Obesity and Type 2 Diabetes Claims Rise Sharply in Pediatric Population

MedicalResearch.com Interview with:

Robin Gelburd, JD President FAIR Health

Robin Gelburd, JD

Robin Gelburd, JD
President
FAIR Health

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

Response: For more than 20 years, an epidemic of obesity has been contributing to increasing rates of type 2 diabetes in the United States. During at least part of that period, both conditions have been found to be rising in young people as well as adults. Using our FAIR Health database of billions of privately billed healthcare claims, we sought to ascertain recent trends in obesity and obesity-related conditions (including type 2 diabetes) in the national, privately insured, pediatric population, which we defined as spanning the ages from 0 to 22 years. Our study period was the years 2011 to 2015.

We found that claim lines with a diagnosis of obesity increased across the pediatric population during the study period. The largest increase among pediatric patients was 154 percent, in the age group 19 to 22 years. Claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population, increasing 109 percent.

In most pediatric age groups, claim lines with an obesity diagnosis occurred more often in females than in males; by contrast, claim lines with a type 2 diabetes diagnosis were more common for males than females in most pediatric age groups.

Other conditions associated with obesity also increased in claim lines among young people. The conditions included obstructive sleep apnea and hypertension, both of which were more common in claim lines for males than females.

We also compared the percent of claim lines for pediatric type 2 diabetes diagnoses to the percent of claim lines for all pediatric medical claims by state. Using that standard, pediatric type 2 diabetes was most prevalent in Ohio, Pennsylvania, North Dakota, Utah and South Dakota. It was least prevalent in New Hampshire, Vermont, Delaware, Hawaii and Rhode Island.

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Type of Sugar, Not Just Amount, Influences Metabolic Effects

MedicalResearch.com Interview with:
Dr. Marta Alegret

Department of Pharmacology, Toxicology and Therapeutic Chemistry
Pharmacology Section
School of Pharmacy and Food Sciences
University of Barcelona

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

Response: In humans, an excessive intake of sugars has been linked to the development of metabolic disturbances, and therefore to an increase in the risk for cardiovascular diseases. Specifically, increased consumption of simple sugars in liquid form, as beverages sweetened with high fructose corn syrup or sucrose, has been linked to obesity, insulin resistance and type 2 diabetes. However, two questions remain unresolved: what is/are the underlying molecular mechanism(s) linking these metabolic alterations to cardiovascular diseases? Are the adverse cardiovascular and metabolic effects of sugar-sweetened beverages merely the consequence of the increase in caloric intake caused by their consumption?

To answer to these questions, we performed a study in female rats, which were randomly assigned to three groups: a control group, without any supplementary sugar; a fructose-supplemented group, which received a supplement of 20% weight/volume fructose in drinking water; and a glucose-supplemented group, supplemented with 20% weight/volume glucose in drinking water.

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Government Endorsed DASH Diet Voted Best Overall

MedicalResearch.com Interview with:

Janet M. de Jesus, M.S., R.D. Program Officer, Implementation Science Center for Translation Research and Implementation Science (CTRIS) National Heart, Lung, and Blood Institute

Janet de Jesus

Janet M. de Jesus, M.S., R.D.
Program Officer, Implementation Science
Center for Translation Research and Implementation Science (CTRIS)
National Heart, Lung, and Blood Institute

MedicalResearch.com: What is the background for the DASH diet? What are the main components?

Response: The DASH eating plan was created for a clinical trial funded by the National Heart, Lung, and Blood Institute (NHLBI). DASH stands for Dietary Approaches to Stop Hypertension. The goal of the original DASH trial was to test the eating plan compared to a typical American diet (at the time in the 1990s) on the effect of blood pressure.

The DASH eating plan is rich in fruits, vegetables, and whole grains. It includes low-fat dairy products, poultry, fish, legumes, vegetable oils, and nuts; and limits intake of sweets and sugar-sweetened beverages and high-fat meats. The eating plan is a good source of potassium, magnesium, and calcium. The DASH eating plan was shown to reduce blood pressure and improve lipid profiles.

A second DASH trial, “DASH-sodium,” showed that adding sodium reduction to the DASH eating plan reduced blood pressure even more.

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Endocannabinoids Link Overeating a Western Diet to Obesity

MedicalResearch.com Interview with:

Nicholas V. DiPatrizio, Ph.D. Assistant Professor of Biomedical Sciences University of California, Riverside School of Medicine Riverside, California, 92521

Dr. Nicholas DiPatrizio

Nicholas V. DiPatrizio, Ph.D.
Assistant Professor of Biomedical Sciences
University of California, Riverside School of Medicine
Riverside, California, 92521

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

Response: Endocannabinoids are a group of lipid signaling molecules that serve many physiological roles, including the control of food intake, energy balance, and reward. Previous research by my group found that tasting specific dietary fats drives production of the endocannabinoids in the upper small intestine of rats, and inhibiting this signaling event blocked feeding of fats (DiPatrizio et al., Endocannabinoid signaling in the gut controls dietary fat intake, Proceedings of the National Academy of Sciences, 2011). Thus, gut-brain endocannabinoid signaling is thought to generate positive feedback to the brain that promotes the intake of foods containing high levels of fats.

We now asked the question of what role peripheral endocannabinoid signaling plays in promoting obesity caused by chronic consumption of a western diet (i.e., high levels of fats and sugar), as well as the role for endocannabinoids in overeating that is associated with western diet-induced obesity. When compared to mice fed a standard low-fat/sugar diet, mice fed a western diet for 60 days rapidly gained body weight and became obese, consumed significantly more calories, and consumed significantly larger meals at a much higher rate of intake (calories per minute). These hyperphagic responses to western diet were met with greatly elevated levels of endocannabinoids in the small intestine and circulation. Importantly, blocking elevated endocannabinoid signaling with pharmacological inhibitors of cannabinoid receptors in the periphery completely normalized food intake and meal patterns in western diet-induced obese mice to levels found in control lean mice fed standard chow. This work describes for the first time that overeating associated with chronic consumption of a Western Diet is driven by endocannabinoid signals generated in the periphery.

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Gastric Bypass Surgery Improves Quality of Life For Obese Teenagers, But Complications Not Rare

MedicalResearch.com Interview with:
Dr Thomas H. Inge MD

University of Colorado Denver School of Medicine
Aurora, CO 80045

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

Response: Gastric bypass surgery helps severely obese teenagers lose weight and keep it off, according to the first long term follow up studies of teenagers who had undergone the procedure 5-12 years earlier. However, the studies show some patients will need further surgery to deal with complications or may develop vitamin deficiencies later in life, according to two studies published in The Lancet Diabetes & Endocrinology.
Severe obesity is classified as having a BMI of 40 or over (around 100 pounds overweight) and affects around 4.6 million children and teenagers in the USA. It causes ill health, poor quality of life and cuts life expectancy.

The studies are the first to look at long-term effects of gastric bypass surgery in teenagers. Until now, it has been unclear how successful the surgery is in the long-term and whether it can lead to complications. Thousands of teenagers are offered surgical treatment each year.

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Gastric Bypass Surgery Found Safe and Effective in Adolescent Severe Obesity

MedicalResearch.com Interview with:
Dr Torsten Olbers PhD

Department of Gastrosurgical Research
Institute of Clinical Sciences
University of Gothenburg, Sahlgrenska University Hospital
Gothenburg Sweden 

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

Response: The background to study was the lack of effective treatments for adolescents with severe obesity and the observation that many adults undergoing gastric bypass regret that they didn’t´t do it earlier.

The medical indication is to hopefully prevent development of diseases and organ damage due to cardiovascular risk factors and to enable them to have normalised psychosocial development (education, relation etc).

In fact most of the adolescents undergoing surgery had parents having undergone surgery.

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Resistant Starches in Diet May Help Reduce Body Weight

MedicalResearch.com Interview with:

Dr Stacey Lockyer BSc(hons) MSc PhD RNutr Nutrition Scientist British Nutrition Foundation Imperial House 6th Floor London

Dr Stacey Lockyer

Dr Stacey Lockyer BSc(hons) MSc PhD RNutr
Nutrition Scientist
British Nutrition Foundation
Imperial House 6th Floor
London

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

Response: This in depth review examines the potential health benefits of resistant starch, a form of starch that is not digested in the small intestine and is therefore considered a type of dietary fibre. Some forms of resistant starch occur naturally in foods such as bananas, potatoes, grains, and pulses, and some are produced or modified commercially and incorporated into food products as a functional ingredient.

There has been increasing research interest in resistant starch, with a large number of human studies published over the last 10 years looking at a variety of different health outcomes such as postprandial glycaemia, satiety and gut health. The review summarises reported effects and explores the potential mechanisms of action that underpin them.

There is consistent evidence that consumption of resistant starch in place of digestible carbohydrates can aid blood glucose control and this has resulted in an approved health claim in the European Union. There is also some evidence that resistant starch can support gut health and enhance satiety, though much more research is needed in these areas.

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Parental Obesity Affects Early Childhood Development

MedicalResearch.com Interview with:

Edwina Yeung, Ph.D Investigator in the Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Developm

Dr. Edwina Yeung

Edwina Yeung, Ph.D
Investigator, Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development

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

Response: About 1 in 5 pregnant women in the United States is obese. Other studies have looked at mothers’ obesity in terms of children’s development, but no U.S. studies have looked at whether there might be a contribution from the father’s weight.

MedicalResearch.com: What are the main findings?

Response: One of the main findings of this study is that maternal obesity is associated with a delay in fine motor skill– the ability to control movement of small muscles, such as those in the fingers and hands. Paternal obesity is associated with a delay in personal-social skills including the way the child interacts with others. Having both a mother and a father with severe obesity (BMI≥35) was associated with a delay in problem solving ability.

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Infections in Infancy, Not Antibiotics Associated With Childhood Obesity

MedicalResearch.com Interview with:

De-Kun Li, MD, PhD Senior Research Scientist Division of Research Kaiser Foundation Research Institute Kaiser Permanente Oakland, CA 94612

Dr. De-Kun Li,

De-Kun Li, MD, PhD
Senior Research Scientist
Division of Research
Kaiser Foundation Research Institute
Kaiser Permanente
Oakland, CA 94612

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

Response: The composition of gut microbia (microbiome) has emerged as a key contributor to human disease risk. The external influence on the composition of microbiome in early childhood, especially in infancy, has been linked to increased risk of childhood obesity. Several studies have examined use of antibiotics in infancy and reported an association between use of antibiotics and increased risk of childhood obesity. This has caused a great uncertainty among both pediatricians and parents regarding treatment of infant infections. However, the previous studies failed to separate the effect of underlying infections for which antibiotics were used from the effect of the antibiotics itself. The contribution of our study was to examine the effects of infections and antibiotic use separately.

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Newly Identified Molecule Turns Fat Storage Gene Off

MedicalResearch.com Interview with:

Prof. Jamal Tazi Institut de Génétique Moléculaire de Montpellier University of Montpellier Montpellier, Cedex, France

Prof. Jamal Tazi

Prof. Jamal Tazi
Institut de Génétique Moléculaire de Montpellier
University of Montpellier
Montpellier, Cedex, France

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

Response: Intense drug discovery efforts in the metabolic field highlight the need for novel strategies for the treatment of obesity. In this study we have used a novel approach to uncover novel drugs to treat obesity. Our approach is based on the finding that in humans the energy expenditure balance can be controlled by a single gene LMNA gene that can produce two different proteins with opposing effect on energy expenditure. We identified a molecule ABX300 that targets the expression of LMNA gene and favors energy expenditure leading to fat loss.

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Centrally-Acting Obesity Medications May Have Significant Side Effects

MedicalResearch.com Interview with:

Igho Onakpoya MD MSc University of Oxford Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health Sciences Oxford UK

Dr. Igho Onakpoya

Igho Onakpoya MD MSc
University of Oxford
Centre for Evidence-Based Medicine
Nuffield Department of Primary Care Health Sciences
Oxford UK

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

Response: Several medicines used to treat obesity have been withdrawn from the market over the last few years. However, the reasons for, and time trends about their withdrawals have not been systematically researched.

We identified 25 anti-obesity medicines withdrawn from the market over the last 50 years. 23 of these analogues of amphetamine or fenfluramine, i.e., neurotransmitters.

The reasons for withdrawal in the overwhelming majority of instances were cardiovascular or psychiatric adverse reactions, and drug abuse and dependence.

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Physicians Perceive Health Insurance as Barrier to Weight Management Efforts

MedicalResearch.com Interview with:
Ruchi Doshi, MPH
MD Candidate 2017 | Johns Hopkins University School of Medicine

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

Response: Current guidelines recommend that physicians collaborate with non-physician health professionals to deliver weight management care. While several studies have looked at barriers physicians face in providing these services, few studies have looked at the barriers that the non-physician health professionals face. Ultimately, we found that one quarter of these health professionals found insurance coverage to be a current challenge to providing weight management care, and that over half of them felt improved coverage would help facilitate weight loss. These findings were consistent regardless of the income level of the patient populations.

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