Obesity Care

Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals

It is common knowledge that exercise can play an important role in treating the physical parts of obesity, however the emotional benefits are less often talked about. In this study, published by the Brazilian journal Arquivos de Neuro-Psiquiatria  63 overweight or obese patients were randomly split into 3 groups, a control group (n=20), a Pilates group (n=22) and a walking group (n=21).  The two exercise groups had to complete three, 60-minute sessions per week of their exercise. There were three psychological assessments conducted on each patient looking at quality of life, depression, state-anxiety and trait-anxiety. These were conducted before and after the 8 weeks.

The Walking group showed improvements in the quality of life domains of social functioning (20.3%) and mental health (21.8%). In addition, there were significant decreases in the levels of depression (35.2%), trait-anxiety (15.1%), and state-anxiety (18.5%).

For the Pilates group, improvements were observed in the quality of life domains of vitality (28%), social functioning (29.2%) and mental health (19%). In addition, there were significant decreases in the levels of depression (27.5%) and trait-anxiety (14.1%).

In some patients with obesity, emotional malfunction seems to inhibit the positive perception of the physical benefits of exercise. An alternative approach could point towards the mental and emotional benefits of exercise; this may be the trigger/motivator for people’s perception of physical activity programs to change and thus be taken up more enthusiastically.

Effect of 7 days of exercise on exogenous carbohydrate oxidation and insulin resistance in children with obesity

It has been shown in adults that the capacity to match carbohydrate (CHO) oxidation with carbohydrate availability, known as metabolic flexibility (MetFlex), may be important for type 2 diabetes prevention. Improved MetFlex is associated with improvements to insulin resistance (IR) and can be achieved with as little as 7 days exercise.

In this small study published in the Journal of Applied Physiology and Metabolism, 12 children (8 boys and 4 girls) underwent 7 days of exercise in order to determine whether MetFlex and IR would improve. Participants underwent a combination of continuous and high intensity exercise sessions over the course of seven days. Each session consisting of 3 20-minute blocks. In spite of good adherence, no improvement to MetFlex or IR was found. The authors go on to comment that future research should investigate exercise volume, sex and pubertal effects on the responsiveness of MetFlex to exercise in children.

Sleep Health and Psychopathology Mediate Executive Deficits in Paediatric Obesity

A new study from Childhood Obesity has found that paediatric obesity is associated with impairment of some components of reward-related decision-making and executive functioning, as well as poorer sleep health and greater risk of internalising psychopathology. Obese children showed reduced ability to adapt behaviour to changing reward contingencies and also the presence of executive dysfunction under everyday behaviour regulation. There were 112 participants in the study, in which researchers conducted a range of tasks to test different psycho-metrics, using only non-food stimuli. Alongside this, parents were asked to fill out standardised questionnaires to assess sleep health, psychiatric symptoms and executive function.

The parental reports indicated that children with obesity had poorer sleep, despite equal sleep duration, and a four times greater risk of experiencing internalising psychopathology. Importantly these mediated the negative effects on everyday behavioural regulation and meta-cognitive abilities. One of the constraints of the study, that the authors highlight, is that it’s unclear whether obesity is the cause or consequence.

Further studies have been proposed which would closely monitor physiological and metabolic variables in Pre and Post weight loss subjects to disambiguate the relationship. The study authors go on to reiterate the importance of understanding this relationship as it could be a key new therapy target.

Harmful effects of overweight are underestimated

A study from the University of Bristol has found that the harmful effects of overweight and obesity are being underestimated. The study, which contained data from around 60,000 parents and their children, analysed how obesity and BMI influences the risk of death. Previous studies have suggested the optimal BMI, at which the risk of death is minimised, is slightly above the recommended ‘normal’ range, meaning that it is good for you to be slightly overweight. However some disease courses can lead to you having a lower BMI but a higher risk of death, this makes it highly difficult to estimate how BMI actually influences risk of death.

The researchers used parent and child combinations as BMI is related due to genetic factors, however the BMI of ‘adult’ children is not influenced by illness amongst the parents, therefore using the offspring BMI avoids the problems inherent with simply relating the parent BMI to their risk of death. They found that when offspring BMI was used instead of the parent’s own BMI, the apparent harmful effects of low BMI were reduced, and the harmful effects of high BMI were greater than those found in the conventional analyses. These results therefore suggest that current studies may tend to underestimate the harmful effects of a higher BMI. The authors are therefore calling for more robust approaches for identifying causal relationships influencing health, especially the relationship of BMI to overall health.

Obesity worsens asthma in preschool children

Findings from a new study published in the Journal of Clinical Immunology have concluded that obesity can add five weeks of asthma symptoms in children ages 2 to 5. The researchers also found that untreated children who were overweight had more asthma attacks than untreated children of a healthy weight. The study also found that the effectiveness of steroid inhalers is not reduced in overweight or obese pre-schoolers, findings that are the opposite in older children and adults. Therefore, this study suggests that either the pathways of inflammation are different in younger children, or that it takes a long time for obesity to reduce the effectiveness of inhaled corticosteroids.

Overall, the study included data from 736 children, and is a retrospective analysis, making the conclusions slightly weaker. Therefore, the researchers hope that further research with a larger number of children might take place, and that this study is the catalyst for it.

Obesity not quite associated with improved survival

A controversial body of research has suggested that obesity may be associated with an improved rate of survival in patients with cardiovascular disease. It has been suggested in the past that because obese individuals have an extra catabolic reserve, and many diseases result in the wasting away at the end of life, they could prolong survival. However, a new study from the New York University College of Global Health has found that this ‘obesity paradox’ is not present among those with new cases of cardiovascular disease. Previous studies often included patients with established cardiovascular disease, where disease related factors may have biased towards an observation of a paradox.

In this study, the researchers used data from a nationally representative set from the United States that contains surveys of more than 30,000 people. Looking at a variety of cardiovascular issues and weight change over time the researchers found a strong association with the ‘obesity paradox’; the risk of death was 18 to 36 percent lower for people with obesity compared to those of a normal weight. However, in those with new cardiovascular disease, this association was not seen. This conclusion suggests that studies which include individuals with established cardiovascular factors are likely to be biased by factors such as disease related weight loss. The authors are keen to highlight that the findings do not support re-evaluation of guidelines to account for the obesity paradox.

Differing ethnic risks of obesity explained

For many years it has been believed that black individuals have a higher risk of developing diabetes, and the reason for this was unexplained. However, a new study published in JAMA has concluded that rates of obesity are what drives the differences in diabetes incidence between black and white individuals. Data from 4,251 individuals enrolled in a separate study was used for this research, spanning a range of states within the USA. Previous studies have found that higher rates of diabetes are present in black populations even when risk factors such as obesity and socioeconomic status are taken into account. Many of these studies measured parameters such as obesity, physical activity, and diet once during their participants’ lives. This study found that the black population tended to gain more weight over time, thereby increasing their risk of developing diabetes.

There will be no easy fix for this complex issue as it involves a variety of biological, socioeconomic, cultural, and behavioural factors. The study authors explained that it is vital for there to be equal access to healthy foods, spaces for physical activity, and economic opportunity to afford these things. If we were to control these risk factors we may go some way to controlling the effects of obesity, such as diabetes.

Binge eating as a weight loss obstacle

A new study from the University of Pennsylvania has found that those who binge eat whilst they are trying to lose weight, drop around half as much as those who do not, these findings have been published in Obesity. In order to assess the role of binge eating, and how addictive behaviours affect treatment for a variety of populations, the researchers used data from over 5,000 overweight and obese patients as part of a multi-centre randomised controlled trial. Over the course of the trial, the participants noted any instances of consumption of excess food resulting from a feeling of lack of control, and these were recorded on questionnaires.

The researchers found that at four years participants that reported no binge eating, or a reduced tendency to do so, lost more weight (4.6% of initial body weight) than those who did binge eat (1.9%). In light of these findings, the authors have suggested that behavioural therapies might benefit those that binge eat if they are trying to lose weight and would be effective in conjunction with established weight loss interventions. Further to this, they proposed that binge eating tendencies should be monitored throughout weight loss periods, so that individuals can benefit from a more targeted approach.

Obesity during pregnancy directly results in foetal overgrowth

A recent study published in JAMA Paediatrics has suggested that being obese during pregnancy increases the risk of giving birth to an atypically large infant, this is independent of other health effects such as diabetes that may also be present. A large foetus – macrosomia – can present a variety of problems during pregnancy and labour. Macrosomia itself can increase the chances of the foetus suffering a bone fracture during delivery and the need for a caesarean section, the risks to the mother include an increased incidence of post-partum haemorrhage.

Using data from over 2,800 pregnant women the researchers were able to categorise, according to BMI, and control for accompanying diseases (such as diabetes and high blood pressure), they also analysed the ultrasound scans of the participants in order to assess the size of the foetus. It was found that foetuses of obese women were generally larger than their non-obese-mother counterparts. Importantly, the researchers were not able to examine the exact reason for the difference in size; they did however theorize that disorders such as insulin resistance in the mothers can lead to an increased blood pressure and therefore overgrowth in the foetus. They called for further study in this area to assess what further health issues the children may face, and to analyse the exact mechanism by which the children are large for dates.

Weight management programme can induce remission in type 2 diabetics

An intensive weight management programme has been shown to induce remission in patients with type 2 diabetes at one year, without the help of medications, according to a new randomised controlled trial. The study has been published in The Lancet and shows that after 1 year, half of the participants had not only induced remission of diabetes but on average each had lost 10kg (compared to 1kg for the control group). Previous research from the same team highlighted that type 2 diabetes is caused by excess fat within the liver and pancreas, they then suggested that intensive weight management with a very low calorie diet could help reverse this.

The researchers explained that current treatments for diabetes do not address the root cause; they focus on reducing blood sugar levels. This study aimed to develop discussion of using weight management and cutting calories as a form of treatment to induce remission. 298 adults took part in the trial, all of whom had been diagnosed with type 2 diabetes within the previous 6 years across the United Kingdom. The programme itself involved a preliminary diet replacement phase for 3-5 months, followed by stepped food reintroduction for 2-8 weeks. This was combined with interventions such as cognitive behavioural therapy and strategies to increase physical activity. All anti-diabetic medications were stopped at the beginning of the trial. The study authors have explained that the weight loss goals provided by the programme are largely achievable for many individuals struggling with weight management. Further to this, follow up of this particular trial will continue for four years in order to assess the long-term results.

Levels of obesity within the healthcare workforce

A recent study has examined the prevalence of obesity amongst health care professionals in England. It found that 25.1% of nurses were obese whilst 31.9% of unregistered care workers were obese. Using data from the Health Survey for England, 20,103 individuals were included. This study itself did not examine the reasons for obesity within the healthcare professional population; however it was hypothesised that the largely disruptive shift pattern of work would be a significant contributor. The study also suggests that being obese could get in the way of providing the best care for patients and may also mean that nurses are more likely to have to take time off due to other health conditions related to obesity.

The researchers were hoping that their findings would help policymakers pay more attention to improving staff health. This would not only have positive implications for the overall health of the workforce but could also help improve patient centred care, especially as many of the general population can look to the health workforce as role models when it comes to medical health.

Obesity knowledge in medical students assessed

Recently, a small team of researchers in Norway developed a 20-item questionnaire assessing level of obesity knowledge and published their results in Obesity Facts. The questionnaire was given to a group of final year medical students and the results were compared against a group of experts and a group of first year students. 281 individuals in total took part in the survey, with the majority of these being final year students (226), with 13 experts and 96 first year students. The results showed that experts scored significantly higher than both the final year students and the first year students. In addition to this the final year students scored significantly higher than the first year students, however it was suggested that their level of obesity knowledge was still inadequate, especially with regard to aetiology, diagnosis and treatment aspects.

As obesity is becoming a global problem it is vital that health care providers are given the adequate knowledge and skills in order to effectively tackle the problem. This study suggests that the provision of these skills should start early, even at medical school, for future doctors so that they may have the confidence to appropriately treat patients who are overweight or obese. Further assessment of medical student competency should be carried out so that universities can revise their curricula and improve the standard of care for overweight individuals.