Obesity Care

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.

Self-regulation strategies can prevent weight gain in young adults

A new study has identified 2 self-regulation strategies that prevent weight gain amongst young adults. By teaching participants to weigh themselves every day and  use that information to maintain a healthy weight or implement behaviour changes, it was shown that weight gain could be prevented. The findings of this study have been published online ahead of print in JAMA Internal Medicine. A total of 599 participants, aged 18-35 took part in this study, of which half were of normal weight, while the others were overweight. They were then split into 3 groups. One group that were taught behavioural and lifestyle changes to prevent weight gain, a second group that focused on a large initial 5-10 pound weight loss to buffer any weight gain, and a control group that received no intervention.

The 2 self-regulation groups both showed reduced weight gain after a 3 year follow-up period. The ‘initial weight loss’ group showed an overall weight loss over this period. The study showed that frequent weighing and either initial weight loss or smaller daily interventions are useful tools in preventing weight gain. The researchers themselves are hoping that the new self-regulation approaches will be taken notice of as they are both cost-effective and easy to carry out for young adults.

Average BMI associated with lowest risk of death increases

Researchers from Copenhagen University Hospital in Denmark recently examined whether BMI associated with the lowest mortality rates has increased in the general population over a period of 30 years and published their findings in JAMA. Previous work has suggested that whilst average BMI is increasing across most countries, the prevalence of cardiovascular risk factors is decreasing; the researchers hypothesised that the BMI associated with lowest all-cause mortality might have changed over this time period.

They found that BMI values have increased by a factor of 3.3 over three decades. This means that the optimal BMI in relation to mortality is in the overweight category (for the last cohort that they examined – 2003-2013). The authors have suggested that the WHO should revise the BMI values that currently categorise people into normal weight, overweight and obese, as the data to form these was collected before the 1990s. However, they acknowledge that further investigation is needed to understand the reasons for these changes as well as any potential implications.

High-fat diets increase tiredness

Researchers at the University of Adelaide have found that men who consume a diet high in fat are more likely to feel tired throughout the day. The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study analysed data from 1800 Australian men over a 12-month period. The study controlled for other demographic and lifestyle factors and found an overall trend that those consuming higher fat diets would feel more tired throughout the day, affecting their work due to the implications for alertness and concentration.

Sleep quality at night was also affected, as those who consumed more fat tended to report a poorer overall quality. Unfortunately, the researchers noticed that the effect is cyclical, as poor sleep and feeling tired throughout the day is associated with cravings for food high in fat. Obviously, the best way to counter this is to not give in to temptation and eat a healthier diet. However, this is much easier said than done. The researchers are hoping to continue their work and to inform future intervention studies so that people can lose weight whilst also improve their sleep quality.

Weight gain in pregnancy imprints on child

A new study published in the Maternal and Child Health Journal has shown that mothers who gain excess weight or have elevated blood sugar levels during pregnancy are more likely to have overweight and obese children. The study examined 24,141 mothers and children over a ten-year period. Even though previous studies have found that women who gain excess weight during pregnancy are more likely to have bigger babies, this study revealed that even normal weight babies could grow up to become overweight or obese children.

The authors of this study hypothesised that an ‘imprinting’ mechanism in these children makes them more susceptible to becoming obese over their early years. The children whose mothers suffered from gestational diabetes were at greatest risk of becoming obese, being 30% more likely to be overweight between ages 2 and 10, than those whose mothers had a normal blood sugar level. The researchers suggest that this study proves that the effect of a mother’s womb during pregnancy is as important as the risk factors that the child is exposed to postpartum.