ACSM Random Updates

Greetings from ACSM! Just waiting to fly back home soon and wanted to drop some random notes. I will have more updates coming in the next few weeks as I get threw over 40 pages of notes. Excellent information presented!

Here they are random, rapid fire style. More details soon
Inspiration Muscle Training

• May work really really well. Poster from highly competitive cross country runners showed a shaving of 40 seconds off 5km times!! That is insane!

Central Pattern Generation

• May be located in the spinal cord! The basic program for gait appears to be there too. Huge implications for spinal cord injury patients.
• Gait has a normal variability to it on each step, we need to replicate this to obtain a normal gait again in rehab areas
• Injuries will alter your gait (I see that all the time)
• Interlimb coordination more important than INTRAlimb coordination
• Rats with full spinal cord cut at around the top of the lumbar area can walk sideways and backwards on a treadmill on 2 legs with body weight support. No input from the brain--must be a FEED FORWARD mechanism on some level

Central vs Peripheral Fatigue

• Studies, posters point to some of each
• BCAAs don't seems to decrease central fatigue (although tyrosine seems to work)

Brain and Cognition and Exercise

• Brain will adapt by increasing neurons
• Brain actually increases in size and weight!! (Up to a limit)
• Enriched environment is important, not just exercise---new movements, use of visual system
• Exercise has an anti-depressant activity

Creatine

• New mechanisms--potential cognition and ergogenic benefits
• Full details soon

Random Tidbits

• Vit D RDA most likely to increase dramatically soon
• Women athletes should probably have ferritin iron test and Vit D test done
• Talk by top protein researchers on protein and exercise--more info soon
• Beta Alanine seems to work great in elite wrestlers (source--conversation on unpublished work)
• NSAIDS and training may NOT interfere with each other

More soon!
Any questions in the meantime, post them here
Mike

Sleep and the Metabolic Syndrome

ACSM
Off to ACSM this Wed, so drop me a line if you are going to be there! Hope to see some of you there and I will have updates as soon as possible

Another sleep study!
Since we are on the topic of sleep, here is more evidence that sleep may mess up your body. The interesting part is that short and LONG sleep duration seem to have an effect. It will be interesting to see more data on this in the future as it is conflicting on some areas currently (e.g abdominal obesity). There are some other growing data (hahaha, bad attempt at humor) to suggest that lack of sleep interferes with insulin sensitivity which could promote a growing waistline! (REF). In the meantime, your mom was right once again that you need your sleep!

Take Away
Short sleep duration compared with 7 to 8 hours of sleep is associated with greater risk for metabolic syndrome and metabolic syndrome criteria of abdominal obesity, elevated glucose, and elevated triglycerides, but not BP and HDL cholesterol.

Long sleep duration compared with reference criteria is associated with increased risk for metabolic syndrome and abdominal obesity but not with increased glucose, triglyceride level, BP, or low HDL cholesterol level.

Self-Reported Sleep Duration is Associated with the Metabolic Syndrome in Midlife Adults

Conclusion: "These data suggest that sleep duration is a significant correlate of the metabolic syndrome. Additional studies are needed to evaluate temporal relationships among these measures, the behavioral and physiologic mechanisms that link the two, and their impact on subsequent cardiometabolic disease."

From Medscape

May 21, 2008 — Risk for metabolic syndrome was associated with sleep duration, according to the results of a cross-sectional community-based cohort study reported in the May issue of Sleep.

"Short and long sleep duration have been linked to various risk factors for cardiovascular disease," write Martica H. Hall, PhD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "In the present study, we evaluated the relationship between sleep duration and presence of the metabolic syndrome, which is a cluster of physiologically interrelated risk factors for cardiometabolic disease."

In the Adult Health and Behavior Project registry, 1214 participants aged 30 to 54 years were divided into 4 groups on the basis of their reported sleep duration. American Heart Association/National Heart Lung and Blood Institute criteria were used to define the metabolic syndrome. The hypothesis that sleep duration significantly correlates with the metabolic syndrome and its components was tested with logistic regression.

The rate of observed metabolic syndrome was 22%, similar to that of published health statistics for US adults. Adjusted odds for metabolic syndrome were increased 45% in both short and long sleepers vs those sleeping 7 to 8 hours per night. Sleep duration was also associated with individual components of the metabolic syndrome (abdominal obesity, elevated fasting glucose, and hypertriglyceridemia). However, after further adjustment for use of antihypertensive medication, prevalence of the metabolic syndrome and its components remained increased only in short-duration sleepers.

"These data suggest that sleep duration is a significant correlate of the metabolic syndrome," the study authors write. "Additional studies are needed to evaluate temporal relationships among these measures, the behavioral and physiologic mechanisms that link the two, and their impact on subsequent cardiometabolic disease."

Limitations of this study include possibly insufficient power to evaluate relationships between sleep duration and the blood pressure component of the metabolic syndrome, as well as the use of cross-sectional data, which cannot address questions of causality.

"Additional experimental and prospective observational studies are needed to evaluate the extent to which sleep duration affects, or is affected by, the metabolic syndrome, abdominal obesity, glucose and lipid metabolism, and blood pressure," the study authors conclude. "Although the present study evaluated a community sample of healthy adults, relationships between sleep and the metabolic syndrome might differ in important ways in other populations. Finally, identification of the proximal behavioral and biologic pathways by which sleep affects components of the metabolic syndrome is essential to developing treatment strategies to augment behavioral and pharmacologic interventions for cardiometabolic disease.

The National Institutes of Health supported this study. Two of the authors have disclosed various financial relationships with Pro Consulting, Actelion, Arena, Cephalon, Eli Lilly, GlaxoSmithKline, Merck, Neurocrine, Neurogen, Pfizer, Respironics, Sanofi-Aventis, Sepracor, Servier, Stress Eraser, and Takeda.

Source: Sleep. 2008;31:635-643 and Medscape

Anniversary, ACSM, Z Health/ KB Seminar and Food Clock Research

1 Year Anniversary of this Blog!

Just wanted to give a huge shout out to everyone that takes time out of their to read this blog. It is a true honor and privilege that you take time (which is a non renewable resource) to read what I have to say here. Thanks again I plan to have more good stuff coming up soon and a few longer in depth article as well as guest interviews. Be sure to check out the first blog entry HERE.

ACSM
I am off to present at the American College of Sports Medicine in Indianapolis this coming Wed-Sat at the end of May. I can't wait as it is an exercise geeks dream! Tons of great research being presented by the best of the best from all around the world. I will have updates here of course (may not happen until I am home though depending on internet access). If you are going to be there, drop me a line!

Z Health and Kettlebell Seminar in MN on Sunday June 8
I will be doing a 2 hours seminar with Fawn Friday, RKC, CFT, soon to be Z Health R Phase certified at the Press Gym in Little Canada on Sunday June 8 at noon. We will be covering a basic overview of KB exercise and Z Health principals too. It will be primarily geared towards Mixed Martial Arts (MMA) athletes, but others will learn stuff too. So if you want to learn how to move better, get stronger and reduce pain, drop me an email to sign up ASAP. Cost is only $35 if you sign up ahead of time. There is limited space, so sign up now.

Research Update
More bleeding edge research of course! Cool article below on how your body regulates sleep in coordinance with your eating schedule. They go on at the end to suggest a 16 hour fast may help those with jet lag. Not sure if I am willing to make that jump yet, but from personal experience I've had the best luck staying on the same eating schedule (usually a meal every 2-3 hours or so) on the NEW schedule and then some melatonin before bed.

So if I was flying to Germany, once I board the plane I set my watch to the new time. This usually entails staying up later (and thus eating more) on the flight there from Minnesota; but once I crash into bed early I feel pretty good the next day.

Does A 'Food Clock' In The Brain Supercede Circadian Rhythm?"

Submitted by News Account on 22 May 2008 - 6:00am. Neuroscience

In investigating the intricacies of the body’s biological rhythms, scientists at Beth Israel Deaconess Medical Center (BIDMC) have discovered the existence of a “food-related clock” which can supercede the “light-based” master clock that serves as the body’s primary timekeeper.

The findings, which appear in the May 23 issue of Science, help explain how animals adapt their circadian rhythms in order to avoid starvation, and suggest that by adjusting eating schedules, humans too can better cope with changes in time zones and nighttime schedules that leave them feeling groggy and jet-lagged.

“For a small mammal, finding food on a daily basis is a critical mission,” explains the study’s senior author Clifford Saper, MD, PhD, Chairman of the Department of Neurology at BIDMC and James Jackson Putnam Professor of Neurology at Harvard Medical School. “Even a few days of starvation is a common threat in natural environments and may result in the animal’s death.”

The suprachiasmatic nucleus (SCN), a group of cells in the brain’s hypothalamus, serves as the body’s primary biological clock. The SCN receives signals about the light-dark cycle through the visual system, and passes that information along to another cell group in the hypothalamus known as the dorsomedial nucleus (DMH). The DMH then organizes sleep-wake cycles, as well as cycles of activity, feeding and hormones.

“When food is readily available,” explains Saper, “this system works extremely well. Light signals from the retina help establish the animals’ circadian rhythms to the standard day-night cycle.” But, if food is not available during the normal wake period, animals need to be able to adapt to food that is available when they are ordinarily asleep.

In order to survive, animals appear to have developed a secondary “food-related” master clock. “This new timepiece enables animals to switch their sleep and wake schedules in order to maximize their opportunity of finding food,” notes Saper, who together with lead author Patrick Fuller, PhD, HMS Instructor in Neurology and coauthor Jun Lu, MD, PhD, HMS Assistant Professor of Neurology, set out to determine exactly where this clock was located.

“In addition to the oscillator cells in the SCN, there are other oscillator cells in the brain as well as in peripheral tissues like the stomach and liver that contribute to the development of animals’ food-based circadian rhythms,” says Saper. “Dissecting this large intertwined system posed a challenge.”

To overcome this obstacle, the authors used a genetically arrhythmic mouse in which one of the key genes for the biological clock, BMAL1, was disabled. They next placed the gene for BMAL1 into a viral vector which enabled them to restore a functional biological clock to only one spot in the brain at a time. Through this step-by-step analysis, the authors uncovered the feeding entrained clock in the DMH.

“We discovered that a single cycle of starvation followed by refeeding turns on the clock, so that it effectively overrides the suprachiasmatic nucleus and hijacks all of the circadian rhythms onto a new time zone that corresponds with food availability,” says Saper. And, he adds, the implications for travelers and shift workers are promising.

“Modern day humans may be able to use these findings in an adaptive way. If, for example, you are traveling from the U.S. to Japan, you are forced to adjust to an 11-hour time difference,” he notes. “Because the body’s biological clock can only shift a small amount each day, it takes the average person about a week to adjust to the new time zone. And, by then, it’s often time to turn around and come home.”

But, he adds, by adapting eating schedules, a traveler might be able to engage his second “feeding” clock and adjust more quickly to the new time zone.

“A period of fasting with no food at all for about 16 hours is enough to engage this new clock,” says Saper. “So, in this case, simply avoiding any food on the plane, and then eating as soon as you land, should help you to adjust – and avoid some of the uncomfortable feelings of jet lag.”

This research was supported by grants from the U.S. Public Health Service.

Z-Health Question--R Phase and Beyond!

I got a cool email the other and just had to share it. Good question about I Phase too

Yesterday's deadlifts were a blast! Thanks for your advice. My forms was a heck a lot better, and my max effort attempt felt smooth!

Just wanted to ask, when would you suggest someone progress from R-phase to I-phase?

Answer
Once you can do ALL the drills on R Phase at the 4 different speeds (see the manual for details, but most people only work in one speed!) with extreme PRECISION, you can move on to I Phase. In most cases require at least a few sessions with a local Z trainer since it is very hard to grasp the amount of precision you need to do the drills from just a manual or DVD (they make great references and reminders though!)

Think of R Phase as the alphabet and if you are missing letters, trying to make words (I Phase) is going to be very hard and not productive either!

In my experience, even with good hands on coaching, most will work on R Phase alone for 6 months to 1-1.5 YEARS. Seems hard to believe I know and I thought that was insane when I started too. I still do R Phase drills and there are few I am still working to "master".

And yes, so far everyone I have seen needs to start at R Phase! Learn the basics first and then move on.

Hope that helps!

Note to upcoming RKC people

It is that time again when many will be coming to Minnesota for the RKC, which is awesome! I will try to order up some good weather for you! Just wanted to tell you that I have some time slots open for Z Health sessions if anyone is interested.

Drop me an email and we will set it up, first come first serve. For more info check out the link HERE.

Rock on!

Z Health Testimonial and Super Stiffness

Z Health R Phase Testimonial
Below is an email Aaron sent me after he completed the first 3 days of the Z Health R Phase Certification. Aaron did some couch surfing at my place for the whole 3 days and it was awesome to bounce ideas off him. Very bright guy and be sure to check out his blog HERE. I got this email only a few days after the cert!

Mike,

We gotta talk.

I have been doing the Z-health R movements and I am doing some movements that I have not done this smoothly and with this much power in a long time. O-lifts, sprinting (my speed in both sprinting and weightlifting is seeming "scary" fast...for me) and 100 kettlebell (the 24kg KB) swings in just 4 minutes without even feeling I did anything (maybe a little glute fatigue but mostly all I felt was a tremendous "pop" in the hips each rep, and the only thing that really stopped me was fatigue in my hands) ...what the hell?

Is this stuff (Z-health) that legit or have I fallen deep into the placebo medicine? In just a few days?

Aaron Schwenzfeier
Strength and conditioning coach at the University of North Dakota

Super stiffness?
Here is an idea I've bouncing around for awhile. I am sure I am not the first person to state this either and I am half expecting an email from the original owner any day now (seriously, if it is you let me know and I will give you credit, no problem).

"So maybe our end result is more muscle “stiffness” but we need to TRAIN MOBILITY to get there?" click HERE for the whole article

I guess I feel that stability is just "coordination"? (I know that is an over simplification.)

So I ran this past John Gray who is a PhD candidate in Dr. Stuart McGill's lab at the University of Waterloo. Dr. McGill is a top researcher on spine biomechanics. I see the word "super stiffness" being used in all sorts of crazy context now, so I thought I would go close to the source for any insight.

John did a great presentation at the NSCA regional conference recently, so be sure to check out his presentation on core stability if he is presenting in your neck of the woods.

Thanks Mike, what you wrote sums it up perfectly. It is all about coordination. But of course, an appropriate explanation of that is a lot more involved!

When people think of stiffness, they think they have to keep their trunk like a block of iron all the time. Not the case, you need to be able to turn it on and off in fractions of a second, so it is the ability to have a stiff torso but also the ability to change stiffness depending on the demands that are placed on it.

John Gray

Choices and Body Composition?

Note: I've been trying out so new blog features to publish items at certain time frames. Well it seems this one got published recently, but the date was a month ago, so you may not have seen it. I apologize if you already saw it. More new stuff soon once I complete my stats final (my final final).

A new study from the U of MN shows that you don't have an unlimited capacity to make decisions. In fact, according to this study, your ability to make decisions is actually LIMITED.

Kathleen D. Vohs, PhD, the study’s lead author and a member of the University of Minnesota’s marketing department, concluded that making choices apparently depletes a precious resource within the human mind. “Maintaining one’s focus while trying to solve problems or completing an unpleasant task was much harder for those who had made choices compared to those who had not,” says Vohs. “This pattern was found in the laboratory, classroom and shopping mall. Having to make the choice was the key. It did not matter if the researchers told them to make choices, or if it was a spontaneously made choice, or if making the choice had consequences or not.” (Source "Newswise Social and Behavioral Sciences")

How Does This Affect My Ability to Loose My Muffin Top
Dan John once said that your ability to make decisions is limited (1), just like the amount of shaving cream in a can. How does this affect your body composition? According to Dan John, you need to prepare for the week by having all your food and supplements ready to go and when it is time to eat, you just take out a container, open it up or heat it in the microwave--boom, you are done! This skips the whole decision process and thus saves "mental energy" and still allows you to make a good food selection.

Does It Work in Real Life?
YES. In chemistry (hold on, step away from the mouse and wait out that urge to clicking away from this site and I promise this will be brief) there is something known as "the rate limiting step" in a series of reactions. The reactions can't proceed any faster than this step. If you can speed up this step, you can speed up a whole series of reactions. You have probably heard "A chain is only as strong as its weakest link"--similar idea. Or the idea of a "king pin" defined as "one innermost or central pin in an arrangement of bowling pins" or "the most important person or element in an enterprise or system" (source Webster's dictionary).

The whole point is to target the rate limiting step, and your results go up exponentially with less work on your part (better leverage).

For most this comes down to simple stuff like grocery shopping and food prep. Get athletes to have all their food ready to go, and BINGO much better nutrition!

Summary
So the point is that despite what you think, there is mounting evidence that your ability to make lots and lots of decisions for free is not possible. In fact, your ability to make decision is limited, so you need to plan ahead for success!

Comments?
REFERENCES
1) John, Dan "Iron John: Free Will & Free Weights" online at T-Nation

Those Darn Shoes and Bad Feet

It is not too often I post links to other blogs, but Lou has a great one today about shoes (click HERE) and I could not have done a better job on the story myself (hehehehe---if you have read any of Lou's work you know I am totally kidding as he is a fantastic writer).

The only thing I would add is that if you do switch to a more minimal type shoe (Nike Frees, Vivos) you NEED to do mobility work on your feet/ankles since you are now really relying on them to move correctly. I do believe this is the best way to go for overall movement health.

It is amazing how many shoulder issues can be helped by mobility work (like Z Health) on the feet and ankles. Sounds crazy, but with each foot strike, that energy (force) has to go somewhere (remember Physics 101--energy is neither created nor destroyed) and it goes "up" your body and normally ends around your face and/or opposite hand/wrist crossing sides at your pelvis.

So if your feet/ankle are hosing this up (see--nice technically terms) with each foot strike, you are screwed (another technical term) for starters and many times all the crazy rehab stuff may only delay the issue. Sometimes the crazy rehab stuff will work, but on a first appointment it is a very rare person that I don't have them do some Z drill for their feet/ankles as part of their "Z Health Homework" I am still working on my feet/ankles now after doing Z for some time, but my feet are much much better now.

For shoes I really like the Nike frees and there are some other good ones out there too. Make sure the ball of the foot AND the HEAL are flexible. The Nike free was one of the only shoes designed by Nike to actually help performance, virtually all of the other ones are more based on marketing and style.

Any comments, let me know!
Mike N

Research Update for May Hormones, Muscle Growth and Inflammation

Hypertrophy with unilateral resistance exercise occurs without increases in endogenous anabolic hormone concentration.

Conclusion: “Unilateral training induced local muscle hypertrophy only in the exercised limb, which occurred in the absence of changes in systemic hormones that ostensibly play a role in muscle hypertrophy.”

My comments
Muscle hypertrophy (increasing muscle mass to get hyoooooooge) is a complicated process and although anabolic hormones do help, they are NOT required for muscle growth!

Cross-transfer effects of resistance training with blood flow restriction.

CONCLUSION: “The results indicate that low-intensity resistance training increases muscular size and strength when combined with resistance exercise with blood flow restriction for other muscle groups. It was suggested that any circulating factor(s) was involved in this remote effect of exercise on muscular size.”

My comments
Nothing like science to show different results from different studies! This one showing a systemic effect due to exercise (probably anabolic hormones but could be related to the nervous system). Previous studies have shown that there is a cross transfer from one limb to the next, so if I only do RIGHT bicep curls, my LEFT bicep will actually increase in strength to some degree

Growth hormone isoform responses to GABA ingestion at rest and after exercise.

CONCLUSIONS: “Our data indicate that ingested GABA elevates resting and postexercise irGH and ifGH concentrations. The extent to which irGH/ifGH secretion contributes to skeletal muscle hypertrophy is unknown, although augmenting the postexercise irGH/ifGH response may improve resistance training-induced muscular adaptations.”

My comments
I can see the supplement add now "GABBA increases GH!!!" While that may be true, this does NOT gaurantee any performance (increased muscle, decreased fat) changes. Yes the amount of GH (dose) does matter, but newer research is showing that how and when (pattern) of release is also very important.

Myocardial gene expression in heart failure patients treated with cardiac resynchronization therapy responders versus nonresponders.

CONCLUSIONS: “In HF patients with electromechanical cardiac dyssynchrony, functional improvement related to CRT is associated with favorable changes in established molecular markers of HF, including genes that regulate contractile function and pathologic hypertrophy.”

My comments
This study shows the amazing ability of the body to ADAPT! Despite what we throw at it, the body will almost ALWAYS ADAPT! This adaptation could be good or bad however. In this case with a better stimulus (CRT--cardiac resynchronization therapy--think of a fancy pacemaker for BOTH sides of the heart) the heart adapted in a POSITIVE fashion, all the way down to molecular markers. Amazing.

The salivary testosterone and cortisol response to three loading schemes.

Conclusion:” The similar T and C responses to the power and maximal strength schemes (of equal volume) support such a view and suggest that differences in load intensity, rest periods, and technique are secondary to volume. Because the acute hormonal responses to resistance exercise contribute to protein metabolism, then load volume may be the most important workout variable activating the endocrine system and stimulating muscle growth.”

My comments
See my above comments--ha! I wish more studies would measure hormonal changes AND performance changes. Most athletes only care about performance changes and you will not have the ability (most of us) to measure hormones anyway. Remember, hormones are only MESSENGERS!!!! Create the best stimulus first and then recover.

Effects of short-term hypocaloric diet on sympatho-vagal interaction assessed by spectral analysis of heart rate and blood pressure variability during stress tests in obese hypertensive patients.

Conclusion:” The LF/high frequency component (HF) ratio of the RR interval at rest on the regular-calorie diet was negatively correlated with the decrease in blood leptin concentration. These results suggest that the autonomic nervous function assessed by analysis of heart rate and blood pressure variability during stress tests may be improved by weight loss due to a short-term low-calorie diet in obese patients with hypertension.”

My comments
Show us again that the nervous system is running the show!

Effects of exercise on adipokines and the metabolic syndrome.

Conclusion: “Future studies are needed to investigate the cellular mechanisms by which exercise training affects inflammation and whether alterations in inflammation are one mechanism by which exercise improves components of the metabolic syndrome in at-risk individuals.”

My comments
Watch for inflammation to continue to play a huge role in exercise physiology and many other fields. Check out the guest blog by Dr. Lonnie Lowery HERE

Interleukin-6 markedly decreases skeletal muscle protein turnover and increases non-muscle amino acid utilization in healthy individuals.

Conclusion: “We demonstrated that IL-6 profoundly alters amino acid turnover. A substantial fall in plasma amino acids was observed with a concomitant 50% decrease in muscle protein turnover, however modest increase in net muscle degradation. We hypothesize that the profound reduction in muscle protein turnover and modest increase in net degradation is primarily caused by the reduced plasma amino acid availability and not directly mediated by IL-6.”

My comments

Most inflammatory compounds are probably not just "good" or "bad". Some is probably needed for a response, but too much will be an issue. Some inflammation is probably needed for optimal muscle growth (hypertrophy) but too much will dampen the optimal response. So how much? Good question and I really have no idea yet!

Any comments, let me know. Hope you enjoyed this highly geeeked out look at some brand new research!

A Drug for Weight Loss?

The holy grail for a weight loss drug marches on since everyone knows the potential market for it is HUGE (bad pun intended).

Historically most of these have not panned out well. Most remember the phen-fen issues and the only 2 drugs approved current in the US are close to worthless. How one of them (Alli) got approved for OTC (over the counter- aka I can buy it in Wal-Mart now) is beyond me. They even DECREASED the dose. So don’t waste your money on Alli, but the readers of this blog already knew that!

New Class of Drugs
There is a new class of drugs under development. Actually there are many but the ones that are the closest to potential US approval are derived from pot (weed/cannabis) of all things!

The primary active ingredients in marijuana (cannabis) appears to be delta-9 THC and has been investigated for years. One of the drugs on the market derived from it going by the substance name of dronabinol is available as a prescription drug Marinol.

The big block buster was going to be acomplia (goes by other names also like Rimonabant) as it was developed as a weight loss drug from the cannabis plant.

Everyone has heard of the "munchies" from smoking pot and this drug blocks the receptor in the brain (known as a cannabinoid (CB1) receptor antagonists for all the geeks). Since it is BLOCKING the receptor it has the OPPOSITE effect as stimulating it; so you "feel" full instead of going on a Doritos hut.

Take Away
So don't worry about big pharma coming to your fat loss rescue and work on fixing up your nutrition and grab some kettlebells.

Sanofi's Acomplia Wins Approval From UK Health Body
Here is the latest
Mike N

PARIS (Reuters) Mar 26 - French drugmaker Sanofi-Aventis said on Wednesday that its obesity-fighting product Acomplia had won approval from Britain's National Institute for Health and Clinical Excellence (NICE).

Sanofi said NICE had recommended that Acomplia should be made available for the management of obese and overweight patients on the UK's state-run National Health Service.

The UK decision contrasts with Germany where Acomplia is not reimbursed by health insurers because it is deemed simply to improve lifestyle.

The British government has made fighting obesity, particularly among young people, one of its key priorities.
In January, official British health data showed that obesity drug prescriptions had soared in the country, and health minister Alan Johnson said the UK faced an obesity crisis.

Acomplia -- also known by the brand name Zimulti in the United States and generically as rimonabant -- was once touted as a multibillion-dollar seller, but hopes for the product dimmed last year when a U.S. expert panel recommended against its approval in the world's biggest market, after it was linked to rare cases of suicidal ideation.

Sanofi said in October it expected only limited sales of the drug in the next few years, until new clinical trial results were ready for submission to regulators in 2009.

The French group is expanding clinical trials of the medicine as a treatment for type 2 diabetes.