Severe Obesity More Common in Rural or Urban Areas in US?

MedicalResearch.com Interview with:

Cynthia L. Ogden, PhD, MRP Chief, NHANES Analysis Branch Epidemiologist, NCHS/CDC Hyattsville, MD 20782

Dr. Ogden

Cynthia L. Ogden, PhD, MRP
Chief, NHANES Analysis Branch
Epidemiologist, NCHS/CDC
Hyattsville, MD 20782

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: 40% of adults and over 18% of youth in the US have obesity. Disparities in obesity have been reported by demographics and urbanization.

We looked at the prevalence of obesity and severe obesity by demographics and by level of urbanization – rural, small/medium metro and large urban. We also looked at trends over time in urban and rural areas.

Obesity and severe obesity rates were higher in rural areas than large urban areas among adults. Among youth, severe obesity rates were higher in rural areas compared to large urban areas.

Differences in age, smoking, education or race/ethnicity between urban and rural areas did not explain the differences we found between urban and rural areas.

Between 2001-2004 and 2013-2016 severe obesity among men in rural areas more than tripled and among women more than doubled. Increases in severe obesity also occurred in urban areas in men and women but they were not nearly as large.

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More Weight Loss Linked To Greater Decrease in Knee Arthritis Pain

MedicalResearch.com Interview with:

Wake Forest professor of Health and Exercise Science Steve Messier, Friday, June 15, 2018.

Prof. Messier

Professor Steve Messier
Director of the J.B. Snow Biomechanics Laboratory
J.B Snow Biomechanics Laboratory
Wake Forest University

MedicalResearch.com: Why did you undertake this study?

Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273.

We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial.

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Developing a Pill That Mimics Effects of Gastric Bypass Surgery

MedicalResearch.com Interview with:

Jeff Karp B.Eng. PhD. Professor of Medicine Center for Nanomedicine and Division of Engineering in Medicine Brigham and Women’s Hospital, Harvard Medical School Boston MA

Prof. Karp

Jeff Karp B.Eng. PhD.
Professor of Medicine
Center for Nanomedicine and Division of Engineering in Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston MA

MedicalResearch.com: How would you briefly explain the most important findings and conclusions of this study to a non-expert?

  • The type-2 diabetes (T2D) epidemic will affect over 642 million people worldwide by 2040. As a result, diabetes costs the US healthcare over $174 billion dollars annually and is the leading cause of blindness, amputations, renal failure, and poor cardiovascular outcomes. Recently, bariatric surgery, bypassing stomach and intestine from the food stream, has shown promising results and shown to be superior to pharmaceuticals in managing T2D. However, the risks of surgery along with permanent changes to gastrointestinal anatomy deters many suitable patients from surgery, with less than 1-2% of Americans who qualify for weight loss surgery actually undergoing the procedure. Therefore, there is an urgent need for a safe, non-invasive and effective treatment for wider diabetic patient population.
  • We envisioned a pill that a patient can take before a meal that transiently coats the gut to replicate the effects of surgery. During the past 8 years, we’ve been working on this idea and have developed a safe gut-coating material that can potentially mimic the beneficial effects of gastric bypass procedures in the form a pill.
  • LuCI can be activated in any part of gastrointestinal tract (e.g. stomach, duodenum, intestine, colon) to form a temporary physical barrier that isolates that part of gastrointestinal tract. In our pre-clinical models, LuCI coated the duodenum to modulate glucose responses in oral glucose tolerance tests.
  • These beneficial effect are observed without any evidence of systemic absorption of the drug.
  • We believe that LuCI could be a new therapeutic approach for T2D that is based on Roux-en-Y gastric bypass surgery, but is safer, associated with significantly less complications, and thus can potentially help a wide T2D patient population.
  • In a separate set of studies, we also showed that luCi allows delivery of certain proteins and drugs, which would normally be degraded by the gastric acid, to the GI tract, protecting it from gastric acid digestion and prolonging their luminal exposure.

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Eating Disorders Occur Across All Age, Ethnic and Gender Groups

MedicalResearch.com Interview with:

Tomoko Udo, PhD Assistant Professor Department of Health Policy, Management, and Behavior School of Public Health University at Albany, State University of New York

Dr. Tomoko Udo

Tomoko Udo, PhD
Assistant Professor
Department of Health Policy, Management, and Behavior
School of Public Health
University at Albany, State University of New York

MedicalResearch.com: What is the background for this study?  

Response: The National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC III) was the largest epidemiological study on psychiatric disorders in US non-institutionalized adults that was conducted by the National Institution on Alcohol Abuse and Alcoholism, and the first one sinceDSM-5 came out. The last population-based study with US adults that examined eating disorders was the National Comorbidity Survey-Replication Study conducted by Hudson and his colleagues and published in 2007.

We felt that it was important to obtain new prevalence estimates in a larger and representative sample especially because the DSM-5 included several changes to the criteria for eating disorders from the earlier DSM-IV. Thus, we thought it was important to provide updated and new prevalence estimates for eating disorders as well as how they are distributed across sex, ethnicity/race, and age.  Many  researchers and clinicians expected higher estimates than earlier studies as a result of “loosening” of diagnostic criteria for eating disorders.

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Obese Women Remain at Risk For Heart Disease, Even When Metabolically Healthy

MedicalResearch.com Interview with:
Nathalie Eckel, MSc

German Diabetes Center
Düsseldorf, Germany 

MedicalResearch.com: What is the background for this study?

 Response: Obesity is associated with metabolic disorders such as diabetes, high blood pressure and hypercholesterolemia, and with a higher risk of cardiovacular disease compared to normal weight. However, there is also the phenomenon of the so-called “metabolically healthy obesity” and “metabolically unhealthy normal-weight”. So far it has been unclear how metabolic risk factors change over time in metabolically healthy people depending on body weight and what cardiovascular disease risk results from this.

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Long Term Antidepressants Associated With Sustained Weight Gain

MedicalResearch.com Interview with:
Dr Rafael Gafoor
Research Associate
Kings College London 

MedicalResearch.com: What is the background for this study?

Response: Obesity and weight gain are global public health problems, with approximately 60% of UK adults currently overweight or obese. Depression is common in people who are severely obese and the rate of antidepressant prescribing is increasing, which could have potential impact on public health. However, little research has been reported on the impact of widespread antidepressant treatment on weight gain. So a UK based research team, led by Rafael Gafoor at King’s College London, set out to investigate the association between the use of antidepressants and weight gain. The researchers analysed body weight and body mass measurement data from the UK Clinical Practice Research Datalink (CPRD) for over 300,000 adults with an average age of 51, whose body mass index (BMI) had been recorded three or more times during GP consultations from 2004-2014. Participants were grouped according to their BMI (from normal weight to severely obese) and whether or not they had been prescribed an antidepressant in a given year. Participants were then monitored for a total of 10 years.

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If Maternal Grandmother is Obese, So is Grandchild?

MedicalResearch.com Interview with:
“Great Grandmother” by David Amsler is licensed under CC BY 2.0Rebecca Somerville MB BCh BAO, BMedSci, MRCPI, MPH, PhD
School of Public Health, Physiotherapy and Sports Science
University College Dublin
Dublin, Ireland 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Rates of obesity in the Western world have increased dramatically over recent decades. The negative health consequences of obesity are well known and significant amounts of research have been conducted into the causes and possible solutions. While it is clear that there have been massive changes in diet and physical activity at a societal level that are primarily responsible for this ‘obesity epidemic’, it is less clear the extent to which obesity, once established, or risk factors for same, can be perpetuated down generations. Family studies lend opportunity to explore these questions, however there are few world wide which incorporate 3 generations.

We therefore sought to examine patterns of central adiposity, as measured by waist circumference, between grandparents and their grandchildren, separately in maternal and paternal lines. We were able to utilize prospectively collected data from the Lifeways Cross-Generation Cohort Study. This is a longitudinal birth cohort, established in Ireland in 2001, involving up to 7 members of the same family (mother, father, child and 4 grandparents). In the 589 families where a child had a waist circumference measurement we found that, at the age of both 5 and 9, there was a direct relationship between the waist circumference of the maternal grandmother and her grandchild (both male and female). This remained after adjustment for a wide range of confounding variables including mother’s waist circumference. There was no relationship seen with any of the other grandparents.

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Not All Calories Affect Health Equally

MedicalResearch.com Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Kimber L. Stanhope, Ph.D., M.S., R.D.
Research Nutritional Biologist
Department of Molecular Biosciences: SVM
University of California, Davis 

MedicalResearch.com:? What are the main findings of this study?

Response: Sugar-sweetened beverages increase risk factors for cardiometabolic disease compared with calorically-equal amounts of starch.

We are not the first group of experts to reach this conclusion. The Nutrition and Chronic Diseases Expert Group reached a similar conclusion last year (Micha, 2017). Yet very different conclusions/opinions are being still being published by other researchers. (Latest example: Archer E., In Defense of Sugar: A Critique of Diet-Centrism. Progress in Cardiovascular Disease, May 1, 2018).

These conflicting conclusions confuse the public and undermine the implementation of public health policies, such as soda taxes and warning labels, that could help to slow the epidemics of obesity and cardiometabolic disease. We hope that the careful review of the evidence and the discussion of issues that can lead to conflicting opinions in nutrition research in this paper will help to clarify this issue.

Consumption of polyunsaturated (n-6) fats, such as those found in some vegetable oils, seeds, and nuts, lowers disease risk when compared with equal amounts of saturated fats.

It is important to note however, that the effects of saturated fat can vary depending on the type of food. Dairy foods such as cheese and yogurts, which can be high in saturated fats, have been associated with reduced cardiometabolic risk.

The non-caloric sweetener aspartame does not promote weight gain in adults.

Aspartame is the most extensively studied of the non-caloric sweeteners. None of the dietary intervention studies that have investigated the effects of aspartame consumption have shown it promotes body weight gain.

This includes studies in which the adult research participants consumed aspartame for 6 months, 1 year or 3 years.

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New Hope For Patients With Rare Form of Overeating Disorder

MedicalResearch.com Interview with:
“Mmm...hamburgers” by jeffreyw is licensed under CC BY 2.0
Dr. Peter Kühnen
Institute for Experimental Pediatric Endocrinology
Charité Universitätsmedizin Berlin
Berlin Germany 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We are focusing our interest on rare monogenic forms of obesity.

The hormones leptin and MSH are playing a pivotal role for the regulation of satiety and body weight. Mutations within this pathway, e.g. in the leptin receptor gene, are leading to severe hyperphagia and early onset obesity.  Although tremendous effort it is extremely difficult for the affected patients to stabilize their body weight for a longer period of time. For this reason it has been analyzed within this investigated initiated trial whether patients with a leptin receptor mutation benefit from a treatment with the MC4R agonist setmelanotide. The treatment led to a reduction of the initially increased hunger feeling and to a reduction of body weight. Additionally, we identified molecular evidences that a specific signaling cascade of the MSH receptor (MC4R) is of importance for the regulation of body weight. Continue reading

Severely Malnourished Children May Benefit From Vitamin D Supplement

MedicalResearch.com Interview with:
Dr Javeria Saleem PhD

Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, United Kingdom

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Severe acute malnutrition is the most extreme and visible form of undernutrition. Affected children have very low weight for their height and severe muscle wasting; they may also have swollen feet, face and limbs. Around 20 million children suffer from severe acute malnutrition worldwide of whom an estimated 1.4 million live in Pakistan. The condition is a major cause of death in children under 5 in Asia and Africa. The standard treatment is to give a high-energy, micronutrient enhanced paste called ready-to-use therapeutic food (RUTF).

Vitamin D deficiency has been reported to be a risk factor for severe wasting in children with severe acute malnutrition Ready-to-use therapeutic food contains relatively modest amounts of vitamin D. However, the effects of adding high-dose vitamin D to this standard treatment have not previously been evaluated.

We therefore did a clinical trial to assess whether high-dose vitamin D hastened recovery in 185 children aged 6-58 months who were receiving standard treatment for severe acute malnutrition in Southern Punjab, Pakistan. The 93 children in the active arm of the study received two doses of 5 mg vitamin D by mouth, while the 92 children in the control arm received placebo (a dummy medicine containing no vitamin D).

Our findings were very striking: after 2 months of treatment, the children who received high-dose vitamin D in addition to standard therapy had significantly better weight gain, and significantly better motor and language development, than those who received standard treatment alone.

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Performance Drops Along With Weight on Ketogenic Diets

MedicalResearch.com Interview with:

Edward "Ted" Weiss, Ph.D. Associate Professor Department of Nutrition and Dietetics Saint Louis University Saint Louis MO 63104

Dr. Weiss

Edward “Ted” Weiss, Ph.D.
Professor
Department of Nutrition and Dietetics
Saint Louis University
Saint Louis MO 63104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Ketogenic diets are popular. They are very low in carbohydrate, with moderate protein and large amounts of fat. They are popular for weight loss but definitive studies of this are lacking.

We tested the effects of a ketogenic diet on high-intensity exercise performance, such as sprinting. The result showed that the ketogenic diet was harmful to performance, reducing performance by 6 – 7% when compared to a high-carbohydrate diet.

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Do Metabolically Healthy Obese Stay Healthy?

MedicalResearch.com Interview with:

Morgana Mongraw-Chaffin, PhD MPH Wake Forest School of Medicine North Carolina

Dr. Mongraw-Chaffin

Morgana Mongraw-Chaffin, PhD MPH
Wake Forest School of Medicine
North Carolina

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While some large studies and meta-analyses of this topic suggest that metabolically healthy obesity (MHO) is not a benign condition, discrepancies persist in the results of individual studies. Lack of a clear explanation for these differences drives the continuing controversy over whether MHO is a useful tool for risk stratification or an intermediate condition on the pathway to cardiometabolic risk.

In the Multi-Ethnic Study of Atherosclerosis (MESA), we found that 48% of those with metabolically healthy obesity transitioned to unhealthy obesity by the end of follow-up. Those who transitioned had higher odds of developing cardiovascular disease compared to those who maintained normal weight. We further found that earlier transition from MHO to unhealthy obesity was associated with higher odds.

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Middle Eastern Diet Linked To Improved Microbiome in Liver Patients

MedicalResearch.com Interview with:

“Turkish Food” by Garry Knight is licensed under CC BY 2.0Jasmohan S. Bajaj, M.D.
Associate Professor
Department of Internal Medicine
Division of Gastroenterology
Virginia Commonwealth University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Altered gut microbiota composition can occur due to diseases and due to changes in the dietary practices. The interaction between these two and their linkage with clinical outcomes in liver diseases, such as cirrhosis is not clear from an international standpoint.

In this study we enrolled healthy subjects, and patients with cirrhosis who were either early or advanced in their process from USA and Turkey. We found that the Turkish subjects, who followed a Middle-eastern diet rich in vegetables and fermented milk products, had high microbial diversity, which was in turn associated with lower hospitalizations over 3 months. There was also an additional beneficial effect of coffee and tea intake. This protection persisted even when the clinical factors were accounted for. Continue reading

Small Intestinal Microbiome Adjusts To Dietary Fats and Sugar

MedicalResearch.com Interview with:

Eugene B. Chang, MD Martin Boyer Professor of Medicine Knapp Center for Biomedical Discovery University of Chicago Chicago, IL  60637

Dr. Chang

Eugene B. Chang, MD
Martin Boyer Professor of Medicine
Knapp Center for Biomedical Discovery
University of Chicago
Chicago, IL  60637 and

Kristina Martinez-Guryn, Ph.D., R.D. Assistant Professor  Biomedical Sciences Program Midwestern University Downers Grove, IL.

Dr. Martinez-Guryn

Kristina Martinez-Guryn, Ph.D., R.D.
Assistant Professor 
Biomedical Sciences Program
Midwestern University
Downers Grove IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Martinez-Guryn: The original goal of this study was to understand why mice devoid of all microorganisms (germ free mice) are protected from diet-induced obesity. We demonstrate that these mice display severely impaired lipid absorption even when fed a high fat diet.

Dr. Chang: We found that many of the processes of dietary lipid digestion and absorption are dependent on and modulated by the gut microbiome which itself responds to dietary cues to adjust the small intestine’s ability and capacity to handle dietary lipids appropriately. This interplay is important for general health, but the findings are also relevant to conditions of overnutrition (obesity, metabolic syndrome) and undernutrition (starvation, environmental enteropathy).  In conditions of overnutrition, high fat, simple sugar, low fiber foods typical of western diets promote small intestinal microbes (which have been largely neglected by the scientific community) that promote fat digestion and absorption. This increases our capacity to assimilate dietary fats which can contribute to the overnutrition problem.  In conditions of undernutrition, these types of gut microbes are lost or minimally represented.  Thus, when nutritional repletion is started, the gut’s ability to upregulate its capacity for dietary lipid digestion and absorption is compromised.

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Obese Children Who Lose Weight Before Adulthood Can Reduce Risk of Diabetes

MedicalResearch.com Interview with:

Lise Geisler Bjerregaard PhD

Dr. Geisler Bjerregaard

Lise Geisler Bjerregaard PhD
Postdoc, PhD, M.Sc. Public Health
Center for Klinisk Forskning og Sygdomsforebyggelse/ Center for Clinical Research and Disease Prevention
Sektion for Klinisk Epidemiologi
Frederiksberg Hospital, Frederiksberg

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Being overweight in childhood and early adulthood is associated with an increased risk of developing type 2 diabetes in adulthood. We wanted to know whether or not remission of overweight before early adulthood can reduce the risks of type 2 diabetes later in life.

We studied the associations between different combinations of weight status in childhood, adolescence and early adulthood, and later development of type 2 diabetes.

We found that men who had been overweight at 7 years of age but normalised weight by age 13 years and were normal weight as young men had similar risks of type 2 diabetes as men who were never overweight. Men who normalised weight between age 13 years and early adulthood had increased risks of type 2 diabetes, but lower risks than men who were overweight at all ages.  Continue reading