Socioeconomic status in childhood and obesity in adults: a population-based study
This paper, published in Revista de Saúde Pública, aimed to determine the relationship between socioeconomic status (SS) in childhood and obesity in adult life. It conducted a cross-sectional analysis of a population of 1,222 adults in Florianópolis, Southern Brazil. Socioeconomic status was determined using the participant’s parents level of education as a proxy. Adult obesity was determined as a combination of BMI and waist circumference (WC).
The results showed a difference between genders. It was found that women with lower SS in childhood had a higher mean BMI and WC in adulthood. While in men, higher SS in childhood was found to be associated with increased BMI and WC in adulthood. It is suggested that this pattern is related to the income of the country, meaning countries of a similar income share this pattern. Although inconclusive, it raises the interesting point that patterns of obesity and socioeconomic status vary in different countries, so researchers must be careful when making assumptions about these two factors.
Read MoreFuture Pharmacotherapy for Obesity: New Anti-Obesity Drugs on the Horizon
This review published in Current obesity reports looks at how our increased understanding of energy regulation and neurohormonal pathways in energy homeostasis (the body’s mechanism for controlling caloric intake and energy expenditure) are being utilised to find pharmacological solutions to obesity. The review looks at centrally acting agents, gut hormones & incretin targets and other novel targets which include anti-obesity vaccines.
Centrally acting agents are drugs which work by altering brain neuronal circuits, by simulating or blocking the effects of other brain neurotransmitters, leading to changes in metabolism and behavior. This paper discusses four of these drugs, which can increase resting energy expenditure- leading to weight-loss- and can also change feelings of hunger/satiety, which then leads to decreased food intake.
Gut hormones and incretin targets are drugs that utilise the complex neurohormonal system of the gut and pancreas to alter feelings of hunger and fullness, with some also improving glucose control. The seven drugs discussed are at varying stages of clinical trials, some only being tested in animals while others are in phase-II. The promise in the phase-II trials is high though, meaning that this new class of anti-obesity drug could soon enter clinical practice.
Five other novel targets were also discussed. Firstly, a drug that reduces production of new fatty acids by the liver and converts stored fats into useful energy; leading to increased energy expenditure. Second, an enzyme inhibitor which leads to reduced absorption of fats in the gut; meaning fewer calories are extracted from food. Third, a triple monoamine reuptake inhibitor of neurotransmitters in the brain, which has proven effective and entered phase-II trials, despite some safety concerns. Fourth is a growth hormone that turns white fat into brown fat; this leads to increased energy expenditure. Alongside this it also provides added benefits such as anti-inflammatory properties. The final drugs discussed are anti-obesity vaccines; these involve targeting molecules that lead to obesity (e.g. ghrelin) or a vaccine to an adenovirus that has been shown to cause significant obesity in mice and may also do so in humans.
Read MorePractical Strategies for Engaging Individuals with Obesity in Primary Care
In this review article published by the Mayo Clinic, Dr Scott Kahan discusses the best strategies for engaging patients in obesity management, as well as looking at the barriers to good clinical practice. His findings are based on PubMed searches as well as his own clinical experience.
The two strategies identified as being practiced sub-optimally are screening and referral for counselling. Screening for obesity has been shown to be effective as it can lead to better perception of weight status, increased likelihood of trying to lose weight and of starting an obesity management programme. Patients with obesity who receive counselling have been shown to have a four-fold increased chance of losing weight.
The reason for suboptimal implementation of these strategies has been attributed to lack of training in obesity at medical school, with only 25% offering a dedicated nutrition course. Other reasons given by healthcare professionals are insufficient time, training, confidence in the method and resources. From the patient perspectives, stigma, inappropriate facilities (e.g. small waiting room furniture), previous negative care experience and a belief in moral failure in seeking help were found as barriers to care.
The practical guidance for improvement, aims at small changes to many aspects of care. It highlights the importance of people-first language and motivating terminology that encourages the patient rather than demeans them. In addition, improvements to the clinical environment so the patient doesn’t feel embarrassed, for example putting the weighing scales in a private place. Integration of digital technology was highlighted, such as reminders to measure BMI, as this would help with sub-optimal screening. In addition, using available online teaching resources and the multi-disciplinary team to minimize the burden of obesity management, as well improve the effectiveness of counselling technique. Finally, taking a long-term view of the support required, with extended duration weight-loss counselling and monitoring of progress.
Read MoreEffectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity.
Pediatrics conducted a pilot study over 12 months in Guangzhou, China, aimed at demonstrating the feasibility of a multifaceted intervention for preschool children and to provide an assessment of the efficacy. The study involved 648 children, who underwent a 3-component intervention (training of staff, initiating a healthy curriculum and close collaboration with families) while the other cohort consisted of 336 children, who received routine health care and acted as the control.
By 12 months, children within the intervention group had a smaller BMIz score increase (0.24) compared to the control (0.41), the prevalence of overweight or obesity was also lower among the intervention group at the end of the study. These results add further weight to the argument that multi-component health behaviour intervention might be the most effective in reducing the burden of obesity.
Read MoreClinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial
In this phase III randomised controlled trial of 151 children, published in the Journal of Pediatrics, the authors sought to investigate whether a skills-based behavioural family clinic and home-based intervention (LAUNCH) would be more effective at reducing BMI than motivational interviewing or to standard care in preschool-aged children with obesity.
LAUNCH is an 18-session clinic and home, family-based behavioral weight management intervention. Motivational interviewing was a parent only intervention consisting of 18 sessions over 6 months and focused on making changes to the child’s caregiver by encouraging diet and activity changes. Standard care informed caregivers of their child’s weight status during the recruitment process, but neither the children nor caregivers received any treatment.
LAUNCH demonstrated a mean (±SD) decrease in BMIz of −0.32 (±0.33) while motivational interviewing yielded a decrease of −0.05 (±0.27), standard care yielded a decrease of −0.13 (±0.31). Children in motivational interviewing and standard care gained almost triple the amount of weight during the 6-month period as children in LAUNCH. This slowing of weight gain resulted in a 4.45% decrease in percent overweight for LAUNCH, while both motivational interviewing and standard care increased in their percent overweight by 2.43% and 1.45%, respectively. Thus, the decrease in BMIz for LAUNCH was not only statistically significant, but clinically meaningful as well.
Read MorePilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals
It is common knowledge that exercise can play an important role in treating the physical parts of obesity, however the emotional benefits are less often talked about. In this study, published by the Brazilian journal Arquivos de Neuro-Psiquiatria 63 overweight or obese patients were randomly split into 3 groups, a control group (n=20), a Pilates group (n=22) and a walking group (n=21). The two exercise groups had to complete three, 60-minute sessions per week of their exercise. There were three psychological assessments conducted on each patient looking at quality of life, depression, state-anxiety and trait-anxiety. These were conducted before and after the 8 weeks.
The Walking group showed improvements in the quality of life domains of social functioning (20.3%) and mental health (21.8%). In addition, there were significant decreases in the levels of depression (35.2%), trait-anxiety (15.1%), and state-anxiety (18.5%).
For the Pilates group, improvements were observed in the quality of life domains of vitality (28%), social functioning (29.2%) and mental health (19%). In addition, there were significant decreases in the levels of depression (27.5%) and trait-anxiety (14.1%).
In some patients with obesity, emotional malfunction seems to inhibit the positive perception of the physical benefits of exercise. An alternative approach could point towards the mental and emotional benefits of exercise; this may be the trigger/motivator for people’s perception of physical activity programs to change and thus be taken up more enthusiastically.
Read MoreEffect of 7 days of exercise on exogenous carbohydrate oxidation and insulin resistance in children with obesity
It has been shown in adults that the capacity to match carbohydrate (CHO) oxidation with carbohydrate availability, known as metabolic flexibility (MetFlex), may be important for type 2 diabetes prevention. Improved MetFlex is associated with improvements to insulin resistance (IR) and can be achieved with as little as 7 days exercise.
In this small study published in the Journal of Applied Physiology and Metabolism, 12 children (8 boys and 4 girls) underwent 7 days of exercise in order to determine whether MetFlex and IR would improve. Participants underwent a combination of continuous and high intensity exercise sessions over the course of seven days. Each session consisting of 3 20-minute blocks. In spite of good adherence, no improvement to MetFlex or IR was found. The authors go on to comment that future research should investigate exercise volume, sex and pubertal effects on the responsiveness of MetFlex to exercise in children.
Read MoreSleep Health and Psychopathology Mediate Executive Deficits in Paediatric Obesity
A new study from Childhood Obesity has found that paediatric obesity is associated with impairment of some components of reward-related decision-making and executive functioning, as well as poorer sleep health and greater risk of internalising psychopathology. Obese children showed reduced ability to adapt behaviour to changing reward contingencies and also the presence of executive dysfunction under everyday behaviour regulation. There were 112 participants in the study, in which researchers conducted a range of tasks to test different psycho-metrics, using only non-food stimuli. Alongside this, parents were asked to fill out standardised questionnaires to assess sleep health, psychiatric symptoms and executive function.
The parental reports indicated that children with obesity had poorer sleep, despite equal sleep duration, and a four times greater risk of experiencing internalising psychopathology. Importantly these mediated the negative effects on everyday behavioural regulation and meta-cognitive abilities. One of the constraints of the study, that the authors highlight, is that it’s unclear whether obesity is the cause or consequence.
Further studies have been proposed which would closely monitor physiological and metabolic variables in Pre and Post weight loss subjects to disambiguate the relationship. The study authors go on to reiterate the importance of understanding this relationship as it could be a key new therapy target.
Read MoreHarmful effects of overweight are underestimated
A study from the University of Bristol has found that the harmful effects of overweight and obesity are being underestimated. The study, which contained data from around 60,000 parents and their children, analysed how obesity and BMI influences the risk of death. Previous studies have suggested the optimal BMI, at which the risk of death is minimised, is slightly above the recommended ‘normal’ range, meaning that it is good for you to be slightly overweight. However some disease courses can lead to you having a lower BMI but a higher risk of death, this makes it highly difficult to estimate how BMI actually influences risk of death.
The researchers used parent and child combinations as BMI is related due to genetic factors, however the BMI of ‘adult’ children is not influenced by illness amongst the parents, therefore using the offspring BMI avoids the problems inherent with simply relating the parent BMI to their risk of death. They found that when offspring BMI was used instead of the parent’s own BMI, the apparent harmful effects of low BMI were reduced, and the harmful effects of high BMI were greater than those found in the conventional analyses. These results therefore suggest that current studies may tend to underestimate the harmful effects of a higher BMI. The authors are therefore calling for more robust approaches for identifying causal relationships influencing health, especially the relationship of BMI to overall health.
Read MoreObesity worsens asthma in preschool children
Findings from a new study published in the Journal of Clinical Immunology have concluded that obesity can add five weeks of asthma symptoms in children ages 2 to 5. The researchers also found that untreated children who were overweight had more asthma attacks than untreated children of a healthy weight. The study also found that the effectiveness of steroid inhalers is not reduced in overweight or obese pre-schoolers, findings that are the opposite in older children and adults. Therefore, this study suggests that either the pathways of inflammation are different in younger children, or that it takes a long time for obesity to reduce the effectiveness of inhaled corticosteroids.
Overall, the study included data from 736 children, and is a retrospective analysis, making the conclusions slightly weaker. Therefore, the researchers hope that further research with a larger number of children might take place, and that this study is the catalyst for it.
Read MoreObesity not quite associated with improved survival
A controversial body of research has suggested that obesity may be associated with an improved rate of survival in patients with cardiovascular disease. It has been suggested in the past that because obese individuals have an extra catabolic reserve, and many diseases result in the wasting away at the end of life, they could prolong survival. However, a new study from the New York University College of Global Health has found that this ‘obesity paradox’ is not present among those with new cases of cardiovascular disease. Previous studies often included patients with established cardiovascular disease, where disease related factors may have biased towards an observation of a paradox.
In this study, the researchers used data from a nationally representative set from the United States that contains surveys of more than 30,000 people. Looking at a variety of cardiovascular issues and weight change over time the researchers found a strong association with the ‘obesity paradox’; the risk of death was 18 to 36 percent lower for people with obesity compared to those of a normal weight. However, in those with new cardiovascular disease, this association was not seen. This conclusion suggests that studies which include individuals with established cardiovascular factors are likely to be biased by factors such as disease related weight loss. The authors are keen to highlight that the findings do not support re-evaluation of guidelines to account for the obesity paradox.
Read MoreDiffering ethnic risks of obesity explained
For many years it has been believed that black individuals have a higher risk of developing diabetes, and the reason for this was unexplained. However, a new study published in JAMA has concluded that rates of obesity are what drives the differences in diabetes incidence between black and white individuals. Data from 4,251 individuals enrolled in a separate study was used for this research, spanning a range of states within the USA. Previous studies have found that higher rates of diabetes are present in black populations even when risk factors such as obesity and socioeconomic status are taken into account. Many of these studies measured parameters such as obesity, physical activity, and diet once during their participants’ lives. This study found that the black population tended to gain more weight over time, thereby increasing their risk of developing diabetes.
There will be no easy fix for this complex issue as it involves a variety of biological, socioeconomic, cultural, and behavioural factors. The study authors explained that it is vital for there to be equal access to healthy foods, spaces for physical activity, and economic opportunity to afford these things. If we were to control these risk factors we may go some way to controlling the effects of obesity, such as diabetes.
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