Factors that predict obesity by adolescence revealed

Three simple factors that predict whether a healthy weight child will be overweight or obese by adolescence have been revealed in a new study led by the Murdoch Children's Research Institute (MCRI).

The research shows three factors -- a child's and mother's Body Mass Index (BMI) and the mother's education level -- predict the onset or resolution of weight problems by adolescence, especially from age 6-7 years onwards.

Each one-unit higher BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by three-fold and halved the odds of resolution.

Similarly, every one-unit increase in the mother's BMI when the child is aged 6-7 years increased the odds at 14-15 years of developing weight problems by 5 per cent and decreased the odds of resolution by about 10 per cent.

Mothers having a university degree was associated with lower odds of a child being overweight and obese at ages 2-5 years and higher odds of resolving obesity issues by adolescence.

Study author MCRI's Dr Kate Lycett said the prevalence of being overweight/obese at the age of 14-15 years was 13 per cent among children with none of these three risk factors at age 6-7 years, compared with 71 per cent among those with all risk factors.

Dr Lycett said identifying these three factors may help clinicians predict which children will develop and resolve excess weight with about 70 per cent accuracy.

"In the case of BMI, it is an objective measure that is easily measured and reflects diet and exercise choices, but is free from the challenges of assessing physical activity and diet in a standard clinical appointment such as recall bias," she said.

The findings, published in the latest edition of the International Journal of Obesity, also found children who are overweight or obese at 2-5 years have a low chance of resolving their weight problems by adolescence when these three risk factors are present.

Data was sourced from 3469 participants at birth and 3276 participants at kinder from the Longitudinal Study of Australian Children. The child's height and weight were measured every two years.

Dr Lycett said until now most studies have overlooked the important questions around which children are likely to become overweight/obese and how it be resolved.

"Because clinicians haven't been able to tell which children will grow up to become teens with excess weight, it's been hard to target interventions for those most at risk," she said.

"The consequences of this are dire, with childhood obesity predicting premature death and being implicated in cardiovascular disease, diabetes and cancer."

The study examined how combinations of 25 potential short clinical markers such as time breastfeeding and amount of outdoor activity at various ages predict weight issues, as well as resolution, by ages 10-11 and 14-15 years.

Intriguingly, short questions about poor diet, low physical activity and other common lifestyle factors were not predictive of weight outcomes.

Lead author Professor Markus Juonala, from the University of Turku in Finland, said a simple risk score, which would be easily available to child health clinicians, could help target treatment or prevention.

"Combining data on these three easily obtainable risk factors may help clinicians make appropriate decisions targeting care to those most at risk of adolescent obesity," he said.

"The benefits of removing a focus on those unlikely to need clinical interventions for obesity has largely been ignored, despite an increasing policy emphasis on avoiding wasteful or unnecessary health care."


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Materials provided by Murdoch Childrens Research Institute. Note: Content may be edited for style and length.

Type 2 diabetes and obesity could be treated by new, less invasive procedure

New research from King's College London published in EBioMedicine, has found that a newly tested medical device, called Sleeveballoon, mimics the effects of traditional bariatric surgery in rodents and produces impressive results on body weight, fatty liver and diabetes control.

Sleeveballoon is a device that combines a balloon with a connected sleeve, which covers the initial parts of the small intestine. It is inserted into the stomach and bowel during minimally invasive surgery under general anaesthetic.

In this study, researchers compared the effects of the Sleeveballoon and traditional bariatric surgery on 30 rodents fed with a high-fat diet, achieving very similar results. Results were also compared to sham-operated rats, with the new device reducing food intake by 60% and resulting in a 57% reduction in fat mass. The effect on diabetes was similarly impressive with blood glucose levels dropping by 65%.

"Gastric bypass surgery is a highly effective treatment of obesity and type 2 diabetes. However, very few eligible patients, only around 1%, are offered surgery and some also prefer less invasive approaches," said lead author Professor Geltrude Mingrone from King's College London.

"We found that the metabolic effects of the Sleeveballoon device are similar to those of the gastric bypass but have distinct advantages over the traditional method. In both, insulin sensitivity and heart functions improved. However, while gastric bypass causes a rapid rise in post food blood glucose levels which can cause hypoglycaemia, the Sleeveballoon induces a slowing down of digestion which has a steadying effect on blood sugar levels. This helps control appetite and hunger, keeping the person fuller for longer and substantially reduces weight."

The device should be removed after 6 to 12 months, and the team are eager to test the device in say more research is needed to manage this process and avoid reversal of the positive effects on obesity and diabetes.

"About two billion adults, or 30% of the world's population, live with overweight or obesity according to the World Health Organisation," said Professor Mingrone.

"At present, 500 million people suffer from type 2 diabetes and about two billion people have fatty liver disease. We hope that our discovery will be tested in humans soon and revolutionise the way we tackle this epidemic."


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Obesity rising faster in rural areas than cities

Obesity is increasing more rapidly in the world's rural areas than in cities, according to a new study of global trends in body-mass index (BMI).

The research, led by Imperial College London and published in Nature, analysed the height and weight data of more than 112 million adults across urban and rural areas of 200 countries and territories between 1985 and 2017.

Height and weight can be used to calculate BMI, an internationally recognised scale which tells us whether an individual has a healthy weight for their height.

The study, involving a network of more than 1000 researchers across the world, found that from 1985 to 2017, BMI rose by an average of 2.0 kg/m2 in women and 2.2 kg/m2 in men globally, equivalent to each person becoming 5-6 kg heavier. More than half of the global rise over these 33 years was due to increases in BMI in rural areas. In some low- and middle-income countries, rural areas were responsible for over 80 per cent of the increase.

The team found that since 1985, average BMI in rural areas has increased by 2.1 kg/m2 in both women and men. But in cities, the increase was 1.3 kg/m2 and 1.6 kg/m2 in women and men respectively.

These trends have led to striking changes in the geography of BMI over the three decades. In 1985, urban men and women in over three quarters of the countries had a higher BMI than their rural counterparts. Over time, the gap between urban and rural BMI in many of these countries shrank or even reversed.

"The results of this massive global study overturn commonly held perceptions that more people living in cities is the main cause of the global rise in obesity," explains senior author Professor Majid Ezzati of Imperial's School of Public Health. "This means that we need to rethink how we tackle this global health problem."

The team found important differences between high-, middle-, and low-income countries. In high-income countries, the study showed that BMI has been generally higher in rural areas since 1985, especially for women. The researchers suggest this is due to the disadvantages experienced by those living outside cities: lower income and education, limited availability and higher price of healthy foods, and fewer leisure and sports facilities.

"Discussions around public health tend to focus more on the negative aspects of living in cities," says Professor Ezzati. "In fact, cities provide a wealth of opportunities for better nutrition, more physical exercise and recreation, and overall improved health. These things are often harder to find in rural areas."

Meanwhile, rural areas in low- and middle-income countries have seen shifts towards higher incomes, better infrastructure, more mechanised agriculture and increased car use, all of which bring numerous health benefits, but also lead to lower energy expenditure and to more spending on food, which can be processed and low-quality when sufficient regulations are not in place. All these factors contribute to faster increase in BMI in rural areas.

"As countries increase in wealth, the challenge for rural populations changes from affording enough to eat, to affording good quality food," adds Professor Ezzati.

The main exception to the global trend was sub-Saharan Africa where women gained weight more rapidly in cities, possibly because of more low-energy work (such as office work), less need for physical domestic tasks such as collecting firewood and fetching water, shorter commutes and greater access to processed foods.

Regional and country data on BMI in rural and urban populations

  • Nationally, BMI decreased slightly between 1985 and 2017 among women in twelve countries in Europe (Greece, Spain, Lithuania, Czech Republic, Italy, Portugal, Serbia, France, Malta) and Asia Pacific (Nauru, Singapore and Japan). At the other extreme, it increased by more than 5 kg/m2 in women in Egypt and Honduras.
  • Among men, BMI increased in every country, with the largest increases in Saint Lucia, Bahrain, Peru, China, Dominican Republic and the USA, all by more than 3.1 kg/m2.
  • Rural women in Bangladesh had the lowest BMI recorded in the study in 1985, at 17.7 kg/m2. Men living in rural Ethiopia had the lowest male BMI at 18.4 kg/m2, also in 1985.
  • Urban women from the US South Pacific territory of American Samoa had the highest BMI recorded, at 35.4 kg/m2 in 2017. Rural men from the same country were highest for males, at 34.6 kg/m2 also in 2017.
  • In 2017, urban women and men in sub-Saharan Africa weighed more than their rural counterparts by a bigger margin than anywhere else, especially women in west African countries like Niger, Burkina Faso, Togo and Ghana.
  • Rural women in central and eastern European countries were heavier than their urban counterparts by the biggest margin -- around 1 kg/m2 or more in Belarus, Czech Republic and Latvia. This gap has remained largely unchanged since 1985.
  • For rural men, the biggest margins of rural over urban BMI were in Sweden, Czech Republic, Ireland, Australia, Austria and the USA -- all with rural BMI more than 0.35 kg/m2 higher than urban BMI.

The research was funded by the Wellcome Trust, the Medical Research Council, the Royal Society and the Academy of Medical Sciences.

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Depression, anxiety may take same toll on health as smoking and obesity

An annual physical typically involves a weight check and questions about unhealthy habits like smoking, but a new study from UC San Francisco suggests health care providers may be overlooking a critical question: Are you depressed or anxious?

Anxiety and depression may be leading predictors of conditions ranging from heart disease and high blood pressure to arthritis, headaches, back pain and stomach upset, having similar effects as long-established risk factors like smoking and obesity, according to the new research.

In the study, first author Andrea Niles, PhD, and senior author Aoife O'Donovan, PhD, of the UCSF Department of Psychiatry and the San Francisco VA Medical Center, looked at the health data of more than 15,000 older adults over a four-year period.

They found that 16 percent (2,225) suffered from high levels of anxiety and depression, 31 percent (4,737) were obese and 14 percent (2,125) were current smokers, according to their study published in the journal Health Psychology on Dec. 17, 2018.

Participants with high levels of anxiety and depression were found to face 65 percent increased odds for a heart condition, 64 percent for stroke, 50 percent for high blood pressure and 87 for arthritis, compared to those without anxiety and depression.

"These increased odds are similar to those of participants who are smokers or are obese," said O'Donovan, who, with Niles, also is affiliated with UCSF Weill Institute for Neurosciences. "However, for arthritis, high anxiety and depression seem to confer higher risks than smoking and obesity."

Cancer an Exception to Conditions Impacted by Depression and Anxiety

Unlike the other conditions investigated, the authors found that high levels of depression and anxiety were not associated with cancer incidence. This confirms results from previous studies, but contradicts a prevailing idea shared by many patients.

"Our findings are in line with a lot of other studies showing that psychological distress is not a strong predictor of many types of cancer," O'Donovan said. "On top of highlighting that mental health matters for a whole host of medical illnesses, it is important that we promote these null findings. We need to stop attributing cancer diagnoses to histories of stress, depression and anxiety."

Niles and O'Donovan discovered that symptoms such as headache, stomach upset, back pain and shortness of breath increased exponentially in association with high stress and depression. Odds for headache, for example, were 161 percent higher in this group, compared with no increase among the participants who were obese and smokers.

Treating Mental Health Can Cut Health Care Costs

"Anxiety and depression symptoms are strongly linked to poor physical health, yet these conditions continue to receive limited attention in primary care settings, compared to smoking and obesity," Niles said. "To our knowledge this is the first study that directly compared anxiety and depression to obesity and smoking as prospective risk factors for disease onset in long-term studies."

The results of the study underscore the "long-term costs of untreated depression and anxiety," said O'Donovan. "They serve as a reminder that treating mental health conditions can save money for health systems."

The two authors evaluated health data from a government study of 15,418 retirees, whose average age was 68. Depression and anxiety symptoms were assessed using data from participant interviews. Participants were questioned about their current smoking status, while weight was self-reported or measured during in-person visits. Medical diagnoses and somatic symptoms were reported by participants.

As More Latin Americans Eat Processed Food, Obesity Rates Surge

Nearly 60 percent of Latin Americans are overweight, according to a UN report

Latin America, once plagued by malnutrition, now faces a different type of public health crisis as processed food increasingly replaces traditionally prepared dishes, leading to a surge in obesity rates, a United Nations report showed on Thursday.

Nearly 58 percent of the region's inhabitants, or close to 360 million people, is either overweight or obese, said the report by the United Nations' Food and Agriculture Organization (FAO) and the Pan American Health Organization (PAHO).

The rapid jump in obesity rates has crisscrossed the region, affecting Latin Americans "regardless of their economic situation, place of residence or ethnic origin," it said.

That has occurred partly as economic growth, increased urbanization, higher average incomes and the region's integration into international markets have reduced the consumption of traditionally prepared food and raised that of ultra-processed products, the report said.

The problem is greatest in countries that are net food importers.

The countries with the highest levels of obesity are the Bahamas, Mexico and Chile, with rates of 69 percent, 64 percent and 63 percent, respectively.

Still, even as obesity rates surge, Latin America is still home to the nation with the highest rate of undernourishment; in Haiti, 53 percent of the population is undernourished.

  • Published in World

Scientists find how obesity gene works, a clue to treatment

Scientists have finally figured out how the key gene tied to obesity makes people fat, a major discovery that could open the door to an entirely new approach to the problem beyond diet and exercise.

The work solves a big mystery: Since 2007, researchers have known that a gene called FTO was related to obesity, but they didn't know how, and could not tie it to appetite or other known factors.

Now experiments reveal that a faulty version of the gene causes energy from food to be stored as fat rather than burned. Genetic tinkering in mice and on human cells in the lab suggests this can be reversed, giving hope that a drug or other treatment might be developed to do the same in people.

The work was led by scientists at MIT and Harvard University and published online yesterday by the New England Journal of Medicine.

The discovery challenges the notion that "when people get obese it was basically their own choice because they choose to eat too much or not exercise," said study leader Melina Claussnitzer, a genetics specialist at Harvard-affiliated Beth Israel Deaconess Medical Center. "For the first time, genetics has revealed a mechanism in obesity that was not really suspected before" and gives a third explanation or factor that's involved.

Independent experts praised the discovery.

"It's a big deal," said Dr. Clifford Rosen, a scientist at Maine Medical Center Research Institute and an associate editor at the medical journal.

"A lot of people think the obesity epidemic is all about eating too much," but our fat cells play a role in how food gets used, he said. With this discovery, "you now have a pathway for drugs that can make those fat cells work differently."

Researchers can't guess how long it might take before a drug based on the new findings becomes available.

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