Individuals who are obese are predisposed to a variety of metabolic conditions, including type 2 diabetes. A characteristic of the fat tissue (adipose tissue) of individuals who are obese is that it is inflammed, and understanding the relationship between such inflammation and the onset of the metabolic conditions is of importance in combating what has become a large public health problem. In a new mouse study, Gökhan Hotamisligil and colleagues, at the Harvard School of Public Health, Boston, found that interactions between adipocytes (fat cells) and inflammatory cells called macrophages seem to underlie the inflammation-related metabolic deterioration associated with obesity.

In the study, when adipocytes isolated from mice lacking proteins known as FABPs, which are molecules that govern metabolic and inflammatory responses, were cultured with normal macrophages, the macrophages expressed reduced levels of inflammatory molecules. Likewise, when macrophages isolated from mice lacking FABPs were cultured with normal adipocyes, the adipocytes responded more to insulin and took up more glucose. Similar results, indicating that FABPs from both adipocytes and macrophages contribute to the inflammatory basis for metabolic deterioration, were obtained in vivo. The authors therefore suggest that this FABP-related pathway may be a novel target for metabolism-related disorders.

Past research has found that patients enrolled in weight-management programs experience greater success as the frequency they meet with physicians or weight-loss counselors about their progress increases. The U.S. Preventative Services Task Force, an organization that recommends guidelines for primary care in the U.S, classifies two provider contacts with patients as intensive. A study by NiCole Keith, associate professor in the Department of Physical Education at Indiana University-Purdue University in Indianapolis, found that this current recommendation may not be intensive enough for low-income and disadvantaged populations.

Her study was conducted in an urban community health center in Indianapolis that primarily serves low-income and disadvantaged populations. The weight-management program, Take Charge Lite (TCL), was free to patients, funded by the Fairbanks Foundation and available to all patients 18 or older with a body mass index indicating they could be overweight or obese — equal to or above 25. The program was developed for English or Spanish-speaking patients and used input from physicians, administrators and patients of the clinic. If patients qualified, their physician gave them information about TCL and the program coach’s contact information. Once a patient phoned, a first visit was arranged at which the patient chose goals, weighed-in, and discussed different weight-loss strategies with the coach. Program participants could attend support groups, education or exercise classes, meet face-to-face with coaches, or have regular weigh-ins. Each of these activities qualified as a contact.

At the end of the program’s first year, the relationship between weight loss and number of contacts was evaluated. Patients with two or fewer contacts per month gained about a pound. Patients with three or four contacts per month lost about two pounds of weight and patients who had five contacts per month lost just over two pounds. Those with six or more contacts lost about five pounds and patients with more than 11 contacts per month lost about six pounds. Keith said the program will continue and that she’s optimistic about its impact. “TCL coaches helped patients find strategies tailored to patient needs and abilities to help with weight loss,” she said. “Indentifying factors associated with weight loss and program participation may improve weight loss services, maximize contact and lead to increased weight loss in this population.”

The workplace, in addition to being a place for making money, has the potential for making a dent in Americans’ struggles with obesity, according to Indiana University researchers. A study led by Whitney E. Hornsby, a graduate student in IU Bloomington’s School of Health Physical Education and Recreation, examined weight and activity levels of 56 people ages 23 to 61 who worked desk jobs. The study found that 80 percent of the employees were overweight or obese, which is higher than the general population, and the employees also reported a lower quality of life than the general population. “Obesity rates have increased while leisure time has stayed the same or increased,” said Jeanne Johnston, assistant professor in the School of HPER’s Department of Kinesiology. “We’re becoming more sedentary in our jobs. As technology improves, it makes it easier or requires us to be closer to our desks.”

• Background: The study, says Johnston, a co-author, is part of the IU researchers’ efforts to use the workplace to stimulate healthier behaviors. She said employee wellness programs typically come in two forms — they make available an on-site fitness facility that typically is rarely used, or they make available health and wellness assessments without the resources to help employees implement the recommended changes. The IU researchers are studying a behavioral change program designed to increase employees’ activity levels to the light and moderate range, rather than launching them into a full-scale workout regimen. “The transition is really important, getting to where people are in their stage of exercise and moving them along the continuum,” Johnston said. “I’m a big believer that we need to help people move from being sedentary to being active, where they can see the results. Then, they might be motivated to join a fitness facility.”

Breast reconstruction in overweight patients can be a difficult challenge for plastic surgeons. A higher body mass index can be associated with greater post-operative complications and poor cosmetic results. This study found that obese women were as likely to be generally satisfied with their breast reconstruction as normal weight patients. For those who had reconstruction using their own skin (TRAM flap), as opposed to a breast implant, body mass index had no effect on satisfaction. The study concluded that for overweight patients, the quality-of-life benefits from breast reconstruction outweighed the surgical risks. More than 57,000 breast reconstructions were performed in 2007, according to the ASPS.