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Ms. Gloria Fleming and Dr. George Bray

Patient: Gloria Fleming, Saint Gabriel, LA
Clinician: George Bray, M.D., Chief, Clinical Obesity and Metabolic Diseases (Diabetes), Pennington Biomedical Research Center, Louisiana State University
Specialty: Clinical Research

Twenty-five years ago, Gloria Fleming had a feeling that something was wrong with her health. She was tired all the time, even after a good night’s sleep, and was constantly thirsty. An active woman with young children, Gloria immediately took her complaints to her primary care physician. What she heard was something that more than five members of her family had heard over the years, “You have diabetes.”

Familiar with diabetes, she took the diagnosis in stride. After all, she had seen so many family members, including her mother, living with diabetes that surely being diagnosed with diabetes was more of a nuisance than a wake-up call. Consequently, she continued with her lifestyle of eating greasy and fatty foods and not exercising regularly. “I was a big eater. I ate large portions of bad foods. And because I was never put on insulin, it was easy to ignore the diabetes.”

As time went on, Gloria’s diabetes became more of a problem, forcing her primary care physician to put her on a three-drug diabetes therapy to control her blood sugar. For Gloria, diabetes medication was sufficient to manage her disease and she relied on the medications to “do all the work,” despite the challenging side effects. Exercise and diet were still not a large part of her life.

Then, about three years ago, Gloria was watching television and saw an ad looking for volunteers to participate in a diabetes clinical trial. Gloria consulted with her primary care physician and together they agreed that participating could bring some tangible and positive results to Gloria’s diabetes treatment. Gloria later found out that she was a participant in “Look AHEAD,” a National Institutes of Health-funded, multi-center trial examining the effect of lifestyle interventions on weight loss and management and overall health risk in those with diabetes.

One of the primary investigators of the Look AHEAD trial is Dr. George Bray, an endocrinologist who has dedicated his professional career to understanding the role of diabetes and obesity. He leads one of the 16 centers involved in the 10-year diabetes trial and monitors changes among each of the 343 diabetes trial participants. Specifically, Dr. Bray and his colleagues are looking at whether or not intervention, through diabetes prescription medication, intensive exercise, behavior modification or diet modification, will help trial participants achieve a 10 percent or more weight loss, and ultimately live longer with diabetes and/or reduce their risk for developing heart disease.

“It’s a research trial looking at lifestyle interventions as a way to see if people with diabetes can benefit long term from weight loss,” says Dr. Bray. “This diabetes trial is very important because we need clinical evidence to show that weight loss isn’t just a good idea, it is, for many, a life-saving requirement.”

Clinical and observational diabetes trials are vital to guiding physicians and other healthcare providers to appropriate and effective treatments. For those with obesity-related diseases like Gloria, research is looking beyond a patient’s caloric intake levels and into the realm of interlinking systemic disorders. What makes someone with diabetes more at risk for heart disease? What role does obesity play? Can one really extend their life expectancy if they achieve weight loss of 10 percent of their body weight? Long-term studies like the Look AHEAD diabetes trial are critical to bringing light to these issues and their possible solutions.

Gloria’s participation in the diabetes and weight loss/management trial means regular check-ins with Dr. Bray and his team, blood work, food measurement, an exercise routine and group discussions among those in her treatment group – all in addition to continued care from her primary care physician.

“I wanted to be in the trial because I knew it was going to be good for me,” says Gloria. “But the encouragement and enthusiasm I was getting from Dr. Bray and his team,” (which includes nurses, behaviorists, psychologists, registered dietitian and exercise physiologists), “made me want to improve for them too. They put so much into the program – they really want you to succeed. So I knew that I had to do my homework or else I’d be letting them, the group and myself down. The trial is like a family and we all support and cheer each other on.”

For Gloria, this diabetes trial has changed her life. In the two years that she’s been a Look AHEAD participant, Gloria has achieved more than just physical improvements – she has regained her sense of self and what it means to have control over your diabetes and your health.

The changes haven’t been easy. “In the beginning,” said Gloria, “my moods and enthusiasm levels were on a roller coaster. I was up, then down, then up again. It was tough and I know I wasn’t any fun to be around. But after a few months, my health and my moods calmed down and I was fun to be around again.”

To date, Gloria has achieved weight loss of 25 pounds and has been taken off two of her three diabetes medications. Her blood levels are consistently at normal levels and she is physically satiated with smaller meals. Gone are the big-portioned meals of fried foods. She can now eat less and still be satisfied.

“If I hadn’t been in this program, I’d still be making the wrong choices. I’m 66-years-old, and I want to live long enough to see my grandchildren graduate from college, and enjoy life in the process. I’m happy to say that because of this trial, my biggest problem isn’t my health anymore, it’s what to do with all those clothes in my closet that don’t fit!”

Ms. Leslie Sutton and Dr. Kathryn Martin

Patient: Leslie Sutton, Boca Raton, FL
Clinician: Kathryn Martin, M.D., Massachusetts General Hospital, Boston, MA
Specialty: Reproductive Endocrinology

At 5’6” and 135 lbs., Leslie Sutton, 41, doesn’t look like someone with an obesity problem. But Leslie’s current weight loss maintenance and positive attitude are the result of hard work and a 12-year partnership with her endocrinologist, Dr. Kathryn Martin.

Leslie has polycystic ovary syndrome or PCOS. PCOS is a hormone disorder characterized by irregular menstrual periods, a high level of androgens, or “male” hormones, and the presence on ultrasound of multiple small cysts on the ovaries.

Women with PCOS are often labeled with obesity, may have unusual or excessive hair growth (also known as hirsutism), and are at increased risk for insulin resistance, diabetes,and fertility problems.

For Leslie, the problems began with her first period. “I was 12 or 13 when I got my first period and my whole body just went wacky,” she says. “I was gaining weight. I had horrible acne and was growing this hair and getting really depressed. It was awful.”

Unfortunately for Leslie, her condition began at a time when little was known about PCOS. She recalls one of her first physicians explaining that her problem with PCOS was hormonal, but that was all the information he was able to provide. Without answers, Leslie spent the next decade struggling with weight loss issues and spiraling self-esteem. By the time she graduated from college and married, she was desperate for help.

“I grew up in New York and was very involved in theater. In the years after my periods started, I went from being this outgoing, warm, intelligent girl to a very shy, overweight woman with an eating disorder. I lived in a cloistered world. I couldn’t go on auditions. It was all so overwhelming.”

Encouraged by her family and friends, Leslie started to seek out doctors who could help. By her own estimate, she saw nearly 20 different doctors in her search for answers. She had physical exams, psychiatric evaluations and saw a series of specialists. According to Leslie, early tests showed slight differences in her hormone levels, but the science at the time was not yet honed enough to detect PCOS.

Then, as a young wife struggling to conceive, a fertility specialist finally put a name to her condition. For Leslie, learning she had PCOS was just the beginning. She still needed information on how to manage PCOS.

“My heaviest weight was 240 and five years after having my twins, I still weighed around 200 lbs.,” she says. “So, I went back to the endocrine experts at Massachusetts General Hospital and they sent me to Dr. Martin.”

“Leslie really wanted answers,” says Dr. Martin. “Although fertility was no longer an issue, she was very concerned about her weight, acne, and hirsutism.” According to Dr. Martin, Leslie’s obesity also put her at risk fordiabetes and other problems high cholesterol , hypertensionthyroid disease. Together, Dr. Martin and Leslie began to address her medical problems and weight loss treatment needs, and Leslie also found some much needed understanding.

“PCOS is so personal for women. You almost don’t feel like a woman. You have facial hair and you feel fat and ugly and no one seems to know what to do with you,” she says. “Finding Dr. Martin literally changed my life. No other doctor knew what Dr. Martin knew back then. She was awesome. She listened to me. She stays up on the research and enabled me to have a comprehensive plan for my recovery. For me that’s what it was, a recovery.”

While she considers her PCOS and obesity situation a “recovery,” it’s important to note that polycystic ovary syndrome is a life-long condition that needs constant attention. In fact, Dr. Martin coordinated a team of specialists who helped Leslie address her obesity, skin care and emotional needs. Leslie worked with dieticians, psychopharmacologists, dermatologists and her Ob/Gyn. Together, Leslie and Dr. Martin also reviewed new research, evaluated options and tried alternative approaches to managing and treating Leslie’s PCOS and obesity issues.

“At first, Leslie was more dependent on my advice, but over time she became her own best advocate,” says Dr. Martin. “She does research and participates in support groups, and she’s worked very, very hard to manage her weight. She looks absolutely wonderful.”

Leslie joined Overeaters Anonymous, saw a dietician, and took medicines to control her hormones and other aspects of PCOS. This combination of approaches worked. Leslie was successful in her weight loss efforts and is now at a clinically healthy weight and has avoided typical PCOS complications like diabetes and high cholesterol.

“Obesity and PCOS are related – so managing the obesity made it easier to deal with Leslie’s care of her polycystic ovary syndrome,” says Dr. Martin. “There’s no single answer for every PCOS patient, so it’s important that women see a specialist, an endocrinologist, who has experience treating the disorder.”

Today, Leslie is a healthy, happy mother of two who devotes much of her time volunteering as a mentor to young women who, like her, have struggled with weight loss and body image. She says having a daughter has only reinforced her belief in how important it is to be healthy and to work with the right kind of healthcare team that helps to approach difficult problems head on.

“Dr. Martin and I have a relationship. She is kind, gentle and passionate. Her supportive energy and knowledge of PCOS really helped me.”
Despite having left Boston for the sunnier climate of Florida, Leslie still sees Dr. Martin regularly, although it now requires a plane ticket to make her appointments.

Adults, Especially Women, Have Calorie-Burning “Brown Fat”

For Release: June 11, 2009

Contact: Arlyn G. Riskind
Director, Media Relations
Phone: (301) 941-0240

ariskind@endo-society.org
Contact: Aaron Lohr
Manager, Media Relations
Phone: (240) 482-1380
alohr@endo-society.org

Adults, Especially Women, Have Calorie-Burning “Brown Fat”

Keeping your baby fat turns out to be a good thing, as long as it is “brown fat”—the kind that burns calories, according to a study that found adults have much more of this type of fat than previously thought. The results, which suggest a new way to treat obesity, were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

Brown fat burns off calories and generates heat in babies and small mammals. Most of our body fat is white fat, which also provides insulation but stores calories. It becomes “bad” fat when you have too much. The “good” fat—brown fat—was considered essentially nonexistent in human adults.

“We now know that it is present and functional in adults,” said the study’s lead author, Aaron Cypess, MD, PhD, MMSc, of the Joslin Diabetes Center in Boston. “Three ounces of brown fat can burn several hundred calories a day.”

For the first time, the researchers were able to measure patches of brown adipose tissue—brown fat—in people, thanks to a high-tech imaging method that combines positron emission tomography and computed tomography, called PET/CT. By evaluating biopsy tissue of what appeared to be brown fat on PET/CT scans in some patients who had neck surgery, the authors confirmed that they were, indeed, looking at stores of brown fat. More than 1,970 study participants had PET/CT scans, from mid-skull to mid-thigh.

Brown fat (when it could be detected) was located in an area extending from the front of the neck to the chest. Of the subjects who had detectable brown fat, about 6 percent had 3 ounces or more of the fat.

“We believe that this percentage greatly underestimates the number of adults in the population who have a large amount of brown fat,” said Cypess, whose results were published in the April 9 issue of the New England Journal of Medicine, along with those of two other independent studies of brown fat in adults.

That is because one of the other studies found that PET/CT can detect much more brown fat if people are in a room cooled to 61°F. Likewise, Cypess and his colleagues found that people who underwent PET/CT in the winter had more brown fat activity than those scanned in the summer.

They also discovered that brown fat is most abundant in young women and least frequent in older, overweight men. In fact, women were more than twice as likely as men to have substantial amounts of brown fat.

“One theory for this is that women may have less muscle mass overall, so they need more brown fat to generate heat and keep warm,” Cypess said.

Brown fat provides a new focus for developing treatments protecting against obesity and its complications, according to Cypess. However, it may not be enough to lose weight to just have brown fat. The researcher said, “We may have to turn it on and make sure it burns calories in a regulated, safe manner.”

Ms. Donna Marie Bloomquest and Dr. Henry Anhalt

Patient: Donna Marie Bloomquest, Brooklyn, NY
Clinician: Henry Anhalt, M.D., Infants and Children’s Hospital of Brooklyn at Maimonides; SUNY Downstate
Specialty: Pediatric Endocrinology - Childhood Obesity

Approximately three years ago, nine-year-old Donna Marie Bloomquest began to gain weight unexplainably. Not an overeater or one to be sedentary, Donna Marie’s body was suddenly changing for no apparent reason. She was embarrassed, confused and fearful that she had done something wrong to cause this change. Within one year, she had gained an astonishing 20 pounds.

Her mother, Christine, became very concerned about Donna Marie’s weight gain, turning to her daughter’s pediatrician for answers. Unfortunately, Donna Marie’s pediatrician did not diagnose her condition as characteristic ofmetabolic syndrome and the youngster’s weight continued to climb.

A referral from a friend resulted in both mother and daughter visiting with a specialist – an endocrinologist named Dr. Henry Anhalt. Dr. Anhalt’s “Kids Weight-Down” program caters to the specific needs of overweight children, childhood (pediatric) obesity, and their families. Designed to address all elements of a person’s weight loss – overall health, diet, lifestyle, etc. – this 12-week-long program incorporates the input from nutritionists and psychologists as well an endocrine team to customize each child’s program.

At the first appointment, Dr. Anhalt noticed a ring around the back of Donna Marie’s neck – a tell-tail sign that she had severe insulin resistance – and quickly diagnosed her with Type 2 diabetes , dyslipidemia (elements of the metabolic syndrome) and hypothyroidism. Donna Marie weighed 140 pounds.

In addition to a regimen of Metformin® twice a day and obesity medications designed to reduce her lipid levels and treat Donna Marie’s thyroid disease,hypothyroidism, she actively participated in Dr. Anhalt’s “Kids Weight-Down” program for weight loss. With her mother’s support, Donna Marie met with behavioral therapists and nutritionists who assessed her childhood (pediatric) obesity situation, identified reachable goals and developed a customized weight loss program.

Donna Marie emerged from the weight loss program with stronger eating and living habits, and has been able to wrangle her blood sugar to normal levels (without needing insulin typically needed with diabetes), while getting her lipid and thyroid hormone levels under control.

Despite Donna’s improved health profile now, she currently weighs 180 pounds and continues to gain weight – an issue being addressed by Dr. Anhalt and his team during Donna’s monthly check-in appointments.

Her mother says that while the teasing Donna Marie experiences at school hurts her, the youngster is determined to be successful in weight loss and is very receptive to treatment – she even asked her mother for a treadmill for Christmas.

The changes in Donna Marie’s life to cope with her thyroid disease (hypothyroidism) and related childhood (pediatric) obesity issues are not easy and require lifestyle modifications by the whole family. Christine is a vegetarian who lives for carbohydrates – mostly pasta and bread. Now, she has to sneak them. But Christine is grateful that her daughter is learning how to manage her thyroid disease (hypothyroidism) condition rather than risk developing an eating disorder down the road as a remedy to her weight loss issue.

“In order for a patient to really benefit long-term from obesity treatment, they need life-long support systems in place,” says Dr. Anhalt. “Most patients, especially children, need reinforcement to maintain the lifestyle changes necessary to regain what’s been lost as a result of obesity. Each child should be treated based on their own unique needs.”

Christine, a single mom, recommends that any mother who sees changes in their children’s weight should immediately seek out the care of an endocrinologist. She says that her daughter’s pediatrician was a barrier to Donna Marie’s hypothyroidism diagnosis and, she feels, may have actually cost her valuable treatment time.

Christine wants people to think about obesity and its causes before they judge the way others look. Acknowledging the looks people give her daughter, she challenges others to consider the possibility that people may be obese because of a medical condition (like thyroid disease, hypothyroidism), not just because they “sit at home and stuff their faces.”

Donna Marie’s health and childhood (pediatric) obesity issues are slowly improving and she hopes to get back to looking “normal.” Although she faces a lifetime of obesity medication, especially for her thyroid disease (hypothyroidism) condition, Donna Marie continues to fight childhood (pediatric) obesity, maintaining a positive outlook and remaining vigilant in her weight loss and treatment.