In the study "Orlistat is as Beneficial as Metformin in the Treatment of Polycystic Ovary Syndrome," leading researchers from the University of Hull in the U.K. examined the efficacy of two weight loss drugs for the treatment of the most common hormonal disorder in reproductive-age women, polycystic ovary syndrome (PCOS). PCOS is an endocrine-related condition characterized by increased male hormone (testosterone) levels, infertility, irregular menstrual cycles, ovarian cysts, excessive hair growth, and increased risk for diabetes and obesity, among other health problems. An examination of a study population of 21 obese adult women (mean age 27+- 0.9 years; mean body mass index 36.7 +- 3.3) allowed researchers to compare the effectiveness of metformin - a type 2 diabetes medication that recently became a commonly prescribed medication for overweight women with PCOS - with the effectiveness of Orlistat - a weight loss product that has yet to be proven a valuable PCOS treatment. The study revealed that Orlistat enabled women to lose more weight and further reduce their total testosterone levels when compared with the women who received metformin. These latest data reveal another potentially effective treatment option - administration of Orlistat - and offer renewed hope for women with PCOS. According to experts, while more research is needed, the clinical implication of Orlistat as a treatment for the millions of women with PCOS is promising.

Translating Research Into Practice: Commentary on the PCOS study from President-Elect Dr. Andrea Dunaif
"We know that metformin is a proven and effective treatment for women with polycystic ovary syndrome. This study suggests that weight-loss medications may be an effective treatment option for not only the obesity but also the testosterone excess associated with PCOS. Further research is clearly warranted to determine where this class of medications will fit into the treatment of PCOS."

For more information on Dr. Dunaif, please see the "Meet the Officers" section of this issue of The Endocrine Edge.

In adolescent girls, physical inactivity may represent a greater health threat than obesity alone. In the study "Cardiovascular Fitness and Exercise as Determinants of Insulin Resistance in Post-Pubertal Adolescent Females," researchers aimed to determine whether weight or fitness might be determinants of insulin resistance, and therefore overall metabolic health in teenage girls and very young women. The investigators analyzed the participants' self-reported activity practices, measured body composition and also quantified cardiovascular fitness by an exercise challenge test. They concluded that physical fitness was a better indicator of insulin resistance than weight or percent body fat. The authors conclude that encouraging adolescent girls to engage in regular physical activity rather than just controlling their weight might better protect future metabolic health. Physical inactivity may represent a greater health risk than an increased weight for approximately 16 percent of children and adolescents living in the U.S. who are currently considered overweight and have few opportunities for physical education*.

Are Obese Individuals Less Satisfied and More Hungry Than Normal Weight Individuals After Eating?

Ghrelin is a gut-brain peptide that signals hunger and increases food intake and body weight. In the study "Postprandial Plasma Ghrelin is Suppressed Proportional to Meal Calorie Content in Normal Weight But Not Obese Subjects," researchers examined the changes in hunger, due to fluctuations in plasma ghrelin levels, among normal weight and obese subjects following six types of test meals. Typically, after eating, one's ghrelin levels will be suppressed causing one to feel full. However, this investigation found that the post-meal satiety, or feeling of fullness, that normal weight subjects felt was much greater than the level of fullness their obese counterparts felt after eating. This study provides additional insight into the impact ghrelin has on reinforcing obesity - basically, obese individuals may eat more because they don't feel as full as their non-obese peers.

See these studies and more in the upcoming issue of JCE&M from The Endocrine Society. To interview an author or to obtain a copy of the studies discussed above, contact The Endocrine Society at media@endo-society.org

Coming this month in the Endocrinology Diets High in Fat? No Way! Bring on the Carbohydrates and Protein.

In the study "Role of the Duodenum and Macronutrient Type in Ghrelin Regulation," researchers compared the effect of diets rich in either carbohydrates (glucose), protein (amino acids) or fat (lipids) on circulating levels of ghrelin, the gut-brain peptide that stimulates hunger and food intake. Earlier research in humans and other animals had shown that circulating ghrelin levels rise just before meals and fall following food intake. It was unclear, however, which nutrients in food suppress ghrelin most effectively. To answer this question, the researchers infused fixed caloric amounts of different macronutrients - carbohydrates, proteins, or fats - into the small intestine of rats. Both carbohydrate and protein infusions suppressed ghrelin levels more effectively than did fat infusions. The authors suggest that poor suppression of the "hunger hormone," ghrelin, by fats might make high-fat diets more likely to promote weight gain than diets rich in carbohydrates or proteins.

See these studies and more in the upcoming issue of Endocrinology from The Endocrine Society. To interview an author or to obtain a copy of the studies discussed above, contact The Endocrine Society at media@endo-society.org

Meet the Officers [RETURN TO TOP]

Anthony Means, Ph.D., is the 2004-2005 President of The Endocrine Society and currently serves as Professor and Chairman in the Department of Pharmacology and Cancer Biology at Duke University Medical Center in Durham, NC. As the leader of the world's largest and most active professional organization of endocrinologists, Dr. Means provide valuable insight into the role of endocrinology in the study, assessment and treatment of endocrine-related conditions, including obesity and its associated diseases. He offers a unique perspective on metabolic and endocrine complications that impact obesity and can discuss the benefits of including an endocrinologist in a collective approach to weight loss.

Andrea Dunaif, M.D., the 2005-2006 President-Elect of The Endocrine Society, currently serves as Professor and Chief in the Division of Endocrinology, Metabolism and Molecular Medicine at the Feinberg School of Medicine of Northwestern University in Chicago, IL. Her primary research interests include polycystic ovary syndrome (PCOS), diabetes and metabolism, and the genetics of complex diseases. She can address the role of endocrinology in the study, assessment and treatment of obesity and related diseases and offers a unique perspective on the metabolic and endocrine complications associated with obesity.

To schedule an interview with the officers of The Endocrine Society or any of The Endocrine Society's experts, please contact The Endocrine Society at media@endo-society.org

Other Happening/Upcoming Events [RETURN TO TOP]

In the January 19 edition of the Journal of the American Medical Association (JAMA), the Centers for Disease Control and Prevention (CDC) issued a correction to its report on obesity, which was initially published in the March 24, 2004 edition of the journal. The CDC now reports that the initial publication of data "overestimated the number of deaths caused by poor diet and physical inactivity. The agency's principal conclusions, however, remain unchanged: tobacco use and poor diet and physical inactivity contributed to the largest number of deaths, and the number of deaths related to poor diet and physical inactivity is increasing."

Fast Facts** [RETURN TO TOP]

According to the revised report from the CDC, the number of deaths caused by poor diet and physical inactivity has increased by approximately 65,000 to an estimated 365,000 from 1990 to 2000. This increase is alarming, however, obesity is not always just a behavioral condition. In fact, more than a third (37 percent) of endocrinologists report at least a quarter of their obese patients have underlying endocrine issues contributing to their obesity.

If you have any questions about this issue of The Endocrine Edge or The Endocrine Society, please contact The Endocrine Society at media@endo-society.org

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*The Centers for Disease Control and Prevention reports that approximately 16 percent of U.S. children are overweight.

**The Endocrine Society conducted an online survey of its membership through its Web site between January 26 and February 16, 2004. The survey yielded a response from 250 endocrinologists. The confidence level of the survey is 95 percent.