blong: 2011

2011年6月25日星期六

Industry role in child obesity less prominent on TV (Reuters)

在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。

NEW YORK (Reuters Health) – Television coverage of childhood obesity is less likely than print media to focus on the role of the food and beverage industry, according to a new report in the journal Pediatrics.

On the other hand, TV networks more often mention solutions on the personal level, like exercising and eating healthy foods.

That is concerning, researchers say, because spotlighting individual ways to combat obesity instead of focusing on underlying societal issues can pull the public's attention away from needed changes.

"If we think the answer to solving the problem is all about individuals changing their behavior, then there is no role for policy changes," said Colleen Barry of Johns Hopkins Bloomberg School of Public Health in Baltimore, who worked on the study.

According to the U.S. Centers for Disease Control and Prevention, childhood obesity has more than tripled over the past three decades, reaching close to 20 percent in 2008.

With her colleagues, Barry analyzed a sample of 806 of the news stories that ran in U.S. magazines and newspapers and on TV networks between 2000 and 2009.

The team found that nearly all stories mentioned some sort of solution to the obesity problem. About two-thirds of TV news stories mentioned diet or exercise changes, while newspapers did so 52 percent of the time and magazines 58 percent of the time.

By contrast, TV networks mentioned system-level solutions -- like creating playgrounds or making sure that healthy foods are available in poor neighborhoods -- less frequently than print media.

Specifically, networks pointed to potential changes in the food and beverage industry only 18 percent of the time, compared to more than 30 percent in newspapers and magazines.

Barry said the reasons for this are unclear, but said industry ads on TV might play a role.

"TV news relies more heavily on advertising dollars from the food and beverage industry, so I think that could provide some influence," she told Reuters Health.

According to data from the Nielsen Company, about 15 percent of ads on TV were paid for by the food industry in 2008, compared to only two percent of the ads in newspapers.

Another possible explanation for the different coverage is that systems-based solutions may be too abstract and therefore harder to address in a visual medium, Barry said.

The researchers also found that childhood obesity coverage had dropped markedly since 2007, although the extra weight is still plaguing our society.

"It's a serious public health problem, and despite efforts to change people's behavior, childhood obesity shows no signs of abating," Barry said.

SOURCE: http://bit.ly/iidweQ Pediatrics, online June 20, 2011.

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Obesity Surgery Yields Clues to Weight-Loss Mysteries (LiveScience.com)

Surgery for obesity began with a simple premise: if you make the stomach smaller, people will eat less, so they will lose weight.

But in recent years the results of obesity surgery have been so outstanding, researchers went back to the drawing boards to figure out what was going on.

Their findings are beginning to present a far more complicated picture of weight — and of how much diet and exercise can really do to change it. Turns out, a slew of hormones from the gut, and their communication with the brain, play a role in the way the body maintains and loses weight.

Chasing down the answer to exactly how obesity surgery works is providing new insights into human weight loss and appetite regulation, researchers say.

"As a result of weight loss surgery, we finally are beginning to understand the physiology of weight loss better than we've ever understood it before," said Dr. Sunil Bhoyrul, a weight-loss surgeon at Olde Del Mar Surgical in La Jolla, Calif.

Their investigations may reveal how to replicate the results of the surgery without requiring patients to go under the knife.

Ghrelin from the gut

There are several different types of weight-loss surgery (also called bariatric surgery), including gastric bypass and gastric banding, but all involve making the stomach smaller. [Infographic: Types of Weight Loss Surgery].

Patients can lose up to 60 to 80 percent of their excess weight in one to four years after surgery, and many have an easier time keeping it off than they did through dieting, Bhoyrul said. However, up to a third can end up back at their pre-surgical weight seven to 10 years later, he noted.

But researchers are realizing that weight loss after surgery is fundamentally different from weight loss achieved by dieting.

A key player in this difference is the hormone ghrelin, which stimulates appetite. When we diet, our ghrelin levels rise, making us hungry. We may lose weight, but our ghrelin levels stay high, and we continue to feel hungry even after eating. Ghrelin levels come down only if we regain the weight, said Dr. Robin Blackstone, a bariatric surgeon at Scottsdale Bariatric Center in Arizona.

"People who are trying to lose weight are being fought tooth and nail by the body to keep that weight on," said Dr. Miguel Burch, associate director of general surgery and minimally invasive surgery at Cedars-Sinai Medical Center in Los Angeles.

But after gastric bypass surgery, ghrelin levels go down significantly, Burch said.

"They're losing more weight than they ever had before and not only are not hungry, they have to force themselves to eat," Burch said. This may be why surgery patients can keep their weight off, he said.

And ghrelin is likely just the tip of the iceberg in terms of hormonal changes that occur. There are likely many more hormones we don't know about that aid in weight loss after surgery, Burch said.

Mind over stomach

Results from the surgery have also highlighted the role of the brain in weight loss and weight gain. Your mind, not just your stomach, manages your waistline.

"We never realized that the brain was so important," Bhoyrul said. "We thought it was just as simple as getting people to eat less. That turns out to be the least of the issues," he said.

The brain is the body's energy thermostat, Bhoyrul said, controlling how quickly you use energy, and when to store and expend it. There is an ongoing conversation between the gut and the brain that takes place via hormones, he said.

Deciphering this conversation could help researchers understand how to best instigate weight loss, Bhoyrul said.

A recent finding underscores how much there is to learn about the stomach-brain connection. Unlike the drop in ghrelin seen after gastric bypass, those who undergo gastric banding experience a drop in their hunger, but not in ghrelin, said Dr. Emma Patterson, a bariatric surgeon in Portland, Ore. This may be because ghrelin communicates with the brain differently after this surgery, Patterson said.

Surgery without the surgery

It might be possible to replicate the results of the surgery using drugs.

"If we can understand how these surgeries work…we can put whatever that thing is in a pill," Patterson said.

One possible target may be an enzyme involved in the production of ghrelin, Burch said.

Indeed, one approach taken by researchers seeking to develop an obesity vaccine has been to block the hormone's production.

However, some have argued that, because many hormones are involved in weight loss, targeting one is unlikely to help people lose weight.

"Most of us are skeptical that 'turning off the ghrelin switch' is the universal answer to all obesity," Bhoyrul said.

Pass it on: The success of obesity surgery is yielding a better understanding of how gut hormones and the brain regulate weight and controls appetite.

This story was provided by MyHealthNewsDaily, a sister site to LiveScience. Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner.

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Obesity and lack of exercise linked to chronic pain (Reuters)

NEW YORK (Reuters Health) – It may not be surprising, but people who exercise at least one hour per week have a lower risk of troublesome back, neck, and shoulder pain, a new study shows.

The new evidence supports the possibility that obesity and physical inactivity play a role in a person's risk of developing chronic pain in those areas, said study co-author Dr. Paul Mork, of Norwegian University of Science and Technology in an email to Reuters Health.

Mork and colleagues followed more than 30,000 adults who participated in a large Norwegian health study. They recorded participants' body mass index (BMI) - a measure of weight related to height - at the start of the study, as well as how often they exercised, and then tracked them over the next 11 years.

The authors divided the participants into four categories based on how often they exercised, and four categories based on their BMI. They also looked at how many people in each category developed chronic neck, shoulder, and lower back pain.

Overall, 1 of every 10 people in the study developed lower back pain, and nearly 2 of every 10 developed shoulder or neck pain.

After taking into account participants' age, BMI, whether or not they smoked, and whether they did manual labor at work,

the research team found that men who were exercising 2 hours or more per week at the start of the study were 25 percent less likely to have lower back pain 11 years later, and 20 percent less like to have neck or shoulder pain, compared men who didn't exercise at all. And women who exercised at least 2 hours per week were 8 percent less likely to develop lower back pain than women who were inactive, and 9 percent less likely to develop neck and shoulder pain.

Weight, not surprisingly, also affected the risk of chronic pain later on. Obese men were almost 21 percent more likely to develop chronic lower back pain than men of normal weight, and 22 percent more likely to develop neck or shoulder pain. Obese women were also 21 percent more likely to develop lower back pain than women of normal weight, and 19 percent more likely to develop neck and shoulder pain.

Based on the results, Mork believes that even moderate physical exercise - just one hour or more per week - "can, to some extent, compensate for the adverse effect of being overweight and obese on future risk of chronic pain."

"Chronic neck and back pain are important to public health due to their substantial influence on quality of life, disability, and health care resources," Dr. Adam Goode from Duke University in Durham, North Carolina told Reuters Health by email. Goode, a physical therapist, was not involved in the study by Mork's group.

Back in the mid-1990s, a study from the Netherlands estimated that low back pain cost that country nearly 2 percent of its gross national product. In their new paper Mork and colleagues write that "just a small reduction in the incidence of chronic lower back pain would have a profound economic impact."

Because of the way it was designed, the Norwegian study can't prove that lack of exercise and being overweight actually caused people's chronic pain, or that regular exercise and a more healthy weight prevented it. It could be that the people who did or didn't have chronic pain are different in ways the study did not measure.

However, given the known benefits of exercise and maintaining a healthy weight, Mork believes that "community based measures aimed at reducing the incidence of chronic pain...should aim at promoting regular physical exercise and the maintenance of normal body weight."

SOURCE: http://bit.ly/jaoix5, online June 11, 2011

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TV and soda: small habits cause weight creep (Reuters)

CHICAGO (Reuters) – Just a few bad habits -- watching TV, eating potato chips, having a sugary soda at lunch or staying up too late at night -- can add up to a steady creep of pounds over the years, U.S. researchers said on Wednesday.

While most studies on diet focus on changes needed to help obese people lose weight, the study by the Harvard team showed tiny changes in diet and lifestyle can make a big impact.

The study focuses on specific lifestyle choices -- foods, activity, sleep habits -- that slowly pack on the pounds. The researchers stressed that the quality of food choices, and not just calories, are key to maintaining a healthy weight.

"These small choices add up," said Dr. Dariush Mozaffarian of the Harvard School of Public Health and Brigham and Women's Hospital, whose study appears in the New England Journal of Medicine.

"Because the weight gain is so gradual and occurs over many years, it has been difficult for scientists and for individuals themselves to understand the specific factors that may be responsible," Mozaffarian, who led the effort, said in a statement.

To get at this, the team analyzed data on 120,877 U.S. women and men from three large studies of health professionals that tracked changes in lifestyle factors and weight every four years over a 20-year period.

All study participants were normal-weight and healthy when they started. Over time, they gained an average of 3.35 pounds (1.59 kg) during each 4-year period for a total average weight gain of 16.8 pounds (7.6 kg) at the end of the 20-year study.

Foods that added most to weight gain over a four-year period included daily consumption of potato chips (1.69 lbs or 0.76 kg), potatoes (1.28 lbs or 0.58 kg), sugar-sweetened beverages (1 lb or 0.45 kg), unprocessed red meats (0.95 lbs or 0.43 kg) and processed meats (0.93 lbs or 0.42 kg).

More than a third of adults and nearly 17 percent of children in the United States are obese, increasing their chances of developing health problems including type 2 diabetes, heart disease, high blood pressure, fatty liver disease and some cancers.

Obesity-related diseases account for nearly 10 percent of U.S. medical spending, or an estimated $147 billion a year.

FOOD THAT SHOULD BE CALLED BAD

Mozaffarian said understanding ways to keep people from becoming obese may be more effective than getting people to lose weight as U.S. policymakers attempt to turn the tide.

Those in the study who lost or maintained their weight over time tended to eat minimally processed foods.

"Fruits, vegetables, whole grains and nuts -- if you increase their intake, you had relative weight loss, presumably because you are replacing other foods in the diet," Mozaffarian said.

The study contradicts the notion that all foods are good for you in moderation.

"The idea that there are no 'good' or 'bad' foods is a myth that needs to be debunked," said Frank Hu of Harvard, who worked on the research.

Mozaffarian said different foods have a different effect on the body. "You can't just say a calorie is a calorie. It doesn't address your feelings of fullness, your blood glucose levels, your blood insulin levels and the other biological responses in your body," he said.

In the study, dietary changes appeared to have the biggest impact on weight gain over time, but other lifestyle changes also were a factor.

For example, watching one hour of TV per day added 0.31 pounds (0.14 kg) over a four-year period.

Sleep also played a role. People in the study who got between six and eight hours of sleep were less likely to gain weight over the study period. But people who got less than six hours or more than eight hours tended to gain weight.

And when people increased their physical activity, they tended to gain less weight during the study period.

SOURCE: http://bit.ly/myrd12 New England Journal of Medicine, June 23, 2011.

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Rushed Discharge After Weight-Loss Surgery May Raise Risks (HealthDay)

WEDNESDAY, June 15 (HealthDay News) -- Weight loss surgery patients who are discharged from the hospital too soon after undergoing gastric bypass have an increased risk of complications and death, a new study has found.

After analyzing data from nearly 52,000 gastric bypass patients, researchers found that those released from the hospital the day of surgery were 12 times more likely to have serious complications (1.9 percent versus 0.16 percent) and 13 times more likely to die than patients who left the hospital after the U.S. average of a two-day stay.

The death rate within 30 days of discharge was 0.1 percent for those who stayed in the hospital for two or more days, versus 0.8 percent for those who left the day of surgery.

Patients who were discharged from the hospital less than 24 hours after an overnight stay were two times more likely to die within 30 days than those who remained in hospital for two days after their surgery, the investigators found.

Like all surgeries, bariatric surgery carries surgical risks, including serious infections, internal bleeding, blood clots, and death, according to the American Society for Metabolic & Bariatric Surgery (ASMBA).

Length of stay appeared to be a greater risk factor than age, gender, race, body mass index and obesity-related conditions, the researchers noted.

The study was scheduled for presentation Wednesday at the annual meeting of the American Society for Metabolic & Bariatric Surgery, in Orlando, Fla. Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"This study shows what a difference a day makes," co-author Dr. John Morton, an associate professor of surgery and director of bariatric surgery at Stanford Hospital & Clinics at Stanford University, said in an ASMBS news release.

"A two-day length of stay appears reasonable for most people and results in a safety profile that rivals gallbladder or hip replacement surgery. To reduce it further may put patients at an increased chance of unnecessary risk," said Morton, who is chair of the ASMBS Access to Care Committee. "A patient should be discharged based on his or her individual risk profile. We counsel our patients to avoid drive-thru fast food, and also advise against drive-thru gastric bypass."

"Bariatric surgery is safer than ever, but discharging patients too soon after surgery may be pushing the envelope too far and may have serious consequences," he added.

More information

The U.S. National Library of Medicine has more about gastric bypass surgery.

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For Many, Weight-Loss Surgery Also Eases Migraines (HealthDay)

WEDNESDAY, June 15 (HealthDay News) -- Severely obese patients who suffer from migraines may see them fade or become less frequent after having weight-reducing gastric bypass surgery, University of Iowa researchers say.

In the three years following surgery, 70 percent of the patients reported being migraine-free and more than 18 percent saw their migraines reduced from five to two a month, the researchers found.

"The association between migraine and obesity is controversial," said lead researcher Dr. Isaac Samuel, director of the University of Iowa Obesity Surgery Program. "Some people say the risk for migraine is higher in obese people; others say the symptoms are worse," he said.

There could be a number of reasons why migraine is relieved by gastric bypass surgery, including hormonal changes that occur after the procedure or certain proteins produced by fat cells, Samuel said.

"Severely obese patients with migraine should be encouraged to have gastric bypass if they want relief of the symptoms," Samuel said. "In addition, people who are obese, but not severely obese, should be encouraged to lose weight if they have migraine."

The findings of the study were due to be presented Wednesday at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery in Orlando, Fla. Since the study is small and it has not appeared in a peer-reviewed journal, its findings should be considered preliminary.

Like all other operations, bariatric surgery carries some medical risks, including. serious infections, internal bleeding, blood clots, and death, according to the American Society for Metabolic & Bariatric Surgery (ASMBA). The organization reports that the overall risk of serious complications is about 4 percent and the risk of dying is one in 1,000.

Weight-loss surgery is also expensive, costing from $17,000 to $35,000 or more, depending on the type of procedure performed.

For the study, Samuel's team reviewed the medical records of 702 patients who underwent gastric bypass surgery between March 2000 and September 2009. In addition to being obese, the patients also suffered from migraines. Of these patients, 81 were selected for the current study.

The researchers found that gastric bypass surgery improved or completely alleviated migraines in most patients. The most pronounced effect was among those patients whose headaches started after they became obese, the researchers note.

Of those who had their first migraine before becoming obese, 46 percent became migraine-free and 29 percent experienced some improvement, Samuel's group says.

These findings were independent of problems associated with migraine such as depression, anxiety or sleep apnea, the researchers added.

Other causes of headache in obese people include pseudotumor cerebri, or idiopathic intracranial hypertension, which is an increase in pressure around the brain that can feel like a migraine and may be caused by obesity. This type of headache also responds well to gastric bypass surgery, the researchers noted.

Commenting on the study, Dr. Elizabeth Loder, chief of the Division of Headache and Pain at Brigham and Women's Hospital in Boston said that "this is an interesting observation but the data seem quite preliminary."

In the absence of a control group, it is not possible to say whether the surgery and ensuing weight loss really "caused" the improvement in migraine, she said.

"Migraine is a condition that naturally waxes and wanes," Loder said. "Some of the improvement might simply reflect this variable disease activity. It is also the case that people who undergo surgery of any kind often report temporary improvement in headaches," she said.

Without a similar group of patients who did not undergo surgery, it is not possible to distinguish among these possibilities, Loder explained.

"In addition, it is unclear what is meant by complete, partial and no resolution, Loder said. "It would be very, very unusual for any treatment to cause complete resolution of migraine," she said.

Another expert, Dr. Richard B. Lipton, vice chairman of neurology, and director of the Montefiore Headache Center at the Albert Einstein College of Medicine in New York City, felt that the findings underscored the need for further research.

"These data are compatible with the epidemiologic studies showing that obesity is a risk factor for migraine progression," he said. "In addition, there is another published observational study showing that migraine improves after bariatric surgery in proportion to the extent of weight loss. Randomized trials are badly needed."

More information

For more information on diabetes, visit the U.S. National Library of Medicine.

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How Overweight Pregnant Women Can Limit Weight Gain (LiveScience.com)

Overweight pregnant women who weighed themselves weekly and received text-message reminders about weight early in their pregnancy gained less weight than women who didn't, a new study shows.

Gaining too much weight during pregnancy can bring on diabetes and may pose risks for babies.

"There is not a lot being done in early pregnancy to avoid weight gain and the complications," said study author Catherine Lombard, of the Monash University School of Public Health and Preventive Medicine in Melbourne, Australia.

The preliminary results from the ongoing study will be presented Sunday (June 12) at the annual meeting of the Endocrine Society in Boston.

The women in the study were overweight, not obese, but were considered at high risk for gestational diabetes due to their weight, age and ethnic background. Further results from the study will determine whether the healthy lifestyle program in which the women participated also reduced gestational diabetes, a serious condition that can cause complications for both the mother and child during the pregnancy.

Overweight and pregnant

Among pregnant women in the United States, about half are overweight or obese, said Dr. Raul Artal, chairman of the Department of Obstetrics/Gynecology and Women's Health at Saint Louis University. Artal conducts research on weight gain during pregnancy but was not involved in the study.

“I and many of my colleagues believe excessive weight gain in pregnancy is a major reason for the obesity epidemic in our country,” Artal said.

The Institute of Medicine guidelines on pregnancy weight gain, which were released in 2009, suggest a gain of 25 to 35 pounds for women of normal weight, 15 to 25 pounds for women who are overweight and 11 to 20 pounds for women who are obese.

Artal said the recommendations "have done a disservice to women." "It is allowing too much weight gain" for women who are already obese or overweight, he said.

Complications from being overweight or obese during pregnancy include higher rates of birth defects and higher risk of gestational diabetes. Women with gestational diabetes are at seven times the risk of getting diabetes later in life than women who do not have the condition, Artal said.

Babies born to mothers with gestational diabetes have their own complications. “These babies have a tendency to be very large and therefore have traumatic deliveries, and more complications in delivery and in the first few days of life,” Artal said. These infants are at higher risk for obesity as children and adults.

Text messages and weekly weigh-in

Lombard’s study included 200 pregnant women who were at risk for gestational diabetes. The participants were divided into two groups, one that underwent the educational program and a control group.

At 14 weeks of pregnancy, researchers gave both groups information that emphasized making small, healthy changes to eating and physical activity, such as walking and eating more fruits and vegetables. One group also received information about how much weight they should gain during pregnancy, an instruction to weigh themselves and frequent reminders by text messaging.

At 28 weeks, the women who had received the extra information had gained, on average, about two pounds less than those in the control group.

This difference might seem small, but it is important at that stage of pregnancy, Lombard said.

Further results will measure weight gain during the entire pregnancy, as well as the rates of gestational diabetes in the two groups. The study is following patients through delivery and the first six weeks of each baby’s life.

Pass it on: A healthy lifestyle program conducted early in a pregnancy can help overweight women avoid excessive weight gain.

This story was provided by MyHealthNewsDaily, sister site to LiveScience.

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Obesity surgery fails to extend life in older men (AP)

CHICAGO – Very obese older men hoping to live longer may be let down by a new long-term study that found weight-loss surgery didn't increase survival for people like them — at least during the first seven years.

Prior studies have found stomach stapling and other obesity surgeries improved survival rates after two to 10 years. The new study in mostly older male veterans suggests one of two things: Not everyone gains equally from surgery, or a survival benefit may show up later in older men, after more years of follow-up.

Previous findings came mainly from studies of mostly younger women.

"Nearly all prior studies have found bariatric surgery to be associated with reduced mortality. But those studies were conducted on very different patient populations using less rigorous methods," said lead author Matthew Maciejewski of the Veterans Affairs Medical Center in Durham, N.C.

The patients' organ damage from obesity could have been too far along for weight loss surgery to reverse it, some experts said.

"It may be too little too late," said Dr. Philip Schauer of Cleveland Clinic's Bariatric and Metabolic Institute. He was not involved in the study. "You may have to intervene earlier for a survival benefit."

Evidence has been mounting for the health benefits of obesity surgery, so the new results may surprise some people. U.S. doctors now perform more than 200,000 obesity surgeries a year at an estimated cost of $3 billion to $5 billion. Schauer said a definitive study on survival could cost $200 million.

The new study, released Sunday to coincide with a medical meeting, will appear in Wednesday's Journal of the American Medical Association.

Benefits of obesity surgery — improved quality of life, weight loss and reductions in diabetes symptoms, blood pressure and sleep apnea — may be reason enough to choose the treatment.

"These results are not an indictment of surgery," Maciejewski said. He and his colleagues plan to follow the patients longer to see if a survival benefit shows up 10 to 14 years after surgery.

The study, while rigorous, wasn't the gold standard where people are randomly assigned to have one treatment or another. Instead, researchers compared nearly 850 patients who had surgery in Veterans Affairs hospitals with other obese veterans. The two groups were as similar as possible, matched for age, gender, race and marital status.

After nearly seven years, the two groups were equally likely to be alive.

Without the painstaking matching analysis, the researchers did see a lower death rate in the surgery group compared to a group of obese patients who didn't have surgery. But that could mean the patients who underwent surgery were healthier than the patients who didn't.

All the surgery patients had gastric bypass, a method that makes the stomach smaller by stapling and allows food to skip much of the small intestine. The smaller stomach holds less food and the digestive detour means the body absorbs fewer calories.

The patients had surgery between 2000 and 2006. Their average age was 49 and their average body mass index was 47. A BMI of 30 or more is considered obese.

In the study, 11 patients died within the first month after surgery, a rate four times higher than in other studies. That could be because the surgery is more difficult in men than in women, said study co-author Dr. Edward Livingston of University of Texas Southwestern School of Medicine.

"Women tend to collect fat in the thighs and hips rather than in the abdomen," Livingston said. Men's fat accumulates in the belly, making it trickier for surgeons to get through it to the organs.

Some outside experts were troubled by the post-surgery death rate. Dr. David Flum of the University of Washington School of Medicine said, regardless of the cause, the higher death rate after surgery would make it difficult to demonstrate a survival advantage.

Dr. Bruce Wolfe, president of the American Society for Metabolic & Bariatric Surgery and a professor of surgery at Oregon Health & Science University in Portland, said the researchers may see a survival benefit with more years of follow up.

"This probably won't deter many people who want surgery," said Wolfe, who wasn't involved in the new study. "They're sick. They have joint disease. They have trouble breathing. They're doing it to improve their health and quality of life."

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Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson.

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Online:

JAMA: http://jama.ama-assn.org

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6 Infertile Women Get Pregnant After Weight-Loss Surgery (LiveScience.com)

Weight-loss surgery may treat infertility in some obese women, a new study says.

Six women in the study who were infertile due to polycystic ovarian syndrome (PCOS), a condition that can occur with weight gain and cause infertility, became pregnant following weight-loss surgery, the researchers say.

The study was small and more research is needed to confirm the findings. But for women with PCOS, weight-loss surgery may be a cure for infertility, said study researcher Dr. Mohammad Jamal, an assistant professor of surgery at the University of Iowa Hospitals and Clinics.

"Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions," including diabetes, Jamal said. "It appears that infertility now joins that list."

However, infertility experts disagree the surgery is a cure. If women with PCOS regain the weight, their infertility would likely return, said Dr. Beth Plante, a clinical assistant professor of obstetrics and gynecology at Brown University Medical School who was not involved in the study.

"We wouldn't typically recommend having the surgery just to treat infertility," Plante said.

But she said weight loss through any means has been shown to improve fertility in those with PCOS.

"If this is how a patient chooses to achieve that weight loss, then we would usually encourage that," Plante said.

The study will be presented today (June 15) at the meeting of the American Society for Metabolic and Bariatric Surgery in Orlando.

Infertility and surgery

PCOS is a disorder in which a woman's levels of sex hormones are out of balance, according to the National Institutes of Health. Symptoms include changes in the menstrual cycle, small cysts in the ovaries and infertility. The condition occurs in up to 10 percent of women of childbearing age, Jamal said.

It's not known what causes PCOS. But obesity, high blood pressure and diabetes are common in those with the condition. Women are usually diagnosed with PCOS in their 20s and 30s, but symptoms can begin at puberty, according to the NIH.

In the new study, Jamal and colleagues reviewed the medical records of 20 women who had PCOS before weight-loss surgery.

Six of these women wanted to become pregnant but had been infertile. All six became pregnant within three years of having the surgery.

Seventeen women in the study had irregular periods before the surgery, and 14 of them saw a restoration of their menstrual cycle afterward.

After the surgery, the women lost an average of 60 percent of their excess weight, the researchers said.

Precautions

The surgery comes with risks, Plante said. For this reason, women with PCOS should only have the surgery if they were already considering it for other reasons, to treat their obesity or other conditions, including high blood pressure and diabetes, Plante said.

In addition, because of potential nutrition deficits after surgery, it is recommended women who undergo weight-loss surgery put off trying to conceive until 18 months after surgery, Jamal said.

Obesity itself can pose risks during pregnancy, including the risk of gestational diabetes. So weight-loss surgery can reduce the risk of many pregnancy complications, Jamal said.

Pass it on: Obese women with polycystic ovarian syndrome may be able to become pregnant after weight-loss surgery.

This story was provided by MyHealthNewsDaily, a sister site to LiveScience. Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner.

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Weight-Loss Surgery Helps Less Obese Patients: Study (HealthDay)

THURSDAY, June 16 (HealthDay News) -- Obese patients whose body-mass index (BMI) falls below the minimum level recommended for weight-loss surgery may have better outcomes than those who are more obese, new research suggests.

An analysis of data from nearly 1,000 patients revealed that those patients whose pre-surgery BMIs were below the federal guideline threshold of 35-plus experienced a 100 percent remission from type 2 diabetes in the year following surgery.

In contrast, the remission rate for type 2 diabetes in obese patients with a BMI of 35 or more was about 75 percent.

"There was a clear trend that as your weight was lower when having gastric bypass surgery, your outcomes were actually better," noted study co-author Dr. John Morton, director of bariatric surgery at Stanford Hospital & Clinics at Stanford University in Palo Alto.

"This finding suggests that perhaps we should be getting patients to surgery sooner than later, before their weight goes too high and the surgery comes less effective," Morton said.

"After all, when we talk about patients below a BMI of 35, we're not talking about people who are just pleasantly plump," Morton added. "These are people with real, substantial risks associated with excess weight, particularly with respect to diabetes, which has a lot of negative consequences."

Morton and his colleagues are slated to present their findings Thursday at the American Society for Metabolic & Bariatric Surgery annual meeting, in Orlando, Fla. Because the study has not been published in a peer-reviewed journal, its findings should be viewed as preliminary.

Guidelines from the National Institutes of Health recommend gastric bypass only for patients whose BMI is 35 or more and who have an obesity-related condition (such as high blood pressure, sleep apnea, joint disease and/or metabolic syndrome) and who have not been able to lose weight through less invasive methods.

For someone with a BMI of 40 or more, an obesity-related disease is not necessary to qualify for weight-loss surgery, according to NIH guidelines.

Morton noted that ideally one's BMI should clock in under 25. For a woman with a height of 5-foot-4, this would roughly equate to weighing about 140 pounds.

A woman of the same height who weighs 200 pounds would actually fall just short of the BMI threshold of 35, he said, while at 300 pounds the same woman would have a BMI of nearly 52.

Morton explained that the current study came about almost accidentally, as a result of a Stanford pre-surgical program designed to educate prospective patients about the surgery and to encourage them to adopt better nutritional habits before the operation.

Out of the 980 obese patients who had met the NIH criteria when they were initially slated for surgery between 2004 and 2010, 12 patients actually showed up for the procedure at BMI levels below the recommended cut-off point for surgery.

The result: a year following surgery, those patients with a BMI under 35 not only experienced better outcomes in terms of diabetes, but lost more weight than those who met the recommended BMI threshold for weight-loss surgery. They also showed more improvement in obesity-related conditions in addition to diabetes.

At check-ins from three-months to a year after surgery, the patients who weighed less than that recommended for gastric bypass had also lost more weight than those with the higher BMIs. At the 12-month mark, they had lost 167 percent of their excess weight, in contrast to those with a BMI of 35 to 40 (112 percent), 40 to 45 (85.3 percent), and 50 (67 percent).

The authors also noted that the time it took to perform the gastric bypass procedure itself was also shorter for those with lower BMIs.

"What we found amounts to what I think is a big lesson: we ought to intervene with these patients earlier than previously thought," said Morton.

Like all operations, weight-loss surgery is not without risk. Complications include serious infections, internal bleeding and blood clots, and the risk of dying is one in 1,000, according to the American Society for Metabolic & Bariatric Surgery.

Weight-loss surgeries are also expensive, costing about $20,000 to $25,000 or more, depending on the procedure.

Dr. David M. Kendall, chief scientific and medical officer of the American Diabetes Association, approached the findings with some caution.

"While these are exciting and interesting findings, it is really the first set of evidence that looks at this specifically," he said. "We need more research with larger groups and for longer periods of follow-up before we can really start ringing the bell."

"More generally, the other thing I would add is that while bariatric surgery has on several occasions shown impressive results across various bands of weight, people need to be reminded that even modest weight loss and improved glucose control in the absence of surgery can help immensely in terms of diabetes control" and prevention, Kendall said.

More information

For more on bariatric surgery, visit the National Institutes of Health.

View the original article here

Weight-Loss Surgery May Not Lower Death Risk: Study (HealthDay)

SUNDAY, June 12 (HealthDay News) -- Weight-loss surgery doesn't decrease the risk of death among severely obese middle-aged adults, a new study says.

U.S. researchers looked at 850 male patients at Veterans Affairs medical centers who had weight-loss (bariatric) surgery between January 2000 and December 2006. Their average age was 49.5 and their average body mass index was 47.4 (a body mass index, or BMI, over 40 is considered severely obese).

The death rate in this group of patients was compared to that of a control group of about 41,000 VA patients (average age 54.7, average BMI 42) who didn't have surgery.

Eleven of the 850 bariatric surgery patients (1.29 percent) died within one month after surgery. Unadjusted analysis of the death rates over a six-year period showed that the bariatric surgery patients had lower death rates than those in the control group, but further analysis showed that bariatric surgery was not significantly associated with reduced risk of death, said Matthew L. Maciejewski, of the Durham VA Medical Center in Durham, N.C., and colleagues.

The study, published online and in the June 15 print issue of the Journal of the American Medical Association, was to be presented Sunday at an AcademyHealth research meeting in Seattle.

Even though bariatric surgery doesn't reduce the risk of death among middle-aged male patients, many of them still decide to undergo the procedure because there's strong evidence that it reduces body weight and obesity-related health problems, and improves quality of life, the researchers said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.

View the original article here

Weight loss surgery may cure diabetes in many cases (Reuters)

NEW YORK (Reuters Health) – Most obese people with diabetes will be cured of the blood sugar disease after undergoing weight loss surgery, a new review of earlier studies suggests.

In a report published in the Archives of Surgery, researchers say eight out of ten patients could stop taking their diabetes medications following a gastric bypass operation.

"Surgery ought to be considered front line therapy for diabetes among obese people," said Dr. Jon Gould, who heads the weight loss surgery program at the University of Wisconsin and was not involved in the review.

The researchers combed through the data of nine studies of diabetics who had either gastric bypass or another form of weight loss surgery called gastric banding.

In gastric bypass, food is diverted around the stomach into a small pouch, reducing the amount of food a person can eat and hindering its absorption.

Gastric banding slips a ring over the top of the stomach to limit how much a person eats.

In 2009, more than 220,000 Americans had some type of weight loss surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

Eight of the nine studies included between 23 and 177 patients, while one study tracked the outcomes of 82,000 patients. Each study followed the patients for at least 12 months after their weight loss surgery.

Among diabetics who had gastric bypass -- the gold standard weight loss surgery in the U.S. -- 83 percent wound up free of diabetes medications, some within days of the procedure.

Sixty-two percent of diabetics who had the gastric banding procedure could stop taking diabetes medication while maintaining good control of their blood sugar.

Dr. Rick Meijer at the Institute for Cardiovascular Research at Vrije Universiteit in Amsterdam and the lead author of the new report said those outcomes exceed what can be achieved with conventional methods of diabetes treatment.

"In standard practice, only a very minor group of individuals with an iron-will can lose enough weight to be cured from type 2 diabetes mellitus," Meijer wrote in an email to Reuters Health. "The rest of patients have a chronic disease with the need of daily medication-regimens."

About 18 million people in the United States have been diagnosed with diabetes. Meijer said about 90 percent of cases are due to excessive weight, though not all obese diabetics would be eligible for weight loss surgery.

It's unclear how long surgery's impact on diabetes can last.

One study included in the review found that 10 years after surgery, just one third of people whose diabetes had abated continued to have good control of their blood sugar.

Gould said many diabetics could benefit from weight loss surgery, but the approach is underutilized, often because private insurance plans do not reimburse for the procedures.

"It's an incredible source of frustration to me and my colleagues," Gould added.

Surgery does have the potential for complications that wouldn't occur with drugs, however.

One recent study that followed patients up to a month after surgery, for instance, found that seven percent experienced some problem. Most were minor wound infections, but massive bleeding, kidney failure and other serious complications occurred in more than two percent of patients.

Other side effects include nausea and some food intolerance. Some patients also gain back weight over time.

Gould said that the initial cost of surgery, compared to the extended costs of diabetes care and other health effects of being obese, can be recouped after 18 months to two years.

"It would be a huge upfront cost, but looking at this from the bigger picture, I think if we can cure instead of manage the complications, we will save money in the long run," he told Reuters Health.

SOURCE: http://bit.ly/iQbrHG, Archives of Surgery, June 2011.

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Weight-Loss Surgery Can Be Effective Despite Depression (HealthDay)

WEDNESDAY, June 15 (HealthDay News) -- Being depressed doesn't reduce the effectiveness of weight loss surgery, a new study finds.

University of Michigan researchers analyzed data from more than 25,469 patients who had weight loss surgery and found that patients who were depressed or depression-free before the surgery all lost nearly 60 percent of their excess weight within one year. They also reported an average 30 percent improvement in quality of life, including greater mobility, social interactions, family life and independent living.

Patients with depression did have a higher rate of minor complications (4 percent versus 3.3 percent), but there were no significant differences in major complications between the two groups. (The average rate of major complications from weight loss surgery is 4 percent.)

The study also found that the use of antidepressants by patients who had depression decreased by about 20 percent (from 72 percent to 60 percent of patients) one year after weight loss surgery and remained at that level after three years of follow-up.

The study was slated for presentation Wednesday at the annual meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

"Depression and anxiety are relatively common among those with chronic diseases like obesity and type 2 diabetes, and these conditions can sometimes interfere with treatment," lead author Dr. Jonathan F. Finks, an assistant professor of surgery at the University of Michigan, said in an ASMBS news release.

"This study suggests bariatric patients suffering from depression can experience health outcomes and quality of life improvements comparable to non-depressed patients. However, doctors and patients still need to consider psychological issues, state of mind and commitment to lifestyle changes after surgery in assessing whether bariatric surgery is appropriate and indicated for any particular patient," he added.

Because this study was presented at a medical meeting, the findings should be viewed as preliminary until they are published in a peer-reviewed journal.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about weight loss surgery.

View the original article here

Report: Fight fat even in toddlers, preschoolers (AP)

WASHINGTON – A food pyramid just for the under-2 set? Contrary to popular belief, children don't usually outgrow their baby fat — and a new report urges steps to help prevent babies, toddlers and preschoolers from getting too pudgy too soon.

That's a growing problem: Already, one in five preschoolers — 2- to 5-year-olds — is overweight or obese.

Topping the list of proposed changes: better guidelines to help parents and caregivers know just how much toddlers should eat as they move from baby food to bigger-kid fare. And making sure preschoolers get at least 15 minutes of physical activity for every hour they spend in child care.

Thursday's recommendations, from the Institute of Medicine, aren't about putting the very young on diets. But those early pounds can lead to lasting bad effects on their health as children grow, says the report.

"It's a huge opportunity to instill good habits at a time when you don't have to change old ones," said Leann Birch, director of Pennsylvania State University's Center for Childhood Obesity Research, who chaired the IOM panel.

Consider: Babies drink milk until they're full and then turn away. But children as young as 2 or 3 are sensitive to portion size, important in not inadvertently training them to overeat.

"If you give them larger portions, they eat more," Birch explained.

Pediatricians generally give pretty explicit directions on how to feed babies. And the nation's dietary guidelines include a special section for preschoolers, including information that a portion size generally is about 1 tablespoon of each food type per year of age.

But overall, those national guidelines are aimed at ages 2 and older — though surveys show even very young children eat too few of the fruits and vegetables they need. So the institute called on the government to create consumer-friendly dietary guidelines for birth to age 2.

That would capture the "dramatic dietary transition that occurs, from consuming one single food to, by the time they're 2, ordering up things from McDonald's and, we hope, having also learned to eat a lot of healthy foods," Birch said.

That will be part of the discussion during the next dietary guidelines update in 2015, said Robert Post, deputy director of the Agriculture Department's Center for Nutrition Policy and Promotion, which oversees that process. But developing guidelines for these younger children is complex because their nutrition needs are based in part on developmental stage, he cautioned.

Of course, parents have the biggest influence over whether healthy eating and being active become a child's norm.

But the report makes the case that children's habits are influenced by far more than their parents — and thus it's time to expand obesity prevention to more of the other places youngsters spend time. For example, nearly three-fourths of children ages 2 to 5 spend at least part of their day in some form of child care.

Among the recommendations:

_Day care and preschool operators should be trained in proper physical activity for young children, provide at least 15 minutes of it per hour, and avoid withholding physical activity as a punishment.

_Child care regulations should limit how long toddlers and preschoolers sit or stand still to no more than 30 minutes at a time — and limit holding babies in swings, bouncy seats or other equipment while they're awake.

_Day care and preschools should practice what's called responsive feeding: providing age-appropriate portion sizes, teaching children to serve themselves properly, requiring adults to sit with and eat the same foods as the children and following babies' cues as to when they've had enough.

_Breastfed infants are less likely to become obese later in childhood, so doctors and hospitals should encourage breastfeeding and limit formula samples aimed at new moms.

_At checkups, doctors should consider the parents' weight in assessing which children are at risk of later obesity, and then alert parents early that preventive steps are needed. About 10 percent of infants and toddlers already weigh too much for their length.

_To increase healthful eating among the poorest children, the government should take steps to get more families who are eligible for federal nutrition-assistance programs to sign up.

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Study Reveals Bariatric Surgery Less Effective in Middle-Aged Adults (ContributorNetwork)

If you're morbidly obese and middle-aged, weight-loss surgery may not decrease your chances of dying, according to a study published Sunday in the online Journal of the American Medical Association. Morbidly obese is defined as having a body mass index greater than 39 and generally means someone who is 100 pounds or more overweight.

Researchers were interested in studying the mortality rates of middle-aged and older adults after bariatric surgery. Data available prior to this study was based almost solely on young, white females who had had the weight-loss surgery. That group of individuals has a lower incidence of mortality related to obesity even before bariatric surgery than do older adults, according to study researchers.

The purpose of the study was to determine the effectiveness of weight-loss surgery in populations with an increased risk of death related to obesity; these populations were identified as being highest in men and minority populations.

The research team studied follow-up data for 850 men with a mean age of 49.5 years and a mean BMI of 47.4 for an average of 6.2 years. The men in the study had the weight-loss surgery between the years 2000 and 2006. Their mortality (death) rate was compared to a control group of 41,000 other men who did not have the surgery, reports Yahoo! News. All the men were patients at medical centers of Veterans Affairs.

Researchers concluded that bariatric surgery in morbidly obese middle-aged men did not decrease their risk of death compared with care that did not include the surgery. Still, this population may opt for weight-loss surgery based on factors other than mortality rate, such as the reduction of body weight, control of obesity-related health conditions and improved quality of life.

In the United States, weight-loss surgery usually involves one of four procedures, explains the Weight-Control Information Network. The four procedures, each with its own risks and benefits, are: adjustable gastric band (AGB); Roux-en-Y gastric bypass (RYGB); biliopancreatic diversion with a duodenal switch (BPD-DS); and vertical sleeve gastrectomy (VSG). The AGB works by decreasing food intake while the other surgeries involve not only the decreased ability to take in food but also affect food absorption and other factors.

Your physician will weigh conditions such as your health, obesity-related health conditions and your eating behaviors in helping to determine which, if any, of the weight-loss surgeries would be to your benefit. The outcome of this new study into mortality rates following bariatric surgery may be a factor in your consideration of the procedure now also.

Smack dab in the middle of the baby boomer generation, L.L. Woodard is a proud resident of "The Red Man" state. With what he hopes is an everyman's view of life's concerns both in his state and throughout the nation, Woodard presents facts and opinions based on common-sense solutions.

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Experts Issue Guidelines on Safe Weight Loss for Athletes (HealthDay)

MONDAY, June 20 (HealthDay News) -- Gymnasts, wrestlers and boxers often feel pressure to lose weight to boost performance, but the drastic methods they sometimes use -- including strictly limiting calories and intentional dehydration -- can be dangerous to their health, experts warn.

To offer guidance to athletes, coaches and parents, the National Athletic Trainers' Association has issued a new set of guidelines for safe weight loss by athletes.

They include: using body composition assessments to measure lean body mass versus fat; gradually shedding no more than 1.5 percent of body weight a week; eating a balanced diet that includes all food groups; and losing weight under the supervision of nutrition, health and weight management experts.

"In the performance sports -- gymnastics, dance, ballet -- they have this huge responsibility to not only do a performance but to look good while they are doing it. It's a unwritten rule that they have to be a certain weight, and they get a lot of pressure, not just from dance masters but from the public's expectations and themselves," said Paula Sammarone Turocy, lead author of the guidelines and chair of the department of athletic training at Duquesne University in Pittsburgh. "We also see it in traditional sports -- jockeys, wrestlers, boxers. They all have weight requirements. If they don't make the weight, they don't compete."

And the pressure to shed weight cuts across all sports, she added. Many cyclists, swimmers, runners, soccer players and even football players believe that losing weight will mean they can run, swim and jump faster.

Getting down to an ideal body weight to improve performance isn't a problem in and of itself, she said. It's when athletes go to extremes that their drive can backfire. "When it's done improperly or done to extremes it does interfere with performance," she explained.

The new guidelines were to be presented Monday at the annual meeting of the National Athletic Trainers' Association in New Orleans and are published in the June issue of the Journal of Athletic Training.

Ashleigh Clare-Kearney has been there. As a high school student, she was a standout gymnast, in more ways than one. She was powerful and graceful, although she was 5-foot-4 and weighed 155 pounds.

"I didn't fit the stereotypical frame, which is 4 feet, 10 inches, 110 pounds," Clare-Kearney said. "I was told, 'You need to lose weight. You will be viewed as a risk. You are not going to be able to compete in elite international competitions.' People said I wouldn't make it because of my size."

She defied their predictions. As a gymnast at Louisiana State University (LSU), she became the NCAA national champion in vault and floor, captain of the team and a NCAA Woman of the Year finalist.

Yet she couldn't deny it -- slimming down would help her performance. She'd put on weight when she got to college, and she knew that carrying less heft might allow her to vault even higher.

Working with the athletic trainers and the coaches at LSU, she got down to about 145 pounds by focusing on nutrition. "I was never going to be 110 pounds. That's not the way I'm built," she said. "What really resonated with me was the way the athletic training staff understood that. They said, 'Let's be realistic.'"

For Clare-Kearney, that included keeping a food diary, making sure to always eat breakfast, drinking water instead of sweetened beverages and eating more fruits and vegetables and less processed foods.

But not every athlete manages to handle the pressure to lose weight so well.

Before competitions, some wrestlers, jockeys and boxers intentionally dehydrate themselves by exercising in heavy clothing and restricting certain foods and fluids to lose weight quickly.

There are even anecdotal reports that elite, international athletes have their blood removed by IV prior to weigh-in. The blood is then re-infused before competition.

Among wrestlers at least, intentional dehydration may be less popular than it used to be due to changes in the rules from the high school level on up that call for urine tests to detect hydration status at weigh-in. In 2006, for example, the National Federation of State High School Associations not only adopted the hydration status rules, but also minimum body fat requirements (greater than 7 percent in boys and 12 percent in girls) in order to compete.

Not only can rapid weight loss hurt performance over the short term because athletes simply don't have the energy to perform at their best, but experts add that restricting calories can also have long-term consequences.

Over time, dietary restrictions can impact the endocrine system, hindering the growth and functioning of muscles and bones. A poor diet can also impair thyroid function, lower metabolism and hormone production and suppress the immune system.

Clare-Kearney, now a law student at Southern University Law Center of Baton Rouge and a volunteer coach for her alma mater, urges young athletes to consider the consequences of their diets.

"Food really does fuel your body. Your body can only handle so much without the proper fuel and nutrition," she said. "And there is life beyond gymnastics. We also have to keep our body healthy for life after gymnastics."

More information

The U.S. National Institute of Mental Health has more on eating disorders.

View the original article here

Older men don't live longer with weight-loss surgery (Reuters)

NEW YORK (Reuters Health) – Weight-loss surgery may not help obese middle aged and older men live longer, according to new research that runs counter to earlier findings in younger people.

The results mean doctors should be extra careful when counseling obese patients about their treatment options, Matthew Maciejewski of Durham VA Medical Center in North Carolina and colleagues write in the Journal of the American Medical Association.

In 2009, more than 220,000 Americans had some type of weight loss surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

Experts say surgery is the most enduring way to bring down one's weight, and earlier studies have suggested it will increase life expectancy by up to three years.

At first, the new study did appear to confirm those findings, but the benefit didn't hold up when comparing similar patients who did or did not have surgery.

The researchers looked back at the outcomes of 850 veterans, mostly men over 50 years old, who'd had weight-loss surgery between 2000 and 2006.

Six years after their surgery, about seven percent of the men had died, compared to 15 percent among a comparison group of obese men who didn't have surgery.

But when patients from the two groups were matched closely according to weight, age, race and other factors, the survival gap disappeared.

Previous studies have found that about seven percent of patients having weight-loss surgery experience complications, although most are minor wound problems.

Serious complications -- such as massive bleeding or kidney failure -- occurred in 2.6 percent of patients in one study from last year.

The new study is the first to compare death rates among heavy middle aged and older men who did or did not have weight-loss surgery, the researchers say, but it did have a number of limitations.

For instance, it's possible that following the patients for longer than six years would have changed the picture in favor of those who had surgery. And, the researchers stress, patients may still want surgery, even if it turns out not to affect their life expectancy, because the weight loss is likely to improve other medical conditions and quality of life.

SOURCE: http://bit.ly/ifujZX Journal of the American Medical Association, online June 12, 2011.

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Ways to Curb Childhood Obesity Outlined in U.S. Report (HealthDay)

THURSDAY, June 23 (HealthDay News) -- Strategies to encourage physical activity, healthy eating and good sleep habits are needed to reduce high rates of obesity among infants, toddlers and preschoolers in the United States, says an Institute of Medicine report released Thursday.

Limiting children's TV time is a key recommendation.

Rates of excess weight and obesity among U.S. children ages 2 to 5 have doubled since the 1980s. About 10 percent of children from infancy up to age 2 years and a little more than 20 percent of children ages 2 to 5 are overweight or obese, the report said.

"Contrary to the common perception that chubby babies are healthy babies and will naturally outgrow their baby fat, excess weight tends to persist," report committee chair Leann Birch, professor of human development and director in the Center for Childhood Obesity Research at Pennsylvania State University, said in an institute news release.

"This is a national concern because weight-related conditions such as diabetes and high blood pressure once occurred almost exclusively in adults but are now occurring at rising rates among teens and young adults," Birch said.

"Child care providers, health professionals, and policymakers can be helpful partners to parents in reducing obesity risk by creating healthy environments and implementing positive practices during the crucial early years of development," she added.

Tackling only one factor will not solve the problem of obesity among infants, toddlers and preschoolers. The issue requires a wide-ranging approach that includes identifying when young children are overweight, increasing physical activity, encouraging healthy eating, and making sure children get enough sleep, the report said.

Recommendations include:

Limiting young children's television and other media use,Requiring child-care providers to promote healthy sleeping practices,Educating parents about age-appropriate sleep times and good sleep habits,Requiring child-care providers to provide opportunities and environments that encourage physical activity,Increasing efforts to promote breast-feeding,Requiring child-care facilities and preschools to follow the meal patterns established by the U.S. Child and Adult Care Food Program.

The report recommendations are aimed at policymakers and health-care and child-care providers, but these professionals can educate and support parents in establishing health habits in the home, too, the report authors said.

The institute is under the umbrella of the National Academy of Sciences.

More information

The U.S. Centers for Disease Control and Prevention outlines how parents can keep their children at a healthy weight.

View the original article here

Can Weight-Loss Surgery Reverse Common Cause of Infertility? (HealthDay)

WEDNESDAY, June 15 (HealthDay News) -- Weight-loss surgery may reverse a common cause of infertility in women, a small, new study suggests.

Polycystic ovarian syndrome (PCOS) is a hormonal imbalance that affects up to 10 percent of women of child-bearing age. An estimated one-third to one-half of women with PCOS are overweight or obese, according to the American Society for Metabolic & Bariatric Surgery (ASMBS).

Researchers at the University of Iowa Hospitals and Clinics in Iowa City reviewed records on 566 morbidly obese women who had gastric bypass surgery. Morbid obesity is having a body mass index (BMI) of 40 or more. The women in the study had an average BMI of 52 and lost substantial weight after surgery.

Researchers contacted 20 women between the ages of 22 and 42. Of those, 14 were fertile prior to surgery and had no interest in having more children, while six women had been diagnosed with infertility and wanted to have children.

Three years after surgery, all six had become pregnant.

"Not many patients come to a bariatric surgeon to treat infertility problems," study co-author Dr. Mohammad Jamal, a clinical assistant professor of surgery, said in an ASMBS news release. "But this study suggests that women with morbid obesity, who are infertile secondary to PCOS, may have a new surgical option. Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions. It appears that infertility now joins that list."

The study was to be presented Wednesday at the ASMBS annual meeting in Orlando.

"Though this is a small study, it has a big result and should be an area for more investigation and should be discussed with morbidly obese women who are having difficulty conceiving," Jamal said.

Women are advised not to try to get pregnant until at least 18 months after bariatric surgery because of physical changes that might harm the fetus.

Experts note that research presented at meetings is considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. National Institute of Child Health and Human Development has more about PCOS.

View the original article here

2011年6月24日星期五

Budget talks suspended as Cantor bolts over taxes (AP)

WASHINGTON – Efforts to find a bipartisan agreement blending huge budget cuts with a must-pass measure to increase how much the government can borrow have entered a new phase after Republican negotiators pulled out of talks led by Vice President Joe Biden.

The exit of House Majority Leader Eric Cantor from the talks on Thursday means the most difficult decisions have been kicked upstairs to GOP House Speaker John Boehner of Ohio and President Barack Obama. The Biden-led group had made solid progress in weeks of negotiations but was at an impasse over taxes.

Cantor, R-Va., said that the Republican-dominated House simply won't support tax increases and that it's time for Obama to weigh in directly because Biden and Democrats were insisting on tax increases. Democrats said it's only fair to blend in additional revenues from closing tax breaks to balance trillions of dollars in spending cuts.

It had long been assumed that the Biden group would set the stage for more decisive talks involving Obama and Boehner. As a result, Cantor's move was interpreted as trying to jump-start the talks rather than blow them up — a view shared by Cantor himself.

"The purpose here is to alter the dynamic," Cantor said.

In fact, Cantor's withdrawal came after Boehner had already made a trek to the White House — in a secret meeting Wednesday night that followed up on a golf outing over the weekend. For his part, Cantor didn't inform Boehner of his decision to leave the talks until Thursday, shortly before the news broke, said a GOP official familiar with the situation. The official required anonymity because of the sensitivity of the information.

The White House sought to put a positive spin on developments.

"As all of us at the table said at the outset, the goal of these talks was to report our findings back to our respective leaders," Biden said in a statement. "The next phase is in the hands of those leaders, who need to determine the scope of an agreement that can tackle the problem and attract bipartisan support. For now the talks are in abeyance as we await that guidance."

The Senate's Republican negotiator, Jon Kyl of Arizona, also exited the talks.

For his part, Cantor said the secretive Biden-led talks had "established a blueprint" for agreement on significant cuts in spending.

One of the byproducts of Cantor's departure was to provide an opportunity for partisans on all sides to make statements at odds with the positions they may have to take to achieve a deal. Democrats insist that at least some new revenues are needed — both to soften spending cuts and to line up the Democratic votes needed to pass the measure.

"It will take Democratic votes to pass any debt-ceiling agreement," said Sen. Chuck Schumer, D-N.Y. "As a result, certain things are going to have to be true. We cannot make cuts to Medicare benefits. We have to allow for revenues like wasteful subsidies for ethanol and oil companies. And we have to do something on jobs."

"President Obama needs to decide between his goal of higher taxes or a bipartisan plan to address our deficit," said Senate Republican leader Mitch McConnell, R-Ky. "He can't have both."

As for Democratic demands for new deficit-financed "jobs" initiatives, McConnell scoffed: "What planet are they on?"

Cantor said that plenty of progress has been made in identifying trillions of dollars in potential spending cuts to accompany legislation to raise the $14.3 trillion cap on the government's ability to borrow money. Passage of the legislation this summer is necessary to meet the government's obligations to holders of U.S. Treasurys. The alternative is a market-shaking, first-ever default on U.S. obligations.

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Tiffany replaces CFO, adds COO title (AP)

NEW YORK – Jewelry retailer Tiffany & Co. is replacing its chief financial officer as it reshuffles longtime executives and adds a chief operating officer position.

The company says 45-year-old Patrick F. McGuiness will replace 55-year-old James Fernandez as chief financial officer.

Fernandez is taking on the newly created post of chief operating officer and McGuiness will continue to report to him.

The moves are effective immediately.

McGuiness has been with Tiffany since 1990 and was most recently senior vice president of finance. Fernandez joined the company in 1989 and has served as CFO as since 1998.

Tiffany and other luxury brands are doing well as the sector rebounds quicker than others. Its first-quarter profit climbed 25 percent on higher revenue across all regions worldwide in its most recent quarter.

Its shares fell 79 cents to $75.64 in morning trading Thursday.

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EU leaders appoint Mario Draghi as new ECB president (Reuters)

BRUSSELS (Reuters) – Italy's Mario Draghi was appointed the new head of the European Central Bank on Friday, to replace current ECB President Jean-Claude Trichet at the end of October, EU Council President Herman Van Rompuy said.

"The European Council has just agreed on the appointment of Mario Draghi as new President of the ECB," Van Rompuy, who chairs EU leaders' talks, said in a message posted on Twitter.

(Reporting by Jan Strupczewski)

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US new home sales fall in May (AFP)

WASHINGTON (AFP) – New US home sales fell 2.1 percent in May, the US Commerce Department said Thursday, indicating that the weak housing market was still weighing down the world's largest economy.

Sales of new, single-family homes were estimated at a seasonally adjusted annual rate of 319,000 in May, down from the revised April figure of 326,000, the Commerce Department said in a monthly report.

The figures for May were better than analysts' consensus estimate of 305,000 and the revised figures for April were a slight improvement over the Commerce Department's original estimate of 323,000.

Still, the overall level remained disappointingly low, pointing to continued weakness in the housing market, a pillar of the US economy which will need to improve for the broader economy to recover.

"The housing market remains the weak point of the current recovery as households are still deleveraging and remain wary of making long-term debt commitment in the context of high unemployment and sluggish economic growth," said Inna Mufteeva, an economist with Natixis.

The 2007-2008 collapse of the US housing market after many years of rising prices was a key reason why the global economy tipped into recession.

On Tuesday, the National Association of Realtors reported that existing home sales in the United States had fallen 3.8 percent in May to a seasonally adjusted annual rate of 4.81 million.

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China accounting scandals put Big Four auditors on red (Reuters)

HONG KONG (Reuters) – The string of accounting problems and stock plunges at publicly traded Chinese groups has sparked deep concerns across the world's biggest audit firms, putting the so-called Big Four on alert from worries that their reputation could be brought down along with a growing list of stricken companies.

Auditing Chinese firms preparing to go public on overseas exchanges is a lucrative business and one that plays into the strengths of the top, international auditing partnerships known as the Big Four: KPMG, Ernst & Young, Deloitte Touche Tohmatsu and PricewaterhouseCoopers.

Yet fears are growing that the struggle to find enough high-quality auditors in China and Hong Kong means it may only be a matter of time until one of the top firms finds itself caught in a blow-up rivaling Enron, which brought down their old rival Arthur Andersen.

"Costs have gone up, fees have gone down, as competition for fees is enormous. You can easily see there is a real risk of an audit firm failing," said Paul Winkelmann, the partner in charge of risk and compliance for PWC in Greater China. According to interviews with professionals at the four firms, each firm is getting more and more cautious about the work they take on from mainland companies looking to IPO. "The whole industry, I will say, is very sensitive and cautious to China IPOs," said an auditor at one of the Big Four, who handles IPO work, who did not want to be named.

The Big Four are also getting nervous about work with existing Chinese clients, turning to lawyers at an earlier stage if they think something might be amiss.

"If a risk situation arises they're now consulting lawyers earlier and dealing with it in a much more structured way than was perhaps the case in the past," said Tom Fyfe, a partner at law firm Barlow, Lyde & Gilbert in Hong Kong who acts for some of the big four in litigation issues.

All four of the audit firms responded to a Reuters request to comment on the matter. The four firms said they have a rigorous approach to risk management.

CHINA BOOMING BIZ

The big four have basked in China's emergence as an economic powerhouse. In 2009 their revenue from work on the mainland stood at 9.1 billion yuan ($1.41 billion) according to the Chinese Institute of CPAs (CICPA), around half of China's accounting industry's revenue. Last year's figures were not immediately available.

As the revenues have risen, so have the risks.

Most of the accounting scandals in the U.S. have come from small Chinese companies who went public via a reverse takeover. Those companies were audited by smaller U.S. or Hong Kong-based accountancy practices, not the Big Four's China firms. But some recent high profile cases have started to drag in the names of the world's most prestigious auditors.

Last month, Deloitte quit as auditor of Longtop Financial Technologies after working on the company's books for six years, citing "recently identified falsity" in their finances.

Ernst & Young was named in two class action lawsuits over its work on Sino-Forest, the Toronto-listed company accused by short-seller Muddy Waters of accounting fraud.

In Hong Kong, KPMG said in January that it had found possible irregularities in the books of China Forestry, leading to a suspension of its shares.

Accounting experts say the firms have been acting as they should by raising the alarm once they find irregularities that can't be explained by the company. They also point out that the Big Four's China businesses and its broad global resources are much better placed than small U.S. firms to conduct audits on Chinese companies.

"I think firms here have always been aware of the risks associated with audit work in China. There is more endemic fraud in Asia, but people are much more aware of it here and so manage the risks accordingly," said PWC's Winkelmann.

Winkelmann, on behalf of the Hong Kong Institute of CPAs (HKICPA), is drafting a paper to present to the Hong Kong government later this year calling for changes to the law on auditor liability. The IPOs are now so large -- last year saw two greater than $20 billion in Hong Kong -- the worry is that a massive IPO liability, if it were to hit an auditing firm, would be too big for the firm to handle. The change calls for a cap on the liability.

The latest string of scandals has laid bare some of the difficulties auditors have in China, forcing the big firms to reappraise their methods, given that a loss of reputation could bring them to their knees.

"There's no doubt about it -- the firms are very alert to these issues and very sensitive to what it means. They will be looking at their risk assessment procedures," said Chris Joy, executive director, HKICPA.

STAFF SHORTAGES

Two of the biggest challenges facing the big four are staffing and the type of companies they audit.

Together the firms now employ just under 40,000 people in mainland China, Hong Kong and Taiwan. While that's a relatively high number compared to other regions, it's not enough to handle the huge demand created by the rapid economic growth of the world's most populous country, experts say.

"We are in tremendous need of experienced accounting professionals and graduating college students," said a spokeswoman for Ernst & Young, which plans to recruit 1500 new staff this year.

Finding them might be tough.

"Between us and the CICPA and other bodies that offer qualifications, we can't produce enough at the moment, but we're not going to compromise the quality of our program just to mass produce accountants," said Joy at the HKICPA.

That skill shortage is likely to be felt even more keenly now that the type of IPO work the big firms are handling is shifting. Whereas 10 years ago the majority of firms going public in China were state-owned enterprises (SOEs), a lot more of the work now is for privately-run businesses.

"Previously the market was for SOEs, and China is not going to allow a major embarrassment with an SOE," said PWC's Winkelmann. "But now it's changing as international firms are starting to do more of the private enterprises in China, which don't come with that government support."

(Reporting by Rachel Armstrong; Additional reporting by Benjamin Lim in BEIJING, George Chen in HONG KONG; Editing by Michael Flaherty)

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Exclusive: Banks, officials nearing Greek bond plan (Reuters)

LONDON/FRANKFURT (Reuters) – European banks and finance officials are nearing a proposal to roll over banks' holdings of Greek sovereign debt without prompting ratings agencies to declare a default, two senior European banking sources said on Friday.

The proposal foresees a voluntary debt rollover into securities of a different and not comparable credit composition, the sources told Reuters on Friday.

Banks, insurers and national finance officials have held meetings this week to seek a solution to Greece's sovereign debt crisis.

German private creditors have been asked by the country's finance ministry to submit data on their Greek exposure and their intentions to roll over the debt by early next week, two other sources familiar with the meetings said.

(Reporting by Alex Chambers, Jonathan Gould and Philipp Halstrick)

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Greek power company seeks court ruling on strike (AP)

ATHENS, Greece – The country's power company says it has filed a suit in an Athens court for the 48-hour rolling strikes by its workers to be declared illegal.

Electricity company employees object to the company's privatization — part of a euro50 billion privatization drive and new austerity measures essential for Greece to continue receiving international rescue loans that are preventing it from defaulting on its debts.

The power company said Friday it had filed a legal request for the strike to be declared illegal — a move which would force the employees back to work.

The strike has led to power cuts across the country, and consumers have been asked to limit their use of electricity and exercise caution when using elevators.

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EU leaders appoint Draghi as next ECB president (AP)

BRUSSELS – European Union leaders appointed Italy's Mario Draghi as the next president of the European Central Bank on Friday — a move that gives investors much-needed certainty over who will lead the institution in its pivotal role in the fight against the crippling debt crisis.

The timing of Draghi's appointment had come under doubt as fellow Italian executive board member Lorenzo Bini Smaghi had until Friday refused to leave his post.

With Bini Smaghi staying on the executive board, France would not have a representative on the six-person board once current ECB chief Jean-Claude Trichet departs on Oct. 31. The French had previously implied they would only support Draghi if a Frenchman or woman takes Bini Smaghi's spot.

However, a European official said Friday that Bini Smaghi had now agreed to step down by the end of the year. The official was speaking on condition of anonymity because the moved had not officially been announced yet.

The European Parliament and the ECB board had already given their approve to Draghi's appointment.

Delaying his appointment until their next summit in September would have underlined divisions among EU leaders, who have already struggled to find a common line on debt-stricken Greece and the best way of containing the financial crisis that has also pushed Ireland and Portugal into needing massive bailouts.

The ECB has played a central role during the debt crisis that has afflicted the 17-country eurozone over the past 18 months or so. For example, Trichet overrode criticism from some of the more hawkish officials at the bank when he backed a multibillion euro (dollar) bond-buying program intended to ease the pressure on the more indebted countries.

More recently, the ECB has found itself in the difficult position of raising interest rates to keep a lid on above-target inflation levels even though the weaker eurozone economies remain weak.

The decision on Draghi was expected a day after EU leaders gave their clearest sign yet that Greece will get a second bailout in the coming weeks, on top of last year's euro110 billion ($156 billion).

"We agreed that there will be a new program for Greece," said German Chancellor Angela Merkel.

The stronger language on aid for Greece was also made possible after debt inspectors from the EU and the International Monetary Fund reached a final deal Thursday with the government in Athens on euro28 billion worth of new austerity measures.

The measures have to be passed by the Greek Parliament next week for the bailout funds to be released. If lawmakers fail to back the package, then Greece will likely be staring at a default on its debts.

Even if it gets a second bailout, many economists think that Greece will have to restructure its debts in some shape or form in the coming years, especially if the economy shrinks further.

___

Angela Charlton contributed to this story.

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Exclusive: Deutsche's firing of top trader sparks probe (Reuters)

NEW YORK (Reuters) – In the fall of 2009, Deutsche Bank quietly fired one of its top derivative traders in London after a colleague in New York complained about finding "substantial trading anomalies" in a multibillion dollar portfolio of high-risk credit default swaps managed by the German-based bank, Reuters has learned.

The bank dismissed Alex Bernand after a quick internal investigation prompted by the employee's complaint led to the discovery of improper trading in one of Bernand's personal brokerage accounts, according to documents seen by Reuters and interviews with people familiar with the situation.

The documents, part of a Sarbanes-Oxley whistleblower action filed against Deutsche in May 2010 by the employee in New York, also reveal that the Securities and Exchange Commission opened an inquiry last year into a related allegation that some of the assets in the derivatives portfolio overseen by Bernand may have been improperly valued in order to hide trading losses.

Deutsche bank spokeswoman Renee Calabro declined to comment on Bernand's dismissal. But she said the allegation that some assets in the bank's derivatives book had been improperly valued was investigated by the bank and is "wholly unfounded."

The SEC investigation and Bernand's October 2009 firing, neither of which has been previously reported, come as Deutsche is aggressively winding down the portion of its derivatives trading business that Bernand had overseen. Earlier this month, the bank reported in an investor presentation that its plan to unwind its "high-risk" credit correlation portfolio "is well ahead" of schedule. The bank first announced a plan to begin "de-risking" some of its derivatives trading desks in late 2008.

In January, Deutsche settled the whistleblower case by agreeing to pay $900,000 to trader Matthew Simpson and promoting him to managing director shortly before he voluntarily agreed to leave the bank in April. It was the largest Sarbanes-Oxley whistleblower settlement for a complaint filed in 2010. Simpson, who now works for Rochdale Securities in Stamford, Connecticut, did not return a phone call seeking comment.

UNFOUNDED ALLEGATION

"This complaint, which is over a year old, has been the subject of a thorough investigation, and we believe that any allegations about financial misreporting are wholly unfounded," said Calabro, who declined to comment on the terms of the settlement with Simpson. "The bank is cooperating with the SEC on its review of the matter."

An SEC spokesman declined to comment.

Bernand, who lives in France, also declined to comment. On his LinkedIn profile, Bernand describes himself as an "independent philanthropy professional."

Simpson's and Bernand's names were redacted from the whistleblower documents seen by Reuters, but their identities were confirmed by two people familiar with the situation.

In its settlement agreement with Simpson, Deutsche also denied "any wrongdoing in connection with the matter." In light of the settlement, the U.S. Department of Labor in February closed its investigation into Simpson's claim that he had been retaliated against by some of his superiors for bringing the allegations of improper trading to the attention of the bank's compliance department.

The firing of Bernand, a one-time rising star in the derivatives world, is something of an embarrassment for Deutsche. In 2006, the bank issued a press release to trumpet his hiring from Bank of America as its global head of credit correlation. At BofA, Bernand had pretty much built the Charlotte, North Carolina-based bank's structured credit trading business from scratch.

Inside Deutsche, the portfolio that Bernand oversaw from London was called the "exotics book," because many of the derivatives in the portfolio were tied to complex securities. At its peak, the portfolio was one of the largest on Wall Street with the assets underlying the trades valued in the tens of billions of dollars.

ILLUSORY PROFITS

The bank's credit correlation desk specialized in using credit default swaps to make proprietary trades that were aimed at hedging some of the bank's exposure to potentially risky corporate bonds, leveraged loans, currencies, indexes and commercial paper. Many of the trades put on by correlation traders involve synthetic collateralized debt obligations (CDOs), financial instruments that use credit default swaps to get exposure to various bonds and other assets.

Some have blamed credit default swaps -- a type of derivative that is supposed to provide a level of insurance against an underlying asset going bad -- with exacerbating the global financial crisis because they increase the level of risk on balance sheets of the world's major banks. However, the synthetic CDOs traded by the correlation desk were not like the more popular variant of CDOs which were stuffed with subprime mortgage securities.

Janet Tavakoli, a Chicago-based derivatives consultant who has written several books on credit derivatives and structured products, said many bank managements did not fully appreciate the illusory nature of the trading profits being generated from derivatives correlation desks before the financial crisis. She said those profits often disappeared and turned into losses when the underlying assets turned south.

"The thing about correlation desks is that it will appear you are making a lot money from trades, but it is all money at risk," said Tavakoli. "I call this kind of trading an invisible hedge fund."

In an early 2010 regulatory filing, Deutsche attributed some of the rise in the bank's value-at-risk, or VAR, at the end of 2009 to a "recalibration of parameters in the Group's credit correlation business."

On Wall Street, VAR is one metric used by a bank to estimate how much money it could conceivably lose in a day if all of its trading bets and hedges went awry. It's an imperfect measurement, but one followed by most industry analysts.

A person familiar with Deutsche said the bank is winding down the credit correlation desk to both reduce its risk profile and better comply with the so-called Volcker Rule's ban on proprietary trading in the United States.

The bank's internal investigation into Simpson's allegations was overseen by the big New York law firm Fried Frank.

The revelation that the SEC is investigating the valuations used for some of Deutsche's derivatives portfolio comes at an awkward time. Over the past few months, the bank has taken some high-profile lumps for its role in contributing to the financial mess.

A Senate report released in April faulted Deutsche for continuing to churn out collateralized debt obligations and other securities backed by subprime mortgages even as the housing market in the United States was starting to crumble. The report from the Senate's Permanent Subcommittee on Investigations said Deutsche aggressively marketed CDOs to its client, "despite the negative views of its most senior CDO trader" about the failing health of the housing market.

Just last month, federal prosecutors in New York filed a civil suit against Deutsche, claiming its MortgageIT subsidiary repeatedly lied about the quality of the mortgages it was issuing to obtain federal guarantees on those iffy home loans. The government seeks to recoup some $1 billion in losses it incurred from insuring the mortgages. Deutsche contends most of the problem loans were issued before the bank acquired MortgageIT in 2007.

Before filing his whistleblower complaint last May, Simpson had built a long track record at Deutsche. Over the dozen years he worked for the bank in New York, he held positions in finance, risk management and then trading. He joined the firm's correlation trading group in 2008 and was responsible for trading derivatives tied to bonds and currencies.

In his whistleblower complaint, Simpson said when he reported his concerns about trading improprieties to Deutsche's compliance department he "expressed concerns for future retaliations."

Among the acts of retaliation that Simpson alleged were being passed over for a promotion in February 2010 and later "stripped" of all his trading and management responsibilities. Calabro said the bank denies Simpson's claim of retaliation.

(Reported by Matthew Goldstein; Editing by Michael Williams and Claudia Parsons)

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