Changing physicians’ mindsets on obesity
An initiative at Touro University College of Osteopathic Medicine has focused on reducing medical students’ negative attitude towards obese people. It is hoped that with this shift in mindset there will be better outcomes for heavier patients. The main idea behind the initiative is to shift the focus of individual responsibility when it comes to a person’s weight and make it a treatable condition. This is a similar strategy to the way that mental health medicine has changed over the years, for example 50 years ago patients with depression were commonly told to ‘get over it’, however now it is seen as a fully treatable condition.
The initiative itself was launched in 2012 and measured medical students’ attitudes using a ‘Fat Phobia Scale’, which identifies stereotypical beliefs such as obese people being lazy. After receiving information on the causes and treatment options for obesity, the same students’ attitudes were assessed at the end of each academic year. Those who completed the program reduced their bias by an average of 7 percent. It is hoped that if these attitude changes become widespread then physicans will spend more time with their overweight patients and take more care of them. Further to this, the authors explained that many patients feel too embarrassed to visit their doctors if they are received with a negative attitude. Based on the results of the four year course, the authors are hoping to expand the course online, making it available at other medical schools. This will also make it possible to gauge the effect on patient outcomes in the near future.
Read MoreBlood-thinning therapy may limit metabolic inflammation
A study published in the Journal of Clinical Investigation has discovered a previously unknown link between obesity and inflammation. By testing genetically manipulated mouse tissue as well as human tissue from obese people, the researchers were able to identify that fibrinogen – a glycoprotein that features in clotting – binds to certain cells that fuel diet-induced obesity. Obesity promotes activation of the clotting system that leads to the conversion of fibrinogen to insoluble fibrin, this in turn leads to accumulation of white blood cells and inflammation. The researchers hope that by targeting fibrin or fibrinogen they may be able to limit the progression of obesity related disease.
By using a drug called dabigatran they were able to block the activity of the enzyme thrombin; this enzyme catalyses the conversion of fibrinogen to fibrin. In the mice this meant that they were protected from the onset of obesity related disease. In order to further prove their results, the scientists assessed the incidence of obesity related disease in genetically modified mice. These mice had a mutant form of fibrinogen and it was found that they were significantly protected from weight gain; they also had markedly less systemic inflammation. The researchers are hoping to continue their work in the future by assessing the effects of dabigatran on patients that are already taking it, whilst also examining the full effect of fibrin on inflammation and obesity.
Read MoreEarly weight loss surgery associated with better outcomes
A new study has shown that only one in three patients who undergo bariatric surgery succeed in getting their BMI under 30. However this rate was much higher for those that had surgery under the BMI of 40, regarded as ‘morbid obesity’. The findings of this study are published in JAMA Surgery and they could help surgeons counsel potential patients about the best timing for their surgery and about their weight loss expectations afterwards. Data from 27,320 surgeries over a 10-year period were used and on average the patients had a BMI of 48 before the operation and got down to 33 by the end of the first year. Around 36% of patients achieved a BMI of under 30 with less than 9% of those that went into surgery with a BMI of above 50 getting down to 30 or below.
In the USA, the National Institute of Health uses a BMI of 40 as the threshold for bariatric surgery, alternatively it is 35 for those patients that are also suffering from obesity related health conditions. It is also an issue in the USA that insurers often require that patients undergo medically supervised weight-loss programs for at least a year before their surgery will be covered. This data may help to show that with an earlier surgical intervention, further health problems in the obese may be avoided. The authors of this study are hoping that their results will help inform referrals for surgery as well as insurance company requirements.
Read MoreChildhood experiences direct towards obesity
A new study from Florida State University has found that people who experience unpredictable childhoods face a higher risk of becoming obese as adults. Past research has shown a link between low socioeconomic status and obesity; however the reason behind it has often been overlooked. One theory suggests that it is due to stressors leading to a wide variety of negative outcomes. This study hypothesised with a perspective called ‘Life History Theory’, which says that people have a limited amount of reproductive energy in life and the way they use that energy is influenced by the structure that they experience during their childhoods.
The researchers go on to explain that many children who experience unpredictable childhood issues such as divorce, crime or frequent moves are more likely to live in the moment and make short term decisions, whilst not planning for the future appropriately. In contrast, predictable childhoods teach that planning for the future is good and as adults these children tend to form long-term goals. The authors admit that their research is not definitive and does not provide a clear answer for the problem of obesity; however they explain that past research has only vaguely encouraged families to reduce stressors without any guidance. This study may provide some ideas on how to help these families by creating structure and predictability for children.
Read MoreExposure to violence linked to obesity
In a study from Duke University, it was found that teens that were exposed to violence consumed more unhealthy food and beverages and suffered from fatigue. The researchers used data from mobile phone applications for over 500 teens in California and North Carolina. The groups carried out initial assessments and baseline measurements were taken; follow up was completed 18 months later. The teenagers were then given an application on their phones which created a survey for them to fill out, they reported on their exposure to violence, their diet, physical activity and their hours of sleep. ‘Exposure to violence’ was defined as physical fighting at home, school, in their neighbourhoods or elsewhere.
The group from California reported unhealthier diets on the days that they were exposed to violence, and fatigue for the day after (attributed to poor sleep quantity and quality). The North Carolina group also reported the fatigue, but no change in diet. However, both groups reported an increase in physical activity on the days that they were exposed to violence; this data was logged using wearable devices. As adolescence is a key period for the development of eating habits and many other behaviours, the researchers are hoping to continue their research in order to examine the full mechanism behind this effect as well as to address the high levels of obesity amongst this age group.
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