A Few Minutes with
Dr. Ann McDermott on the Boston Obesity,
Genetics, and Lifestyles Study
By: Jody Abrams
Dr. McDermott, I think your study
is very important to people of size.
You are the project director of the
Boston Obesity, Genetics and Lifestyles
Study. Exactly what is this study?
What is the one, most important thing
you would like people to get from the
work you are trying to do?
We know that worldwide, more than 1
billion adults are overweight and over
300 million are obese. Currently
we know that the severity and prevalence
of obesity varies by gender and race;
the risk profiles for diabetes and cardiovascular
disease vary by gender, obesity, severity,
and race; in addition, our environment
and daily lifestyle choices, including
diet and physical activity, have tremendous
impact on weight gain, loss, and maintenance. We
also know that different overweight individuals
respond differently to a given weight
loss treatment. We are doing this
study because the causes of obesity are
many. It is thought that over half
the variation in weight gain is caused
by genetic differences in humans. In
plain terms, body weight and composition
have many factors involved and we need
to have a much better understanding in
order to offer the best treatment. Hence,
our BOGL study name is also a play on
words on the complexity of the weight
and weight loss issue…which boggles
the mind.
We all (patients and clinicians) have
so many questions we need answered and
we have the power to do something about
that now…we can be part of the
solution. The BOGL Study has the
potential to become a very important
resource for patients, clinicians, and
scientists, if we work together and each
person contributes to the solution in
their way.
What do you hope to accomplish?
We hope this study provides much needed
information that brings us closer to “personalized
medicine” – that is, the
information permits patients and clinicians
to make the best treatment choices, the
ones with the greatest return and the
least negative side effects for the individual. We
need to understand exactly which behaviors
are associated with the best success
and which with less successful outcomes. Also,
we need sufficient data to allow realistic
expectations of weight loss and health
outcomes – how much lost, how fast,
how much maintained on each treatment
option offered at this clinic, and the
impact on overall health. This
is why we need to have a large number
of volunteers represent each OCC treatment
approach, many different periods of treatment
time, and different levels of success.
You seem to have a lot of passion
for this project, but you are not a
fat person…why do you have such
enthusiasm for this study?
Personal history has played a role. My
father’s side of the family was
always obese (BMI>40), with the exception
of one aunt who always weighed less than
100 lbs-same genetic background, same
environment. We were always told
that our family was “strong like
a bull” and “programmed to
be big!” However, while in
their 40’s two of my uncles went
through emotionally tumultuous times
and started to walk miles each day to
help deal. Next they started eating
lots and lots of fruits and veggies,
and then started shedding lots of weight. Low
and behold, 12 plus years later, they
both maintained their daily exercise/diet
habits are both slim and trim (BMI<24). My
family was raised to believe that being
heavy was inevitable and I saw first
hand that it was not true.
I have a love of the science process
and the belief that we can each impact
our own state of health. I was
interested in identifying a big problem
that affected lots of people, asking
the right questions upfront, collecting
information, analyzing data and finding
objective answers to those questions
so that patients and clinicians would
have the answers they need to optimize
treatment. I try really hard to
keep an objective view, to squelch preconceived
notions, and be open to any answer.
Why do you think Americans are now
fatter than ever?
This is a complex question, given the
rapid global increase in overweight and
obesity of all ages and all socioeconomic
categories over the past 25 years.
Off the top of my head, you have environmental
factors like a decrease in day in, day
out physical activity. As newly
created jobs require less manual labor,
people are becoming more sedentary. We
also work about 200 hours more per year
than 24 years ago and down-sizing has
added to our workload. The fatigue
at the end of the day may be a result
of our stress level, not necessarily
the energy we have expended.
Further, children also have decreased
activity in that fewer schools offer
physical education classes, intramural
and junior varsity activities. There
is less free play time and a greater
reliance on structured competition sports
which offer few kids the opportunity
to move and excludes less skilled players.
There is a greater reliance on cars
for transportation. Even for the
little errands that could be walked,
people take their cars. Movement
is a good thing!
We also use push button doors, escalators
instead of stairs, elevators. These
little things add up…not to mention
all the meals eaten out in restaurants
which offer food made by others so you
don’t know exactly the ingredients
and their volume. There are no
boundaries to where and when you eat. Next
time you walk down the street, notice
how many people are eating or drinking
something other than water. Also
portion sizes are out of control. Do
you remember the normal size of a coffee
cup twenty years ago?
We watch too much TV and the food industry’s
effective marketing is designed to make
you want their foods. We also include
in our lifestyle daily “treats” which
tend to be calorie rich and in fact,
can be the caloric equivalent of a meal
without providing satiety or health promoting
vitamins and minerals.
It has been suggested that in some people
these environmental factors can effect
gene regulation, much in the way some
families are sensitive to high salt diets
and need to remove them from the diet,
while others aren’t affected.
Having talked with you a bit, I know
you are a competitive swimmer. Since
there is no substitute for exercise
and it’s a must in creating a
healthy lifestyle, how would you encourage
someone to begin if they’ve associated
exercise as another punitive part of
dieting?
My mantra is “movement is good.” This
includes both daily physical activity
and structured exercise. Anybody
that tells me they “don’t
like exercise” hasn’t been
exposed to the right exercise format
and the right instructor yet. Historically,
too many exercise programs have focused
on a “one size fits all” approach
or used pain as an indicator of “good
work.” You need to find the
right program for you. An exercise
prescription that leads you to your goal
as quickly as possible is very important. This
is where an exercise physiologist comes
in – someone with the scientific
and medical background to assess your
current health status.
If you haven’t seen Dr. Pino
yet, I highly recommend seeing him. He
seems to be especially perky in the
morning. I think it’s the
coffee, but nevertheless, he’s
an excellent motivator.
Repeat the mantra…”Movement
is good.” Physical activity,
the everyday movements needed for living,
can’t be overlooked either. Find
ways to increase energy expended throughout
your life.
When all is said and done, do you
think Gastric Bypass will have been
a truly viable option, or just another
fad?
Gastric Bypass is a very serious surgery,
not taken lightly. My hope is that
as the research unfolds, the medical/science
fields will continue to evolve, surgical
techniques will continue to refine, and
additional options will be developed,
allowing for the best option for the
individual to be selected. For
example, the Pacer study currently being
conducted at the OCC will clarify whether
this newer, less invasive method is an
effective option.
In 1994, the Department of Health
said that it does not matter what type
of commercial diet a person chooses. All
diets have a 97% failure rate in that
most people will regain their weight,
plus additional weight within (5) years. Given
this statistic, why do you think the
medical profession continues to push
diets even though the data shows they
have little to no success and why do
you think we have such a hard time
successfully losing and keeping off
weight?
While we all know people who have cycled
through various weights, we all know
people who have broken the odds and been
extremely successful. The National
Weight Control Registry [http://www.uchsc.edu/nutrition/WyattJortberg/nwcr.htm]
(NWCR) was established to investigate
the successful weight losers – what
was it that made them so special and
what can we learn from them? Based
on their findings, it was clear that
a number of approaches can lead to long-term
success (maintenance), but the behavior
changes involved both diet and exercise
habits and these were rigorous, and became
day-in-day-out lifelong habits –not
just treatment for weight loss. Anyone
in the U.S. who has lost > 30 lbs.
and kept it off for more than a year
is encouraged to join [recruitment line: Carrie
Brill (303) 315-4087] Many people
are able to make drastic changes for
the short-term, but sustainable changes
are required for weight maintenance. Currently,
only 20% of people trying to lose weight
follow a combination of diet and exercise
program as recommended. Take a
look at the NWCR website; see what the
successful people have to say. Learn
from the winners!
Gastric Bypass (GB) seems to sport
an 85% success rate. Why do you
think this rate is so high? Do
you think it is accurate?
Keep in mind the criteria used to define
a successful outcome in the research
literature: weight loss of 50%
or more of excess weight. In 2003,
a large follow up study was conducted
in Sweden. While this study may
reflect the same surgical procedures,
the auxiliary treatments provided by
the clinics involved may differ from
the OCC’s. So is this statistic
accurate? That’s exactly
what we want to know!
Having participated in the BOGL study
myself, I cannot think of one viable
reason that anyone would not want to
give of their time to this study given
its tremendous importance and value
to our cause. What are some of
the reasons that people turn you down?
How can we (patients and members of
the OCC community) help to spread the
word about your study?
Patients have been VERY supportive of
this project, tremendously open, and
most helpful. The staff and I always
remark how much we enjoy each day in
clinic, as a result. As far as
declining participation, I have had very
few – maybe one in every fifty
people haven’t asked why, but would
welcome that information. The OCC
patients are teaching us a great deal.
The BOGL Study is very inclusive – we
are open to any OCC patient currently
undergoing any type of weight loss treatment
and also to previous treated patients
who are continuing to be followed. The
only BOGL exclusion criteria we have
are current enrollment in the Pacer Study. However,
Pacer volunteers can join BOGL when their
follow-up time is finished.
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