In my day to day endocrinology practice one of the first complaints I hear from people, no matter what the medical problem, is about weight. Almost always, it is either because they are gaining or unable to lose it. When I began my medical practice 40 years ago, this was also the case. What is it about weight that prevents more progress from being made? Could it be because in nature having adequate amounts of stored fat on the body eg belly fat, is essential for survival in the same way having gasoline in the fuel tank of a car is needed to keep it going? Not to mention the role of fat as an insulator against the cold. Imagine trying to live through a winter without clothes, the way primitive humans did? Being covered in fat was literally a lifesaver. The more we know about the role of fat (adipose) in our lives the better we are equipped to live with (and without) it.
It’s tempting to think that all fat is built the same, but this is not true.
There are actually three types of fat; white, brown, and beige fat, and they are distributed in different parts of the body in different proportions, as either visceral fat (inside the body and organs) or subcutaneous fat (under the skin).
White fat is the fat most people are familiar with – over 73.2% of all Americans carry too much and are classed as either overweight or obese (CDC, 2017 to 2018). While some white fat is absolutely essential for a healthy metabolism, every body has its limits.
Brown fat is found mainly in babies and plays a key role in providing energy and keeping us warm. Adults retain a small percentage of brown fat around their necks and shoulders.
Beige, or brite fat, is similar to brown fat and is optimized for burning fat rather than storing it, unlike white fat.
As we can see, white fat is the ‘bad stuff,’ and is the type of fat that many of us worry about.
Visceral and Subcutaneous Fat
Fat is distributed as either visceral or subcutaneous fat, and there is a big difference between the two.
Subcutaneous fat is stored under the skin in the limbs and extremities; arms, belly, thighs, and buttocks. When you pinch your arm or leg, you’re likely feeling a layer of subcutaneous fat distributed under the skin. Made up of mostly white fat, some subcutaneous fat is essential for hormonal function, as well as keeping warm.
While people with different body compositions will likely carry different percentages of subcutaneous fat, everyone has their limits. Subcutaneous fat is not totally harmless, but it poses fewer risks than visceral fat.
Visceral fat is stored primarily around and inside the abdomen. Yes – fat is more than skin deep and is stored inside of us as well as under our skin.
The increased health risk of visceral fat is linked to its proximity to the vital organs.
The closer fat is to the stomach and abdomen, the greater the chance is that it penetrates under the skin, wrapping itself around the liver, heart, kidneys, pancreas, and other organs. A study conducted by the University of Chicago and published in 2016 also found that visceral fat behaves differently from subcutaneous fat and resists fat burning (lipolysis). This also explains why abdominal fat is seen as ‘stubborn fat’ that is hard to lose.
Around 59% of all US adults were abdominally obese in 2015 to 2016, representing a massive increase from around 47% in 1999 to 2000 (CDC, 2016).
Visceral fat poses a much greater risk than subcutaneous fat in developing in the following conditions:
Type 2 diabetes
High blood pressure
Certain types of cancer, such as stomach cancer, bowel cancer, pancreatic cancer and liver cancer
How to Measure Visceral Fat
Traditionally, BMI (body mass index) has been the go-to yardstick for measuring body fat. Today, many health authorities encourage the use of both BMI and abdominal fat measurements. The measurement of waist circumference is a popular method to assess abdominal fat. It’s possible to have a healthy BMI and high waist measurement, and vice-versa.
To briefly summarize, aging reduces our percentage of lean muscle mass, which lowers our metabolic rate. Additionally, whilst it’s perhaps natural to indulge a little more as we get older, it’s easy to eat more and exercise less. That gives your body every excuse to pile on that abdominal fat!
Multiple studies, including this one published in the Journal of Menopausal Medicine, have also found that estrogen replacement therapy (ERT) can mitigate some of this weight gain. However, estrogen replacement is not without its risks and is unsuitable for many.
Namely, ERT can increase the risk of blood clots leading to strokes and embolisms and cause headaches, swelling, or edema. ERT is also often linked to an increased risk of breast and ovarian cancer. It is worth mentioning however, studies reviewed by Breastcancer.org show that the risk is only significant after using ERT 10 years or more (in the case of estrogen-only therapy). Combination HRT which includes both estrogen and progesterone poses a much greater risk.
As such, ERT is certainly not a ‘silver bullet’ for treating menopause-related abdominal weight gain.
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It’s tempting to think that our bodies simply ‘slow down’ as we age, which makes it harder to keep weight off, but a study of 6,600 people aged between one week old to 95-years-old revealed that it’s not as simple as one might assume.
In our prior post, we defined what metabolism really is (a mixture of at least 3 different processes), so we can now move on to discussing how these processes change as we age.
A 2021 study, published in Science, found that our total daily energy expenditure is 50% faster in our first year of life than during adulthood. After our first birthday, our daily energy expenditure begins to taper off by some 3% each year until around the age of 20.
But here’s the surprise; instead of our total daily expenditure slowing gradually from say, the age of 30 onwards, it tends to remain very stable until the age of 50 or 60. After then, it decreases only slightly, by around 0.7% per year.
“Some people think of their teens and 20s as the age when their calorie-burning potential hits its peak…But the study shows that, pound for pound, infants have the highest metabolic rates of all.” – Dr. Katzmarzyk, Professor and Associate Executive Director for Population and Public Health Sciences at the Pennington Biomedical Research Center.
In essence, what this study shows is that the metabolism – and total energy expenditure – slows over time because of a mixture of factors, and not just because of age only. In other words, many people gain weight as they age for reasons other than what is often simply described as “the body slows down as you age”.
If you’re struggling more with your weight as you age, there are probably a few different things going on.
Problems and Solutions for Age-Related Weight Gain
1: Your Diet Has Changed
Diets can change in either direction with age, they might vastly improve as we realize the benefits of a healthy diet, or they might slip deeper and deeper into bad habits and indulgence!
What we do know is that a high-fat, low-protein diet lowers the thermic effect of food, which means that more excess calories end up deposited as fat.
A 2016 study from Purdue University found that a high-protein diet can boost the metabolism, boosting energy expenditure by around 100 calories per day. That’s 100 calories you’re losing for free, without moving, simply by eating high protein foods. For how long the increase in calorie burning by high protein diet lasts, is not clear, however.
Grabbing a shelf full of protein supplements in your 50s, 60s, or 70s is probably not required.
The following is a list of natural high-protein foodstuffs to consider:
Beans, peas, and legumes
Oats and grains
Dark leafy vegetables
2: You’re Moving Less
Next up, it’s all too easy to start moving less with age. Rather than low-level exercise, it’s usually the more vigorous activities that start getting neglected with age.
Exercise demands remain quite consistent throughout life, and it’s generally now recommended that older adults up to the age of around 50 to 60 commit to a similar exercise regime as those aged much younger. The older we become however, limitations on exercise duration and intensity are imposed by illness and degenerative conditions such as arthritis, heart and lung disease and whatever injuries have occurred over the years.
A strong body of research has also found that more rigorous exercise like high-intensity interval training can protect seniors from an array of diseases whilst bolstering their metabolism. It is strongly advised, particularly in older individuals, that before stepping up your exercise regime to always consult a physician prior to starting.
3: You’ve Lost Muscle Mass
Muscle loss (sarcopenia) reduces BMR whilst simultaneously reducing the number of calories burnt during exercise. Harvard Health cites that muscle loss can hit 3% to 5% per year after the age of 30. A higher percentage of lean muscle tissue boosts the level of calories burnt during exercise and at rest, so fighting against muscle loss is a potent way to maintain a steady metabolism.
It’s possible to fight against muscle loss by engaging in strength and resistance training in addition to your standard exercise regime. Follow a strength or resistance training plan approved by a professional, aimed at your age group and skill level and always take things slowly at the start.
4: Your Hormone Levels Have Changed
The hormone levels of both men and women progressively change with age.
Whilst men obviously do not experience anything like the level of hormone change that comes with female menopause, they may still experience somewhat of a “male menopause” which involves the loss of testosterone often beginning during the 50’s. Obesity in men is also associated with lower testosterone levels, creating a vicious cycle of increasing obesity causing lower testosterone which then inhibits the ability to lose weight, and so on.
Medical News Today primarily recommends lifestyle changes to support hormone levels, including increasing exercise and decreasing consumption of processed and fatty foods. Limiting alcohol consumption is also recommended not only to reduce caloric intake but alcohol may also suppress male hormone (testosterone) production.
Some herbs and supplements are also suggested to support metabolic hormones – Ginseng, Maca, and Ashwagandha are amongst those that show the most promising preliminary evidence, though large-scale studies are still lacking.
Summary: How Getting Older Affects Your Metabolism
Age does affect the metabolism, but it’s not as simple as your body just “slowing down” as you get older – and we are not powerless to stop it!
We have greater control over our metabolism than generally assumed and making just a handful of small changes might be all it takes to beat the “middle-aged spread”.
Considering all 3 components of the metabolism – BMR, TEF, and TEE – helps target strategies aimed at improving each, such as switching to a high-protein diet to increase calorie burning during eating, increasing exercise, and also supporting hormone function, and increasing lean muscle mass to boost BMR.
A combined, holistic approach provides a much better outcome than focusing on just one part of the metabolism in isolation of the others.
What is Metabolism and How Does It Change with Age?
By Gary M. Pepper, M.D. and Sam Jeans, MSc
Our bodies undergo many transitions as we age, some good and some not so good!
In the latter category of “not so good”, many people tend to struggle more with their weight as they get older. Obesity rates are higher in older populations, and in the United States, more than 30% of both men and women over 60 are obese.
Obesity in older age brings about much of the same risks as it does at any age, including an increased risk of heart disease, diabetes, high blood pressure, stroke, and mobility problems, and the risks climb ever higher with each year that goes by!
Unraveling what happens to our metabolism as we age helps provide strategies for staying healthy and reducing the risks of putting on excess weight. The popular consensus is that, as we age, our bodies ‘slow down’, which makes it tougher to keep weight off, but does that really tell the whole story?
At its most fundamental, metabolism encompasses every chemical process required to sustain life. It’s easy to confuse the entire concept of metabolism with just the basal metabolic rate (BMR) alone, but this is just one component of metabolism.
Many people use the terms interchangeably, whereas, in fact, there are three main components to metabolism:
1: The Basal Metabolic Rate (BMR)
The body is in constant motion, so even when we’re totally sedentary, sleeping, or otherwise at rest, we require energy and nutrients to function correctly.
So long as the heart pumps, the lungs breathe and the body and its organs go about their business growing and repairing cells, we are utilizing energy in one form or another, and this is our basal metabolic rate (BMR).
The BMR varies depending on the following factors:
Body Size and Muscle: Larger bodies have greater energy demands and higher BMRs.
Lean Muscle Tissue: Whilst it’s true that larger bodies have greater energy demands, BMR also increases relative to the proportion of the body that is made up of lean muscle. Muscle burns more energy than most other tissues.
Body Fat Percentage: Fat burns energy at a much lesser rate than most cells. A high body fat percentage relative to lean muscle tissue results in a lower BMR, even if the body itself is physically larger.
Age: Age does affect the BMR for a few different reasons, which we will discuss shortly.
Growth: Younger children have generally higher BMRs due to body growth, and they also need more energy to maintain their body temperatures.
Gender: Men likely have higher BMRs than women on average as they’re larger and have higher percentages of lean muscle tissue.
Genetics: Genetics do play a role in BMR, but there is debate surrounding quite how drastic the influence of genetics is compared to other factors.
Hormones: Hormone levels, particularly those governed by the thyroid gland, also influence BMR. Hypothyroidism (sluggish thyroid function) is associated with a lower BMR whereas hyperthyroidism (excessive thyroid function) is associated with elevated BMR. Metabolism-related hormones are also influenced by diet, for example, iodine deficiency may result in an underactive thyroid that lowers BMR.
Activity Level: Whilst physical activity burns energy directly as a result of exercise, it also raises BMR by stimulating the growth and repair of new cells, such as muscle cells.
Infection: Infections stimulate an immune response that requires energy, thus boosting BMR.
Environment/Temperature: Colder environments may increase BMR slightly as our bodies work harder to maintain a stable core temperature. Conversely, hotter environments may increase BMR as our bodies work harder to cool down.
2: Thermic Effect of Food (TEF)
The consumption of food itself requires energy and some foods are much easier to digest than others.
It takes considerable effort for our bodies to move food through the digestive system, and our body also needs to absorb and transport nutrients from that food, which further requires energy.
A concept that tends to pop up in various diet plans is ‘calorie negative food’ – that is food that burns more calories to digest than they provide as food. Sadly, there is no evidence that we can ‘eat ourselves thin’ by consuming calorie-negative food!
TEF varies considerably depending on the food consumed and its macronutrients content:
Fat has a thermic effect of some 0 to 5%, which means that for every 100 calories of fat consumed, the body burns just 0 to 5 calories
Carbohydrates have a thermic effect of around 5 to 10%, so for every 100 calories of carbs consumed, the body burns just 5 to 10 calories.
Protein has a much higher thermic effect of around 20 to 30%, so for every 100 calories of protein consumed, the body burns 30 calories (Source: Healthline).
Thirdly, our body requires energy to sustain movement and exercise. This is highly variable and obviously depends on physical activity levels – the more we move, the more energy we require to breathe, fuel our muscles, and repair cells.
The total accumulative energy required for these 3 metabolic components – BMR, TEF, and TEE, makes up our total daily energy expenditure.
In Part 2 of this article, we will cover how aging affects our metabolism and what we can do about it. Check back at metabolism.com for the publication date.
When kids come up against that common eat right and exercise refrain, they may be all too apt to brush health concerns aside as something only adults have to consider. Heart issues, kidney problems, and especially type 2 diabetes — those words have an “adults only” connotation.
However, the potential to develop type 2 diabetes in adulthood or even earlier comes with a clear link to overweight and obesity at young ages. With it comes an elevated risk for associated health complications, too. While research has indicated some alarming trends, there are also promising findings that hint at the opportunity for individuals to make sustainable change.
Sustainable change isn’t about simple calorie counting — where those calories come from can have just as big an impact on overall health. Families can have fun experimenting with recipes and food choices to give kids the power to view nutrition as a holistic part of their everyday routine.
Prediabetes and Type 2 Diabetes Cases on the Rise
Type 2 diabetes, a disease once known as adult-onset diabetes, has started to impact young people more and more. Recent research paints an increasingly unsettling picture.
But it’s not just prediabetes acting as a glimpse of a problematic but distant future. Researchers are also seeing a shift in type 2 diabetes prevalence in youths. A CDC report from 2020, for example, found the rate of new type 2 diabetes cases for young people under 20 years old in the United States increasing 4.8% per year.
Obesity and Overweight As Diabetes Risk Factors
Though not the only factors, obesity and overweight are helping to spur the rise in type 2 diabetes among children and adolescents. A 2005 review in the journal Pediatricsexamined the ongoing trend. The review noted that having overweight or obesity actually serves as the biggest risk factor for youth to develop type 2 diabetes, highlighting weight loss and prevention of weight gain as strategies to combat eventual disease development.
Indeed, as the number of overweight and obese children has increased, so too has the number of type 2 diabetes cases in younger people. Early diabetes development means affected young people may start experiencing complications associated with diabetes at an earlier age as well.
What Happens When Young People Develop Type 2 Diabetes?
Younger diabetes diagnosis and the potential for complications at an earlier age speak to the heart of the looming public health problem.
An earlier type 2 diabetes diagnosis goes hand in hand with greater risk. Earlier development means longer exposure to the disease, and young people who develop type 2 diabetes may need treatments like insulin earlier in life. Evidence also exists hinting at early-onset type 2 diabetes as a more aggressive form of the disease.
Children and adolescents with type 2 diabetes face health issues similar to their adult counterparts, but may experience these complications starting at an earlier age, according to the review in Pediatrics. Cardiovascular complications, kidney issues, health problems that threaten the limbs — the list goes on. Even if the diabetes diagnosis doesn’t come during childhood or adolescence, kids who are overweight or obese are still at a higher risk to develop the disease eventually.
Research Highlights Promising Opportunities for Change
The news isn’t all bad, though. Consider a study by Bjerregaard et al published in the New England Journal of Medicine in 2018.
Acknowledging that children who have overweight are at an increased risk for type 2 diabetes in adulthood, the study looked at Danish men who had their weights and heights measured at 7 and 13 years old and then again in early adulthood, defined in the study as between the ages of 17 and 26. The researchers sought to determine if children who were overweight at a young age would continue to have an increased risk of developing adult type 2 diabetes if they no longer were overweight at puberty or later.
The study uncovered promising statistics. Men who maintained a normal weight in early adulthood after losing weight between 7 and 13 years old had a risk of type 2 diabetes similar to men who had normal weight at all ages. While men who lost weight between 13 years old and early adulthood had a higher diabetes risk than men who had never been overweight, the risk was still lower than in men who were overweight at all ages included in the study.
Reversing the Trend Starts At Home
Focusing on being overweight in puberty as an important factor ultimately increasing the risk of developing type 2 diabetes later in life, the New England Journal of Medicine study indicates just how important learning healthy habits at a young age can be.
Family factors — such as food available at home and food preferences of family members — can influence what kids eat, and these factors have been associated with rising obesity cases. On the flip side, if kids learn about healthy eating, positive nutritional choices, and exercising at home, those lessons can carry over into choices kids make beyond the walls of their home.
Being overweight or obese aren’t the only risk factors for developing type 2 diabetes, and a holistic, empowering approach to any weight loss recommendations for kids is certainly a must. Still, the clear link means it’s something kids and the adults in their lives should pay attention to. Type 2 diabetes comes with the potential for complications in childhood and beyond — and the risks only increase with earlier disease onset. Yes, the stakes are high, but research indicates the lasting, positive impact that changes to nutrition and activity can have
Professional chefs understand how important food presentation is for the success of a meal. One element of the eating experience that can be under estimated however, is the effect of color. Scientific studies have shown that the color of the food and the eating environment effect appetite, often in a significant way. (more…)
This article is the first in a series at metabolism.com; “Overweight Kids….Trouble in Paradise”.
In the opener, we touch on many aspects of what can be a toxic tangle. In coming articles we plan to break out and do a deeper dive into each of the aspects presented. Subscribe to metabolism.com below to avoid missing the next article, “ Are Overweight Kids Destined for Diabetes?”
By Gary M Pepper, M.D.
Childhood obesity presents one of the most urgent public health issues in the United States today. The intimate interaction between parents and their children further complicates the problem. Parents shape the eating habits their children develop — but that also means parents can serve as important partners helping their children to make healthier nutritional choices.
About one in three children in the United States are classified as overweight or obese, as Kumar and Kelly note in their review published in Mayo Clinic Proceedings in 2017. These authors point out the prevalence of obesity increases as children get older. A 2014 study published in The New England Journal of Medicine, following children from entry into kindergarten through the end of eighth grade, also found that the prevalence of obesity increased by the time kids reached eighth grade. This research showed more children who were overweight when they entered kindergarten became obese by age 14 years old as compared to their normal-weight kindergarten classmates, with the biggest increase in obesity occurring between first and third grades.
Technically speaking, obesity is defined as a body mass index (BMI) of 30 or greater https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm. Childhood obesity comes with other health issues that affect physical and mental health. As the prevalence of childhood obesity has increased, so too has the prevalence of health complications in childhood typically thought to afflict mostly adults. Unfortunately, childhood obesity also tracks into later years: A high percentage of adolescents with obesity continue to remain obese as adults.
The Rise of Childhood Obesity: Complex Causes, Dangerous Combinations
While endocrine and genetic disorders can lead to obesity, most kids don’t have an underlying endocrine or single genetic cause for weight gain. The 2017 review published in Mayo Clinic Proceedings pinpoints a positive energy balance combined with genetic predisposition for weight gain as the most common cause of obesity for children. In other words, kids are taking in more calories through food than they are expending with physical activity.
Childhood obesity results from complex interactions of factors related to a child’s genetics, epigenetics, and environment along with ecological effects such as family, community, and school. The environmental factors that can lead to weight gain are also quite complex and include:
Adverse life experiences.
Parental and general culinary culture conditioning.
Perinatal factors (such as birth size, catch-up growth, antibiotic use).
Psychosocial and emotional distress.
Increased caloric consumption, aggravated when specific food intake is resulting in a high sugar burden.
Decreased caloric expenditure.
The last two factors form a dangerous intersection. Sweet snacks and beverages, fast foods, big portions, and high-glycemic foods all contribute to increased caloric consumption. Decreased caloric expenditure due to reduced physical activity and a trend toward sedentary activities (think: computers, phones, tablets, and televisions) is also on the rise. Together, more calories taken in and less caloric expenditure creates the positive energy balance spurring weight gain.
The current pandemic paints a dire picture. With fewer opportunities for activity and a marked increase in negative emotional triggers, today’s kids are facing a unique challenge. Children need support and guidance to make healthy choices perhaps more than ever before.
Health Issues Associated With Childhood Obesity
Childhood obesity can have serious health implications, with complications manifesting both during adolescence and later in life. Related health issues include:
Children with obesity run an increased risk of developing diabetes. Along with the challenges of managing diabetes itself comes the risk of additional acute and chronic complications.
Abundant research has shown an association between weight in adolescents and the development of diabetes in adulthood. In the past 20 years the incidence of obesity in children and the incidence of diabetes in adulthood has increased hand-in-hand.
A 2017 study by Meyers-Davis et al in The New England Journal of Medicine found the incidence of both type 1 and type 2 diabetes increased significantly among youths between 2002 and 2012. Type 1 diabetes — which usually develops before the age of 35 years and requires insulin treatment — is not necessarily associated with being overweight. Type 2 diabetes, on the other hand, is typically associated with onset after the age of 35 years and almost always has overweight as the major factor.
Despite the common assumption that type 1 diabetes is the “worse” of the two types of diabetes, a study by Constantino et al published in Diabetes Care in 2013found that early-onset type 2 diabetes came with greater mortality, more complications, and more unfavorable cardiovascular disease risk factors than type 1. Early-onset type 2 diabetes can also create metabolic challenges that last a lifetime.
Weight in childhood can play into cardiovascular health later in life. Twig et al examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes as adults, In 2016, their research paper in The New England Journal of Medicine, concludes that overweight and obesity at a young age was strongly associated with increased cardiovascular deaths in adulthood. A 2013 study in Diabetes Care also noted cardiovascular deaths drove the increased death rate associated with type 2 diabetes, with many deaths occurring right in the prime of life.
All in all, childhood obesity can lead to various cardiovascular complications, including:
High blood pressure.
Diabetes and being overweight have been associated with an increased risk of several cancers, both as individual causes and as intertwined factors. Pearson-Stuttard et al looked at the incidence of cancers (such as liver and endometrial cancers) that could be attributed to diabetes and high BMI in a 2018 study in The Lancet Diabetes & Endocrinology. The study found many cancer cases linked to the prevalence of both. Though the combined effects are striking, the research also indicated that high BMI alone was responsible for twice the number of cancer cases caused by diabetes itself.
Other Health Issues in Childhood and Beyond
Kids (and even parents) might think about many of the above risks as “adult” problems. However, childhood obesity is not just about a risk of death many years in the future. Kids can start experiencing the effects of obesity as young adults — or even earlier.
For example, a study by He et al in Fertility and Sterility published in 2018 investigated the association between childhood obesity and infertility in women. The research noted that childhood obesity appeared to increase the risk of infertility for women of reproductive age.
The 2017 review in Mayo Clinic Proceedings also listed a range of systems in the body that can be impacted by obesity during childhood, including:
As noted in that review, childhood obesity can have psychosocial consequences as well. Children with obesity are more likely than their peers to experience bullying and discrimination, and they may contend with anxiety, depression, and poor self-esteem.
What Can Parents Do Today?
The 2017 review from the Mayo Clinic underscores family-based lifestyle interventions as a cornerstone of weight management for kids. This approach is twofold, incorporating dietary modifications and increased physical activity.
Parents can guide kids learning to make healthier choices for their meals and snacks while encouraging unstructured physical activity (like playing outdoors) for younger kids and more structured physical activity (such as after-school sports) for older kids. At the same time, parents should limit screen time for tasks other than schoolwork — the Mayo Clinic recommends less than two hours of screen time per day for kids older than 2 years old and avoiding screen time altogether for kids younger than 2.
That’s easier said than done, of course. In the current pandemic reality, finding opportunities to turn off the screens and get outside are harder to come by than ever before. Even in the best of times, financial and cultural barriers to healthy eating and physical activity still exist. We’ll explore how parents can empower kids to change their dietary and activity habits later in this series.
Obesity can impact just about every part of the body, and obesity in childhood can have serious implications for years to come. Parents can play a big role in getting their kids motivated to change their eating habits. By offering a compassionate, nonjudgmental source of support, parents can give their kids the tools they need to make healthy and sustainable changes.
Metabolism.com and Dr. Gary Pepper wish to acknowledge and thank Farryl Last for her expert assistance in the preparation of this article,
Elizabeth J. Mayer-Davis, Ph.D., Jean M. Lawrence, Sc.D., M.P.H., M.S.S.A., Dana Dabelea, M.D., Ph.D., Jasmin Divers, Ph.D., Scott Isom, M.S., Lawrence Dolan, M.D, Giuseppina Imperatore, M.D., Ph.D., Barbara Linder, M.D., Ph.D., Santica Marcovina, Ph.D., Sc.D., David J. Pettitt, M.D., Catherine Pihoker, M.D., Sharon Saydah, Ph.D., M.H.S., Lynne Wagenknecht, Dr.P.H. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. The New England Journal of Medicine 2017; 376:1419-1429.
Maria I. Constantino, Lynda Molyneaux, R.N, Franziska Limacher-Gisler, Abdulghani Al-Saeed, M.D., Connie Luo, R.N., Ted Wu, M.D., Ph.D., Stephen M. Twigg, M.D., Ph.D., Dennis K. Yue, M.D., Ph.D., Jencia Wong, M.D., Ph.D. Long-Term Complications and Mortality in Young-Onset Diabetes. Diabetes Care 2013; 36(12): 3863-3869.
Gilad Twig, M.D., Ph.D., Gal Yaniv, M.D., Ph.D., Hagai Levine, M.D., M.P.H., Adi Leiba, M.D., M.H.A., Nehama Goldberger, M.Sc., Estela Derazne, M.Sc., Dana Ben-Ami Shor, M.D., Dorit Tzur, M.B.A., Arnon Afek, M.D., M.H.A., Ari Shamiss, M.D., M.P.H., Ziona Haklai, M.A., Jeremy D. Kark, M.D., Ph.D. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. The New England Journal of Medicine 2016; 374:2430-2440.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of â€œsomething missingâ€ in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.