esta situación", explica el presidente de la SEEDO.

Para ello destaca el papel de Atención Primaria como una de las "armas más efectivas" para combatir la obesidad desde la prevención. Casanueva recomienda "lograr un alto nivel de empatía con el paciente", para ello es indispensable que el médico sea percibido como un aliado para que sus recomendaciones surtan efecto.

"Cuando un paciente no se siente comprendido o apoyado por su médico, no acostumbra a seguir sus consejos ni de hábitos de vida saludables ni de pérdida de peso", añade.

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Artificals sweeteners may harm your health even no-calorie ones

A new research in Trends in Endocrinology & Metabolism along with previous studies indicate that everyone should say goodbye to these no-calorie sweeteners for several important reasons you may not even realize.

What’s not so sweet about artificial sweeteners

If you believe no-calorie artificial sweeteners are safe and healthy, that they can help you lose weight or prevent you from gaining weight, and that they are good to use if you have diabetes, you would not be alone in these beliefs. However, a new study, as well as previous investigations, suggests quite the opposite.

Two thirds of Americans are either overweight or obese, so providing more products with artificial sweeteners should be a good thing, right? One area where consumption of diet products has risen steadily is diet drinks, with a recent report from the Centers for Disease Control and Prevention noting that diet beverage intake increased from 18 percent in 2000 to 21 percent in 2010 among women and from 14 percent to 19 percent among men during the same period.

However, drinking just one artificially sweetened beverage per day may increase your risk for a variety of health problems, including type 2 diabetes, obesity, metabolic syndrome, and cardiovascular disease. If you thought sugar-based drinks were associated with these same risks, you are right.

In fact, according to Susan E. Swithers of Purdue University, the author of a new study, the data to support claims that artificially sweetened drinks help with weight loss, weight gain prevention, and other benefits “are not very strong.” She also stated that “although it seems like common sense that diet sodas would not be as problematic as regular sodas, common sense is not always right.”

What might be considered common sense, however, is avoiding both artificially sweetened and sugar-sweetened beverages, since both types reportedly are associated with major health problems. The reason for this finding, according to the authors, seems to be that artificial sweeteners alter certain patterns in the brain’s pleasure regions, causing people who drink these beverages to not feel satisfied by the sweet taste.

In fact, when lab animals have been given artificial sweeteners, they have tended to highly desire more sweets. The result has been a tendency to overeat sugary, high-calorie foods and gain significant amounts of weight.

Thus the not-so-sweet news for anyone who has been consuming artificially sweetened beverages and foods is that “the intake of sugars needs to be expanded to limit intake of all sweeteners, not just sugars,” according to the study’s author. But there is more.

More health hazards from artificial sweeteners

Let’s look at some previous studies on artificial sweeteners and their potential hazards. Aspartame is a good place to begin, as there are reports that the chemical has a negative impact on brain function.

One new study from the Washington University School of Medicine looked at aspartame (e.g., Equal, NutraSweet) and its safety record. Investigators reported several concerns about aspartame:
Aspartame metabolizes into phenylalanine, aspartic acid, and methanol, and excess phenylalanine has an impact on serotonin and dopamine levels, which are hormones involved in the regulation of appetite, mood, and sleep.

One of aspartame’s metabolites, called diketopiperazine, has cancer-causing properties and plays a role in the development of tumors of the central nervous system. Thus use of foods and beverages that contain aspartame may pose a health hazard.

Other dangers of using artificial sweeteners relate to an increased risk of developing conditions associated with type 2 diabetes, including glucose resistance and insulin resistance. In particular, investigators at Washington University School of Medicine looked at Splenda (sucralose) and its impact on glucose and insulin resistance.

In the study, researchers evaluated the effect of artificial sweeteners among severely obese people who did not have diabetes and who did not use artificial sweeteners regularly. They found that use of an artificial sweetener “was related to an enhanced blood insulin and glucose response.”

A Danish study evaluated the impact of both sugar-based and artificially sweetened beverages on pregnant women. Overall the investigators discovered that high intake of both types of beverages is associated with an increased risk of preterm delivery.

A possible link between artificial sweeteners and cancer has long been debated, with scores of studies indicating an increased risk of various types of tumors in animal studies. Far fewer studies have examined the association in humans.

One example in the latter category is a study that was published in the December 2012 issue of the American Journal of Clinical Nutrition. The Boston-based researchers looked at the intake of artificially sweetened and sugar-based sodas and the risk of leukemia and lymphoma in adults.

The investigators reviewed data from the Nurses’ Health Study and Health Professionals Follow-Up Study, spanning 22 years of information. They found an increased risk of non-Hodgkin lymphomas and multiple myelomas among men (but not women) who consumed at least one diet soda daily when compared with men who did not drink diet soda.

The bottom line is that much controversy and debate surround the use of artificial sweeteners. Scores of studies in animals suggest their use can cause a variety of cancers, allergic reactions, and even neurological problems, yet authorities such as the Food and Drug Administration, the Environmental Protection Agency, and the European Food Safety Authority, among others, have continued to declare these synthetic products are safe for human consumption.

A number of health experts and consumer advocate groups, such as Dr. Andrew Weil and the Center for Science in the Public Interest, have pointed out the health dangers of artificial sweeteners. Weil, for example, explains in a Prevention article that these synthetic sweeteners have “never been shown to help anyone lose weight, and some of them are downright bad for you.”

Weil also warned that “aspartame, saccharin, and sucralose all have been shown to increase the risk of some health problems, including obesity, headaches, and some types of cancer.” Are these products you want to feed to your children and yourself?

Evidence against the safety of artificial sweeteners continues to build, despite resistance from food industry manufacturers and others with a financial interest in their remaining on the market. Perhaps it’s time for everyone who is concerned about their health to say goodbye to artificial sweeteners.

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El té verde: mucho más que antioxidantes

Además de ser un maravilloso antioxidante, esta infusión alivia problemas recurrentes de salud, de manera rápida y natural. Algunos de sus principales beneficios son:

Disminuye el riesgo de cáncer: las catequinas del té contienen sustancias anticancerígenas, gracias a los polifenoles. Según un estudio del Instituto Nacional del Cáncer de los Estados Unidos y también el Instituto del Cáncer de China, reveló que quienes bebían, al menos una taza de esta infusión a la semana, tuvieron el 57% menos de riesgo de padecer cáncer de esófago y en las mujeres, aumento a un 60%.

Quema grasas: al ser un agente de termogénesis, ayuda de manera natural a gastar más energías, conllevando un descenso de peso. Acelera el metabolismo mediante los polifenoles (sustancias antioxidantes), aceleran el metabolismo, ayudando a las enzimas digestivas a que trabajen mejor, logrando un efecto adelgazante. Y también, es diurético, es decir colabora el proceso de diuresis, depurando el organismo de toxinas acumuladas.

Reduce el estrés: ciertos compuestos de este té disminuyen la formación y la actividad de radicales libres, reduciendo el estrés. Asimismo, posee un aminoácido llamado L-teanina, cuyo efecto principal es la relajación, sin somnolencia y aumenta los niveles de hormona llamada dopamina que mejora el estado de ánimo.

Sin embargo, esas no son todas sus bondades, sino que sólo unas pocas. El té verde también reduce el riesgo de cáncer, previene enfermedades cardiovasculares, combate el envejecimiento, previene las arrugas, reduce el riesgo de artritis, fortalece los huesos, ayuda a bajar el colesterol, previene la obesidad, es bueno para la diabetes, fortalece la memoria, protege contra el mal de Parkinson, es hepatoprotector, previene la hipertensión, protege de intoxicaciones alimentarias, reduce los niveles de glucosa en la sangre, estimula la inmunidad, evita gripes y resfriados, alivia el asma, combate infecciones en los oídos, contribuye en el tratamiento contra el herpes, previene caries, reduce el estrés y alivia las alergias.

¿Cómo consumirlo?

Según la Escuela de Medicina de Harvard, se debe tomar una taza de té tres veces al día. La hierba debe permanecer en agua caliente de tres a cinco minutos y es mejor si se consume recién macerado.

El mejor momento para beberlo es entre comidas, ya que puede impedir la absorción de hierro de las frutas y vegetales. Y si prefieres tomarlo en el desayuno o durante la comida, el problema se soluciona añadiéndole limón o leche.

Por último, los médicos recomienda beberlo al menos, dos horas antes de dormir, para prevenir el insomnio.

Fuente

Obesity-induced gut microbial metabolite promotes liver cancer through senescence secretome

Obesity has become more prevalent in most developed countries over the past few decades, and is increasingly recognized as a major risk factor for several common types of cancer. As the worldwide obesity epidemic has shown no signs of abating, better understanding of the mechanisms underlying obesity-associated cancer is urgently needed. Although several events were proposed to be involved in obesity-associated cancer, the exact molecular mechanisms that integrate these events have remained largely unclear. Here we show that senescence-associated secretory phenotype (SASP) has crucial roles in promoting obesity-associated hepatocellular carcinoma (HCC) development in mice. Dietary or genetic obesity induces alterations of gut microbiota, thereby increasing the levels of deoxycholic acid (DCA), a gut bacterial metabolite known to cause DNA damage. The enterohepatic circulation of DCA provokes SASP phenotype in hepatic stellate cells (HSCs), which in turn secretes various inflammatory and tumour-promoting factors in the liver, thus facilitating HCC development in mice after exposure to chemical carcinogen. Notably, blocking DCA production or reducing gut bacteria efficiently prevents HCC development in obese mice. Similar results were also observed in mice lacking an SASP inducer or depleted of senescent HSCs, indicating that the DCA–SASP axis in HSCs has key roles in obesity-associated HCC development. Moreover, signs of SASP were also observed in the HSCs in the area of HCC arising in patients with non-alcoholic steatohepatitis, indicating that a similar pathway may contribute to at least certain aspects of obesity-associated HCC development in humans as well. These findings provide valuable new insights into the development of obesity-associated cancer and open up new possibilities for its control.

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What about Overweight and Obesity in United States?

According to the first CLINICAL GUIDELINE ON THE IDENTIFICATION, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY IN ADULTS based on evidence from approximately 394 randomized controlled trials (RCTs) found in MEDLINE from January 1980 to September 1997:

Highlights

1. According to the latest statistics from the third National Health and Nutrition Examination Survey, 97 million Americans are overweight or obese.
2. Excess weight is often accompanied by hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers.
3. The total costs attributable to obesity-related disease approach $100 billion annually in the United States.
4. Overweight is here defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity as a BMI
   of 30 kg/m2.
5. A variety of effective options exist for the management of overweight and obese patients, including
   dietary therapy approaches such as low-calorie diets and lower-fat diets; altering physical activity patterns; behavior therapy techniques; pharmacotherapy*; surgery; and combinations of these technique.
6. *As of September 1997, the Food and Drug Administration (FDA) requested the voluntary withdrawal from the market of dexfenfluramine and fenfluramine due to a reported association between valvular heart disease and the use of dexfenfluramine or fenfluramine alone or combined with phentermine. The use of these drugs for weight reduction, therefore, is not recommended in this report. Sibutramine is approved by FDA for long-term use. It has limited but definite effects on
   weight loss and can facilitate weight loss maintenance.
7. Weight loss drugs that have been approved by the FDA for long-term use can be useful adjuncts to dietary therapy and physical activity for some patients with a BMI of 30 with no concomitant risk factors or diseases, and for patients with a BMI of 27 with concomitant risk factors or diseases. 
8. Weight loss surgery is one option for weight reduction in a limited number of patients with clinically severe obesity, i.e., BMIs 40 or 35 with comorbid conditions. Weight loss surgery should be
   reserved for patients in whom efforts at medical therapy have failed and who are suffering from the complications of extreme obesity.
9. Randomized trials suggest that weight loss at the rate of 1 to 2 lb/week (calorie deficit of 500 to
   1,000 kcal/day) commonly occurs for up to 6 months.
10. A review of 44 pharmacotherapy RCT articles provides strong evidence that pharmacological therapy (which has generally been studied along with lifestyle modification, including diet and physical activity) using dexfenfluramine, sibutramine, orlistat, or phentermine/fenfluramine results in weight loss in obese adults when used for 6 months to 1 year. Strong evidence also indicates that appropriate weight loss drugs can augment diet, physical activity, and behavior therapy in weight loss. Adverse side effects from the use of weight loss drugs have been observed in patients. As a result of the observed association of valvular heart disease in patients taking fenfluramine and dexfenfluramine alone or in combination, these drugs have been withdrawn from the market. Weight loss drugs approved by the FDA for long-term use may be useful as an adjunct to diet and physical activity for patients with a BMI of 30 with no concomitant obesity-related risk factors or diseases, as well as for patients with a BMI of 27 with concomitant risk factors or diseases; moreover, using weight loss drugs singly (not in combination) and starting with the lowest effective doses can decrease the likelihood of adverse effects.
11. Women in the United States with low incomes or low education are more likely to be obese than those of higher socioeconomic status.
12. In the majority of epidemiologic studies, mortality begins to increase with BMIs above 25 kg/m2.
13. The environment is a major determinant of overweight and obesity. Environmental influences on overweight and obesity are primarily related to food intake and physical activity behaviors. In countries like the United States, there is an overall abundance of palatable, calorie-dense food. In addition, aggressive and sophisticated food marketing in the mass media, supermarkets, and restaurants, and the large portions of food served outside the home, promote high calorie consumption.
14. Since 1995, the use of the prescription drugs fenfluramine or dexfenfluramine for weight loss had increased greatly to 14 million prescriptions in 1'5 years. The increased interest in drug treatment of obesity derives from the poor long-term results often obtained with behavior therapy, including diet and physical activity, as noted earlier in this report. The rationale for the addition of drugs to these regimens is that a more successful weight loss and maintenance may ensue. However, as of September 1997, the FDA requested the voluntary withdrawal of fenfluramine and dexfenfluramine from the market, due to a reported association between valvular heart disease with the drugs dexfenfluramine and fenfluramine, alone or combined with phentermine. In November 1997, the FDA provided clearance for marketing the drug sibutramine hydrochloride monohydrate for the management of obesity, including weight loss and maintenance of weight loss when used in conjunction with a reduced-calorie diet.

AMA declares obesity a disease in USA

The American Medical Association (AMA) voted Tuesday to declare obesity a disease, a move that effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.

In the end, members of the AMA's House of Delegates rejected cautionary advice from their own experts and extended the new status to a condition that affects more than one-third of adults and 17% of children in the United States.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans," said Dr. Patrice Harris, an AMA board member.

Tuesday's vote is certain to step up pressure on health insurance companies to reimburse physicians for the time-consuming task of discussing obesity's health risks with patients whose body mass index exceeds 30. It should also encourage doctors to direct these patients to weight-loss programs and to monitor their often-fitful progress.

The AMA's decision essentially makes diagnosis and treatment of obesity a physician's professional obligation. As such, it should encourage primary care physicians to get over their discomfort about raising weight concerns with obese patients. Studies have found that more than half of obese patients have never been told by a medical professional they need to lose weight — a result not only of some doctors' reluctance to offend but of their unwillingness to open a lengthy consultation for which they might not be reimbursed.

"As things stand now, primary care physicians tend to look at obesity as a behavior problem," said Dr. Rexford Ahima of University of Pennsylvania's Institute for Diabetes, Obesity and Metabolism. "This will force primary care physicians to address it, even if we don't have a cure for it."

The new designation follows a steep 30-year climb in Americans' weight — and growing public concern over the resulting tidal wave of expensive health problems. Treatment of such obesity-related illnesses as cardiovascular disease, Type 2 diabetes and certain cancers drives up the nation's medical bill by more than $150 billion a year, according to the Centers for Disease Control and Prevention.

Projected increases in the obesity rate could boost that figure by an additional $550 billion over the next 20 years, a recent Duke University study concluded.

In laying out the case for and against the redefinition of obesity, the AMA's Council on Science and Public Health argued that more widespread recognition of obesity as a disease "could result in greater investments by government and the private sector to develop and reimburse obesity treatments."

The Food and Drug Administration, which has approved just two new prescription weight-loss medications since 1999, would probably face increased pressure to approve new obesity drugs, spurring new drug development and more widespread prescribing by physicians, the council noted.

"The greater urgency a disease label confers" also might boost support for obesity-prevention programs such as physical education initiatives and reforms to school lunch, the council added. In addition, it speculated that "employers may be required to cover obesity treatments for their employees and may be less able to discriminate on the basis of body weight."

But the council also said that making obesity a disease could deepen the stigma attached to being overweight and doom some patients to endless nagging — even if they were otherwise healthy or had lost enough weight to improve their health.

It might also shift the nation's focus too much toward expensive drug and surgical treatments and away from measures to encourage healthy diets and regular exercise, the council wrote in a background memo for AMA members.

Dr. Daniel H. Bessesen, an endocrinologist and obesity expert at the University of Colorado Anschutz Medical Campus, called the AMA's shift "a double-edged sword." Though the semantic change may reflect "a growing awareness that obesity is not someone's fault," he worried that "the term disease is stigmatizing, and people who are obese don't need more stigmatizing."

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