Obesity Care

Poor muscle health in Individuals with obesity increases risk of early death, study finds

A pivotal study presented at the European Congress on Obesity (ECO) in Venice, Italy, from 12-15 May, 2024, has unveiled a stark correlation between suboptimal muscle health and an increased risk of premature death among individuals with obesity.

The research, carried out by a Swedish team on a UK cohort, established that individuals with compromised muscle composition were three times more likely to die during the study period compared to those with healthier muscle conditions. Dr. Jennifer Linge of AMRA Medical in Linköping, Sweden, spearheaded the research and shared compelling insights. “By examining muscle composition, we can predict which individuals with obesity are most at risk of early death in the forthcoming years,” Dr. Linge explained, highlighting the potential of muscle analysis as a predictive tool for mortality.

In recent years, weight loss has become a central strategy in managing chronic conditions such as type 2 diabetes and cardiovascular diseases. With pharmaceutical advancements, patients are now achieving significant weight reductions, previously possible only through surgical interventions. However, this brings to light concerns about possible detrimental effects on muscle health, including severe muscle mass loss and reduced mobility.

Dr. Linge elaborated on the complexities of muscle health in individuals with obesity, “Although individuals with obesity typically have more muscle mass, their muscles tend to be comparatively weaker. They also exhibit lower muscle quality, as well as reduced mobility and function.” She emphasised the importance of thorough muscle composition assessments, which consider both muscle quantity and quality, in evaluating the safety of rapid weight loss treatments, particularly for more vulnerable patients, such as those with sarcopenic obesity or advanced age.

The study also highlighted a critical gap in research concerning muscle health among populations with obesity, despite existing evidence from MRI studies that link poor muscle health with reduced functional performance, increased illness, and higher mortality rates in individuals with non-alcoholic fatty liver disease (NAFLD) and the general populace.

To address this, Dr. Linge and her colleagues utilised the AMRA Researcher software to analyse MRI scans from 56,109 participants in the UK Biobank study. They measured muscle volume and muscle fat, establishing a personalised muscle volume z-score to benchmark each individual’s muscle volume against the norm for their sex and body size.

From the extensive dataset, 9,840 participants—half of whom were men, with an average age of 64.4 years and a mean BMI of 33.5 kg/m²—were identified as having obesity and had comprehensive data on muscle composition. Of these, 2,001 (20.3%) exhibited adverse muscle composition. Over an average follow-up of 3.9 years, 174 participants died, predominantly from ischemic and hypertensive diseases.

The study findings indicated that neither low muscle volume z-score nor high muscle fat alone significantly influenced mortality risk. However, adverse muscle composition—characterised by both low muscle volume and high muscle fat—was strongly associated with a tripled risk of death during the follow-up period. This association persisted even when adjustments were made for factors like strength (hand grip), other diseases (cancer, type 2 diabetes, and coronary heart disease), and lifestyle factors (smoking, alcohol consumption, and physical activity), revealing a 70% increased risk of early death.

Sex, age, type 2 diabetes, and smoking were also noted as factors increasing the risk of premature death.

Dr. Linge concluded, “These results underscore the paramount importance of maintaining muscle health in people with obesity. It is crucial to determine whether drugs that achieve significant or rapid weight loss are inadvertently causing excessive muscle loss or worsening muscle quality, to ensure safer treatment approaches for obesity, particularly for those at greater risk.” This call to action not only emphasises the significance of maintaining muscle health but also the necessity of careful evaluation of treatment strategies for obesity.

Workers with obesity are twice as likely to take long-term sick leave

In a comprehensive study recently presented at the European Congress on Obesity in Venice, it was discovered that employees with obesity are significantly more likely to require sick leave compared to their healthier counterparts, highlighting a growing concern over obesity’s impact on workforce productivity and economic output. This pioneering research offers a detailed analysis of how obesity levels are influencing work attendance, revealing that the issue is contributing to a culture of increased sickness absence, which is straining the economy.

The study, which scrutinised the behaviour of 123,000 workers across Europe, including the UK, indicates that Britain’s performance is notably poor, with six out of ten adults classified as having either overweight or obesity. This finding places the UK among the worst of 28 countries examined. The timing of this revelation is critical as the UK is currently experiencing unprecedented levels of long-term sickness.

Researchers reported that workers in the highest obesity bracket were 2.5 times more likely to have been absent from work due to illness for a week or more over the past year, compared to those maintaining a healthy weight. Additionally, even individuals with mild overweight were found 22% more likely to have taken at least seven sick days annually.

This alarming data coincides with UK Prime Minister Rishi Sunak’s appeal last month to curb the “sick note culture” by not overly medicalising normal life stresses, a statement made in light of proposed welfare reforms. This appeal comes as the Office for National Statistics highlights that long-term sick leave figures have surged from 2.1 million to 2.8 million people since before the pandemic, with an estimated £50 billion allocated annually towards sickness benefits for working-age individuals.

Critics argue that the government’s efforts to address sick leave will be futile without serious measures against obesity, a major public health threat linked to numerous long-term illnesses. They emphasise the grave consequences facing the UK, branding it the “sick man of Europe” due to its inability to address significant health issues, with obesity being the foremost.

Presented at the European Congress on Obesity in Venice, the study’s findings further establish that higher body weight correlates with increased absenteeism. Separate studies corroborate these findings, showing the UK as having the third highest obesity rates among Organisation for Economic Co-operation and Development (OECD) countries. This extensive research is the first to detail how obesity impairs productivity by keeping individuals out of work, thereby exacerbating societal exclusion.

In the UK, long-term sickness has now become the leading cause of women exiting the workforce, with an additional 500,000 women becoming economically inactive due to this issue in the past five years. This surge is largely attributed to conditions like back pain, often exacerbated by excessive weight.

The study’s lead, Dr Thomas Czypionka from the Health Economics and Health Policy Research Group at the Institute for Advanced Studies in Vienna, emphasised the broad spectrum of health complications arising from obesity, including hypertension, diabetes, arthritis, and sleep apnoea. He highlighted the urgent need for stringent measures to tackle obesity, particularly through the reduction of ultra-processed food consumption.

Policy makers and health experts agree that addressing obesity is critical for improving public health and economic productivity. The government has initiated steps such as imposing sugar reduction targets in soft drinks and mandating calorie counts on menus to mitigate obesity levels. Further, a £2.5 billion plan aims to assist over a million people, including those with obesity-related health conditions, to overcome barriers to employment.

On the frontline, equipping busy clinicians with practical tools to raise and address excess weight in everyday consultations is the focus of short professional training such as the College of Contemporary Health’s Obesity Toolbox, a CPD-accredited online course.

This comprehensive study not only underscores the profound individual and societal impacts of obesity but also stresses the imperative for coherent public health strategies to curb this escalating issue.

CCH insight

With obesity placing growing pressure on individuals and the wider economy alike, frontline healthcare professionals have a pivotal role to play. CCH’s Obesity Toolbox (1.5 hours, fully online, CPD-accredited) condenses the essential tools and techniques for addressing excess weight with patients – from starting the conversation sensitively to physical activity, dietary change and behaviour change – making it a fast, practical starting point for busy practitioners.
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Close to half of all cancer diagnoses linked to obesity, research finds

A pivotal study has revealed a significant correlation between obesity and an increased risk of various cancers, intensifying concerns over a looming public health crisis. Conducted at Lund University in Malmo, Sweden, this extensive research tracked over four million adults over four decades, uncovering that excess weight could be a contributing factor in more than 30 different types of cancer.

This landmark research, set to be unveiled at the European Congress on Obesity in Venice, has been described as “groundbreaking” by experts, highlighting a potential health crisis in the making. The urgency of these findings has prompted health charities to call for immediate governmental action in response to this alarming revelation. They emphasise the economic burden of obesity, which is estimated to cost the UK nearly £100 billion annually, with NHS expenses alone reaching £19 billion.

The Health Secretary, Victoria Atkins, asserted the government’s commitment to addressing this issue robustly, with plans to leverage apps and technology to transform public health approaches expected to roll out this summer. Atkins stressed the government’s goal for citizens to enjoy longer, healthier lives.

Detailed findings from the study indicated that, of the 332,500 cancer cases recorded during the research period, 40% could be linked to obesity. Annually, the UK sees around 390,000 new cancer diagnoses, suggesting approximately 150,000 cases could be obesity-related. Previously, global studies had identified 13 cancers linked to excess weight, including cancers of the bowel, breast, womb, and kidney. This latest study has extended that list, identifying a total of 32 cancer types associated with obesity. Notably, a five-point increase in Body Mass Index (BMI) was found to enhance cancer risks significantly—by 24% in men and 12% in women for previously established obesity-related cancers. Additionally, this increase was connected to a 17% higher risk for men and 13% for women in 19 other newly associated cancers, including malignant melanoma and various rare cancers like those of the pituitary glands and small intestine.

The comprehensive nature of the study, examining 122 types and subtypes of cancer over 100 million years of follow-up, underlines the severe public health implications. Researchers highlighted that keeping a normal weight could potentially prevent a substantial proportion of cancer cases, with established obesity-related cancers accounting for 25% of all cases and this proportion rising to 40% when including potential obesity-related cancers.

Obesity rates in the UK have nearly doubled since the 1990s, with a current 26% of adults in England categorised as having obesity and another 38% as having overweight. Obesity now surpasses smoking as the primary cause of four major cancers, though smoking remains a significant risk factor.

Forecasts by Cancer Research UK suggest that reducing obesity could prevent approximately 8,000 cancer cases in England by 2040. Prof Jason Halford, president of the European Association for the Study of Obesity, emphasised the strength of the analysis and the need for further research to confirm these associations and explore the underlying mechanisms.

The NHS is exploring innovative approaches, including the use of weight loss medications like Wegovy, to tackle obesity effectively. Government plans to promote healthier lifestyles through technology and legislative measures are also underway, aiming to make healthy choices more accessible to the populace.

Katharine Jenner, director of the Obesity Health Alliance, a coalition of 50 health charities, stressed the clear results of the study and the need for urgent, effective public health policies to prevent obesity and associated diet-related cancers. This includes implementing restrictions on junk food marketing and introducing levies on unhealthy foods to facilitate healthier choices for all.

Lead researcher Dr Ming Sun highlighted that the impact of obesity on cancer might be more extensive than previously understood, suggesting it as a risk factor for more cancer types, particularly rarer ones that have seldom been studied in this context. The study’s findings underscore the necessity of public health measures to tackle the obesity epidemic and its detrimental effects on health outcomes comprehensively. Dr Jennifer L Baker, co-chairman of EASO’s childhood obesity working group, further elucidated potential biological mechanisms such as chronic inflammation and hormonal changes that might explain the increased cancer risk associated with obesity.

In conclusion, this study serves as a critical indicator of the link between obesity and an increased risk of various cancers, urging immediate and robust action to mitigate this public health threat.

Study reveals heart damage risks in sedentary children

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

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

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

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

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

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

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

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

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

Melatonin offers new hope for obesity prevention according to recent studies

Recent collaborative research spearheaded by the University of Granada (UGR) has unveiled significant findings regarding the use of melatonin in the prevention of obesity. This research, conducted by a team comprising experts from UGR’s Department of Pharmacology, the Federico Olóriz Neurosciences Institute, the Biosanitary Institute of Granada, and the University of Qatar, has shown promising results in mitigating the risks associated with visceral obesity. This type of obesity is especially concerning as it involves fat accumulation deep within the abdomen, surrounding vital organs, thus posing heightened health risks.

The studies, which were led by Professor Ahmad Agil of UGR and published in the well-regarded journals Antioxidants and Biomedicine & Pharmacotherapy, employed a methodical approach to their experimentation. Using adult rats with obesity and diabetes of both sexes, the research demonstrated that chronic administration of melatonin at a dosage of 10 mg/kg of body weight per day over three months is significantly more effective in preventing obesity compared to short-term treatments. Notably, the treatment resulted in a reduction of visceral fat by approximately 3%. Moreover, the studies highlighted melatonin’s ability to alleviate muscle-fibre atrophy associated with obesity, transform muscle fibre types into a more oxidative and slower phenotype, and increase mitochondrial activity and content—factors which collectively contribute to the observed reduction in weight gain among the treated rats.

An intriguing aspect of the research involved combining melatonin treatment with exposure to slightly cold water, around 17°C, which simulates the average sea temperature. This combination was found to further enhance weight loss, suggesting a potential new approach to managing obesity in humans.

Professor Agil underscored the growing prevalence of obesity, overweight, and type 2 diabetes across both developed and developing nations. He attributed these conditions to poor adaptation of the human genome to current environmental factors that include sedentary lifestyles, consumption of hypercaloric diets, and exposure to persistent artificial light which disrupts natural circadian rhythms and reduces endogenous melatonin levels.

To counter these challenges, Professor Agil recommends several lifestyle adjustments based on individual circadian rhythms. During the day, he suggests exposure to natural light, engaging in physical activity, opting for low-calorie, unprocessed diets, and incorporating thermogenic spices in meals while avoiding snacks between meals and reducing the use of insulating clothing and heating in homes. At night, recommendations include sleeping in complete darkness, avoiding blue light-emitting devices before bedtime, and practising fasting to boost melatonin levels naturally. For older adults and those suffering from obesity, Professor Agil advises the administration of melatonin under medical supervision.

The overarching goal of these studies is to integrate strategies like melatonin administration and intermittent fasting into medical practices to address the complex challenges posed by ‘diabesity’—a confluence of diabetes and obesity—and its associated complications, such as hepatic steatosis, hypertension, and lipid disorders. The research builds on 13 years of prior studies which have consistently shown that pharmacological use of melatonin can serve as a viable strategy in treating central obesity and its related complications. Moreover, melatonin has been found to activate brown fat and enhance the conversion of subcutaneous fat to a more metabolically active form, thus promoting the formation of beige fat cells from mesenchymal stem cells in humans.

These findings not only reaffirm the potential of melatonin in treating visceral obesity but also highlight the necessity for further clinical trials to confirm its efficacy in human subjects. Encouraging results from existing human trials support the progression to more extensive studies focusing on melatonin’s role in maintaining mitochondrial homeostasis and potentially slowing or halting the progression of obesity and its complications through prolonged pharmacological use.

The research has received funding from the SAF2016-79794-R project of the Ministry of Science, Innovation and Universities and is also supported by the European Regional Development Fund (ERDF).

Twenty years of research validates mediterranean diet’s role in lowering hypertension risk

A landmark study published in the European Journal of Clinical Nutrition has shed light on the enduring benefits of the Mediterranean diet in preventing hypertension (HTN) over an extensive 20-year period. Conducted among a group of initially non-hypertensive adults, this research marks a significant step in understanding long-term dietary impacts on health.

Hypertension remains a critical challenge globally, significantly influencing the onset of heart diseases and strokes, predominantly in low- and middle-income nations. Despite advancements in medication that stabilise blood pressure, approximately 30% of adults still suffer from HTN, which escalates both the healthcare costs and mortality associated with cardiovascular diseases (CVD). Lifestyle changes such as adopting balanced diets, regular physical activity, and smoking cessation are crucial for managing and preventing HTN. Official health guidelines recommend diets rich in plant-based foods, healthy fats, and lean proteins while being low in sodium and alcohol. The Mediterranean diet, celebrated since the 1960s for its role in preventing chronic conditions and reducing CVD mortality, has lacked long-term concrete evidence of its efficacy in managing blood pressure, prompting further investigation.

The study in question, known as the ATTICA study, complies with the Declaration of Helsinki and explores CVD incidence among Greek adults. Beginning in 2001-2002 with 4,056 individuals from the Attica region invited to participate, 3,042 agreed, embarking on a two-decade-long health journey. Initial assessments involved detailed face-to-face interviews at homes or workplaces by trained health professionals, who collected extensive socio-demographic, clinical, and biochemical data. Key health measures included fasting blood samples for glucose, insulin, total cholesterol, and high sensitivity C-reactive protein levels, among others. Participants also underwent physical examinations to ensure no pre-existing CVD and to measure blood pressure. Lifestyle factors including diet, exercise, and smoking habits were meticulously recorded, using a validated food frequency questionnaire to evaluate adherence to the Mediterranean diet through the MedDietScore.

Throughout the 20-year study period, participant engagement was maintained through regular follow-ups, with the latest in 2022 assessing 2,169 of the original cohort. This follow-up re-evaluated their health outcomes, including HTN, diabetes, and CVD development, corroborating data through family reports and medical records for deceased participants.

Statistical analyses utilised advanced software to contrast initial and 10-year dietary patterns, identifying four distinct adherence trajectories to the Mediterranean diet. Techniques such as correlation coefficients, chi-squared tests, and logistic regression models were employed to ascertain the connection between dietary adherence and HTN risk, accounting for variables like age, sex, body mass index, lifestyle habits, and initial health status.

Findings revealed that at the start, participants averaged 41 years of age with a near-equal gender distribution and showed moderate adherence to the Mediterranean diet, scoring an average MedDietScore of 27.1. Physically, 63.1% were minimally active, and about half were classified as having overweight or obesity. Early medical evaluations noted a 35.3% prevalence of hypercholesterolemia and a 3.9% incidence of diabetes.

Analysis of initial data highlighted a strong negative correlation between adherence to the Mediterranean diet and both systolic and diastolic blood pressures, indicating that higher dietary adherence correlated with lower blood pressure levels. Over the study’s duration, 314 individuals developed hypertension, representing a 22.2% incidence rate. Those who developed HTN typically were older, predominantly male, had higher obesity rates, poorer cardiometabolic profiles, and greater tobacco use compared to those who remained free from HTN.

In-depth analysis demonstrated that participants with low initial MedDietScore faced significantly higher HTN development rates than those with medium or high adherence levels. Statistical evaluation confirmed that each point increase in MedDietScore at baseline correlated with a 7% decrease in HTN risk over 20 years, a relationship that persisted even after adjusting for demographic and lifestyle factors.

The study also examined changes in diet adherence from the start to the 10-year point, revealing varied patterns. Notably, participants consistently adherent to the Mediterranean diet showed a remarkably lower incidence of HTN, with a 46.5% reduced risk in the fully adjusted model, underscoring the diet’s protective effect against HTN when sustained over time.

Heightened risk of iron deficiency in children with overweight and obesity

A comprehensive study conducted by the University of Leeds’ nutritional scientists has revealed a significant correlation between overweight and obesity in children and young people and an increased risk of iron deficiency. The research, spearheaded by the School of Food Science and Nutrition, involved a meticulous analysis of numerous medical studies across 44 countries, focusing on individuals under 25 years old. These studies assessed levels of essential vitamins and minerals, including iron, in relation to body weight.

The findings indicated that iron deficiency is prevalent among both underweight and overweight youths. Professor Bernadette Moore of the School of Food Science and Nutrition highlighted the broader implications of these findings, suggesting that “Iron status may be the canary in the coalmine, signalling deeper health issues like prolonged inflammation, which is linked to serious conditions including heart disease, diabetes, and fatty liver.”

Unlike deficiencies in zinc and vitamin A, which were primarily found in undernourished children, iron deficiency in overweight children appears to stem from inflammation that disrupts iron absorption. This research, funded by the UK Biotechnology and Biological Sciences Research Council and published in the ‘BMJ Global Health’ journal on 10 May 2024, marks a significant advancement in understanding the nutritional challenges faced by children with obesity.

The impact of iron deficiency on cognitive functions such as attention, concentration, and memory is well-documented, with potential links to conditions like autism and ADHD. This study is pioneering in its focus on the association of iron deficiency with childhood obesity, an area previously unexplored.

Xiaomian Tan, a doctoral researcher at the University, emphasised the importance of this study, stating, “While the link between undernutrition and deficiency of crucial micronutrients in children’s growth is established, the risks posed by obesity—leading to what can be described as a hidden form of malnutrition—are less understood.”

The study also addresses the broader socio-economic implications. Historically, nutrient deficiencies have been associated with hunger, especially in lower- and middle-income countries where they contribute significantly to child mortality. However, the phenomenon of ‘hidden hunger’—nutrient deficiencies in the context of an energy-dense but nutrient-poor diet—is becoming more prevalent in both affluent and developing nations. This is often linked to diets dominated by ultra-processed foods in wealthier countries and limited dietary variety in poorer regions.

The dual burden of malnutrition and overnutrition is particularly pressing in regions like Africa and Asia, which are undergoing rapid economic changes and dietary shifts towards Western high-sugar, high-fat foods. Between 2000 and 2017, the number of overweight children under five years old rose significantly in these continents, alongside an increase in stunting.

Professor Moore also pointed out the alarming trend in the UK, where one in three children by age 11 have overweight or obesity, which compounds the risk of inflammation-driven iron deficiencies. She advocates for increased physical activity and dietary improvements to mitigate these risks.

The call for further research is clear, with an emphasis on the need for more comprehensive studies that address micronutrient deficiencies within the context of the growing global epidemic of obesity, particularly in regions currently lacking detailed data.

New research debunks perceived benefits of overweight/obesity in lung cancer patients

In Buffalo, New York, the widely held belief that having overweight or obesity could have protective benefits for lung cancer patients has been critically re-examined by researchers at the Roswell Park Comprehensive Cancer Center. Despite obesity being linked to an increased risk and poorer prognosis in at least thirteen different cancer types, lung cancer has been noted as a striking exception. Previous studies suggested that patients with a higher Body Mass Index (BMI) faced a reduced risk of disease recurrence and enjoyed longer survival rates post-surgery, a phenomenon dubbed “the obesity paradox”. This has raised questions about the paradoxical role of obesity in lung cancer outcomes compared to its universally acknowledged negative impact on other cancer types.

Sai Yendamuri, MD, MBA, FACS, the Chair of Thoracic Surgery at Roswell Park, spearheaded a research initiative that has shed light on crucial “confounding factors” that distorted earlier conclusions, suggesting a beneficial link between overweight conditions and lung cancer patient prognoses. Dr. Yendamuri, along with a distinguished team including Santosh Patnaik, MD, PhD, Assistant Professor of Oncology in the Department of Thoracic Surgery, and Joseph Barbi, PhD, Assistant Professor of Oncology in the Department of Immunology, presented their groundbreaking findings at the annual American Association for Cancer Research (AACR) symposium held in San Diego, California, from April 5 to 10, 2024.

The research illuminated the inadequacy of BMI as a reliable measure of obesity, pinpointing it as one of the key factors leading to the misinterpretation of previous studies’ results. BMI, a simple calculation based on height and weight, fails to accurately represent the body’s fat percentage, its distribution, or differentiate between fat types. Through a meticulous case-control study utilising CT imaging, the team discovered that early-stage lung cancer patients exhibited a greater fat content without necessarily having a higher BMI, compared to high-risk individuals without lung cancer.

Moreover, the study revealed a heightened risk of disease recurrence in surgically treated lung cancer patients with substantial volumes of visceral fat—the dangerous type lodged between abdominal organs—regardless of their BMI status. Laboratory findings complemented these observations, suggesting that the rapid growth of lung tumours might be facilitated by an obesity-induced increase in suppressor leukocytes, which dampen the immune system’s ability to fight cancer.

Further investigations into patients categorised as having obesity through CT imaging rather than BMI calculations confirmed the suppression of the immune response within the lung microenvironment, allowing for unchecked cancer cell proliferation. These insights underscore the urgency for developing more precise obesity measurement methods to better understand its impact on lung cancer patients and tailor treatment approaches accordingly.

Dr. Yendamuri advocated for the exploration of blood-based testing as a future direction for accurately assessing obesity, circumventing the limitations of CT scans not typically conducted for all cancer patients. Identifying blood-based biomarkers correlating with imaging-derived fat measurements could revolutionise how obesity is gauged, facilitating more informed treatment decisions.

Another aspect of the study addressed the observed effects of certain medications, like metformin used for diabetes management, which appeared to offer additional anticancer benefits exclusively to patients with obesity. Laboratory and retrospective analyses supported the notion that in individuals with obesity, metformin could enhance the vulnerability of lung carcinoma tumours to immunotherapy, particularly immune checkpoint inhibitors (ICIs), promoting a more effective antitumor immune response.

Reflecting on the broader implications of their work, Dr. Yendamuri highlighted the necessity of re-evaluating the design of future studies to account for the limitations of BMI as an obesity measure and the distinct effects of medications in patients with obesity. Addressing the “obesity paradox” can pave the way for clearer, more beneficial patient recommendations, thereby potentially enhancing patient outcomes significantly. The team’s research, backed by both public and private funding, including support from the Roswell Park Alliance Foundation and National Institutes of Health agencies, marks a significant step forward in demystifying the complex interplay between obesity and lung cancer.

Obesity and high-fat diets linked to swift vascular ageing in the brain

A new study conducted in mice traces how obesity and a high-fat diet may accelerate ageing in the blood vessels that supply blood to the brain. The work is being presented this week at the American Physiology Summit, the flagship annual meeting of the American Physiological Society (APS), in Long Beach, California. 

The findings suggest that obesity and a poor diet can cause damage to accumulate in the blood vessels, reducing the supply of oxygen to parts of the brain and ultimately leading to cognitive decline. The study could help scientists find ways to intervene and preserve brain function in people with obesity, which is estimated to affect about 42% of U.S. adults. 

“This project highlights the critical roles of vascular components and cellular ageing in cognitive deterioration, pinpointing novel potential therapeutic targets for dementia prevention and treatment,” said Sharon Negri, PhD, the study’s first author and a postdoctoral research fellow in the laboratory of Stefano Tarantini, PhD, in the Department of Neurosurgery at the University of Oklahoma Health Sciences Center. 

Previous research has found strong links between mid-life obesity and an increased risk of cognitive decline and dementia later in life. The scientists sought to uncover the mechanisms behind this association, with a particular focus on the role of diet and vascular health. 

To do this, the researchers studied the impact of a high-fat diet on blood flow to the brain and memory performance in aged mice with obesity. By using a special mouse model, they were also able to measure cellular senescence, a process when cells stop dividing and making new cells. Cellular senescence increases with ageing and contributes to a variety of ageing-associated diseases. 

“Obesity may cause the cells in blood vessels in the brain to age faster and reach senescence. If a link between obesity and cellular senescence is established, it could open up new lines of investigation aimed at exploring therapeutic avenues to prevent or slow down the progression of senescence, with the potential to mitigate obesity-related health issues, including cognitive decline.” – Sharon Negri, PhD, study’s first author

The results showed that after three months, mice fed a high-fat diet had increased cellular senescence and reduced density of healthy blood vessels in the brain, as well as evidence of impaired learning in a maze test, compared with normal-weight mice fed a standard diet. In addition, the scientists found that removing the senescent cells using Navitoclax, an investigational cancer drug that selectively kills senescent cells, improved features of the brain vasculature. 

If further experiments confirm that it is possible to reverse the detrimental effects of senescence, Negri and Tarantini next plan to evaluate whether various lifestyle interventions could help to prevent or reduce obesity-induced cognitive impairment.

Revolutionising obesity treatment with new gender-specific microbiome findings

Recent investigations to be unveiled at the European Congress on Obesity (ECO) held in Venice, Italy, from the 12th to the 15th of May, 2024, have shed light on the pivotal role that variations in gut microbiota composition play in the genesis and evolution of obesity, revealing notable distinctions between genders. This differentiation may significantly influence the metabolism of various nutrients, thereby affecting the presence of bioactive molecules within the gut that are crucial in the progression of metabolic diseases.

The gut microbiota encompasses a complex consortium of microorganisms, including bacteria, viruses, fungi, and protozoa, that reside within the gastrointestinal tract. A state of imbalance within this microbial community, known as dysbiosis, has profound effects on metabolic health, altering the risk of developing diseases such as obesity. Yet, the specific microbial species that contribute to a higher or lower risk of obesity and their exact impact on metabolic health remain subjects of ongoing research.

In an effort to deepen understanding of the role these microorganisms play in obesity, researchers conducted an analysis of metagenomic and metabolomic data from a Spanish cohort. This analysis aimed to decipher the mechanisms through which gut microbes contribute to obesity’s development.

The study involved examining the faecal metabolome—the vast array of metabolites found in the gut and excreted in faeces, produced by gut bacteria as they metabolise food. These metabolites enter the bloodstream, where they can have significant health impacts.

A total of 361 adults (251 women and 110 men, with a median age of 44 years) from the Spanish Obekit study—a randomised trial exploring the relationship between genetic variants and responses to a hypocaloric diet—were included in the analysis. Participants were categorised based on their obesity (OB) index into LOW (BMI ≤ 30 kg/m²; fat mass percentage ≤ 25% for women or ≤ 32% for men; waist circumference ≤ 88 cm for women or ≤ 102 cm for men) or HIGH (BMI > 30 kg/m²; fat mass > 25% for women or > 32% for men; waist circumference > 88 cm for women or > 102 cm for men) obesity levels. This grouping ensured a balanced representation of sexes and ages within each category.

Microbiota profiling through genetic analysis was employed to ascertain the diversity, composition, and relative abundance of bacteria in participants’ stool samples.

Key findings indicated that individuals with a HIGH OB index displayed significantly reduced levels of Christensenella minuta—a bacterium associated with leanness and health. In men, an increased presence of Parabacteroides helcogenes and Campylobacter canadensis was strongly linked to elevated BMI, fat mass, and waist circumference. Conversely, in women, a higher abundance of Prevotella micans, Prevotella brevis, and Prevotella sacharolitica was strongly indicative of increased BMI, fat mass, and waist circumference, but these associations were not observed in men.

Further analyses, examining a broader spectrum of metabolic compounds in the blood, identified variations in certain metabolites, particularly elevated levels of bioactive lipids—phospholipids and sphingolipids—which are implicated in metabolic disease development and are key modulators of insulin sensitivity and contributors to diabetes and vascular complications in individuals with a HIGH OB index.

Dr. Paula Aranaz, the study’s lead author from the Centre for Nutrition Research at the University of Navarra in Spain, explained, “Our findings underscore the significant role of bacterial imbalance in the onset and progression of obesity, highlighting notable differences between genders. This imbalance affects the metabolism of bioactive molecules in the metabolome, which in turn influences metabolic disease development.”

Dr. Aranaz further elaborated on the protective role of the Christensenella minuta bacterium against obesity and noted that the microbial species influencing obesity risk differ by sex. This necessitates gender-specific interventions to prevent an obesity-promoting microbiome. She emphasised the need for additional research to pinpoint when the shift to an obesity-favourable gut microbiota occurs, to better time potential interventions.

She concluded with optimism, stating, “This study demonstrates the utility of combining metagenomics with metabolomics to unravel the mechanisms at play in metabolic disease development, such as obesity. This innovative, comprehensive approach has the potential to foster the creation of nutritionally precise strategies for weight management that alter specific bacterial strains or bioactive molecule levels.”

However, the authors acknowledged certain limitations of their study, including its relatively small sample size—particularly for men—and its geographical limitation to one region in Spain. Given that factors such as climate, geography, diet, and culture can influence the gut microbiome, the applicability of these findings to other populations may be limited.

Healthcare professionals struggle to tackle childhood obesity due to insufficient training

In the face of the escalating childhood obesity crisis, healthcare professionals are encountering significant hurdles, primarily due to a glaring deficiency in training and operational bandwidth. This predicament was illuminated through a study published in the British Journal of General Practice, wherein researchers from the University of Birmingham conducted thorough interviews with healthcare professionals (HCPs) to delve into their experiences with aiding families in the battle against childhood obesity.

One revealing testimony from the study highlighted the practical challenges faced by HCPs: “I had one mum and her child was overweight, but she was a young parent and she actually didn’t know how to cook the dinners and, yeah… we spent a lot of time with her giving her worksheets, how to cook, make potato and beans rather than going to the fish and chip shop.” This account underscores the multifaceted nature of the obesity issue, which extends beyond medical intervention to encompass educational and lifestyle components.

The research unearthed several themes that have frustrated healthcare professionals in their efforts to support families. Among these was the constrained time and training available to HCPs, compounded by a scarcity of specialist services and limited access to routinely collected data on children’s weight. A poignant concern was the risk of eroding trust by broaching the sensitive subject of weight, alongside the need to navigate cultural sensitivities carefully.

Miranda Pallan, Professor of Child and Adolescent Public Health at the University of Birmingham and senior author of the paper, brought to light the pressures faced by healthcare professionals. “This study brings a fresh awareness about the pressures that healthcare professionals face, including the limitations that they face in trying to provide preventative care for young people,” she remarked, emphasising the barriers to offering effective guidance and support.

Echoing these concerns, Dr Ellen Fallows, a sessional GP with a keen interest in childhood obesity, noted a pervasive reluctance to address the root causes, primarily due to a lack of time, knowledge, and incentives among healthcare professionals. “Everyone thinks it is everyone else’s problem, no one is actually talking about the root causes with parents – which is predominantly food quality,” Dr Fallows observed. She advocated for the wider availability of quality training resources as a vital first step in equipping HCPs to tackle this issue.

The study also touched upon the contentious use of BMI centiles for assessing children’s weight issues, revealing a division among healthcare professionals. Some, including doctors and primary care nurses, admitted to being less familiar with BMI centiles and questioned its suitability for younger children. One participant noted, “We used to use the [height and weight] centile charts and actually the BMI will put a lot more children in an overweight category than the centile charts will.”

The collective insights from this study underscore a pressing need for a strategic overhaul in how childhood obesity is approached within the healthcare system. While the direct teaching of nutritious cooking to families might be beyond the scope of HCPs, the findings advocate for an enhanced support framework, enabling practical advice and referrals to specialist services. As childhood obesity continues to pose a serious, multifaceted challenge, the call for a comprehensive strategy that includes better training, resources, and a unified effort to address its root causes has never been more urgent.

Study reveals sweeteners do not elevate hunger while aiding in blood sugar reduction

In a groundbreaking research endeavour, the substitution of sugar with both artificial and natural sweeteners has been shown to not increase hunger levels in individuals, whilst also facilitating a reduction in blood sugar levels. This discovery comes from a rigorous double-blind randomised controlled trial, which observed that foods containing sweeteners do not lead to heightened appetite sensations or alter appetite-related hormone reactions compared to their sugary counterparts. Notably, this substitution offers additional advantages, such as the lowering of blood sugar levels, a crucial factor for individuals at risk of developing type 2 diabetes.

The incorporation of sweeteners as a sugar substitute in food products has sparked considerable debate, with prior studies providing inconclusive evidence regarding their potential to stimulate appetite. However, this recent study, adhering to the highest standards of scientific proof, delivers compelling evidence that sweeteners and sweetness enhancers do not adversely affect appetite. Moreover, they play a significant role in reducing sugar intake.

Conducted under the auspices of the University of Leeds in collaboration with the Rhône-Alpes Research Center for Human Nutrition, this study forms part of the extensive research undertaken by the SWEET consortium. Comprising 29 European partners from research, consumer, and industry sectors, the consortium aims to investigate the long-term benefits and possible risks associated with the transition to sweeteners and sweetness enhancers, focusing on public health and safety, obesity, and sustainability. The research received funding from Horizon Europe.

Catherine Gibbons, the study’s lead author and an Associate Professor at the University of Leeds’ School of Psychology, stressed the importance of reducing sugar intake in combating the escalating prevalence of obesity-related metabolic diseases like type 2 diabetes. She noted that removing sugar from foods without offering a substitute could potentially compromise taste and heighten cravings for sweet foods, thus making adherence to a low-sugar diet challenging. The substitution of sugars with sweeteners and sweetness enhancers in food products represents a prevalent dietary and food manufacturing strategy to diminish sugar consumption and enhance the nutritional value of commercial foods and beverages.

Graham Finlayson, Principal Investigator and Professor of Psychobiology at the University of Leeds, highlighted the scrutiny that the use of sweeteners and sweetness enhancers has attracted, including claims linking their consumption to adverse health outcomes. These reports have muddled public perception, particularly among those at risk of metabolic diseases, about the safety of these substances.

“Our study provides essential evidence supporting the daily use of sweeteners and sweetness enhancers in managing body weight and blood sugar levels,” Finlayson stated.

This pioneering study, a first of its kind, examined the impact of consuming biscuits infused with either sugar, the natural sugar alternative Stevia, or the artificial sweetener Neotame on a group of 53 adult men and women with overweight or obesity issues. Prior research on sweeteners and sweetness enhancers predominantly utilised beverages as a medium and seldom included participants with overweight or obesity or both sexes. Moreover, these studies usually focused on a single sweetener, primarily aspartame, against a control, with very few examining the effects of repeated daily consumption of a known sweetener or sweetness enhancer as part of a regular diet.

The trial, executed at the University of Leeds and the Rhône-Alpes Research Center for Human Nutrition in France between 2021 and 2022, involved participants aged between 18 to 60, all with overweight or obesity. It comprised three two-week consumption phases, with participants consuming biscuits containing different fillings: sugar, Stevia, or Neotame, with intervals of 14-21 days between each phase.

The initial and final days of these phases were conducted in a laboratory setting. Participants, after an overnight fast, provided blood samples to establish baseline glucose, insulin, and appetite-related hormone levels. They were also asked to evaluate their hunger and food preferences. Following the biscuit consumption, participants rated their fullness over several hours, and measurements were taken for glucose and insulin levels, along with ghrelin, glucagon-like peptide 1, and pancreatic polypeptide – hormones linked to food consumption.

The findings indicated no significant differences in appetite or endocrine responses between the sweetener types and sugar. However, insulin levels, measured two hours post-consumption, along with blood sugar levels, were observed to decrease.

Professor Anne Raben, joint co-ordinator of the SWEET project from the University of Copenhagen, Denmark, remarked, “The findings affirm that sweeteners are a beneficial tool in reducing the consumption of added sugar without triggering a compensatory increase in hunger or energy intake. This supports the effectiveness of sweeteners in managing appetite, energy, and weight.”