Eating Disorders Increase Risk of Death

 

People who suffer from anorexia, bulimia, as well as unspecified eating disorders, have a higher rate of death than those without the disease, according to newly published research out of Loughborough University in the U.K.

Researchers poured over three dozen studies conducted between 1966 and 2010. The studies followed over 17,000 individuals with eating disorders and found that individuals who had suffered from anorexia, bulimia,or other eating disorders had a higher rate of death than their healthy eating counterparts. Individuals with anorexia nervosa were 5 times more likely to die, with 1 in 5 anorexia-related deaths due to suicide. Bulimics, and those with unspecified eating disorders, were twice as likely to die.

People with anorexia have a distorted body image that causes them to see themselves as overweight even when they’re dangerously thin. Often refusing to eat, exercising compulsively, and developing unusual habits such as refusing to eat in front of others, they lose large amounts of weight and may even starve to death.

Physical problems associated with anorexia nervosa include damage to the heart and other vital organs, low blood pressure, slowed heartbeat, constipation, abdominal pain, loss of muscle mass, hair loss,sensitivity to the cold, and fine body hair growth.

While eating disorders may start with preoccupations with food and weight, they are most often about much more than food. People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem overwhelming. Treatment should include a multi-dimensional approach, to heal both the body and the mind, working on behavior modification and lifestyle changes. Deep-rooted behavioral issues are also often a cause of eating disorders, and should be addressed to accomplish full recovery.

Hospitalizations for eating disorders jumped by 119 percent between 1999 and 2006 for kids younger than 12 and severe cases of both anorexia and bulimia have risen, as has “partial syndrome” eating disorders(where some, but not all, of the symptoms occur).

Researchers in this U.K. study could find no singular cause to account for the increase in deaths among those with eating disorders, but the effects of the disease on major organs are thought to be a contributing factor.

Can Obesity Increase the Risk of Breast Cancer?

Although smoking cigarettes and drinking alcohol increase the risks of developing cancer, being overweight increases the risks of developing breast cancer, particularly in women who are beyond menopause. New research shows a correlation between breast cancer in postmenopausal women and high sex hormone levels such as testosterone and estrogen.

According to the study at the University of Oxford, commissioned by Cancer Research UK, obesity is becoming the biggest driving force behind the most common form of breast cancer, beating out cigarettes and alcohol as a leading cause of death for women beyond menopausal age.

According to the researchers who conducted the study, “Although the breast cancer risk for postmenopausal women is known to be associated with levels of sex hormones such as estrogens, the factors that determine the levels of these hormones are not well understood. While obesity is thought to increase the risk of cancer through its association with high levels of estrogen, it is unclear how other risk factors affect sex hormone levels.”

The researchers preformed an analysis that combined the results of thirteen previously completed studies of 6,000 women who did not have breast cancer to see how their hormone levels were related to age, alcohol and cigarette use, and weight.

The BBC study, which was published in the British Journal of Cancer, concluded that “Compared to slim women, the hormone levels, chiefly the estrogen hormones, were higher in overweight women.” The study also found that women who drink two or more alcoholic drinks a day, or who smoked 15 or more cigarettes a day, had higher hormone levels.

Although the findings give weight to the importance of maintaining a healthy weight, it should be noted that because the factors were analyzed at only a single point in time, the study does not take into account how factors such as lifestyle changes and health issues are related to each other. For example, the study cannot prove whether or not the rise in a woman’s hormone levels causes weight gain, or if a woman’s weight gain causes a rise in hormone levels.

The study did not analyze data on women with cancer, instead it focused on whether obesity and lifestyles were related to hormone levels which can increase cancer risk.

Obesity Surgery Tied to Lower Diabetes Risk in Pregnancy

NEW YORK (Reuters Health) - Severely obese women who undergo weight-loss surgery may have a decreased risk of developing diabetes during future pregnancies, a new study suggests.

Researchers found that among 700 women who had undergone obesity surgery, those who'd had the procedure before becoming pregnant were 77 percent less likely to develop pregnancy-related diabetes than those who'd had a pregnancy before their surgery. They also had a lower rate of cesarean section.

The findings, published in the Journal of the American College of Surgeons, add to evidence of the potential health benefits of weight-loss surgery.

Research has shown that the surgery, which restricts the amount of food a person can eat, can spur substantial weight loss and help control obesity-related conditions like type 2 diabetes.

Studies have come to conflicting conclusions, however, regarding the effects on gestational diabetes, a form of the disorder that arises during pregnancy.

While gestational diabetes usually resolves after childbirth, during pregnancy it may cause the fetus to grow abnormally large, which can make a C-section or forceps necessary and raise the risk of postpartum bleeding. Women who develop gestational diabetes are also at increased risk of type 2 diabetes later in life.

For the new study, Dr. Anne E. Burke and colleagues at Johns Hopkins University in Baltimore reviewed insurance records of 23,594 U.S. women who had undergone obesity surgery between 2002 and 2006.

Of those women, 346 had given birth during that same time period, but before having the surgery; another 354 had given birth after the surgery—typically about 20 months later.

Most had undergone gastric bypass, in which the upper portion of the stomach is stapled off to create a small pouch that restricts the amount of food a person can eat at one time. The surgeon also creates a bypass around the rest of the stomach and a portion of the small intestine, which limits the body's absorption of food.

A minority—42 women overall—had undergone gastric banding, where an adjustable band is used to create the pouch at the upper part of the stomach.

Burke's team found that among women who had delivered before weight-loss surgery, 27 percent developed gestational diabetes during the pregnancy. That compared with eight percent of those who'd delivered after their surgery.

Similarly, the rate of C-section was lower in the latter group: 28 percent versus 43 percent.

The researchers then factored in two other variables: the women's age and whether they had ever had a C-section in the past, which raises the odds of having one in subsequent pregnancies. With those factors considered, obesity surgery was linked to a 77 percent reduction in the risk of gestational diabetes and a 52 percent decrease in the odds of C-section.

The findings "add to a growing body of evidence in favor of a protective effect" of weight-loss surgery against gestational diabetes and C-section, Burke told Reuters Health.

However, she added, "I do not think this is saying that obese women need to delay pregnancy until after having this surgery."

For one, only certain, severely obese women would be candidates for the procedure. Moreover, Burke pointed out, women should first try to shed weight through diet and exercise before turning to surgery.

The study has limitations, the researchers acknowledge. Chief among them is the fact that it was a review of insurance records, rather than a controlled study where women were recruited and then followed over time to compare the pregnancy outcomes of those who had obesity surgery with those who did not.

According to Burke, it would be difficult, for both practical and ethical reasons, to conduct a randomized, clinical trial -- in which women would be randomly assigned to have weight-loss surgery either before or after a pregnancy.

But, she noted, it would be more feasible to do a study where women were followed over time to look at the pregnancy outcomes of women who chose to have weight-loss surgery and those who did not.

In general, weight-loss surgery may be an option for people with a body mass index (BMI) of 40 or higher, which puts them in the category of severe obesity. It may also be an option for people who are less severely obese but have chronic medical conditions like type 2 diabetes or high blood pressure.

The risks include short-term complications from surgery, like serious bleeding, infection and blood clots; longer-term risks include vitamin and mineral deficiencies and hernia development. And an estimated 10 percent of patients have an unsatisfactory weight loss or eventually regain much of the weight they had shed.

An estimated 220,000 Americans underwent some form of weight-loss surgery, most often gastric bypass, in 2009, according to the American Society for Metabolic & Bariatric Surgery.

On average, the procedures cost about $20,000 to $25,000. Whether surgery is a cost-effective way to prevent gestational diabetes is a question for future research, according to Burke's team.

A study published last month found that weight-loss surgery may curb the costs of managing type 2 diabetes.

The study, which examined insurance claims of more than 2,200 weight-loss surgery patients, found that among those with diabetes before the surgery, only 15 percent were still taking diabetes medications two years after the procedure. (See Reuters Health story of August 16, 2010.)

Diabetic patients' yearly healthcare costs averaged nearly $6,400 in the two years before surgery; the typical cost of the surgery plus hospitalization was almost $30,000.

The researchers concluded that because the weight loss won by surgery can be maintained for years, the procedure could be cost-saving in the long run for people with type 2 diabetes.

SOURCE: http://link.reuters.com/kub83p Journal of the American College of Surgeons, August 2010.