DIET Thin people may be fat inside
Fri, 11 May 2007 00:15:53 GMTBy MARIA CHENG, AP Medical Writer
LONDON - If it really is what's on the inside that counts, then a lot of thin people might be in trouble. Some doctors now think that the internal fat surrounding vital organs like the heart, liver or pancreas — invisible to the naked eye — could be as dangerous as the more obvious external fat that bulges underneath the skin.
"Being thin doesn't automatically mean you're not fat," said Dr. Jimmy Bell, a professor of molecular imaging at Imperial College, London. Since 1994, Bell and his team have scanned nearly 800 people with MRI machines to create "fat maps" showing where people store fat.
According to the data, people who maintain their weight through diet rather than exercise are likely to have major deposits of internal fat, even if they are otherwise slim. "The whole concept of being fat needs to be redefined," said Bell, whose research is funded by Britain's Medical Research Council.
Without a clear warning signal — like a rounder middle — doctors worry that thin people may be lulled into falsely assuming that because they're not overweight, they're healthy.
"Just because someone is lean doesn't make them immune to diabetes or other risk factors for heart disease," said Dr. Louis Teichholz, chief of cardiology at Hackensack Hospital in New Jersey, who was not involved in Bell's research.
Even people with normal Body Mass Index scores — a standard obesity measure that divides your weight by the square of your height — can have surprising levels of fat deposits inside.
Of the women scanned by Bell and his colleagues, as many as 45 percent of those with normal BMI scores actually had excessive levels of internal fat. Among men, the percentage was nearly 60 percent.
Relating the news to what Bell calls "TOFIs" — people who are "thin outside, fat inside" — is rarely uneventful. "The thinner people are, the bigger the surprise," he said, adding the researchers even found TOFIs among people who are professional models.
According to Bell, people who are fat on the inside are essentially on the threshold of being obese. They eat too many fatty, sugary foods — and exercise too little to work it off — but they are not eating enough to actually be fat. Scientists believe we naturally accumulate fat around the belly first, but at some point, the body may start storing it elsewhere.
Still, most experts believe that being of normal weight is an indicator of good health, and that BMI is a reliable measurement.
"BMI won't give you the exact indication of where fat is, but it's a useful clinical tool," said Dr. Toni Steer, a nutritionist at Britain's Medical Research Council.
Doctors are unsure about the exact dangers of internal fat, but some suspect it contributes to the risk of heart disease and diabetes. They theorize that internal fat disrupts the body's communication systems. The fat enveloping internal organs might be sending the body mistaken chemical signals to store fat inside organs like the liver or pancreas. This could ultimately lead to insulin resistance, type 2 diabetes, or heart disease.
Experts have long known that fat, active people can be healthier than their skinny, inactive counterparts. "Normal-weight persons who are sedentary and unfit are at much higher risk for mortality than obese persons who are active and fit," said Dr. Steven Blair, an obesity expert at the University of South Carolina.
For example, despite their ripples of fat, super-sized Sumo wrestlers probably have a better metabolic profile than some of their slim, sedentary spectators, Bell said. That's because the wrestlers' fat is primarily stored under the skin, not streaking throughout their vital organs and muscles.
The good news is that internal fat can be easily burned off through exercise or even by improving your diet. "Even if you don't see it on your bathroom scale, caloric restriction and physical exercise have an aggressive effect on visceral fat," said Dr. Bob Ross, an obesity expert at Queen's University in Canada.
Because many factors contribute to heart disease, Teichholz says it's difficult to determine the precise danger of internal fat — though it certainly doesn't help.
"Obesity is a risk factor, but it's lower down on the totem pole of risk factors," he said, explaining that whether or not people smoke, their family histories and blood pressure and cholesterol rates are more important determinants than both external and internal fat.
When it comes to being fit, experts say there is no short-cut. "If you just want to look thin, then maybe dieting is enough," Bell said. "But if you want to actually be healthy, then exercise has to be an important component of your lifestyle."
FDA panel wants more anemia drug studies
Fri, 11 May 2007 00:21:04 GMTBY MATTHEW PERRONE, AP Business Writer
SILVER SPRING, Md. - Two months after federal regulators ordered additional warnings be added to the labels of blockbuster anemia drugs, government advisers said Thursday Amgen Inc. and Johnson & Johnson should be required to add more warnings and conduct additional safety studies.
The Food and Drug Administration's outside panel of experts voted overwhelmingly in favor of expanding warnings about the risks of death, blood clots and other side effects for Amgen's Aranesp and Johnson & Johnson's Procrit.
Wall Street analysts said prior to the meeting that the biggest threat to the revenue the companies get from these drugs would be if panelists wanted to add warning labels that would limit prescribing the drugs to certain patients.
Shares of Amgen rose 47 cents to $57.80 in after-hours trading after ending the trading session down $5.77, or 9.1 percent, to $57.33. Johnson & Johnson shares rose 40 cents in after- hours trading to $62.90 and ended the trading session down $1.61, or 2.5 percent, to close at $62.50.
A drop in anemia drug sales would pose a much larger challenge to biotech maker Amgen than to diversified competitor Johnson & Johnson. Last year Aranesp was Amgen's best-selling product with sales of $4.1 billion, or nearly 30 percent of full-year revenue. When combined with Epogen, a version of the drug used only in kidney failure patients on dialysis, the medication accounts for more than half of Amgen's annual sales.
The panel of experts, at a meeting in a hotel here, also voted unanimously that the companies should be required to conduct new studies to definitively prove the safety of the two widely prescribed drugs. Anemia drugs accounted for $10 billion in revenue for these two companies last year alone.
The FDA is not required to follow the panel's recommendations although it typically does.
Johnson & Johnson and Amgen have conducted more than a dozen studies of the drugs to date although panelists Thursday said what is needed is a large, comprehensive study of whether people who take the drugs die sooner than those who don't.
In March, the FDA ordered warnings be added to the drugs' labels after recent studies showed using the drugs outside of approved guidelines could increase the growth of tumors and the risk of death in some patients.
It was not made clear during Thursday's meeting whether the additional warnings favored by panelists would apply to all uses of the drugs or just non-approved use.
Many physicians prescribe anemia drugs aggressively to raise their patients' red blood cell levels to that of a healthy person, believing the higher red blood cell levels improves quality of life.
In presentations to the panel Thursday, FDA staff focused on four studies suggesting overprescribing or prescribing for unapproved uses could in fact increase a patient's risk of death.
Still, a majority of panelists voted against requesting that product packaging be changed to recommended lower dosing levels.
"We will be working with the FDA as they consider the committee's recommendations," said Amgen spokeswoman Tricia Hawkins.
A spokeswoman for Johnson & Johnson stressed that the company has not seen negative side effects from its drug when used as directed.
"When used according to the label, Procrit is safe and effective, and has an acceptable risk-benefit profile," said J&J's Stephanie Fagan.
Aranesp and Procrit are man-made versions of a naturally occurring protein that increases production of red blood cells. The drugs are approved to treat the blood disorder anemia when it is caused by chemotherapy and kidney disease.
FDA's meeting did not address use of the drugs in kidney patients. The agency said it would hold a seperate meeting on that issue in the fall.
Aftershocks from the newest recommendations could be felt later this year as the Center for Medicare and Medicaid Services reconsiders when and how much it pays for anemia drugs. The agency, which provides health care to more than 80 million Americans, has said it will use FDA's analysis of the drugs' safety in its reassessment.
Medicare officials have already told local plan providers they can stop paying for Aranesp and Procrit when used in cancer patients who are not on chemotherapy because that use is not government approved. Amgen said last month that action alone would probably cost the company $500 million in sales this year.
While it's difficult to predict what additional payment changes might be made, analysts worry the agency could stop paying for the drugs under certain circumstances. Medicare officials are scheduled to release preliminary guidelines in September.
Suicide risk said higher for veterans
Fri, 11 May 2007 00:08:14 GMTBy HOPE YEN, Associated Press Writer
WASHINGTON - Veterans returning from http://www.va.gov
FTC says milk ads under fire are ending
Fri, 11 May 2007 00:20:06 GMTBy JENNIFER C. KERR, Associated Press Writer
WASHINGTON - An ad campaign that suggested milk can help people lose weight is ending, the Federal Trade Commission told a doctors' group that had complained.
The Physicians Committee for Responsible Medicine contended the weight loss claims were false and misleading. The group, in a 2005 petition, asked the commission to order a halt to the dairy advertisements.
The agency did not take that step, but said in a letter to the committee that the groups behind the ads planned to end them.
"It is obvious that the industry did not have a leg to stand on," Neal Barnard, president of the Washington-based doctors committee, said Thursday. His group advocates a vegan diet, which typically includes no animal products.
The two marketing campaigns at issue involve the "Milk your diet. Lose Weight!" ads on television, Internet and in magazines, and the "3-A-Day. Burn More Fat, Lose Weight" ads, which are now mostly Web-based.
The FTC, in a letter May 3 to the committee, said the agency met with Agriculture Department officials and representatives for the two campaigns, which decided "to discontinue all advertising and other marketing activities involving weight loss claims until further research provides stronger, more conclusive evidence."
Susan Ruland, a spokeswoman for the "Milk your Diet" campaign, said there was nothing misleading about the ads.
"We absolutely stand behind our weight loss campaign and the science supporting our messages," said Ruland, who represents the National Fluid Milk Processor Promotion Board. "There's a strong body of scientific evidence that demonstrates a connection between dairy and weight loss."
Still, she said, the board plans to phase out the milk ads and focus the campaign instead on how dairy can help promote a healthy diet.
The National Dairy Promotion and Research Board said it has already changed its "3-A-Day" campaign.
The Agriculture Department, which has oversight of the two boards, had approved the ads. A spokesman said the agency supports the decision to pull back from the campaigns.
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On the Net:
Physicians Committee for Responsible Medicine: http://www.pcrm.org
Agriculture Department: http://www.usda.gov
Federal Trade Commission: http://www.ftc.gov/
