Obesity

Posted on Cardiovascular disease, Diabetes, Obesity

Alarming surge in global crisis of childhood overweight and obesity

Global Crisis of Childhood Overweight and 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.

Posted on ADHD, Autism, Children's health, Obesity

Obesity in mums doubles the possibility of autism in babies? Does this research chime with your experience?

When screening pregnant women for gestational diabetes, casual blood glucose testing misses 70% of the cases. This Kobe University study should encourage obstetricians to depend on more reliable tests to help prevent pregnancy complications and the development of type II diabetes in mothers and children.
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.

Posted on Diabetes, Obesity

Impact of weight loss and blood sugar control in T2 Diabetes

Study finds that type 2 diabetes patients treated with GLP-1RAs who lowered their BMI also reduced their cardiovascular risk
Study finds that patients with type 2 diabetes treated with GLP-1RAs who reduced their BMI also lowered their cardiovascular risk.

A research team from the Cleveland Clinic has recently conducted the first study evaluating the separate real-world effects of weight loss and blood sugar control on clinical outcomes in individuals with type 2 diabetes who are being treated with antidiabetic medications, specifically GLP-1RAs, which includes drugs like Ozempic and Wegovy.

The study discovered that for every 1% decrease in BMI, there was a 4% decrease in cardiovascular risk, irrespective of changes in blood sugar levels. Additionally, effective control of blood sugar, regardless of weight change, was associated with a reduced risk of chronic kidney disease. These findings are significant from a clinical standpoint and underscore the importance of addressing both glycemic control and obesity in individuals with type 2 diabetes.

The retrospective findings, which were published in Diabetes, Obesity, and Metabolism, used de-identified electronic health record-derived data from over 1,300 patients with type 2 diabetes who were evaluated at Cleveland Clinic.

Posted on Diabetes, Obesity, Weight Loss

Weight loss could reduce the risk of severe infections in diabetics

Small study finds 6 point stimulation of outer ear with simple metal beads helped reduce waist circumference, body fat and BMI in men living with obesity

New research being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Madrid, Spain (9-13 September) suggests that weight loss interventions could reduce the risk of severe cases of flu and other infections in people with diabetes.

The study by Rhian Hopkins and Ethan de Villiers at the University of Exeter Medical School in Exeter, UK, found evidence suggesting that a higher BMI is associated with severe infections.

In contrast, there was no evidence that mild hyperglycemia contributes to the likelihood of a severe infection.

Hopkins stated, “Up to one in three hospitalizations among people with diabetes are due to infections, and individuals with diabetes are twice as likely to be hospitalized with infections compared to the general population. They also face a high risk of readmission.”

Previous studies have found that higher BMI and poor blood sugar control are associated with severe infections. However, these studies have been observational and thus haven’t been able to prove causal links.

“If one or both of these factors can be shown to be causal, it may be possible to design interventions to lower the risk of severe infections in those at high risk, such as people with diabetes.”

The recent study utilized data from the UK Biobank, which contains medical and genetic information on approximately 500,000 individuals in the UK. The study aimed to investigate the impact of elevated BMI and inadequate blood sugar regulation on the likelihood of being hospitalized due to bacterial and viral infections.

A higher BMI was found to be associated with hospitalisation with infections.  Similarly, every five-point increase in BMI was associated with a 32% increase in the likelihood a severe viral infection.

An association between mild hyperglycemia and severe infections was found. The likelihood of hospitalization due to bacterial infection increased by 32% per 10mmol/mol rise in HbA1c, a measure of blood sugar levels.

This suggested that a higher BMI is one of the causes of severe bacterial and viral infections.

However, mild hyperglycaemia did not appear to cause severe infections.

Although the study didn’t focus on individuals with diabetes, Ms Hopkins says that, given their vulnerability to infections, the results may be particularly relevant to them.

She adds: “Infections are a significant cause of death and ill health, particularly in people with diabetes. Anyone admitted to hospital with a severe infection is also at high risk of being admitted again with another. However, we currently have few practical ways to prevent this.

“This study demonstrates that higher BMI is a cause of hospital admission with infection. Clinicians could discuss weight loss options for people with a high BMI at risk of severe infections and readmission to hospital for infection.”

“While this message may be particularly relevant to people with diabetes, it applies more widely.”

Further research is needed to determine if more severe hyperglycaemia is a cause of severe infections.

Posted on Obesity, Pain Management

Abdominal fat linked to chronic pain, especially in women

Reducing this fat may reduce chronic pain particularly if it’s at multiple body sites
“Reducing this fat may help reduce chronic pain, especially if it is present in multiple body sites.”

Reducing excess fat deposits in the abdomen may help reduce chronic musculoskeletal pain, especially if it’s experienced at multiple body sites, suggest the researchers. Previously published research has shown that obesity is associated with musculoskeletal pain. Still, it’s not known if excess fat tissue is linked to chronic musculoskeletal pain at multiple body sites, say the researchers. To find out, they drew on data from 32,409 participants in the UK Biobank study who completed questionnaires and underwent health assessments. Around half (51%) were women, and their average age was 55.

They underwent MRI scans of their abdomen to measure the amount of fat around the abdominal organs (visceral adipose tissue or VAT)  and the amount of fat just under the skin that can be pinched (subcutaneous adipose tissue or SAT).  When attending for their scan, participants were asked if they had experienced any pain in their neck/shoulder, back, hip, knee or ’all over the body’ for more than 3 months.  The MRI scan and pain assessments were repeated around 2 years later for 638 participants. Comprehensive analyses showed a dose-response association between the number of chronic pain sites and VAT, SAT, the ratio of the two, and weight (BMI).  The association was stronger in women, among whom the odds ratio of a higher number of chronic pain sites was twice as high for VAT and 60% greater for both SAT and the VAT: SAT ratio. In men, these odds ratios were 34% 39%, and 13% higher, respectively. 

Higher levels of fat tissue were also associated with greater odds of reporting chronic pain, and again the association was more pronounced in women.  All these associations remained even after adjusting for age, height, ethnicity, household income, educational attainment, alcohol intake, smoking status, physical activity, coexisting conditions, sleep duration, psychological problems and length of follow-up.

This is an observational study, and as such, can’t establish cause and effect, and the authors also acknowledge various limitations. These include the relatively small size of the repeat imaging sample and the absence of an assessment of severity in the pain questionnaire. They add that more follow-up visits would also have allowed more information to be gathered on patterns and fluctuations in the number of chronic pain sites. However, they conclude: “Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain.  Therefore, reducing abdominal adiposity may be considered a target for chronic pain management, particularly in those with pain in multiple sites and widespread pain.” They suggest that the stronger associations seen in women may be a consequence of sex differences in fat distribution and hormones.