Obesity Care

Excess weight, obesity more deadly than previously believed

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

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

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

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

Scientists find link between obesity and dementia

According to a new study published in the journal Alzhiemers & Dementia journal , obesity could be a major factor in the development of dementia. Researchers found that having overweight or obesity in mid-life could increase the risk of developing Alzheimer’s disease and other forms of dementia later in life.

The study analysed data from over 1.3 million adults in the United States, Europe, and Asia. It found that people who had overweight or obesity in mid-life had a 31% higher risk of developing dementia than those who were of a normal weight. The risk increased to 82% for those who had severe obesity.

The researchers also found that having type 2 diabetes further increased the risk of developing dementia in individuals with overweight or obesity. This is because obesity and diabetes are both associated with inflammation, insulin resistance, and other metabolic abnormalities that can damage the brain and increase the risk of dementia.

The study’s lead author, Dr. Elina Hyppönen, emphasised that the findings highlight the importance of maintaining a healthy weight throughout life to reduce the risk of dementia. She suggested that lifestyle interventions, such as exercise and a healthy diet, could help prevent obesity and diabetes and lower the risk of dementia.

The study’s findings add to the growing body of evidence linking obesity and dementia. Previous research has suggested that obesity can increase the risk of cognitive decline and reduce brain volume, particularly in the hippocampus, which is critical for memory and learning.

The World Health Organization estimates that around 50 million people worldwide have dementia, and that number is expected to triple by 2050. The study’s authors suggest that preventing obesity and diabetes could be an important strategy for reducing the global burden of dementia.

A good night’s sleep may make it easier to stick to exercise and diet goals, study finds

Preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023 suggests that people who get regular and uninterrupted sleep are more successful at sticking to their exercise and diet plans while trying to lose weight. 

The researchers found that good sleep health was associated with higher rates of attendance at group interval sessions, adherence to caloric intake goals and improvement in time spent performing moderate-vigorous physical activity. The researchers examined 125 adults with overweight or obesity over 12 months in a weight loss program that included measurements of sleep habits through patient questionnaires, sleep diaries and wrist-worn devices. 

They measured adherence to the program by percentage of group intervention sessions attended, percentage of days that participants ate between 85-115% of their recommended daily calories, and change in daily duration of moderate or vigorous physical activity. 

The study’s limitations include that it did not incorporate any intervention to help participants improve their sleep, that the study sample was not recruited based upon participants’ sleep health characteristics, and that the overall sample population had relatively good sleep health at baseline. Additionally, the sample was primarily white and female, so it is unclear whether these results are generalisable to different population groups.

Overall, the preliminary research suggests that sleep may play a key role in promoting self-control and making healthy choices, highlighting the need for public health efforts to promote healthy sleep habits and the importance of getting enough sleep for maintaining a healthy lifestyle.

Obesity in pregnancy increases the risk of cardiovascular disease in offspring, animal study shows

New research reveals that maternal obesity during pregnancy can have a negative impact on the lifelong health and function of a foetus’s heart. 

Researchers from the University of Colorado, US, have found a connection between maternal obesity and a higher risk of cardiac problems in offspring later in life due to the nutrients received while in the womb. The study involved feeding female mice a high-fat diet equivalent to a human eating a burger, chips, and a fizzy drink daily until they had obesity. Researchers then studied the foetuses of the mice while in the womb and up to 24 months after birth. They analysed their genes, proteins, and mitochondria and found that the heart is affected by the nutrients it receives while growing in the uterus. This leads to alterations in how the organ metabolises carbohydrates and fats. Due to the nutrients found in the high-fat diet, the hearts developed a preference for fats and moved away from sugar.

The study found that the hearts of both female and male offspring grew larger than average, impairing the organ’s ability to function normally due to an increase in weight. Male offspring showed signs of cardiovascular impairment from the start, while females’ health became worse over time. This may be due to increased oestrogen levels present in female mice that offer initial protection against cardiovascular dysfunction. However, this resistance weakens as oestrogen levels decline with age.

Having obesity during pregnancy can lead to the development of cardiovascular and metabolic conditions in humans, such as type 2 diabetes, heart disease, and cancer. The study’s lead author, Dr. Owen Vaughan, suggests that by improving our understanding of the mechanisms involved, this research can pave the way for treatments that could be used in early life to prevent later-life cardiometabolic illnesses. This could include offering more tailored advice on nutrition to mothers or children based on their body mass index or sex or developing new drugs that target metabolism in the heart of the foetus. Therefore, keeping active through regular exercise and maintaining a healthy diet during pregnancy are essential for reducing the risk of developing health complications.

Obesity in your 50s ‘gives you the same health problems as a 75-year-old’, study shows

Having obesity can cause you to age prematurely, with 55-year-olds who are significantly overweight expected to experience the same health problems as 75-year-olds without obesity.

Researchers in Finland and the UK carried out a study on the likelihood of multiple morbidity, whereby individuals are at risk of experiencing several health conditions at the same time, based on their age and weight. The research found that individuals with obesity are five times more likely to suffer from simple multi-morbidity and over 12 times more likely to suffer from complex multi-morbidity compared to individuals with healthy weights. The study used a group of 115,000 Finns and found that just under 20% of people with healthy weights had two health problems by the age of 75. In contrast, among those with obesity, the same proportion was reached by 55 years old. A separate study of 500,000 Britons showed similar results.

According to the study, obesity advances the age at which individuals are likely to experience health problems. While health problems such as heart disease, type 2 diabetes, and cancer are already known to be more likely among individuals with obesity, this study is the first to provide a quantification of how obesity can cause health problems to emerge earlier. The study found that the impact of obesity on mortality is not as significant, meaning that those who are severely overweight are more likely to suffer from health problems for many years than to die decades earlier.

The Lancet Diabetes & Endocrinology medical journal has published a warning by two Israeli medics about the implications of increasing numbers of older people with obesity, who may be subject to more drug side effects and interactions, adverse events, complications, hospital admissions, and disabilities. Unemployment and welfare dependency may also rise as a result.

Scant obesity training in medical school leaves doctors ill-prepared to help patients

Published in NPR, “Scant Obesity Training in Medical School Leaves Doctors Ill-Prepared to Help Patients” highlights the lack of obesity education in medical schools, leaving doctors unprepared to help patients with obesity. According to the article, only about 25% of U.S. medical schools require a course on nutrition and only about half require a course on obesity. The article argues that this lack of training leads to missed opportunities for doctors to help patients manage their weight and can result in patients not receiving the care they need. It also notes that the COVID-19 pandemic has only magnified the need for medical professionals to be equipped to address obesity, as people with obesity are at higher risk for severe illness from the virus.

Higher obesity levels linked to lower productivity in England, research shows

Published in The Guardian, “Higher obesity levels linked to lower productivity in England, research shows” discusses the findings of a new study that shows a correlation between obesity levels and lower productivity in England. The study found that people with obesity tend to miss more work days due to health issues and are less productive when they are at work, leading to a loss of economic output for the country. The article notes that the findings of the study have implications for both employers and policymakers, as addressing obesity and promoting healthy lifestyles could lead to improved health and increased productivity for the workforce. The article also highlights the need for comprehensive programs and policies aimed at reducing obesity levels and improving overall health in England.

Only eating between 7am and 3pm helps people with obesity lose weight

Published in New Scientist, “Only eating between 7am and 3pm helps people with obesity lose weight” describes the results of a study that found that time-restricted eating (TRE) can be an effective tool for weight loss in people with obesity. The study found that individuals who only ate between the hours of 7am and 3pm lost an average of 8% of their body weight in just 12 weeks. The article notes that the benefits of TRE go beyond weight loss, as it has also been linked to improved metabolic health, reduced inflammation, and better sleep. The article suggests that TRE could be a simple and effective way for people with obesity to improve their health, but more research is needed to fully understand the effects of this eating pattern.

Bariatric surgery may reduce cancer risk in patients with obesity and type 2 diabetes

Research findings derived from a Swedish Obese Subjects (SOS) study, published in Diabetes Care, found that in people with obesity and type 2 diabetes (T2D), bariatric surgery may play a role in cancer prevention. “Durable” remission of T2D is often achieved after weight-loss surgery, further associating it with a reduced cancer risk. 

The study examined long-term outcomes after bariatric surgery versus usual care in people with obesity. Researchers examined outcomes of 701 patients with obesity and T2D at baseline. A total of 393 of these patients (mean age, 48.6 years) underwent bariatric surgery while 308 patients (mean age, 50.5 years) received conventional obesity treatment. The investigators analysed cancer events, reported in the Swedish National Cancer Register, over the median follow-up of 21.3 years.

In patients treated with bariatric surgery, the incidence rate for first-time cancer during the follow-up period was 9.1 per 1,000 person-years (95% CI, 7.2–11.5). In contrast, the incidence rate for first-time cancer in patients treated with usual obesity care was 14.1 per 1,000 person-years (95% CI, 11.2–17.7). The incidence rate for first-time cancer diagnosis was significantly lower in the patients treated with bariatric surgery (adjusted hazard ratio [HR], 0.63; 95% CI, 0.44–0.89; P =.008).

Compared with the control group, bariatric surgery was associated with a significantly reduced incidence of cancer in women, (HR, 0.58; 95% CI, 0.38–0.90; P =.016). However, with bariatric surgery in men, there was no similar association (HR, 0.79; 95% CI, 0.46-1.38; P =.0413). Diabetes remission at 10 years follow-up was also associated with a reduction in cancer incidence (HR, 0.40; 95% CI, 0.22–0.74; P =.003).

The ascertainment of diabetes diagnoses was a limitation of the study, which were based on a single time point measurement and/or the use of a diabetes medication. Additionally, the majority of participants in the surgery group had received vertical banded gastroplasty or banding, which is rarely used today. High postoperative mortality following bariatric surgery was reported during the original SOS study.

“In conclusion, with increasing rates of obesity and diabetes worldwide, a greater emphasis on cancer prevention strategies is needed,” the researchers wrote. “Bariatric surgery may greatly reduce the risk of cancer among patients with obesity and diabetes. Durable diabetes remission seems imperative for cancer prevention in patients with obesity and diabetes.”

Research finds weight loss in boys with obesity improves testosterone levels

A study, published in the European Journal of Endocrinology, and conducted by researchers at both Saint Louis University School of Medicine and University of Buffalo has found that adolescent boys with obesity who lose weight following bariatric surgery improve their testosterone levels.

Sandeep Dhindsa, M.D., a SLUCare endocrinologist and the director of SLU’s Division of Endocrinology, Diabetes and Metabolism, and first author on the paper stated, “Boys with obesity do not achieve sufficient testosterone levels at puberty and weight loss can theoretically improve testosterone. We checked the testosterone levels in boys with obesity who underwent bariatric surgery. Those who lost weight had increased testosterone levels. Those who regained weight had a lowering of testosterone again.”

In the study, researchers evaluated the changes in sex hormones following bariatric surgery in 34 male patients between the ages of 14 to 19. These participants were part of a long-term multi-centre study, the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS is the first large study to systematically document the outcome of metabolic bariatric surgery for treatment of adolescents with severe obesity in the United States.

Following surgery the participants were followed for five years. Total testosterone, estradiol, luteinizing hormone, follicle stimulating hormone, sex hormone binding globulin, insulin and glucose were all measured before surgery, six months’ post-operative and annually thereafter. 

The study showed that bariatric surgery, in addition to treating obesity and reversing Type 2 diabetes, reversed low testosterone levels.

“Males usually achieve their peak testosterone concentrations at puberty, followed by a gradual decline for the rest of their life. Adolescent males with obesity start off with a lower testosterone. We do not know the long-term effects on fertility and sexual function. Testosterone is also important for muscle and bone growth. Our study provides strong evidence that weight loss can restore normal testosterone concentrations in these boys,” Dhindsa said.

73% of participants had subnormal free testosterone levels prior to surgery. Only 20% had subnormal free testosterone concentrations two years later. That percentage rose to 33% due to regained weight among some participants five years later.

Common causes of low testosterone in adults are ageing, obesity and diabetes. Male adults with obesity have lower testosterone levels than adults who are of a lean weight.

Obesity raises risk of gum disease

According to new research from the University of Buffalo, chronic inflammation caused by obesity may trigger the development of cells that break down bone tissue, including the bone that holds teeth in place. The study sought to improve understanding of the connection between obesity and gum disease.

The study also found that excessive inflammation resulting from obesity raises the number of myeloid-derived suppressor cells (MDSC), a group of immune cells that increase during illness to regulate immune function. MDSCs, which originate in the bone marrow, develop into a range of different cell types, including osteoclasts, a cell that breaks down bone tissue. This research was published in October in the Journal of Dental Research

Also known as periodontal disease, gum disease affects more than 47% of adults 30 years and older, according to the Centers for Disease Control and Prevention. Bone loss is a major symptom of gum disease and may ultimately lead to tooth loss.

Keith Kirkwood, professor of oral biology in the School of Dental Medicine at the University of Buffalo said the following about the study, “although there is a clear relationship between the degree of obesity and periodontal disease, the mechanisms that underpin the links between these conditions were not completely understood.” 

“This research promotes the concept that MDSC expansion during obesity to become osteoclasts during periodontitis is tied to increased alveolar bone destruction,” says Kyuhwan Kwack, postdoctoral associate in the Department of Oral Biology. “Taken together, this data supports the view that obesity raises the risk of periodontal bone loss.” 

The findings may shed more light on the mechanisms behind other chronic inflammatory, bone-related diseases that develop concurrently with obesity, such as arthritis and osteoporosis, Kirkwood says.

Can rye help reduce weight and obesity?

New research published in Clinical Nutrition has indicated that consuming whole grain rye products can benefit your health greater than refined wheat products. The new study was conducted at Chalmers University of Technology, Sweden. It examined how people lost more body fat and weight when eating a diet with high-fibre products containing whole grain rye, compared to those who ate refined wheat products.

This study is the biggest to look at the consequences of consuming specific grains on body weight and body fat, and the first to examine rye specifically. Scientists have also suggested that obesity is caused by what we are eating, and not by how much.

Researchers analysed 242 men and women with overweight aged from 30 to 70 for 12 weeks. Their weight, body composition, blood samples, and appetite was examined at the start, halfway through, and end of the study. The participants were given a specific daily quantity of either whole grain rye or refined wheat, both with the same energy value, and were given the same guidance from a dietician on how to eat healthily.

Although both the rye and wheat groups lost weight during the study, those who ate rye products lost an average of one kilogram more than those who ate wheat products, with the difference attributable to fat loss.

“Although we saw an overall difference in weight loss between the rye and the wheat group, there was also very large variation within those groups. Increasing our understanding of why different people respond differently to the same foods can pave the way for more specifically tailored diets based on individual needs,” says Rikard Landberg, Professor of Food and Health at Chalmers University of Technology.

Obesity and excess weight are among the biggest health challenges in the world and require many different measures. One idea is to develop foods that contribute to an increased feeling of fullness and have positive effects on metabolism, and previous studies had observed that those who eat rye, which has a very high content of dietary fibre, feel more full than those who eat the corresponding amount of energy in the form of refined wheat.

“But surprisingly,” says Kia Nøhr Iversen, “in this study, we actually never observed any difference in appetite. We think this may be simply because the method we used to measure appetite was not good enough. We are therefore working on evaluating and developing the method further.”