Obesity Care

Immune cells in brain drive overeating

A study, from the University of California in San Francisco, has found that immune cells within the brain, known as microglia, could be responsible for weight gain caused by overeating. It has been known for some time that the hypothalamus contains neurons that regulate food intake and energy expenditure; in this study the researchers fed mice a high fat diet which is known to cause an increase in microglia. It was found that the high fat diet caused local inflammation within the hypothalamus, when compared to the control group of mice. They also found that the mice who had been fed high fat foods continued to consume more afterwards.

In order to prove that the increase in microglia was the cause of the overeating, some of the mice were given a drug that depleted their levels of the cell. They found that mice treated with the drug consumed 15% less and gained 20% less weight, compared to mice on the same diet. Mice were then engineered to form microglia that couldn’t mount an inflammatory response and they gained 40% less weight, suggesting that the effect of microglia could be crucial in our understanding of the development of obesity. The researchers are hoping to move their study on to humans in the near future to properly examine the effect of microglia on overeating and obesity and potentially help control them. In the immediate future they are going to investigate how the consumption of high-fat foods leads to the activation of microglia, and whether there is any way to stop these signals from being processed.

TV in the bedroom linked to childhood obesity

Preschool children can spend up to 12 hours a day in sedentary time, which can include watching television, playing electronic games and reading. Few preschool children are meeting the current recommendations of less than 1 hour of screen time per day, and are spending large amounts of time engaging in screen time. According to new research, children who have a TV in their bedroom at the age of 7 are more likely to become overweight.

Prof Russell Viner of the Royal College of Paediatrics and Child Health, who was not involved in the study, has said that “The study indicates, more research is needed to fully understand this complex area, but this is a high quality study covering a very large and nationally representative sample and provides a reasonably strong basis to think that the links shown here are real….it highlights that having a TV in the bedroom from seven years increases the risk of being overweight four years later, regardless of the child’s weight in earlier childhood. As such, the findings must be taken very seriously.”

Specialist clinics key to tackling obesity complications in pregnancy

In the UK, approximately 20% of pregnant women are obese and 2% have very severe obesity (BMI) ≥40 kg/m2.

According to a recent study, attendance at a specialised antenatal clinic for obesity was associated with reduced rates of stillbirth and low birthweight. It was also associated with improved detection of gestational diabetes.

The improvement in clinical outcomes was associated with an increase in the mother-to-be being attended to by healthcare staff. This allowed for complications to be identified earlier and therefore to obstetric triage and clinical interventions. This included induction of labour as well as caesarean sections.

Specialist antenatal clinics for severely obese mothers-to-be could help to cut the rates of pregnancy complications linked to obesity.

Maternal obesity linked to birth defects

A major study has found that women who are obese when they conceive are more likely to have a baby with serious birth defects.

Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity.

The study concluded that for women who are planning a pregnancy, efforts should be taken to encourage a reduced adiposity in those with a BMI above the healthy range, therefore greater than 25.

New type of weight measurement more accurate than BMI in teenagers

Researchers from the University of Alabama have found that triponderal body mass index (TMI) may be more accurate than BMI in estimating body fat amongst adolescents. In a study published in JAMA Paediatrics the researchers found that during adolescent development, weight was not proportional to height squared, which is the calculation for BMI. By examining data from 2,285 children and adolescents, in the Nutrition and Health Examination Survey, they found that TMI estimated body fat better than BMI. TMI itself is calculated by dividing weight by the cube of the height, they also reported that comparing TMI was much easier as it did not involve complicated percentiles, as comparing BMI does.

One particular area that the authors found BMI to be worse than TMI was the incorrect diagnosis of overweight. BMI calculations would do this 19.4% of the time, whilst TMI would result in 8.4% incorrect diagnoses, this data is especially important in lean adolescents. The authors stress that tracking body fat through adolescence is difficult as there is a complex relationship between height and weight due to the commencement of puberty. Further to this they highlighted that TMI should be considered in the context of other health and demographic factors. It is hoped that more research will be undertaken to assess the accuracy of TMI in a wider range of ethnicities and age ranges.

Childhood obesity quadruples risk of developing Type 2 Diabetes

According to a large-scale study published in the Journal of the Endocrine Society a child with obesity faces a four-fold increased risk of developing type 2 diabetes by the time they are 25 than their normal weight counterparts. The study examined data from 375 GP practices around the UK, using the UK Clinical Practice Research Datalink. In total this amounted to 369,362 children between the ages of 2 and 15. Children and adolescents with obesity constituted nearly half of all diagnoses of Type 2 Diabetes between 1994 and 2013. As expected, there was no relationship between obesity and Type 1 diabetes, which is caused by an underlying autoimmune disorder.

Dr Ali Abbasi, lead author from King’s College London said, “given that diabetes and obesity are preventable from early life, our findings and other research will hopefully motivate the public and policymakers to invest and engage in diabetes prevention efforts.” Both obesity and type 2 diabetes are large scale health problems that often present together, hopefully this research will be taken into account by experts and policy makers in the future.

Routine and regular bedtimes may help stave off obesity

A study from the Ohio State University has concluded that regular bedtimes, mealtimes, and limited screen time is related to emotional health and obesity in preschool children. The study has been published in the International Journal of Obesity, and uses data from the UK Millennium Cohort Study. For the research itself, data from 10,955 children was included; this was then combined with reports of routine and self-regulation to make the link with obesity rates. Regular bedtimes, mealtimes and limited screen times were all associated with improved emotional health regulation, children with greater dysregulation were more likely to be obese in later life. Even children who ‘usually’ had a bedtime had much higher rates of emotional dysregulation than those who ‘always’ had a bedtime.

It is hoped that this research will prompt further work into looking at the role of emotional self-regulation in weight gain and how routines can support healthy development. It is important to note that this work does not prove that routines prevent obesity, only that they improve emotion regulation, which in turn has a large effect on obesity.

Weight management program reduces job absenteeism

Obesity does not only have direct medical costs, but it also has wider economic costs that many of us do not think about. Examples of this are, missed time from work and lost productivity. This study, from the University of Michigan, aimed to analyse the effects of a weight management program with the focus being the impact that it had at work. The program itself is billed as a two year, multicomponent and multidisciplinary program for people with moderate to severe obesity. Low-calorie meal replacements are used in the early stages with a stepwise progression to food based diets and an eventual change in behaviour being the final outcome.

92 participants from a range of industries were involved in the study, the program itself was shortened to six months. However, the individuals lost an average of 41 pounds, further to this it was reported that before the program was initiated they were spending 5.2 fewer hours at work than what their employers expected, after the program they were spending 6.4 hours more than expected. A change in job performance was not seen, therefore the authors are hoping to further this research to discover if they can affect job productivity.

Metabolic syndrome branded the new ‘silent killer’

Metabolic syndrome is a cluster of three or more risk factors that increase your chances of developing heart disease, stroke and diabetes. These include, but are not limited to – increased blood pressure, abdominal obesity, high triglycerides, high blood pressure, and insulin resistance. Now, researchers from Florida Atlantic University, are claiming that metabolic syndrome has become a ‘silent killer’ of the modern age. They estimate that 1 in 3 adults in the USA are affected by metabolic syndrome, and as obesity is a major accelerator for the development of the problem, they say that being overweight is overtaking smoking as the leading avoidable cause of premature death in the US.

They have warned that individuals with metabolic syndrome remain largely asymptomatic, but have a similar risk of a first coronary event as those who have suffered one before. It is also suggested that metabolic syndrome is underdiagnosed and undertreated. In the commentary the researchers stress the importance of therapeutic lifestyle changes beginning in childhood as they estimate that the current generation of children and adolescents in the USA will be the first since 1960 to have higher mortality rates than their parents due mainly to cardiovascular disease. The export of the American diet and lifestyle was also accused of increasing global rates of obesity and physical inactivity. It is hoped that from now, metabolic syndrome will become more understood and clinicians will look for it in their patients in order to stop this growing problem.

Should weight loss be included in pain management?

A study from Leeds Beckett University has suggested that weight loss programmes should become part of pain management for obese patients. The team investigated 74 patients who were divided into groups according to their weight. They then applied pressure, cold and heat to different areas of their bodies. According to the researchers, obese patients are more susceptible to pressure pain than their normal weight counterparts. A similar result was found in the overweight participants. There was no difference in heat tolerance between the groups.

Study author, Dr Osama Tashini, explained that obese people are highly likely to experience pressure pain due to the mechanical impact of increased weight on their joints; this study found that it was not only the joints where they experienced high amounts of pain. Therefore, he has proposed, that as part of a normal pain management plan, overweight and obese patients should be counselled in weight loss. He did however point out that the study did not display clear causality, as obese patients may have been more sensitive to pressure pain before they gained weight, and were therefore more likely to not partake in physical activity.

Is birth weight a risk factor for fatty liver disease?

A study from the University of California has found that children with a high birth weight are more likely to develop hepatitis from fatty liver disease. This is after researchers conducted a study in 530 individuals under the age of 21 who had a confirmed diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD). They collected the birth weights of the individuals and found the link. Interestingly, they also found that children with a lower birth weight were more likely to develop scarring of the liver.

NAFLD describes a spectrum of diseases that begin with fatty deposits on the liver, as this disease progresses, the liver can become fibrotic and then enters a period of cirrhosis, which means it is permanently scarred. In extreme cases this can eventually lead to liver cancer. Birthweight itself involves many factors including maternal and in utero, this is one of the first studies to identify the risks of both extremes of weight in relation to developing NAFLD in later life.

Mobile health interventions – Improving youth health outcomes

A new meta-analysis has been published in JAMA Pediatrics that assesses the use of mobile-phone apps, and improved health outcomes, in children. Up until now, the only systematic review of mHealth intervention effectiveness focused exclusively on childhood obesity. The authors found that overall, smartphones can be extremely useful in not only promoting healthy behaviours such as diet and exercise, but also promoting the uptake of vaccines amongst children. They analysed 37 studies in total, looking at evidence that behaviours were changed in children (defined as 18 years old or younger). As many children now have access to mobile phones the authors wanted to thoroughly examine this modality as a form of education for children, parents and caregivers.

mHealth interventions can reach many people and can contain dynamic health-related data, further to this using certain algorithms these apps can deliver personalised advice at times when a caregiver may not be available. However the authors are keen to highlight that the best results were seen when a caregiver was still involved in the process and given the early stage of mHealth literature, these results must be replicated and furthered to fully examine the extent to which a caregiver should be involved, and what type of professional this is.