Showing posts with label obesity. Show all posts
Showing posts with label obesity. Show all posts

Tuesday, November 11, 2014

BMI Changes Between Fifth and Tenth Grades

By: Lewis First, MD, MS; Editor-in-Chief 

School lunch. Photo by US Dept. of Agriculture via Flickr
We have certainly published studies on overweight or obese toddlers and preschoolers with the hope of intervening as early as possible to attenuate the increasing weight gain—but what happens to weight gain and BMI in pre-adolescent children as they enter and move through adolescence? Does weight gain get worse or better? Can you influence the trajectory of that weight gain in this age group as much as if you altered things in early childhood?

Schuster et al. (doi: 10.1542/peds. 2014-2195) studied the factors that can result in progression to obesity as well as BMI reduction factors in a cohort of fifth graders followed through tenth grade. Those fifth graders who already had a negative body image due to their being overweight or obese, lower socioeconomic status, and/or an obese parent had the most difficulty lowering their BMI as they moved through adolescence.

What’s worse—fifth graders who were not yet overweight but had a negative body image of themselves, combined with an obese parent and/or a sedentary television-watching lifestyle were on a pathway to increasing their BMI trajectory unless intervening actions could be taken.

If you are interested in learning more as to what factors enhance or inhibit a child from becoming overweight or obese between fifth and tenth grade so you can better counsel your patients accordingly, this study weighs in admirably for your consideration.

You would be a pound foolish not to read it—if you want to work with your overweight or obese teens to lower elevated BMIs. And speaking of lowering BMIs in teens—have you found some ways to do this that yield success in your practice? Share your thoughts: leave a comment below, send us an eLetter on our journal website, or find us on Facebook or Twitter.

Related Reading:

Thursday, October 16, 2014

Obesity and Interpersonal Dynamics at Family Meals

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Phyllis Buchanan via Flickr
We certainly run a lot of studies on the role of proper nutrition and exercise in preventing a child from becoming overweight or obese, but what about the dynamics of a family meal itself? Could certain characteristics regarding a family eating together be protective against obesity and other characteristics that contribute to excess weight gain?

Berge et al. (doi:10.1542/peds.2014-1936) performed a cross-sectional observational study in which family meals were videoed in the homes of 120 low-income and minority communities. Communication among family members and other aspects of parent-child and child-sibling dynamics were studied and compared to a child’s weight status. The results are fascinating and indicate the more positive the family dynamic around the table, the less risk of a child being overweight.

While this study cannot prove causality, it is certainly food for thought in regard to our promoting the importance not just having healthy food on the table, but the whole family being gathered together to share and support each other through conversation and other positive dynamics practiced at the family table. Read this study and learn more that you, in turn, can share with your patients’ families.

Related Reading:

Monday, August 25, 2014

Parental Perceptions of Overweight 20 Years Ago and Today: The Times (and BMIs) They Are a Changin’!

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by via Flickr
Part of the problem of trying to get a family to help their overweight child lose weight is getting parental buy-in—and that begins when parents agree that their child is medically perceived to be overweight. One would think that parents would view their child as being overweight quite easily—and while that may have been true 20 years ago—it is not as easily perceived today—at least according to a study we are sharing this week by Hansen et al. (doi: 10.1542/peds.2014-0012).

The authors looked at survey data from parents on close to 3,000 children (ages 6-11 years) enrolled in the National Health and Nutrition Examination Survey in 1988 through 1994 and another cohort enrolled in 2005 to 2010 and found some substantive differences. Parents today are less likely to perceive their child as overweight: They did not view weight gain above the 85th percentile but below the 91st percentile as concerning, whereas 20 years ago it was.

What does this shift in social norms mean for the health of children who are showing increased body weight and crossing high percentiles on a growth curve? Weigh in on the information contained in this study and then perhaps share it with parents of overweight patients and see if it can’t help them realize that their child’s increasing BMI over time really is a problem.

Related Reading:

Tuesday, May 6, 2014

Impulsivity and Non-nutritious Food Advertisements: A Worrisome Combination

Photo by Honza Soukup via Flickr
There are studies in the peer-reviewed literature that demonstrate the influence of unhealthy food advertisements on caloric intake of children. Yet what happens when childrenespecially impulsive childrenare exposed to online “advergames” promoting energy-dense, high-calorie foods?

Folkvord et al. (doi: 10.1542/peds. 2013-3384) perform a fascinating study to show how the power of media persuasion in an impulsive child can triumph over being asked directly to refrain from eating. The impulsive children, along with the non-impulsive children, were randomized to play advergames while being rewarded to not eat while playing these games. Interestingly, this power of media persuasion does not triumph in children who lack impulsivity. In addition, the authors explore how these advergames, even when no reward is offered for non-eating, can contribute to increased caloric intake in both impulsive and non-impulsive children.

If you were skeptical about the role advertising plays in becoming susceptible to eating the product being advertised, this study should remove any doubt of skepticism. In fact, hopefully the media will advertise this study so parents, as well as pediatricians, can recognize the risks of overexposure to food advertisements, particularly the non-nutritious ones, in terms of their association with increased weight gain in children who watch these more than others. This is a study well-worth ingesting your time to read and learn about.

Related Reading:

Wednesday, April 9, 2014

Does Parental Obesity Influence the Risk of a Child Developing an Autism Spectrum Disorder?

Most of us have probably not considered the role of increased parental BMI in being associated with an increased risk of autism spectrum disorder (ASD)—and yet Suren et al. (doi: 10.1542/peds. 2013-3664) certainly did in designing their research hypothesis for a study we are releasing this week.

Photo by Cade Martin, via the CDC
Using a sample of almost 93,000 children from a Norwegian data base used in the Norwegian Mother
and Child (prospective) Cohort Study, the authors looked at maternal pre-pregnancy and paternal BMI and the subsequent risk of a child developing an ASD.

While the study cannot claim any kind of causality, the association is a curious one that the authors speculate upon in their discussion, which makes this study fascinating to read and think about.

Let us know if you agree by responding to this blog in the comments section below, by sharing your thoughts via an eLetter on our journal’s website or through Facebook or Twitter.

Related Reading:

Tuesday, April 8, 2014

What Are the Direct Costs of Childhood Obesity? A New Study Weighs In

The epidemic of childhood obesity warrants an appropriate amount of attention in our journal and others in regard to strategies to reduce the severity of this problem beginning in childhood.

Photo by Debora Caragena via the CDC
While there are many medical reasons to do so, this week Finkelstein et al. (doi: 10.1542/ peds. 2014-0063) offer an economic argument by using a review of studies in PubMed and Web of Science to estimate or impute lifetime direct medical costs of an obese child who stays obese
through adulthood.

The costs are significant and may further energize all of us to pay attention to the myriad of studies that do describe innovative programs involving the individual patient, the family and sometimes an entire community to combat the this problem in our country.

While recently JAMA (doi: 10.1001/jama.2014.732) noted a plateauing of obesity rates in children ages 2 to 5, there is still much to be done, and this article at least puts a price tag on what doing nothing about obesity might mean. If our younger patients can maintain the gains as they get older (which is not yet being seen in older age groups), we find ourselves not only improving health outcomes in these patients but saving on health care costs as well.

Read the study and think about what you are doing to reduce the cost of obesity in your own patient population.

Thursday, February 6, 2014

Parental Misperceptions of Their Child’s Weight: Implications for Obesity Prevention and Treatment

As pediatricians, one of the challenges we face is when a family does not see their child as being as overweight or obese as the growth chart might indicate. Why does this occur and what can we do about it?

Photo by PublicDomainPictures via Pixabay
Lundahl et al. (doi: 10.1542/ peds.2013-2690) weigh in with a large meta-analysis involving 69 articles and 78 samples of almost 15,800 overweight children to understand how often underestimation of weight status occurs and what contributes to this problem.

The researchers identified significant risk factors that can lead to underestimating a child’s weight that may be useful to help parents better acknowledge the rising trend in their child’s weight so that appropriate healthy strategies can be better implemented to tackle this problem.

Do you find parents in your practice do not grasp the import of a child becoming overweight or obese? Have you found ways to convince parents to see the reality of the situation? Leave a comment below, or share your thoughts via an eLetter, Facebook or Twitter. We’d love to hear from you.

Monday, November 25, 2013

Adiposity and Screen Time: Do Different Types of Media Exposure Make a Difference?

We are all aware of the association between increased screen time and weight gain, but just what type of screen activity carries an increased risk of gain in BMI?

Photo by Lexie Flickinger via Flickr
Falbe et al. (doi: peds.10.1542/2013-0887) seek the answer to that question using reports of screen time data in more than 4,000 girls and 3,500 boys as well as BMI changes over time. Needless to say, TV certainly plays a key role given how much food advertising appears through that medium, but don’t discount the role of electronic games, DVDs, and videos.

To gain a better understanding of just which form of screen time affects which gender more and with what magnitude of BMI change, screen this article carefully and then see if the hypothesis being tested applies to the overweight patients in your practice as well. Whether you agree or disagree with the findings in this study, let others know with a response below or via our journal’s Facebook page or tweet your response @Lewis_First.

Related Reading:

Friday, November 22, 2013

Genes and Obesity

Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he reflects on recent research into genes and obesity: 

A friend of mine has wrestled with being overweight for years. She is very careful about her diet, exercises maniacally, and limits her alcohol consumption.  Despite these efforts, her BMI has always been > 30.  Her weight does not seem to be related to lack of self-control and is not easily understood. My friend’s weight problems may be due to her genes. 

As reported in The New York Times (July 19, 2013), researchers have known for a long time that some aspects of weight gain are hereditary. Twins raised apart tend to have the same weight, while adopted children tend to have the body mass of the biologic parents, not their adopted parents. Evidence has accumulated over time to suggest that dozens of genes may be involved in increasing appetite, and new research suggests that at least one gene is associated not only with appetite but with a change in mammalian metabolic rate. 

The investigators developed knockout mice deficient in brain and body expressed “melanocortin receptor accessory protein 2” (MRAP2). When allowed to eat as much food as desired, the MRAP2 deficient mice were voracious and quickly became extremely obese.  When MRAP2 deficient mice were fed the same number of calories as normal mice however, only the MRAP2 deficient mice became obese. The MRAP2 mice had to be fed 10 to 15 percent fewer calories in order to demonstrate the same weight gain as their normal siblings.  How MRAP2 controls weight gain is not entirely understood, but researchers suspect that MRAP2 regulates “melanocortin 4 receptor” (Mc4r), a protein previously implicated in mammalian obesity. Without MRAP2 production, appropriate appetite and energy metabolism regulated by Mc4r is impaired. Interestingly, four children in a registry of 500 severely obese children were found to have alterations in the MRAP2 gene while none of the healthy controls in the same study did.

While still very preliminary, researchers are now looking for alterations in the MRAP2 gene that could lead to partial expression and hence, explain some of the variance in weight gain among people consuming the same number of calories. While it will not help my friend lose weight, I think she will appreciate learning that obesity is not always about loss of self-control.

*This filler excerpt can be found in the November 2013 Pediatrics print journal p. 871, or online here.

Wednesday, November 6, 2013

Sleep Duration & Food Intake, Appetite-Regulating Hormones & Body-Weight: Are They Related?

We have published a number of studies recently (as have other journals) noting the importance of getting adequate sleep to improve physical and mental health and wellbeing—but how does increased sleep improve physical health—particularly when it comes to reducing the risk of becoming overweight or obese?
Photo by AlexRamos10 via Pixabay

Hart et al. (doi: peds.10.1542/2013-1274) used a cross-over design study for 37 children who over three weeks were told to first sleep as they normally do for a week. The second week they either increased or decreased their time in bed by 1 ½ per night, then did the opposite for the final week of the study. Dietary intake, fasting leptin and ghrelin levels that help regulate appetite and weight were the outcome measures.

The results of this study are not ones that will make you fall asleep—but rather be much more of a wake-up call for taking more careful sleep histories in your patients and then helping them improve their sleep hygiene.

Tuesday, November 5, 2013

Strength Training: A Solution for Increasing Physical Activity

In this era of children being sedentary and thus overweight and obese, we can always be on the lookout for therapeutic solutions that result in increased fitness and better physical activity energy expenditure.

Photo by Eric McGregor, via Flickr
Meinhardt et al. (doi: peds.10.1542/2013-1343) offer a solution through strength training as a result of a randomized trial in which over a hundred school-age children were randomized to a 19 week twice-weekly strength training program versus routine physical education classes. Measures of physical activity energy expenditure were made at baseline, after 19 weeks of the intervention, and 3 months later.

You’ll get a boost out of the results, as will your patients, if you can interest them in strength training and the physical activity it requires. Exercise your mind as well as your body and find the strength to learn from this interesting study—and then see if strength training might be something your community can offer to your school-age patients.

Friday, September 27, 2013

A Glance Into the Future: Fecal Transplants for Weight Loss

Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he reflects on fecal transplants reported to assist with weight loss: 

Each day I am bombarded with information about how to lose weight. There seems to be an almost endless array of diet or exercise recommendations and oodles of gadgets “guaranteed” to work. In the past few months, one of my relatives has tried to lose weight following the South Beach diet, then a Paleolithic diet, and most recently using a smart phone application. Maybe she should try a fecal transplant.

As reported in The New York Times (Health: March 28, 2013), the bacterial flora in our guts may be at least partially responsible for weight loss or gain. Researchers have never quite understood all the reasons why people lose weight following gastric bypass surgery. However, in a recent study conducted in mice, researchers concluded that approximately 20% of the weight loss is most likely due to a change in bacterial flora.

Fattened mice that underwent gastric bypass surgery lost weight and had altered intestinal flora. Mice that underwent a sham surgery where the intestine was simply severed and re-anastomosed did not lose weight and the microbiota did not change.

Next, intestinal contents from each group were transplanted into mice lacking intestinal flora. The mice that received material from the bypass surgery group lost weight while the mice receiving material from the sham group did not.

In a study conducted in adults with potential gastrointestinal disorders, researchers found that indirect evidence of the presence of Methanobrevibacter smithii in the gut was directly related to body mass. The individuals with the highest levels of methane and hydrogen on breath tests were more likely to have more body fat. One possible explanation for this finding is that M. smithii may contribute to the breakdown of foodstuffs, making more calories available.

The general dieter may not be ready for a fecal transplant to help increase weight loss, but the more we learn about our gut and the bacteria that inhabit it, the more we realize how intertwined we are.

*This filler excerpt can be found in the July 2013 Pediatrics print journal p. 71, or online here.

Monday, September 16, 2013

Adolescent Obesity-Related Behaviors: What Do the Trends Show?

Given the high prevalence of teen obesity that we have observed over the past decade, one wonders whether adolescent physical activity, sedentary behaviors, and dietary behaviors have gone up or down during the same time period.  Well stop wondering, and read the article by Iannotti and Wang (doi: 10.1542/peds.2013-1488) we are early releasing this week.  The authors looked at nationally representative samples of students in grades 6 to 10 at three different time points between 2001 and 2009 and administered a national survey assessing their physical activity, sedentary and dietary behaviors, and body mass index (BMI) during the school year.

The results may surprise you and even make you smile when you see that the trend direction of obesity-related behaviors appears to be changing for the better, although BMI does not.  So maybe all those articles and studies we have been publishing indicating the benefits of physical activity, nutrition, and less sedentary behaviors such as TV watching and video-game playing are having an effect and it’s just too early to see that effect play out in BMI itself.  Weigh the data for yourself and then keep educating your teen patients so they too become part of the positive trends that will hopefully decrease the prevalence of obesity in this country.