Author Interviews, Cost of Health Care, Gastrointestinal Disease, Weight Research / 22.10.2015

[wysija_form id="5"]Salman Nusrat M.D. Assistant Professor, Section of Digestive Diseases and Nutrition University of Oklahoma Health Sciences CenterMedicalResearch.com Interview with: Salman Nusrat M.D. Assistant Professor, Section of Digestive Diseases and Nutrition University of Oklahoma Health Sciences Center Medical Research: What is the background for this study? What are the main findings? Dr. Nusrat: Obesity is a global epidemic and is one of the most taxing issues affecting healthcare in the United States. It is a well-established risk factor for increased morbidity and mortality. We looked at how morbid obesity (BMI>40) affected inpatient health care utilization over the last two decades. We found that:
  • From 1997 to 2012, the number of patients discharged with a diagnosis of morbid obesity increased 11 folds from 10,883 to 124,650
  • The majority of these patients were female (~80%) and aged between 18-44 years.
  • Southern States accounted for majority of these admissions (37%). Majority of these patients were insured (~90%) and about three quarters of these admissions were in area with mean income above the 25 percentile.
  • The number of hospitalizations for patients aged >45 years increased from 33% to 50%.
  • -Even though the length of stay decreased from 5 days (1997) to 2.1 days (2012), the aggregate charges increased from $198 Million (1997) to $5.9 Billion (2012).
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AHA Journals, Author Interviews, Weight Research / 17.10.2015

Dr. Eric J. Belin de Chantemèle PhD Georgia Regents University Augusta Georgia MedicalResearch.com Interview with: Dr. Eric J. Belin de Chantemèle PhD Georgia Regents University Augusta Georgia  Medical Research: What is the background for this study? What are the main findings? Response:  Obesity is currently a worldwide epidemic and a major risk factor for cardiovascular disease including among others hypertension, endothelial dysfunction, atherosclerosis and coronary artery disease. Despite decades of research, the mechanisms linking obesity to cardiovascular disease still remain incompletely understood. Obesity is commonly associated with increased levels of the mineralocorticoid hormone aldosterone. Excessive amounts of aldosterone promote hypertension, vascular and heart disease but also lead to inflammation, and facilitate the development of diabetes. The present study aimed at deciphering the origin of these high aldosterone levels. We have been the first to demonstrate that the adipocyte derived hormone leptin controls the level of expression of the enzyme producing aldosterone: aldosterone synthase (CYP11B2), in the adrenal glands, and leptin stimulates the release of aldosterone. This was demonstrated in different mouse models as well as in cultured human adrenocortical cells. We also demonstrated that leptin-mediated aldosterone production promotes the development of cardiovascular disease, notably impairs endothelium-dependent relaxation in major arteries and promotes the development of cardiac fibrosis. Both endothelial dysfunction and cardiac fibrosis are precursors of major cardiovascular disease. (more…)
Author Interviews, Smoking, University of Pennsylvania, Weight Research / 16.10.2015

MedicalResearch.com Interview with: Dr. Samuel H. Preston Ph.D Professor, Department of Sociology and Population Studies Center University of Pennsylvania Philadelphia, Pennsylvania  Medical Research: What is meant by the Obesity Paradox? Is it reported more in some groups? Dr. Preston: The obesity paradox is a term that is used when a study finds that obese people have lower mortality than non-obese people. The finding is considered paradoxical because the obese do not have lower mortality in cross-sections of the general population. The paradox is, however, commonly observed among people who suffer from a particular illness such as heart disease or diabetes.  Medical Research: What are the main findings of your study? What is reverse causation and how does it affect obesity studies? Dr. Preston: We find in a nationally representative sample that, among people suffering from cardiovascular disease, mortality is indeed lower for people who are overweight or obese than for people of normal weight. So the paradox appears among this group. However, when we study people's mortality according to their maximum lifetime weight, the paradox disappears. We attribute its disappearance primarily to the fact that many  people who have lost weight from their maximum are doing so because they are ill. This phenomenon is referred to as "reverse causation" because illness is affecting weight rather than weight affecting illness and mortality. (more…)
Author Interviews, Genetic Research, Nutrition, Weight Research / 05.10.2015

Jacqueline Alvarez-Leite MD, Ph.D Full Professor, UFMG Moore Laboratory Massachusetts General HospitalMedicalResearch.com Interview with: Jacqueline Alvarez-Leite  MD, Ph.D Federal University of Minas Gerias in Brazil Medical Research: What is the background for this study? What are the main findings? Dr. Alvarez-Leite : Obesity is now a global epidemic and bariatric surgery is now the main therapeutic option for those individuals with extreme obesity in which clinical treatments failed. However, a significant proportion of those patients regain the weight lost 3-4 years after surgery. Therefore, some metabolic or genetic trait may be related to weight regain. The rs9939609 single nucleotide polymorphism (SNP) in the fat mass and obesity- associated (FTO) gene is one of the most studied genes involved in obesity. However, few studies have been conducted on patients who underwent bariatric surgery. In our study, we evaluated the influence of  this FTO SNP on body weight and composition, and weight regain in 146 patients during a 60-mo follow-up period after bariatric surgery. We observed that there was a different evolution of weight loss in individual with obesity carriers of the FTO gene variant after bariatric surgery. However, this pattern is evident at only 2 y post bariatric
 surgery, inducing a lower proportion of surgery success (percentage of excess weight loss >50%) and greater and earlier weight regain after 3-y of follow-up. Multiple regression 
analyses showed that the variation in rs9939609 was a significant and independent predictor for regaining weight during the 
5-y follow-up period. (more…)
Author Interviews, Kaiser Permanente, Pediatrics, Weight Research / 05.10.2015

MedicalResearch.com Interview with: Dr-Corinna-Koebnick Corinna Koebnick, PhD Research scientist with Research & Evaluation Kaiser Permanente Southern California MedicalResearch: Please describe your study, what you were looking for, and why.  Dr. Koebnick: This study is based on the Kaiser Permanente Southern California Children’s Health Study, which includes all children and adolescents 2–19 years of age in Southern California who are actively enrolled in a large, integrated, managed health care system. We examined the body weight from electronic health records of more than 1.3 million children and adolescents 2-19 years of age from 2008 to 2013. The objective of this study was to investigate recent trends in pediatric obesity in Southern California between 2008 and 2013. Several recent studies have investigated national trends in childhood obesity in the United States and indicated that childhood obesity rates may have reached a plateau, but are not declining. Ours is one of the few studies that is large enough to be able to detect small changes in the prevalence of obesity in time periods of less than 10 years. MedicalResearch: What are the findings of this study?  Dr. Koebnick: Our study provides strong indication that the prevalence of overweight and obesity between 2008 and 2013 has not only plateaued, but also is slowly declining. While the decline in overweight and obesity was less pronounced in girls, adolescents, some minority groups and youth living in low income and low education areas, the decline was remarkably stable across all groups and significant even in minority youth and youth of lower socioeconomic status. We found the prevalence of overweight and obesity decreased overall by 2.2 percent and 1.6 percent, respectively. This change corresponds to a relative decline of 6.1 percent in overweight youth and 8.4 percent in obese youth. Although a decline was seen across all groups, the decrease was not as strong in adolescents aged 12-19 years, in girls compared to boys, and Hispanic and black children compared to non-Hispanic whites. (more…)
Author Interviews, BMJ, Weight Research / 01.10.2015

Dr Jonas Minet Kinge PhD Researcher, Department of Health Statistics, Norwegian Institute of Public Health Associate professor, Department of Health Management and Health Economics University of Oslo Norwegian Institute of Public Health Oslo, NorwayMedicalResearch.com Interview with: Dr Jonas Minet Kinge PhD Researcher, Department of Health Statistics, Norwegian Institute of Public Health Associate professor, Department of Health Management and Health Economics University of Oslo Norwegian Institute of Public Health Oslo, Norway Medical Research: What is the background for this study? What are the main findings? Response: Previous studies have shown that the number of people with obesity increases with the gross domestic product (GDP) of a country. Previous research has also indicated that education can be an important factor in this context. The aim of this new study was to explore the assumption from previous studies that obesity is linked to GDP and education, and to include new data from several different countries. The results from this study confirm that there is an association between obesity, education and GDP. The prevalence of obesity increases with rising GDP, but only among individuals with lower levels of education. There is no significant increase in obesity among those with higher education. This means that:
  • In countries with low GDP there is more obesity among those with high education.
  • In countries with high GDP there is more obesity among those with low education.
  • The study also found that the relationship was somewhat more marked among women than among men.
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Author Interviews, Pediatrics, Weight Research / 16.09.2015

MedicalResearch.com Interview with: Annemarie Schalkwijk, MSc/MD PhD candidate, GP in training Diabetes Research Group EMGO Institute for Health and Care Research VU University Medical Center Amsterdam The Netherlands Medical Research: What is the background for this study? Dr. Schalkwijk: Overweight and obese children are at increased risk of becoming overweight and obese adults and therefore are an important risk factor for developing type 2 diabetes. It is known from the literature that being overweight or obese is associated with environmental, parental and socioeconomic status (SES) characteristics. However, the interdependence of these variables has not been studied before.Therefore, the aim of our study is to assess the influence of the amount of green space, accessibility to a garden and the safety of the surroundings during ages 3-5 on being overweight or obese at age 7. Furthermore, we want to assess if parental choices and SES moderate or mediate this influence. Medical Research: What are the main findings? Dr. Schalkwijk: Statistically significant associations (p≤0.05) were found between low levels green space, not having access to a garden, shabbiness of the neighborhood and childhood obesity (OR (95% CI) respectively: 1,14 (1,02-1,27), 1,35 (1,16-1,58), 1,22 (1,05-1,42)). Parental determinants were related to the environmental determinants and childhood overweight/obese but did not moderate or mediate the association between the latter two. Therefore no parental variables were left in the model. As for SES, the highest level of education in the household did diminish the magnitude of the associations found between the environmental determinants and being overweight/obese. In the final model the remaining significant associations with childhood overweight/obese were no garden access for lower educated households and shabbiness of the neighborhood for higher educated households (OR (95% CI) respectively: 1,38 (1,16-1,58), 1,38 (1,12-1,70). We can conclude from our study, that environmental factors do have an association with children being overweight or obese. However, these associations are complex and might not be as distinct as previously assumed. (more…)
Author Interviews, CDC, Pediatrics, Weight Research / 15.09.2015

MedicalResearch.com Interview with: Jessica M. Robbins, PhD Adjunct Assistant Professor Public Health Epidemiologist Philadelphia Department of Public Health  Medical Research: What is the background for this study? Response: The rapid increase in child obesity rates across the US in recent decades has affected Philadelphia as it has other cities.  The Philadelphia Department of Public Health has worked with the School District of Philadelphia to analyze data on students' heights and weights to determine trends in obesity since the 2006-2007 school year.  Data we had examined through the 2009-2010 school year indicated that the prevalence of obesity and severe obesity were declining in this population, and notably were declining in African-American and Hispanic students as well.  We updated the analyses with data through the 2012-2013 school year to see if that trend had continued. Medical Research: What are the main findings? Response: Overall, the prevalence of obesity and particularly of severe obesity continued to decline, although more slowly than in the earlier period.  However, there were some disturbing disparities, with improvement largely limited to boys.  Girls in grades kindergarten through 5 and Hispanic girls actually saw increased obesity since 2009-2010. (more…)
Author Interviews, Menopause, Weight Research / 15.09.2015

Jennifer W. Bea, PhD Assistant Professor, Medicine Assistant Research Scientist, Nutritional Sciences University of Arizona Cancer Center Tucson, AZ 85724-0524MedicalResearch.com Interview with: Jennifer W. Bea, PhD Assistant Professor, Medicine Assistant Research Scientist, Nutritional Sciences University of Arizona Cancer Center Tucson, AZ 85724-0524 Medical Research: What is the background for this study? What are the main findings? Dr. Bea: The analysis was based on a subgroup of the largest study of post-menopausal women in the United States, Women's Health Initiative (WHI), which has been answering important questions about health and wellness among post-menopausal women since the 1990s. In the analysis, body mass index, a proxy for body fat, and actual body composition (i.e. fat and muscle mass) determined by an imaging technique called dual energy X-ray absorptiometry (DXA) were used to predict risk of death. In the younger post-menopausal women,  aged 50–59 years, higher body fat increased risk of death by more than 2 times and the highest muscle mass decreased risk of death by almost 60%. Importantly, the relationships were reversed among the older women, aged 70–79 years (P < 0.05). These results were true in spite of BMIs in these groups spanning nearly the full range of possible BMIs (16.4–69.1kg/m2). These data indicate that BMI does not estimate mortality risk as well as we would hope among post- menopausal women. (more…)
Author Interviews, Weight Research / 12.09.2015

Dr.Manuel Fernández-Real MD, PhD Biomedical Research Institute of Girona (IDIBGI) CIBERobn Obesity Hospital of GironaMedicalResearch.com Interview with: Dr.Manuel Fernández-Real MD, PhD Biomedical Research Institute of Girona (IDIBGI) CIBERobn Obesity Hospital of Girona Medical Research: What is the background for this study? What are the main findings? Response: Obesity is an important determinant of increased cardiovascular risk. Increased fat mass has been assumed to constitute the main prominent contributor to changes in carotid intima-media thickness (c-IMT). A link among fat free mass and total blood volume, stroke volume and cardiac output has been also previously reported. In this manuscript we describe that  carotid intima-media thickness was positively associated with lean body mass in men (r =0.328, p <0.0001) and women (r = 0.268 p =<0.0001). c-IMT values increased across lean mass quartiles (p < 0.0001).  Stepwise linear regression analysis showed that age and lean mass (but not fat mass or traditional cardiovascular risk factors) contributed to 46.2% of c-IMT variance in men (p=<0.0001). (more…)
Author Interviews, NYU, Pediatrics, Weight Research / 02.09.2015

Brian D. Elbel, PhD, MPH Associate professor, Departments of Population Health, Division of Health and Behavior and Medicine, Division of General Internal Medicine Marie Bragg, PhD Assistant professor Department of Population Health Jonathan Cantor, MS Department of Population Health, Section on Health Choice, Policy and Evaluation NYU Langone Medical Center MedicalResearch.com Interview with: Brian D. Elbel, PhD, MPH Associate professor, Departments of Population Health, Division of Health and Behavior and Medicine, Division of General Internal Medicine Marie Bragg, PhD Assistant professorDepartment of Population Health Jonathan Cantor, MS Department of Population Health, Section on Health Choice, Policy and Evaluation NYU Langone Medical Center  MedicalResearch: What is the background for this study? Response: On July 17th, 2014 the New York City Council proposed the “Healthy Happy Meals” bill in an effort to improve the nutritional value of fast food restaurant meals marketed to children. The bill states a restaurant cannot offer an incentive item (i.e. a toy) in combination with the purchase of a meal unless the meal met several nutritional standards. The meals with toys would be required to:
  • Be less than 500 hundred calories total
  • Be less than 600 milligrams of sodium total
  • Have less than 35% of total calories come from fat
  • Have less than 10% of total calories come from saturated fat
  • Have less than 10% of total calories come from added sugar
  • Contain one half cup of fruit or vegetable or one serving of whole-grain products
This study examined potential reductions in purchased calories, sodium and percentage of calories from fat that could occur among children if the policy were to go into effect. MedicalResearch: What are the main findings? Response: Researchers collected receipts for fast food purchases for 422 children who were accompanied by 358 adults. On average, adults purchased 600 calories for each child, with 36 percent of those calories coming from fat. One third of the children in the sample had a children’s meal, with 98% of the purchased children’s combination meals would be restricted from handing out a toy with the meal if the bill passed. If the bill passed, there would be a 9% reduction in calories purchased for kid’s meals, the equivalent of 54 calories. Similarly, researchers found that there would be a 10% (83 mg) reduction in sodium purchased and a 10% reduction in the percentage of calories from fat purchased for children. This all assumes that children ordered what they did previously but the meals meet the nutrition criteria. (more…)
Author Interviews, Breast Cancer, NIH, Weight Research / 31.08.2015

Dr. Alexandra White PhD in Epidemiology University of North Carolina at Chapel Hill Postdoctoral fellow National Institute of Environmental Health ScienceMedicalResearch.com Interview with: Dr. Alexandra White PhD in Epidemiology University of North Carolina at Chapel Hill Postdoctoral fellow National Institute of Environmental Health Science MedicalResearch: What is the background for this study? Dr. White: Many studies have shown that being overweight or obese is a risk factor for postmenopausal breast cancer. We know less about how obesity impacts breast cancer risk in premenopausal women. About a third of U.S. adults are obese, which is defined as having a body mass index (BMI) greater than 30. Similarly, the prevalence of abdominal obesity, measured by a person’s waist circumference, has increased by 10% in the last decade. In 2012, more than two-thirds of U.S. women had a waist circumference that indicated abdominal obesity. Abdominal obesity may be a better predictor than BMI for breast cancer risk and other chronic diseases, because it is related to insulin resistance and can reflect metabolically active fat stores. In order to understand how different types of obesity (overall vs. abdominal) influence breast cancer risk, we used information from >50,000 participants in the Sister Study. The Sister Study, led by scientists at the National Institute of Environmental Health Sciences, part of the National Institutes of Health investigates environmental and genetic risk factors for breast cancer. (more…)
Author Interviews, Kidney Disease, Lancet, Weight Research / 21.08.2015

Dr. Csaba P. Kovesdy MedicalResearch.com Interview with: Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Kovesdy: Obesity has reached epidemic proportions in modern societies, and has been linked to adverse outcomes such as diabetes mellitus, hypertension, cardiovascular disease and mortality. In addition, obesity is also associated with chronic kidney disease through a variety of mechanisms. Our population is ageing, and previous studies have suggested that the effect of obesity on certain outcomes like mortality may be different in older vs. younger individuals, but this has not been previously examined for chronic kidney disease. We have this examined the association of granular BMI categories with progressive loss of kidney function in a very large cohort of patients with normal estimated GFR in patients of different ages. We found that the association of a BMI of >30 kg/m2 with progressive loss of kidney function was not present in younger individuals (< 40 years of age), and increased as people aged, with >80 years old displaying the strongest associations between obesity and loss of kidney function. In addition to this we also examined the association of BMI with mortality in different age groups, and found uniform U-shaped associations that did not vary by age. (more…)
Author Interviews, Diabetes, JAMA, Weight Research / 19.08.2015

Melanie J Davies MB ChB MD FRCP FRCGP Professor of Diabetes Medicine 
NIHR Senior Investigator Leicester Diabetes Unit
Leicester Diabetes Centre Bloom
University of Leicester MedicalResearch.com Interview Invitation Melanie J Davies MB ChB MD FRCP FRCGP Professor of Diabetes Medicine 
NIHR Senior Investigator Leicester Diabetes Unit
Leicester Diabetes Centre Bloom
 University of Leicester   MedicalResearch: What is the background for this study? What are the main findings?
 Dr. Davies: This study was designed to test the efficacy and safety of Liraglutide using a dose of 3mg for weight loss among patients with type 2 diabetes.  It was a large international study in which we compared once daily subcutaneous Liraglutide at a dose of 3mg to Liraglutide 1.8mg which is the current maximum dose licenced in patients with diabetes and placebo.  In all patients we offered a calorie deficit diet and lifestyle advice to increase physical activity.  Our main findings were that the dose of 3mg of Liraglutide resulted in greater weight loss than both other arms of the study indeed 54% of patients at 56 weeks achieved more than 5% weight loss and a further 25% were able to achieve more than 10% weight loss.  The 3mg of Liraglutide compared to the placebo, there were also significant impacts on HbA1c and other cardiovascular risk factors such as systolic blood pressure and lipids as well as improving patient quality of life particularly physical functioning and patient treatment satisfaction.  (more…)
Author Interviews, Nutrition, University Texas, Weight Research / 28.07.2015

Junfeng Jiao, PhD Assistant Professor, The University of Texas at Austin School of Architecture Director, Urban Information Lab Austin, TexasMedicalResearch.com Interview with: Junfeng Jiao, PhD Assistant Professor, The University of Texas at Austin School of Architecture Director, Urban Information Lab Austin, Texas Medical Research: What is the background for this study? Dr. Jiao: The increase in obesity rates has been explained by dietary changes including the consumption of high-energy, low-nutrient foods. Over the past thirty years, trends reveal increases of eating away from home. Public Health professionals have hypothesized that the heightened exposure to the ubiquitous fast food establishments may be an avenue through which health and diets are impacted. Medical Research: What are the main findings? Dr. Jiao: This study examined whether the reported health impacts of eating at a fast food or quick service establishment on a frequent basis were associated with having such a restaurant near home. Results indicated that eating at a fast food or quick service restaurant two times or more per week was related with perceived poor health status, overweight, and obese. Simply living close to such establishments was not related to negative health outcomes such as being overweight or obese, having cardiovascular disease (CVD) or diabetes. (more…)
Author Interviews, Colon Cancer, Duke, Weight Research / 10.07.2015

S. Yousuf Zafar, MD, MHS Associate Professor of Medicine Duke Cancer Institute Duke Clinical Research InstituteMedicalResearch.com Interview with: S. Yousuf Zafar, MD, MHS Associate Professor of Medicine Duke Cancer Institute Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Zafar: Multiple studies have suggested that obesity and colorectal cancer are related. For instance, obesity has been linked with an increased incidence of colon cancer. Obesity has also been associated with a greater risk of colon cancer recurrence. To date, no study has looked at the role of obesity in outcomes for patients with metastatic colorectal cancer. In our study of over 6000 patients receiving treatment for metastatic olcolorectal cancer, we found that patients with the lowest body mass index (BMI) were at greatest risk for worse survival. This does not mean that obesity is good. More likely, it means that those who are very underweight are least able to tolerate the best treatment, or being very underweight is a biologic marker of poor prognosis. (more…)
Author Interviews, Columbia, Diabetes, NEJM, Weight Research / 03.07.2015

Dr. F. Xavier Pi-Sunyer MD Division of Endocrinology and Obesity Research Center Columbia University, New YorkMedicalResearch.com Interview with: Dr. F. Xavier Pi-Sunyer MD Division of Endocrinology and Obesity Research Center Columbia University, New York Medical Research: What is the background for this study? What are the main findings? Dr. Pi-Sunye: In a large randomized trial, the drug Liraglutide was compared to placebo in overweight and obese non-diabetic volunteers. Over 52 weeks, in combination with diet and increased physical activity, Liraglutide lowered body weight by 8.4 kg as compared to 2.8 kg in placebo. 63% vs 27% lost at least 5% of baseline weight, 33% vs 10% lost more than 10% of baseline weight. (more…)
Author Interviews, Microbiome, Weight Research / 30.06.2015

Dr. Karine Clément M.D., Ph.D. Assistant Professor, Nutrition Department Hotel-Dieu hospital ParisMedicalResearch.com Interview with: Prof. Karine Clément MD, PhD Director ICAN - Institute of Cardiometabolism And Nutrition Hôpital La Pitié-Salpêtrière, Paris www.ican.paris [email protected] Medical Research: What is the background for this study? What are the main findings? Dr. Clément: Obesity, associated with insulin resistance, is a chronic inflammatory disease revealed by a moderate but long-term increase in the levels of inflammatory molecules in the blood. Our groups and others have shown that several organs such as adipose tissues, liver, pancreas and muscles are also sites of inflammation with accumulation of immune cells such as macrophages and lymphocytes. This low-grade inflammatory state perturbs the tissue biology and contributes to the development and/or maintenance of insulin resistance and diabetes. In addition our teams and others showed that the intestinal functions are altered in obesity such as sugar and lipid absorption of and enteroendocrine nutrient signaling to the whole body. Our teams showed modifications of immunity in the obese intestine, and particularly in the jejunum part where most of sugar and lipid absorption takes place. Obesity increases the absorptive surface of the intestine and the colonization of the epithelium by CD8αβ T lymphocytes not affecting tissue integrity, thus differing from IBD inflammation. The cytokines secreted by the CD8 T cells of obese, but not lean subjects, are able to inhibit insulin action in enterocytes. In these patients, the increase of intestinal CD8 T cell density correlates with sugar absorption capacity and with the level of obesity and associated complications such as liver disease (NASH – Non-Alcoholic SteatoHepatitis) and dyslipidemia. (more…)
Author Interviews, Social Issues, Weight Research / 24.06.2015

MedicalResearch.com Interview with: Ruopeng An, PhD Assistant Professor, Department of Kinesiology and Community Health College of Applied Health Sciences University of Illinois at Urbana-Champaign Champaign, IL 61820 Medical Research: What is the background for this study? What are the main findings? Response: Health disparity is a particular type of health difference that is closely linked with social, economic and environmental disadvantage. One fundamental goal in the Healthy People 2020 is to “achieve health equity, eliminate disparities, and improve the health of all groups”. Obesity is a leading risk factor for many adverse health outcomes such as type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, and certain types of cancer. Sweeping across the nation during the past 3 decades, the prevalence of obesity increased from 15% in 1980 to 35% in 2012 among U.S. adults. The obesity epidemic is marked by salient demographic and socioeconomic disparities pertaining to gender, race/ethnicity, education, income and geographic location. In this study, we examined the annual trends in educational disparity in obesity among U.S. adults 18 years and older from 1984 to 2013 using data from a nationally-representative health survey. We found that the obesity prevalence among people with primary school or lower education increased from 17.46% or 3.41 times the prevalence among college graduates (5.12%) in 1984 to 36.16% or 1.73 times the prevalence among college graduates (20.94%) in 2013. In any given year, the obesity prevalence increased monotonically with lower education level. The obesity prevalence across education subgroups without a college degree gradually converged since early 2000s, whereas that between those subgroups and college graduates diverged since late 1980s. Absolute educational disparity in obesity widened by 60.84% to 61.14% during 1984-2013 based on the Absolute Concentration Index and the Slope Index of Inequality, respectively; meanwhile, relative educational disparity narrowed by 52.06% to 52.15% based on the Relative Index of Inequality and the Relative Concentration Index, respectively. The trends in educational disparity in obesity differed substantially by gender, race/ethnicity, age group, and obesity severity. (more…)
Abuse and Neglect, Aging, Weight Research / 21.06.2015

MedicalResearch.com Interview with: Dr. Min Du Ph.D Department of Animal Sciences Washington Center for Muscle Biology Washington State University Pullman, WA Medical Research: What is the background for this study? What are the main findings? Response: The beige fat is only recently identified and is highly inducible. we observed that polyphenolic compounds including resveratrol enhances AMPK activity, and hypothesized that resveratrol might enhance the formation of beige fat through activation of AMPK. Therefore, we used resveratrol, a very well characterized polyphenolic compound as a representative of polyphenolic compounds in fruits, to check its effects on the formation of beige fat. We found that resveratrol induced the formation of beige adipocytes both in vitro and in vivo. We further found that the lipid oxidation rate was enhanced due to the formation of beige fat, which is correlated with the anti-obesity effect of resveratrol. (more…)
Author Interviews, OBGYNE, Weight Research / 12.06.2015

MedicalResearch.com Interview with: Theresa A Lawrie World Health Organization Department of Reproductive Health and Research Geneva, Switzerland MedicalResearch: What is the background for this study? Response: Excessive weight gain in pregnancy is associated with various undesirable outcomes in pregnancy. The aim of the review was to assess data from all relevant clinical trials in the field, to determine whether diet and/or exercise interventions during pregnancy were effective in reducing the chance of excessive weight gain in pregnancy. We also wanted to know whether these interventions could reduce the chance of having large babies (macrosomia), as this is associated with difficult labor, c/section, postpartum hemorrhage, birth injuries and other complications. MedicalResearch: What are the main findings? Response: Altogether 49 trials contributed data to the review. Approximately half the trials recruited women of any pre-pregnancy weight, the other half recruited women who were overweight or obese at the start of pregnancy. Most of the trials were conducted in high income countries. Interventions varied, some involved individual counseling, others group sessions, some were counseling interventions only, other programs were actively supervised by fitness trainers. Health outcomes for women receiving the intervention programs in addition to routine antenatal care (the intervention group) were compared with those of women receiving the routine antenatal care only (the control group). We found that diet or exercise or combined interventions led to an average 20% reduction in the number of women gaining excessive weight in pregnancy. This reduction was fairly consistent across the different types of interventions, although the largest effect was observed for combined diet and supervised exercise interventions. Overall findings suggested a small reduction in caesarean section (of about 5%) and in large babies (of about 7%).  However, a bigger reduction in large babies (in the region of a 19% reduction) was noted for exercise-only interventions, which were more likely to be supervised interventions. Other findings: We also found no difference in the risk of preterm birth between groups. Fewer women in the intervention group were assessed as having high blood pressure during pregnancy (although we assessed this as low quality evidence). Low quality evidence also suggested that women in the intervention group were likely to retain less weight at six months postpartum compared with the control group. Interestingly, data from two studies suggested that women receiving diet and exercise interventions were less likely to have babies with breathing difficulties at birth. These findings will hopefully be corroborated by other studies. A limitation of the review, is that we did not include gestational diabetes as an outcome as this is partly covered in a separate Cochrane review. Our exploratory analyses, however, suggested that there may be a reduction in gestational diabetes for certain types of interventions, and we hope to include these data in future review updates. In general, we did not find differences in outcomes for women according to pre-pregnancy weight or BMI. (more…)
Author Interviews, Heart Disease, JACC, Weight Research / 31.05.2015

MedicalResearch.com Interview with: Christopher X Wong MBBS MSc PhD Clinical Research Fellow | Clinical Trial Service Unit, Oxford Clinical Senior Lecturer | Centre for Heart Rhythm Disorders, Adelaide Clinical Trial Service Unit, University of Oxford Roosevelt Drive, Oxford Medical Research: What is the background for this study? What are the main findings? Dr. Wong: Atrial fibrillation is an increasingly common heart rhythm disorder. This study demonstrates that even small increments in obesity are associated with a significantly increased risk of atrial fibrillation. Our data suggest that for every 1 unit reduction in body mass index there may be a 3-5% reduction in atrial fibrillation; for every 5 unit reduction, there may be 10-29% reductions. It should also be noted that this is likely to be a significant underestimate of the effect of weight reduction on atrial fibrillation rates as weight control has favourable effects on other risk factors for atrial fibrillation, such as hypertension and diabetes. Given the more than 45 million people with atrial fibrillation worldwide, even small but widespread reductions in obesity would thus help contain this ‘epidemic’ of atrial fibrillation. (more…)
Author Interviews, Diabetes, Genetic Research, Weight Research / 22.05.2015

MedicalResearch.com interview Dorota Kaminska, MSc Department of Clinical Nutrition University of Eastern Finland MedicalResearch: What is the background for this study? What are the main findings? Response: The prevalence of obesity is increasing worldwide, making it one of the biggest health problems currently facing both developed and developing countries. Obesity is considered a primary risk factor for developing type 2 diabetes. While the majority of people with type 2 diabetes are obese, most of obese people do not develop diabetes, indicating that obesity is not the only risk factor for type 2 diabetes. Both obesity and type 2 diabetes are multifactorial complex diseases that are caused by a combination of genetic, environmental, and lifestyle factors. Results from twin studies suggest that genetic factors explain 50% to 90% of the variance in body mass index (BMI) and from 45% to 85% of the diabetes risk. However genetic variations identified by genome wide association studies (GWAS) explain only 2-4% of the obesity risk and 5-10% of the type 2 diabetes risk. Several options have been debated to be a source of so called “missing heritability”, including, among others, structural DNA variations, gene-gene and gene-environment interactions, epigenetic modifications and RNA splicing. We used adipose tissue samples from Kuopio Obesity Surgery (KOBS), very low calorie diet (VLCD), Metabolic Syndrome in Men (METSIM) and European Network on Functional Genomics of Type 2 Diabetes (EUGENE2) studies to determine alternative splicing pattern of selected genes. The study focused on determining the effects of obesity and weight loss on alternative splicing of metabolically active genes (TCF7L2 and INSR). We showed that alternative splicing of both genes is dysregulated in obesity and type 2 diabetes, resulting in impaired insulin action in adipose tissue. Additionally we demonstrated, that obesity induced changes in splicing can be reversed by weight loss induced by gastric bypass surgery or very low calorie diet. Furthermore, the study identified alternatively spliced genes in the genomic regions associated with obesity risk, demonstrating that splicing of the MSH5 gene in subcutaneous fat is regulated by weight loss. The study also found that body mass index is a main determinant of TRA2B, BAG6 and MSH5 splicing in subcutaneous fat; however, the functional consequences of this finding require further investigation. These findings imply that the obesity-associated gene variants might act through regulation of splicing which in turn might underlie the pathogenesis of obesity in individuals carrying the risk variants. (more…)
AHA Journals, Author Interviews, Heart Disease, Metabolic Syndrome, Race/Ethnic Diversity, Weight Research / 21.05.2015

Michelle Schmiegelow, MD, PhD-studerende Hjertemedicinsk Forskning Gentofte Universitetshospital HellerupMedicalResearch.com Interview with: Michelle Schmiegelow, MD, PhD-student Hjertemedicinsk Forskning Gentofte Universitetshospital Hellerup Medical Research: What is the background for this study? Dr. Schmiegelow:  Obesity has become a worldwide epidemic, but the excess cardiovascular risk observed in obese individuals may primarily be attributable to metabolic mediators, rather than obesity per se. Several studies conducted in primarily non-Hispanic white populations suggest that obese individuals without the metabolic syndrome, defined as metabolically healthy obese, have a cardiovascular risk similar to that of normal weight metabolically healthy individuals. We used prospectively collected data from the Women’s Health Initiative studies to evaluate whether obesity unaccompanied by metabolic abnormalities was associated with increased risk of cardiovascular disease (CVD) across racial/ethnic subgroups in postmenopausal women. Additionally, we examined whether the use of the metabolic syndrome to define the metabolically healthy obese applied to the various racial/ethnic subgroups by quantifying the number and type of metabolic syndrome components. All women were classified by obesity level and metabolic health status at baseline. The women were thus categorized according to body mass index (BMI, kg/m2) into normal weight (BMI 18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (30.0 kg/m2) women. Metabolic health status was first defined by presence of the metabolic syndrome (yes/no), and second by number of metabolic syndrome components. In accordance with the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute we defined the metabolic syndrome as any two of the following (criteria for women): increased waist circumference ≥80 cm; increased level of triglycerides ≥150 mg/dL (≥1.7 mM); decreased level of HDL-C <50 mg/dL (<1.3 mM); increased blood pressure with either systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or treatment with antihypertensive drugs; and impaired fasting serum glucose ≥100 mg/dL (6.1 mM). Medical Research: What are the main findings? Dr. Schmiegelow: The study population comprised 14,364 women without diabetes or prior cardiovascular disease. The women had a median age of 64 years (interquartile range 57–69), and 47% were white, 36% were black and 18% were Hispanic. Over a median follow-up of 13 years (interquartile range 12–14 years), 1,101 women (7.7%) had a first cardiovascular event. The main findings of this study were that metabolic abnormalities appeared to confer more cardiovascular risk among black women than among white women. Consistent with other studies, among white women without the metabolic syndrome, obesity was not associated with increased cardiovascular risk compared with normal weight women. Conversely, black overweight and black obese women had increased cardiovascular risk compared with normal weight black women without the metabolic syndrome, even in absence of the metabolic syndrome. According to number of metabolic syndrome components, black overweight or obese women with just two metabolic abnormalities had increased risk of cardiovascular disease, although they would be considered “metabolically healthy” based on the standard definition, particularly since one of these abnormalities were abdominal obesity for 79% of overweight and 98% of obese women, irrespective of race/ethnicity. White obese women with three metabolic abnormalities did not have a statistically significantly increased cardiovascular risk compared with normal weight metabolically healthy women. Thus, cardiovascular disease risk appeared to be elevated in black women by the presence of only two or three metabolic abnormalities to a degree that would require four or more metabolic abnormalities among white women. These findings did not appear to be driven by any particular combination of metabolic abnormalities. (more…)
Author Interviews, Weight Research / 12.05.2015

MedicalResearch.com Interview with: Dr Margaret Ashwell OBE, FAfN, RNutr (Public Health) Ashwell Associates Ashwell, Hertfordshire, United Kingdom. Visiting Research Fellow, Oxford Brookes University

MedicalResearch: What are the main findings from this study?

Dr. Ashwell: In this study, the authors explore the differences in CVD risk factors between overweight and non-overweight people (by BMI) according to their shape (waist-to-height ratio -WHtR) Data for their analysis was taken from the Health Survey for England 2009 (HSE). They found significant differences in levels of total cholesterol (TC) and glycat­ed haemoglobin (HbA1c—a measure of blood sugar control used to diagnose diabetes). Out of 2917 people aged 16 years and over, 346 classified as ‘normal’ by BMI, have WHtR exceeding 0.5 (12% of the total,sample, or 34% of normal weight people). These could be called non-overweight ‘apples’, who have a lot of fat around the waist but not a high BMI. The researchers classified the HSE population into four groups (2×2) using standard boundary values of BMI (above or below 25kg/m2) and WHtR (above or below 0.5). The group with ‘low/normal BMI but high WHtR (non-overweight ‘ap­ples’) had significantly higher mean TC than the group with high BMI but low WHtR (overweight ‘pears’—people with a higher than normal BMI but less fat around the waist): 5.73mmol/L vs. 4.98mmol/L. Similarly, HbA1c levels were higher among non-over­weight ‘apples’ than among overweight ‘pears’ (5.62% vs. 5.33%). These differences were similar and also significant in both sexes.

MedicalResearch: Why do you say that piece so string can be used for primary screening?

Dr. Ashwell: Since a good boundary value for waist-to-height ratio is 0.5, you don't even need a tape measure to screen those at risk. It can be done with a piece of string. Measure the height of child with string, fold it in half and see if it fits around his/her waist.   If it doesn't, that child should proceed to the next stage of screening. (more…)
Author Interviews, Pediatrics, Weight Research / 12.05.2015

Matthew PearceMedicalResearch.com Interview with: Matthew Pearce NHS Gloucestershire Clinical Commissioning Group UK Medical Research: What is the background for this study? What are the main findings? Response: Despite evidence to suggest that the prevalence of childhood obesity in the UK has stabilized in recent years, we know that approximately one in five children start their school life either overweight or obese, increasing to one in three children by the last year in primary school. Our research was the first to undertake an in-depth analysis on the UK’s National Child Measurement Programme (NCMP) and retrospectively track the weights of individual children over a 7-year period. Our study included a sample of 1863 children in South Gloucestershire, Bristol in the UK. Our results were found to be similar to cross sectional data with obesity prevalence approximately doubling between the first (4/5yrs old) and last year (10/11yrs old) of primary school. Our findings provide little reassurance that those children who are obese in early childhood ‘grow out of ’ excess adiposity. Including overweight, we found that 84% of obese children at Reception year went on to be either overweight or obese by Year 6. Although previous studies have failed to identify any significant differences in BMI change between boys and girls during mid-childhood, our research found that more boys than girls dropped a weight category (from overweight or obese) by the time they reached Year 6. We found that the odds ratios of being overweight (BMI ?85th percentile) or obese (?95th percentile) based on BMI at Reception were similar to published literature. Our data found children who are within the upper range of the healthy weight category (75th–85th percentile) at Reception had an increased risk of being overweight or obese by the time they reach year 6. (more…)
Author Interviews, Nutrition, Sugar, Weight Research / 08.05.2015

Dr. Dragos Petrescu Department of Public Health and Primary Care CambridgeMedicalResearch.com Interview with: Dr. Dragos Petrescu Department of Public Health and Primary Care Cambridge Medical Research: What is the background for this study? What are the main findings? Response: Consumption of sugar-sweetened beverages is a major contributor to obesity, particularly in children. Recent systematic reviews provide good evidence that reducing portion size reduces consumption. Similarly, evidence suggests that container shapes and product placement in supermarkets can influence consumption. The public acceptability of "nudging" -- altering properties such as the size, the shape, and location of sugar-sweetened beverages -- to improve public health is unknown. Here we compared the acceptability in UK and USA samples of government interventions to reduce consumption of sugar-sweetened beverages: three nudge interventions (limiting portion size, changing container shape, and changing shelf location) and two traditional interventions (increased taxation and an education campaign). We found that for the majority of UK and USA samples, the education campaign and the three nudge interventions were acceptable, with education attracting most support.  By contrast, only a minority of participants supported taxation. (more…)
Accidents & Violence, Author Interviews, Weight Research / 08.05.2015

MedicalResearch.com Interview with: Claudia Sikorski Dr. rer. med. Claudia Sikorski, Dipl.-Psych. Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) Institute of Social Medicine, Occupational Health and Public Health Universität Leipzig, Medizinische Fakultät Leipzig Medical Research: What is the background for this study? What are the main findings? Response: Obesity is a highly stigmatized condition. People with obesity are often regarded a lazy, slow and sloppy. One consequence of these negative attitudes may be discrimination, e.g. the unfair treatment of individuals with obesity. This study, conducted by Jenny Spahlholz, myself and colleagues reviews observational and experimental studies that investigated the occurrence and nature of discrimination in obesity. (more…)