Diet and Lifestyle

Healthy Eating Linked to Lower Risk of Total Mortality

— Lower risks of death due to cardiovascular disease, cancer, respiratory disease noted

by Kristen Monaco, Staff Writer, MedPage Today January 9, 2023

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A photo of a couple serving dinner in their kitchen.

Adhering to healthy eating patterns was associated with lower risk of total and cause-specific mortality, a prospective cohort study with up to 36 years of follow-up showed.

Among 75,230 women from the Nurses’ Health Study and 44,085 men from the Health Professionals Follow-up Study, those who scored in the highest quintile for healthy eating patterns recommended by the Dietary Guidelines for Americans (DGAs) had a 14% to 20% lower risk of total mortality versus those in the lowest quintile, reported Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues in JAMA Internal Medicineopens in a new tab or window.

The pooled multivariable-adjusted hazard ratios of total mortality with four healthy eating patterns were (P<0.001 for trend for all):

  • Healthy Eating Index 2015 (HEI-2015): HR 0.81 (95% CI 0.79-0.84)
  • Alternate Mediterranean Diet (AMED): HR 0.82 (95% CI 0.79-0.84)
  • Healthful Plant-Based Diet Index (HPDI): HR 0.86 (95% CI 0.83-0.89)
  • Alternate Healthy Eating Index (AHEI): HR 0.80 (95% CI 0.77-0.82)

This lower risk was consistent across all racial and ethnic groups.

“This is one of the largest and longest-running studies that examine the associations of dietary scores for four healthy eating patterns recommended by the DGAs with the risk of total and cause-specific mortality in large cohort studies,” Hu told MedPage Today.

“Every 5 years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) release an updated version of the Dietary Guidelines for Americans,” he explained. “It is important to evaluate adherence to DGA-recommended eating patterns and health outcomes, especially mortality, so that timely updating of DGAs can be made.”

Hu noted that these findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being created by the USDA and HHS to evaluate the current evidence on different eating patterns and health outcomes.

Beyond total mortality, healthier diets were also significantly linked to lower risk of cause-specific mortality.

Across the four different dietary patterns, people in the highest quintile saw a 6% to 13% lower risk of death from cardiovascular disease versus those in the lowest quintile. Likewise, those in the highest quintile saw a 6% to 15% lower risk of death due to heart disease, a 7% to 18% lower risk of cancer-related death, and a 35% to 46% lower risk of respiratory disease-related death.

In addition, those with the highest scores on the AMED and AHEI also saw a modestly lower risk of death due to neurodegenerative disease (HR 0.94, 95% CI 0.90-0.99 and HR 0.93, 95% CI 0.87-0.99, respectively).

“Although previous studies have found an inverse association between healthy eating patterns and mortality, our study provides evidence that healthy eating patterns reduce the risk of cause-specific mortality including cardiovascular disease, cancer, respiratory, and neurodegenerative mortality,” said Hu. “The findings on respiratory and neurodegenerative mortality are novel.”

However, eating a healthy diet according to any of the four patterns did not appear to be protective against stroke-related deaths.

Hu said clinicians can recommend a “variety of healthy dietary patterns” to patients in order to reduce their risk for chronic diseases and premature death.

“These patterns such as the Mediterranean diet, DASH diet, vegetarian diet, or other versions of healthy diets can be adapted to meet individual health needs, food preferences, and cultural traditions,” he noted. “These healthy dietary patterns typically include high amounts of plant foods such as fruits, vegetables, whole grains, nuts, and legumes, and lower amounts of refined grains, added sugars, sodium, and red and processed meats.”

“It is also important to balance caloric intake with physical activity to maintain a healthy weight,” he added.

Among the women included in the analysis, mean baseline age was 50.2 and 98% were white; for men, mean age was 53.3 and 91% were white. In total, 31,263 women and 22,900 men died during follow-up. The leading cause of death was cancer, followed by cardiovascular disease, heart disease, neurodegenerative disease, respiratory disease, and stroke.

Dietary data were taken from semiquantitative food frequency questionnaires including more than 130 items, which were completed every 2 to 4 years.

  • author['full_name'] Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

Disclosures

The study was supported by a grant from the National Heart, Lung, and Blood Institute.

Hu reported no disclosures. Other co-authors reported relationships with Kubara Honke, Grants-in-Aid for Scientific Research, the G-7 Scholarship Foundation, the Japan Diabetes Society, the LOTTE Foundation, Layer IV, the U.S. Department of Agriculture, the U.S. Highbush Blueberry Council, the National Institutes of Health, Mars Edge, and the National Heart, Lung, and Blood Institute.

Primary Source

JAMA Internal Medicine

Source Reference: opens in a new tab or windowShan Z, et al “Healthy eating patterns and risk of total and cause-specific mortality” JAMA Intern Med 2023; DOI: 10.1001/jamainternmed.2022.6117.

Vitamin D and Mortality – In the News

Improving vitamin D levels in Older Age is Linked to Lower risk of all-cause Mortality

Sources: BMC Geriatr 22, 245 (2022)
LIfe Extension, Feb. 2023

Judith E. Brown. Nutrition Now, 7th Edition

The participants in this study included 1,362 individuals in the Chinese Longitudinal and Health Longitudinal Survey, aged 60 to 113 whose serum vitamin D levels were measured in 2012 and 2014. Mortality data were collected in 2018.

Deficient vitamin D levels were detected in 67.5% of the participants in 2012 and 68.4% in 2014.

During follow-up, 420 deaths occurred. Individuals who were deficient in vitamin D in 2012 and 2014 had more than twice the mortality risk than those who maintained higher levels.

Among participants who maintained sufficient vitamin D were deficient in 2012 and not deficient in 2014, the risk of dying was 30% and 53% lower, respectively, compared to participants who were deficient at both points in time.

This highlights the need to address vitamin D deficiency in older individuals to support longevity and healthy aging.

Editor’s Note: The greatest benefit associated with improved vitamin D status was found among women and those people who were 80 years of age or older.

What are the primary functions of vitamin D? This fat-soluble vitamin is needed for absorption of calcium and phosphorus needed for bone formation and muscle activity. It inhibits inflammation and is involved in insulin secretion and blood glucose level maintenance. It can be toxic with the long term use of 10,000 IU daily. The RDA is 600 IU for adult women and men; the Upper Tolerable Intake (UL) is 4,000 IU.s or 100 ug.

This highlights the need to address vitamin D deficiency in older individuals. Based on the evidence for bone benefits, however, a nutrition panel recently increased the RDA for vitamin D to 600 IU for people up to age 70 and to 800 IU for those over 70. That’s a fairly sizable boost over the previous recommendations of 200 IU per day through age 50, 400 IU for ages 51 to 70, and 600 IU for ages over 70. They also raised the safe upper limit of daily intake for most age groups from 2,000 to 4,000 IU. to support longevity and healthy aging. 1 microgram vitamin D = 40 IU as both terms are used on supplement labels. It is primarily found only in vitamin D-fortified milk, cereals, and other foods such as fish.

The best way to measure effects of supplemental intake or vitamin D status is by a blood test. Vitamin D3 is the most active form and is made from a form of cholesterol in the skin cells upon exposure to ultraviolet rays from the sun. See your doctor for guidance.

Nutrigenomics

What is Epigenetics?

Epigenetics refers to the inheritable changes in your DNA that don’t change the actual DNA sequences. That means these changes are potentially reversible.

What is DNA Methylation?

Your DNA consists of four bases called cytosine, guanine, adenine, and thymine. A chemical unit called a methyl group (designated by CH3 or one carbon atom and three hydrogen atoms) can be added to cytosine.

When that happens, that area of the DNA is methylated. When you lose that methyl group, the area becomes demethylated.

DNA methylation often inhibits the expression of certain genes. For example the methylation process might stop a tumor-causing gene from “turning on”, preventing cancer.

Researchers are currently working to better understand the factors that affect DNA methylation. Based on some earlier findings, there is some evidence that diet plays a role. This opens up the potential to reduce genetic risk of developing certain conditions such as breast cancer or heart disease through simple lifestyle changes.

The patterns of DNA methylation change through out your life, from fetal development to end of life. Studies suggest thqt DNQ methylation slows down as we age. Genes that were once repressed by methylation start to become active and possibly result in a variety of diseases. Interestingly, another study found that participants”who consumed more alcohol were more likely to have decreased DNA methylation. In contrast, those who consume a lot of folate were more likely to have increased methylation.

“Can Diets Change Your DNA? The question is “are you really what you eat? The answer appears to be No. However, we have known for years that gene expression influences metabolism. A study published in Nature Microbiology in 2016 indicates that nutrition may play an important role in how some DNA sequences are expressed. The study that how genes behave is strongly influenced by the food we eat. Even so, we are still a long way from the kind of personalized medicine that will furnish nutritional therapies to treat a wide spectrum of conditions.” Stay tuned for the future. Source: You Are what Your Grandparents Ate. Judith Finlayson, 2019.

You may want to search my blog for a simple description of the association between nutrigenomics and diet with the Agouti yellow mouse.

CLICK HERE.

In the News: Vitamin D

Low levels of vitamin D linked to poor cognitive function

Source: Medical News Today, Sunday, December 11, 2022
<newsletter@newsletter.medicalnewstoday.com>
“There is growing evidence for how your body relies on vitamin D to ward off inflammation, cancer, and heart disease. Having enough of it in your blood is linked to a lower risk of dying prematurely. But what about vitamin D and the brain? What is its role in cognition, or dementia, if any? As one researcher told Medical News Today this week, “we did not know if vitamin D was even present in the human brain.”

The researcher, Kyla Shea, PhD, is lead author of a study offering the first evidence that vitamin D is not only present in the brain, a healthy level of it is associated with better cognitive function and a lower risk of dementia in older adults.

The evidence comes from the postmortem study of the brains of 290 individuals who had agreed to donate their organs after death. Researchers found that higher concentrations of vitamin D across the brain were associated with up to a 33% lower chance of developing dementia.

It is early days, so precisely how vitamin D supports healthy cognitive function is not yet understood. Dr. Shea sees signs that it is involved in cell-signaling pathways that may be part of neurodegeneration, but more research is needed to build on this groundbreaking study.” Stay tuned???

All about omega-3 fats and the Brain : Source: Medical News Today

The following study presents an interesting connection between omega-3 fats, brain function and cognitive decline.

Erica Watts, Oct 7, 2022

Fact Checked by Alexandra Sanfins, PhD.

  • Omega-3 fatty acids have many benefits and play a role in heart health and cognitive functioning.
  • A new study demonstrates that there may be a connection between consuming omega-3 and an increase in brain functioning for people in midlife.
  • The cross-sectional study analyzed the omega-3 blood levels of people in their midlife and assessed their MRIs and thinking skills to see whether there was a difference in people with higher or lower omega-3 levels.

“According to the new study published in Neurology, the medical journal of the American Academy of Neurology, people who have higher omega-3 levels in their middle ages may have an edge over people who take in lower levels of omega-3.

The study was led by researchers at the University of Texas Health at San Antonio, TX, who were concerned about the lack of research on how omega-3 can impact people in their midlife.

Omega-3: Things to know

According to the National Institutes of Health (NIH)Trusted Source, omega-3 fatty acids “are a group of polyunsaturated fatty acids that are important for a number of functions in the body.” In addition to playing a role in heart health and cognitive functioning, omega-3 fatty acids are also part of the cell membraneTrusted Source and affect cell functioning.

As Professor Stuart Phillips noted during a Live Long and Master Aging podcast, “Some fats that we ingest, and particularly the omega-3 or long-chain polyunsaturated fatty acids are actually what we refer to as essential fats. We need to have them in our diet because we don’t have the ability to make them ourselves.”

Prof. Phillips is the director of the Physical Activity Center of Excellence at McMaster University in Ontario, Canada.

The NIHTrusted Source lists three types of omega-3 fatty acids: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)..

While people can take omega-3 supplements, it is also in a number of foods. Some good sources of omega-3 include fish (such as salmon and tuna) nuts and seeds (chia seeds and flax seeds).

Studying Omega-3’s effect

The researchers studied 2,183 men and women with an average age of 46. They excluded people who had dementia or a history of having a stroke from their participant pool.

Omega-3s are present in the brain, particularly in the hippocampus. The hippocampus plays a role in learning and memory, and a reduction in the volume can point to possible dementiaTrusted Source.

The participants also underwent a neurological assessment. The tests measured the participants’ abstract thinking, processing speed, executive function, and delayed episodic memory.

Omega-3 and brain health 

Using blood samples, the researchers analyzed the fatty acid composition (omega-3’s) of each participant. The participants also consented to having their brains scanned using MRI technology. The researchers were also interested in the volumes of gray and white matter.

The researchers placed approximately 25% of the participants in the low group where the participants had omega-3 fatty acids blood levels falling under 4%. This group had an average count of 3.4%.

The rest of the participants were put into the high group; their average omega-3 level was 5.2%.

Comparing the blood samples, MRI results, and neurological assessments, the study authors determined that higher levels of omega-3 fatty acids correlate to a higher hippocampus volume and better abstract reasoning.

Researchers observed that the people in the high group also had higher gray matter volumes, better reading scores, and slightly higher logical reasoning scores.

In contrast, the people in the low group tended to be less likely to have a college degree and more likely to be smokers and have diabetes compared to the higher group.

“This exploratory study suggests that higher [omega-3 blood levels] are associated with larger hippocampal volumes and better performance in abstract reasoning, even in cognitively healthy middle-aged adults from the community, suggesting a possible role in improving cognitive resilience,” write the authors.

“These results need to be confirmed with additional research, but it’s exciting that omega-3 levels could play a role in improving cognitive resilience, even in middle-aged people,” said study author Prof. Claudia L. Satizabal, Ph.D.

Prof. Satizabal is an assistant professor at the Department of Population Health Sciences at UT Health San Antonio, TX.

Diet and brain health 

The authors noted that other researchers have conducted similar studies in older populations but believe that it is necessary to see what impacts omega-3 supplements have on people in their midlife because they start experiencing cognitive decline.

According to the authors, “One of the main challenges for some of these studies may be that dietary interventions are carried out perhaps too late for significant improvements in symptomatic participants, as cognitive changes may be well established over the previous 15 to 20 years.”

“Improving our diet is one way to promote our brain health. If people could improve their cognitive resilience and potentially ward off dementia with some simple changes to their diet, that could have a large impact on public health.”

– Prof. Satizabal

Dr. Natalie King, a neuroscientist and founder of Florae Beauty, not involved in the study, spoke with Medical News Today and discussed the importance of diets on brain health.

“Everything we do and consume affects our brain, and there have been numerous studies, including the one shared, that highlight the effects of food and drink on overall brain health and function,” said Dr. King.

“Omega-3 fatty acids, in particular, have been found to be beneficial when it comes to improving mental function as well as supporting an overall wellness plan when considering disease pathologies like mood disorders and others affecting learning and memory,” Dr. King continued.”

Until we know how much omega-3 fats are needed to improve optimal brain function in the meantime, adequate EPA and DHA dosage is often obtained by consuming 8 ounces of fatty fish weekly. Deep fried fish have been found to be a poorer source of EPA and DHA than baked or broiled fish. The top sources include: salmon, farmed and wild, anchovies, herring, whitefish, mackerel, and sardines. Tuna (light) canned in oil only provides lower amounts.

Judith E. Brown, Nutrition Now, 7th Edition.

Supplements are plentiful on the market; however, consult your physician for dosage and any conflicts with other medications such as blood thinners. It is important to remember that dietary supplements are produced and marketed with few regulations as to safety, quality or efficacy.

The Mind Diet

The MIND diet (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) is a combination of the Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension). It focuses more on the weekly consumption of foods like beans, berries, nuts, whole grains, leafy veggies, and recommends low-fat and fat-free dairy foods.

Both diet patterns encourage physical activity and support heart health and the prevention of hypertension.

The patterns are also high in antioxidants and are considered anti-inflammatory. Both diets protect against oxidative damage to blood vessels, which may help reduce the risk of dementia. It appears to “be the best of both worlds” in the healthy diet world.

CLICK HERE.

Do Seniors Need a Daily Boost?

Daily multivitamins help keep seniors’ brains sharp, may ward off dementia

September 14, 2022

by John Anderer

WINSTON-SALEM, N.C. — Could the secret to a sharp brain in old age be as simple as taking a daily multivitamin? New joint research from Wake Forest University and Brigham and Women’s Hospital suggests as much. Scientists conclude that multivitamins can improve thinking skills in older individuals and help stave off cognitive decline.

Study authors note that the findings are still preliminary and require further confirmation before any concrete health recommendations can be made. Nonetheless, establishing a new, affordable such as taking a daily multivitamin way to fight cognitive decline and dementia in old age could potentially benefit millions. Today, over 6.5 million Americans are living with Alzheimer’s disease (the most common form of dementia), and a staggering one in three senior citizens pass away with Alzheimer’s or another form of dementia.

“There’s an urgent need for safe and affordable interventions to protect cognition against decline in older adults,” says Dr. Laura D. Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine and co-principal investigator of the trial, in a statement. Baker worked alongside Dr. Mark Espeland, also a professor of gerontology and geriatric medicine at Wake Forest.

Multivitamins versus cocoa extract

This project, named the COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind), was funded by the National Institute on Aging of the National Institutes of Health. Participants include 21,442 men and women living all over the United States.

Researchers investigated if taking either a daily cocoa extract supplement or a daily multivitamin-mineral supplement would influence health outcomes and risk profiles in relation to heart disease, stroke, cancer, and other health issues. Why cocoa extract? Prof. Baker explains cocoa extract is rich in compounds known as flavanolsPrior research suggests flavanols may have a positive influence on cognition. Moreover, deficiencies in several essential micronutrients and minerals among older adults may increase the risk for cognitive decline and dementia.

The research team tested the daily intake of a placebo versus a cocoa extract supplement, as well as the daily intake of a multivitamin-mineral versus a placebo. Over 2,200 participants, all aged 65 years and older, were tracked for a period of three years. Additionally, subjects completed memory and cognition tests over the phone at baseline and on an annual basis.

‘First evidence of cognitive benefit in large longer-term study’

“Our study showed that although cocoa extract did not affect cognition, daily multivitamin-mineral supplementation resulted in statistically significant cognitive improvement,” Prof. Baker explains. “This is the first evidence of cognitive benefit in a large longer-term study of multivitamin supplementation in older adults.”

Study authors estimate taking a multivitamin for three years roughly translates to a “60 percent slowing of cognitive decline (about 1.8 years)”. They also note the benefits were especially pronounced among those with significant cardiovascular disease.

“It’s too early to recommend daily multivitamin supplementation to prevent cognitive decline,” Baker concludes. “While these preliminary findings are promising, additional research is needed in a larger and more diverse group of people. Also, we still have work to do to better understand why the multivitamin might benefit cognition in older adults.”

The study is published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Omega 3 Fats and Cognition

In 2016 a large study confirmed findings from 21 cohort studies (181,000 people)that supported that fish consumption was protective against the risk of dementia and Alzheimer’s disease. It was published in the American Journal of Clinical Nutrition and recommended “fishery products” for a lower risk of cognitive impairment.

Source: Y. Zhang, et al., “Intakes of Fish and Polyunsaturated Fatty Acids and Mild-to-Severe Cognitive Impairment Risks: A Dose-Response Meta-Analysis of 21 Cohort Studies, American Journal of Clinical Nutrition 103, no 2 (2016):330-40.

CLICK HERE.

Ultra- Processed Foods and Cognition

In a study of 105, 159 adults over a period of 5 years, it was found that “even a 10% increase in the consumption of ultra-processed foods was associated with a higher risk of heart disease and stroke, the development of some cancers, and type 2 diabetes. In addition, some increased exposure to harmful chemicals from food packages was reported.” Source: Medical News Today, 2019.

CLICK HERE.

Weight Gain? The Brain and Gut Disconnect?

“A good predictor of who will gain weight is who says they plan to lose some. Last year, 108 million Americans went on diets. Long-term studies of dieters find that they’re more likely to end up gaining weight in the next two to fifteen years than people who don’t diet.” Sandra Aamodt, Ph.D. Why Diets Make Us Fat. 2016.

Rebound’ Weight Gain: A Disconnect Between Brain and Gut May Be a Factor

Healthline. By Christopher Curley, September 15, 2022

Fact Checked: Jennifer Chesak

“Experts say weight gain after weight loss is common among adults and children.

  • Researchers say a new study indicates that a disconnect between the brain and the gut may be a reason that people tend to gain weight after initially losing weight.
  • They say in many people who have lost weight their gut will tell them they’re full after eating a meal, but their brain will try to tell them they’re still hungry.
  • Experts say the disconnect may be due to the body’s attempt to store fat during weight loss.

Nearly halfTrusted Source of adults in the United States try to lose weight each year, but many will not keep that weight off long-term.

In fact, only about one in five people who are overweight can maintain weight loss for a year or longer, research showsTrusted Source.

While there are many competing theories about why that is, ranging from psychological to biological, a new study of children with obesity suggests the answer might lie in a disconnect between gut hormones and brain signals.

Researchers at Seattle Children’s Hospital in Washington put children with obesity on a 24-week weight loss program, monitoring their brain activity and gut hormone responses before and after the trial.

At the end of the weight loss program, the researchers reported that after eating a meal the children’s gut showed normal levels of regulatory hormones indicating that they were full and satisfied.

Their brains, however, showed levels of activity signaling that they were still hungry.

The researchers also found that the more weight a child lost, the more likely they were to react to food cues after completing a meal —their brain essentially telling them they were still hungry while their gut was telling them the reverse.

“Our results imply that during weight loss intervention, your body acts to conserve fat through maintaining hunger responses in the brain and that this needs to be addressed,” Dr. Christian Roth, a lead study author and professor at Seattle Children’s Hospital, said in a press release.

Roth said larger, more extensive studies would be required to confirm these findings.

“It would also be useful to investigate how long the disconnect between central and local appetite regulation persists after maintained weight loss, to guide intervention plans,” he added.

“This is a very interesting study and I think that a lot of these findings are applicable to adults as well,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.

“I see in my patients that they feel the need to eat, even if their stomach feels full,” Ali told Healthline. “There is certainly a strong psychological component to eating behavior that surgery and medications cannot always address completely.”

“I feel this research is on the right track and we need to find a way to satisfy the brain as well as the gut,” he added. “This will require extensive research in both children and adults to find the right solution.”

Beyond hormones

One of the more notable aspects of the study is how it complicates our understanding of how hormones affect appetite and rebound weight gain.

Previous studies have shown that an increase in appetite hormones after weight loss might be a key driver of these rebound gains.

The results of this study paint a more nuanced picture where even if gut hormones are normal, the brain is out of sync.

“The study underscores our understanding of obesity and weight homeostasis as a chronic disease of the brain,” said Dr. Mert Erogul, an attending physician at Maimonides Medical Center in New York.

“The regulation of appetite is enormously complex and layered,” he told Healthline. “From the digestive tract, there are hormones that signal fullness, such as leptin, CCK, and peptide YY. There are also hormones that signal hunger, such as ghrelin. These are in constant interplay with seemingly subjective feelings that come from the brain such as food preference and liking as well as motivation to eat.”

Ultimately, experts say this may require a holistic approach to weight loss and maintaining a healthy weight.

“Rebound weight gain is very common and happens for many physiological, behavioral, and psychological reasons,” said Dr, Steve Patching, a medical director of bariatric surgery at Sutter Hospital in Sacramento, California.

“Believe it or not, weight loss actually sets up your body for weight gain,” he told Healthline. “This is because the body always strives for symbiosis. This is why we often still feel hungry or even starving after we eat a ‘normally satiating’ meal. It is also why correct weight loss should be done slower than we often want.”

Weight loss needs to occur in the context of a durable commitment to changes in diet and lifestyle,” he said. “Even then, obesity medicine specialists recognize that people who are overweight often need lifelong therapy with medications to maintain weight loss.”