Childhood Obesity

Obesity medication liraglutide proven safe and effective in children under 12, research claims

A ground-breaking study has confirmed that liraglutide, a medication used to treat obesity, is both safe and effective in children aged 6 to under 12 years. The research, presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September), and simultaneously published in the New England Journal of Medicine (NEJM), provides a promising new option for the treatment of paediatric obesity.

The findings demonstrate that children within this age group who were administered liraglutide for just over a year experienced a 7.4% reduction in Body Mass Index (BMI) compared to those given a placebo. Furthermore, these children showed improvements in blood pressure and blood glucose regulation.

The SCALE Kids trial, which is the first clinical study to investigate the safety and efficacy of liraglutide in a paediatric population, offers a glimmer of hope for children living with obesity. According to the researchers, this new development may enable these young individuals to lead healthier, more productive lives.

Professor Claudia Fox, the lead author of the study and an expert in Paediatric Obesity Medicine at the University of Minnesota Medical School in Minneapolis, USA, remarked: “Obesity is the most common chronic disease in childhood. Left untreated, it almost universally persists into adulthood, leading to significant health problems such as diabetes, cardiovascular disease, and in some cases, premature death. Early intervention is therefore critical.”

She continued by highlighting the limited treatment options currently available: “At present, effective treatments are scarce. The primary approach to addressing obesity remains lifestyle therapy, focusing on diet and physical activity changes. However, when used alone, the effects are often modest, and no medication is currently approved for treating general obesity in children younger than 12.”

Liraglutide, already approved as an adjunct to lifestyle therapy in adults and adolescents with obesity, was the focus of this study to assess its safety and efficacy for younger children. Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics a naturally occurring hormone. By stimulating the GLP-1 receptor, liraglutide reduces appetite, slows the emptying of the stomach, and promotes feelings of fullness after eating. This medication is administered via daily injections.

The phase 3 study, funded by Novo Nordisk, the pharmaceutical company that manufactures liraglutide, involved 82 children (53.7% of whom were male) aged 6 to under 12 years. At the start of the trial, the average age of the participants was 10 years, their average BMI was 31.0 kg/m², and their average body weight was 70.2 kg (11 stone 1 pound). Over half (54.9%) of the participants were living with at least one obesity-related complication, such as insulin resistance or early onset puberty.

The study divided participants into two groups: 56 children received daily injections of liraglutide (up to 3 mg or the maximum tolerated dose), while 26 children were given weekly placebo injections over a period of 56 weeks. Importantly, all participants received individualised counselling at every visit to encourage adherence to a healthy diet and regular physical activity, with the goal of achieving 60 minutes of moderate to high-intensity exercise each day.

At the conclusion of the treatment period, the average BMI reduction was 5.8% for the liraglutide group, compared to a 1.6% increase in BMI in the placebo group, amounting to a 7.4% difference between the two groups. Similarly, the mean change in body weight was a 1.6% increase for those taking liraglutide and a 10% increase for those on the placebo, revealing an 8.4% difference in body weight change between the two groups.

Furthermore, nearly half (46.2%) of the children receiving liraglutide experienced at least a 5% reduction in BMI, compared to only 8.7% of those in the placebo group. Professor Fox and her team emphasised that since children of this age are continually growing, an increase in body weight over the course of a year would be expected. Therefore, BMI, which accounts for height as well as weight, provides a more informative measure of change.

Professor Fox stated: “Although there is no universally agreed-upon definition of a clinically meaningful reduction in BMI for children, a 5% reduction has been linked with improvements in certain obesity-related health conditions. In our study, we observed that diastolic blood pressure and haemoglobin A1c (HbA1c), which is a measure of blood sugar control, improved more significantly in children who were treated with liraglutide compared to those receiving the placebo.”

Both groups experienced side effects, with 89.3% of the liraglutide group and 88.5% of the placebo group reporting at least one side effect. Gastrointestinal side effects, such as nausea, vomiting, and diarrhoea, were the most common and affected 80.4% of children receiving liraglutide, compared to 53.8% of those receiving the placebo.

Serious side effects were reported by 12.5% of children in the liraglutide group and 7.7% in the placebo group. Four of the seven serious adverse events in the liraglutide group were gastrointestinal in nature. A small proportion (10.7%) of children in the liraglutide group discontinued the treatment due to side effects, whereas no participants in the placebo group withdrew for this reason. The side effects observed align with those previously documented in adolescents and adults using liraglutide.

It was noted that BMI and body weight increased in both groups after the treatment was discontinued, highlighting the need for sustained intervention.

In conclusion, the study found that liraglutide at a 3.0 mg dose resulted in a significantly greater reduction in BMI compared to placebo in children aged 6 to under 12 years living with obesity. The medication was generally well-tolerated, and no new safety concerns were identified.

Professor Fox highlighted the significance of the findings: “The results of this study offer substantial promise for children living with obesity. Up until now, children have had virtually no options to treat obesity and were often simply told to ‘try harder’ with diet and exercise. Now, with the possibility of a medication that targets the underlying physiology of obesity, there is renewed hope that children can lead healthier, more productive lives.”

This study marks a critical step forward in the treatment of paediatric obesity and provides a potential new path for children who previously had limited options.

Rising BMI and fat mass linked to ultra-processed food consumption in young Chilean children

A recent study published in BMC Medicine has illuminated the significant relationship between the consumption of ultra-processed foods (UPFs), rising obesity rates, and certain metabolic indicators among preschool-aged children in Chile. The findings underscore the potential long-term health risks associated with diets high in UPFs, particularly in young children, a demographic increasingly vulnerable to the adverse effects of poor nutrition.

Study Overview

The study was conducted as part of the Food and Environment Chilean Cohort (FECHIC) study, a prospective cohort investigation designed to explore the impact of dietary habits on health outcomes in Chilean children. The researchers focused on the influence of UPF consumption on obesity and metabolic outcomes over a two-year period, with initial data collection beginning in 2016.

Participant Selection and Data Collection

The study analysed dietary data from 962 children, all of whom were around four years old at the start of the research. Dietary intake information was collected using the United States Department of Agriculture’s (USDA) multiple-pass technique, a method known for its accuracy in capturing 24-hour dietary recalls. Mothers served as the primary respondents, providing detailed accounts of their children’s food intake during structured in-person interviews. Where necessary, the children themselves contributed additional details about their eating habits, especially for meals consumed outside the home, such as during school hours.

In order to maintain the integrity of the study, records indicating extreme levels of UPF consumption were excluded. The researchers utilised the NOVA classification system to categorise all foods consumed by the participants. This system divides foods into four categories: natural and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. To estimate the children’s UPF consumption both in terms of grams and calories, the Multiple Source Method (MSM) was employed.

Assessment of Adiposity and Metabolic Indicators

Two years after the initial data collection, when the children had reached the age of six, the research team measured various indicators of adiposity and metabolism. Adiposity indicators included waist circumference, body fat mass (both as a percentage and in kilograms), and body mass index (BMI) z-scores. The metabolic indicators assessed were fasting blood glucose levels, insulin levels, the homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, and total cholesterol.

To evaluate the children’s energy requirements, the Dietary Reference Intake (DRI) equation was applied. The relationship between UPF intake and the various health outcomes was analysed using linear regression models, which were adjusted for covariates such as age, sex, baseline BMI z-scores, screen time, and maternal factors including BMI, age, education, employment status, and socioeconomic status.

Results and Analysis

At the beginning of the FECHIC study, the average age of the children was five years, with a slight female majority (52%). The average BMI z-score was recorded at 1.0, indicating a tendency towards overweight. The mothers were, on average, 31 years old, with 55% having attained a medium level of education.

By the end of the two-year study period, the average fat mass of the children had risen to 24%, and the average fasting glucose level was measured at 82 mg/dL. Notably, UPFs accounted for 48% of the children’s total caloric intake at four years of age, and 39% of their total food intake by weight. Despite UPFs contributing the majority of calories, minimally processed foods still constituted the largest portion by weight (57%).

The adjusted regression models revealed significant positive associations between UPF consumption and several key indicators of obesity, including BMI, waist circumference, fat mass in kilograms, and percentage fat mass. However, the study did not find a direct relationship between UPF intake and the metabolic markers assessed.

Sensitivity analyses, which included models without the use of stabilised inverse probability of censoring weights and considered UPF intake in quartiles, produced consistent results, further reinforcing the study’s findings.

Discussion

The study’s results suggest that the proportional contribution of UPFs to the diet is more impactful than the total quantity consumed. This observation aligns with broader research indicating that health improvements often follow a shift away from diets dominated by ultra-processed foods.

UPFs are typically characterised by a poor nutritional profile, with high levels of added sugars and saturated fats, and low concentrations of essential vitamins and minerals. The production processes involved in creating UPFs often use refined ingredients that not only reduce satiety but also increase glycaemic response, leading to a higher propensity for overeating. Additionally, UPFs are energy-dense but low in water content, allowing for rapid consumption of both volume and calories, which further promotes excessive intake. The low protein density in these foods may also contribute to an overconsumption of other, potentially unhealthy, foods.

There is also concern that the widespread consumption of UPFs increases exposure to rare or unnatural food additives, which could pose additional, as yet unquantified, health risks.

Conclusion and Recommendations

The findings from this study indicate a clear link between UPF consumption and rising obesity rates among Chilean preschoolers, though no significant connection to metabolic consequences was observed within the two-year period. Longer follow-up studies are necessary to fully understand the long-term risks associated with UPF consumption in young children.

In light of these findings, health authorities and policymakers are urged to strengthen global initiatives aimed at creating environments that encourage diets rich in minimally processed foods. There is a pressing need to restrict children’s access to UPFs, which are increasingly prevalent in modern diets, to curb the growing trend of childhood obesity and its associated health risks.

Children with obesity more likely to develop immune-related skin conditions

New research highlights the significant link between childhood obesity and the increased likelihood of developing immune-mediated skin diseases (IMSDs), including conditions such as alopecia areata, atopic dermatitis, and psoriasis. The study underscores the importance of maintaining a healthy weight in childhood as a potential preventative measure against these skin conditions.

The findings, published in the Journal of Investigative Dermatology, are based on an extensive analysis of 2,161,900 Korean children tracked from 2009 to 2020. The study aimed to explore the relationship between obesity, dynamic changes in body weight, and the development of IMSDs over time.

IMSDs can have profound impacts on the quality of life, affecting children’s emotional, physical, social, and functional well-being, as well as that of their families. Although some biologics have shown promise in treating conditions like atopic dermatitis and psoriasis in children, there remains a dearth of effective treatment options. Furthermore, the lack of clinical trials for systemic therapies continues to pose significant challenges in managing IMSDs in paediatric populations.

In recent years, childhood obesity rates have risen sharply, exacerbating what has now become a pressing public health issue. The COVID-19 pandemic and associated lockdowns have further compounded this crisis. Despite the clear association between obesity and chronic inflammatory skin diseases, such as psoriasis and atopic dermatitis, the exact mechanisms through which obesity contributes to these conditions remain unclear.

Dr Seong Rae Kim, MD, Co-lead investigator of the study from the Department of Dermatology at Seoul National University College of Medicine, Seoul, Republic of Korea, explained, “Previously, many studies have looked at the link between childhood obesity and IMSDs. However, most of these studies only looked at data from one point in time or compared groups with and without the condition (i.e., obesity or overweight), and they had small sample sizes. Very few studies have followed children over a long period to see how their body weight affects the development of these skin conditions. This means we still don’t know for sure whether having obesity or overweight causes atopic dermatitis and psoriasis or if the opposite is true. Also, no studies have yet looked at the effect of body weight on alopecia areata or how dynamic changes in a child’s weight affect development of common IMSDs.”

The study stands out due to its scale and comprehensive approach, following children longitudinally to assess how fluctuations in body weight influence the risk of developing IMSDs. This extensive dataset, drawn from a national database covering nearly all infants and children in Korea, provided researchers with a unique opportunity to gain insights into the complex relationship between weight and skin health.

Dr Hyunsun Park, MD, Ph.D., another co-lead investigator from the same institution and a member of the Laboratory of Intestinal Mucosa and Skin Immunology, elaborated on the team’s broader research interests, stating, “Our research team is very interested in the skin-gut axis. We think that various factors, including diet, obesity, or other lifestyles can affect the gut environment and contribute to the development of IMSDs. We are trying to find the puzzle pieces to demonstrate how they are connected, and our current research is a step towards that understanding. We conducted a large study using data from a national database in Korea, which includes information on almost all infants and children across the country. Our goal was to see how a child’s weight and changes in their weight are related to the development of alopecia areata, atopic dermatitis, and psoriasis.”

The study’s results were telling. It was found that children with obesity had a higher likelihood of developing IMSDs compared to their peers of normal weight. Atopic dermatitis, in particular, showed the most significant association with changes in body weight. Children who transitioned from a normal weight to being overweight were at an elevated risk of developing atopic dermatitis. Conversely, those who managed to reduce their weight from overweight to normal had a reduced risk of developing the condition compared to children who remained overweight.

Dr Seong-Joon Koh, MD, Ph.D., another co-lead investigator from the Department of Internal Medicine and Liver Research Institute at Seoul National University College of Medicine, as well as the Laboratory of Intestinal Mucosa and Skin Immunology, concluded, “Our findings support the importance of promoting weight maintenance among children who are already within the normal weight range because it may help reduce the risk of developing atopic dermatitis. In addition, prevention of excessive weight gain and purposeful weight loss, including adopting healthy diet strategies in children with obesity to prevent atopic dermatitis, particularly before school age, should be promoted. Implementing purposeful interventions, including nutritional strategies, to decrease body weight may aid in reducing the risk of developing IMSDs in children.”

This study offers crucial insights that could influence public health strategies and clinical practices, advocating for early interventions in managing childhood obesity as a means to reduce the burden of IMSDs. The research underscores the need for continued exploration into the connections between body weight, lifestyle factors, and immune-mediated skin diseases to better understand how to prevent and treat these conditions effectively.

Early school-based health education reduces abdominal fat accumulation in children

A groundbreaking study by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Fundación SHE, with financial support from “la Caixa” Foundation, has unveiled significant findings regarding the prevention of abdominal fat accumulation in children through early, classroom-based health education. The research, documented in the Journal of the American College of Cardiology (JACC), underscores the effectiveness of instilling healthy habits from an early age, positioning primary school as a critical stage for impactful health interventions.

Childhood obesity remains a pressing public health issue, with a notable prevalence in socioeconomically vulnerable groups. Addressing this through school-based programmes has shown mixed results, largely due to varying levels of scientific rigour and implementation fidelity. This study examines the efficacy of a structured health education programme during the formative years of primary education in Madrid, focusing on its ability to curb the rise in obesity markers among young children.

The study engaged 1,771 students from 48 public primary schools in the Comunidad de Madrid. These schools were categorised into four distinct groups. The first group participated in a comprehensive health-promotion programme, the SI! Program–Comprehensive Health, over six years, encompassing emotional management, healthy eating habits, active lifestyles, and basic anatomy and cardiovascular knowledge. The next two groups engaged in the same programme but limited to three-year spans; one from the start and another in the final three years. The fourth group received no specific health interventions. The assessment criteria included body mass index, weight gain, and abdominal fat accumulation, measured at three key stages: at the outset, mid-point, and conclusion of the study.

Results indicated that early intervention (first three years of primary school) was significantly more effective in preventing undesirable increases in body mass index and abdominal fat compared to later interventions or no intervention at all. This early intervention group exhibited the least weight gain and abdominal fat accumulation among all cohorts.

The findings advocate for the strategic placement of health education in the early academic curriculum as a preventive tool against childhood obesity. Rodrigo Fernández-Jiménez, head of the Cardiovascular Health and Imaging laboratory at CNIC and co-author of the study, highlighted the unique position of schools as ideal environments for the execution of such health-promotion programmes. He emphasised the absence of adverse effects and the potential widespread benefits of these interventions.

Gloria Santos-Beneit, the Scientific Director of Fundación SHE and lead author of the study, stated, “The results of this study suggest that interventions promoting healthy lifestyle habits can be more effective at reducing childhood obesity if implemented early, in the first years of elementary school.”

Building upon these insights, Dr. Valentín Fuster, Director General of CNIC, announced the initiation of a new study to explore the efficacy of modified and extended versions of the SI! Program. This new study aims to reduce the burden on educators by incorporating “learning bites” and reintervention strategies throughout the elementary school years, potentially enhancing the sustainability and impact of health education.

This extensive study demonstrates the critical role of early, structured health education in preventing the accumulation of abdominal fat in children. By capitalising on the receptive and formative phase of early education, such interventions can provide a foundation for healthier future generations, underscoring the necessity for well-designed, scalable health-promotion programmes in schools.

CNIC operates under the umbrella of the Carlos III Health Institute (ISCIII), linked to the Spanish Ministry of Science, Innovation, and Universities. Supported by the Pro-CNIC Foundation, it collaborates with major Spanish private entities, consolidating its mission through a pioneering public-private partnership model. The institution has also been honoured as a Severo Ochoa Centre of Excellence, highlighting its pivotal role in cardiovascular research and health promotion.

Alarming surge in severe obesity among adolescents in Ireland

Since 2018, Ireland has witnessed a tenfold increase in referrals of adolescents to specialised obesity clinics, highlighting a critical and worsening health issue among young people. Dr. Órla Walsh, a paediatric specialist at Children’s Health Ireland in Temple Street, has expressed deep concern over the rising number of young patients exhibiting severe symptoms of obesity. Over the past six years, the situation has escalated, with Dr. Walsh noting the overwhelming demand for treatment at her medically-led complex obesity clinic. “I’m running a clinic that is merely the tip of the iceberg. It is a tertiary clinic, which means we only see cases of severe complex obesity that also present with at least two other complications. Since its inception last year, our waiting list has grown to include 419 children,” Dr. Walsh explains.

The pervasive influence of obesity on both the physical and psychological well-being of children is profound. Dr. Walsh stresses that neither the child nor their family is at fault, pointing to genetic factors and an environment that promotes obesity. “The relentless marketing by food and beverage companies significantly contributes to the problem. Our children are inundated with advertisements daily, pushing fast food, processed items, and oversized portions,” she remarks.

A study presented in Dublin last year offered a glimmer of hope, showing promising results from weekly weight loss injections of semaglutide, a medication under the brand names Wegovy and Ozempic. Nearly half of the children treated no longer met the criteria for clinical obesity following the treatment. However, access to such medications is restricted; adolescents can only use these drugs if they are diabetic or if they can afford private treatment, costing approximately £200 a month.

Dr. Walsh highlights the inequality in access to treatment, especially among socioeconomically disadvantaged adolescents. She contrasts the situation in Ireland with international standards where adolescents have access to weight loss medications and bariatric surgery, which are not readily available in Ireland. Efforts have been made to urge the Health Service Executive (HSE) to provide weight loss medication freely to children suffering from complex obesity. “Treating these adolescents can prevent complications later in life. Investing in adolescent health yields a triple benefit: improving their current and future health, and potentially the health of their future children,” Dr. Walsh advocates.

The paediatrician also runs a general adolescent clinic and sees a troubling trend of obesity-related medical complications such as hypertension, pre-diabetes, and obstructive sleep apnoea, along with significant psychiatric comorbidities. “The stigma, shame, and bullying associated with obesity severely affect their mental health, leading to anxiety, depression, and often undiagnosed eating disorders,” she reveals.

Further stressing the urgency, a 2022 international report indicated that Ireland had the highest rate of risk factors for non-communicable diseases in European adolescents. The study surveyed nearly 500,000 children aged between 11 and 17, revealing that 63% of Irish adolescents exhibited four or more risk factors such as physical inactivity, poor diet, and substance use, compared to just 13% of their Swedish counterparts.

Dr. Walsh reflects on her recent observations in Sweden, where a healthier environment for children starkly contrasts with the situation in Ireland. “Sweden offers extensive support for child health, including widespread access to playgrounds, pools, and government-supported child care, which contributes to a healthier societal setup,” she notes.

The article concludes with the HSE’s response on the current status of obesity treatments under consideration for reimbursement, including medications like Saxenda and Wegovy, which are aimed at adults and potentially extendable to adolescents.

Dr. Walsh’s observations and the data presented underscore a dire need for systemic change to combat adolescent obesity in Ireland, a public health challenge that has only intensified in the wake of the global pandemic.

New study finds financial rewards enhance obesity interventions for teens

A recent study has demonstrated that adolescents suffering from severe obesity achieve a more significant reduction in body mass index (BMI) when meal-replacement therapy is supplemented with financial incentives, as opposed to meal-replacement therapy alone. These findings have been documented in an article published by JAMA Pediatrics.

Justin Ryder, PhD, an associate professor involved in both the Surgery Division of Pediatric Surgery and Pediatrics, collaborated on this research. Ryder highlighted the importance of developing more effective treatments for severe obesity, which currently impacts approximately 20% of children and adolescents in the U.S. The Centers for Disease Control and Prevention defines severe obesity as having a BMI at or above the 95th percentile for one’s age and gender. This condition predisposes individuals to a host of future health issues including adult obesity, cardiovascular diseases, and type two diabetes.

Previous studies have shown that meal replacement therapy (MRT), which replaces regular meals with controlled, pre-portioned meals totalling 1,200 calories per day, tends to be more effective than traditional lifestyle changes for reducing BMI in young people with severe obesity. In light of these findings, the recent study aimed to assess whether the addition of financial incentives would enhance the effectiveness of MRT.

“There’s literature for adults that supports that tying in financial incentives to weight loss or physical activity programs increases adherence, and so we wanted to see whether or not adding financial incentives to a behavioural/nutrition weight loss program using meal replacement therapy would increase adherence and through adherence, increase the efficacy of the treatment,” explained Ryder.

The research involved 126 adolescents, divided into two groups of 63 participants each. For one year, one group received MRT along with financial incentives based on their weight reduction from baseline, while the other group received only the MRT. At the end of the 52-week period, the group that received both MRT and financial incentives exhibited a greater decrease in BMI—by 6 percentage points—and a higher reduction in total body fat mass—4.8 kilograms compared to their counterparts who only received MRT.

Ryder added, “Using a cost-effectiveness analysis, we looked at mean fat mass lost between the two treatments and found that despite providing the additional meal replacements for per pound lost, it was cost-effective to do so.”

The study’s authors also noted the need for the development of interventions that maintain effectiveness beyond a one-year timeframe. “While financial incentives plus MRT appears to be a longer-term strategy than MRT alone, treatment withdrawal will likely result in BMI increase. As such, research is needed to identify strategies that are scalable and feasible in the long term given the chronic nature of obesity,” they mentioned.

This pivotal research was funded by multiple grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health National Center for Advancing Translational Sciences. Financial support for the meal programs was provided by Healthy For Life Meals, contributing to the resources necessary for this comprehensive study.

New clinic for childhood obesity to open in Surrey, UK

Surrey is set to benefit from a pioneering initiative aimed at combating childhood obesity, as revealed by the BBC. The newly established Complications from Excess Weight (CEW) clinic, a part of Ashford and St Peter’s Hospitals NHS Foundation Trust, is preparing to welcome its first referrals in early autumn, 2024.

This service forms part of a broader national strategy, initiated by NHS England in 2022, to open 30 dedicated clinics across the country. These clinics are designed to offer comprehensive support services, including mental health care and nutritional guidance, to children grappling with obesity.

The teams at these clinics will consist of multidisciplinary professionals such as consultant paediatricians, dietitians, and psychologists, who are committed to a holistic treatment approach for the affected children and their families.

Vicky Williams, the Associate Director of Women and Children’s Services at Surrey Heartlands Integrated Care System, highlighted the urgent need for such services: “Obesity affects one in four children in the UK and it can increase the likelihood of a child developing serious health issues.” She emphasised the importance of early intervention and continuous support to prevent future complications. Williams expressed optimism about the local availability of the service, stating, “It means that, in future, children and young people will be referred to a specialist service in Surrey, closer to home, instead of having to travel further away – so it’s good news for families in Surrey.”

Furthermore, the NHS Frimley Integrated Care Board mentioned that currently, children eligible for the CEW clinic’s services in its area are receiving care from consultants based in Southampton. Plans are underway to establish a similar clinic closer to home for patients from Surrey Heath and Farnham, North East Hampshire, and East Berkshire.

The urgent need for such clinics is underscored by alarming statistics; NHS leaders have noted that obesity impacts one in four children in the UK, potentially leading to severe health problems such as Type 2 diabetes, liver disorders, and early onset heart disease. Data from the latest child measurement programme in schools indicates that nearly 13% of children assessed in Surrey during the 2022/23 school year were living with obesity by the time they reached year six of primary school.

Previous governmental measures include the 2018 imposition of a tax on high-sugar soft drinks and limitations on the promotion of unhealthy products in supermarkets across England.

The new Labour government has expressed a firm commitment to addressing this health crisis. A Department for Health and Social Care spokesperson detailed forthcoming measures: “We will introduce tight restrictions on advertising junk food, alongside banning children from being able to purchase sugary, high caffeine energy drinks. By building a healthier society, we will help to build a healthy economy.” This statement underscores the government’s proactive stance on cultivating a healthier future for the next generation.

US panel advises intensive behavioural counselling for children with obesity

A panel of experts in the United States has revised its guidance for paediatric obesity screening, with new recommendations highlighting the necessity for intensive behavioural interventions for children over the age of six who have a high body mass index (BMI). This update, issued by the U.S. Preventive Services Task Force, was published in the Journal of the American Medical Association (JAMA) Tuesday, 18th of June, 2024.

Replacing their 2017 advice, the Task Force previously suggested that primary care providers merely screen children for obesity. The urgency of the update is underscored by data showing that nearly 20% of U.S. children are classified as having obesity, a condition defined as having a BMI at or above the 95th percentile for a child’s age and sex. The prevalence of obesity is notably higher among Latino, Native American, and Black children, as well as those from lower-income backgrounds.

Dr. Wanda Nicholson, Chair of the Task Force and a professor of prevention and community health at George Washington University, emphasised the complexity of factors contributing to childhood obesity but pointed to strong evidence supporting intensive counselling. “Fortunately, we know that there are proven ways that primary care clinicians can help many children and teens to address the high BMI,” Dr. Nicholson stated. She highlighted that “Our evidence shows that the behavioural counselling intervention of 26 or more hours can help them achieve a healthy weight and improve their quality of life.”

Notably, the new recommendations do not advocate for the prescription of weight-loss drugs such as Ozempic or other GLP-1 medications for children, citing insufficient research on the benefits and potential harms of such treatments in younger populations. “We’re calling for more research into both the benefits and potential harms of medication therapy for kids and teens,” Dr. Nicholson explained.

The advised behavioural interventions typically encompass three core elements: education on healthy eating habits, counselling on weight-related behavioural changes—including goal-setting—and supervised exercise sessions.

The Task Force has awarded these recommendations a ‘B’ grade, reflecting a high degree of confidence in the moderate benefits of the interventions. Importantly, this grade also mandates that the recommended services be covered by most private health insurance plans in the U.S. without a copayment, as per federal law.

Despite the clear benefits, Dr. Nicholson acknowledged the challenges these recommendations might pose for affected families. “Twenty-six hours of counselling is a commitment both by the child or teen and their parents,” she remarked, noting that obstacles such as finding a provider who offers intensive counselling or reliable transportation to sessions could limit access to these essential services.

Dr. Nicholson expressed optimism about the potential outcomes of these investments in health. She mentioned that most of the research reviewed by the Task Force spanned six to twelve months of counselling, but stressed the need for further studies to explore the impacts of longer-term counselling initiatives.

Research reveals fathers’ diet affects child health before birth

A pioneering study conducted by Helmholtz Munich and the German Center for Diabetes Research has shed new light on the significant influence of paternal diet and body mass on the health of future generations even before conception occurs. This groundbreaking research offers vital insights that could lead to the development of targeted preventive health strategies for men planning to father children. The crux of the findings suggests a direct correlation between a father’s nutritional habits and the reduced risk of offspring developing metabolic conditions such as obesity and diabetes in later life.

Dr. Raffaele Teperino, who leads the Environmental Epigenetics research group at Helmholtz Munich, spearheaded this inquiry along with his team. Their research primarily focused on mitochondrial tRNA fragments (mt-tsRNAs) present in sperm, which are crucial in the epigenetic transmission of health characteristics, effectively regulating gene expression that impacts the health trajectory of children.

The empirical evidence was derived from the LIFE Child cohort data, encompassing over 3,000 families. Analysis from this cohort illustrated a clear link between paternal body mass and children’s propensity towards obesity and metabolic diseases, a connection that remains irrespective of maternal weight, genetic factors, or environmental influences.

To corroborate these findings, Dr. Teperino’s team undertook experimental studies on mice. These experiments involved feeding mice a high-fat diet and observing the resultant effects on their reproductive systems, particularly focusing on the epididymis where sperm matures. The findings were striking: offspring of mice fed a high-fat diet exhibited a marked increase in susceptibility to metabolic diseases.

Further laboratory studies involved creating embryos via in-vitro fertilisation using sperm from these diet-affected mice. Remarkably, mt-tsRNAs from the sperm of high-fat diet mice were detected in the early stages of these embryos, significantly altering gene expression which, in turn, influenced the development and health of the resulting offspring.

Professor Martin Hrabě de Angelis, co-author and Research Director at Helmholtz Munich, emphasised the importance of these findings: “Our research confirms that acquired phenotypes, like diabetes and obesity, can be epigenetically transmitted across generations. This underscores epigenetics as a molecular bridge that connects environmental factors with genetic frameworks across generational lines, a process evident not only through maternal lineage but, importantly, through paternal contributions as well.”

This research underscores the critical role of paternal health in the pre-conception phase and presents a compelling case for enhanced preventive health strategies targeting prospective fathers. These strategies, particularly focused on dietary guidance, could significantly mitigate the risk of obesity and diabetes in children, enhancing generational health outcomes.

The study also touches on the broader implications concerning mitochondrial functions. Commonly recognized as cellular powerhouses, mitochondria possess their own DNA (mt-DNA), which orchestrates protein production within mitochondria through mt-RNA and is traditionally inherited maternally. This research brings to light the lesser-known fact that fathers also contribute mt-tsRNAs during fertilisation, which play a role in the epigenetic regulation of gene expression in early embryos. This epigenetic influence by paternal mt-tsRNAs not only underscores their role in shaping the mitochondrial function but also highlights their indirect yet pivotal influence on the metabolic health of their children.

Social media a “powerful” tool for obesity awareness amongst teenagers

Amid the rising global challenge of obesity, particularly among adolescents, there emerges an “urgent necessity” to leverage social media for disseminating scientific knowledge about obesity. This call to action was highlighted by Dr. Antonella Franceschelli, MD, PhD, at the European Congress on Obesity (ECO) 2024 in Venice, Italy. Dr. Franceschelli, affiliated with the UniCamillus International Medical University in Rome, stressed the significant influence that social media holds over young individuals.

Dr. Franceschelli’s team conducted an analysis focusing on the impact of obesity-related content on TikTok. Between 2021 and 2024, 108 videos from the account ‘Dr Anthos’ garnered a staggering 4631 views, averaging 42,495 views per video. A notable highlight was a video on the glucagon-like peptide 1 receptor agonist semaglutide, which achieved nearly a million views. This indicates a strong interest and engagement among the youth regarding obesity treatments and scientific discussions online.

The growing prevalence of obesity requires innovative strategies, particularly as over 90% of teenagers actively engage on social media platforms. Brands frequently target this demographic with food and beverage promotions, which can have mixed impacts on young consumers’ health, contributing to obesity, hypertension, and type 2 diabetes. However, Dr. Franceschelli suggests that this same medium offers immense potential to promote healthy eating and obesity awareness among youth.

Different platforms like TikTok, Instagram, and Facebook serve as powerful tools for medical professionals to reach out to the public and educate them on new therapeutic advancements. Each platform’s unique features provide distinct opportunities for effective communication. The ‘Dr Anthos’ TikTok account serves as a prime example, offering short videos about obesity management, including dietary advice, exercise tips, and medical treatments, alongside live Q&A sessions with healthcare experts. These videos especially resonate with audiences, with topics on obesity medication averaging 135,945 views per video and healthy eating tips reaching up to 10,262 views.

Live Q&A sessions have particularly facilitated direct interaction between specialists and the public, with some discussions attracting up to 2000 participants. These interactions have proven impactful, prompting significant increases in appointments for obesity treatment following these sessions. Dr. Franceschelli underscored the importance of creating tailored, constantly updated content on social media to maintain effective communication and engagement.

Additionally, Dr. Franceschelli advocated for the involvement of a social media consultant to refine the approach of health professionals online, ensuring that the content is communicated ethically and effectively. She also highlighted the personal commitment required, dedicating at least an hour daily to interact with patients and colleagues through these platforms.

Parallel research presented by Dr. Franceschelli at the congress explored the psychological aspects of obesity, particularly through the lens of social media profile images, such as those on WhatsApp. An analysis of 59 patients revealed a tendency among individuals with severe obesity to choose profile pictures that obscure their physical appearance, opting instead for images of pets, family, or landscapes. This behaviour suggests potential body dysmorphic disorder, a psychological condition where individuals perceive themselves as overweight, despite reality, often leading to shame and anxiety.

This insight into the psychological dimensions of obesity underscores the necessity of a holistic treatment approach, incorporating cognitive behavioural therapy and other psychological interventions along with medical and nutritional strategies.

Janet Lydecker, PhD, from Yale University, reflected on the broader implications of disseminating research via social media. She emphasised the importance of interrupting the flow of non-evidence-based content with scientifically validated information. However, she also cautioned about the potential for misinformation and the challenges audiences face in discerning reliable content online. Social media can propagate weight biases and misinformation, making it imperative for content creators to monitor how their contributions are interpreted and used.

This detailed examination at ECO 2024 illustrates the critical role of social media in confronting the obesity epidemic by fostering informed discussions and providing accessible educational content to the youth, potentially steering public health in a positive direction.

Severe obesity in early childhood could halve life expectancy, study shows

A groundbreaking study revealed at the European Congress on Obesity in Venice, Italy, on 12-15 May, 2024, has provided a quantitative analysis on how childhood obesity affects life expectancy and long-term health. This research, conducted by stradoo GmbH, a life sciences consultancy based in Munich, Germany, involved collaboration with experts from universities and hospitals across the UK, Netherlands, France, Sweden, Spain, the U.S., and Germany. Dr. Urs Wiedemann of stradoo presented these findings, highlighting the critical influence of obesity’s onset age, its severity, and its duration on lifespan.

The study shows that early-onset obesity has particularly severe consequences. For instance, a four-year-old with severe obesity (BMI Z-score of 3.5), who does not manage to reduce their weight, is projected to have a life expectancy of just 39 years, nearly half the average lifespan.

Dr. Wiedemann noted the sporadic nature of existing data on the significant lifespan reduction associated with childhood obesity and its potential health complications, such as cardiovascular diseases and type 2 diabetes. The study aimed to refine our understanding of these impacts to better shape preventative strategies and treatment approaches, ultimately extending lifespan and enhancing quality of life.

To achieve this, the research team developed a model focused on early-onset obesity. This model considered several critical variables, including the age when obesity begins, the duration of obesity, irreversible health risks that persist despite weight loss, and the severity of obesity, measured by BMI Z-scores.

BMI Z-scores, which adjust body mass index values for age and gender, were central to the analysis. For example, a 4-year-old boy with a typical height of 103 cm and a weight of 19.5 kg would have a BMI Z-score of 2, marking the onset of obesity. More severe cases, like a child of the same age and height weighing 22.7 kg, would have a BMI Z-score of 3.5, indicative of severe obesity.

The findings were supported by data from 50 clinical studies involving over 10 million participants, with approximately 2.7 million aged between 2 and 29. This large-scale data analysis underscored the heightened risk of developing comorbidities such as type 2 diabetes and cardiovascular diseases with higher and earlier BMI Z-scores.

For instance, a child with a BMI Z-score of 3.5 at age 4, without weight loss, faces a 27% likelihood of developing type 2 diabetes by age 25 and a 45% chance by age 35. In comparison, a child with a BMI Z-score of 2 at the same age would have significantly lower risks (6.5% by age 25 and 22% by age 35).

The research also demonstrated the life-extending potential of early weight loss. A child with severe early-onset obesity (BMI Z-score of 4 at age 4) who does not lose weight would have an expected lifespan of 37 years and a 55% risk of developing type 2 diabetes by age 35. Conversely, reducing their BMI Z-score to 2 by age 6 could increase their lifespan to 64 years and lower their diabetes risk to 29%.

The findings also highlighted the greater benefits of earlier weight loss over delaying weight reduction. However, the model did not consider certain variables such as the underlying causes of obesity, genetic factors, or the complex interplay of different comorbidities, which may affect the outcomes.

In conclusion, Dr. Wiedemann stressed the severe impact of childhood obesity on longevity and health, advocating for early intervention and consistent management to prevent the onset of severe health conditions. The study reinforces the critical nature of childhood obesity as a life-threatening condition that requires immediate and sustained medical attention.

Study reveals heart damage risks in sedentary children

A recent study has highlighted alarming trends in heart health among children and young adults, revealing that excessive sedentary behaviour, commonly referred to as being a ‘couch potato’, could lead to an enlarged heart. This condition significantly increases the risk of heart attacks, strokes, and premature mortality.

Researchers have identified that sedentary habits account for up to 40% of the total increase in heart size from the ages of 17 to 24. The study also discovered that limited physical movement contributes to the enlargement of teenagers’ hearts independently of other contributing risk factors such as obesity or hypertension.

Andrew Agbaje, an associate professor of clinical epidemiology and child health at the University of Eastern Finland in Kuopio, referred to childhood and teenage sedentary behaviour as a “ticking time bomb.” Agbaje, in a recent press release, stressed the severity of the health threats posed by inactivity during youth. “There is growing evidence that childhood sedentariness is a serious health threat that warrants urgent attention,” he stated.

Conversely, the study noted that children who participate in regular light physical activity can mitigate the risk of heart enlargement significantly. Such activities have been found to reduce the increase in heart mass by 49%. “Engaging in three to four hours of light physical activity daily is an effective countermeasure to sedentary habits,” Agbaje explained.

Activities beneficial for cardiovascular health include playing outdoor games, walking pets, running errands on foot, cycling to local destinations, strolling in parks, gardening, and playing casual sports like basketball, soccer, and frisbee.

The study also observed that children who engage in more intense workout routines might see an approximate 5% increase in heart mass, which is attributed to strengthening of the heart muscle rather than harmful enlargement.

This research followed nearly 1,700 participants in the UK from the age of 11 to 24. To monitor their physical activity levels, participants wore motion-tracking devices around their waists for periods ranging from four to seven days at ages 11, 15, and 24. Initial data showed that children spent an average of six hours a day in sedentary activities, which alarmingly increased to nine hours by young adulthood.

The study further incorporated echocardiograms taken at ages 17 and 24 to assess heart structure and function, revealing significant insights into the impact of lifestyle on cardiac health.

Published on the 7th of May, 2024 in the European Journal of Preventive Cardiology, this study underscores the critical need for integrating more physical activity into the daily routines of young people to combat the adverse effects of a sedentary lifestyle on heart health.