Good reasons to lose weight before treating

[copyman]

Seeing Kathy73 post about being SVR reminded me about the importance of losing weight before TX. If I recall she was very sensitive about being overweight. It is great she was still able to achieve SVR.

Here are some studies why losing weight before treatment is important, not to mention other health issues from being overweight.

Obese patients who are treated for chronic hepatitis C virus (HCV) infection are more likely to have a better outcome if the underlying abnormalities caused by excessive fat tissue are corrected first, according to a review published in the medical journal Hepatology.

The lead author, Dr. Michael R. Charlton of the Mayo Clinic, Rochester, Minnesota, and colleagues point out that obesity is considered to be a metabolic condition, not simply a matter of being very overweight.

Obesity in patients with HCV infection is associated inflammation and insulin resistance, a "prediabetic" abnormality of blood sugar. These patients may also have steatosis, "fatty liver disease;" progression of fibrosis, scarring of the liver; and poor response to interferon and ribavirin, the standard treatment for HCV infection.

Patients with hepatitis C and obesity-related fatty liver disease are also at greater risk for more advanced liver disease.

Weight loss to reduce fat tissue is an important first step in improving response to treatment, the investigators advise. Also important is treatment with diabetes drugs, such as metformin and pioglitazone, to improve insulin sensitivity and reduce fat accumulation in the liver. This might reverse disease progression, the researchers note.

Other approaches to enhance patients' response to combination drug therapy may include longer duration of treatment and higher doses to counteract the decreased response to the drugs. Rather than basing doses on weight, they suggest, drug doses could be based on body mass index, a ratio of height to weight.

"Treatment strategies that focus on improving underlying metabolic factors associated with poor response to combination therapy," conclude the researchers, are "more likely to overcome the low sustained viral response rates observed in obese patients infected with HCV."
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According to the results of the research, type 2 diabetes (DM), obesity and hypertension (HTN) are associated with overall and liver related mortality in hepatitis C (HCV) infected patients. In HCV-infected patients, the top three predictors of liver related mortality were having higher body mass index (BMI), presence of insulin resistance (IR) and elevated serum cholesterol. Overall mortality in HCV patients was most linked to metabolic syndrome, higher BMI and hypertension.

Metabolic syndrome is a combination of medical problems that increase risks of cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age. Recent data have suggested that metabolic syndrome is associated with adverse outcomes in HCV patients. This study set out to assess which aspects of metabolic syndrome are of most risk to such HCV patients and to quantify their specific impact on mortality.

Professor Zobair Younossi MD, MPH from the Center for Liver Diseases at Inova Fairfax Hospital and the Executive Director of Betty and Guy Beatty's Center for Integrated Research, Virginia, USA, who led the study, said: "Exploring the risk factors associated with adverse outcomes in HCV patients helps us to better understand the complex nature of this highly prevalent disease. This study shows a clear association between key components of metabolic syndrome and mortality in HCV patients and demonstrates the importance of lifestyle improvements and coaching in the management of HCV patients, to potentially minimise the onset and impact of metabolic syndrome and its associated mortality risks."

[susan400]

My BMI is 21.7.  I am physically active i.e. regularly work out at the gym.  My blood sugar is not a critical issue, I am not insulin insensitive and I don't have metabolic syndrome.  My A1C is always normal and has never been abnormal. My blood pressure is always low normal.  So, I really don't have the need to be losing weight.  However, if I started putting on weight and went on over into the 'overweight' category of a BMI or my waist size dramatically increased like over 35 inches, then, I'd be concerned enough about it to make some changes.  I personally have no intention of going on some kind of huge diet and/or make a plan to drop alot of pounds, prior to any treatments that may become available to me.  I do well just to stay well and keep from getting illnesses from sick people.  Once I pick up any kind of a virus or 'bug' it takes me forever to get over it, it's like my immune system is a piece of cr*p now.  I am finally getting over this sinus infection/bronchitis after dealing with it for about 3 wks!  I finished the medrol dose pack yesterday and I still have one more Levaquin to take tomorrow.  I am still have a bit of coughing, but nothing like it was.  

Susan400

[nygirl7]

My doctor is a skinny emaciated runner and he's always harping on me.  I figure my BMI is pretty darn low and he should leave me alone but he just wont......he must have his reasons but it's annoying. What do i Have to be a size 2 to make him happy? That isn't ever going to happen LOL.

[GSDgirl]

Deb, I just checked mine on 2 different calculators and 20 is healthy.  mine is 23 right now and it is still in the healthy range.  High healthy range, I better not gain any weight over the holidays LOL

Denise

[nygirl7]

I third it!  :D  You have to do everything you can to win this battle and if losing some weight increases your chances you just have to try!

My BMI is about 20.4 and my doctor is always at me to lose a couple more pounds. Personally I think he's a bit mental - but he is always going on about heart disease and diabetes and everything -  he takes it VERY seriously and that's not even to do with treatment it's just to live a healthier life. Of course, he also wants me to start jogging but that ain't gonna happen ;)

[meakea]

I second that "good for you!"  There are many of the negative strikes that we have no control over (such as menopausal) but the weight issue is one that can be improved and kudos to you for taking the bull by the horns to jockey a more favorable position for yourself in the battle against HCV!  Awesome.

[Trinity4]

Good for you almawe!  There are many other reasons besides starting hepc treatment to keep that BMI at a normal range.  We've GROWN to be a fat society and people don't understand how important it really is to keep the weight off.  Obesity to me is like hepc.  You may be able to get away with it for a long time but at some point it's going get ya!

Trinity