Obesity Care

Artificially sweetened drinks in pregnancy linked to higher risk of overweight in offspring, Danish study finds

A large Danish cohort study published in the British Journal of Nutrition has found a significant association between maternal consumption of artificially sweetened beverages (ASBs) during pregnancy and an increased risk of overweight in their children from mid-childhood through to adolescence. The findings raise new questions about the long-term effects of artificial sweeteners during pregnancy, especially among women seeking alternatives to sugar to manage gestational weight.

Background

Childhood obesity has more than doubled over the past three decades, with excess weight in early life known to heighten the risk of type 2 diabetes, cardiovascular disease, and other long-term health conditions. Many pregnant individuals opt for diet drinks containing artificial sweeteners to avoid excess calorie intake and potential weight gain. These beverages are commonly perceived as a healthier substitute for sugar-sweetened alternatives.

However, emerging evidence suggests that artificial sweeteners may have unintended metabolic consequences, including disruption of gut microbiota, altered insulin responses, and increased cravings for sweet foods—even before birth. Although previous studies have reported conflicting results, some have linked prenatal exposure to ASBs with a higher likelihood of obesity in offspring. Given the widespread consumption of artificially sweetened products during pregnancy, further research into their long-term health implications is essential.

Study Design and Methodology

The present study is based on data from the Danish National Birth Cohort (DNBC), a nationwide longitudinal study that enrolled 101,042 pregnant women between 1996 and 2002. Participants were followed throughout pregnancy and their children tracked up to the age of 18.

Researchers collected detailed dietary and lifestyle information through telephone interviews at gestational weeks 12 and 30, and again at 6 and 18 months postpartum. A comprehensive food frequency questionnaire was administered at week 25 of pregnancy, capturing the frequency of ASB and sugar-sweetened beverage (SSB) intake. Consumption was categorised into four levels: none, less than one 250ml serving per week, 1–6 servings per week, and one or more servings per day.

The primary outcomes of interest were large-for-gestational-age (LGA) birth weight and overweight status of offspring at multiple time points: 5 and 12 months, and ages 7, 11, 14, and 18 years. Height and weight data were obtained from a combination of healthcare providers, parental reports, and self-reports by adolescents. Overweight status was defined using sex- and age-specific body mass index (BMI) cut-offs derived from standard deviation scores.

Women with pre-existing diabetes or incomplete data were excluded. Researchers adjusted for a wide range of confounding variables, including maternal age, pre-pregnancy BMI, smoking, physical activity, socioeconomic status, dietary quality (including SSB intake via the Healthy Eating Index), paternal BMI, and breastfeeding duration. Analyses were conducted using multiple logistic and linear regression models in R software.

Key Findings

Of the full cohort, 66,668 individuals provided valid data on ASB consumption, and 66,568 on SSB intake. Researchers found that women who consumed one or more servings of ASB per day were generally younger, had a higher pre-pregnancy BMI, were more likely to smoke, and had lower socioeconomic status. In contrast, those consuming fewer than one ASB per week tended to be more physically active and breastfed their infants for longer durations.

Early Life Outcomes
In infancy (at birth, 5 months, and 12 months), no association was found between maternal ASB consumption and increased risk of LGA or overweight in children.

Later Childhood and Adolescence
However, a consistent association emerged from age 7 onwards. Children whose mothers consumed either 1–6 ASBs per week or one or more per day during pregnancy had significantly higher odds of being overweight at ages 7, 11, 14, and 18 years, compared with children of mothers who reported no ASB consumption.

After adjusting for relevant confounding factors, daily ASB consumption remained significantly associated with higher overweight risk in offspring. At 18 years of age, the adjusted odds ratio (OR) for being overweight in the group exposed to ≥1 ASB per day was 1.26 (95% confidence interval [CI]: 1.12–1.42) compared to the non-exposed group. This pattern supports a potential dose-response relationship, where higher ASB intake correlates with greater risk.

SSBs and Unexpected Findings
Surprisingly, maternal consumption of SSBs was linked to a lower risk of overweight in offspring at ages 11 and 18. For example, children of mothers who consumed one or more SSBs daily had an adjusted OR of 0.72 (95% CI: 0.60–0.86) for overweight at 18 years, compared to those whose mothers did not consume SSBs. These findings were echoed in BMI z-scores: offspring exposed to ≥1 ASB per day had higher scores, while those exposed to ≥1 SSB per day had lower scores.

Researchers cautioned, however, that these inverse associations with SSBs could be influenced by unmeasured differences in socioeconomic or lifestyle factors. Mothers consuming SSBs tended to have lower pre-pregnancy BMIs and higher socioeconomic status, which may have contributed to the unexpected results, although adjustments were made for these variables.

Additional Analyses

Subgroup analyses, which used total energy intake as an adjustment factor rather than the Healthy Eating Index, yielded only minor differences in ASB-related outcomes, suggesting that the observed associations were not solely attributable to higher overall calorie intake.

Further modelling, in which ASBs were theoretically substituted with SSBs, indicated a reduced risk of overweight, reinforcing the hypothesis that artificial sweeteners themselves may play a role in long-term weight outcomes for children.

Of particular note is the timing of the observed effects: associations with overweight status only emerged from age 7 onwards. There was no elevated risk detected in infancy, which the authors suggest may reflect the onset of independent eating behaviours and the influence of early taste preferences shaped in utero. “These findings support the hypothesis that prenatal exposure to artificial sweeteners may alter long-term metabolic or taste-related pathways,” the authors noted.

Nevertheless, the study was unable to fully exclude the possibility of residual confounding by factors not captured in the dataset, such as the child’s postnatal diet or physical activity levels. Moreover, a significant data gap between 12 months and 7 years limits understanding of when weight differences may first begin to emerge.

The researchers also raised the possibility that individuals consuming ASBs during pregnancy might continue their use postpartum, potentially passing on artificial sweeteners through breastmilk. However, this remains speculative and was not directly examined in the study.

Implications and Conclusions

This large-scale cohort study adds to a growing body of evidence suggesting that consumption of artificially sweetened drinks during pregnancy may have unintended long-term consequences for the offspring. While the absolute increase in overweight risk is modest, the association persisted consistently across multiple age points and appeared to follow a dose-dependent pattern.

In contrast, the observed lower risk of overweight associated with SSB consumption should be interpreted cautiously. The authors emphasised that this may not reflect a protective effect of sugary drinks, but rather underlying lifestyle or demographic differences.

“These results challenge the current dietary recommendations for pregnant individuals—particularly those with overweight or diabetes—who are often encouraged to substitute sugar with artificial sweeteners,” the authors wrote.

Although more research is needed to clarify mechanisms and account for limitations such as the postnatal diet and the mid-childhood data gap, the study calls for a re-examination of nutritional advice during pregnancy. It also highlights the need for further investigation into safer and more effective alternatives for managing gestational weight.

Given the rising prevalence of childhood obesity, even small shifts in population-level risk carry important public health implications.

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High-fat diet and obesity impair key immune functions, new study finds

A recent study published in The Journal of Immunology has shed new light on how a high-fat diet (HFD) and obesity can compromise the immune system’s ability to fight infection. The research focuses on neutrophils—white blood cells that serve as one of the body’s first lines of defence against invading bacteria and viruses—and reveals that exposure to a high-fat diet alters their number, maturity, and function.

The study was led by Dr Kanakadurga Singer, Associate Professor in the Departments of Paediatrics and Molecular & Integrative Physiology at the University of Michigan Medical School. Her team used a widely accepted mouse model to examine the effects of a high-fat diet on immune response. Male mice were fed either a standard diet or a high-fat diet known to induce obesity. The researchers then isolated neutrophils from the animals’ blood and bone marrow to assess their function.

Mice fed the high-fat diet not only had an increased number of neutrophils but also displayed significant changes in the characteristics of these cells. Many of the neutrophils were either immature or aged, and crucially, they showed a diminished ability to kill bacteria.

“When neutrophils were exposed to Pseudomonas aeruginosa, a bacterium known to cause pneumonia, the neutrophils from high-fat diet-fed mice exhibited a significantly reduced capacity to ingest and eliminate the bacteria,” the study reported. This impaired response suggests that individuals with obesity may have weakened early immune defences, increasing their susceptibility to infection.

In addition to compromised bacterial killing, neutrophils from the high-fat diet group demonstrated alterations in gene expression related to fat storage and metabolism. They also showed a reduced ability to store and release tumour necrosis factor-alpha (TNF-α), an important signalling molecule that regulates inflammation and immune responses.

The findings are particularly relevant given the high prevalence of obesity. In the United States, 40.3% of adults are currently living with obesity—a condition that often develops when energy intake consistently exceeds energy expenditure, especially through diets rich in fat and/or sugar. Obesity is increasingly recognised as a state of chronic, low-grade inflammation, which is believed to contribute to the development of various obesity-related conditions, including impaired immunity.

“The link between chronic inflammation and increased infections highlights the importance of understanding how immune cells like neutrophils are affected by obesity,” explained Dr Singer. “We hope that by understanding how neutrophil function is altered with exposure to high-fat diet, we can take future steps to restore function and improve patient health outcomes.”

She added:

“We hope this study lets investigators and clinicians know that although neutrophils may be increased in number in individuals with elevated BMI or diet-induced obesity, these neutrophils may not be functional.”

The study offers important insights into how dietary patterns and weight status can influence immune health. The next step, according to Dr Singer, is to explore the underlying mechanisms driving neutrophil dysfunction in the context of a high-fat diet.

“We hope to build on these findings by uncovering what is causing the impairment of neutrophils exposed to HFD,” she said. “My team plans to conduct further studies on why these neutrophils are defective, especially in their bacterial killing function, and if these neutrophils are impaired in killing specific types of bacteria or a wide range. Hopefully, we can identify other implications of neutrophil dysfunction due to HFD and if there are ways to improve this impaired function.”

This research underscores the complex interplay between nutrition, body weight, and immune function, reinforcing the need for a deeper understanding of how diet-induced obesity affects health at the cellular level.

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Waist-to-height ratio identified as a more precise indicator of childhood obesity than BMI, study finds

A recent study has highlighted the limitations of body mass index (BMI) in accurately identifying overweight and obesity in children and adolescents. Researchers found that BMI was nearly three times more likely to classify children as overweight when compared to waist-to-height ratio, a measurement that better reflects body fat distribution. The study, a collaborative effort between the University of Eastern Finland and the Universities of Bristol and Exeter in the United Kingdom, was published in Obesity and Endocrinology. 

BMI is widely used as a screening tool for childhood obesity, as it is a simple calculation based on weight and height. However, one of its key limitations is that it does not differentiate between fat mass and lean muscle mass. This means that children with a higher proportion of muscle could be mistakenly classified as overweight or obese.

In contrast, waist-to-height ratio takes into account central adiposity—the accumulation of fat around the abdomen—which is a more reliable predictor of obesity-related health risks. Recognising this, leading health organisations have begun to shift their recommendations regarding obesity assessment. The Lancet Commission on Obesity and the European Association for the Study of Obesity (EASO) have both advised that BMI alone should not be used as the sole diagnostic measure for obesity in adults. Instead, they recommend confirming obesity using waist-to-height ratio or other indicators. Similarly, the UK’s National Institute for Health and Care Excellence (NICE) has endorsed waist-to-height ratio as a useful tool for predicting obesity-related health risks in children, particularly those linked to central fat accumulation.

Largest Longitudinal Study Comparing BMI and Waist-to-Height Ratio in Children

This latest study represents the most extensive follow-up research globally to compare BMI and waist-to-height ratio in paediatric populations. The study followed 7,600 children from the University of Bristol’s Children of the 90s cohort, tracking their growth and body composition changes from the age of 9 years through to 24 years.

At the age of 9, researchers identified 1,431 children as overweight based on BMI. However, when these same children were assessed using waist-to-height ratio, the findings were markedly different:

• 25% were classified as having high fat
• 11% had excess fat
• 64% had normal fat levels, according to the study’s waist-to-height ratio cutpoints

Conversely, among the 517 children classified as having high fat based on waist-to-height ratio:

• 70% were classified as overweight by BMI
• 24% were classified as having obesity by BMI
• Only 6% were within the normal BMI range

These findings underscore the risk of BMI misclassifying children’s weight status, either overestimating or underestimating body fat levels.

Waist-to-Height Ratio as a More Accessible Alternative to DEXA Scanning

For precise measurement of body fat, dual-energy X-ray absorptiometry (DEXA) is considered the gold standard. However, this technology is expensive and not widely available in primary care settings. Previous research using the same dataset demonstrated that waist-to-height ratio can predict body fat with up to 85% accuracy when compared to DEXA results. The cutpoints for high, excess, and normal body fat used in this study were derived from earlier findings in the same cohort of children and adolescents.

Furthermore, the validity of these cutpoints was externally tested in a separate population of 3,329 adults in the United States to assess their predictive value for metabolic health outcomes. Researchers found that:

• High waist-to-height ratio fat levels were associated with increased odds of prediabetes
• Excess waist-to-height ratio fat levels correlated with a higher risk of developing type 2 diabetes

These results highlight the potential for waist-to-height ratio to serve as a universal and cost-effective screening tool for obesity-related health risks across different age groups and populations.

Expert Perspective: Waist-to-Height Ratio as a More Reliable Metric for Childhood Obesity

Dr Andrew Agbaje, a physician and associate professor (docent) of Clinical Epidemiology and Child Health at the University of Eastern Finland, emphasised the advantages of waist-to-height ratio as a more precise measure of adiposity in young people.

“Waist-to-height ratio is an affordable and universally accessible, accurate, and precise tool for detecting high and excess fat in children and adolescents,” he stated.

His previous research has demonstrated that waist-to-height ratio is a strong predictor of both total body fat and central fat distribution, reinforcing its value in obesity assessment.

“Overweight and obesity in children and adolescents should not be diagnosed with BMI alone but could be confirmed with waist-to-height ratio where a DEXA scan is lacking,” Agbaje concluded.

Research Funding and Support

Agbaje’s research has been made possible through financial support from multiple organisations, including:

• Jenny and Antti Wihuri Foundation
• Finnish Cultural Foundation (Central Fund and North Savo Regional Fund)
• Orion Research Foundation
• Aarne Koskelo Foundation
• Antti and Tyyne Soininen Foundation
• Paulo Foundation
• Yrjö Jahnsson Foundation
• Paavo Nurmi Foundation
• Finnish Foundation for Cardiovascular Research
• Ida Montin Foundation
• Eino Räsänen Fund
• Matti and Vappu Maukonen Fund
• Foundation for Paediatric Research
• Alfred Kordelin Foundation
• Novo Nordisk Foundation

Implications for Future Obesity Screening and Management

The findings of this study contribute to the growing body of evidence suggesting that waist-to-height ratio should be incorporated into routine obesity screening in children and adolescents. Given its affordability, accessibility, and stronger correlation with body fat distribution, it presents a valuable alternative to BMI in both clinical and public health settings.

As global obesity rates continue to rise, ensuring the accuracy of diagnostic tools is essential for early intervention and effective management. This research reinforces the need for a shift in obesity screening practices, with waist-to-height ratio emerging as a more reliable and equitable measure of adiposity in young people.

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Chronic stress and obesity identified as accelerators of early pancreatic cancer development

A groundbreaking study led by researchers at the University of California, Los Angeles (UCLA) has uncovered a significant link between chronic stress, obesity, and the early progression of pancreatic cancer. The findings provide new insights into how lifestyle factors can influence the onset and severity of one of the most aggressive and deadly forms of cancer.

Understanding the Biological Link Between Stress, Obesity, and Pancreatic Cancer

Through preclinical models, scientists identified a key molecular mechanism that explains how both stress and obesity can trigger changes in pancreatic cells, potentially leading to cancerous growth. The study revealed that stress-related neurotransmitters and obesity-associated hormones activate a protein called CREB, which is closely linked to cancer cell proliferation. Interestingly, these two factors stimulate CREB via distinct biological pathways:

• Stress hormones engage the β-adrenergic receptor/PKA pathway
• Obesity-related hormones predominantly activate the PKD pathway

Despite originating from separate physiological processes, both pathways ultimately contribute to the same oncogenic effect, suggesting that chronic stress and obesity work in tandem to promote pancreatic cancer progression.

Preclinical Findings: Diet, Social Stress, and Cancer Risk

In a series of mouse experiments, researchers found that a high-fat diet alone was sufficient to induce the growth of precancerous pancreatic lesions. However, when combined with social isolation stress, the mice developed significantly more advanced lesions, indicating that stress can compound the harmful effects of an unhealthy diet.

Notably, the study also observed sex-specific differences in how stress influenced cancer progression. Female mice subjected to social isolation exhibited a more pronounced acceleration in cancerous changes compared to their male counterparts. The researchers hypothesise that this disparity could be linked to differences in biological stress responses, particularly the influence of oestrogen and heightened β-adrenergic receptor activity, which may increase susceptibility to stress-induced cancer development.

Potential Clinical Implications and Treatment Strategies

The findings suggest that stress and obesity-driven molecular pathways play a crucial role in accelerating pancreatic cancer onset. This raises the possibility of leveraging existing medications to mitigate these risks. As β-adrenergic receptors appear to be central to stress-induced cancer growth, commonly prescribed beta-blockers—widely used for managing high blood pressure—could be repurposed as a preventive strategy to slow down cancer progression in at-risk individuals.

While further clinical research is needed to confirm these findings in human populations, the study provides compelling evidence that lifestyle factors can significantly influence cancer risk. Interventions targeting stress management, diet modification, and pharmacological prevention may collectively contribute to reducing the incidence of pancreatic cancer.

Publication Details

The study was published in Molecular Cancer Research, offering critical insights into the interplay between stress, obesity, and cancer biology.

Research Team

The study’s first authors are Xiaoying Sun, a postdoctoral researcher in the departments of medicine and surgery at UCLA, and Yaroslav Teper, a project scientist at the David Geffen School of Medicine at UCLA. The senior authors include Dr. Guido Eibl, professor in residence in the department of surgery at UCLA Health, and Dr. Enrique Rozengurt, distinguished professor of medicine and chief of research in the division of digestive diseases at UCLA.

Other contributing authors, all affiliated with UCLA, include James Sinnett-Smith, Mineh Markarian, Dr. Joe Hines, and Dr. Gang Li. Additionally, Eibl, Rozengurt, Hines, and Li are members of the UCLA Health Jonsson Comprehensive Cancer Center.

Funding and Support

The research received funding from several prestigious institutions, including:

• National Cancer Institute
• National Institute of Allergy and Infectious Diseases
• Ronald S. Hirshberg Endowed Chair of Pancreatic Cancer Research
• Ronald S. Hirshberg Foundation

These findings highlight the critical need for public awareness and proactive health measures to reduce stress and maintain a healthy lifestyle as potential strategies for cancer prevention.

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Smoking and obesity combined may greatly accelerate multiple sclerosis progression, study finds

New Research Highlights the Amplified Risk of Disease Progression and Cognitive Decline

A recent study has found that smoking and obesity, two well-known risk factors for multiple sclerosis (MS) progression, may have a compounding effect when present together. Among 3,336 individuals with MS, researchers observed that those who both smoked and were living with obesity faced a significantly increased risk of disease progression and cognitive decline compared to those who had neither risk factor. These findings highlight the importance of lifestyle interventions in managing MS and potentially slowing its progression.

Background: The Known Risks of Smoking and Obesity in MS

Previous studies have established that both smoking and obesity independently contribute to the progression of MS. Individuals with MS who smoke have been found to experience faster deterioration in physical and cognitive functions, while obesity has been linked to increased inflammation and greater disability over time.

Outside of MS, research in conditions such as heart disease and diabetes has shown that smoking and obesity do not merely add to the risk of poor health outcomes—they interact in ways that amplify those risks beyond what would be expected from either factor alone. However, until now, limited research has explored whether this type of interaction also occurs in MS. Understanding whether these risk factors reinforce each other in MS progression could be critical in developing more effective prevention and management strategies.

Study Overview: Investigating the Combined Effects of Smoking and Obesity

A team of researchers from the Karolinska Institute in Sweden conducted an extensive review of medical records from 3,336 individuals with MS. Their aim was to determine whether smoking and obesity interact to worsen disease progression and cognitive decline.

To measure disease progression, the researchers used the Expanded Disability Status Scale (EDSS), a standardised system that evaluates disability levels in people with MS. The EDSS assesses a range of neurological functions, including walking ability, muscle strength, vision, and cognitive performance.

Key Findings: A Significant Interaction Between Smoking and Obesity

Consistent with previous research, the study confirmed that both smoking and obesity independently increased the risk of faster disease progression. Smoking was also linked to a greater likelihood of cognitive impairment. However, the most striking finding was that the combination of these two risk factors led to an even greater acceleration of MS progression and cognitive decline.

When comparing different groups of people with MS:

• Non-obese smokers had a 21% higher risk of reaching EDSS level 4 (which signifies significant disability but preserved walking ability) compared to non-smokers who were not obese.
• Individuals who were obese but did not smoke had a 33% higher risk of reaching EDSS 4.
• However, individuals who both smoked and were living with obesity had an 86% higher risk of reaching EDSS 4, demonstrating that these two factors together substantially increase the likelihood of disability progression.

In addition to physical disability, the study found that smoking and obesity also interacted to exacerbate cognitive decline, further impairing memory, concentration, and problem-solving abilities in individuals with MS.

Implications: The Importance of Modifiable Risk Factors

The findings of this study are particularly significant because both smoking and obesity are modifiable risk factors. Unlike genetic predisposition or other non-preventable aspects of MS, these behaviours can be changed, offering individuals the opportunity to potentially slow their disease progression.

“This study suggests that dropping even one unhealthy habit could potentially lead to a substantially reduced risk of unfavourable disease outcomes,” the researchers noted.

For individuals with MS, quitting smoking and achieving a healthy weight could have far-reaching benefits, not only in terms of reducing the risk of disability but also improving overall well-being. There are numerous resources available to support these lifestyle changes, including smoking cessation programmes, dietary counselling, and physical activity interventions tailored to those with MS.

Understanding Multiple Sclerosis

Multiple sclerosis is a chronic and unpredictable condition that affects the central nervous system. The disease occurs when the immune system mistakenly attacks the protective covering of nerve fibres, leading to inflammation and damage that disrupts communication between the brain and the rest of the body.

Symptoms of MS vary widely among individuals and may include:

• Fatigue – Debilitating tiredness that affects daily activities.
• Mobility Challenges – Weakness, muscle stiffness, and difficulties with balance and coordination.
• Cognitive Changes – Issues with memory, concentration, and problem-solving.
• Vision Problems – Blurred or double vision, or even vision loss in severe cases.

Currently, there is no cure for MS, but early diagnosis and treatment can help slow the disease’s progression and improve quality of life. Researchers continue to make significant progress towards developing more effective therapies and, ultimately, achieving a future free from MS.

Conclusion: A Call for Awareness and Action

This study underscores the importance of addressing modifiable lifestyle factors in the management of MS. While the condition itself remains incurable, interventions such as smoking cessation and weight management can make a meaningful difference in slowing disease progression and reducing disability risk.

Healthcare professionals and individuals with MS alike should take note of these findings and explore available support options for making healthier lifestyle choices. The research serves as a powerful reminder that even small changes can contribute to better long-term outcomes in the management of multiple sclerosis.

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Childhood obesity at cancer diagnosis leads to worse survival outcomes

A recent study published in Cancer has found that children who have obesity at the time of their cancer diagnosis experience significantly poorer survival outcomes compared to their peers without obesity. The findings indicate a notable reduction in both event-free survival (EFS) and overall survival (OS) rates, underscoring the need for further research into the underlying mechanisms and potential interventions.

Study Overview and Methodology

Researchers examined the relationship between obesity and cancer outcomes in children aged 2 to 18 years who were newly diagnosed with cancer. The study drew data from the Cancer in Young People in Canada database, covering cases from 2001 to 2020. A total of 11,291 children with cancer were included, with a median age at diagnosis of 7.6 years.

Among the participants, 55.0% were boys, and 10.5% were classified as having obesity at the time of diagnosis. The cohort included children with various types of cancer:

• Leukaemias (37.1%)
• Lymphomas (14.5%)
• Central nervous system (CNS) tumours (21.8%)
• Other solid tumours (26.6%)

Key Findings on Survival Outcomes

The study revealed a significant disparity in survival rates between children who had obesity at diagnosis and those who did not.

Event-Free Survival (EFS) Outcomes

• The median follow-up period for EFS was 4.5 years.
• The five-year EFS rate was 77.5% for children with obesity, compared to 79.6% for children without obesity (P = .04).
• Multivariable analyses confirmed that obesity at diagnosis was associated with a significantly increased risk of adverse outcomes, with an adjusted hazard ratio (aHR) of 1.16 (95% CI, 1.02-1.32; P = .02).

Overall Survival (OS) Outcomes

• The median follow-up period for OS was 4.7 years.
• The five-year OS rate was 83.0% for children with obesity, compared to 85.9% for those without obesity (P = .004).
• Multivariable analyses demonstrated a stronger association between obesity and reduced OS, with an adjusted hazard ratio (aHR) of 1.29 (95% CI, 1.11-1.49; P = .001).

Influence of Age and Gender

According to the researchers, the negative impact of obesity on survival outcomes was more pronounced in certain subgroups:

“The adverse impact of obesity on EFS and OS was more prominent in girls and in children younger than 10 years,” the researchers noted.

Interestingly, for children who continued to have obesity in the years following their cancer diagnosis, there was no significant difference in survival rates when compared to children without obesity. This finding was consistent across all cancer types within the study cohort.

Causes of Death and Obesity’s Role

The study also examined whether the causes of death differed between children with and without obesity. The results showed no significant differences in the primary causes of mortality, which included:

• Disease progression or relapse – 88.9%
• Treatment-related toxicity – 4.4%
• Other causes – 6.8%

Potential Mechanisms and Future Research

While the exact mechanisms by which obesity contributes to poorer cancer outcomes remain unclear, the researchers highlighted specific trends within subgroups of children diagnosed with acute lymphoblastic leukaemia (ALL) and CNS tumours:

“Although obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, this finding was likely driven by the trends detected in children with ALL and CNS tumours,” the researchers wrote.

This suggests that certain cancer types may be more affected by the presence of obesity, necessitating further investigation into biological and physiological factors at play.

Furthermore, the researchers emphasised the importance of understanding whether changes in body weight during treatment could impact survival outcomes:

“Further studies are needed to better characterise the pathophysiologic mechanisms linking obesity and survival in paediatric oncology. Furthermore, it is crucial to determine whether normalisation of weight during treatment positively affects cancer outcomes to inform future trial designs and supportive care interventions.”

Funding and Disclosures

This research received partial funding from the Fonds de Recherche du Québec–Santé. One of the study’s authors disclosed conflicts of interest; for full details, readers are encouraged to refer to the original publication.

Conclusion

This study provides compelling evidence that children with obesity at the time of a cancer diagnosis are at a significantly higher risk of experiencing inferior survival outcomes. While obesity did not appear to affect the cause of death, its association with poorer EFS and OS rates—particularly in younger children and girls—warrants urgent attention. Future research is essential to explore potential interventions, including weight management strategies during treatment, to improve survival outcomes in paediatric oncology.

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Study reveals teenagers with obesity consume more calories later in the day, highlighting the role of circadian rhythms in eating behaviours

A new study conducted by researchers at Mass General Brigham and the Warren Alpert Medical School of Brown University has found that adolescents with obesity tend to consume a greater proportion of their daily caloric intake later in the day compared to their peers with a healthy weight. The research sheds light on the influence of the body’s internal biological clock, or circadian system, in shaping eating behaviours and could have implications for future interventions in weight management and metabolic health.

The findings, published in the Proceedings of the National Academy of Sciences (PNAS), add to the growing body of evidence suggesting that meal timing, in addition to calorie consumption, plays a crucial role in overall health. Researchers sought to isolate the effects of the circadian system from external factors such as social cues, light exposure, and daily routines, allowing for a clearer understanding of how biological rhythms regulate food intake.

Investigating the Link Between the Circadian System and Eating Habits

“Going into this study, we knew that the circadian system affects hunger and metabolism. What remained unclear, however, was whether the circadian system—when isolated from influences of environmental and behavioural cycles, including the light, sleep, and activity cycles—directly influences food consumption,” said Frank A.J.L. Scheer, PhD, professor of Medicine and director of the Medical Chronobiology Program at Brigham and Women’s Hospital. “This study is the first to demonstrate that food intake itself is regulated by our internal body clock.”

To investigate this, researchers conducted an experiment involving 51 adolescents aged between 12 and 18 years, with an average age of 13.7 years. Participants were divided into three groups based on their body mass index (BMI): 24 individuals with a BMI in the healthy weight range, 13 classified as overweight, and 14 as having obesity.

To ensure that external influences such as light exposure and social schedules did not interfere with results, participants were placed on a carefully controlled routine in a dimly lit environment. They followed an artificial 28-hour sleep-wake cycle, which gradually shifted their biological clocks out of sync with the natural day-night cycle. The controlled setting removed access to natural light and external time cues, ensuring that any variations in eating habits were driven primarily by internal biological rhythms rather than external environmental factors.

During the study, participants were provided with six fixed meal opportunities during their wake period. They were allowed to eat as much as they wanted from a standardised menu, while researchers meticulously recorded the quantity of food consumed and the time at which it was eaten.

Findings Reveal Distinct Eating Patterns Based on Body Weight

The results demonstrated a clear trend across all groups: calorie consumption was lowest in the morning and increased as the day progressed, peaking in the late afternoon and early evening. However, there was a significant difference in eating patterns among participants based on body weight. Adolescents in the overweight and obesity groups consumed substantially more calories later in the day compared to those with a healthy weight.

These findings suggest that biological rhythms may play a role in promoting late-day eating, particularly in individuals with higher body weight. The study raises important questions about how circadian misalignment—such as eating at biologically suboptimal times—could impact long-term metabolic health and contribute to weight gain over time.

Potential Implications for Adolescent Health and Future Interventions

Adolescence is a critical period for growth and metabolic regulation, making it essential to understand how sleep-wake cycles and circadian rhythms influence eating behaviours.

“The critical nature of adolescent development to set the stage for a lifetime of health highlights the need to understand the roles played by sleep/wake and circadian timing processes for eating behaviour,” said Mary A. Carskadon, PhD, lead investigator of the study from the Warren Alpert Medical School. “The knowledge gained here opens a door to potential interventions that can enhance teen health moving forward.”

While the study provides strong evidence of an association between circadian rhythms, eating habits, and weight status, it does not establish whether altered meal timing contributes to obesity or if pre-existing obesity influences circadian-driven eating patterns. Further research is needed to determine whether adjusting the timing of meals—such as encouraging earlier eating or aligning meals more closely with the body’s natural rhythms—could play a role in supporting weight management and metabolic health in young people.

Given the growing prevalence of obesity among adolescents, understanding the biological underpinnings of eating behaviours could pave the way for targeted strategies to improve health outcomes. Future studies will explore whether interventions that shift meal timing can mitigate the risk of obesity and related metabolic conditions, providing a potential avenue for improving long-term health in young people.

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Healthy eating habits in adolescents start with the foods available at home

A recent study published in the Journal of Nutrition Education and Behavior, an Elsevier journal, provides compelling evidence that the home food environment has a more significant impact on adolescent dietary behaviours than the availability of fast-food and convenience stores in the surrounding neighbourhood. This research contributes to the ongoing conversation about adolescent nutrition and obesity by highlighting the critical role that food availability within the home plays in shaping young people’s eating habits.

The study, conducted as a cross-sectional analysis, aimed to determine the relative influence of home and neighbourhood food environments on adolescent dietary choices. Researchers examined whether the presence of healthier food options at home, such as fruits and vegetables, encouraged better eating habits while also investigating the impact of the density of fast-food outlets and convenience stores in the local area. The findings underscore the importance of household food availability as a key factor in promoting a nutritious diet, reinforcing the notion that interventions targeting the home environment may be more effective in improving adolescent nutrition than efforts aimed at modifying broader neighbourhood food landscapes.

Key Findings: The Home Environment as a Major Dietary Influence

The study’s findings reveal that the availability of fruits and vegetables at home is strongly associated with healthier eating patterns among adolescents. Greater access to these nutrient-dense foods was linked to increased consumption of fruits and vegetables, higher overall diet quality (as measured by the Healthy Eating Index), and a reduction in the intake of fast food and other less nutritious options.

Conversely, the presence of energy-dense, nutrient-poor foods—such as sweets and high-fat snacks—was correlated with higher consumption of these items among adolescents. This suggests that the types of foods stocked in the home can either support or hinder efforts to establish healthy eating patterns during a critical stage of development.

The study also found that while the neighbourhood food environment does play a role, its impact is comparatively less pronounced. For instance, a higher number of fast-food outlets in an adolescent’s local area was associated with increased consumption of sugary beverages. However, an unexpected finding was that the presence of more convenience stores in the neighbourhood was linked to a greater intake of nutrient-dense foods. This may be due to the availability of certain healthier options in these stores, although further research is needed to fully understand this relationship.

Methodology: A Comprehensive Approach to Studying Adolescent Nutrition

To conduct this research, the study analysed data from 204 adolescents living in Nebraska. The researchers used a combination of validated questionnaires, geographic information systems (GIS) mapping, and dietary recall assessments to evaluate the availability of food at home, the density of fast-food and convenience store retailers in participants’ neighbourhoods, and the overall quality of dietary intake.

The study employed advanced hierarchical regression analyses to isolate the independent contributions of home and neighbourhood food environments on adolescent dietary outcomes. Data collection included both in-laboratory assessments and follow-up dietary recalls to capture eating behaviours across different contexts, ensuring a more nuanced understanding of how these environments shape food choices.

Lead author Saira Sarwar, MA, from the Department of Psychology at the University of Nebraska-Lincoln, emphasised the importance of these findings, stating, “These findings underscore the importance of targeting the home food environment as a modifiable factor in dietary interventions for adolescents.”

Implications for Public Health and Future Research

The study’s findings have significant implications for public health strategies aimed at improving adolescent nutrition and reducing the risk of obesity. Given the strong association between home food availability and dietary quality, interventions that encourage parents and caregivers to provide more fruits, vegetables, and other nutrient-dense foods at home could have a substantial impact. Public health campaigns and nutrition education programmes may be most effective when they focus on empowering families to create a healthier home food environment rather than solely addressing external factors such as the presence of fast-food outlets.

While the research provides valuable insights, further studies are needed to confirm these findings and explore additional factors that may influence adolescent dietary behaviours. Future research could investigate how economic, cultural, and psychological factors shape food purchasing decisions within households and how these elements interact with the broader food environment. Additionally, longitudinal studies tracking dietary patterns over time could offer deeper insights into how home and neighbourhood influences evolve and affect long-term health outcomes.

Conclusion

This study highlights the critical role of the home food environment in shaping adolescent dietary habits, reinforcing the idea that interventions aimed at improving food choices within the household may be more impactful than those focused solely on modifying the external food landscape. As concerns over adolescent obesity and poor dietary habits continue to grow, these findings provide valuable guidance for health professionals, policymakers, and families seeking effective strategies to promote healthier eating behaviours among young people.

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China strengthens focus on physical education to address rising childhood obesity

China is set to make physical education a central pillar of its school curriculum, elevating its importance to match that of core academic subjects such as Chinese, mathematics, and English. The move is part of a broader national strategy to promote a “holistic education” and counter the rising prevalence of childhood obesity.

According to the country’s Ministry of Education, primary and secondary schools must ensure that physical education teachers receive equal status to their academic counterparts and that structured efforts are made to enhance participation in key sports such as football, basketball, and volleyball.

“These measures are part of a broader push for a more holistic approach to education, integrating physical fitness with academic development to cultivate well-rounded students who are prepared for the future,” the Ministry stated.

A Long-Term Strategy for Educational Reform

The initiative aligns with China’s broader education strategy, outlined in its first national plan to build a “strong education nation” by 2035. Under this policy, all primary and secondary school students will be required to engage in at least two hours of physical activity per day. The initiative is designed not only to address rising obesity rates but also to mitigate other health concerns such as myopia (short-sightedness), which has become increasingly prevalent among young people.

To support this push, the government is tackling a nationwide shortage of physical education teachers. As of mid-2022, China faced a deficit of approximately 120,000 physical education teachers, with rural schools experiencing the greatest impact. To bridge this gap, the Ministry of Education has announced plans to recruit retired athletes and military veterans to help expand the pool of qualified instructors.

In addition to recruitment efforts, physical education teachers will receive equal pay to their counterparts in academic subjects. They will also benefit from performance-based salary adjustments, particularly for additional duties such as after-school sports programmes and coaching school teams.

Obesity Trends and Public Health Implications

The urgency of these measures is underscored by alarming trends in childhood obesity. A sharp increase in obesity rates has been observed since 2019, exacerbated by reduced physical activity during COVID-19 lockdowns and a rise in unhealthy eating habits, including increased consumption of processed and fast foods through online delivery platforms.

Medical professionals predict that obesity rates will continue to climb over the next decade, driven by economic slowdowns and structural shifts that may contribute to less active lifestyles and poorer dietary habits.

Statistics highlight the extent of the issue. The proportion of boys living with obesity in China surged from 1.3% in 1990 to 15.2% in 2022. Although this figure remains below the 22% obesity rate among boys in the United States, it surpasses rates observed in Japan (6%), the United Kingdom and Canada (12%), and India (4%). Among girls, obesity prevalence increased from 0.6% in 1990 to 7.7% in 2022.

“Obesity has become a major public health issue in China, ranking as the sixth leading risk factor for death and disability in the country,” the National Health Commission reported in October.

A Shift Towards a Healthier Future

China’s renewed focus on physical education reflects a growing recognition that health and academic success are interconnected. By embedding structured physical activity into the daily lives of students and ensuring teachers are equipped to deliver high-quality instruction, authorities hope to foster a culture of fitness that will extend beyond childhood and into adulthood.

As the country moves forward with these reforms, the effectiveness of its policies will be closely watched. If successful, China’s approach could serve as a model for other nations grappling with similar challenges in childhood obesity and youth health.

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Early intervention in childhood obesity treatment yields long-term benefits, study finds

A recent study from researchers at Karolinska Institutet, published in JAMA Pediatrics, has revealed that effective weight-loss treatment during childhood for young individuals with obesity has enduring positive impacts on their health in adulthood. The findings indicate a reduced risk of severe obesity-related health conditions and premature mortality. However, the study also shows that such treatment does not appear to affect the likelihood of developing depression or anxiety later in life.

Long-term Health Benefits

The research demonstrates that children and adolescents who respond successfully to obesity treatment experience lower rates of obesity-related diseases, including type 2 diabetes, hypertension, and dyslipidaemia (elevated levels of fats in the blood), by the time they reach young adulthood. These conditions are commonly associated with long-term complications of obesity, highlighting the importance of early intervention.

The treatment studied, referred to as “behavioural lifestyle therapy,” focuses on encouraging healthy eating, regular physical activity, and proper sleep hygiene in children and their families.

“These results are very good news,” said Dr Emilia Hagman, principal researcher at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet. “Whether or not the treatment of obesity in childhood has long-term health benefits has been debated, since weight loss is hard to maintain.”

Reduced Risk of Premature Mortality

In addition to improved health outcomes, the study found that young people who responded well to obesity treatment had a lower risk of premature death. A previous study by the same research group, published in PLOS Medicine, highlighted that children living with obesity face a significantly increased risk of mortality in early adulthood. This earlier research revealed that over one-quarter of deaths among young adults with obesity were directly related to obesity, with causes including somatic conditions and suicide.

“This emphasises the importance of providing early treatment,” said Dr Hagman. “We know that timely intervention increases the likelihood of success and helps mitigate the long-term health risks associated with obesity.”

Mental Health Outcomes

The researchers also explored the relationship between obesity treatment outcomes and mental health. The findings showed that the risk of depression and anxiety in young adulthood remained unaffected, regardless of whether the participants had successfully managed their weight during childhood.

“It has been believed that weight loss could decrease symptoms of depression and anxiety, but we can now show that’s not the case,” said Dr Hagman. “Even though there’s a link between the two comorbidities, they must be treated in parallel.”

Study Methodology

The study followed more than 6,700 individuals who received treatment for obesity during childhood. These participants were identified through the Swedish Childhood Obesity Treatment Register (BORIS) and were monitored into young adulthood using data from the Swedish Patient Register, the Prescribed Drugs Register, and the Cause of Death Register. A matched control group from the general population, selected based on age, sex, and geographic location, was also included in the study.

One limitation noted in the study was the exclusion of GLP-1 receptor agonists, a class of medications that has recently gained prominence in obesity care. These drugs were not approved for use in children during the period when the study participants were undergoing treatment.

“I’m in favour of their use as these drugs ease feelings of hunger, which is something that some children struggle with,” said Dr Hagman. “That said, lifestyle therapy is still the foundation of all treatments for childhood obesity.”

Future Directions

Building on this research, the team at Karolinska Institutet plans to focus on identifying the most effective therapy options for individuals with obesity. They aim to pinpoint key health and risk markers that predict long-term outcomes.

The findings underscore the critical importance of early and sustained intervention in addressing childhood obesity, not only to mitigate immediate health risks but also to support long-term well-being. While the study highlights significant progress, it also emphasises the need for comprehensive strategies to address the physical and mental health challenges faced by individuals with obesity.

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Exposure to air pollution before pregnancy linked to higher childhood obesity risk, study finds

A recent study involving over 5,000 mothers and their children has revealed a significant link between exposure to air pollution during the three months before pregnancy and an increase in children’s body mass index (BMI) and associated obesity risk factors up to the age of two. The findings, supported by the National Institute of Environmental Health Sciences, were published in the journal Environmental Research.

While previous research has established connections between air pollution exposure during pregnancy and various health challenges in children, such as respiratory conditions and a heightened risk of chronic diseases, limited attention has been given to the preconception period. This timeframe, which typically refers to the three months before pregnancy begins, is critical as environmental exposures during this stage can influence the health of sperm and eggs during their final developmental phases.

In one of the largest studies of its kind, researchers from the Keck School of Medicine of USC, Duke University, and Fudan University in Shanghai examined data from 5,834 mother-child pairs recruited from maternity clinics across Shanghai. The study found that higher exposure to PM2.5, PM10, and NO2—key pollutants—prior to pregnancy was associated with an increase in children’s BMI or BMIZ, a standardised score comparing a child’s BMI to peers of the same age and sex.

“These findings imply that the three months before conception are important, and that people who plan to bear children should consider taking measures to lower their air pollution exposure to reduce their children’s risk for obesity,” said Dr Jiawen Liao, a postdoctoral research associate in population and public health sciences at the Keck School of Medicine and the study’s lead author.

Subtle but significant increases

The research team, led by Dr Weili Yan and Dr Guoying Huang from the Children’s Hospital of Fudan University, took advantage of a unique opportunity to begin collecting data even before pregnancy started. This allowed for the examination of preconception environmental exposures in an unprecedented way.

Using advanced machine learning models developed by Dr Jim Zhang of Duke University, the researchers estimated daily pollution exposure levels at participants’ home addresses. The models incorporated satellite data, pollutant simulations, and meteorological variables to calculate exposure to PM2.5 (fine particulate matter), PM10 (larger particulate matter), and NO2 (a gas largely emitted by motor vehicles).

Following the births, the researchers tracked the children’s weight and height at three-month intervals until the age of two using electronic medical records. This data was then used to measure growth rates of weight, BMI, and BMIZ. By comparing individuals with relatively low exposure (25th percentile) to those with higher exposure (75th percentile), the team quantified the impact of air pollution on children’s outcomes.

A higher level of preconception exposure to PM2.5 was linked to a 0.078 increase in child BMIZ at age two. Similarly, PM10 exposure correlated with a 0.093 kg/m² increase in BMI. From six months onward, children exposed to elevated levels of all three pollutants demonstrated higher growth rates in weight, BMI, and BMIZ.

“The magnitude is small, but because air pollution is widespread and everybody is exposed, the risk of air pollution exposure on children’s obesity risk may be substantial and may start before their mothers’ pregnancy,” explained Dr Zhanghua Chen, an assistant professor of population and public health sciences at the Keck School of Medicine and the study’s senior author.

Public health implications

Although this study is observational, meaning it does not prove causation, its findings underscore the potential risks of air pollution exposure during the preconception period. The researchers emphasised that individuals can take proactive steps to mitigate potential harm.

Suggested measures include wearing a mask or staying indoors during periods of poor outdoor air quality and using air purifiers to improve indoor air conditions. While the study primarily focused on mothers, researchers noted that men planning to conceive could also benefit from adopting these precautions.

Recognising and acting on the many early-life influences on a child’s weight is a growing part of paediatric practice, and the focus of professional training such as the College of Contemporary Health’s Childhood Obesity Essentials, a CPD-accredited online short course covering the prevention and management of childhood obesity.

Looking ahead, the team at the Keck School of Medicine, including Dr Liao and Dr Chen, is embarking on a new study to monitor preconception air pollution exposure in Southern California. Additionally, they are testing the effectiveness of indoor air purifiers in reducing the risk of heart and metabolic problems in the general population.

This comprehensive study highlights the critical importance of the preconception period for long-term child health, offering new insights into how air pollution may contribute to obesity risk.

CCH insight

Research like this reinforces how early – even before conception – the roots of childhood obesity can be laid, and how much prevention matters. CCH’s Childhood Obesity Essentials CPD short course (6 hours, fully online, CPD-accredited) gives healthcare professionals the core knowledge to support children with, or at risk of, obesity and their families, spanning nutrition, psychology, physical activity and evidence-based prevention and intervention strategies.
Explore Childhood Obesity Essentials →

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Childhood obesity and poor heart health linked to increased dementia risk later in life

Childhood obesity and poor cardiovascular health may increase the risk of developing dementia in old age, according to a recent study conducted by the University of Oxford. Researchers found that factors such as high body mass index (BMI), elevated blood pressure, and low physical activity levels during childhood and adolescence were associated with structural changes in the brain by the age of 20. These changes were observed particularly in regions of the brain known to be affected by dementia.

Study Details

The study, published in the journal eBioMedicine, sheds light on how poor health during early life stages could lay the foundation for cognitive decline in later years. While prior research has linked midlife health to brain health in old age, this study highlights the potential role of early-life cardiovascular health in influencing dementia risk.

Researchers, led by a team at the University of Oxford’s Department of Psychiatry in collaboration with University College London, analysed data from 860 participants involved in the Avon Longitudinal Study of Parents and Children. This long-term research project tracks various health measures over time to better understand their implications.

The research team examined participants’ blood pressure and BMI between the ages of seven and 17, their physical activity levels between ages 11 and 15, and brain scans taken in early adulthood at around 20 years old. They found that poor cardiovascular health markers, such as higher childhood blood pressure and accelerated BMI growth during teenage years, were linked to differences in the structure of grey matter in the brain, including its thickness and surface area. These changes were especially pronounced in brain regions commonly affected by dementia.

Expert Insights

Holly Haines, lead author of the study, commented, “Our research shows that cardiovascular health in the earliest stages of life may already be important for the structure of brain regions known to be affected in dementia in old age – much earlier than previously thought.”

Co-author Associate Professor Sana Suri from the University of Oxford’s Department of Psychiatry added, “The findings suggest that we should be thinking about targeting modifiable lifestyle risk factors, such as obesity and exercise, decades before current lifespan models of dementia suggest. The early adolescent years merit greater consideration in the context of dementia prevention.”

Implications for Prevention

The study underscores the importance of addressing lifestyle factors early in life to reduce dementia risk. Researchers emphasised that these findings provide preliminary evidence but called for further investigation to confirm their conclusions. If validated, this could shift the focus of dementia prevention strategies to much earlier stages of life.

Dr Richard Oakley, Associate Director of Research and Innovation at the Alzheimer’s Society, remarked, “Dementia is the UK’s biggest killer. Although no single behaviour is guaranteed to prevent dementia, we do know there are things you can do to reduce your own risk. Certain factors, such as being overweight and lack of exercise between the ages of 40 to 65, are known to be linked to a higher risk of developing dementia later in life. However, this study aimed to understand if poor cardiovascular health in childhood could increase the risk of dementia. “The study found that where being overweight, lack of exercise, and high blood pressure were present in early life, there were changes in the brain regions that could contribute to developing dementia, suggesting that it’s never too early to make healthy changes to reduce your dementia risk.”

David Thomas, Head of Policy and Public Affairs at Alzheimer’s Research UK, noted, “This study suggests that not looking after our hearts, even in adolescence, could lead to changes in the brain later on in life, which may influence the risk of developing dementia. “Up to 45 per cent of dementia cases can be prevented by avoiding risk factors that we can influence, such as physical inactivity and smoking. These are habits that some people pick up in early life, without knowing the potential long-term consequences for their brain health. “Recent action from the Government to support the health of future generations, including the landmark Tobacco and Vapes Bill, are positive steps towards tackling some of the factors that affect our risk of developing dementia. But with the number of people affected by dementia on the rise, more must be done.”

Call to Action

The findings from this study highlight the urgent need for public health initiatives aimed at improving cardiovascular health in children and adolescents. By addressing modifiable risk factors early, such as promoting regular physical activity, maintaining a healthy weight, and managing blood pressure, it may be possible to reduce the burden of dementia in future generations.

As the understanding of dementia risk factors evolves, this research reinforces the idea that prevention must start far earlier in life than previously thought.

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