Obesity Care

Obese children have a 60% higher healthcare cost

An Australian study has found that obese children aged two to five have a 60% higher healthcare cost than their healthy weight counterparts. The article, published in Obesity, is one of the first to directly compare the healthcare costs of obesity in preschool children when compared to those of a normal weight. The study included 350 children in total, and found that obese children were also 2-3 times more likely to require hospital admission. Commonly these children were being admitted for ear, nose and throat problems, as well as respiratory disorders.

The researchers are hoping to highlight the fact that whilst childhood obesity has a huge impact on the health of a child, there are also economic impacts that may have previously been overlooked. Worldwide, it is thought that around 6.9% of children are obese, but in wealthier countries this number is far higher, with 23% of Australian children suffering from overweight and obesity. It has been shown before that obesity tracks into adulthood, and this can cause further health problems, but this study serves to highlight that the economic impact should not be ignored, and healthcare funders should take this information into account.

Young and overweight? A greater risk for future heart failure

The time in one’s life at which an individual chooses to lose weight may have more of an effect on their risk of having a heart attack than previously thought. Research from the Norwegian University of Science and Technology has found that those who don’t adopt a healthy lifestyle early, and recover from overweight, are at a far higher risk of developing heart problems, compared to those who have already adapted their habits. The study analysed data from 26,000 people over 30 years and found that the most recent BMI measurement corresponded to the risk of having a heart attack, however the person’s average BMI over a 30-year period was strongly related to the risk of heart failure.

The researchers noticed that those with a higher BMI early in life were at the greatest risk of developing heart failure. They adjusted for a variety of personal and lifestyle factors, and concluded that obesity may weaken the heart, and obesity at a young age predisposes it to failure. A secondary analysis within the study found that maintaining a stable weight over a period of time lowered people’s risk of future heart failure, highlighting the dangers of yo-yo dieting.

SORLA – Controlling insulin signals and promoting obesity

SORLA is a protein that influences the balance of metabolic processes in fat tissue. An increased amount of SORLA can make cells overly sensitive to insulin, which leads them to break down less fat. A collaborative team of researchers at the Max Delbrück Center for Molecular Medicine and the University of Leipzig have discovered new mechanisms by which SORLA functions. By analysing the SORLA levels in 362 obese people, they found that the more SORLA you have, the more obese you are, they then established a causal link by expressing high levels of SORLA in mice, and analysing weight fluctuation patterns.

The researchers studied SORLA and found that it makes cells express more receptors for insulin, thereby making them oversensitive to it; this in turn meant that these cells would not break down fat, leading to deposits of fat in tissue. Disruptions in insulin signalling are a feature of diabetes and with this research a whole new pathway of insulin signalling has been discovered, which could lead to potential treatments of both diabetes and obesity.

Timing of meals as important as substance

A review on research into meal patterns has found that eating at irregular times could increase your risk of developing metabolic syndrome. With many peoples’ lives getting busier, and our lifestyle getting more irregular, when we eat has become a major problem. Two papers published in the Proceedings of the Nutrition Society explore the effects that irregular meal patterns have; they have found that eating inconsistently affects the ‘circadian rhythm’ or the body clock. Many metabolic processes follow the circadian pattern, such as appetite control and metabolism of food. Other studies have shown that people who work shifts, and therefore eat at irregular times, are much more likely to develop conditions such as cancer, cardiovascular disease, and metabolic syndrome.

Eating small sized meals frequently has been a characteristic of many fad diets, however this may not be healthy, as some studies show that a greater number of meals leads to a greater risk of obesity. The authors are keen to point out that what we eat is also extremely important. Meal patterns differ globally, as well as the importance of certain meals, this could aid future studies on the effects of timings of meals on the development of disease such as metabolic syndrome. However, currently there is limited evidence on this phenomenon, and the authors are hoping that larger scale studies will be performed to further our understanding of it.

Overweight adolescents have increased risk of liver disease

A 40-year study of 45,000 men has shown that BMI in late adolescence predicts the development of liver disease in later life. The study was performed in Sweden and was conducted in order to improve prevention programs for liver disease, by increasing our ability to predict it. The researchers noticed that whilst there has been an increase in the global prevalence of obesity, there has also been a rise in the prevalence of liver disease. It is known that the two are linked, therefore they are hoping to reduce the impact of complications caused by obesity, by improving our understanding of how to predict them.

The study took place over 40 years and included 45,000 Swedish conscripts, of which only 1% were lost to follow-up. Overall, it was shown that there was a 64% increased risk in men who were overweight in late adolescence compared to those who were a normal weight. The researchers hypothesise that this may be due to the fact that those who developed liver disease were exposed to overweight and obesity for an increased period of time. The authors of the study are hoping to further this research in the future, by gaining an understanding of the type and magnitude of risk for liver disease that overweight carries.

Obesity linked to abnormal reward response to sugary food

In a study published in Diabetes, it was found that age, obesity and dopamine may influence an individual’s preference for sweet foods. It is believed that the finding may reveal a dysfunction in the brains of individuals with obesity.

The researchers studied 20 subjects with healthy weights and compared them to 24 people classified as obese (therefore with a BMI of 30 or higher). The study participants received drinks containing varying levels of sugar in order to determine their individual preference for degree of sweetness. PET scans were then conducted to identify dopamine receptors linked to rewards in each of the participants’ brains.  The PET scans revealed that although there was a relationship between dopamine receptors and preference for sugary item and age in lean participants, that pattern was not the same in the brains of obese participants.

Mother’s high-fat, high-sugar diet may affect future generations

 Obesity can predispose offspring in subsequent generations to metabolic problems, a recent study published by the Washington University School of Medicine has found. Kelle H Moley, professor at Washington University, said that “our data was the first to show that pregnant mouse mothers with metabolic syndrome can transmit dysfunctional mitochondria through the female bloodline to three generations”.

The team conducted the research in mice who were fed foods consisting of 60% fat and 20% sugar. The mouse offspring were later fed a controlled diet of standard rodent chow which is high in protein and low in fat and sugar. Even though the pups (grand-pups and great-grand pups) were fed a healthy diet they developed insulin resistance and metabolic problems. “Over the decades, our diets have worsened, in large part due to processed foods and fast foods. We’re seeing the effects in the current obesity crisis,” Kelle H Moley said.

Low folate during pregnancy may be linked to childhood obesity

In a study published online in JAMA Pediatrics it was found that proper maternal folate levels during pregnancy may protect children from a future risk of obesity, particularly those born to obese mothers. The study, funded by the National Institutes for Health, found an L-shaped association between maternal folate and childhood weight. An elevated risk was observed in children born to mothers in the lowest quartile of folate concentration. If the mother had not only low folate levels but was also obese the risk was higher.

Xionbin Wang, MD, MPH, ScD, from Johns Hopkins University, the study’s principal investigator, said: “our findings underscore the need to establish and ensure optimal rather than minimal maternal folate concentrations for preventing offspring adverse metabolic outcomes, especially among obese mothers.”

Larger bottles may start infant weight issues

Feeding babies form a larger bottle may put them at higher risk for greater-than-normal weight gain and weight-for-length size, according to a study published in Pediatrics. In the study, 298 babies were assessed and it was found that bottle size in early infancy was an important factor when measuring for unhealthy weight gain and obesity risk at 6 months of age.

The infants were fed exclusively from bottles containing formula, and almost half of parents used a ‘large’ bottle which is defined as one that holds 6 ounces (approximately 170ml) or more of formula. The study found that infants fed from the ‘large’ bottles gained about 7 ounces more and had larger weigh-for-length size at the 6-month mark.

Dr Charles Wood, co-author of the study and a paediatrician, hypothesised that “potentially, they (the infants) were being overfed”. The study concluded that reducing bottle size may be one way that early onset obesity could be reduced.

Obesity and gestational diabetes in mothers linked to early onset of puberty in daughters

According to a study published in the American Journal of Epidemiology, daughters of overweight mothers, who develop gestational diabetes, are significantly more likely to experience earlier onset of one or more signs of puberty.

The study was based on long-term research of an ethnically diverse sample of girls and their mothers. The girls were followed from 2005 to 2012 with yearly clinic visits where their heights, weights and other parameters were measured and recorded. The researchers found that girls whose mothers were overweight before their pregnancy and who had gestational diabetes were 2.5 times more likely to have earlier onset of pubic hair development than their peers whose mothers were not overweight during pregnancy and who did not have gestational diabetes.

Ai Kubo, MPH, PhD, the study’s lead author and an epidemiologist at the Kaiser Permanente Division of Research, explained that “very few previous studies have examined the association between maternal pregnancy or pre-pregnancy factors and the timing of puberty in daughters. Understanding what causes earlier onset of puberty is important in designing prevention strategies”. Kubo highlighted that “women who are planning on becoming pregnant or are pregnant should be aware that their obesity or gestational diabetes may influence their child’s health in the future, beyond the known risk of childhood obesity.”

Barriers to better obesity care

A recent study published in Obesity, Science and Practice found that only a few patients who are eligible for obesity medication are actually utilising them. Those who do receive medication are more likely to be young females, who are insured and use antidepressants and NSAIDS. In another recent investigation, found in the Pink Sheet, industry analysts have described how this is leading to a ‘slow goodbye’ for obesity medication, as the market declines. The researchers suggest that this could be a contributing factor to the rise in severe obesity, as obesity is being allowed to develop in the people that aren’t being effectively treated. It is also suggested that there are 3 main factors that interfere with the delivery of obesity care: the widespread bias and lack of understanding of obesity, the relatively few healthcare professionals who can treat it, and health plans that aren’t comprehensive.

The bias is thought to be the most influential factor, and this describes the idea that healthcare professionals think obese people to be non-compliant and weak-willed, often overlooking the complexities of the disease. In addition to this, there is a lack of healthcare professionals specialising in obesity care, meaning that much primary care is unequipped to treat and effectively manage it. Furthermore, health plans do not routinely cover obesity care; employers are commonly viewing obesity as a lifestyle condition, and not a real disease.

Most of this research was conducted in the United States, and reveals the sluggishness of progress within the country. There seems to be too much of a blame culture, which is having a negative effect on any progress that is being made. A greater utilisation of obesity services is required, as well as an increase in healthcare professionals entering the field, and the acceptance of obesity as a disease.

The effect of social class on childhood obesity

Researchers at the University of Liverpool have been conducting research into the influence of early life factors that contribute to childhood obesity rates in people of different socio-economic backgrounds. The researchers estimated the risk of overweight and obesity in 12,000 children, according to their socioeconomic circumstances at birth. They also examined the potential impact of a range of factors that were identified using questionnaires. These included whether the mother was overweight before the pregnancy, whether she smoked during it and how the child was fed postpartum.

The study found that being overweight before pregnancy, smoking during pregnancy, lack of breastfeeding and early weaning onto solid foods were all significantly related to a higher BMI by age 11. The researchers suggest that these factors partially account for the social inequalities found in childhood overweight. They go on to explain that policies to support mothers to maintain healthy weight and stay educated on these early life factors are important and should be developed.

To learn more about obesity, its prevention, and its treatment please look at CCH’s Postgraduate Academic Courses in Obesity Care, and CPD Short Courses in topics such as childhood obesity and behaviour change, designed to up-skill health professionals in this vitally important, and often overlooked, area of care.