A study published in the New England Journal of Medicine found that ten years after undergoing bariatric surgery during their teenage years, more than half of the participants maintained significant weight loss. Additionally, many of these individuals showed improvements in obesity-related conditions, including type 2 diabetes, high blood pressure, and high cholesterol.
“Our study demonstrates remarkable results from the longest follow-up of weight loss surgery during adolescence, confirming that bariatric surgery is a safe and effective long-term strategy for managing obesity,” stated lead author Justin Ryder, PhD. He is the Vice Chair of Research in the Department of Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and an Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine.
Bariatric surgery is significantly under-utilized in the U.S., with only one out of every 2,500 teens with severe obesity undergoing the procedure. Based on existing recommendations, nearly five million adolescents qualify for effective weight loss interventions, such as bariatric surgery.
Hillary Fisher, now 31 years old, is glad she decided to undergo surgery at the age of 16. She was one of 260 adolescents who participated in the long-term Teen-LABS study.
“I felt overwhelmed by the daily struggles I faced due to my weight, health issues, and bullying in high school,” Ms. Fisher said. “After several unsuccessful attempts to lose weight, I weighed 260 pounds, and we decided that bariatric surgery was the solution. It changed my life; the improved health and self-esteem that came with losing 100 pounds were significant for me, and I would absolutely do it again.”
Notably, the study found that 55 per cent of the participants who had type 2 diabetes as teenagers and underwent surgery were still in remission of their diabetes at 10 years.
“This is considerably better than the outcomes reported in people who underwent bariatric surgery as adults, a major reason why treating obesity seriously in adolescents is so important,” added Dr. Ryder.
Indeed, a recent multi-centre randomized controlled trial found diabetes type 2 remission in adults to be 12-18 per cent at seven to 12 years after bariatric surgery.
A rigorous workout suppresses hunger more than moderate exercise in healthy adults, with females potentially more affected, according to a small study published in the Journal of the Endocrine Society.
The study investigates how exercise intensity affects ghrelin levels and appetite in men and women. Ghrelin, known as the “hunger hormone,” is linked to feelings of hunger.
“We discovered that high-intensity exercise reduces ghrelin levels more effectively than moderate-intensity exercise,” said lead author Kara Anderson, Ph.D., from the University of Virginia and the University of Virginia Health System in Charlottesville, Virginia. “Additionally, we found that individuals felt ‘less hungry’ after high-intensity exercise compared to when they engaged in moderate-intensity exercise.”
Ghrelin circulates in acylated (AG) and deacylated (DAG) forms, which are known to affect appetite. The study noted that data on the impact of exercise intensity on AG and DAG levels and their effects on appetite is sparse and primarily limited to males.
To address this shortfall, the study examined eight males and six females. Participants fasted overnight and then completed exercises of varying intensity levels, determined by blood lactate measurements, followed by self-reported measurements of appetite.
The study noted that females had higher levels of total ghrelin at baseline compared with males. However, only females demonstrated “significantly reduced AG” following the intense exercise.
“We found that moderate intensity either did not change ghrelin levels or led to a net increase,” the study noted. These findings suggest that exercise above the lactate threshold “may be necessary to elicit a suppression in ghrelin.”
Researchers also acknowledged that more work is needed to determine the extent to which exercise’s effects differ by sex.
Ghrelin has been shown to have wide-ranging biological effects in areas including energy balance, appetite, glucose homeostasis, immune function, sleep, and memory.
“Exercise should be thought of as a ‘drug,’ where the ‘dose’ should be customized based on an individual’s personal goals,” Anderson said. “Our research suggests that high-intensity exercise may be important for appetite suppression, which can be particularly useful as part of a weight loss program.”
Researchers have unveiled a novel approach to tackle obesity by targeting fat absorption in the small intestine.
Researchers have introduced a new method to address obesity by targeting fat absorption in the small intestine. The advanced nanoparticle system, designed to transport therapeutic molecules directly to the digestive tract, has displayed significant potential in preventing diet-induced obesity.
Presented today at UEG Week 2024, the study focuses on an enzyme called Sterol O-acyltransferase 2 (SOAT2), which plays a critical role in fat absorption in the small intestine.3,4 By inhibiting this enzyme, the study offers a promising therapeutic approach to reducing fat absorption and potentially preventing obesity.
Despite extensive research into fat metabolism, effective inhibitors of intestinal fatty acid uptake have remained elusive until now. Lead researcher Dr. Wentao Shao explained, “For years, researchers have studied fat metabolism, but finding an effective way to block fat absorption has been difficult. While most strategies focus on reducing dietary fat intake, our approach targets the body’s fat absorption process directly.”
The research team has developed an innovative delivery system using nanoparticles. These are tiny capsules made from a polymer core and coated in a protective shell. The system is designed to efficiently carry small interfering RNAs (siRNAs) to the small intestine. Once there, the siRNAs can reduce SOAT2 expression, which in turn inhibits fat absorption. In mouse models, the animals treated with nanoparticle therapy absorbed less fat and avoided obesity, even when on a high-fat diet.
“This oral treatment offers several advantages”, said Dr Shao. “It’s non-invasive, has low toxicity, and it has high potential for better patient compliance compared to current obesity treatments, which are often invasive or difficult to maintain. This makes it a promising alternative.”
The study also uncovered the underlying mechanism by which SOAT2 regulates fat absorption. Inhibition of SOAT2 in the small intestine triggers the degradation of CD36, a protein responsible for transporting fat. This process involves both cellular stress and the recruitment of E3 ligase RNF5, an enzyme that enhances CD36 degradation.
Previous studies have shown that blocking hepatic SOAT2 leads to fat accumulation in the liver,5,6 whereas this intestine-specific approach circumvents that risk, offering a safer and more focused treatment for obesity.
The harmful consequences of this epidemic are already evident: childhood hypertension and type 2 diabetes, among others. Researchers sound the alarm and discuss both challenges and potential solutions. Credit Alex Dolce, Florida Atlantic University
Since 1990, the rise in childhood overweight and obesity has surged across every continent, almost doubling in prevalence. While the United States has the highest prevalence, other nations are not far behind.
In Southern Europe, including Greece, Italy, and Spain, 10 to 15% of children are obese. At the same time, Eastern European countries have somewhat lower rates but are experiencing a rapid increase that may soon match Southern Europe. Globally, Asia has nearly half of all overweight children under the age of 5, and Africa has one-quarter of such children. In Latin America, about 20% of children under 20 are overweight. Many developing countries face the dual challenge of both overweight/obesity and malnutrition in their children.
“Pediatric overweight and obesity have reached epidemic levels in the U.S. and are becoming a pandemic globally. These conditions lead to high blood pressure, type 2 diabetes and lipid disorders, which contribute to metabolic syndrome. In adults, these issues significantly increase the risks of heart attacks, stroke, liver disease, obstructive sleep apnea, arthritis and certain cancers – many of which are now occurring at younger ages,” said Charles H. Hennekens, M.D., first author and the first Sir Richard Doll Professor of Medicine and Preventive Medicine, FAU Schmidt College of Medicine. “Through coordinated clinical and public health efforts, we can address these troubling trends and work toward a healthier future for children and families globally.”
In the commentary, the authors report on the leading causes of this epidemic including high body mass index (BMI), which increases the risks of many serious health issues. In the U.S., a preschooler is considered overweight if their BMI exceeds the 85th percentile. Research shows that these children are at a significantly higher risk of being overweight during adolescence compared to those with a BMI at the 50th percentile. This underscores the misconception that children simply “outgrow” overweight issues.
In addition, the authors note that health care providers and public health practitioners face major challenges in boosting daily physical activity among children, which is crucial for increasing metabolic rates, lowering BMI, and reducing future risks of coronary heart disease.
“With declining physical education in schools and excessive time spent on electronic devices, many children fail to meet recommended activity guidelines. This sedentary behaviour contributes to overweight and obesity through poor diet, reduced sleep, and decreased physical activity,” said Panagiota “Yiota” Kitsantas, Ph.D.,
The authors also caution that while increasing levels of daily physical activity is necessary, it isn’t sufficient to make a major impact on the rates of childhood overweight and obesity. The rise of high sugar containing foods, along with consumption of ultra-processed foods also are major contributors.
“Nearly 70% of the average U.S.-based child’s diet is made up of ultra-processed foods,” said Hennekens. “Moreover, consumption of ultra-processed foods among children under 24 months is rising worldwide, triggering not only the potential of developing obesity but also decreased immunological protection.”
The authors say that more research is needed to pinpoint which components of ultra-processed foods contribute to weight gain in children. However, they warn that a diet high in ultra-processed foods is linked to rising rates of overweight and obesity, with schools being a major source of these foods.
“Evidence suggests that enhancing school lunch nutritional standards could help reduce obesity, particularly among low-income children,” said Kitsantas. “We recommend adopting school food policies that remove ultra-processed foods from menus and promote healthier alternatives, alongside educational programs on healthy eating, despite the challenges posed by external influences on children.”
Among the challenges highlighted in the commentary is the use of social media and advertising, which significantly affect children’s food choices and behaviors that include sharing unhealthy food posts and recognizing many unhealthy food brands upon exposure.
“Despite recommendations from the World Health Organization and public health authorities to restrict food marketing aimed at children, few countries have implemented such measures,” said Hennekens. “The effectiveness of existing regulations in today’s media landscape is uncertain, creating an opportunity for health providers and public health practitioners to educate families about the impact of this advertising.”
The authors explain that addressing the rising pediatric obesity epidemic requires a multifaceted approach. In 2023, the American Academy of Pediatrics endorsed WHO guidelines and released their own recommendations for managing pediatric overweight and obesity. These guidelines advise health care providers and public health practitioners to tackle social determinants of health, use motivational interviewing to modify nutrition and activity behaviors, and consider pharmacotherapy or surgery to meet personalized patient goals.
However, the authors say that while there are approved drug therapies available, before prescribing pharmacologic options, maternal and child health care providers should employ therapeutic lifestyle changes.
“While the ultimate goal is prevention of pediatric overweight and obesity as well as metabolic syndrome, to paraphrase Voltaire, we should not ‘let the perfect be the enemy of the good,’” said Hennekens.
In conclusion, the authors urge leveraging all available resources to at least stabilize the rising rates of childhood obesity and its associated health issues. Ignoring these challenges could lead to an unprecedented global epidemic of childhood and adolescent obesity, with severe future health consequences, as seen in the U.S.
“Health care and public health professionals must collaborate across disciplines to address these issues with patients, families, communities and policymakers. United efforts can help reverse these troubling trends and ensure a healthier future for children worldwide,” said Kitsantas.
Children born to mothers with obesity before and during pregnancy have a higher possibility of neuropsychiatric and behavioural conditions, such as autism and attention deficit hyperactivity disorder (ADHD), according to new research from the University of South Australia.
Funded by the Centre of Research Excellence in Health in Preconception & Pregnancy and conducted in partnership with Curtin University, Monash University, SAHMRI, and a team of national institutions, the systematic review and meta-analysis of more than 3.6 million mother-child pairs across 42 epidemiological studies found that obesity during pregnancy:
Increases the chance of ADHD in children by 32%. Doubles the chance of developing autism in children (by 2.23 times). Increases the possibility of conduct disorders by 16%
The study also found that maternal pre-conception obesity or overweight was linked with an increased risk of ADHD, autism, conduct disorder and psychotic disorder, as well as a 30% increased risk in both externalising symptoms and peer relationship problems.
“Maternal obesity has long been associated with a range of adverse perinatal outcomes, including preterm birth, low birth weight, stillbirth, and it is also linked with macrosomia or high birthweight,” Dr Duko says.
“In this study, we examined maternal overweight and obesity before and during pregnancy, finding that both are significantly linked with psychiatric and behavioural problems in children later in life, specifically autism, ADHD and peer relationship problems.
“Given the rising global obesity rates among women of reproductive age, and the growing numbers of children identified with neurodiverse conditions, it’s important that we acknowledge the potential long-term consequences of maternal adiposity on child mental health.”
In Australia, approximately 1 in 150 people are autistic , and more than 8% of children aged 4-11 are diagnosed with ADHD. Globally, 1 in 8 people live with obesity.
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