Tag Archives: obesity

Zip Code or Genetic Code -which is more important for longevity?

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From NY Times: http://t.co/fNm0nFOUdK

An excerpt:

Fairfax County, Va., and McDowell County, W.Va., are separated by 350 miles, about a half-day’s drive. Traveling west from Fairfax County, the gated communities and bland architecture of military contractors give way to exurbs, then to farmland and eventually to McDowell’s coal mines and the forested slopes of the Appalachians. Perhaps the greatest distance between the two counties is this: Fairfax is a place of the haves, and McDowell of the have-nots. Just outside of Washington, fat government contracts and a growing technology sector buoy the median household income in Fairfax County up to $107,000, one of the highest in the nation. McDowell, with the decline of coal, has little in the way of industry. Unemployment is high. Drug abuse is rampant. Median household income is about one-fifth that of Fairfax.

One of the starkest consequences of that divide is seen in the life expectancies of the people there. Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq….           

There have long been stark economic differences between Fairfax County and McDowell. But as their fortunes have diverged even further over the past generation, their life expectancies have diverged, too. In McDowell, women’s life expectancy has actually fallen by two years since 1985; it grew five years in Fairfax.

“Poverty is a thief,” said Michael Reisch, a professor of social justice at the University of Maryland, testifying before a Senate panel on the issue. “Poverty not only diminishes a person’s life chances, it steals years from one’s life.”

That reality is playing out across the country. For the upper half of the income spectrum, men who reach the age of 65 are living about six years longer than they did in the late 1970s. Men in the lower half are living just 1.3 years longer.

This life-expectancy gap has started to surface in discussions among researchers, public health officials and Washington policy makers. The general trend is for Americans to live longer, and as lawmakers contemplate changes to government programs — like nudging up the Social Security retirement age or changing its cost-of-living adjustment — they are confronted with the potential unfairness to those who die considerably earlier.

The link between income and longevity has been clearly established. Poor people are likelier to smoke. They have less access to the health care system. They tend to weigh more. And their bodies suffer the debilitating effects of more intense and more constant stress. Everywhere, and across time, the poor tend to live shorter lives than the rich, whether researchers compare the Bangladeshis with the Dutch or minimum-wage workers with millionaires.

But is widening income inequality behind the divergence in longevity over the last three decades? …

Living in Fairfax is different than living in McDowell.

In Fairfax, there are ample doctors, hospitals, recreation centers, shops, restaurants, grocery stores, nursing homes and day care centers, with public and private entities providing cradle-to-grave services to prosperous communities…

The jobs tend to be good jobs, providing health insurance and pensions, even if there is a growing low-wage work force of health aides, janitors, fast-food workers and the like. “It’s a knowledge-based work force,” Mr. Fuller said. “And we have an economy built on services, technology-intensive services.”

…350 miles away, …

Coal miners still dig into and blast off the tops of steep Appalachian hills. But the industry that once provided thousands of jobs is slowly disappearing, and the region’s entrenched poverty has persisted. The unemployment rate is 8.8 percent, down from more than 13 percent in the worst of the recession. The current number would be even higher if more residents hadn’t simply given up looking for work.

Government assistance accounts for half of the income of county residents. Social workers described shortages of teachers, nurses, doctors, surgeons, mental health professionals and addiction-treatment workers. There is next to no public transportation…

Many people … have multiple woes: “Diabetes. Obesity. Congestive heart failure. Drug use. Kidney problems. Lung conditions from the mines.” Problems often start young and often result in shorter lives, she said. Earlier that day, she handed me a list of recent funerals with about half highlighted in yellow; they signified that the deceased was under 50…

But dollars in a bank account have never added a day to anyone’s life, researchers stress. Instead, those dollars are at work in a thousand daily-life decisions — about jobs, medical care, housing, food and exercise — with a cumulative effect on longevity…

As such, the health statistics for Fairfax and McDowell are as striking as their income data. In Fairfax, the adult obesity rate is about 24 percent and one in eight residents smokes. In McDowell, the adult obesity rate is more than 30 percent and one in three adults smokes. And the disability rate is about five times higher in McDowell.

In both counties, food availability matters. There are only two full-size grocery stores in McDowell; minimarts and fast-food restaurants are major sources of nutrition. “We don’t have gyms or fitness centers,” said Pamela McPeak, who grew up in McDowell getting creek water to flush her family’s toilet. “It’s cheaper to buy Cheetos rather than apples.” She now runs a nonprofit program that provides tutoring and helps high school students get into college.

Education is also correlated with longevity, as it is with income and employment. Educated individuals are much more likely to work, and much more likely to have higher incomes. In McDowell, about one in 18 adults has a college degree; in Fairfax, the share is 60 percent.

Finally, and perhaps most powerfully, researchers say that a life in poverty is a life of stress that accumulates in a person’s very cells. Being poor is hard in a way that can mean worse sleep, more cortisol in the blood, a greater risk of hypertension and, ultimately, a shorter life…

It is hard to prove causality with the available information. County-level data is the most detailed available, but it is not perfect. People move, and that is a confounding factor. McDowell’s population has dropped by more than half since the late 1970s, whereas Fairfax’s has roughly doubled. Perhaps more educated and healthier people have been relocating from places like McDowell to places like Fairfax. In that case, life expectancy would not have changed; how Americans arrange themselves geographically would have…

In particular, changes in smoking and obesity rates may help explain the connection between bigger bank accounts and longer lives. “Richer people and richer communities smoke less, and that gap is growing,” said Dr. Murray at the Institute for Health Metrics and Evaluation…

To some extent, the broad expansion of health insurance to low-income communities, as called for under Obamacare, may help to mitigate this stark divide, experts say. And it is encouraging that both Republicans and Democrats have recently elevated the issues of poverty, economic mobility and inequality, But the contrast between McDowell and Fairfax shows just how deeply entrenched these trends are, with consequences reaching all the way from people’s pocketbooks to their graves.

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Active Video Games –Part of Weight Loss Program?

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From JAMAPediatrics (full article): http://t.co/CmwQjCyhdJ

An excerpt:

Design, Setting, and Participants      Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools .. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%).

Interventions      All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program…

Results      Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], −10.9% [1.6%] vs −5.5% [1.5%]; P = .02) and BMI z score (−0.25 [0.03] vs −0.11 [0.03]; P < .001).

Conclusions and Relevance      Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight.

Comment: The costs of the games and game consoles were about $350 according to the authors.  Since this was a short study (16-weeks), it is not clear that this will be cost-effective.  However, any tools that may help kids become more active are certainly welcome.

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7 Ways Parents Can Influence Risk of Obesity

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Here’s a link with some good advice for parents about developing healthy eating habits http://t.co/ChlRj2hEWV from Huffington Post and an excerpt (from Kristin Kirkpatrick, M.S., R.D., L.D):

I was recently called out for not being a “fun” mom because I wouldn’t buy artificially colored “fun” junk food for my son. …

We strive to teach manners, independence and kindness to our children but we often times fail to teach something just as important — the value of exercise and healthy eating. The majority of your child’s attitudes about food and nutrition, they’re desire to be physically active and even their weight will come directly from their parent’s.

Here are eight things about you that will most likely be passed down to your children. 

1. You’ve got a weight problem While part of your child’s risk for obesity, and even how picky they might be about trying certain foods may be caused by genetic factors, the bulk of your child’s predisposition to be overweight may actually be determined by your weight.  That’s right, if you’re overweight or obese, your child’s chances of following the same fate are between 25 to 50 percent. What about your child’s other parent? If he or she is also overweight, the chances just shot up to 75 percent.

A 2012 study found that a simple formula could predict a baby’s propensity to become obese and noted in the study that based on longitudinal cohort data, that 20 percent of children predicted to have the highest risk at birth make up 80 percent of obese children. The calculation is based on five factors including birth weight, the body mass index of the parents, the number of people in the household, the mother’s professional status and whether she smoked during pregnancy…

2. You use food to reward or withhold on a regular basis …

3. In your home, junk food is its own food group A 2014 study  suggested that it wasn’t actually the vast presence of fast food establishments that was to blame for the pediatric obesity epidemic but rather overall bad habits that originated in the home. Homes that followed a “Western diet” defined in the study as having a prevalence of sugared sweetened beverages, salty snacks, high-fat sandwiches, candy and desserts were more likely to have obese or overweight kids with poor dietary habits.

The desire for junk food may actually be affected before birth as well. A 2013 animal study found that pregnant mothers who consumed junk foods, particularly fast food, actually altered the opiate signaling pathways in the brains of their offspring, making their baby’s more likely to crave foods high in fat and sugar.

4. You’re a couch potato A 2013 study found that kids whose moms encouraged them to exercise and eat well (and modeled these behaviors in themselves) were more likely to engage in physical activity and adhere to healthy eating habits. That means more movement, mom and dad, and less couch time! In addition to keeping kids sedentary, spending too much time on the couch as a family exposes your little one to more commercials that promote unhealthy foods, a risk factor for childhood obesity…

Limiting overall “screen time” in young children is also critical and has been shown  to reduce the risk for obesity and chronic conditions. Finally, if you’re thinking about letting your little one have a TV in his or her bedroom, think again! A 2012 study found that children having a TV in their room were more likely to have a higher waist circumference.

5. You’re labeling your child as “picky” Have you ever told another parent that your child is a picky eater? Simply labeling your child as picky could cause them to turn away from fruits and vegetables according to one study. The study showed that moms who labeled their child as “picky” had children who were less likely to try various types of produce and were actually less likely to eat fruits and vegetables themselves.

6. You think breakfast is for sissies Habitual breakfast in children is associated with  higher academic performance, a reduced risk for obesity and an increased intake of vitamins and minerals.

7. There’s no mealtime routine in your family … Eating as a family unit has been linked  with increased fruit and vegetable consumption and lower intakes of soft drink consumption. Further, adolescents who experience family meals often have a better diet as they head into adulthood.

Parents, it’s your job to help shape the taste buds, views about food and weight for life. That doesn’t mean your kid should never have a cookie. It just means that these foods shouldn’t be the norm. Teach your kids about which foods make them strong and which foods make them weak by using words and phrases they’ll understand such as “This salad will help you grow tall,” or “This apple makes mommy’s brain super strong.”

Most importantly, if your child already has a weight problem or less-than-perfect eating habits, it’s not too late to help him or her change. The step is recognizing the problem (few parents  actually do) and working together with your child to change behavior. I’m happy to keep my “non-fun” mom status if that means that I can help my son be a healthy eater and maintain a normal weight throughout his life. One day …perhaps he’ll realize just how “fun” being healthy, staying fit and avoiding sickness can really be.

 

“More to It Than Meets the BMI”

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This blog post title is quoted from a clever editorial which reviews the use of BMI and the effect of obesity with outcomes after liver transplantation (Liver Transpl 2014; 20: 253-54, related article pages 281-90.)

Key points from editorial and study:

  • Study enrolled 202 consecutive adult (mean 51 years) patients (200-2010) as part of cohort study.  Data was obtained at time of transplantation and reviewed with retrospective analysis. NAFLD was transplant indication in 7%.
  • “Use of BMI as a marker of obesity is flawed.” Authors showed only 86% agreement between calculated BMI and percent body fat as measured with DXA.
  • Patients with high BMI due to greater lean muscle mass may have improved outcomes.  Sarcopenia (loss of muscle mass) likely has greater effect on outcomes.
  • The study shows that the combination of diabetes and obesity increases the risk of complications and prolongs hospital stays (5.81 days, P<0.01).
  • Metabolic risk factors had no effect on 30-day, 1-year, or 5-year patient survival.

Another article in same issue: Liver Transpl 2014; 20: 311-22. This study retrospectively examined 148 normal-weight, 148 overweight, and 74 obese patients who underwent living donor liver transplantation. Key finding: “there were no differences in graft survival [hazard ratio (HR) =0.955] or recipient survival [HR = 0.90]” between these groups.  Obese patients do require larger grafts which can delay identifying suitable donor.

Bottomline from editorial: “this study shows us that the combination of diabetes and obesity dramatically increases the risk of complications” but not survival.  “If there comes a day when the cost of a human life is less than the cost of a 6- to 7-day hospital stay, that is the day to reckon. None of us may survive.”

Related blog post:

Sarcopenia, fatigue, and nutrition in chronic liver … – gutsandgrowth

Can parents not know if their child is overweight?

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Answer to the blog title: Yes

When I look back at classroom pictures from 30 years ago, so many kids look thin compared to today’s kids.  Perhaps, the perception of what is normal has been lost.  In fact, recent studies (doi: 10.1542/peds.2013-2690) indicate that parents often do not know whether their child is overweight,  especially between the ages of 2-5.

A link from NY Times twitter feed: http://nyti.ms/1ctfgcm 

An excerpt:

Many parents apparently believe their children are leaner than they actually are.  A review of studies published in Pediatrics found that two-thirds of parents underestimate the weight of their offspring.

“If parents don’t recognize that their children are overweight, that prevents them from undertaking actions to correct it,” said the lead author, Alyssa Lundahl, a graduate student in psychology at the University of Nebraska-Lincoln…

Ms. Lundahl and her colleagues reviewed 121 studies that included more than 80,000 parental estimates of the weight of their children who were between the ages of 2 and 19. More than half of parents of overweight and obese children underestimated their weight, and so did about 14 percent of parents of normal weight children. Parents were most likely to underestimate the weight of 2- to 5-year olds.

The reasons for the misunderstanding are not known…“When health care professionals are able to correct a parent’s false impression,” Ms. Lundahl said, “they are more likely to do something about it.”

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Is a Three Year-Old Too Young for Bariatric Surgery?

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Maybe not.

Recent article from WSJ (from Jeff Schwimmer’s twitter feed): http://online.wsj.com/news/article_

Here is an excerpt:

Daifailluh al-Bugami was just a year old when his parents noticed that his lips turned blue as he slept at night. It was his weight, doctors said, putting pressure on his delicate airways.

Now Daifailluh is 3, and at 61 pounds he is nearly double the typical weight of a child his age. So the Bugamis are planning the once unthinkable: To have their toddler undergo bariatric surgery to permanently remove part of his stomach in hopes of reducing his appetite and staving off a lifetime of health problems.

That such a young child would be considered for weight-loss surgery—something U.S. surgeons generally won’t do—underscores the growing health crisis here and elsewhere in the Middle East. Widespread access to unhealthy foods, coupled with sedentary behavior brought on by wealth and the absence of a dieting and exercise culture, have caused obesity levels in Saudi Arabia and many other Gulf states to approach or even exceed those in Western countries…

Daifailluh’s doctor, Aayed Alqahtani, is a leading advocate of a radical approach to the problem. Patients travel to him from across the country and the Gulf region. Over the past seven years, he has performed bariatric surgery on nearly 100 children under the age of 14, which experts on the procedure believe is the largest number performed by one doctor on young children… “We should not deprive our patients from bariatric surgery based on their age alone,” the surgeon says. “If they have [medical] conditions that threaten their lives, then we should not deny the bariatric surgery…”

Pediatric surgeons in the U.S. say they also are facing demands from families to operate on younger patients. Thomas Inge, surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital, says he will be operating on a 12-year-old later this month. He says that as younger and younger children are referred for consideration of surgery, care teams will need to carefully weigh the pros and cons…

Many doctors say they aren’t ready to follow Dr. Alqahtani yet. Kirk Reichard, chairman of the pediatric-surgery committee for the American Society for Metabolic and Bariatric Surgery, notes that there are no data to show that surgery doesn’t affect young children’s long-term sexual maturation or cognitive functioning.

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Brain Response to Physical Activity different in Obesity

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From NY Times (http://nyti.ms/1afnEyJ) review of the following article:

Int J Obes (Lond). 2013 Dec 24. doi: 10.1038/ijo.2013.245. [Epub ahead of print]

Differences in neural activation to depictions of physical exercise and sedentary activity: An fMRI study of overweight and lean chinese women. Jackson T, Gao X, Chen H.

An excerpt:

Overweight women’s brains respond differently to images of exercise than do the brains of leaner women…

The scientists asked their volunteers to complete two questionnaires, one of which probed the extent to which they considered exercise desirable; would they agree, for instance, that, “if I were to be healthy and active, it would help me make friends”? The other set of questions examined whether they expected exercise to be unpleasant; if they were to be physically active on most days, for example, would they expect to wind up feeling sore, or maybe even embarrassed by exercising in public?

The researchers next had each woman lie inside a functional magnetic resonance imaging machine, which scans blood flow to specific areas of the brain, indicating areas of increased activity. Then they started a slide show.

For some time, scientists have known that many overweight people’s brains operate differently than the brains of thinner people when they look at images related to eating. In previous neurological studies, when heavier volunteers viewed pictures of food or food preparation, they typically developed increased activity in portions of the brain involved in reward processing, or an urge to like things, including in an area called the putamen. At the same time, their brains showed relatively blunted activity in areas that are thought to induce satiety, or the ability to know when you are full. These changes generally are reversed in the brains of thinner people shown the same images.

But no brain-scanning studies had examined whether being heavy might also affect people’s brain responses — and presumably their attitudes — toward physical activity.

So, to address that gap, the researchers now flashed a series of photographs before their volunteers. Ninety of the images showed people being joyously active by running, dancing, leaping, playing tennis and such. The women were asked to vividly imagine themselves performing the same actions, using hand gestures and limited bodily contortions, to the extent possible within the confines of the scanner.

Ninety additional images featured relaxed, sedentary behaviors, including stretching out on a sofa and sitting in a desk chair. Again, the women were directed to imagine themselves similarly lounging. The various images of activity and quiet were interspersed with photographs of landscapes.

While the women viewed the pictures, the functional M.R.I. machine monitored their brain activity.

The resulting readouts revealed that overweight women’s brains were put off by exercise. Shown images of people being active, these women developed little activation in the putamen region of the brain, suggesting that they did not enjoy what they were seeing. At the same time, a portion of the brain related to dealing with negative emotions lit up far more when they viewed images of moving than of sitting. Emotionally, the brain scans suggested, they anticipated disliking physical activity much more than they expected to disdain sitting.

Leaner women’s brain activity, by and large, was the opposite, with the putamen lighting up when they watched others work out and envisaged doing the same themselves.

Healthy Obesity?

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From NY Times,  nyti.ms/1diH2d4 –an excerpt:

The idea that there are obese people who are nonetheless healthy may be a myth.

Although some overweight or obese people have normal cholesterol, glucose levels and blood pressure — elements of so-called metabolic health — a new study suggests that obesity by itself increases the risk for heart disease, stroke, diabetes and death.

Researchers analyzed 12 studies that had together followed more than 61,000 adults, most for at least 10 years. About 9 percent of the subjects were obese and metabolically healthy — that is, they had normal LDL, HDL and total cholesterol, along with healthy blood pressure and blood sugar levels. The report was published online last week in Annals of Internal Medicine.

Compared with metabolically healthy people of normal weight, the obese group had a 24 percent increased risk for fatal and nonfatal cardiovascular events like heart attack and stroke, and for death by any cause.

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Have you seen the Duodenal-Jejunal Bypass Liner?

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A recent article (Clin Gastroenterol Hepatol 2013; 11: 1517-20) reports on the effects of the duodenal-jejunal bypass liner (DJBL) on improvement in parameters of nonalcoholic liver disease (NAFLD).  The study enrolled 17 patients who had obesity and type 2 diabetes mellitus.

The following link provides more details on this technique (from a 2009 study) and provides a picture (Figure 2) of the 60 cm sleeve that is placed endoscopically:

Radiographic appearance of endoscopic duodenal … – GI Dynamics

These studies indicate that less invasive approaches may develop as alternatives to bariatric surgery.

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Sweetened Beverages -A Big Problem for Little Kids

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Many times we may look at a study and think that the results could easily have been anticipated.  Yet, there are many examples when our assumptions are flat-out wrong.

A recent study (Pediatrics 2013; 132: 413-20 -thanks to Jeff Lewis for this reference) helps solidify what we think we already knew, namely that sugar-sweetened beverages (SSB) contribute to weight gain in young children.  This study showed that 2-5 year-olds, followed in the Early Childhood Longitudinal Survey–Birth Cohort (n=9600), who had more frequent SSB consumption had higher BMI z scores by age four (P < .05) than infrequent/nondrinkers of SSB.  This study, for the first time, shows this effect in this younger population.

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