Losing a Few Pounds May Help the Obese

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Losing a Few Pounds May Help the Obese

By DANIEL Q. HANEY, AP Medical Editor

For the obese, a small loss may be a big victory. Evidence is building that

really heavy people may be able to greatly improve their odds of dodging

weight-related illnesses while remaining very heavy.

The secret: Lose just a few pounds. Weight reduction, it appears, is powerful

medicine for the large, no matter how seemingly insignificant the dose.

Many obesity experts agree that getting down to a normal size may not be

necessary to avoid much of the bad effects of being big. Dropping just 10 or 15

pounds — too little to even miss on many people — can have a surprising and

substantial effect on the body processes that obesity disrupts.

If true — and the idea still has some skeptics — this means that at least a

partial antidote to the apocalyptic predictions about the obesity epidemic may

be within reach, even if people remain vastly overweight by every measure.

" The bad news is people are getting more and more obese, " says Dr. Christie

Ballantyne, a cardiologist at Methodist Hospital in Houston. " The good news is

losing a modest amount of weight can have really profound health benefits. "

Of course, many big people want to slim down so they will look better. But

doctors say the best reason for getting control of weight is to be healthier.

" That is one of the most important public health messages to get out to people, "

says Dr. Judith Fradkin, diabetes endocrinology head at the National Institute

of Diabetes and Digestive and Kidney Diseases. " The goal should be to become

healthy, not become a fashion model. If you move in the right direction even a

little bit, that can make a big difference in health. "

That's good news for people who throw up their hands in defeat because they

cannot get down to their ideal weight. Just a loss of 15 pounds for someone 90

pounds too heavy can make a big difference, Fradkin says.

There is little doubt among mainstream experts that obesity is a potentially

deadly condition, blamed for about 300,000 deaths annually in the United States

alone. For a middle-aged person, it is considered to be about as bad for health

as smoking is.

Many experts believe that the real hazard of being overweight is the torrent of

hormones and other chemicals pumped out by fat storage cells, which become

hyperactive when filled to capacity with fat.

The damaging effects of obesity are obvious on a physical exam. Not every

nondiabetic, overweight person has all these abnormalities — which can raise the

risk of heart attacks, diabetes and strokes — but many do. The most common:

_HDL cholesterol, the good variety, is unusually low — below 40 in men and 50 in

women — even though the bad LDL is normal.

_Blood pressure is 130 over 85 or greater.

_Fasting blood sugar is between 110 and 126.

_Free-floating fats called triglycerides are over 150.

_C-reactive protein, a sign of bloodstream inflammation, is high, often over 3.

Experts believe that overactive fat can do all of this, at least in part by

making the body less receptive to signals from insulin that tell it to store up

energy. As a result, the liver has to produce more insulin, which can be harmful

itself at high levels and raises the risk of diabetes.

The benefits of losing just a bit of weight are often apparent in people with a

body-mass index well into the obese range — 35 and beyond. Typically, these

people are at least 50 pounds overweight and often much more.

In his weight clinic, Ballantyne watched patients whose BMI's averaged 41. After

losing about 7 percent of their weight in a month, most of these ominous signs

got substantially better, even though their BMI's still averaged 38.

Their blood pressure fell to normal. Triglycerides dropped 40 percent back into

the healthy range. Inflammation dropped between a quarter and a third. HDL

budged upward slightly.

In many cases, the benefits are as big as typically seen with a fistful of

pills, says Ballantyne. " You are altering the metabolic functions more

profoundly than the weight, which is great news. "

Doctors say people whose weight continues to fall do best, and those who put

some of it back on lose part these improvements. Still, they seem much better

off having lost and partially regained than never having lost at all.

The biggest questions, though, are how long these improvements last and whether

they translate into better survival, as doctors expect they should.

" I think it would probably help them, " says Dr. Xavier Pi-Sunyer, head of

obesity research at St. Luke's Roosevelt Hospital Center in New York City. " But

is there good evidence this is so? We don't have it. "

In fact, there is little firm evidence that losing weight, either big amounts or

small, translates into longer life. Some of the best data comes from two large

studies published in recent years on overweight people who are at high risk of

diabetes.

Both show that a little weight loss and exercise reduces the risk of this

disease and presumably its complications, including heart attacks, kidney

failure, blindness and early death. In the larger of the two, people who shed an

average of 12 pounds and walked 20 minutes a day over three years cut their

diabetes risk in half.

But why? Exercise almost certainly helps, many say, but the critical importance

of a small weight loss also makes biological sense.

Very overweight people have more fat cells than normal-size folks, and their fat

cells are also more biologically active. When people lose weight, these fat

cells shrink.

" When you go from a BMI of 39 to 36, you still have got a lot of fat cells, "

says Dr. Jensen, an endocrinologist at the Mayo Clinic. " But instead of

a lot of big fat ones, you have a lot of small ones. They do a better job of

regulating hormones and fuel release than do big fat cells. That's why you get a

big improvement in health when you still have excess body fat. "

Dr. Ken Fujioka, a nutrition expert at the Scripps Clinic in San Diego, says if

someone loses 5 or 10 percent of their weight, their body does not want to lose

any more, so it slows its metabolism. While that makes further weight loss more

difficult, it still seems to be beneficial.

" It keeps the blood sugar and cholesterol in much better control, " he says. " If

your body learns to live off less calories, and it can, it seems to be a good

thing. "

___

EDITOR'S NOTE: Medical Editor Q. Haney is a special correspondent for The

Associated Press.

___

On the Net:

Diabetes study: http://content.nejm.org/cgi/content/abstract/346/6/393

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