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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No Link Found Between Caesarean Delivery and Childhood Obesity

MedicalResearch.com Interview with:
Sheryl L. Rifas-Shiman, MPH
Lead Research Analyst
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute
Landmark Center
Boston, MA 02215 

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

Response: Caesarean delivery rates remain high and variable across hospitals, regions, and countries.
Caesarean delivery may be a risk factor for childhood obesity, possibly because delivery route can influence the intestinal microbiomes, which may influence energy regulation.

Previously reported associations of caesarean delivery with childhood obesity may be confounded by maternal BMI and sociocultural factors. To address this possibility, we studied sibling pairs from the Linked CENTURY Study, a longitudinal clinical database of well-child visits in Massachusetts linked to each child’s birth certificate, to isolate the effect of caesarean delivery from most other factors. Continue reading

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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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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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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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

US Free Trade Agreements Can Contribute to “Globesity”

MedicalResearch.com Interview with:

These are trends in calorie availability in Canada and synthetic controls, 1978-2006. Data from the United Nations Food and Agricultural Office (2016). 'Synthetic controls' are constructed from a weighted combination of OECD countries, where weights correspond to the similarity of each country with Canada before CUSFTA.  CREDIT American Journal of Preventive Medicine

Trends in calorie availability in Canada and synthetic controls, 1978-2006. Data from the United Nations Food and Agricultural Office (2016). ‘Synthetic controls’ are constructed from a weighted combination of OECD countries, where weights correspond to the similarity of each country with Canada before CUSFTA.
Credit:
American Journal of Preventive Medicine

Pepita Barlow, MSc, Department of Sociology
University of Oxford, Manor Road Building, Manor Road,
Oxford, United Kingdom
 

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

Response: The escalating global prevalence of overweight and obesity, or “globesity,” is often described as a pandemic. Globalization via free trade agreements (FTAs) with the US has been implicated in this pandemic because of its role in spreading high-calorie diets rich in salt, sugar, and fat through the reduction of trade barriers like tariffs in the food and beverage sector.  

We used a “natural experiment” design (that mimics a randomized controlled trial as closely as possible) and data from the United Nations Food and Agricultural Office to evaluate the impact of the 1989 Canada-US Free Trade Agreement on caloric availability in Canada (CUSFTA).  

We found that CUSFTA was associated with an increase in caloric availability and likely intake of approximately 170 kilocalories per person per day in Canada. Additional models showed that this rise in caloric intake can contribute to weight gain of between 1.8-9.3 kg for men and 2.0-12.2 kg for women aged 40, depending on their physical activity levels and the extent to which availability affects caloric intake.  Continue reading

Obesity Increased in Adults But Not Youth in Last Ten Years

MedicalResearch.com Interview with:
Craig M. Hales, MD Cheryl D. Fryar, MSPH; Margaret D. Carroll, MSPH; David S. Freedman, PhD; Cynthia L. Ogden, PhD

National Center for Health Statistics
National Center for Chronic Disease Prevention and Health Promotion
US Centers for Disease Control and Prevention
Atlanta, Georgia

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

Response: In this analysis we examined recent trends in the prevalence of obesity and severe obesity among both youth and adults, by sex and age group.

Among adults, obesity and severe obesity prevalence has increased over the last 10 years.  Obesity prevalence increased from 33.7% in 2007-2008 to 39.6% or almost 40% in 2015-2016, and severe obesity increased from 5.7% in 2007-2008 to 7.7% in 2015-2016.  We see this same pattern of increasing prevalence of obesity and severe obesity in both men and women, and in different age groups.

On the other hand, among youth, we saw no increasing or decreasing trends in obesity or severe obesity prevalence over the 10 year period.  And this was true for both boys and girls and for different age groups.

Measured height and weight is the gold standard for generating accurate estimates of obesity prevalence.  The National Health and Nutrition Examination Survey is unique in that it combines both interviews in the home and physical examinations in mobile examination centers, and it is the only national survey where people’s height and weight are physically measured.  This is why NHANES is such an important source of data for understanding trends in obesity in youth and adults. 

Citations: 

Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016. JAMA. Published online March 23, 2018. doi:10.1001/jama.2018.3060

 

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Weight Gain Causes Loss of Taste Buds and Flavor Intensity

MedicalResearch.com Interview with:

Robin Dando, PhD Assistant Professor Director, Cornell Sensory Evaluation Facility Department of Food Science Cornell University Ithaca, NY 14853

Dr. Dando

Robin Dando, PhD
Assistant Professor
Director, Cornell Sensory Evaluation Facility
Department of Food Science
Cornell University
Ithaca, NY 14853

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

Response: For many years, people have been interested in if gaining weight can change how we perceive foods, thus maybe encouraging less healthy food choices.  There is some evidence in previous work that if we become obese, we seem to perceive things as tasting less intense.  Now if this were the case, to make up for this we might eat more of whatever food it was we were eating, or conversely we might choose something that tasted more intense, to make up this difference.  More intense usually means higher calories, so if we took either of these approaches, we’re at risk for weight gain.

In our study, we examined the taste buds of mice who were fed an unhealthy diet that induces obesity, versus sibling mice fed a more healthy diet that keeps them lean.  The mice gaining weight ended up after only 8 weeks with a lot fewer taste buds than the lean mice.  This loss of taste buds represents one explanation for foods tasting less intense to the obese.

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Obese Patients Live Shorter and Sicker Lives with More Heart Disease

MedicalResearch.com Interview with:

Dr. Sadiya S. Khan, MD MS Division of Cardiology, Department of Medicine Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois

Dr. Khan

Dr. Sadiya S. Khan, MD MS
Division of Cardiology, Department of Medicine
Department of Preventive Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois

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

Response: In recent years, controversy has grown regarding findings termed the “obesity paradox” whereby individuals with cardiovascular disease who are obese have “better” outcomes. These findings have led to confusion for patients who are obese.

The main findings of our study help clarify the adverse cardiovascular risks for obese individuals with a shorter overall health span and lifespan. Obese participants in our study lived shorter and sicker with more years lived with cardiovascular diseases and greater lifetime risk of developing cardiovascular disease.  Continue reading

Sustaining Physical Activity With Age Decreases All-Cause Mortality Risk

MedicalResearch.com Interview with:
“physical-activity-120112-M-2021D-019” by MilitaryHealth is licensed under CC BY 2.0
Trine Moholdt, PhD
Research Fellow
Department of Circulation and Medical Imaging | Exercise, Cardiometabolic Health and Reproduction
Norwegian University of Science and Technology

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

Response: Although obese individuals have an increased risk of cardiovascular disease, evidence from many observational studies shows that in those who already have cardiovascular disease, being overweight or obese is associated with lower risk of mortality compared to their normal weight counterparts.

This phenomenon is often called the “obesity paradox”. Recently we observed that in individuals who have a high physical activity level, there is no such obesity paradox and body mass index did not associate with survival time in those who with high physical activity (Moholdt et al, American Journal of Medicine, 2017).  Continue reading

Endocrine Disrupter PFAS Chemicals Linked To Weight Regain, Especially in Women

MedicalResearch.com Interview with:

Gang Liu, PhD Postdoctoral Research Fellow Department of Nutrition Harvard T.H. Chan School of Public Health

Dr. Gang Liu

Gang Liu, PhD
Postdoctoral Research Fellow
Department of Nutrition
Harvard T.H. Chan School of Public Health 

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

Response: Although many approaches can be used to achieve a short-term weight loss, maintenance of weight loss has become a key challenge for sustaining long-term benefits of weight loss. Accumulating evidence has suggested that certain environmental compounds may play an important role in weight gain and obesity development.

The potential endocrine-disrupting effects of perfluoroalkyl substances (PFASs), which are extensively used in many industrial and consumer products including food packaging, paper and textile coatings, and non-stick cookware, have been demonstrated in animal studies, but whether PFASs may interfere with body weight regulation in humans is largely unknown.

In a 2-year POUNDS Lost randomized clinical trial that examined energy-restricted diets on weight changes, baseline plasma concentrations of major PFASs were measured among 621 overweight and obese participants aged 30-70 years. Body weight was measured at baseline, 6, 12, 18, and 24 months. Resting metabolic rate (RMR) and other metabolic parameters, including glucose, lipids, thyroid hormones, and leptin, were measured at baseline, 6, and 24 months.

We found that higher baseline levels of PFASs were significantly associated with a greater weight regain, primarily in women. On average, women in the highest tertile of PFASs regained 1.7-2.2 kg more body weight than women in the lowest tertile. In addition, higher baseline plasma PFAS concentrations, especially perfluorooctanesulfonic acid (PFOS) and perfluorononanoic acid (PFNA), were significantly associated with greater decline in RMR during the first 6 months and less increase in RMR during weight regain period.  Continue reading

Fit Obese Patients Can Be Healthy

MedicalResearch.com Interview with:
“Elliptical Stationary Bikes GVSU Winter Hall Exercise Center 2-4-15” by Steven Depolo is licensed under CC BY 2.0Jennifer L. Kuk, PhD

Associate Professor
York University
School of Kinesiology and Health Science
Sherman Health Science Research Centre
Toronto, Ontario  

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

– The benefits of fitness are well know, but it was unclear whether the benefits applied to those with severe obesity.  This is even more important give that the health risks associated with severe obesity are exponentially higher than in mild obesity.  Fitness in this study was defined as the top 80% of a normal population.This means that unfit is the bottom 20%.  In the past, research has shown that this threshold of fitness is associated with the biggest health benefits.

– We see that 40% of individuals with mild obesity are fit, while 11% of those with severe obesity are fit.  Individuals with high fitness had no differences in health risk, despite the large differences in obesity (~50-100 pounds).  Conversely, those within the unfit group did have significantly higher glucose, blood pressure and lipids with higher obesity levels.

In other words, fitness was able to protect individuals with severe obesity from many of the expected negative health consequences.  Continue reading

School Based Healthy Lifestyle Program Did Not Bend Childhood Obesity Curve

MedicalResearch.com Interview with:
“Lt. Governor Brown Visits Hamilton Elem_Mid School to Highlight Summer Meals Program” by Maryland GovPics is licensed under CC BY 2.0Peymané Adab, MD

University of Birmingham in England

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

Response: Childhood obesity is an increasing problem worldwide. In the UK, the proportion of children who are very overweight doubles during the primary school years. Furthermore during this period inequalities emerge. At school entry there is little difference in the likelihood of being overweight between groups. However on leaving primary school, children from minority ethnic groups and those from more deprived, compared to more affluent backgrounds are more likely to be overweight. Excess weight in children is linked with multiple health, emotional and social problems.  As children spend a lot of time at school, it seems intuitive that they are an ideal setting for prevention interventions.

Although a number of studies have investigated the evidence for school obesity prevention programmes, the results have been mixed and methodological weaknesses have prevented recommendations being made. As a result we undertook a major high quality trial to evaluate an intervention that had been developed in consultation with parents, teachers and the relevant community. The 12 month programme  had four components. Teachers at participating schools were trained to provide opportunities for regular bursts of physical activity for children, building up to an additional 30 minutes each school day. There was also a workshop each term, where parents came in to cook a healthy meal (breakfast, lunch of dinner) with their children. In conjunction with a local football club, Aston Villa, children participated in a six-week healthy eating and physical activity programme. Finally, parents were provided with information about local family physical activity opportunities.

We involved around 1500 year 1 children (aged 5-6 years) from 54 state run primary schools in the West Midlands. At the start of the study, we measured their height and weight and other measures of body fat, asked the children to complete a questionnaire about their wellbeing, to note everything they ate for 24 hours, and to wear an activity monitor that recorded how active they were. After this, the schools were randomised to either receive the programme or not. We then repeated the measures 15 and 30 months later.

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