Winter 2004 - Patient Newsletter

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 [] (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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