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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Preventing childhood obesity before conception
A research team from Case Western Reserve University, Cleveland, have recently received funding to determine if childhood obesity can be prevented even before a woman falls pregnant. They will specifically be analysing whether an exercise and nutrition program designed for mothers will have any effect on their future children’s health. Most studies up to this point have focused on programs after the woman has become pregnant, this is the first study of its kind. The Lifestyle Intervention in Preparation for Pregnancy Program (LIPP) will aim to reduce body fat and improve lipid and glucose metabolism in the body in women who are planning on having children.
For the study 200 women will be randomly assigned to two groups: usual care and LIPP, the women in LIPP will then be sub-divided into groups of 10 and receive varying amounts of education on nutrition, exercise programs and support groups. The team are currently seeking further funding so that they may be able to follow the women and any subsequent births in the future. The researchers are particularly excited as they might be able to prove that childhood obesity can in fact be prevented well before birth, and not simply treated after it has occurred.
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Brain signals dulled in obese children
The signals from our brain that tell us we’re full do not appear to work properly in obese children. This is the outcome of a study that is due to be presented at the Endocrine Society’s 99th annual meeting. The study used images of high-calorie foods and measured the brain activity of obese children after a meal, compared to their normal weight counterparts. Using a technique called Functional Magnetic Resonance Imaging (fMRI) the researchers were able to measure the brain activity in real-time.
For the trial, 54 obese children and 22 lean children were included, they were each shown pictures of high-calorie foods and low-calorie foods and then fed the same meal. This was calculated as 33% of the weight-based estimated daily calorie intake for each child, so that they were all ‘equally full’. They were then showed the images again and provided with a buffet meal. It was found that before the meal, there was no significant difference in brain activity between the two groups; further to this, both groups had similar self-ratings of fullness after the meal. However, when shown the images again, the obese children showed more brain activation in the regions of satiety processing than the normal weight children. This suggests that obese children have a somewhat blunted satiety response that does not halt them from craving high-calorie foods. The researchers are hoping to repeat the experiment after providing a six-month behavioural weight loss program to the children, to examine what can be done to change their habits.
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Is being overweight in pregnancy associated with the development of cerebral palsy?
A new study published in JAMA has found increased rates of cerebral palsy in children whose mothers are overweight or obese. The study was conducted in Sweden and analysed data from 1,423,929 children born between 1997 and 2012. In total, 3,029 children were diagnosed with cerebral palsy during this time, and it was found that increasing BMI was associated with an increased reporting of cerebral palsy. It is estimated that 45% of these cases was due to asphyxia-related complications.
Maternal overweight can increase the risk of asphyxia-related neonatal complications, preterm delivery, and congenital malformations, all of which are in turn associated with an increased risk of cerebral palsy. The authors want to highlight that whilst the effect of maternal obesity on cerebral palsy might be small when compared to other risk factors, the associated risk is relevant to public health due to the large number of women who are overweight and obese.
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Weight gain in a child’s first six months
Researchers from the University of Delaware have found that rapid weight gain in a child’s first six months could be a risk factor for obesity in later life. The researchers stated that nearly 10 percent of infants were considered ‘high weight for length’ and were keen to examine how infants could achieve a healthy weight as they enter childhood. It has been shown before that breastfeeding gives protection to babies against rapid weight gain and obesity, however in the USA around 60% of infants are exposed to formula as the exclusive form of nutrition or in combination with breast milk.
The authors of this study were aiming to examine how the various compositions of infant formulas affect energy balance, weight gain and growth. It was found that infants who received cow’s milk formula had a quicker weight gain, whilst those that received hydrolysed protein formula and breastmilk had a slower and similar weight gain. The researchers are hoping to conduct further research into the various effects of formula on weight gain, and the potential lasting effects. They also hope that parents are given more information in the future about what is best for their baby.
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