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.
Read MoreChemicals in urine can predict how body will respond to junk food diet
Researchers at Imperial College London have found that certain compounds in urine can be used to show who is at a greater risk of developing obesity or diabetes due to a poor diet. The research was conducted in mice and helps us to understand how the gut microbiome contributes to our health, as the chemicals that were detected were released by the bacteria in our gut. It has been known for some time that different people will have varying outcomes when exposed to a high-fat diet, making it difficult to create a universal diet plan that works for everyone, however the effect of the gut microbiome is less well known.
By using genetically similar mice and analysing their urine, the researchers were able to identify some chemical signatures that were predictive of some outcomes, such as weight gain and glucose tolerance – which is an early sign of diabetes. The findings themselves will be made part of a larger trial that will involve around 2,000 participants which aims to identify how and why people react differently to similar diets and how their microbiomes influence this. It is also hoped that this could lead to a more personalised diet for those wishing to control their weight or to avoid health conditions such as diabetes or cardiovascular disease.
Read MoreNew combination of drugs cause enhanced weight loss
Researchers at the University of Pennsylvania have found that a unique combination of weight loss drugs can have a dramatic effect on laboratory animals. The researchers studied the effect of two different drug classes that affect the hormones amylin and glucagon-like peptide-1 (GLP-1). They found that cycling between the two drug regimens over the course of a month achieved a greater degree of weight loss than normal regimens. These include a continuous combined therapy or using just one of the drugs.
Unlike many other trials that examine new drugs, this research involves drugs that are already approved by many different organisations, including the FDA. This means that the types of regimens being suggested could be in use in the very near future. Currently, the authors are finalising their work to show how the two hormonal systems interact with each other to achieve this greater weight loss.
Read MoreMaternal obesity linked to childhood neurodevelopmental problems
A study published in the American Journal of Preventative Medicine has linked maternal obesity to an increased risk of behavioural problems in male children. In this study data from the 1979 and 1986 U.S. National Longitudinal Survey of Youth was used. They also assessed whether the effect of maternal weight on childhood behavioural problems was affected by race or gender of the child. In total, nearly 5,000 mother and child pairs were involved from 1986 to 2012, the study itself focused on children between the ages of 9 and 11 as this is a time when behavioural problems commonly manifest.
Interestingly, the study showed that boys whose mothers entered pregnancy with a higher weight were at a higher risk of behavioural problems in later life than their female counterparts, in fact there was no link demonstrated with females. Further to this, boys whose mothers entered pregnancy underweight were also at a higher risk of behavioural problems. There was no difference for race. It is hoped that this research will be furthered by looking into the effects by adolescence. The researchers are also hoping to highlight the need for early intervention with women to attain a healthy weight before they become pregnant, as it not only affects them but the future health of their children too.
Read MoreBeing large at birth correlates to childhood obesity
A new study, from the University of Virginia School of Medicine, has suggested that infants with a high birthweight are more likely to become obese children. The study itself examined the data of 10,186 children born both prematurely and at term. The findings were consistent for both sets of children. It was found that children born with a high birthweight (described as >10lb) were 69% more likely than average weight children to be obese by age four and by age six, 23.1% of high birthweight children were obese, whilst only 14.2% of average birthweight children were.
The study found the relationships consistent despite adjusting for factors such as socioeconomic status. The researchers are calling for doctors to counsel parents of high birthweight children, so that the development of obesity in later life can be prevented. It is also hoped that even if doctors do not counsel their patients, new parents will alter their lifestyle habits to help their children avoid future weight and health problems.
Read MoreImmune cells in brain drive overeating
A study, from the University of California in San Francisco, has found that immune cells within the brain, known as microglia, could be responsible for weight gain caused by overeating. It has been known for some time that the hypothalamus contains neurons that regulate food intake and energy expenditure; in this study the researchers fed mice a high fat diet which is known to cause an increase in microglia. It was found that the high fat diet caused local inflammation within the hypothalamus, when compared to the control group of mice. They also found that the mice who had been fed high fat foods continued to consume more afterwards.
In order to prove that the increase in microglia was the cause of the overeating, some of the mice were given a drug that depleted their levels of the cell. They found that mice treated with the drug consumed 15% less and gained 20% less weight, compared to mice on the same diet. Mice were then engineered to form microglia that couldn’t mount an inflammatory response and they gained 40% less weight, suggesting that the effect of microglia could be crucial in our understanding of the development of obesity. The researchers are hoping to move their study on to humans in the near future to properly examine the effect of microglia on overeating and obesity and potentially help control them. In the immediate future they are going to investigate how the consumption of high-fat foods leads to the activation of microglia, and whether there is any way to stop these signals from being processed.
Read MoreTV in the bedroom linked to childhood obesity
Preschool children can spend up to 12 hours a day in sedentary time, which can include watching television, playing electronic games and reading. Few preschool children are meeting the current recommendations of less than 1 hour of screen time per day, and are spending large amounts of time engaging in screen time. According to new research, children who have a TV in their bedroom at the age of 7 are more likely to become overweight.
Prof Russell Viner of the Royal College of Paediatrics and Child Health, who was not involved in the study, has said that “The study indicates, more research is needed to fully understand this complex area, but this is a high quality study covering a very large and nationally representative sample and provides a reasonably strong basis to think that the links shown here are real….it highlights that having a TV in the bedroom from seven years increases the risk of being overweight four years later, regardless of the child’s weight in earlier childhood. As such, the findings must be taken very seriously.”
Read MoreSpecialist clinics key to tackling obesity complications in pregnancy
In the UK, approximately 20% of pregnant women are obese and 2% have very severe obesity (BMI) ≥40 kg/m2.
According to a recent study, attendance at a specialised antenatal clinic for obesity was associated with reduced rates of stillbirth and low birthweight. It was also associated with improved detection of gestational diabetes.
The improvement in clinical outcomes was associated with an increase in the mother-to-be being attended to by healthcare staff. This allowed for complications to be identified earlier and therefore to obstetric triage and clinical interventions. This included induction of labour as well as caesarean sections.
Specialist antenatal clinics for severely obese mothers-to-be could help to cut the rates of pregnancy complications linked to obesity.
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