Obesity Care

How does birth weight affect adult obesity in a low resource context?

South Africa is experiencing rapid increases in weight gain across the entirety of its population. Obesity is rising in both males and females, across all ages and socioeconomic groups. Like many other low-middle-income countries, it is experiencing a double burden of malnutrition alongside these high obesity rates. Malnutrition is present in one quarter of children under the age of three, resulting in stunting.

This stunting has been reported to be associated with adulthood disease risk, including obesity. Researchers thus far have not been able to look at this relationship in a low-middle-income country in the same participants by following them from birth into early adulthood. The authors of this study were able to do this for the first time using the Birth to Twenty Cohort which is a longitudinal study of children born in 1990 in South Africa.

Authors found that relative weight gain from birth into adulthood was positively related to fat mass, including both visceral and subcutaneous fat in adulthood. Being stunted at age two was inversely associated with fat-free soft tissue mass (i.e. lean body mass) in adulthood. This finding is analogous to trends that have been shown across Brazil, Guatemala and India.

What is driving rates of obesity in Chinese boys?

Over recent decades, alongside economic development, China has undergone a rapid nutrition transition that has resulted in a dramatic acceleration of obesity. Unlike other countries across the world, like the USA and UK, where childhood obesity rates have stabilised, the prevalence in China continues to worsen.

This crisis in China is also unique in terms of how it presents between genders. Dissimilar to other countries, obesity is higher in boys than girls. Boys are almost twice as likely to have obesity. Up until now, there has been limited evidence explaining why these unique sex differences have emerged.

Using a cross-sectional national health survey, Wang and colleagues revealed, as would be expected, that adolescent boys were much more likely to have energy intakes exceeding expectations. Importantly however, it found significantly different self-perceptions by sex, with boys much more likely to underestimate their weight and be satisfied with their current health behaviours.

These weight perceptions were supported by mothers, who were more accurate in predicting their daughter’s weight vs those with a son. Clearly, weight-related beliefs in China have a role to play in the increasing – and widening – rates of obesity in children.

The lasting impact of where we live

The neighbourhoods we live in influence how we behave and ultimately shape our health outcomes. Regardless of how much money an individual earns, if they live in a less-affluent neighbourhood evidence would tell us that they will have poorer health outcomes than if they lived in a more affluent neighbourhood. This effect is particularly strong when looking at obesity and diabetes.

While this has been long understood, little is known about when risk factors emerge in childhood and adulthood in individuals living in socioeconomically different neighbourhoods, and the cumulative effect of disadvantage over childhood. Researchers from Finland set out to answer this question through a population cohort, where participants were measured at repeated intervals for adiposity and behavioural risk factors. By linking postal codes to neighbourhood deprivation scores, researchers assessed the impact of living conditions on diabetes outcomes.

They found that detrimental lifestyle factors by neighbourhood living conditions are present right from childhood and worsen into adulthood. These risk factors accumulate over time to accelerate increased rates of obesity, hypertension and fatty liver by middle age.

When do trends of inactivity begin?

Physical activity is important for both the current and future health of children. For a long time a belief has been held that children are adequately active with a dramatic decline in behaviour beginning from later adolescence into adulthood. This decline is much more significant in girls then in boys. Based on this understanding, for many years adolescent physical activity has been targeted by both national and international organisations. However, there has been a recent suggestion that declines in activity begin earlier than adolescence.

A group of researchers from Glasgow set out to determine when exactly changes in activity take place. They used a UK longitudinal cohort study from North-East England with data on participants across eight years. In physical activity research, questionnaires have shown to be highly unreliable and inaccurate, but they are often what is used in cohort studies as they are low cost. In this cohort, objective data using accelerometers (electronic monitors that record activity patterns across the day) were used at four separate years, making it a valuable resource to look at changes over time.

The researchers revealed that all trajectories of activity behaviour declined from seven years of age with no indication of a difference by gender. This analysis proves earlier understanding wrong and provides a strong case that policy and intervention efforts should begin well before adolescence.

Assessment of dietary patterns, physical activity and obesity among older US adults

Obesity in older adults results in premature declines in physical and mental health and cognitive functioning. Evidence shows that the incidence of obesity and chronic diseases are higher in rural areas than in urban areas. Furthermore, more older adults are concentrated in these rural areas. There is limited understanding of the behavioural factors driving increases in obesity in older adults in rural communities. Specifically, if differences in dietary behaviour between rural and urban settings contribute to elevated obesity rates. A study recently published in in PLOS One set out to firstly assess rural-urban differences in obesity rates in older adults, and secondly the relationship with dietary patterns.

Researchers used census data in a sample of respondents aged 65 years of age and above from the USA. Regression models were utilized to investigate if rural-urban disparities in obesity, and associations with risk factors of fruit consumption, green vegetable consumption and physical activity. The results revealed, consistent with earlier evidence, that obesity rates were highest in rural areas. In these rural areas, fruit consumption was the lowest. A negative association between obesity and fruit and green vegetable consumption was observed in urban but not rural settings. These findings illustrate the importance of considering urban-rural status when developing obesity prevention programs and strategies. Interventions need to address the unique barriers experienced between the two settings.

Predictors of weight gain in school children

Childhood obesity is a growing public health concern given the rising prevalence rates observed in both developed and developing countries. There are a multitude of health-related consequences that worsen into adulthood. Current estimates demonstrate that about 25% of children are overweight or obese. Given that obesity tracks into adulthood understanding why and how it emerges in early life is critical to developing effective preventative efforts.

In the European Journal of Clinical Nutrition, a recent analysis explored predictors of BMI change, overweight and obesity in school children. This was conducted in a prospective manner using a cohort of Irish school children 6-10 years of age. Height and weight were assessed objectively and lifestyle factors through a questionnaire with parents. These measurements were assessed five years apart at baseline and follow-up. Logistical regression models were then run by the researchers to understand the associations.

Initial BMI was the main predictor of subsequent overweight and obesity in schoolchildren, followed by the socioeconomic status of the school. Schools in disadvantaged areas had higher rates of obesity. Alongside this processed food consumption, lower levels of participation in sport clubs and low fruit intake was associated with higher levels of obesity. These findings illustrate the need for programmes aimed at preventing obesity with a focus on early years and disadvantaged communities.

Access to green space plays a role in the development of diabetes

Socioeconomic characteristics of the urban environments and neighbourhoods are associated with rates of obesity and type 2 diabetes. Access to green space within an individual’s residential area has been shown to be beneficial for health and well-being however, there is limited understanding of the relationship with type 2 diabetes. The aim of this study in the BMJ Open was to investigate the relationship between green space, body mass index (BMI) and type 2 diabetes.

The study examined this relationship in adults (25-74 years of age) in a large German city through the Dortmund Health Study. Researchers used geographical information systems to develop three indicators of green space: proportion of green space, available recreation area per person and distance to the next park or forest. Through regression analyses researchers demonstrated no association between green space and BMI. However, a lack of green space and further distance from parks or forests resulted in increased incidence of type 2 diabetes. The results suggest the availability of green space is an important part of the residential environment playing a role in the development of type 2 diabetes. It is essential to consider the built environment individuals live in when developing prevention plans and actions.

Childhood obesity inequalities in Britain are increasing over time

Across most high-income countries in the world socioeconomic inequalities in childhood obesity have been well documented. However, it is not clear how they have changed over time. Using Britain as an example, this study published in The Lancet, investigated how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time.

The analyses demonstrated that from 1953 to 2015 socioeconomic associated inequalities in childhood obesity emerged and widened, while height differences became narrower. In 2001, at age 11 a there was a difference of 1.40 kg at the 50th weight percentile whereas a difference of 4.88 kg was observed at the 90th weight percentile. This finding that relative socioeconomic inequalities in obesity are worsening is consistent with other cross-sectional evidence including the UK’s national measurement program.

These significant changes show the impact of social changes on child and adolescent growth and development. The increasingly obesogenic environments in societies disproportionately affects disadvantaged children. These findings illustrate that the numerous policy initiatives implemented in Britain since 1991 have been insufficient and ineffective.

As these inequalities continue to widen there is clearly a need for new approaches to reduce differences in rates of childhood obesity between advantaged and disadvantaged populations. These trends are similar in many countries globally. Without effective interventions, inequalities seen in childhood and adolescence will continue to widen further throughout adulthood with significant health consequences.

Acute and Chronic Effects of Exercise on Appetite, Energy Intake, and Appetite-Related Hormones

The simple equation for obesity is Energy out < Energy in. The simplest way of increasing our ‘Energy out’, is to exercise more. However, the benefits of exercise extend beyond just calories, and in fact, it’s thought that exercise can improve subjective and homeostatic mediators of appetite in directions associated with enhanced meal-induced satiety. The degree to which this effect exists in an individual is highly variable and difficult to predict. This review, published in Nutrients, seeks to understand how adiposity, sex, and habitual physical activity modulate exercise-induced appetite, energy intake, and appetite-related hormone responses.

The review found that changes in perceptions of appetite, energy intake, and macronutrient composition in response to acute and chronic exercise stimuli are not modulated by levels of body adiposity or sex. However, in individuals with higher levels of habitual physical activity, they may exhibit improved sensitivity of the appetite control system through better compensatory adjustments for the energy content and density of food.

Although not conclusive, this paper draws attention to the benefits of exercise and need for an improved understanding of the individual factors that modulate appetite, appetite-related hormones, and food intake. Responses to exercise may help to explain the individual variability in body weight changes, and to facilitate the development of more efficacious weight management interventions.

A long-term maternal diet intervention to avoid the obesogenic effect in the offspring

The American Heart Association states that obesity among girls and women has generated a vicious cycle that contributes to the obesity epidemic. Studies into maternal overnutrition have found that high-fat diets in humans (which reflects the western diet), whereby the baby is exposed to over-nutrition during gestation, have increased risks of obesity, diabetes and other complications. In this study, published in The Journal of Nutritional Biochemistry, the diets of pregnant mice are varied to see whether they can prevent obesity related disease in the offspring, regardless of the weight-management of the mother.

The researchers transitioned the mice to normal fat (NF) diet 1 week, 5 weeks and 9 weeks before conception and continued this throughout gestation and lactation. After this, the offspring were given a high-fat diet for 12 weeks then sacrificed. They found that the mice whose parent had the NF diet for 9 weeks had a reduced risk of obesity, diabetes and other complications, regardless of maternal weight, suggesting a metabolic memory in the offspring that can be improved. Although the metabolic profiles of mice and humans are vastly different, the ease of access and economy of lifestyle interventions mean that a strategy to improve maternal diet for a period before conception, may be able to help prevent multi-generational obesity.

Eating faster is associated with general and abdominal obesity among Chinese children

Eating faster results in an increased rate of energy intake. However, the relationship between children’s eating speed, food intake and general abdominal adiposity is unknown, and forms the basis of this paper. A total of 50,037 Chinese children aged 7-17 years were enrolled from 7 provinces in China in 2013. Objective measurements of anthropometrics were taken and food speed was assessed by questionnaire.

There was a significant increasing trend across the slow, medium, and fast eating speed groups observed, in the prevalence of general obesity (7.2%, 10.0% and 15.9%), abdominal obesity (16.1%, 21.8%, and 29.4%) and waist-to-height ratio (WHtR) ≥ 0.5 (11.1%, 14.8%, and 22.0%). Compared with medium eating speed, fast eating speed was positively associated with obesity, abdominal obesity, and WHtR ≥ 0.5, while slow eating speed was negatively associated with these outcomes. They also found increased speed was associated with increased consumption.

Although this paper doesn’t tell us anything of the mechanism of this phenomenon, there are several biologically plausible suggestions. Such as, fast-eating leads to lower satiety and higher calorie intake, while slow-eating leads to enhanced thermic effect of food and also influences the release of gastrointestinal satiety hormones. More research should be done to see if it’s possible to change eating speed in adults, and whether this has any effect on obesity, as this could provide a simple non-invasive therapeutic target.

5 Resources All Health Professionals Should Know About

A lot of resources that are available for healthcare professionals (HCPs) are outdated, too commercial, and lack trust from the HCP community. But there are some hidden gems however, especially concerning the fields of modern health conditions, that we believe will be beneficial for those who utilise them.

1. Professr

Have you ever wanted somewhere other than Facebook to communicate with fellow health professionals?
Professr is UK based digital startup with a dedicated platform for health professionals to communicate and network with one another.

The platform is provided as a free resource to health professionals, with the intention of encouraging multidisciplinary communication and helping health professionals to support each other in an increasingly high pressure healthcare environment. This is particularly important for those who are newer to their field of practice (i.e. junior doctors), or those who work in remote or isolated conditions (i.e. outreach workers).

Professr’s forum-like features allow members to upvote and downvote answers to questions relating to healthcare, creating a repository of community-rated information. Having an opportunity to gain insights with professionals from multiple disciplines enriches the perspective of a health professional and can aid in providing better outcomes for patients.

2. CCH Toolkits

The College of Contemporary Health (CCH) is renowned as the leading global educator for obesity. They offer a range of course types including postgraduate courses and modules, short courses and on-demand courses. The short courses and on-demand courses both offer continuing professional development (CPD) credits which can be used to build professional standing, while the postgraduate options are ideal for healthcare professionals who are looking to further develop their skills and understanding in weight management and obesity care.

Besides a full range postgraduate and short courses, CCH has developed an ever growing range of toolkits. CCH toolkits are designed to be used as handouts for health professionals who can use them for themselves, or distribute to their patients.

These toolkits are easily available, open for the public, and completely free. Here you will find resources associated with health, weight management, nutrition, sleep, fatigue, mental health and many other contemporary health issues that you can refer to, and use, both personally and professionally.

The CCH Team are committed to building a comprehensive library of resources, and are constantly updating their website with new toolkits, so be sure to come back frequently or subscribe to CCH’s mailing list and have new toolkits delivered to your mailbox monthly.

You can sign up here: https://www.contemporaryhealth.co.uk/preferences

3. Conferences (Diabetes Professional Care)

Conferences are an excellent resource for health professionals that are often not utilised enough. They provide a great place to network, learn from industry leaders, and build relationships with those who share a passion for the same field of health you practise in.

Although conferences can sometimes be rather pricey to attend, some of the best ones, are in fact, free. An example of a great free-to-attend conference is Diabetes Professional Care (DPC). DPC is the is a unique, free-to-attend, CPD-accredited event for healthcare professionals (HCPs) involved in the prevention, treatment and management of diabetes, and its related conditions. Launched in 2015, DPC meets a real and increasing need for accessible education among HCPs by arming them with the skills and knowledge to provide better care for their patients.

DPC2017 attracted a record attendance of 3,235 visitors – and DPC2018 promises to be even bigger and better. So, if you’re a professional responsible for delivering diabetes care pathways at any level, it is the one event you can’t afford to miss.

This year’s DPC is on the 14th and 15th of November in London’s Kensington Olympia.

You can find more information here: https://www.diabetesprofessionalcare.com/

4. BMJ Best Practice

Healthtech is a constantly growing field and isn’t just limited to our two previously mentioned healthtech innovators such as great social platforms like Professr, and forward thinking online education institution, the College of Contemporary Health.

Instead, there has been an emergence of tools that help personal performance as a health professional and aid practice. One such tool is BMJ Best Practice.

BMJ Best Practice is ranked one of the best clinical decision support tools for health professionals worldwide. It takes you quickly and accurately to the latest evidence-based information, whenever and wherever you need it. They provide a step-by-step guidance on diagnosis, prognosis, treatment and prevention that is updated daily using robust evidence based methodology and expert opinion. Their goal is to support you in implementing good practice.

You can find more information on BMJ Best Practice here: https://bestpractice.bmj.com/info/

5. Podcasts. (Dr Chatterjee’s Feel Better, Live More)

In the field of health, there are always new developments and information that health professionals are constantly being bombarded with, and in many cases, just don’t have the time to read, watch, or catch up with. Podcasts are an excellent way of keeping up-to-date with the latest information without having to invest a huge amount of time or focus doing so. Podcasts can be listened to passively while you’re commuting, doing the washing up, or whatever mundane task you may be performing.

Our podcast pick is Dr Chatterjee’s Feel Better, Live More. It covers a range of topical issues in health, usually with highly influential guests who are experts in the area being covered. Topics have ranged from childhood obesity with Jamie Oliver, to brain nourishing foods with neuroscientist, Dr Lisa Mosconi.

The podcast is usually released on a weekly basis so it can fit into your busy schedule, perhaps your Monday morning commute.

For more information please click here: drchatterjee.com/blog/category/podcast/