Obesity

NEW BRUNSWICK, N.J. -- Portions of buffet-style food that college students pile on their trays have generally grown significantly in 20 years, a sign of so-called portion distortion.

NEW ORLEANS -- Among the many things destroyed by Hurricane Katrina a year ago was the illusion of adequacy in the system of health-care delivery here. Now visionaries believe health-care planners have a rare chance to scrap the old and start anew.

The patient was a 40-year-old African American woman, with no significant past medical history, who presented to our medical center with a 4-week history of shortness of breath and lower extremity edema. The onset was progressive and initially occurred only with moderate exertion until about 2 weeks before presentation; at that time, her symptoms had worsened to the point where she experienced shortness of breath at rest. Orthopnea also developed at this time. The patient also reported intermittent palpitations, wheezing, and a dry cough of unknown duration.

ABSTRACT: Subclinical hypothyroidism is associated with elevated low-density lipoprotein (LDL) cholesterol levels and several factors related to atherosclerosis, including increased C-reactive protein levels and impaired endothelium-dependent vasodilatation. However, considerable controversy exists about screening for and treating this thyroid disorder. Thyroxine therapy lowers elevated LDL cholesterol levels in patients whose serum thyroid-stimulating hormone (TSH) concentrations are higher than 10 mIU/L ; thus, most experts recommend treatment for such patients. However, there is no consensus regarding the management of patients with TSH levels of less than 10 mIU/L. Although the evidence supporting treatment of these patients is not compelling, it is reasonable to offer a therapeutic trial of thyroxine to those who have symptoms.

The term "prehypertension" was introduced in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines to describe blood pressures (BPs) of 120/80 mm Hg to 139/89 mm Hg.1

To initiate a discussion with a patient about excess weight without causing embarrassment or offense, try reporting the patient's body mass index (BMI), saying something like the following: "Mr X, did you know that your BMI is 36?" Patients typically answer with something such as "No--what's a BMI?" This creates an easy opening for discussion of the comorbidities associated with excess weight and counseling about lifestyle changes.

A healthy 56-year-old woman, who is seeing you for her annual checkup, asks if she still needs to continue the calcium supplements she has been taking. She has heard reports on the evening news that calcium and vitamin D were of negligible value in women her age--and could even cause kidney stones. How would you respond? What is the latest thinking about calcium and vitamin D supplements for postmenopausal women?

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman who is employed as a secretary. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

The optimal approach to subclinical hypothyroidism continues to be debated. Experts disagree over screening for thyroid dysfunction, the threshold TSH level for treatment, and the upper limit of normal of the TSH reference range.

Should patients with prehypertension be treated with antihypertensive drugs?

Calcium and Vitamin D Supplements: Breaking News on Fracture Prevention

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

To initiate a discussion with a patient about excess weight without causing embarrassment or offense, try reporting the patient's body mass index.

A 44-year-old African American woman presented to the emergency department with constipation of 4 days' duration. She also complained of a sticking sensation in her throat over the past year and dysphagia to solids but not liquids. Over the past 2 years, she had an unintentional 40-lb weight loss, which she attributed to decreased appetite.

BOSTON -- As angry men age, taking a deep breath for an exclamation of rage may grow ever more difficult, according to investigators here.

NASHVILLE, Tenn. -- A glass of fruit or vegetable juice every other day may help fend off Alzheimer's disease, a prospective study of older Japanese-Americans suggested.

WASHINGTON -- Plates groaning with food, a society that discourages walking, and long hours of working and commuting are all conspiring to make Americans obese, according to a report released by a non-profit group.

LOS ANGELES -- In advanced ovarian cancer, excess weight shortens the time to recurrence and increases the risk of death, researchers here say.

IRVINE, Calif. -- Too much work is mirrored in high sphygmometer readings, according to a survey of those who toil in California.

ROCKVILLE, Md. -- Even carrying a few extra pounds in patients who are not frankly obese is enough to increase the risk of death, according to two large studies.

LEIDEN, The Netherlands -- Whether by road, rail, or air, travel for more than four hours caused a two-fold increase in the risk of deep-vein thrombosis, researchers here reported.

TORONTO -- Human growth hormone appears to reverse some elements of HIV-treatment related lipodystrophy, researchers reported here.

CINCINNATI -- Cellulite is forever, or pretty close to it, even in the face of weight loss, according to researchers here.

DALLAS -- Schools are not making the grade when it comes to physical education, according to the American Heart Association.

CHAPEL HILL, N.C. -- Patients can lose weight over the short term by following the dictates of their terminals, with automatically generated computer feedback reinforcing adherence to a healthy diet and activity regimen.

SEATLLE -- Low testosterone may be a signal that a man's body is running down-or maybe out.

LOS ANGELES -- Unmarried life may impinge on life expectancy, according to researchers here.

MINNEAPOLIS -- Teens with a poor body image tend to behave in ways that are self-perpetuating, researchers here said, and may react better to positive encouragement rather than to criticism.

BOSTON -- There are a lot more chubby babies than there used to be, reported investigators here. That goes for chubby preschoolers, too.

WASHINGTON -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.