ct scanner

How does a CT Scanner Work?

One of the benefits of being a patient at the Medical and Surgical Clinic of Irving is access to our extensive network of specialty providers and other services. Because of this network, patients can quickly get the care they need. Your doctor may assign various tests, including CT scans, depending on your health needs. If your doctor requests a CT scan, you might be wondering what exactly is a CT scan? You might know what a CT scanner does, but you don’t know how it works. We’re here to explain the basics of how a CT scanner works.

A CT scanner is a complicated piece of technology, but it does an amazing job identifying potential maladies in the body by using x-ray imaging and computer imaging. Unlike a traditional x-ray, which only uses one beam, a CT scanner sends out countless beams. Another difference between an x-ray and CT scanner is how the machine sees into the body. Using the multiple beams, the CT scanner uses an x-ray detector that reads different levels of densities. This is another difference between an x-ray scanner and CT scanner: unlike an x-ray, which is great at seeing one density, a CT scanner uses its wider spectrum to create 3D cross-sections of whatever part of your body that needs to be scanned.

Depending on your needs, a doctor might use contrast dye, as this helps the CT scanner get a much clearer image. Additionally, if your doctor needs to see into your abdomen, they might request you use barium. This is usually ingested, typically the night before, to allow the substance to reach your stomach and intestines. If the scan is looking at your blood vessels, the barium might be injected. This might cause a tingling sensation.

Our CT scan allows patients to lay down on a table. The table slides through the x-ray detector. You will usually be asked to hold your breath as the CT scanner works to keep the image focused and still. This may be repeated a few times in order to get the proper image. This process should be comfortable for you, but if you have any discomfort or if you feel anxious at all, please inform the technician.

A CT scanner is a powerful tool for doctors to help find problems and make sure your body is functioning correctly. If your doctor has requested a CT scan, you now know how a CT scanner works and can feel a bit more relaxed as you undergo this diagnostic procedure.


Three Medical Appointments to Make in 2017

2017 is just getting started. A new year is always a great time to start fresh and do the things that you have been putting off doing. Because your health is the most important thing, the beginning of the year is a perfect time to schedule medical appointments. At the Medical and Surgical Clinic of Irving, we offer over 20 specialties to help you achieve better health.

Here are three appointments you should consider making in 2017 to start your year off with a clean bill of health!

  • Schedule a physical

A physical exam is a general examination that your general care physician performs. A physical exam is designed to screen for certain diseases, look for potential problems in your future, check on your vaccinations, and give you a general sense of the healthiness of your current lifestyle. Getting regular physicals helps you in the long run by detecting potential problems early enough to do something. Because of a physical’s importance, insurance provided through the Affordable Care Act (ACA or Obamacare) cover a physical every year. There’s no reason not to get a physical at that point!

  • Visit an Ophthalmologist

Are you having problems with your eyes? Even if you can see clearly and feel like you have no problem with your eyes, experts recommend that you visit the eye doctor every or every other year, depending on your age and family history with eye problems. Particular groups that should see an ophthalmologist regularly are elderly and schoolchildren. In fact, you should take your child to the eye doctor by the time they turn 6 months, as recommended by the American Optometric Association (AOA). You might even take your child for their first visit earlier if they have any risk factors, such as a premature birth, developmental delays, or other birth complications. The AOA also recommends that adults over the age of 61 visit the ophthalmologist every year.

  • Reduce the discomfort by seeing an allergist

If you have problems with allergies, seeing an allergist can make a huge difference in your life. After being referred to an allergist by your doctor, your Irving specialist will most likely recommend an allergy test to identify specific allergens that cause you discomfort. Depending on the results of the test, your doctor may recommend allergy shots. Allergy shots do not “cure” allergic reactions, as there is no cure for allergies; however, allergy shots allow your body to get used to allergens and reduce the symptoms. If you are suffering from allergies and over-the-counter medicine does not provide relief, consider talking to your doctor today about it.


Seeing the right specialist regularly can make all the difference in detecting disease, improve your health, and ultimately better your quality of life. Additional procedures you should consider include:

  • Annual Well Women exams at the OB/GYN or your primary care physician.
  • Colonoscopies for adults and individuals at risk for colon cancer with your gastroenterologist
  • Mammograms for women
  • Bone Density testing for osteoporosis
  • Dental cleanings
  • Hearing tests
  • Dermatologist visits to check for skin cancer

If you are searching for an Irving specialist, you can turn to the team at the Medical and Surgical Clinic of Irving. Our team of professionals offer over 20 different types of medical specialties. At the very least, if you haven’t seen the doctor in a while, consider scheduling a routine check-up and getting a physical. Get to know our doctors by clicking here.


Weight-Loss Bonus: Costs for Obesity-Related Meds Drop

Marlene Busko
November 18, 2013

Obese patients who successfully shed pounds by following a medical weight-loss program may reap the reward of lower medication costs for common comorbidities, new research suggests. The single-center, retrospective study was presented in an oral presentation at Obesity 2013: The Obesity Society Annual Scientific Meeting.

After following the program for an average of 22 weeks, patients who typically had a starting weight of about 250 pounds lost about 44 pounds. They also spent, on average, $70 less a month for medications for 4 common comorbidities: diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD).

This shows that “weight loss in a medically supervised setting has the potential to significantly decrease the medication expenses associated with obesity comorbidities, most of all diabetes,” Clay P. Wiske, a medical student currently at Harvard Business School, in Boston, Massachusetts, told the audience.

“There hasn’t been very much published on the cost of medical weight-management programs…partly because [the programs are] not very homogeneous,” senior author Vincent Pera, MD, from Brown University in Providence, Rhode Island, told Medscape Medical News. “My guess is that no matter how the weight loss is achieved [including by bariatric surgery], you would see these kinds of benefits in medication reduction.”

The research was about “medication cost savings” as opposed to “cost-effectiveness,” he acknowledged, and the calculations did not include the cost of participating in the 5-month program, which was about $2000 per patient. About 2 or 3 insurance companies cover the entire cost, he noted.

The latest obesity guidelines, issued by the Obesity Society last week, stress medically supervised programs as a central tenet for successful weight loss, emphasizing that the evidence shows patients need help to shed the pounds. However, this type of program is very poorly reimbursed at present, at least by the Centers for Medicaid & Medicare Services (CMS) — at a rate of around $20 a visit. Coverage of such programs by private insurers in the United States is patchy; it is hoped the new recommendations will encourage more of them to reimburse such schemes.
Can “Low-Risk” Strategies Cut Costs?

Mr. Wiske told the audience that because many recent studies have looked at potential cost savings following bariatric surgery, “we were curious to see whether we would see savings with interventions that were less risky, such as medically supervised weight loss.”

On average, an obese adult living in the United States pays an estimated $2460 more in annual healthcare costs than his or her thinner counterparts, he said. The researchers hypothesized that the medically supervised weight-loss program offered at the Merriam Hospital in Providence, Rhode Island would lead to a decrease in medication costs.

They retrospectively analyzed data from 589 obese patients who participated in this program between 2009 and 2012 and, importantly, completed at least 16 weeks of treatment.

The patients had a mean age of 49 years and 70% were women. When they entered the program, they were taking an average of 4.6 medications, of which 1.6 were for the studied 4 comorbidities.

At baseline, half of the patients had hypertension, 47% had hyperlipidemia, 44% had GERD, and 20% had diabetes. Some patients did not have any of these comorbidities.

When they enrolled, the patients received counseling about 3 types of 1200-calorie-a day meals:

  • Complete meal replacement.
  • 800 calories from meal replacements plus one “regular” meal.
  • No meal replacements, but instead, a tailored, healthy diet.

The meal replacements were Optifast (Nestle) products, most commonly shakes, said Mr. Wiske. About 20% of patients did not take meal replacements, and the rest were split between the 2 types of meal-replacement plans.
All patients were offered weekly physician visits, weekly weigh-ins, counseling sessions with a dietician and an exercise physiologist, plus group education and discussion sessions.

On average, the patients lost about 17.5% of their initial body weight. The weight loss and medication reduction were similar for the patients in the 3 groups.

The average overall monthly wholesale cost of the studied medications fell from $150 to $77, with the largest reduction coming from the drop in cost of diabetes medications.

A multivariate linear model adjusted for physician visits demonstrated that total weight loss, number of nutrition and exercise counseling sessions attended, previous diagnosis of hypertension and hyperlipidemia, as well as number of initial medications were all positively correlated (P < .05) with percent decrease in monthly wholesale medication costs.
Longer Study Needed

“Future research should focus on the longevity of this effect and should include all healthcare costs,” Mr. Wiske concluded.

In response to a question asking how they were able to get people who weigh 250 pounds to stick to a 1200-calorie diet, he explained that the patients were all highly motivated, and some had entered the program because it was a prerequisite for surgery.

Asked to comment, session moderator Ken Fujioka, MD, from Scripps Clinic, San Diego, California, observed that although this was a retrospective study, “still, it had some interesting points — it showed that if you get weight loss, you can save some money…you save medication cost and you get somebody healthy.” However, the study was short and did not examine all costs.

And recent studies looking at bariatric surgery have been unable to prove long-term overall healthcare cost savings, he noted.

Obesity 2013: The Obesity Society Annual Scientific Meeting. Oral presentation, presented November 14, 2013.


Current BMI Cutoffs May Miss Metabolic Disease Risk

Marlene Busko
November 14, 2013

ATLANTA — About a third of men and almost half of women classed as nonobese based on body mass index (BMI) alone had a high percentage of body fat; moreover, they were 10 times more likely to have metabolic syndrome than their peers, researchers report. In addition, gauging risk based on sedentary behavior alone may be misleading, they discovered.

The new findings, based on data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES), were presented in a poster here at Obesity 2013: The Obesity Society Annual Scientific Meeting.

“BMI is potentially missing a lot of people who are at risk,” since they have “normal-weight obesity,” lead author Mark D. Peterson, PhD, from the University of Michigan, Ann Arbor, told Medscape Medical News.

Dr. Peterson does not believe that the BMI threshold to detect obesity will ever be lowered from 30 kg/m2. But he hopes the study results will draw attention to a segment of the population that might be missed when screening for disease risk if waist circumference or percentage of body fat is not considered.
The study also suggests that overall level of physical activity, not time spent being sedentary, is the better predictor of metabolic syndrome, say he and his colleagues.
Does BMI Accurately Predict Metabolic Syndrome?

The best way to screen for obesity, risk for cardiovascular disease, and diabetes remains controversial, and misclassification is common, the researchers explain. While BMI is used as a surrogate marker for adiposity to screen people, it does not distinguish between fat and muscle, Dr. Peterson pointed out.

In addition, time spent being sedentary is believed to contribute to risk for preventable disease and mortality, which is a growing topic of interest, he noted.

To investigate these 2 aspects of screening, the researchers analyzed data from 5576 participants of the 2003–2006 NHANES who were 20 to 85 years old and for whom data were available detailing blood pressure, measures of BMI, waist circumference, body fat, and activity levels.

Nonfasting serum measures of HDL cholesterol and high-sensitivity C-reactive-protein (hs-CRP) concentrations were also taken, as were fasting measures for triglycerides, plasma glucose, and insulin. Metabolic syndrome was defined as the presence of any 3 or more of the following:
 Abdominal obesity (> 102 cm for men; > 88 cm for women).
 Elevated triglycerides (> 1.7 mmol/L).
 Reduced HDL cholesterol (< 1.0 mmol/L in men; < 1.3 mmol/L in women).
 Hypertension (> 130 mm Hg systolic and/or > 85 mm Hg diastolic).
 Elevated fasting glucose (> 100 mg/dL).

Total body fat percentage was based on dual-energy X-ray absorptiometry readings, and obesity was defined as body fat of 25% or more for men and 35% or more for women.

Activity levels were based on 4 days of measurements from an accelerometer, which is a small device worn attached to the hip that is similar to a pedometer but that also counts movement intensity, Dr. Peterson explained.

A Very Obese Nation

BMI readings of 30 kg/m2 and above had excellent specificity in both men and women but very poor sensitivity; based on this cutoff, 30.6% of men and 37.5% of women were defined as being obese. Using body-fat percentage instead, the researchers found that 71.1% of men and 79.6% in women in this representative national population sample would be classed as obese (P < 0.001).

And 32.8% of the men and 45.7% of the women with a normal weight based on BMI measurements (18.5–24.9 kg/m2) were identified as obese according to body-fat percentage.

While less than a fifth of the men (17.5%) and women (16.7%) surveyed had metabolic syndrome, those who were classed as obese according to percentage of body fat had about a 10-fold increased likelihood of metabolic syndrome (odds ratio [OR], 9.64 for men; OR, 10.58 for women).

Age, education, percentage of body fat and being in the highest quartile for sedentary behavior (> 9.5 hours for men and > 9.25 hours for women) were all significantly associated with higher odds of having metabolic syndrome. Lower annual income was an independent predictor of metabolic syndrome for women only.

However, after adjustment for overall total activity, sedentary behavior was no longer associated with an increased risk for metabolic syndrome.

Use a BMI of 27.5 to Define Obesity?

“Dr. Peterson has some evidence that maybe we should be using a [BMI] cut point of 27 to 28 — and anything above that would be obese — which correlates better with body-fat percentage than the cut point of 30,” William D, Johnson, PhD, from Pennington Biomedical Research Center, Baton Rouge, Louisiana, pointed out when asked to comment. He himself has a BMI of 30 kg/m2, he noted, which brings this study close to home.

“If people would accept that cut point, that would redefine BMI,” he added, but like Dr. Peterson, he does not think that is likely, although some underdeveloped countries where people are very lean do use a lower BMI to define obesity, he noted.

This study was supported in part by the National Institutes of Health National Center for Medical Rehabilitation Research, National Institute on Neurological Disorders and Stroke, and National Institute on Aging.


New Study Suggests That High Blood Sugar Is Tied to Memory Problems

A recent study published in Neurology, a highly cited and peer-reviewed neurology journal, suggests that elevated blood sugar, even if it isn’t at a level considered “unhealthy,” can lead to memory loss.

German researchers conducting the study wanted to look further into the association between high blood sugar and memory loss after previous studies have shown that people with Type 2 diabetes may have an increased risk of developing dementia, a condition that causes people to suffer symptoms of cognitive decline such as forgetfulness and issues with speech and clear thinking.  Diabetes causes unhealthy elevated levels of glucose (sugar) in the bloodstream due to a body’s inability to recognize and use insulin to absorb glucose.

The study involved 143 people with an average age of 63 who did not have diabetes or pre-diabetes. People who were overweight, consumed more than 3.5 servings of alcohol daily and/or currently suffered from symptoms of memory impairment also were excluded from the study. After fasting for at least 10 hours, the participants had their glucose levels tested and an MRI image taken of their brains to determine the size of their hippocampi, a region of the brain linked to memory. They were then asked to perform a series of memory tests.

The results showed that those who had lower blood sugar levels obtained higher scores on the memory tests. When comparing the results with the scans of the participants’ hippocampi, the researchers further concluded that the “DTI-based (diffusion tensor imaging) measurements demonstrated that not only the volume of the hippocampus, but also the microstructural integrity is lower if blood sugar levels are higher.”

This means that people with higher blood sugar levels – even if they still fall within a range considered “healthy” – have hippocampi that do not function as efficiently as people with lower blood sugar levels and have less capable memories.

People with weights that fall into the obesity range and those over the age of 55 are most at risk of developing memory loss and cognitive impairment and should especially take note of these findings.

Blood sugar levels can be regulated with medication if necessary, but they can also be controlled naturally. Here are a few ways to keep the body’s blood sugar at optimum levels:

  • Exercise regularly, including both cardio and strength training workouts.
  • Eat diets rich in “low glycemic index” fruits, vegetables, lean proteins and whole grains.
  • Maintain a healthy weight.
  • Manage stress.

In addition, study author Dr. Agnes Flöel recommends that those who are most at risk for developing dementia have regular medical checks that include monitoring of fasting glucose and HbA1c levels so that any issues with blood sugar levels will be detected early and treated immediately.

The Medical and Surgical Clinic of Irving is here to serve patients interested in proactively avoiding potential memory loss or other health issues related to high blood sugar. Schedule an appointment with a member of our highly experienced Family Medicine physicians today to take charge of your long-term health.








November Is National Diabetes Awareness Month

Learn More About Diabetes and How Medical and Surgical Clinic of Irving Is Actively Combating the Disease

Diabetes is a disease that affects the body’s ability to produce or recognize insulin, which in turn causes issues with proper management of the blood’s glucose (or sugar) levels. Insulin is a hormone that allows for the body’s cells to absorb glucose and use it for energy.

When the body is unable to use glucose for energy due to a lack of insulin or its inability to recognize insulin, the body’s cells become starved for energy. Left untreated, this can lead to serious health issues including heart attack, stroke, blindness or, in very severe cases, mild or severe nerve damage that may eventually require amputation. Nearly 26 million adults and children in the U.S. have the disease in one of its variety of forms: gestational diabetes, type 1 diabetes and type 2 diabetes.

Understanding the Different Types of Diabetes

Gestational diabetes is developed by some women during pregnancy, often around the 24th week. Those who are diagnosed with gestational diabetes did not necessarily have diabetes prior to their pregnancy and will not necessarily have diabetes after giving birth. It is important for them to follow their doctor’s advice on glucose levels throughout the pregnancy to promote the best health for themselves and their babies. Unlike with other forms of diabetes, it is possible that gestational diabetes will only last the duration of the pregnancy and will not be a lifelong illness.

Type 1 diabetes is a disease caused by the pancreas’ total inability to produce insulin. This type of the disease is most common in children but also affects adults. Only 5 percent of people in the U.S. with diabetes have type 1 diabetes. Type 1 diabetes can be easily managed with doctor recommended insulin therapy and a variety of additional medical treatments.

Type 2 diabetes is the most serious and most common form of the disease.  Those who suffer from Type 2 diabetes produce too much insulin due to what’s called “insulin resistance.” This means that the body’s cells are unable to properly use that insulin to absorb glucose for energy. People with Type 2 diabetes require a doctor’s uniquely tailored treatment plans and regular blood sugar and cholesterol level monitoring to successfully combat the disease as effectively as possible.

Steps to Take to Start Managing Symptoms Today

Although there is no cure for diabetes types 1 and 2, there are simple life changes that people can make to help mitigate their symptoms. Here are a few ways to combat diabetes that, partnered with a medical treatment plan, can help patients to take control of their symptoms so that they can get back to enjoying their lives.

  • Stay at a healthy weight.  Avoiding processed foods and simple sugars while choosing “low glycemic index” fruits and vegetables and lean proteins can help with this.
  • Get moving with some light or vigorous cardio workouts three to five times weekly.
  • Do something twice a week to increase muscle strength.
  • Wash hands frequently to avoid illness. Those with diabetes are affected more seriously by viruses such as the flu or a cold, so it’s important to keep as healthy as possible.
  • Stop or don’t start smoking or using tobacco.

How Medical and Surgical Clinic of Irving Helps Patients Fight Diabetes

Although taking the steps above will help to minimize the negative symptoms of diabetes, it’s still necessary for those with the disease to regularly see a doctor for checkups to ensure that blood sugar and cholesterol levels are remaining normal and that serious symptoms of the disease do not go untreated.

The expert family medicine, internal medicine and endocrinology physicians at Medical and Surgical Clinic of Irving are available to schedule appointments for diabetes assessments and recommend ongoing treatment plans. Visit our specialties page to learn more about the experienced practitioners available to assist patients with diabetes by monitoring their illness and proactively treating its symptoms. Read through each physician’s biography to discover more about their experience treating diabetes.






Relief From Sinusitis With Noninvasive Balloon Sinuplasty

Dr. Timothy Thomason and Dr. Constance Zhou Offer Relief From Sinusitis With Noninvasive Balloon Sinuplasty

Experienced otolaryngologists Dr. Timothy Thomason and Dr. Constance Zhou are available to schedule consultations for those suffering from severe sinusitis to determine whether Balloon Sinuplasty is appropriate.

Sinusitis is an inflammation of the sinus lining which causes a person’s sinus opening to become blocked and prevents normal mucus drainage. Symptoms include facial pain, sinus pressure, loss of smell and taste, sinus headaches and sore throat due to drainage and fatigue. Sinusitis may last for a few weeks or drag out longer than 12 weeks. At that point, patients should definitely visit their doctor to evaluate a plan for care.

While sinusitis can be triggered by bacterial or viral infections caused by allergies, it is important that what are actually allergies is not mistaken for sinusitis so that proper treatment is given.  This is why it is essential to see a doctor regarding recurring symptoms and receive a professional opinion. Thomason and Zhou are available to assess the extent of patients’ sinusitis symptoms and determine the best course of action to take to provide effective relief.

More than 37 million Americans are affected by sinusitis annually. While some patients are able to manage their symptoms with medication or natural remedies such as using saline nasal sprays, taking prescribed antibiotics and/or inhaling steam, studies show that up to 60 percent of patients find medicines do not provide them with relief from chronic painful sinus pressure and abnormal drainage.

In the past, the traditional surgery recommended for relief from chronic sinusitis involved removing bone and tissue to enlarge the sinus opening and clear blocked sinuses. The drawbacks of this approach include a long recovery time, pain and scarring.

Balloon Sinuplasty is a breakthrough procedure that corrects sinusitis with a minimally invasive technique requiring a very short recovery time of only two to three days. Thomason and Zhou perform Balloon Sinuplasty in-office at the Medical and Surgical Clinic of Irving. The process is endoscopic, involves no cutting or removal of bone or tissue and does not require general anesthesia.

During the procedure, a tiny, latex-free balloon is inserted into the nose and inflated. Once inflated, the balloon efficiently restructures the blocked sinus opening and reestablishes appropriate drainage. After the procedure is complete, patients experience relief from sinus pressure and are able to breathe normally. A clinical study reports that symptoms improved in 95 percent of patients after receiving Balloon Sinuplasty.

Thomason and Zhou have experience performing Balloon Sinuplasty at the Medical and Surgical Clinic of Irving and are available to discuss the procedure in further detail with patients who feel they could benefit.

Thomason is a native Dallasite who has been practicing medicine in Irving, Texas, since 2007. He is a department head at the Medical and Surgical Clinic of Irving and specializes in rhinoplasty, allergy and sinus treatment, facial plastic and reconstructive surgery, thyroid surgery and the surgical management of obstructive sleep apnea. When he isn’t working with patients to improve their ear, nose and throat health, he’s typically spending time with his wife and three sons camping in the great outdoors or tossing a ball around the backyard.

Zhou came to Dallas by way of Oklahoma City, OK, to attend the University of Texas Southwestern Medical Center. She loved the area so much that after graduation, she remained there for her residency in otolaryngology. Zhou specializes in general adult and pediatric otolaryngology, sinus disease, allergy treatment, thyroid surgery and facial plastic surgery. In her spare time she enjoys photography and spending time with her family and close friends.

Patients suffering from chronic sinusitis can take a step toward improving their quality of life by scheduling a consultation with Thomason or Zhou today. To book an appointment and evaluate whether Balloon Sinuplasty is appropriate for them, patients should call 972-253-4250.



Phone App Aids Weight Loss

Smartphone apps could help people to lose weight by encouraging them to notice and record the amount of food they consume as they eat, according to a new feasibility study presented here at the ECO2013, the 20th European Congress on Obesity.
The research by Eric Robinson, PhD, from the University of Liverpool, United Kingdom, and colleagues builds on their previous work on attentive eating, which concluded that distractions, such as radio, television, and computers, increased food intake by up to 50%, both during a meal and later in the day.
On the basis that paying attention to what is eaten and remembering it clearly help reduce energy intake, Dr. Robinson and colleagues designed a smartphone application that would help promote food memory in overweight or obese people.
The 1.5-kg average weight loss observed in their 4-week study “is similar to a recent more intensive 2-month trial that investigated the impact of dietary/exercise advice and habit formation,” said Dr. Robinson. This suggests that “raising awareness of eating and weight loss achieved” could be a fruitful approach, he observed.
Approached by Medscape Medical News for comment, Allan Geliebter, PhD, from the New York Obesity Research Center at Columbia University, New York City, said that heightening awareness of food intake is an important factor in combating excessive food consumption. And the use of a phone app is particularly exciting, because of its practicality and the intrinsic attractiveness of such technology, he noted.
Promising Findings, but Longer-Term Trials Needed
The app consists of 3 main parts. Before eating or drinking, users photograph the food/drink about to be consumed under a “snap” function; they are reminded by text to complete a “most-recent” photograph when they have finished.
Second, users focus on the on-screen “most-recent” image after the meal and answer questions on quantity eaten and feelings of satiety.
The final part opens a chronological slide show of the consumption episodes recorded during that day. A short text message instructs users to remember what they have eaten and reminds them to eat attentively and to snap their next meal.
Twelve overweight (n = 5) and obese (n = 7) participants took part in the trial. Mean body mass index (BMI) was 32.1, mean weight was 96.3 kg, and mean age was 42 years. They were compensated with £30 ($45) for their time.
Mean weight loss was -1.5 kg over the 4 weeks. Half the participants (6/12) lost 1 kg or more, 4 lost between 0 and 1 kg, and the remaining 2 gained between 0.1 and 0.4 kg. The individuals accessed the application on average 5.7 times a day, and the mean number of eating and drinking episodes recorded daily was 2.7.
“Our study introduces a new attentive eating approach aimed at reducing dietary intake and promoting weight loss, supported by theoretical models of the role of memory on energy intake regulation,” said Dr. Robinson.
“Results suggest that a simple smartphone…intervention based on these principles is feasible and could promote healthier dietary practices. Maybe you can’t imagine people using this app for the rest of their lives, but it might help them to develop better eating habits.
“Given that our trial was a very brief intervention with little contact time and no nutritional advice or support, this is a promising finding,” he added.
However, he stressed that a larger, randomized controlled trial “testing proof of principle for an attentive eating intervention on weight loss is now warranted,” because long-term maintenance of changes to the diet and weight loss are hard to achieve.
Dr. Geliebter told Medscape Medical News: “This has huge potential for taking action on obesity on a population basis, particularly since it is an app — which makes it intrinsically attractive.” However, one of the important factors determining whether it will ultimately prove successful when it is rolled out will be “whether [or not] the app is free,” he observed.

Article written by Rachel Pugh
Research was funded by the UK National Institute for Health Research National School for Primary Care Research. Neither Dr. Robinson nor Dr. Geliebter has reported relevant financial relationships


Stop the Pop!

Consumption of even 1 soft drink per day may be associated with increased negative behavior in young children, new research suggests.
A cohort study of almost 3000 5-year-olds showed that those who drank 1 to 4 servings of soda per day had significantly higher aggressive measurement scores than their peers who drank no soda.
In addition, those who consumed 2 or more servings had higher withdrawn behavior scores, and those who consumed 4 or more servings had higher attention problem scores.
“We were seeing a dose-response effect. So with every increase in soda consumption, the association and the scores basically increased,” lead author Shakira Suglia, ScD, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, told Medscape Medical News.
“This held up even after we adjusted for candy or fruit juice consumption and for a variety of social factors, especially for aggression with the highest level of soda consumption,” she added.
Although the investigators suggest that “future studies should explore potential mechanisms” that might explain these association, Dr. Suglia noted that past research has shown that even 1 soda per day is too many for young children.
“Certainly water or milk is more nutritious and a better alternative. Our advice is consistent with what is already out there: for the very young kids, any soda is not a healthy option. And even for adolescents, I think parents should really limit the amount of soda their kids are drinking.”
The study was published online August 15 in the Journal of Pediatrics.
World’s Biggest Soda Consumers
According to the researchers, more soda per capita is sold in the United States than in any other country.
Although past research has suggested an association between soft drink consumption and aggression, depression, and suicidal thoughts in adolescents, the current investigators sought to examine possible links between sodas and negative behaviors in young children.
The ongoing Fragile Families and Child Wellbeing Study was created to assess 4849 pregnant women from 20 cities in the United States at delivery. Follow-up interviews were conducted starting when their children were approximately 2 years of age.
For this analysis, the investigators evaluated data on 2929 of these children (52% boys; 51% black, 28% Hispanic/other, 21% white).
When the children were 5 years of age, their mothers filled out the Child Behavior Checklist (CBCL) and reported approximate servings of daily soda consumed, up to “4 or more.”
The mothers were also asked about the consumption of candy/sweets and fruit juice, television viewing habits, social risk factors (including maternal depression and intimate partner violence), and sociodemographic factors.
Results showed that 43% of the children drank at least 1 serving of soda per day, with 4% of the participants drinking 4 or more servings per day.
Unadjusted analysis showed that higher levels of soda consumption were associated with significantly higher overall aggression scores, as well as higher scores on the withdrawal and attention subscales of the CBCL (all, P < .05).
After adjusting for sociodemographic factors, results showed that the participants who drank at least 1 soda per day had a 0.74-point higher mean aggressive behavior score (95% confidence interval [CI], 0.1 – 1.4) than those who drank no soda (P < .05).
Consuming 2, 3, or 4 or more servings was associated with even higher mean aggression scores of 1.8, 2.0, and 4.7, respectively (all, P < .05).
Those who drank 4 or more daily servings also had higher mean scores on the attention problems (1.7; 95% CI, 1.0 – 2.4) and withdrawn behavior (2.0; 95% CI, 0.8 – 3.1) subscales (both, P < .05).
Adjusting for consumption of candy/sweets or fruit juice, television viewing, probable maternal depression, intimate partner violence, paternal incarceration, and obesity in separate analysis of 1868 of the participants still showed an association between high levels of soda consumption and negative behaviors.
Those who consumed 4 or more daily servings of soft drinks had fully adjusted mean scores of 2.62, 1.75, and 0.88 on the aggression, attention problems, and withdrawal subscales compared with those who consumed no soda.
Are All Sodas Equal?
Further analyses showed that the children who consumed the highest levels of soda were more than twice as likely to destroy others’ belongings (odds ratio [OR], 2.54), physically attack people (OR, 2.28), or get into fights (OR, 2.12).
“In this large sample of 5-year-old urban US children, we found strong and consistent relationships between soda consumption and a range of problem behaviors, consistent with the findings of previous studies in adolescents,” write the investigators.
However, future studies “in other populations of children and of a longitudinal nature may provide further insight into the relationship between soda consumption and child behavior,” they add.
When asked, Dr. Suglia reported that the study did not ask about the specific types of soda consumed, such as whether they included diet or noncaffeinated drinks.
“So it would be interesting in the future to try to parse out whether the findings are specific to a certain ingredient that we should be focusing on, such as caffeine or sugar, or is it just overall diet or lack of something they should be consuming? More specific data could be helpful,” she said.
The original study was funded by the National Institute of Child Health and Human Development. The study authors have disclosed no relevant financial relationships.
J Pediatr. Published online August 15, 2013.


Offspring of Obese Mothers at Risk for Early Heart Death

Troy Brown
Aug 13, 2013
Individuals born to obese mothers have an increased risk for premature all-cause and cardiovascular death as adults, according to an analysis of data from nearly 30,000 women and 40,000 offspring in Scotland.
Rebecca M. Reynolds, PhD, a professor of metabolic medicine in the Endocrinology Unit, British Heart Foundation/University Centre for Cardiovascular Science at the University of Edinburgh, Queen’s Medical Research Institute, United Kingdom, and colleagues report their findings in an article published online August 13 in BMJ.

“Our results suggest that the intrauterine environment has a crucial and long lasting effect on risk of premature mortality in offspring,” the authors write.

Data were collected from birth records, the General Register of Deaths in Scotland, and the Scottish Morbidity Record systems from 1950 to the present day. The primary outcome measures were death and hospital admissions for cardiovascular events up to January 1, 2012, in individuals aged 34 to 61 years at the time of follow-up.

The study included 28,540 women whose body mass index (BMI) was measured at their first antenatal visit, and their 37,709 offspring. A total of 21% (n = 5993) of the mothers were overweight, and 4% (n = 1141) were obese.

Among the offspring, 6551 deaths occurred from any cause. The highest causes of death were cardiovascular disease (24% of deaths in men and 13% of deaths in women) and cancer (26% of deaths in men and 42% of deaths in women).
All-cause mortality increased significantly in those born to mothers who were obese (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.03 – 1.35). In addition, there was a nonsignificant trend for increased risk among offspring whose mothers were overweight (HR, 1.02; 95% CI, 0.95 – 1.09). This pattern was the same in both the entire cohort and in mothers with BMI measurements obtained before 20 weeks of pregnancy.

In an adjusted analysis, the mortality risk increased for both the offspring of overweight (adjusted HR [AHR] ratio, 1.11; 95% CI, 1.03 – 1.19) and obese (AHR, 1.35; 95% CI, 1.17 – 1.55) mothers. The researchers adjusted for gestation, when weight was obtained, mother’s age at delivery, social class, current age of offspring, birth weight, and sex of offspring.

Moreover, overweight (AHR, 1.19; 95% CI, 1.09 – 1.30) and obesity (AHR, 1.40; 95% CI, 1.17 – 1.68) in mothers were significantly associated with premature death from all causes in offspring. Birth weight and all-cause mortality were not related, and there was no interaction between birth weight and maternal obesity with respect to outcomes.

Cardiovascular Risks Elevated

Overall, 7.6% of the offspring had hospital admissions for a cardiovascular event. After adjusting for other factors, maternal overweight (AHR, 1.15; 95% CI, 1.04 – 1.26) or obesity (AHR, 1.29; 95% CI, 1.06 – 1.57) was significantly associated with increased cardiovascular events in offspring for all hospital admissions for cardiovascular disease combined.

Maternal overweight was significantly associated with other cerebrovascular disease (AHR, 1.61; 95% CI, 1.10 – 2.36), peripheral artery disease (AHR, 1.52; 95% CI, 1.10 – 2.10), and other cardiovascular disease (AHR, 1.13; 95% CI, 1.02 – 1.26) in the offspring.

Maternal obesity was also significantly associated with other cardiovascular disease (AHR, 1.31; 95% CI, 1.05 – 1.63). Similar patterns were observed when data from the women with BMI recorded in early pregnancy were analyzed separately and when the analyses were conducted after adjustment for current socioeconomic status.

Weight Should Be Considered Early

Finally, the researchers found that the odds of death were higher in offspring born to mothers with a low or high BMI compared with mothers with a BMI of 23 kg/m2. The odds of death were lowest among offspring born to women with a BMI of 24 to 28 kg/m2.

In an accompanying editorial, Pam Factor-Litvak, PhD, an associate professor of epidemiology in the Department of Epidemiology at Mailman School of Public Health, Columbia University, New York City, notes the study leaves 2 questions unanswered: What is the role of the early postnatal environment? What is the role of parental obesity?

The goals of diet and exercise management during pregnancy “are to balance the risks of fetal growth, obstetric complications, and maternal complications,” Dr. Factor-Litvak writes. “However, the results of studies of maternal obesity and offspring outcomes suggest that interventions should begin before pregnancy.”

This study was supported by grants from the chief scientist office, Scotland, and Chest, Heart and Stroke, Scotland. Tommy’s and the British Heart Foundation also provided support. One coauthor reports working for Pfizer since 2011. One coauthor has received research grants from noncommercial funding agencies for pregnancy-related conditions, funding from UK government agencies for reporting on maternal deaths, honoraria for book chapters and books in obstetrics and gynecology, and consulting fees from Preglem. One coauthor is an unpaid consultant to Hologic. Dr. Factor-Litvak has disclosed no relevant financial relationships.

Published online August 13, 2013.