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Overweight (high BMI) and Treating...
I'm 1 month post treatment with SOC.
What is so wrong about people with a high BMI being encouraged to try treatment? If it doesn't work by 4 or 12 weeks they can just stop the way any other treater can stop. Why can't we be encouraged too? The reason I'm putting this out there is because I don't feel that there is a whole lot of support for the individuals who have a high BMI and are thinking of treating. In fact I've seen them discouraged!
What is so wrong about people with a high BMI being encouraged to try treatment? If it doesn't work by 4 or 12 weeks they can just stop the way any other treater can stop. Why can't we be encouraged too? The reason I'm putting this out there is because I don't feel that there is a whole lot of support for the individuals who have a high BMI and are thinking of treating. In fact I've seen them discouraged!
Sorry.... had no idea the post was THAT long...did post the article in another thread, however. Hopefully induces good discussion on the topic. I think it brings out the subject in better detail rather than simply saying obesity period is a risk factor.
kathy: That's it Trish! You got it! That's exactly what I was trying to impart here:
"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight because, for a significant number of people, that's much easier said than done. If it were that easy, we'd all be doing it. So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."
Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture. "
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Kathy, don't get me wrong. I maintain that it's important to talk in facts. What I would do differently after your thread giving me reason to digest this topic a little more is to deliver that truth with a little more understanding and sensitivity. Studies don't actually say that people with high BMI or people who are obese or overweight should not treat. They point out the risk factors. Anyone going into treatment should be aware of the risk factors and approach treatment with full awareness of these risk factors and with strategies to mitigate them wherever possible. In your case, the risk factors generally associated with being obese, such as diabetes and IR, are not present and that's a good thing for you. Someone else who is obese may not be so lucky.
What is really important is to talk about the why here and I really have to thank you for bringing up this topic. It made me read more and I came across an article that explains they "why" in better detail. There have been discussions about IR here but not every overweight person has IR, as you've capably pointed out. It is, however, something that overweight/obese persons should investigate prior to starting treatment. Also, different responses per Genotype:
"Different HCV genotypes seem to be associated with steatosis through differing mechanisms. Genotype 3 HCV appears to directly promote the build-up of fat in liver cells, while steatosis in genotype 1 patients appears to be linked with co-existing metabolic conditions such as insulin resistance."
http://www.hivandhepatitis.com/hep_c/news/2006/072806_a.html
Did you know that excess fat in the body can decrease the amount of interferon "on active duty" in the body when you take your injection? I didn't:
"Finally, excess fat tissue reduces the amount of circulating interferon in the body during treatment, possibly due to impaired absorption after injection. "
I'm going to post the article in it's entirety in this thread - or another one - because there was just so much good stuff in it. Your question was why can't obese people treat - and again, this article does NOT say that they should not treat. It promotes awareness of the challenges for obese persons and it doesn't avoid the truth. The best case scenario is to lose weight. No doubt about that. It goes on, however, to talk about other strategies if this is not a reality and let's face it, it is extremely hard for many people to do. That does not, however, change the risk factors.
"Management of Obesity
The Mayo Clinic researchers reported that reducing body weight and improving underlying metabolic factors may help "overcome the low sustained viral response rates observed in obese patients infected with HCV."
The first-line approach to managing obesity involves lifestyle modification, including exercise and a healthy, balanced diet. Weight loss has been shown to improve insulin sensitivity, lower ALT levels, and improve liver histology.
If such measures are not adequate, anti-diabetes drugs such as metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia) may also be used to increase insulin sensitivity, which may help reduce fat accumulation in the liver. While these medications have not yet been studied extensively in people with hepatitis C, there is data suggesting that they are associated with reduced ALT and improved liver histology in HCV negative patients with non-alcoholic fatty liver disease.
The authors also suggested that use of higher doses of pegylated interferon and ribavirin for extended periods might help overcome the lower response rates observed in obese patients. Weight-based dosing and longer treatment durations are currently the subject of considerable research, but the authors also suggested higher dosing based on levels of insulin resistance or amount of visceral fat, rather than body weight alone.
Together, these studies suggest that liver disease progression should be considered among the deleterious outcomes of obesity and the metabolic syndrome, along with diabetes and cardiovascular disease."
I want to thank you again for bringing this up. I think it's an important discussion and one that is far more nuanced than simply saying that being overweight is a risk factor in and of itself for positive treatment outcomes. That would be misleading and not enough information on it's own to allow people to properly address the risk factors that COULD be introduced as a RESULT of being overweight.
That blanket statement with no explanation could induce the kind of panic that I see in LuckyLiver's post.
I hope you are SVR, Kathy. I've seen your posts all along and I've felt your encouragement in the past for my own treatment outcomes and for many others. We often see posts from people who say things like "this is my situation, has anyone been successful with this situation?" and they are desperately looking for some hope. I hope you will be able to say "I treated while overweight and I am SVR" and it will give them hope.
Trish
"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight because, for a significant number of people, that's much easier said than done. If it were that easy, we'd all be doing it. So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."
Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture. "
----------------------------------------------------------------------------------------------------------
Kathy, don't get me wrong. I maintain that it's important to talk in facts. What I would do differently after your thread giving me reason to digest this topic a little more is to deliver that truth with a little more understanding and sensitivity. Studies don't actually say that people with high BMI or people who are obese or overweight should not treat. They point out the risk factors. Anyone going into treatment should be aware of the risk factors and approach treatment with full awareness of these risk factors and with strategies to mitigate them wherever possible. In your case, the risk factors generally associated with being obese, such as diabetes and IR, are not present and that's a good thing for you. Someone else who is obese may not be so lucky.
What is really important is to talk about the why here and I really have to thank you for bringing up this topic. It made me read more and I came across an article that explains they "why" in better detail. There have been discussions about IR here but not every overweight person has IR, as you've capably pointed out. It is, however, something that overweight/obese persons should investigate prior to starting treatment. Also, different responses per Genotype:
"Different HCV genotypes seem to be associated with steatosis through differing mechanisms. Genotype 3 HCV appears to directly promote the build-up of fat in liver cells, while steatosis in genotype 1 patients appears to be linked with co-existing metabolic conditions such as insulin resistance."
http://www.hivandhepatitis.com/hep_c/news/2006/072806_a.html
Did you know that excess fat in the body can decrease the amount of interferon "on active duty" in the body when you take your injection? I didn't:
"Finally, excess fat tissue reduces the amount of circulating interferon in the body during treatment, possibly due to impaired absorption after injection. "
I'm going to post the article in it's entirety in this thread - or another one - because there was just so much good stuff in it. Your question was why can't obese people treat - and again, this article does NOT say that they should not treat. It promotes awareness of the challenges for obese persons and it doesn't avoid the truth. The best case scenario is to lose weight. No doubt about that. It goes on, however, to talk about other strategies if this is not a reality and let's face it, it is extremely hard for many people to do. That does not, however, change the risk factors.
"Management of Obesity
The Mayo Clinic researchers reported that reducing body weight and improving underlying metabolic factors may help "overcome the low sustained viral response rates observed in obese patients infected with HCV."
The first-line approach to managing obesity involves lifestyle modification, including exercise and a healthy, balanced diet. Weight loss has been shown to improve insulin sensitivity, lower ALT levels, and improve liver histology.
If such measures are not adequate, anti-diabetes drugs such as metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia) may also be used to increase insulin sensitivity, which may help reduce fat accumulation in the liver. While these medications have not yet been studied extensively in people with hepatitis C, there is data suggesting that they are associated with reduced ALT and improved liver histology in HCV negative patients with non-alcoholic fatty liver disease.
The authors also suggested that use of higher doses of pegylated interferon and ribavirin for extended periods might help overcome the lower response rates observed in obese patients. Weight-based dosing and longer treatment durations are currently the subject of considerable research, but the authors also suggested higher dosing based on levels of insulin resistance or amount of visceral fat, rather than body weight alone.
Together, these studies suggest that liver disease progression should be considered among the deleterious outcomes of obesity and the metabolic syndrome, along with diabetes and cardiovascular disease."
I want to thank you again for bringing this up. I think it's an important discussion and one that is far more nuanced than simply saying that being overweight is a risk factor in and of itself for positive treatment outcomes. That would be misleading and not enough information on it's own to allow people to properly address the risk factors that COULD be introduced as a RESULT of being overweight.
That blanket statement with no explanation could induce the kind of panic that I see in LuckyLiver's post.
I hope you are SVR, Kathy. I've seen your posts all along and I've felt your encouragement in the past for my own treatment outcomes and for many others. We often see posts from people who say things like "this is my situation, has anyone been successful with this situation?" and they are desperately looking for some hope. I hope you will be able to say "I treated while overweight and I am SVR" and it will give them hope.
Trish
"Being overweight does mean that a person is unhealthy."
jd, I think that's quite inaccurate. You don't quantify what you mean by overweight and it's not true to say that all overweight people are automatically unhealthy. I think I've been overweight for some time, statistically. When I started treatment, I didn't have a single health issue or concern other than HCV. I had no thyroid issues at the time, I had no diabetes, no high cholesterol, no high blood pressure, in fact my blood pressure was quite low, so low my nurse was shocked. My cardio was in great shape. If someone came up to me and said I was unhealthy because I was overweight, it would be laughable.
I think it's more accurate to say that being overweight puts you at a higher risk for health complications and the more overweight you are, perhaps the greater the risk.
jd, I think that's quite inaccurate. You don't quantify what you mean by overweight and it's not true to say that all overweight people are automatically unhealthy. I think I've been overweight for some time, statistically. When I started treatment, I didn't have a single health issue or concern other than HCV. I had no thyroid issues at the time, I had no diabetes, no high cholesterol, no high blood pressure, in fact my blood pressure was quite low, so low my nurse was shocked. My cardio was in great shape. If someone came up to me and said I was unhealthy because I was overweight, it would be laughable.
I think it's more accurate to say that being overweight puts you at a higher risk for health complications and the more overweight you are, perhaps the greater the risk.
Uh oh... one more thing ? I hadn't heard anything about BMI affecting your success with tx. Guess who is REALLY overweight? So, this the deal.... I am stage 3/4 and feeling extreme fatigue and body aches as a result of HCV. I am trying to arrange my treatment and now I read this. What a stunner! I had no idea and my doctor never shared this information with me. Now I am super worried about the choice for tx. Due to my fatigue and achiness I really don't feel like exercising. I am often dizzy too, which creates a problem for exercise. My mindset was that I would get through treatment, feel more energy and THEN I would be able to focus on my weightloss. Now I am super confused. This whole thing makes me want to spit. I can't get insurance to approve the treatment, there is a question of whether the treatment will even work and now I find out that my weight could also affect the outcome. What a kick in the pants! It just makes me shake my head.
Kathy, I was so caught up in the discussion that I wasn't sure if I wished you good luck. Anyway just in case I didn't, best of luck with becoming SVR. I think you will be fine.
FLGuy, funny stuff. Since we are talking about momma's... your momma is so fat that she needs her picture printed out on a wide format copier ! (blue print machine).
and by the way I did pick up on the word you used "fuser". this is a very common part used in every laser printer or copier.
Good stuff
FLGuy, funny stuff. Since we are talking about momma's... your momma is so fat that she needs her picture printed out on a wide format copier ! (blue print machine).
and by the way I did pick up on the word you used "fuser". this is a very common part used in every laser printer or copier.
Good stuff
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