Obesity and Population Health

Eli Lilly announces multibillion-euro German plant to scale up obesity drug production

Eli Lilly and Company, the American pharmaceutical giant, has announced plans to establish its first production facility in Germany, situated in the western town of Alzey, with an investment of 2.3 billion euros ($2.5 billion). This move, initially reported by Reuters, comes in response to the rapidly escalating demand for innovative diabetes and obesity treatments. The strategic investment will expand the production capabilities for key diabetes and obesity medications, including Mounjaro and Trulicity, as well as the injection devices required for their administration.

On Friday, Eli Lilly highlighted the significant role Germany’s skilled workforce will play in enhancing the company’s supply of incretin-based treatments, with the site expected to become operational in 2027. Incretins, a class of peptide-based medications like Mounjaro, are designed to mimic intestinal hormones that curb appetite and promote insulin release.

The expansion of Eli Lilly’s manufacturing footprint into Germany aligns with broader industry trends, where pharmaceutical companies are facing mounting political pressure to localise the production of critical healthcare products. The COVID-19 pandemic brought to light the fragility of global supply chains, prompting a reevaluation of manufacturing strategies to better serve market demands.

The German Health Minister, Karl Lauterbach, expressed his support for the investment at a press briefing in Berlin. He underscored the importance of this development for Germany’s stature as a pharmaceutical hub, emphasising the potential for more rapid access to novel treatments and reduced reliance on precarious supply chains.

The selection of Alzey as the site for this new production complex was influenced by several factors, including the availability of a skilled workforce, the existing infrastructure, and the prospect of creating a manufacturing nexus in conjunction with Eli Lilly’s existing site in Fegersheim, France. Edgardo Hernandez, the head of manufacturing at Eli Lilly, pointed out Germany’s rich heritage in engineering and science, as well as the proximity to numerous equipment manufacturers, as pivotal in the site selection process.

Mounjaro is on the cusp of gaining approval for weight loss treatment in the European Union, following the EU drugs regulator’s recommendation for its approval. However, Germany’s public health insurance currently does not cover weight-loss medications, meaning that patients seeking Mounjaro for non-diabetic weight loss will likely have to bear the costs independently. Minister Lauterbach indicated that there are no immediate plans to reassess these regulations.

Over the past three years, Eli Lilly has made public commitments exceeding $11 billion towards global manufacturing. In their third-quarter financial disclosure, the company earmarked over $8 billion for expansion projects in Indiana, North Carolina, and Limerick, Ireland, over the coming years. Despite this, Eli Lilly anticipates continued supply constraints while it ramps up manufacturing capacity. Concurrently, the firm has appealed to medical professionals outside the United States to halt new patient prescriptions of Trulicity due to heightened demand.

This investment announcement occurs amidst vigorous debate over the European Union’s proposal to reduce the standard period for market exclusivity, prompting Eli Lilly to invest strategically in the region and partake in shaping industry dialogue.

Eli Lilly, with a longstanding presence in Germany since 1960 and a current workforce of 1,000 employees in various domains, anticipates the new Alzey facility will create up to 1,000 high-calibre jobs for engineers, technicians, and scientists, further reinforcing the company’s commitment to innovation and healthcare advancement.

Obesity’s role in severe flu outcomes unveiled by new study

Researchers in a pivotal study recently featured in Nature Communications have uncovered vital insights into why individuals with obesity are at an elevated risk for severe influenza. This comprehensive investigation combines both human clinical data and animal model analysis to unravel the complexities of immune response in obesity that heighten the vulnerability to influenza.

The global health landscape is facing a critical challenge with the rising prevalence of obesity, affecting over 13% of adults worldwide. The risks associated with obesity have been underscored during viral pandemics, such as the H1N1 outbreak and the recent COVID-19 pandemic, where obesity has been consistently linked with worse outcomes and heightened severity of respiratory infections.

This latest study seeks to bridge the knowledge gap in understanding how obesity mechanistically contributes to increased susceptibility to viral infections, beyond the recognised impacts of altered lung function, cardiovascular issues, and metabolic disturbances.

Researchers embarked on a meticulous study design, sampling blood and airway cells from individuals with obesity —those with a BMI over 35 kg/m^2—undergoing bariatric surgery. The study meticulously matched these participants with control subjects of normal weight, ensuring parity in age, gender, and ethnicity.

The investigative team conducted thorough clinical sampling using state-of-the-art techniques, including blood analysis, nasal synthetic absorptive matrix (SAM) sampling, and bronchoscopy.

A suite of laboratory experiments followed. These involved exposing various cell types, including bronchoalveolar lavage (BAL) cells and bronchial epithelial cells (BECs), to different strains of influenza viruses. The response of these cells was measured through advanced techniques like RNA extraction, protein quantification, and a range of assays including flow cytometry and metabolomics.

In vivo studies also played a role, with mice models used to examine the effects of administering recombinant mouse leptin followed by influenza virus infection. This holistic approach aimed to dissect the immune response in both the peripheral and airway-specific compartments.

The study’s findings are eye-opening. Contrary to initial assumptions, the researchers found no significant difference in the response of bronchial epithelial cells between individuals with obesity and individuals of a  normal-weight, suggesting that epithelial inflammation is not inherently altered in those with obesity during influenza infection.

However, the study did identify a significant compromise in the antiviral responses of BAL macrophages from patients with obesity. These cells displayed a reduced induction of critical interferons, such as IFN-α, IFN-β, and IFN-λ, which are vital components of the body’s antiviral defence system. Moreover, the production of key pro-inflammatory cytokines like IL-6, IL-8, and TNF was found to be less effective in individuals with obesity.

Metabolomic analysis of the BAL fluid identified significant changes in metabolite levels in patients with obesity, providing a clue to altered biochemical pathways in the lungs due to obesity.

The data from the MOSAIC cohort added a further layer of understanding, highlighting that immune dysregulation in patients with obesity was confined to the airway mucosa, with no significant systemic immune disturbances.

The study’s revelations pave the way for potential therapeutic strategies, including the manipulation of leptin pathways, which may be pivotal in mitigating the risk of severe influenza infections in populations with obesity.

By casting light on the molecular and immunological shifts that occur in the context of obesity, this research could form the foundation for developing tailored interventions that bolster the immune response in this high-risk group, enhancing their resilience to influenza and other viral respiratory infections.

Teachers could play a major role in combating childhood obesity

Recent scholarly insights have underlined a potentially transformative role that educators can play in combating the alarming rates of childhood obesity, particularly in the United States (US). As published in the reputable journal Nutrients, a meticulous study embarked on an exploratory journey to gauge the impact teachers could make in mitigating this health crisis among the younger generation.

The roots of childhood obesity have embedded themselves deep within the US, displaying a consistent upward trend, with a pronounced prevalence in disadvantaged regions. The escalating concern has drawn concerted interventions from health authorities at local, state, and federal levels, spotlighting schools as pivotal arenas for executing preventative measures.

At the heart of these initiatives lies an appreciable emphasis on the instrumental role of teachers. By being on the frontlines of programme delivery, they emerge as invaluable assets in recognising and diffusing obesity-curbing strategies among students. However, the pressing commitments inherent to the teaching profession pose a formidable challenge to prioritising their health – a dilemma exacerbated by the outbreak of the COVID-19 pandemic, which brought to light the imperative of maintaining teacher well-being.

In 2022, a seminal report from the RAND Corporation shed light on a concerning level of job-induced stress among teachers, pointing towards a positive correlation between employer-facilitated wellness programs and reduced stress levels. Multiple strands of research echo a similar sentiment: a robust student-teacher rapport is a cornerstone for fostering student engagement, regular attendance, enhanced emotional well-being, and an overall conducive academic atmosphere.

An investigative team from the American University, Washington, orchestrated an elaborate five-year intervention venture beginning in 2017. The primary objective was to immerse educators in a milieu of nutrition literacy, aimed at equipping them with the requisite skill set to impart obesity-preventive knowledge among elementary scholars in Washington, DC. The study encapsulated four schools, two of which were designated as control while the others were intervention cohorts. Teachers, pivotal to this initiative, furnished demographic details and partook in Teacher Health Surveys before and subsequent to the intervention period.

Survey feedback, encapsulated through a Likert scale, facilitated an overall health score, amalgamated from various metrics including chronic conditions, self-efficacy, health education ideologies, and general health standings. The project’s crux was to evaluate the influence of a professional development scheme on augmenting teachers’ capacity to infuse nutrition-centric discourse into their pedagogical regimen.

Each intervention session commenced with a wellness-centric activity, transitioning into a demonstration lesson from “Serving up MyPlate: A Yummy Curriculum.” Teachers at the intervention forefront were required to integrate a minimum of three nutrition-dedicated lessons throughout the academic year. To measure the pedagogical impact, a Student Nutrition Literacy Survey was administered at both the outset and the conclusion of the intervention.

The data depicted a collective participation of 92 educators from both the control and intervention factions. The demographic backdrop of these teachers showcased a reasonable level of uniformity across the schools. An age average of 36 years, a predominant female representation (84.8%), and a significant Black demographic (68.5%) constituted the participant profile.

A cadre of 55 teachers from the intervention spectrum attended the professional development suite, orchestrating 71 nutrition-oriented lessons. A meticulous Poisson regression analysis unearthed a predictive association among job stress, professional development attendance, and self-efficacy towards the incorporation of nutrition lessons. An incremental self-efficacy score and each additional session attendance manifested a 25% and 48% increased likelihood, respectively, of infusing nutrition lectures into the curriculum. Interestingly, a stark inverse relation was observed between stress levels and self-efficacy scores.

The investigative lens also focused on the ripple effect of health scores, lesson implementations, and aggregate health scores. A noticeable inverse relationship emerged between lesson execution and stress levels, indicating that session attendance contributed to lower stress levels among teachers. Moreover, a higher aggregate health score was recorded for teachers who integrated three or more nutrition lessons compared to their counterparts. The student demographic, comprising both intervention and control schools, showcased a balanced representation concerning age, gender, and grade level.

The baseline knowledge levels didn’t exhibit significant discrepancies between the students of intervention and control schools. However, a commendable uptick in scores was observed among students of the intervention cohort who were recipients of nutrition education from session-attending teachers. Notably, students exposed to three or more nutrition lessons reflected a 10% enhancement in their scores compared to those receiving two or fewer lessons.

The observations evinced the practicability and sustainability of a short-term professional development module aimed at fostering teacher health while concurrently advancing nutrition education. It’s imperative to highlight that although the rise in healthful eating awareness is promising, it doesn’t necessarily translate to a behavioural modification. A holistic approach to enhancing student health necessitates a foundational support structure for teacher health, underscoring the necessity of workplace professional development.

Empowering teachers with a robust knowledge repository, a wealth of resources, and adeptness in managing their health not only transforms them into educational conduits but also as potent change agents in the classroom. By co-opting teachers as collaborative partners in the quest to curb childhood obesity, a more structured pathway towards attaining health equity is envisioned. The study, in essence, reinforces the potential of a professional development framework as a viable stratagem in advancing teacher well-being and fortifying the bulwark against childhood obesity.

CDC reports nearly half of US states have over 35% of adults living with obesity

Obesity continues to extend its grasp across an increasing number of states in the US, as recent data from the Centers for Disease Control and Prevention (CDC) underscores. According to the fresh batch of information, as of 2022, a minimum of 35% of the adult population in 22 states was categorised as having obesity. This signifies a growth from the 19 states documented in 2021.

Drawing a comparison to a decade prior, the CDC highlighted that no state had reported an adult obesity prevalence of 35% or above, underlining a troubling upward trajectory.

This data has been gleaned from the Behavioral Risk Factor Surveillance System, a meticulously conducted interview survey collaboratively administered by the CDC along with state health departments. The criteria for obesity was a Body Mass Index (BMI) of 30 or above, as ascertained through the survey.

Three states bore the brunt of obesity with more than 40% of their adult populace having obesity—Louisiana, Oklahoma, and West Virginia. The list further includes Alabama, Arkansas, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, Nebraska, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, Virginia, and Wisconsin, all having an obesity prevalence of at least 35% among adults.

An in-depth examination of the 2022 Adult Obesity Prevalence Maps divulges certain demographic groups being disproportionately affected by obesity, with discernible discrepancies across racial and ethnic lines.

The data revealed that a minimum of 35% of American Indian or Alaska Native adults had obesity in 33 states, alongside black adults in 38 states, Hispanic adults in 32 states, while the corresponding figure for white adults stood at 14 states. Notably, the obesity rates among Asian adults did not cross the 35% threshold in any state.

Karen Hacker, MD, MPH, who helms the CDC’s National Center for Chronic Disease Prevention and Health Promotion, articulated the dire need for enhanced support directed towards obesity prevention and treatment, terming it an “urgent priority”. She elaborated on the multifaceted nature of obesity, being influenced by a gamut of factors including dietary habits, physical activity levels, sleep patterns, genetic factors, and certain medications.

Dr. Hacker emphasised that the solution doesn’t adhere to a one-size-fits-all approach, but acknowledged the effectiveness of certain key strategies like addressing core social determinants of health. These include better access to healthcare, the availability of healthy and affordable food, and safe venues for engaging in physical activity.

The CDC’s 2022 maps accentuate the necessity for population-centric interventions to ensure universal access to healthy foods, safe exercising environments, stigma-free obesity prevention and treatment initiatives, alongside evidence-backed healthcare services encompassing medication and surgery.

The repercussions of obesity extend beyond the societal stigma, with individuals suffering from obesity being at an escalated risk for severe health conditions like heart disease, stroke, Type 2 diabetes, certain types of cancer, deteriorated mental health, and aggravated repercussions from COVID-19, as per CDC’s observations.

In a bid to combat this escalating obesity epidemic, the CDC’s Division of Nutrition, Physical Activity, and Obesity is propelling a slew of proven strategies at the state and local levels. These strategies encompass making physical activity safer and more accessible, facilitating healthier food choices, promoting breastfeeding, fortifying obesity prevention standards in early care and education settings, and augmenting the availability and access to family healthy weight programs.

The CDC has been vociferous in endorsing supportive environments for healthy eating and active lifestyles across various settings. Among the suggested preventative strategies are increased consumption of fruits and vegetables, encouraging breastfeeding, embracing physical activity, averting sedentary lifestyles, and minimising screen time, all of which are projected to play a vital role in reversing the obesity trend sweeping the nation.

Student’s bad eating habits could herald lifelong illness

Recent research emerging from UBC Okanagan delivers a stern warning: the unhealthy eating habits fostered during one’s university tenure could set the stage for a lifetime mired in significant health challenges, including obesity, respiratory ailments, and depression.

The caution comes from Dr. Joan Bottorff, a distinguished Professor affiliated with UBCO’s School of Nursing, who is part of a global team of investigators delving into the dietary habits of university attendees. The extensive study encapsulated the dietary patterns of nearly 12,000 medical scholars from a total of 31 universities located in China, striving to decipher the correlation between dietary behaviours, obesity, and a gamut of diseases.

Dr. Bottorff emphasised the crucial fact that the foundations for many unhealthy eating patterns are laid during the university phase and could persist for a substantial duration of an individual’s life.

“There’s a considerable amount of data that outlines how the consumption of high-calorie meals and sugar-laden foods and beverages by many students during this period can be a precursor to obesity,” Dr. Bottorff stated. While she acknowledged that these aren’t the sole contributing factors to obesity, they are significant and warrant attention.

The groundbreaking study, which recently graced the pages of Preventive Medicine Reports, was spearheaded by Dr. Shihui Peng from the School of Medicine at Jinan University in China. Although prior research robustly associates unhealthy diets with numerous chronic diseases, this particular inquiry aimed to unveil the link between poor dietary habits and infectious diseases, including common colds and diarrhoea.

Dr. Bottorff highlighted that while the structure of the study didn’t allow for a cause-effect demonstration, the association between unsound eating habits, obesity, and respiratory diseases was robustly substantiated.

She further brought to light the biomedical research backing the nexus between obesity and infectious diseases, a linkage further spotlighted amidst the COVID-19 pandemic. Dr. Bottorff explained, “Recent studies concerning COVID-19 reveal a tendency of individuals with obesity experiencing severe symptoms and outcomes, with explanations pointing towards compromised breathing due to excess weight and subpar inflammatory and immune responses.”

The quintessence of the problem, as per Dr. Bottorff, is rooted in the high-sugar, high-calorie dietary routine embraced by many students, which potentially morphs into a long-term plight, as these habits could segue into obesity. Moreover, she noted a vicious cycle where stress and anxiety could trigger overeating, which in turn could lead to further stress and depression.

She underscores the importance of not overlooking this perilous trend among university-goers, where a substantial fraction is known to indulge in unhealthy diets. “The nutritional quality of the food they consume is directly tied to obesity, which opens the gates to a host of other health issues extending beyond chronic diseases to infectious diseases,” she reiterated.

Dr. Bottorff recommends a university-wide initiative where students are educated on the principles of healthy eating. Additionally, she stresses the imperative for institutions to shoulder the responsibility of offering healthy and affordable food alternatives to the entire student body.

Reflecting on the matter, Dr. Bottorff advocated for a thorough examination of the food environment presented to students, ensuring that cafeterias and vending machines are stocked with healthy food choices. The collaborative effort between UBC Student Wellness and Food Services is a move in the right direction, addressing food security and literacy to mitigate the adverse impact of unaffordable food options and university-induced stress on students’ dietary choices.

Students facing food insecurity now have the recourse of a low-barrier food bank and a meal share program. Concurrently, the culinary team at UBCO Food Services, working in tandem with a registered dietitian, has been prioritising locally sourced, organic, and sustainably produced ingredients to diversify the food options available.

Encouraged by the progress, especially with healthier choices being more accessible in cafeterias and the reorganisation of vending machine items to place healthier options at eye level, Dr. Bottorff acknowledges the strides taken by many post-secondary institutions in addressing these issues. “The momentum gathered over the last four or five years is heartening,” she remarked, “It’s a positive deviation from the past, although there’s still a long journey ahead to fully tackle this issue.”

Obesity-linked heart deaths triple in 20 years

Recent research disclosed a concerning surge in the number of US adults succumbing to heart disease where obesity was cited as a pivotal contributing factor, exhibiting a threefold rise between 1999 and 2020. This alarming revelation was documented in a study published in the Journal of the American Heart Association, leveraging data encapsulated in the comprehensive database curated by the Centers for Disease Control and Prevention (CDC).

Analysing death certificates facilitated a granular examination of the escalation in obesity-correlated cardiac deaths over the span of two decades. The researchers pinpointed a total of 281,135 heart disease fatalities attributed to obesity during the period under scrutiny. This translated to a tripling of the death rate, spiralling from a rate of 2.2 per 100,000 individuals to a significant 6.6 deaths per 100,000 populace, thereby showcasing a worrying trend in health outcomes related to obesity.

Ironically, this spike unfolded amidst a nearly 18 percent decrement in overall heart disease mortalities from 1999 to 2020, pointing towards a deep-seated issue relating specifically to obesity-linked cardiac ailments.

The racial and gender disparities were stark, with the black populace shouldering a higher mortality rate compared to other racial cohorts. Moreover, a gendered analysis revealed a preponderance of these deaths amongst males, albeit black females demonstrated a marginally elevated mortality rate relative to their male counterparts.

Obesity, delineated as a profound risk catalyst for heart disease, presently afflicts approximately 115 million individuals in the US, encompassing around 42% of the adult demographic and 20% of the juvenile population, as per CDC statistics. A decade-long observation underscores a rise by nearly 10% in adult obesity, illuminating the swelling magnitude of this health crisis.

Medical professionals accentuate the multifaceted pathways through which obesity can foster heart disease, encompassing the enhancement of blood pressure levels, fostering a surge in detrimental cholesterol whilst diminishing beneficial cholesterol levels, amplifying diabetes susceptibility, and facilitating the accrual of fatty substances within arterial structures.

The in-depth study unearthed that the primary culprits behind obesity-associated heart disease fatalities within the scrutinised period were ischemic heart disease — characterised by artery narrowing — accompanied by heightened blood pressure. This dual identification not only underscores the critical role of cardiovascular health monitoring in obesity management but also necessitates intensified focus on preventive measures to curb the steady increase in obesity-related cardiac deaths.

The findings evoke an urgent call for bolstered interventions targeting obesity prevention and management, steering individuals towards healthier lifestyles to avert the onset of associated cardiac complications. The study stands as a testament to the urgent necessity for a comprehensive approach in mitigating obesity-related health ramifications, fostering a society armed with the knowledge and resources to combat this escalating health concern effectively.

Wales takes strong action against junk food meal deals to combat obesity crisis

 In a determined effort to address the growing obesity problem, Wales is set to implement strict measures aimed at curbing the promotion and accessibility of unhealthy meal deals and temporary price reductions on foods high in fat, sugar, or salt. With almost two-thirds of adults in Wales classified as having either overweight or obesity, the Labour-led government intends to go beyond the initiatives taken in England by enacting legislation to tackle the promotion of ultra-processed foods.

The Welsh government plans to mirror the UK government’s approach in England to restrict volume promotions, such as buy one get one free deals. Additionally, Wales will introduce proposals targeting meal deals and temporary price reductions, acknowledging the urgency of the crisis and the need for more comprehensive actions.

Lynne Neagle, the Welsh Deputy Minister for Mental Health and Wellbeing, emphasised the pressing nature of the situation, stating, “Rising levels of obesity are causing a significant burden of preventable illness in Wales. We must act immediately.” Neagle clarified that the government does not intend to ban meal deals altogether but aims to shift the focus towards healthier, more nutritionally balanced options. Many meal deals currently include large bags of crisps and snacks that are high in fat and sugar. The objective is to ensure that affordable meal deals are available, which are lower in calories, fat, and sugar.

Research conducted by Public Health Wales revealed that three-quarters of lunchtime meal deals exceed recommended calorie and salt levels for a meal. The unhealthiest lunch options provide two-thirds of the daily calorie intake, over 122% of the daily fat intake, 149% of the recommended sugar intake, and 112% of the daily salt intake. The majority of dinnertime meal combinations exceed average energy requirements.

The researchers concluded that if an individual purchased an average meal deal for lunch five days a week, they could gain more than 6 pounds (2.8 kg) in a year. If they opted for a high-calorie meal deal five days a week, the weight gain could reach 47 pounds (21 kg) within a year.

Neagle clarified that temporary price reductions would not be banned either, stating, “Our aim is to rebalance our food environments so that the healthy choice becomes the easy choice.”

The UK government recently delayed the planned ban on buy one get one free deals for junk food by two years, citing concerns over the cost of living crisis. However, the Welsh government is committed to implementing its restrictions by 2025 and intends to proceed even if the UK government does not follow suit.

Neagle expressed hope for alignment across the UK, stating, “It would be great if England moved forward with these plans. We believe that consistency throughout the UK is beneficial, but we have a responsibility to address the crisis we are currently facing in Wales.”

Neagle dismissed the notion that these measures amount to a “nanny state” intervention, highlighting that tackling obesity extends beyond individual responsibility and encompasses the unhealthy food environment people are exposed to on a daily basis.

The regulations will apply to major food retailers, and the government will also explore measures to curb the purchase of unhealthy food online and offers associated with loyalty cards.

According to the Welsh government, 62% of individuals aged 16 and over in Wales either have overweight or obesity.

James Evans, the Welsh Conservatives’ Shadow Minister for Mental Health and Wellbeing, stressed the need for clear assurances from the Welsh Labour government that meal deals will not be banned and that any new regulations will not increase the average weekly cost for shoppers.

What’s wrong with GPs’ obesity guidance – and what actually works?

General practitioners (GPs) often dispense vague and unproductive weight-loss advice to patients struggling with obesity, reveals a study led by the University of Oxford and published in the journal Family Practice. Having analysed 159 audio recordings of consultations in 137 UK surgeries, researchers found that doctors’ advice, such as “reduce your carbohydrates” and “move more,” was largely generic and rarely tailored to the patients’ pre-existing knowledge and habits.

The complexity of obesity management, particularly its multifactorial nature, can make the provision of comprehensive, effective advice a daunting task for many overworked and diligent GPs. However, in a healthcare landscape where a mere 0.1% of doctors have received any training in obesity care (1), it becomes essential to question the status quo.

Indeed, the imperative nature of this issue becomes clearer when considering the qualitative research led by Dr. Madeleine Tremblett at the University’s Nuffield Department of Primary Care Health Sciences. For patients living with obesity, Tremblett argues that the common message to “eat less and do more” isn’t fitting. Micro-behavioural changes typically suggested by GPs often fail to create meaningful weight-loss impacts for these patients.

GPs themselves require guidance about evidence-based advice they can offer to people living with obesity, hinting at the need for a more profound understanding and specialised training in obesity care.

While many nutrition professionals acknowledge that weight-loss management is a specialist subject, the current training gap among healthcare professionals indicates an unmet need in medical education. We need to look beyond a sole consultation with a nutritionist and understand the value of comprehensive training, such as that provided by the College of Contemporary Health (CCH).

The case of Mel Idroos, a PGDip in Lifestyle Medicine (Obesity Care) graduate from CCH, serves as an inspiring example of the difference professional training in obesity care can make. Working in the Well-being directorate, Mel’s patient base predominantly consists of individuals with overweight or obesity.

With her Postgraduate Diploma from CCH, Mel has already begun to apply her newfound knowledge, developing and delivering Tier 2 adult weight management services. Mel’s experience underscores the potential of robust and comprehensive training in the treatment of obesity. With her newfound confidence, she can now navigate the complexities of patient questions and provide valuable advice that enhances patient health outcomes.

The training offered by institutions like CCH, coupled with practical implementation, can bring a significant change in patient care. It’s therefore essential for health systems and medical institutions to acknowledge this training gap and equip healthcare professionals with the skills they need to improve their patients’ health.

Obesity is a complex condition that demands a sophisticated approach. Only by tailoring advice to the unique needs and circumstances of each patient can we hope to make strides in obesity care. It’s time to move beyond the “one-size-fits-all” advice and equip our healthcare professionals with the skills to provide non-judgemental nuanced, patient-specific advice. Only then can we truly claim to be tackling the obesity epidemic head-on.

Thus, training healthcare professionals in obesity care is not just an opportunity to improve individual patient outcomes, it’s a public health imperative. Institutions like the College of Contemporary Health, which provide such comprehensive training, are leading the way in this essential work.

1. Candesic Consultancy (2015) Obesity training levels in the UK workforce (analysis of HSCIC workforce statistic)

Survey reveals Ireland has second highest rate of obesity in EU

New data indicates that Ireland ranks second within the European Union (EU) for obesity rates, with over a quarter of its adult population falling into this category.

Statistics released by Eurostat, the EU’s statistical office, show that in 2019, obesity was prevalent in 26% of the Irish adult population. This figure significantly overshadows the EU average of 16%, with only Malta recording a higher rate at 28%. Comparatively, Ireland ranked seventh in a similar survey in 2014, with an obesity rate of 18%.

However, when examining the combined data for those classified as overweight, including individuals identified as having obesity and “pre-obesity,” Ireland presents a better picture. Over half of the adults in the country, about 56%, are categorised as having overweight, which positions Ireland near the middle among the 27 EU nations. Croatia and Malta top this list with 64% of their adults having overweight, while Italy and France record the lowest figures, with 45% of adults in these countries classified as having overweight.

Body Mass Index (BMI), a metric that measures body fat in relation to an individual’s height and weight, is used to determine whether a person has overweight. A BMI of 25 or above classifies a person as having overweight, while a BMI of 30 or higher indicates obesity. A BMI range of 18.5-25 is considered normal.

In 2019, according to Eurostat data, slightly over half of all adults in the EU had overweight. Of this population, 45% maintained normal weight, 53% were classified as having overweight, and nearly 3% were considered underweight.

A representative from Eurostat emphasised the serious public health implications of obesity, which notably elevates the risk of chronic diseases such as cardiovascular disease, type-2 diabetes, hypertension, and certain types of cancer. The spokesperson further explained that obesity could also be linked with various psychological issues. “The societal implications of obesity are significant, resulting in substantial direct and indirect costs that place considerable burden on healthcare and social resources,” they said.

The study discovered that in all 27 EU member states, more men than women had overweight. In Ireland, this discrepancy was evident with 61% of males having overweight compared to 49% of females. However, the rates of obesity were relatively equal, with 26% of Irish men and 25% of Irish women categorised as having obesity.

Eurostat’s data also highlighted a correlation between age and weight, with higher rates of individuals with overweight in older age groups, excluding those aged 75 and above. The highest rate of individuals with obesity in Ireland (32%) was documented among individuals aged between 65-74.

Moreover, a clear link was identified between educational attainment and weight, with a decreasing prevalence of individuals with overweight as education levels increased.

Geographically, in Ireland, people residing in the Border region, which includes counties Cavan, Donegal, Leitrim, Louth, Monaghan, and Sligo, exhibited the highest likelihood of having overweight or obesity. Around 59% of adults in this region had overweight, and 30% had obesity. In contrast, the west region (counties Galway, Mayo, and Roscommon) and the south-west region (Cork and Kerry) recorded the lowest rates of individuals with overweight, at 53%.

The Central Statistics Office compiled these Irish figures by analysing a survey of approximately 7,600 individuals, conducted as part of the Irish Health Survey 2019.

Obesity associated with diminished bone strength, particularly in men

Despite the protective implication often associated with high body weight in terms of fracture risk, recent studies suggest that obesity may in fact raise the risk of fractures, particularly in men with high body fat content.

A comprehensive examination of dual x-ray absorptiometry (DXA) data from a broad spectrum of over 10,000 U.S. individuals revealed an intricate connection between body weight and bone density. Dr. Rajesh Jain and Dr. Tamara Vokes, both from the University of Chicago, discussed these complex findings in the Journal of Clinical Endocrinology & Metabolism.

The duo discovered that each 1 kg/m2 increase in lean mass index correlated with a 0.19 higher T-score in people below 60 years of age. However, every corresponding increase in fat mass index was associated with a 0.10 decline in T-score, with a significant statistical difference (P<0.001).

Their research indicated that while lean mass positively impacted bone mineral density (BMD) equivalently in both genders, the deleterious effect of fat mass was more pronounced in men, leading to a 0.13 lower T-score per additional 1 kg/m2, compared to a 0.08 drop in women (P<0.001 for interaction).

“Our analysis of a large, heterogeneous population presenting a wide range of BMI indicated a clear negative correlation between bone density and fat mass, and a positive correlation with lean mass,” Jain and Vokes stated.

The researchers highlighted that despite lean mass exhibiting a stronger overall impact than fat mass, the detrimental effects of fat on BMD were significantly more evident in men and individuals with excessive fat content.

These insights hold critical clinical implications as they suggest obesity could contribute to declining BMD in patients traditionally not perceived as high fracture risk, and who therefore might not typically undergo DXA screening.

Contrasting previous studies constrained by small sample sizes or referral bias, Jain and Vokes’ findings reflect broader U.S. population data. They emphasise that obesity does not provide immunity against low BMD, advocating for clinicians to assess bone density, especially when other risk factors are present.

To reach their conclusions, the researchers assessed data from the National Health and Nutrition Examination Surveys conducted from 2011 to 2018. This dataset encompassed body composition and DXA measurements for 10,814 individuals aged 20 to 59.

Using linear regression models with total body BMD as the dependent variable, the researchers scrutinised the impact of lean and fat mass, accounting for age, gender, race/ethnicity, height, and smoking status. Notably, they highlighted the challenge of disentangling the interconnected influences of fat and lean mass on bone density.

Prior studies exploring the impact of fat mass on bone density reported varying results due to differing statistical methods and are somewhat outdated, the researchers pointed out. Moreover, the current study benefited from a densitometer with a higher weight limit, allowing for the examination of more severe obesity cases.

However, the study had limitations, including its focus on adults below 60 years, leaving room for potentially different body composition and bone mass relationships in older individuals. It also didn’t evaluate factors besides sex hormones that might elucidate the observed gender differences in the link between fat mass and bone density.

Despite women generally having a higher proportion of body fat, fat accumulation patterns differ by gender, with women typically storing fat in the hip and thigh areas, and men in the trunk and abdomen. Jain and Vokes acknowledged that differences in fat distribution might influence BMD, although their study could not conclusively prove this.

Men and women have different obesity drivers, pointing to the need for tailored interventions

A recent study conducted by researchers from UCLA has found sex-specific brain signals that may indicate why men and women develop obesity differently. Published in the journal Brain Communications, the study combined data from multiple modes of MRI imaging with clinical features and personal histories of patients to identify sex-specific mechanisms in the brain associated with obesity. The study aims to help tailor obesity interventions based on an individual’s sex.

The researchers analysed data from 183 participants aged between 18 and 55, which included 42 males with a non-obese BMI, 23 males with a high BMI, 63 females with a non-obese BMI, and 55 females with a high BMI. All participants completed a battery of self-report questionnaires that assessed various factors, including childhood trauma, anxiety and depression, visceral sensitivity, food addiction, bowel symptoms, and personality traits.

The researchers conducted three different brain MRIs to assess the structure, function, and connectivity of each participant’s brain. They then analysed the data sets from the three scans, along with clinical information, using an analytical tool to identify a limited number of variables from multiple data sets to predict an outcome.

The results of the study showed that specific network connectivity changes were associated with high BMI, regardless of sex. The researchers also found that in females, brain regions and networks had alterations associated with early life trauma, consistent with previous studies that showed that females with obesity may have greater anxiety, lower resilience, and difficulty integrating emotions with action-directed goal planning. The study also revealed that females may be more susceptible to the sight, smell, and taste of highly processed foods.

According to the researchers, the study’s results suggest that tailoring treatment plans for females with a high BMI should focus on emotional regulation techniques and vulnerability factors. However, they note that the study identified associations, not cause and effect. Future studies are needed to determine whether changes in the brain are a factor in the development of obesity or a result of the condition. The study builds on previous research that examined sex-related differences in the prominence and signalling of brain regions in obesity, which showed that women’s obesity was associated with emotion-related and compulsive eating, while men’s eating behaviour tended to be affected by a greater awareness of gut sensations and visceral responses.

The Potential Role of Digital Health in Obesity Care

The journal Advances in Therapy has recently published a paper exploring the use of digital health technologies in improving obesity care.

Obesity is a complex and chronic condition that increases the risk of developing several diseases, including type 2 diabetes mellitus, cardiovascular disease, and certain cancers. The prevalence of obesity continues to rise and poses a significant economic burden on healthcare systems worldwide. Current obesity treatment approaches tend to focus on individual responsibility, diet, and exercise, but they fail to acknowledge the complexity of the condition and the need for a whole-system approach.

A new approach is necessary that recognises the complexity of obesity and offers patient-centred, multidisciplinary care tailored to the needs of each individual. Digital transformation can significantly benefit obesity treatment, particularly through telehealth and mobile health, which can provide improved support and monitoring of behaviour change. Furthermore, artificial intelligence (AI) can revolutionise obesity care by enabling real-time patient monitoring and personalised interventions.

Digital health technologies offer a range of potential benefits for people with obesity, including improved quality, efficiency, and cost-effectiveness of care at all stages, from patient assessment to treatment and ongoing monitoring and support. Telehealth and mobile health are already widely used in healthcare and can reduce barriers to effective obesity care, improve access to care, and ultimately improve long-term weight management and obesity-related health outcomes. However, equitable access to telehealth and mobile health services must be ensured for patients from the most deprived communities.

Machine learning and AI can play an increasingly important role in healthcare and provide several opportunities for obesity care. By analysing large datasets from electronic health records, healthcare professionals can enhance their understanding of obesity’s complexity, leading to improved patient assessment and personalised treatment. Additionally, AI can be applied to mobile health technologies, connected via the Internet of Medical Things, to provide real-time patient monitoring and personalised weight management interventions.

In the immediate future, the most significant digital advancement in obesity care is likely to be the increased use of telehealth support, allowing greater access to care, more frequent consultations, and longer-term support. Over time, this will increasingly be supported by mobile health apps and devices. Ultimately, interventions and ongoing support are likely to be delivered using AI technology through a chatbot or avatar.

Please read the full paper here: The Potential Role of Digital Health in Obesity Care

Excess weight, obesity more deadly than previously believed

A new study from the University of Colorado Boulder, and published in the journal Population Studies, has found that the risk of death from excess weight or obesity is much higher than previously believed, with mortality rates increased by between 22% to 91%. 

The research challenges the “obesity paradox,” which suggests that only extremely high levels of excess weight are associated with increased mortality risk. The study analysed data from nearly 18,000 people and found that using body mass index (BMI) to study health outcomes can bias findings, potentially leading to underestimates of the consequences of living in an environment where unhealthy food is cheap and sedentary lifestyles are the norm. The study estimates that about one in six U.S. deaths are related to excess weight or obesity.

The research found that a full 20% of people classified as having a “healthy” weight had previously been in the overweight or having obesity category, and that these individuals had a substantially worse health profile than those in the “healthy” category whose weight had been stable. The study also found that the health and mortality consequences of high BMI are duration-dependent, meaning that people who have spent most of their lives at a low BMI but have recently gained weight may have better health profiles than those who have had overweight or obesity for most of their lives.

The study’s author, Ryan Masters, hopes that the research will alert scientists to be “extremely cautious” when making conclusions based on BMI, and will draw attention to the public health crisis of an “obesogenic” environment in the U.S. Masters noted that the prospects of healthy ageing into older adulthood do not look good for groups born in the 1970s or 1980s who have lived their whole lives in this obesogenic environment. The study estimates that about 16% of U.S. deaths are related to excess weight or obesity, a figure that is eight times higher than previous research had suggested.

More than half of the world will have overweight or obesity by 2035 – report

A new report by the World Obesity Federation predicts that more than half of the global population will have overweight or obesity by 2035. The report estimates that by 2035, 2.7 billion adults worldwide will have overweight, and 1.1 billion will have obesity.

The report points out that having overweight or obesity is a significant risk factor for many chronic diseases, including type 2 diabetes, cardiovascular disease, and some types of cancer. The cost of treating these diseases puts a significant burden on healthcare systems worldwide, with the federation estimating it will cost more than $4 trillion annually by 2035, or 3% of global GDP.

The report warns that the COVID-19 pandemic has exacerbated the problem by limiting access to healthy food and exercise opportunities, increasing stress and anxiety, and disrupting healthcare services. People who have overweight or obesity are also more likely to experience severe symptoms or complications from COVID-19.

The report calls for urgent action to address the growing obesity crisis, including measures to promote healthy eating, physical activity, and access to healthcare. It also calls for better regulation of the food industry to ensure that healthy options are available and affordable to all.

The authors of the report note that the obesity crisis is a complex issue that requires a multifaceted response from governments, healthcare providers, and individuals. They stress the importance of a coordinated and sustained effort to prevent and treat obesity, which they believe is essential for the health and well-being of individuals and societies worldwide.

The authors of the report have said they are not blaming individuals, but instead calling for a focus on the societal, environmental, and biological factors involved in the conditions. The report’s findings will be presented to United Nations policymakers and member states next week.

Obesity rates likely to double by 2030 with highest increases in lower-income countries

New global estimates indicate that more than a billion people worldwide will have obesity by 2030, which is twice the number recorded in 2010. Unfortunately, no country is on track to meet the World Health Organization’s (WHO) goal of halting obesity by 2025, and the number of people affected is predicted to rise drastically over the next eight years. Specifically, the number of people with obesity is expected to triple in low-income countries compared to 2010. The figures are from the fourth World Obesity Atlas, which was published by the World Obesity Federation.

The rise in obesity has been fastest in low- and middle-income countries. The highest rates of obesity are found in North America, Latin America, and the Caribbean, and the numbers of people with obesity in Africa are expected to triple, with more women affected than men. The report also states that obesity was a major contributor to Covid-19 deaths. Almost a quarter (22%) of preventable deaths from non-communicable diseases in Africa are attributed to being from overweight.

Dr. Adelheid Onyango, from the WHO’s regional office for Africa, noted that undernutrition remains a significant problem across the continent, but the growing problem of obesity cannot be ignored. The region has weak policies and regulatory systems concerning processed, high-fat, and sugary foods, which contributes to the problem of obesity.

The World Obesity Atlas also ranked countries in terms of their preparedness for obesity, including their health systems. High-income countries are the most prepared, while lower middle- and low-income countries are the least prepared, increasing concerns about the impact of obesity on already vulnerable populations.

More than 150 health experts and advocates have written to health ministers calling for an international action plan to tackle obesity. The World Obesity Federation’s chief executive, Johanna Ralston, said political and health leaders must recognise the severity of the situation and take decisive and people-centred action to address the issue.

WHO: Obesity in Europe at ‘epidemic proportions’

The World Health Organization (WHO) Regional Office for Europe has released a report warning that obesity rates in the European Region have reached “epidemic proportions.” 

The report states that the number of adults and children who have overweight or obesity is increasing, with 59% of adults and nearly one in three children affected. The report also highlights that no country in the European region is currently on track to halt the rise of obesity by 2025. Early studies from some countries showed that the prevalence of having overweight or obesity increased in children and teenagers during the pandemic.

The report highlights meal delivery apps as a potential contributor to the obesity problem, as they may encourage sedentary behaviour. The use of these apps was accelerated during the pandemic when people were advised to stay at home. The report recommends policies to ensure that restaurants that are required to display nutrition information also do so on apps. It also suggests that, where applicable, meal delivery companies be classified as food businesses to be held accountable in the same way.

The report finds that obesity and overweight are responsible for more than 1.2 million deaths across the region each year. Kremlin Wickramsinghe, ad interim head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases, called for the attention of the highest level of governments during a briefing, highlighting that obesity is linked to at least 13 different types of cancer and is likely directly causing at least 200,000 new cancer cases every year in the region. In some countries, the report predicts that obesity will overtake smoking as the leading risk factor for preventable cancer in the decades ahead.

The WHO report warns that if action is not taken to address the issue, the burden of obesity-related illnesses and the associated healthcare costs will continue to rise, placing significant strain on healthcare systems and national budgets.