News to Empower You

Dace Trence, MD, FACE, MACE


Despite a rising, recognized prevalence of overweight and obese people in the U.S., most of these individuals are not actively doing much, if anything, to lose their extra weight. A recent report on an analysis of data obtained from almost 23,000 obese adult participants in the 2012 National Health and Wellness Survey, an annual Internet- based survey given to randomly selected U.S. citizens who represent a typical sample of the adult U.S. population, revealed that the majority of individuals responding were not doing anything about their excess weight.

Fifty-nine percent of those considered obese answered that they were not actively making any effort to lose their weight. Two percent reported taking prescription weight- loss medication or having bariatric surgery. And 39 percent were trying methods including decreased calorie intake, increasing physical activity or both. But most were doing nothing—not a healthy choice!

What is the take-home message

If you are concerned about your weight, talk to your health care team about resources available to you; many are free and web-based and can be accessed through your smart phone, tablet or computer. If you need additional help, ask about a referral to a registered dietician, an exercise trainer or exercise physiologist, and talk with your doctor about whether you might be a candidate for medication or surgery. Obesity is now considered a disease, with risk for significant complications...heart attacks, stroke, cancers and many others. Information and help are available!


Okay, okay, you might be thinking. I will get in to see my doctor or other healthcare team member to start my program to better health by getting some of this weight off. But what can I do right now? Is there any science to help me? Well, yes there is.

At an international meeting this May in Europe, study results were reported that showed yogurt ingestion by itself, and even more so if added to a Mediterranean diet plan, could have a significant impact on reducing the risk of obesity. The report highlighted results from a follow-up over 6.6 years of adults, not obese at the start of the study and an average age of 37.1 years, who were asked about their intake of low-fat yogurt and other foods at the entry into the study. Every two years, they were asked again to report their food intake, and weight, among other data, was obtained. Of the more than 8,500 individuals in the study, 1,860 study participants became either overweight or obese over the subsequent 6.6 years. Among the dietary questions asked was whether participants ate one serving of yogurt daily (considered as a high intake by study definition), or two or less servings per week (defined as low consumption).

Those reporting a high consumption had a 12 percent lower risk of becoming overweight or obese than those reporting the low consumption. If the high yogurt intake was also reported in the setting of a Mediterranean diet rich in fruits, vegetables and fish, then the risk of becoming overweight or obese decreased by 25 percent as compared to neither high intake of yogurt or no Mediterranean diet. If high-fat yogurt was included with a Mediterranean diet, then the risk was decreased by an amazing 36 percent! If high-fat intake was combined with a diet high in fruit intake, the risk for becoming overweight or obese was decreased by 21 percent, as compared to low intakes of both.

What is the take-home message?

Is yogurt magic? Of course not! But clearly it could be a more filling snack and food than many other possible choices. There are many types of yogurts, as well as many portion sizes. Watch the carbohydrate content of yogurt if you have diabetes, particularly if there are additives to your yogurt choice, such as preserved fruits or fruits in syrup. These can contain a lot of carbohydrates, not the best of choices if you are worried about your blood sugar. You can add fresh fruit to your plain yogurt. Even vanilla-flavored yogurt can be tasty, but again, look for the carbohydrate content per serving! And enjoy the bounty of summer fruits and vegetables—it makes the Mediterranean diet easy this time of year!


You might now be thinking, enough of this concern about weight! Sorry...the data just keep supporting that being significantly overweight just is very bad for health. Adults with class III obesity (defined as a body mass index—BMI—of 40-59.9, or, as example, a weight of 350 pounds for a female with a height of 5 feet 6 inches) are more likely to die from all causes than those within normal weight range, but particularly from heart disease, cancer and diabetes. Among more than 9,500 study participants classified as obese class III (BMI 40.0-59.9) and over 300,000 normal weight (BMI 18.5-24.9) participants, investigators looked at what happened medically to these participants over 30 years. Adjustments were made for sex and age and excluded those who reported ever smoking cigarettes or already having a known history of chronic disease, including heart disease, cancer, stroke or emphysema.

Among participants categorized as class III, mortality rates were almost triple for men and for women. Heart disease deaths were the largest complication for those with class III obesity, followed by cancer and diabetes within the class III range, hazard ratios increased for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/ nephrotic syndrome/nephrosis (kidney problems), chronic lower respiratory ( lung ) disease and influenza/pneumonia as BMI increased.

What is the take-home message?

If your weight falls into this high of a BMI (and an easy way to calculate your BMI is to google “BMI calculator,” which will ask for your height/weight and then automatically give you the calculated result), ask your health care team what you can do to help yourself.


Finally, let’s talk about stress and its effects on heart disease. It has been well known that stress is not good for cardiovascular optimal health. The challenge has been defining how much stress is acceptable (if any?) and how much is not. Could it have different effects among different individuals, how can stress be measured, and goodness, what is the mechanism for this? Not easy questions, not easy to research.

A recent study has suggested a mechanism for the negative effect of stress on atherosclerosis, the ongoing damage to blood vessels of the heart (as well as those vessels going to and from the heart). A lot of attention has been paid to inflammation of these vessels, inflammation through an increased production of inflammatory products called cytokines [si-toe-kin-es]. Researchers recently reported results from a study showing disturbing images to study participants who then had brain activity measured, as well as thickness of their carotid (main neck vessel arteries), in combination with blood levels of a specific inflammatory product. As the stress level increased, the level of inflammatory product increased, as did the thickness of the carotid vessel. Although it would be difficult to understand how carotid artery thickness could suddenly change, the inflammatory marker change could certainly be much faster.

What is the take-home message?

None of us can get away from stress entirely. But we can take advantage of what is known to help with stress management: spend “down time” with family and friends, take a walk with your dog, work in your garden or plan some time away. All are helpful and good for your heart and circulatory vessels!

Dr. Dace Trence is Director of the Diabetes Care Center and Professor of Medicine at the University of Washington Medical Center in Seattle. She is also the University of Washington Endocrine Fellowship Program Director and Director of Endocrine Days, a medical education program for endocrinologists practicing in the Pacific Northwest. She is on the American College of Endocrinology Board of Trustees and chairs the CME Committee and is also chair of the AACE Publications Committee.