Global Health & Policy

Water with school lunches to prevent obesity

Encouraging children to drink plain water with their school lunches could prevent more than half a million children in the USA from becoming overweight or obese, a new study from the University of Illinois suggests. Not only will the incidence of overweight decrease, but it is thought that with this simple measure, over $13 billion could be saved in various medical and social costs. The findings are based on a nationwide study that involved 1,200 elementary schools between 2009 and 2013.

It is thought that by consuming more water at lunchtime, children are concurrently eating less fat and sugar; further to this the authors suggest that the intervention does not pose any significant nutritional hazards. Interestingly, the school-based water intervention holds potential as a low- or moderate-cost population-level programme in developing countries as well as developed. The authors themselves are hoping that the intervention will be expanded to all public and private schools across the country, so that more data can be gathered and the rewards can be seen sooner rather than later.

A change to global dietary guidelines?

After the results of a recent study, a team of researchers are calling for a change to global dietary guidelines. Findings from over 135,000 individuals across 18 different countries were used and it was found that high carbohydrate intake is linked to a worse total mortality, while high fat intake is associated with a lower risk. For the study, food types and quantities were assessed using a country-specific food questionnaire, this was then compared with cardiovascular disease and mortality.

Currently, it is recommended to limit total fat intake to less than 30% of energy, and saturated fats to 10%. This study has found that increasing this limit to 35% with a concomitant lowering of carbohydrates could lower mortality risk. By studying the effects of fats and carbohydrates on blood lipids, they also found that whilst LDL (‘bad’ cholesterol) increases with consumption of saturated fats so does HDL (‘good’ cholesterol), the overall effect is a net decrease in the total cholesterol/HDL ratio. LDL cholesterol forms the basis of many dietary guidelines, however this proves that it may not be reliable on its own in predicting the effects of saturated fat on cardiovascular events, other blood lipid markers will have to be utilised. It is hoped that these results can be replicated and the research furthered, so that accepted guidelines become more accurate.

Living near fast food outlets increases risk of obesity

Researchers, from the University of the West of England, have found that children living closer to fast food outlets are more likely to gain a significant amount of weight between the first and last year of school. Using data from over 1,500 UK children the authors were able to discover a link between proximity of fast food outlet and weight gain over time, and published their results in the Journal of Public Health. The study also found that there is a higher density of fast food outlets within poorer neighbourhoods. Thus, highlighting the need for analysis of how the environment impacts on Public Health, and therefore the identification – and hopefully solution – of particular problems.

Matthew Pearce, the lead author, said that understanding the reasoning behind why the amount of children that are obese doubles between the first and last year of primary school is important to protect the future of health of children. However, the authors accept that their study only shows a relationship between the two measures and other aspects of each neighbourhood will also impact on the health of the children, such as cycling and walking infrastructure.

Global research project reveals 30% of the world’s population affected by weight problems

A new study has found that globally more than 2 billion children and adults suffer from health problems related to being overweight or obese.

In 2015, of the 4 million deaths attributed to excess weight, nearly 40% occurred in people who had a body mass index that fell below the threshold considered ‘obese’.

According to authors of the paper in The New England Journal of Medicine, the findings represent “a growing and disturbing public health crisis”.

Excess weight affected 2.2 billion children and adults worldwide in 2015, or 30% of all people. This includes nearly 108 million children and more than 600 million adults with BMI exceeding 30, the threshold for obesity, according to the study. The prevalence of obesity has doubled since 1980 in more than 70 countries and has continuously increased in most other nations.

“Excess body weight is one of the most challenging public health problems of our time, affecting nearly one in every three people,” said Dr. Ashkan Afshin, the paper’s lead author.

American Medical Association approves obesity training

Following finding that 53% of health professionals have reported needing more training in obesity management, and 50% having requesed better tools to help patients understand obesity risks, the American Medical Association has approved a policy to offer training to health professionals for obesity prevention and management.

Medical students in the United States will now be trained to prevent, diagnose and manage obesity.

“Obesity continues to impact the health of a great number of people across the country, contributing to an increase in associated conditions such as cardiovascular disease and type 2 diabetes,” Jesse M. Ehrenfeld, MD, AMA Board Member, said in a press release. “We know that the health consequences and financial burden of obesity are devastating, yet many of our medical students and physicians are unaware of how to address obesity in their patients. We must ensure that all physicians and physicians-in-training have the tools and information they need to better understand obesity so they can provide their patients with the best care possible.”

How to save billions in medical costs with small changes

A team from Johns Hopkins University has found that increasing the percentage of elementary school children (ages 8-11) in the US who participate in 25 minutes of exercise three times a week from 32% to 50% could save $21.9 billion. This number is a combination of medical costs and lost wages over the course of a lifetime. They also reported that there would be a reduction in the amount of overweight and obese children by 4.18% (equating to 1.2 million people). For the study, the team developed a computational model that relied on data from the National Health and Nutrition Examination Survey; they found that on average, 32% of children aged 8-11 get 25 minutes of physical activity three times a week.

The authors are keen to point out that their research shows that not only will encouraging exercise in children reap health benefits, but will pay big dividends when they grow up. They were also keen to admit that the savings are most likely an underestimate as there are other costs that weren’t taken into account, such as improving bone density and improving muscle mass. According to this data, schools in the USA should add more to their physical education programmes, as it is not only in the children’s best interests, but also the nation’s.

School based nutrition intervention improves BMI

A California-based programme that aims to improve children’s dietary behaviours and prevent obesity has been shown to be effective. The initiative was called ‘The Shaping Healthy Choices Program’ and involved 409 students aged 9-10, split into a control group and an intervention group. The program itself took place over the course of a year and involved the use of gardens established at the school and education on fruit and vegetables. This was also supplemented by cooking demonstrations and health fairs for the parents as well as the public.

As a result of the program, students showed vast improvements on nutritional knowledge and vegetable identification. The intake of fruit and vegetables in the intervention group however did not increase as hoped, however significant improvements in BMI were seen in this arm of the trial, with the overweight and obese population declining from 55.6% to 37.8%. The authors hope that this is due to the positive health messages that are conveyed through the programme, and are keen for these types of programmes to be used in the community so that a wider range of individuals may benefit.

Maine state senator delivers bill demanding better obesity care

The Maine state senator, Nate Libby, has recently presented a bill committed to reducing the obesity and chronic disease rate in Maine by providing better obesity care. By making nutritional therapies and obesity medications more affordable, Senator Libby is hoping to make the people of Maine healthier, whilst also saving money on treatments that they might have needed in the future.

The aim is to provide better access to evidence-based obesity care whilst also reducing the prices of a range of therapies available to the obese population of Maine. Whilst in many other US states costs for treating the complications of obesity are rising rapidly, it is hoped that Maine could act as a pioneer in the way it develops its obesity program, and that other states would soon follow in its footsteps.

‘No fat’ and ‘no sugar’ labels are misleading the public

A new study led by the University of North Carolina has found that terms such as ‘no fat’ and ‘no sugar’ give consumers a false sense of confidence when purchasing such items, in fact they rarely reflect the actual nutritional quality of the food. The researchers found that foods with the ‘low fat’ or ‘low sugar’ claims often had a worse nutritional profile than those without. It was found that producers of these foods would make compromises in their manufacture. For example, they might lower the fat content of a drink, but then raise the sugar content in parallel, giving the illusion that the new drink is healthier due to a ‘lower fat content’.

The US Food and Drug Administration allow manufacturers to assign labels to their foods, however the researchers of this study suggest that these labels are confusing and misleading as they are relative and commonly only about one nutrient. Foods with the ‘low’ claim are even more confusing, as the FDA categorises that as food that has less than three grams per reference amount customarily consumed, however the reference point varies for different types of food (eg cheesecake against brownies). Data from more than 80 million food purchases was analysed in this study and the authors hope to continue their research into looking how these claims affect consumer choice and how they interact with other sales strategies.

The Swedish decline in childhood obesity

Data from Sweden has indicated that childhood obesity may be on the decrease in Sweden. A study has shown that the percentage of overweight and obese boys of 8 years old has decreased to it’s lowest level since the early 1990s. The researchers used data from the BMI Epidemiology Study (BEST) in Gothenburg, which has been collecting measurements from school health care systems for children born in 1946 onwards. In total, the study analysed data from 13 age groups of children born at five year intervals from 1946 to 2006. Each group consisted of 425, but this number was expanded when the researchers began to notice the reduction in obesity rates.

It was found that there was a clear reduction in mean BMI, overweight and obesity, however whilst this trend has been observed, the overall rates are still very high. The researchers are keen to point out that whilst they are not sure what has caused the decrease, we must continue on this trend in order to bring rates down even further. They also plan to conduct a similar study on girls in the near future.

Majority of health workers in Houston are obese

A recent study involving health workers in Houston hospitals has found that 78% of them are overweight or obese. 924 employees across six different hospitals took part in the research. Dr Shreela Sharma, lead author, explained that these results were above the national average and also worrying as obesity is linked to so many chronic diseases. Whilst intake of fruit and vegetables was consistent across all weight groups, it was the intake of fatty foods and sugary beverages that really separated each group.

Many of the participants in the study were classed as hospital administrators and technicians and lead sedentary lifestyles, furthermore 48% of participants reported not having any moderate physical activity during the week. Dr Sharma suggested that there is such a high number of overweight hospital workers due to the ‘nurturer effect’, where those who look after others are less likely to look after themselves. In addition to this, many of the workers were dissatisfied with their worksite wellness programs, saying that not much was being done to look after employees’ health. Overall, Dr Sharma stressed that hospital employers must also look after their own workforce whilst also caring for the public.

Should there be more PE at school and clearer labelling?

A recent ComRes poll has indicated that a third (34%) of Britons believe that increasing the amount of mandatory physical education in schools would be one of the most effective ways of reducing levels of obesity. 33% also suggest that clearer food labelling would also help address obesity within the UK. At the moment, schools in the UK must include PE in their curriculums, however they are allowed to decide how much time is spent in these lessons, after the government target of 2 hours a week was scrapped five years ago.

Further to this, 23% thought that a ban on junk food advertising before the watershed would also aid in the fight against obesity. Similar percentages (24% and 21% respectively) would also like to see supermarkets lend their weight to the fight by encouraging the purchase of healthy items and introducing bans on promotion of unhealthy foods. Barbara Dinsdale, Head of Lifestyle at heart Research UK explained that Britons want to see clear information and to be incentivised to make healthy choices. The poll itself was conducted in partnership with the launch of the annual JanUary campaign (formerly National Obesity Awareness Week), which is championed by the National Obesity Forum and Heart Research UK.