Obesity Care

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.

Obesity potentially linked to 18 additional cancers, expands understanding of risks

In a groundbreaking study recently published in The Lancet Regional Health – Europe, researchers have further explored the complex associations between body mass index (BMI) and the risk of developing obesity-related cancers. The study builds on previous findings and uncovers 18 additional cancers that may be linked to obesity, broadening the scope of understanding in the field of cancer research.

The rising prevalence of obesity and overweight worldwide underscores the urgency of understanding their impact on morbidity. Increasing evidence suggests that obesity is not just a health risk but may also serve as a preventable cause of various cancers. The 2016 report by the International Agency for Research on Cancer (IARC) had already established a connection between BMI and 13 specific cancers, laying the groundwork for further exploration.

Building on these earlier findings, an umbrella review later confirmed that most of these cancers were indeed linked to obesity. However, much of the existing research has focused on overall cancer risk without delving deeply into the associations between BMI and specific morphological cancer subtypes.

The present study seeks to bridge this gap by investigating potential obesity-related cancers, including their subtypes, and by quantifying the strength of these associations. The researchers utilised data from the Obesity and Disease Development Sweden (ODDS) study, drawing from an extensive database that spans several decades.

Cancer diagnoses recorded between 1963 and 2019 were meticulously identified through the Swedish Cancer Register, which classified cancers using standardised codes. The 13 cancers previously recognised by the IARC as obesity-related served as a foundation for this study, but the researchers also applied an explorative decision algorithm to identify additional cancers potentially linked to obesity. These were defined as cancers showing a positive association with increased obesity risk, either compared to normal weight or per a 5 kg/m² increase in BMI.

To determine the strength of the association between BMI and cancer risk, BMI was evaluated in categorical terms (such as underweight, overweight, etc.) or per a 5 kg/m² increment, provided there were sufficient cases—250 for categorical evaluations and 100 for incremental evaluations.

The analysis employed Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). These models were stratified by birth year and sex, and adjustments were made for several variables, including baseline age, mode of height and weight assessment, education level, country of birth, and marital status. Additionally, for cancers known to be related to smoking, the models were repeated in individuals with available smoking data to adjust for this significant confounder. The Wald test was then utilised to examine potential interactions based on sex.

The study’s scope was vast, including 4.14 million individuals—2.01 million females and 2.12 million males—with an average baseline age of 31.3 years for females and 23.1 years for males. The average BMI recorded was 22.5 kg/m² for males and 24 kg/m² for females, with obesity prevalence noted at 9% in females and 3% in males. Over a median follow-up period of 24.2 years, 332,501 cancer cases were identified—139,685 in females and 192,816 in males. The median age at cancer diagnosis was 55.7 years for females and 63.1 years for males.

The findings revealed that obesity was associated with an elevated risk of 18 cancers (16 in females and 15 in males) relative to normal weight or per a 5 kg/m² increase in BMI. Importantly, these cancers had not previously been established as obesity-related and accounted for 15% of all cancer cases identified in the study.

For females, these potential obesity-related cancers included those of the cervix, vulva, head and neck (specifically squamous cell carcinoma), and nodular melanoma. For males, the study identified cancers of the penis, head and neck (particularly adenocarcinoma), and malignant melanoma. Moreover, both sexes exhibited increased risks for cancers of the small intestine, stomach, oral cavity, paranasal and nasal sinuses, biliary tract, adrenal glands, pituitary gland, pancreatic islets, connective tissue, parathyroid gland, and both myeloid and lymphoid neoplasms.

Interestingly, there were notable sex-based interactions in the risk of certain cancers, including malignant melanoma, lymphoid neoplasms, and cancers of the lip, head and neck, tongue, and connective tissue. Additionally, specific subtypes of some potential obesity-related cancers demonstrated a stronger association with BMI than others. When smoking was considered, the association between BMI and some cancers persisted, while it weakened for others.

Beyond these newly identified cancers, obesity was also linked to an increased risk of all established obesity-related cancers, which constituted a quarter of all cases. The hazard ratios for these established and potential obesity-related cancers were 1.17 and 1.24 in males and 1.13 and 1.12 in females, respectively.

The absolute risk of developing a potential obesity-related cancer by the age of 80 was 5.7% for males with obesity and 5.5% for those with normal weight. In females, the corresponding risks were 4.2% for those with obesity and 3.5% for those with normal weight. When considering both established and potential obesity-related cancers, the combined risk by age 80 was 14.2% for males with obesity compared to 12% for those with normal weight, and 18.7% for females with obesity compared to 16.3% for those with normal weight.

In summary, this study has significantly expanded the list of cancers potentially linked to obesity, identifying 18 new cancers across various organ systems, including the gastrointestinal tract, endocrine organs, head and neck, genitals, and haematological malignancies. While the association between BMI and these newly identified cancers was somewhat weaker in males compared to the established obesity-related cancers, it was comparable in females. The findings underscore the need for further studies that account for cancer-specific confounders to validate these associations and deepen our understanding of the complex relationship between obesity and cancer.

The impact of high-protein diets on weight, energy, and blood sugar regulation

Over the past two decades, there has been a marked increase in interest surrounding the role of dietary protein in enhancing health outcomes. This heightened attention is largely driven by growing evidence that links protein intake with a variety of metabolic benefits. A recent comprehensive review published in Frontiers in Endocrinology delves into the effects of dietary protein on energy intake, appetite regulation, and postprandial blood sugar levels, offering valuable insights into both the short-term and long-term impacts of protein consumption.

Immediate Effects of Protein Consumption

Current research suggests that high-protein diets play a significant role in promoting weight loss, reducing weight gain, and improving glycaemic control. One of the key benefits of protein intake is its ability to lower postprandial (after eating) blood sugar levels and suppress energy intake. These effects are thought to be linked to protein’s capacity to stimulate gastrointestinal (GI) hormones and other post-absorptive mechanisms. Additionally, protein consumption has been shown to reduce hunger and increase feelings of fullness, with these effects being dose-dependent in both healthy and obese individuals.

A notable meta-analysis has highlighted the ability of protein-rich diets to reduce hunger, lower food intake, and diminish the desire to eat, while simultaneously increasing feelings of fullness. This reduction in postprandial blood sugar levels is one of the mechanisms through which protein aids in appetite control. However, it is important to note that the benefits of increased protein consumption may only last for a period of six to twelve months.

Comparative studies on various protein sources have produced interesting findings. For example, preloads containing milk proteins such as casein or whey, as well as proteins from turkey, egg, tuna, or soy, have been evaluated for their effects on satiety and blood sugar regulation. Among these, whey protein has been found to have the most profound impact on reducing blood sugar levels, although some studies suggest that it might be less satiating than other proteins. Nevertheless, milk proteins have consistently demonstrated a stronger ability to lower blood glucose compared to proteins derived from peas, eggs, or fish.

The digestion of proteins and their by-products stimulates the release of GI hormones such as incretins, cholecystokinin (CCK), glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and peptide tyrosine-tyrosine. These hormones are crucial in the regulation of postprandial blood sugar levels as they are transported to peripheral organs where they increase pyloric pressure and insulin secretion. This, in turn, helps to reduce blood sugar levels after meals.

The effects of different proteins on GI functions also vary, with whey protein generally showing greater efficacy than other sources. For instance, a study involving intraduodenal (directly into the duodenum) infusion of whey protein revealed a dose-dependent stimulation of plasma CCK, GLP-1, and pyloric pressures in both lean and obese participants. The high content of branched-chain amino acids, particularly isoleucine and leucine, in whey protein is thought to contribute significantly to its ability to reduce glycaemia and energy intake.

Medium- and Long-Term Effects

The impact of high-protein diets on weight loss has been extensively studied, particularly through ad libitum (eating at one’s own discretion) and energy-restricted dietary interventions. Regardless of the method employed, diets rich in protein have consistently led to greater weight loss compared to standard diets, especially in interventions lasting up to six months. Interestingly, ad libitum high-protein diets appear to be particularly effective.

A meta-analysis of 24 clinical trials observed a modest but significantly greater reduction in body weight and fat mass with an isocaloric energy-restricted high-protein diet compared to a standard diet over an average period of 12 weeks. Another meta-analysis, encompassing 74 trials, reported reductions in body weight, waist circumference, and body mass index (BMI) following six months on a high-protein diet.

However, the long-term effects of high-protein diets remain less clear, as studies extending beyond one year are limited. For instance, a meta-analysis of 15 clinical trials with interventions lasting at least 12 months found no clear benefits or detriments associated with high-protein intake concerning sustained weight loss. One 12-month study did observe modest improvements in weight maintenance with a high-protein diet compared to diets high in fat or carbohydrates, but the overall evidence remains inconclusive.

Plant Versus Animal Protein

The source of dietary protein—whether plant-based or animal-based—also plays a crucial role in determining health outcomes. Numerous studies have indicated that consuming large amounts of animal protein may increase the risk of developing diabetes, while plant proteins tend to offer protective effects.

Epidemiological studies consistently show a correlation between high animal protein intake, weight gain, and an elevated risk of obesity. For example, one study found that higher daily consumption of total and animal protein, predominantly sourced from chicken and red meat, was associated with significant weight gain over a period of 6.5 years.

In contrast, plant protein consumption has not been linked to either protective or adverse outcomes. In a study investigating the relationship between different protein sources and long-term weight gain across three cohorts, animal proteins were independently associated with weight gain over four years, whereas plant proteins were linked to weight loss.

Moreover, long-term consumption of animal proteins has been frequently associated with an increased risk of diabetes, while plant proteins appear to have neutral or even protective effects. The mechanisms underlying these differences are not entirely understood, but they may involve factors such as the glycaemic load, amino acid composition, and the insulinotropic (insulin-stimulating) effects of animal proteins, which could contribute to the beneficial effects observed with plant protein consumption.

Conclusion

There is substantial evidence supporting the role of increased protein intake in improving glycaemic control and promoting weight loss, particularly in the context of high-protein diets. However, the long-term health benefits of such diets are not yet fully understood, and more comprehensive, longitudinal studies involving diverse populations are needed to draw definitive conclusions. As research continues to evolve, it is clear that both the quantity and source of dietary protein are critical factors in determining the overall impact on health.

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.

Gestational diabetes does not increase breast cancer risk, study finds

A recent study has found that gestational diabetes does not elevate the risk of developing breast cancer, providing reassurance to millions of women worldwide. This significant research will be presented at the upcoming Annual Meeting of the European Association for the Study of Diabetes.

Gestational diabetes, a condition that affects nearly 15% of pregnant women globally, has long been a subject of concern due to its association with various long-term health risks. These include a heightened likelihood of developing type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic kidney disease, and certain mental health conditions. However, the link between gestational diabetes and breast cancer, the most common cancer among women, has remained unclear until now.

Women who are older, living with obesity, or have a family history of diabetes are at a greater risk of developing gestational diabetes. This condition, characterised by insulin resistance, has been the focus of much research due to its potential to trigger a range of health issues.

Dr Maria Hornstrup Christensen, the senior author of the study, emphasised the importance of understanding breast cancer risk factors. “Breast cancer is the most common cancer, as well as the leading cause of cancer deaths in women worldwide. It also has a very high treatment cost compared with other cancer types. If we know who is more likely to develop breast cancer, we might be able to detect it earlier when it is easier to treat, reducing deaths and treatment costs and the psychological and physical toll on women,” she said.

To investigate the potential connection between gestational diabetes and breast cancer, a team of researchers conducted an extensive study involving 708,121 women who gave birth in Denmark. Out of these, more than 24,000 women developed gestational diabetes during one or more of their pregnancies. The health outcomes of these women were tracked over an average period of 11 years, during which 7,609 cases of breast cancer were recorded.

The study’s findings revealed that women who had experienced gestational diabetes were no more likely to develop breast cancer than those who had not. This result is particularly significant given the concern surrounding insulin resistance, a key feature of gestational diabetes, which has also been linked to breast cancer in prior studies.

Dr Christensen remarked on the study’s implications, stating, “It will be reassuring for women who have had gestational diabetes to know that they are not at higher risk of developing breast cancer.”

She added a note of caution, however, highlighting the need for continued vigilance regarding other health risks. “They do, however, need to be alert to the fact that they are at higher risk of some conditions, including type 2 diabetes. And all women, regardless of whether or not they have had gestational diabetes, should be breast aware and check their breasts regularly for changes.”

This research provides a new understanding of the health implications of gestational diabetes, offering relief to many while underscoring the importance of ongoing health monitoring and awareness. The study represents a significant step forward in our understanding of the relationship between gestational diabetes and long-term health outcomes.

Weight-loss surgery enhances kidney transplant eligibility in patients with chronic kidney disease and obesity

In the United States, an estimated 40% of individuals undergoing dialysis are classified as having clinical obesity. This has led to patients with obesity becoming the fastest-growing demographic within the population affected by advanced chronic kidney disease (CKD). Regrettably, many of these patients find themselves ineligible for kidney transplant listings due to their body mass index (BMI) exceeding the stringent criteria set for transplantation.

While the impact of weight-loss therapies on patients with CKD has not been thoroughly examined, there exists a prevailing belief that a higher BMI might offer a survival advantage, particularly among those receiving dialysis. However, this perspective presents a paradox, as patients who experience delays in kidney transplantation due to not meeting the BMI requirements face an increased risk of mortality.

Dr. Aleksandra Kukla, a transplant nephrologist at Mayo Clinic in Rochester, Minnesota, elaborates on this issue: “The aim of our retrospective study was to describe the outcomes in candidates for kidney transplantation with obesity who were undergoing sleeve gastrectomy (SG) to meet BMI criteria for kidney transplant.

“These patients were participants in the Transplant Metabolic (TRANSMET) Program between February 2020 and August 2023. We compared 54 patients who underwent SG with 50 patients who did not have surgery. The mean BMI was similar in both groups at 41.7 kg/m².”

The findings of the study revealed that patients on dialysis achieved comparable weight-loss results to those not on dialysis. Over a median follow-up period of 15.5 months, 37 out of 54 patients (69%) who underwent SG were successfully placed on the active transplant list, and 20 of those 54 patients (37%) received a kidney transplant within 20 months of their surgery. In stark contrast, among the nonsurgical group, only 14 out of 50 patients (28%) were actively listed for a transplant, and a mere 5 out of 50 patients (10%) ultimately received a transplant.

Dr. Meera Shah, from the Endocrinology, Diabetes, and Nutrition department at Mayo Clinic in Rochester, Minnesota, further explains the comprehensive approach of their programme: “The bariatric transplant programme consists of a multidisciplinary team that assesses candidates for weight-loss surgery to ensure minimal perioperative complications and optimal long-term outcomes.”

Interestingly, the study noted no significant differences in major health complications or hospitalisation rates between the surgical and nonsurgical groups. However, there was a noted trend in the surgical group towards a decline in physical performance and an increase in frailty scores following SG, a change that aligns with the recognised rise in sarcopenia—loss of muscle mass—commonly observed after bariatric surgery.

Dr. Kukla concludes with an important consideration: “The findings of this study support the role of SG in CKD patients with obesity awaiting kidney transplant. As we further develop treatment protocols for obesity in CKD patients, we should include interventions to preserve or improve physical functioning, including physical therapy or health and wellness coaching. Although SG can be safe and effective in this population, it is not recommended in all patients with CKD and obesity. Our patients are best served by the expertise of a multidisciplinary team to evaluate all treatment options and formulate a plan that meets their goals.”

This study underscores the potential of sleeve gastrectomy as a viable intervention for patients with CKD and obesity, aiding them in meeting the BMI criteria necessary for kidney transplantation. However, it also highlights the critical need for a balanced approach that addresses both weight loss and the preservation of physical function to optimise patient outcomes.

Emphasise lifelong health gains over weight loss in obesity treatment, study suggests

The focus of obesity treatment should shift from mere weight loss to a broader perspective of lifelong health improvements, according to new research published in The Lancet this week.

Professor Carel le Roux, a spokesperson for the Irish Society for Clinical Nutrition and Metabolism (IrSPEN), emphasised that the true measure of success in treating obesity should not be confined to the number of kilograms lost, but rather the enhancements in overall health and quality of life. “The success of treating obesity should not be measured in kilograms, but improvements in health and quality of life,” he stated.

While the prevailing recommendation is to aim for a 15% reduction in body weight as an initial target to address most obesity-related complications effectively, Professor le Roux highlighted the inherent challenges in establishing a universal weight goal suitable for all patients. The diverse range of complications associated with obesity makes it “difficult to identify a single realistic weight goal suitable for all patients,” he noted.

In an interview on RTÉ’s Morning Ireland, Professor le Roux, who is also a co-author of the study, underscored that obesity should not be seen as a curable condition, but rather one that can be managed through continuous treatment. “Researchers now understand that obesity cannot be cured but can be controlled if treatments are continued lifelong,” he explained.

He warned that discontinuing treatment after achieving weight loss can lead to a relapse in obesity, negating all the health benefits that had been gained. “If obesity treatment is stopped once weight loss is achieved, the disease of obesity relapses and all of the benefits are lost,” he said.

“We want people to live longer, but also to live better, if we control the disease lifelong,” he continued, emphasising that the ultimate goal is not just about shedding pounds, but about combining weight loss with significant health gains, including a reduction in heart attacks. He added, “We’re not saying that it’s not about weight loss on its own, but it’s about the combination of health gain and actually living longer because of reduction of heart attacks.”

Professor le Roux stressed the importance of a sustainable approach to treatment, tailored to the individual’s needs and circumstances. “It doesn’t matter what the treatment is, provided it works for you and you can maintain it in the long term. Please don’t start a treatment if you’re not prepared to take it for the rest of your life,” he advised.

Addressing the societal stigma surrounding obesity, Professor le Roux, an obesity specialist at St Vincent’s University Hospital, pointed out that many individuals who have obesity have been unfairly blamed for their condition from a young age. “Most people who have obesity have been blamed for it since a young age,” he said, highlighting the need to shift the narrative from blame to responsibility. “While it is not their fault, it is their responsibility to treat the disease.”

He drew parallels with other chronic conditions to underscore this point. “The same way it would be your responsibility to treat the disease of asthma or epilepsy,” he added, illustrating that once people recognise obesity as a disease, they can access the appropriate treatment. “It becomes plain sailing and it’s incredible how it transforms peoples’ lives because they feel healthier, they feel more functional, they can do more things, and their quality of life improves dramatically,” he said.

Professor Helen Heneghan, a Bariatric Surgeon, echoed the sentiments of Professor le Roux, noting that medications for obesity are only effective as long as they are taken, necessitating long-term use to maintain the associated health benefits. “Obesity medications only work while patients take them and that long-term use is required to maintain the health benefits,” she remarked.

However, Professor Heneghan also identified several challenges affecting long-term adherence to obesity treatments, including high costs, supply chain issues for newer medications, and patient dissatisfaction with side effects. “A current issue with obesity treatment is that long-term adherence is low, which is affected by many factors such as high costs to patients, supply chain shortages for the newer medications, and patients’ dissatisfaction with side effects,” she explained.

For patients who do not achieve their treatment goals with medications, Professor Heneghan suggested that bariatric surgery should be considered. She further noted that patients who do not respond optimally to bariatric surgery or experience a recurrence of obesity-related conditions might benefit from transitioning to obesity medication. “If obesity treatment goals are not reached with medications, bariatric surgery should be considered,” she advised, adding, “People with a suboptimal response to bariatric surgery, or a recurrence of obesity-related diseases, may then benefit from moving to an obesity medication.”

Dr Mick Crotty, the Obesity Lead at the Irish College of General Practitioners, highlighted a significant barrier to effective obesity treatment: the widespread misconception that obesity is a self-inflicted condition that can be resolved simply by eating less and exercising more. “Many problems partly result from the common misconception that obesity is a self-imposed condition that can be treated by asking people to eat less and move more,” he said.

This misconception, Dr Crotty argued, contributes to the disparity in care provided to individuals with obesity compared to those with other chronic diseases, both at the individual and systemic levels. He called for the Health Service Executive (HSE) to ensure that the level of access to effective obesity treatments matches that of other chronic diseases. “The HSE should plan to maintain the same level of access or coverage for effective treatments for obesity as for other chronic diseases,” he concluded.

Obesity during pregnancy linked to increased risk of infant death

A comprehensive study conducted by a team of statistical researchers across multiple institutions has uncovered a slightly increased risk of sudden unexpected infant death (SUID) in babies born to mothers with obesity. The study, which was published in the prestigious journal JAMA Pediatrics, utilised extensive data from the National Center for Health Statistics (NCHS) to explore this potential link. Additionally, the journal has featured an Editorial Comment that further discusses the implications of the findings.

Previous research has established that maternal obesity during pregnancy is associated with a range of adverse outcomes, including heightened risks of general infant mortality and various maternal and infant health complications. Despite this, the specific connection between maternal obesity and the risk of SUID had not been thoroughly investigated until now.

To delve into this potential association, the research team focused on data from the NCHS covering the years 2015 to 2019, with particular attention to infant deaths occurring within the first year of life. The study considered all live births that occurred at 28 weeks of gestation or later and followed the infants for up to 364 days postpartum. The researchers then conducted a comparative analysis of SUID cases among infants born to mothers with obesity versus those born to mothers without obesity.

The analysis revealed that among the 19 million live births during the study period, 16,545 infants tragically succumbed to SUID. Of these deaths, 5.4% were found to be attributable to maternal obesity during pregnancy. This translates to a SUID rate of 0.74 per 1,000 live births for infants born to mothers without obesity, compared to a significantly higher rate of 1.47 per 1,000 live births for infants born to mothers with obesity.

In addition to the increased risk of SUID, the study also highlighted that mothers with obesity are more prone to experiencing sleep apnoea during pregnancy. Previous research has indicated that sleep apnoea is associated with several pregnancy-related health issues, including preeclampsia—a condition characterised by high blood pressure and potential damage to other organ systems, most often the liver and kidneys. There is also some evidence suggesting that sleep apnoea can adversely affect foetal growth, further compounding the risks associated with maternal obesity.

The research team emphasises the need for further investigation into the link between maternal obesity and SUID, particularly in light of the rising prevalence of obesity among pregnant women. As the number of women with obesity who become pregnant continues to grow, understanding the underlying mechanisms and risk factors becomes increasingly important to inform public health strategies and improve outcomes for both mothers and infants.

Given the serious implications of these findings, the researchers advocate for continued and expanded research in this area to develop more targeted interventions and support systems aimed at reducing the risk of SUID and improving overall maternal and infant health outcomes.

Walnut consumption linked to lower obesity rates in young women, study reveals

A recent study conducted by researchers at the Indiana University School of Public Health-Bloomington, USA, and funded by the California Walnut Commission, has uncovered a significant connection between walnut consumption and lower rates of obesity, particularly in younger women. This research highlights the potential role of walnuts and other nuts in promoting healthy weight management.

The study, published in the Current Developments in Nutrition journal, focused on the dietary habits of over 19,000 adolescents and young adults in the United States. The data was drawn from the National Health and Nutrition Examination Survey, encompassing individuals aged between 12 and 19 years for adolescents and 20 and 39 years for young adults. The research aimed to explore the relationship between walnut consumption and obesity-related metrics, including Relative Fat Mass (RFM), a validated tool used to estimate body fat percentage and regional fat distribution.

Dr Carla Miller, a Professor of Nutrition at Indiana University School of Public Health-Bloomington, commented on the findings: “While additional research is needed, these results showed that food should not be judged based on calories alone. The addition of nuts, like walnuts, as a part of a healthy eating pattern, may help lower the risk of obesity.”

She added, “Whether it is a handful as a snack or part of a meal, even in small amounts, nuts, including walnuts, can and should be a part of a nutritious diet to support well-being.”

The study’s findings were particularly striking among young women who regularly consumed walnuts. This group exhibited a significantly lower prevalence of obesity compared to their peers who did not include walnuts or other nuts in their diets. The protective effects of walnuts were less pronounced in other demographic groups. For example, young men and adolescent boys who consumed walnuts did not show a statistically significant reduction in obesity rates. However, adolescent girls and young women who consumed any type of nuts, including walnuts, had a noticeably lower RFM than those who did not consume nuts.

Interestingly, the study revealed an unexpected trend among young men who consumed both walnuts and other types of nuts. This group was found to have a higher likelihood of obesity, a result not observed among adolescent boys. This inverse association suggests that the relationship between nut consumption and obesity may vary based on gender and age, underscoring the complexity of dietary impacts on health.

The researchers caution that while these findings are promising, further studies are needed to confirm the observed associations and better understand the underlying mechanisms. The current research suggests a potential link between a walnut-rich diet and lower body fat levels, but more comprehensive studies are required to establish causality.

One of the study’s notable findings was the generally low consumption of nuts across the population. Despite the potential health benefits, 76% of adolescents and 69% of young adults reported not consuming walnuts daily. Additionally, the average intake of nuts in all groups fell well below the recommended daily amount of 56 to 85 grams. Adolescents averaged just 2 grams per day, while young adults consumed an average of 4 grams per day.

This research adds to a growing body of evidence supporting the health benefits of walnuts. A study conducted last year indicated that regular walnut consumption could improve cognitive development in adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Furthermore, walnuts have been shown to positively influence heart health by stimulating the body’s natural production of the amino acid L-homoarginine, which plays a role in cardiovascular function.

In conclusion, while more research is needed to fully understand the relationship between walnut consumption and obesity, particularly in young women, these findings suggest that incorporating walnuts into a balanced diet could be a valuable strategy for promoting healthy weight management and overall well-being.

New study uncovers brain circuit responsible for balancing hunger and pleasure-driven eating

Humans eat for two primary reasons: to satisfy hunger and for the pleasure derived from food, even when they are not hungry. While hunger-driven eating is essential for survival, pleasure-driven consumption can accelerate the onset of obesity and related metabolic disorders. A groundbreaking study published in Nature Metabolism has identified specific neural circuits in the mouse brain that promote hunger-driven feeding while suppressing pleasure-driven eating. These findings offer promising avenues for developing new strategies to combat obesity.

“Ideal feeding habits would balance eating for necessity and for pleasure, minimising the latter. In this study, we identified a group of neurons that regulate balanced feeding in the brain,” stated Dr. Yong Xu, co-corresponding author, professor of paediatrics – nutrition, and associate director for basic sciences at the USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine.

Previous research has highlighted the role of neurons marked by the GABAergic proenkephalin (Penk) marker, an endogenous opioid hormone, in regulating feeding and body weight balance. However, their specific role in differentiating hunger-driven and pleasure-driven feeding had not been fully understood.

In this study, Xu and his colleagues demonstrated that activating Penk neurons in a brain region called the diagonal band of Broca (DBB) in male mice promotes an ideal feeding pattern, increasing hunger-driven feeding while reducing pleasure-driven eating.

“I was surprised by this finding,” Xu remarked. “We and other groups had previously shown that certain groups of neurons affect both feeding types in the same way – they either increase or decrease both types. Here, we found that activating DBB-Penk neurons has opposite effects on the two types of feeding; they increase hunger-driven feeding while decreasing eating for pleasure.”

The researchers delved into the mechanisms behind these opposite effects. They discovered that DBB-Penk neurons project into two different brain areas, each regulating a distinct type of feeding behaviour.

“A subset of DBB-Penk neurons that projects to the paraventricular nucleus of the hypothalamus is preferentially activated upon food presentation during fasting periods, facilitating hunger-driven feeding,” Xu explained. “On the other hand, a separate subset of DBB-Penk neurons that projects to a different brain region, the lateral hypothalamus, is preferentially activated when detecting high-fat, high-sugar (HFHS) foods and inhibits their consumption. This is the first study to show a neural circuit that is activated by a reward, HFHS, but leads to terminating instead of continuing the pleasurable activity.”

Remarkably, mice in which the entire DBB-Penk population had been eliminated showed a significant behavioural change. When given a choice between chow and HFHS diets, these mice reduced their consumption of chow but increased their intake of HFHS foods, leading to rapid development of obesity and metabolic disturbances.

“Our findings indicate that the development of obesity is associated with impaired function of some of these brain circuits in mice,” Xu noted. “We are interested in further investigating molecular markers within these circuits that could be suitable targets for the treatment of human diseases such as obesity.”

The study’s contributors include Hailan Liu, Yongxiang Li, Meng Yu, Olivia Z. Ginnard, Kristine M. Conde, Mengjie Wang, Xing Fang, Hesong Liu, Longlong Tu, Na Yin, Jonathan C. Bean, Junying Han, Yongjie Yang, Qingchun Tong, Benjamin R. Arenkiel, Chunmei Wang, and co-corresponding author Yang He, affiliated with institutions such as Baylor College of Medicine, Baylor’s USDA/ARS Children’s Nutrition Research Center, Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, and the University of Texas Health Science Center at Houston.

One-third of NHS diet programme participants achieve type 2 diabetes remission, study finds

A recent study published in The Lancet Diabetes & Endocrinology has revealed that approximately one-third of participants in the National Health Service (NHS) shakes and soups diet programme in England have achieved remission from type 2 diabetes. This study, which evaluated the effectiveness of total dietary replacement (TDR) for insulin-independent diabetes remission, sheds light on the potential of structured diet interventions in managing type 2 diabetes on a large scale.

The escalating rates of diabetes in the United Kingdom have led the NHS to implement the Type 2 Diabetes Path to Remission (T2DR) initiative. This programme is centred around a low-calorie, micronutrient-rich diet, which has been shown to result in significant weight loss and sustained remission of diabetes. While clinical trials have demonstrated the efficacy of such dietary interventions, their effectiveness in broader, real-world contexts has remained unclear until now.

The T2DR programme is designed to help individuals lose weight, maintain that weight loss, and reduce their reliance on glucose-lowering medications. The programme comprises 20 sessions divided into three phases: the TDR phase, the food reintroduction phase, and the weight maintenance phase. The TDR phase, lasting 12 weeks, focuses on strict calorie intake regulation accompanied by coaching. Following this, the food reintroduction phase spans 4 to 6 weeks, during which participants are guided on healthy eating habits and goal-setting. The final phase, weight maintenance, involves monthly coaching sessions aimed at behaviour modification and encouraging physical activity to help participants sustain their weight loss and health improvements.

This study utilised prospective, national-level data to assess whether the NHS’s T2DR programme effectively promotes remission of type 2 diabetes. Researchers analysed data from English adults aged between 18 and 65 who had been diagnosed with type 2 diabetes within the previous six years and were referred to the T2DR programme by their general practitioners between September 2020 and December 2022. Participants included in the study had a body mass index (BMI) of at least 27 kg/m² for white individuals, with a lower threshold of 25 kg/m² for individuals of other ethnicities.

To determine the programme’s effectiveness, the researchers linked programme data with records from the National Diabetes Audit (NDA). They specifically examined glycated haemoglobin (HbA1c) levels and the use of oral hypoglycaemic medications. Eligible participants had recent HbA1c levels ranging from 43 to 87 mmol/mol if they were on glucose-lowering medications, or 48 to 87 mmol/mol if they were not.

The primary outcome of the study was diabetes remission at one year, defined by two HbA1c readings below 48 mmol/mol taken at least three months apart, without the use of glucose-lowering medications. These readings were collected from three months before the initial HbA1c measurement up to 15 months later. Secondary outcomes included the absolute and percentage changes in body weight, as well as the proportion of participants achieving at least 10% and 15% weight loss within one year.

The study focused on participants who began the TDR-based programme before 2022 and had completed it by December 2022, which included having their body weight recorded at the one-year mark. Researchers employed multivariate regression analyses to account for various factors, including demographic characteristics (age, gender, socioeconomic status, and ethnicity), clinical variables (duration of diabetes, baseline BMI, and HbA1c levels), and details about the programme’s delivery method and provider. Sensitivity analyses were also conducted to evaluate different timings for subsequent HbA1c measurements, ranging from 11 to 15 months after the initial reading.

Between September 2020 and December 2022, a total of 7,540 individuals were referred to the T2DR programme. The average age of participants was 50 years, with 43% being male and 64% identifying as white. Of these, 1,740 individuals initiated the TDR phase before 2022, with the aim of completing the programme within one year. Among those who started the programme before 2022, 55% (960 individuals) successfully completed it.

Out of all participants referred to the programme, 34% were not taking glucose-lowering medications, 50% were on one medication, and 16% were on two or more, with metformin being the most commonly prescribed.

The mean weight loss among the 1,710 participants who started the programme before 2022 was 9.40 kg, or 8.3% of their initial body weight. For the 945 participants who completed the programme, the average weight loss increased to 10 kg, or 9.3% of their starting weight. Among those with at least two HbA1c readings, 27% (190 individuals) achieved diabetes remission, with an average weight loss of 15 kg, or 13%. Of the 945 individuals who completed the programme, 48% (450 participants) had two HbA1c readings available, and of these, 32% (145 individuals) achieved remission, with an average weight loss of 16 kg, or 14%.

Furthermore, 42% of the 945 individuals who completed the programme lost at least 10% of their baseline weight, and 20% lost at least 15%. Among those who achieved remission, 76% (110 participants) lost at least 10% of their baseline weight, and 45% (65 participants) lost at least 15%. Sensitivity analyses produced consistent results, reinforcing the findings.

The study concluded that 27% of participants in the NHS T2DR programme achieved diabetes remission, demonstrating that remission is possible outside of controlled research settings with widespread implementation. However, remission rates in real-world applications are lower, and data collection is more limited compared to randomised controlled trials. These findings are significant as they provide valuable insights for policymakers regarding the operational effectiveness of the TDR approach and its potential impact on public health.

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.