Tag Archives: obesity

Eating the Right Foods and Weight Loss

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In a recent NY Times article, Rethinking Weight Loss and the Reasons We’re ‘Always Hungry’, the idea that too many calories causes obesity is challenged:

“…overeating doesn’t make you fat. The process of getting fat makes you overeat.”

Here’s an excerpt:

Dr. Ludwig, an obesity expert and professor of nutrition at the Harvard T.H. Chan School of Public Health, argues that weight gain begins when people eat the wrong types of food, which throws their hormones out of whack and sets off a cycle of cravings, hunger and bingeing. In his new book, “Always Hungry?,” he argues that the primary driver of obesity today is not an excess of calories per se, but an excess of high glycemic foods like sugar, refined grains and other processed carbohydrates…

Simply cutting back on calories as we’ve been told actually makes the situation worse. When we cut back on calories, our body responds by increasing hunger and slowing metabolism. It responds in an effort to save calories…

It’s the low fat, very high carbohydrate diet that we’ve been eating for the last 40 years, which raises levels of the hormone insulin and programs fat cells to go into calorie storage overdrive.

My take: The idea of changing the types of foods that we consume is not new in the fight against excessive weight gain.  Some of the best data on healthy eating is associated with the Mediterranean diet.

Related blog posts:

Another review (from the NY Times) of the book ‘Happy Gut’ describes a diet promoted by a NY internist to help with problems like irritable bowel: Seeking a ‘Happy Gut’ for Better Health. “Cutting out dairy and gluten reversed many of his symptoms. Replacing processed foods with organic meats, fresh vegetables and fermented foods gave him more energy and settled his sensitive stomach.”

Banning Mills

Banning Mills

 

Should Teenagers with Severe NAFLD Undergo Bariatric Surgery?

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A recent commentary (Stavra A. Xanthakos and Jeffrey B. Schwimmer. Nat Rev Gastroenterol Hepatol. 2015 Jun; 12(6): 316–318.) discusses the role of bariatric surgery for teenagers with severe nonalcoholic fatty liver disease (NAFLD).  Full text Link: On a knife-edge—weight-loss surgery for NAFLD in adolescents.

Here’s an excerpt:

Abstract: A new position statement from Europe endorses expert-based recommendations to consider bariatric surgery as a treatment for severe NAFLD in severely obese adolescents. This article discusses the problem of severe paediatric obesity, its relationship with NAFLD, and the knowledge and needs regarding bariatric surgery in adolescents… it is critical that adolescents with NAFLD undergoing bariatric surgery be evaluated and managed in bariatric surgery centres with appropriate paediatric multidisciplinary expertise and a commitment to rigorously phenotype NAFLD histology at baseline and to follow outcomes prospectively as long as possible. These procedures can be particularly challenging in adolescents, who are prone to relocate in adulthood and thus might not return for follow-up. High quality prospective multicentre studies with low attrition rates, such as the Teen Longitudinal Assessment of Bariatric Surgery (USA) and the Adolescent Morbid Obesity Study (Sweden) have begun to provide short to intermediate term (1–2 year) outcomes after adolescent bariatric surgery, but do not include prospectively collected data on histological liver outcomes to support evidence-based recommendations regarding NASH as a specific indication for bariatric surgery. However, given the benefits that are emerging for type 2 diabetes and sleep apnoea, (which are comorbid conditions often associated with NASH), we concur with previously published expert guidelines that conclude that bariatric surgery is not contraindicated in a non-cirrhotic patient with NAFLD who otherwise meets appropriate medical and psychosocial criteria for bariatric surgery.2 The adolescent and family should, however, be counselled that a positive outcome with respect to NAFLD is, as yet, not a foregone conclusion.

Related blog posts:

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Tipping Point for Obesity?

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A bit of encouraging news from California where investigators showed a small drop in the prevalence of childhood obesity from 2008 to 2013 (C Koebnick et al. J Pediatr 2015; 167: 1264-71).  Using a population-based cohort of ~1.3 million patients, the authors found the following:

  • Obesity prevalence decreased from 19.1% (2008) to 17.5% (2013).  This was observed across all ages, sexes, races, and socioeconomic groups but with variability.
  • Younger children had a greater decline in obesity prevalence compared with adolescents: ages 2-5 years:  -15.4% decline, ages 6-11 years: -11,8% decline and in 12-19 years: -4.5%.

My take: This is a good indication that increased awareness of the obesity epidemic may be leading to some improvement.

Related blog posts:

Lights at Life University

Lights at Life University

Antibiotics and Growth in India

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A recent study (Rogawski ET, et al. J Pediatr 2015; 167: 1096-102) examined a prospective observational cohort of 497 children in India (from “semi-urban slums”).  The authors found that early exposure to antibiotics were not associated with increased or decreased growth.

“There are several potential explanations for the lack of a growth-promoting effect.  Most of the previous studies showing increased weight gain or risk of obesity associated with antibiotics were conducted in high-income countries with Western diets.”

My take: This was a negative study on antibiotics and obesity.  This suggests that the effects of antibiotics with regard to weight gain may be limited and/or modified by diet.

Also noted: Wakamoto H, et al. J Pediatr 2015; 167: 1136-42.  This study showed that Krebs von den Lungen-6 (KL-6) which is abundant on type II alveolar pneumoctyes and respiratory epithelial cells is a fairly good serum biomarker for chronic aspiration in this study of children with severe motor and intellectual disabilities.  Figure 1 shows the distribution of KL-6 among the 37 with aspiration and the 29 without aspiration.  The median in the former was 344 vs 207 in the later, though there was overlapping results.

Related blog posts:

Sandy Springs

Sandy Springs

Overlooking Obesity in Hospitalized Children

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A recent study (MA King et al. J Pediatr 2015; 167: 816-20) shows that physicians and physician trainees rarely addressed overweight/obesity in hospitalized children at a Utah pediatric hospital.

Using a chart review and an administrative database, the authors note that overweight/obesity was identified in 8.3% (n=25) and addressed in 4% (n=12) of 300 hospitalized children with overweight/obesity.  They conclude that “this represents a missed opportunity for both patient care and physician trainee education.”

My take: In many cases, addressing overweight/obesity at a stressful time like a hospitalization may be unwelcome. In children who are not very sick, offering nutritional counseling would be worthwhile.  For others, I think encouraging outpatient followup would be reasonable.

Also noted: “High Prevalence of Nonalcoholic Fatty Liver Disease in Adolescents Undergoing Bariatric Surgery” SA Xanthakos et al. Gastroenterol 2015; 149: 623-34. In this cohort of 242 adolescents, 59% had NAFLD.  None had cirrhosis; stage 3 fibrosis was identified in 0.7%. Comment: I’m surprised that only 59% had NAFLD.

white flower

In the News: Weight Loss Intragastric Balloons

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Two intragastric balloons have been approved for weight loss by the FDA.

FDA approval of ReShape  The FDA announced that 326 obese patients participated in a clinical trial where 187 who were randomly selected to receive the balloon lost an average of 14.3 pounds or 6.8 percent of their body weight when the device was removed at six months. The control group lost an average of 7.2 pounds or 3.3 percent of their body weight. Six months later, the patients who received the balloon had kept off 9.9 pounds of the original 14.3 pounds.

FDA approval Orbera intragastric balloon The pivotal study of ORBERA, known as IB-005, was a multicenter, prospective, randomized, non-blinded comparative study. Subjects from 15 U.S. investigational sites were enrolled between June 20, 2008 and October 10, 2010. The database for this PMA reflected data collected through October 28, 2011 and included 448 subjects…

From GI & Hep News: During a 20- to 30-minute procedure, the deflated Orbera silicone balloon is placed in the stomach via an endoscopic procedure under a mild sedative, where it is then filled with saline until it is about the size of a grapefruit, according to the company. The patient usually can go home on the same day; the balloon is deflated and removed 6 months later….

At 6 months, the mean percent total body weight loss was about 10% in the balloon group, vs. 4% in the control group, a significant difference (P less than .001)… The majority of excess weight loss achieved at 6 months was also maintained at 12 months.

NY Times: Cutting Sugar Improves Children’s Health in Just 10 Days

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Perhaps this is not the best day of the year for this topic….

A recent small study of 43 children is summarized by the NY Times: Cutting Sugar Improves Children’s Health in Just 10 Days

An excerpt:

Obese children who cut back on their sugar intake see improvements in their blood pressure, cholesterol readings and other markers of health after just 10 days, a rigorous new study found.

The new research may help shed light on a question scientists have long debated: Is sugar itself harming health, or is the weight gain that comes from consuming sugary drinks and foods mainly what contributes to illness over the long term?

In the new study, which was financed by the National Institutes of Health and published Tuesday in the journal Obesity, scientists designed a clinical experiment to attempt to answer this question. They removed foods with added sugar from a group of children’s diets and replaced them with other types of carbohydrates so that the subjects’ weight and overall calorie intake remained roughly the same.

After 10 days, the children showed dramatic improvements, despite losing little or no weight. The findings add to the argument that all calories are not created equal, and they suggest that those from sugar are especially likely to contribute to Type 2 diabetes and other metabolic diseases, which are on the rise in children, said the study’s lead author, Dr. Robert Lustig, a pediatric endocrinologist at the Benioff Children’s Hospital of the University of California, San Francisco.

My take:  For a long time, I have been telling patients that if they make only one change, I would start by eliminating sugar-sweetened beverages. While this is a small study, it reinforces the view that sugar intake needs to be limited.

This post included last year’s pumpkin (Halloween 2014):  NASPGHAN Postgraduate Course 2014 -Liver Module – gutsandgrow

This year’s pumpkin:

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NY Times: Frequent Antibiotics May Make Children Fatter

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The topic of antibiotics and obesity has been discussed several times on this blog (see links below).  More information on this topic has been published and is summarized by the NY Times: Frequent Antibiotics May Make Children Fatter

Children who regularly use antibiotics gain weight faster than those who have never taken the drugs, according to new research that suggests childhood antibiotics may have a lasting effect on body weight well into adulthood.

The study, published in the International Journal of Obesity, examined the electronic medical records of 163,820 children ages 3 to 18, counting antibiotic prescriptions, body weight and height. The records, which covered pediatric exams from 2001 through 2012, showed that one in five — over 30,000 children — had been prescribed antibiotics seven or more times. By the time those children reached age 15, they weighed, on average, about 3 pounds more than children who had received no antibiotics.

While earlier studies have suggested a link between antibiotics and childhood weight gain, they typically have relied on a mother’s memories of her child’s antibiotic use. The new research is significant because it’s based on documented use of antibiotics in a child’s medical record.

This story was covered by Time:  Too many antibiotics may make children heavier

My Take: More evidence that antibiotics could contribute to obesity.  Perhaps this will help with antimicrobial stewardship.

Related blog posts:

  1. Could antibiotics make you fat? | gutsandgrowth
  2. Could Obesity Be Cured/Created at Birth with Manipulation of …
  3. Missing Bacteria in Refractory Malnutrition | gutsandgrowth
  4. Preterm Neonatal Microbiota and Effect of Perinatal …
  5. Early Antibiotics and Obesity | gutsandgrowth

Days of Future Past and Declining Liver Graft Quality

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In the most recent ‘X-men’ movie (Days of Future Past), the disastrous future is averted by having Wolverine go back in time to correct a mistake. Overall, while there are a good number of movies that have used this trick, this particular movie is pretty clever. For whatever reason, this movie came to mind as I was reading a recent study: “Declining Liver Graft Quality Threatens the Future of Liver Transplantation in the United States” (ES Orman et al. Liver Transpl 2015; 21: 1040-50).  The authors extrapolate data from UNOS to assess what the liver transplantation (LT) picture may look like in 2030. Their results/conclusion:

“If donor liver utilization practices remain constant, utilization will fall from 78% to 44% by 2030, resulting in 2230 fewer LTs.”  “The transplant community will need to accept inferior grafts and potentially worse post transplant outcomes and/or develop new strategies for increasing organ donation.”

The authors note that the national epidemics of diabetes and obesity will result in more cases of NAFLD-related liver failure while at the same time worsen the quality of available grafts. In the associated editorial, (RH Wiesner, pages 1011-12) the author emphasizes that the future is not quite so set.

  • the prevalence of diabetes and obesity in donors for 2030 might not be as great as feared; in addition, medical/surgical advances may diminish the complications associated with obesity
  • there will be a marked decrease in transplants due to hepatitis C virus related cirrhosis and hepatocellular cancer

His conclusion: “in the future, we will be using donor livers that we have never used before and will be achieving similar excellent results as we have today.” Which vision of the liver transplantation future is correct?

Related blog post: AASLD/NASPGHAN 2014 Guidelines for Evaluation of Pediatric …

Bison, Yellowstone

Bison, Yellowstone

“Fat Report Cards” –Do They Help?

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Probably not.

From NY Times: Body Report Cards Aren’t Influencing Arkansas Teenagers,   Excerpt:

It is one of the boldest and most controversial tactics in the battle against childhood obesity: A growing number of schools are monitoring their students’ weight and sending updates home, much like report cards.

Ten states, including Ohio, Pennsylvania and Illinois, now require schools to send such notifications, sometimes called “B.M.I. letters,” or less charitably “fat letters.” But a new study of the first state to adopt the practice shows that the letters have had almost no effect, at least on older teenagers…

The Arkansas study by Dr. Gee looked at the B.M.I. results of juniors and seniors who had been evaluated and, after the 2007 legislative changes, those who had not. It found that students whose families had received the letters showed no appreciable improvement in B.M.I. scores after two years, compared with those who had not been screened. Another peer-reviewed study of such letters, a 2011 examination of younger students in California, had similar findings.

Empire State Building

Empire State Building